공공의료기관 간호사의 이직의도에 관한 구조모형

Abstract

본 연구는 공공의료기관 간호사의 이직의도에 영향을 미치는 간호근무환경, 극복력 및 소진의 관계를 규명하여 이직의도를 감소시키기 위한 간호사 인력관리에 기초자료를 제공하고자 시도되었다. 공공의료기관 중 전국의 13개 지방의료원에서 근무하는 간호사 339명을 대상으로 2018년 4월 1일부터 4월 26일까지 구조화된 설문지를 활용하여 자료수집을 하였다. 본 연구는 문헌고찰을 토대로 공공의료기관 간호사의 이직의도를 설명하는 관련요인들로 가설적 모형을 구축하고, 실제 자료 간의 적합도와 가설을 검정하는 모델 검증 연구이다. 본 연구의 가설적 모형은 간호근무환경, 극복력, 소진 및 이직의도의 4개 요인으로 구성되었다. 수집된 자료의 분석은 SPSS WIN 23.0과 AMOS 23.0을 이용하여 실수, 백분율, 평균, 표준편차, 왜도, 첨도, Pearson’s correlation coefficients로 분석하였으며 연구 모형의 적합도를 검증하기 위해 최대우도법(Maximum Likelihood Method)을 이용하여 통계량, GFI, CFI, TLI, RMSEA로 확인하였다. 본 연구 결과는 다음과 같다. 1. 본 연구 대상자의 간호근무환경은 평균 75.57점이었으며 하위영역 평균은 병원운영에 간호사참여 23.14점, 양질의 간호를 위한 기반 24.05점, 간호관리자의 능력·리더십·간호사에 대한 지지 11.35점, 충분한 인력과 물질적 지원 8.44점, 간호사와 의사의 협력 8.59점이었다. 극복력은 평균 107.26점이었으며 기질적 패턴 17.43점, 관계적 패턴 14.76점, 상황적 패턴 36.35점, 철학적 패턴 21.10점, 전문가적 패턴 17.62점이었다. 소진은 평균 60.53점이었고 하위영역 평균은 신체적 소진 20.88점, 정서적 소진 20.38점, 정신적 소진 19.27점이었다. 이직의도는 평균 19.22점이었다. 2. 본 연구 최종 모형의 적합도 지수는 통계량은 585.797 (p<.001), GFI는 .901, CFI는 .916, TLI는 .904, RMSEA는 .070 로 모형이 적합한 것으로 나타났다. 3. 대상자가 간호근무환경을 긍정적으로 인식할수록(γ=-.267, p<.001), 극복력이 높을수록(γ=-.643 p<.001) 소진은 낮았다. 간호근무환경과 극복력이 소진을 설명하는 설명력은 60.0%였다. 4. 대상자가 간호근무환경을 부정적으로 인식할수록(γ=-.274, p<.001), 극복력이 높을수록(γ=.296, p<.001) 그리고 소진이 높을수록(β=.797, p<.001) 이직의도는 높았다. 간호근무환경, 극복력 및 소진이 이직의도를 설명하는 설명력은 69.0%였다. 5. 간호근무환경은 소진을 매개로 이직의도에 간접 효과(γ=-.213, p=.002)를 나타냈고, 극복력은 소진을 매개로 이직의도에 간접 효과(γ=-.513, p=.003)를 나타냈다. 본 연구결과 간호근무환경과 극복력은 이직의도에 직접적 영향뿐 아니라, 소진을 매개로 간접적 영향을 미치는 것으로 나타났다. 따라서 공공의료기관 간호사의 이직의도를 감소시키기 위해 간호근무환경을 개선하고, 극복력을 향상시키고 소진을 예방할 수 있는 프로그램 개발이 필요하다. 이는 공공의료기관 간호사의 이직의도를 낮추는데 긍정적인 효과를 유도할 수 있을 것이다.;The purpose of this study was to provide basic data on nurse manpower management to reduce the turnover intention by identifying the relationship between nursing work environment, resilience, and burnout affecting the turnover intention of nurses in public medical institutions. Data were collected from 339 nurses working at 13 provincial medical centers nationwide among public hospital from April 1, 2018 to April 26, 2018 using structured questionnaires. This study was a model verification study design to establish a hypothetical model with relevant factors explaining the turnover intention of nurses in public medical institutions based on literature review and to test the goodness of fit between actual data and the hypothesis. The hypothetical model of this study consisted of four factors: nursing work environment, resilience, burnout and turnover intention. The analysis of the collected data was performed by using SPSS WIN 23.0 and AMOS 23.0 with real numbers, percentages, means, standard deviations, skewness, kurtosis, and Pearson's correlation coefficients, and maximum likelihood method to verify the goodness of fit of the research model through statistic, GFI, CFI, TLI, and RMSEA. The results of this study were as follows: 1. The mean of the nursing work environment of the subjects was 75.57. The subdomain mean was 23.14 for nurse participation in hospital affairs, 24.05 for nursing foundations for quality of care, 11.35 for nursing manager ability, leadership, and support for nurses, 8.44 points for staffing and resource adequacy, and 8.59 points for collegical nurse-physician relations. The mean of resilience was 107.26, 17.43 for dispositional pattern, 14.76 for relational pattern, 36.35 for situational pattern, 21.10 for philosophical pattern and 17.62 for professional pattern. The mean of the burnout was 60.53 points, and the subdomain mean was 20.88 points for physical burnout, 20.38 points for emotional burnout, and 19.27 points for mental burnout. The mean of the turnover intention was 19.22 points. 2. For the goodness of fit index of the final model of this study, statistic was 585.797(p<.001), GFI was .901, CFI was .916, TLI was .904 and RMSEA was .070. These numbers suggest that the model considered for this study was suitable. 3. The burnout was low as nurses positively recognize the nursing work environment(γ=-.267, p<.001), and the burnout was low as the resilience was higher (γ=-.643, p<.001). The explanatory power that the nursing work environment and resilience explain the burnout was 60.0%. 4. In the case of turnover intention, the degree of the turnover intention was low as nurses positively recognize the nursing work environment(γ=-.274, p<.001). The higher the resilience, the higher the turnover intention(γ=.296, p<.001), and the higher the burnout, the higher the turnover intention(β= .797, p<.001). The explanatory power that the nursing working environment, resilience, and burnout explain the turnover intention accounted for 69.0%. 5. The nursing working environment showed an indirect effect(γ=-.213, p=.002) with the burnout serving as a mediation to the turnover intention, and the resilience had an indirect effect(γ=-.513, p=.003) with the burnout serving as a mediation to the turnover intention. This study showed that the nursing working environment and resilience have a direct effect on the turnover intention and an indirect effect with the burnout serving as a mediation to the turnover intention. Therefore, it is necessary to strategically organize an intervention program to improve the nursing work environment, enhance the resilience, and prevent the burnout in order to reduce the turnover intention of nurses in public medical institutions by considering working departments, working style, and career. Through this, it is desirable to have a positive effect on solving the problem of supply and demand of manpower by lowering the turnover intention of nurses in public medical institutions.