临床护士职业倦怠与资质过剩感及心理契约破裂的相关性分析

摘要/Abstract

摘要： 目的了解临床护士职业倦怠现状,分析资质过剩感及心理契约破裂与职业倦怠的相关性,以期为管理者制定降低职业倦怠的干预措施提供参考。方法采用便利抽样法,2023年7—8月选取天津市某三级甲等医院291名护士为调查对象,采用一般资料调查表、职业倦怠量表、资质过剩量表和护士心理契约调查问卷进行问卷调查,并对数据进行分析。结果 291名临床护士职业倦怠总分为（49.55±10.27）分,资质过剩感总分为（29.95±10.21）分,心理契约破裂总分为（66.40±18.07）分。临床护士职业倦怠与资质过剩感及心理契约破裂均呈正相关（r=0.540、0.691,均P<0.01）,职业倦怠中情绪衰竭、玩世不恭与资质过剩感及心理契约破裂各维度均呈正相关（r=0.405~0.583,均P<0.01）,成就感低落与资质过剩感及心理契约破裂各维度均呈负相关（r=-0.548~-0.390,均P<0.01）。最高学历、值夜班次数、日均睡眠时间、资质过剩感及心理契约破裂均是临床护士职业倦怠的影响因素（均 P<0.05）,其中资质过剩感及心理契约破裂是护士职业倦怠的主要影响因素,可解释总变异的42.4%。结论天津市某三级甲等医院291名临床护士职业倦怠处于中等水平,职业倦怠与资质过剩感和心理契约破裂呈正相关。管理者可通过降低临床护士的资质过剩感及心理契约破裂水平,以减弱其职业倦怠感,进而降低护士离职率,维持医疗卫生服务体系的稳定发展。

关键词: 临床护士, 职业倦怠, 资质过剩感, 心理契约破裂

Abstract: Objective To understand the current situation of job burnout among clinical nurses,and to analyze the correlation between overqualification and psychological contract breach with job burnout,with a view to providing reference for managers to formulate interventions to reduce job burnout. Methods Convenience sampling method was used to select 291 nurses from a grade-A tertiary hospital in Tianjin from July to August 2023 as survey subjects. General information questionnaire,Maslach burn-out inventory general survey,perceived overqualification scale,and psychological contract questionnaire of nursing staff were used for questionnaire survey,and the data were analyzed. Results The total score of 291 clinical nurses' job burnout,overqualification and psychological contract breach were（49.55±10.27）,（29.95±10.21） and （66.40±18.07）points,respectively. The job burnout of clinical nurses was positively correlated with overqualification and psychological contract breach（r=0.540,0.691,both P<0.01）,the emotional exhaustion dimension and the cynicism dimension of job burnout were positively correlated with each of the dimensions of overqualification and psychological contract breach（r=0.405-0.583,all P<0.01）,and the dimensions of the sense of underachievement were negatively correlated with each of the dimensions of overqualification and psychological contract breach （r=-0.548--0.390,all P<0.01）. The highest educational level,number of night shifts,average daily sleep time,overqualification and psychological contract breach were all the influencing factors of job burnout among clinical nurses（all P<0.05）,among which the overqualification and the psychological contract breach were the main influencing factors of job burnout among nurses,which could explain 42.4% of the total variance. Conclusion Totally 291 clinical nurses in a grade-A tertiary hospital in Tianjin have moderate levels of occupational burnout,which is positively correlated with overqualification and psychological contract breach. Managers can reduce the level of clinical nurses' overqualification and psychological contract breach in order to weaken their job burnout,and then reduce the rate of nurses' turnover and maintain the stable development of the health care service system.

Key words: Clinical nurse, Job burnout, Overqualification, Psychological contract breach

中图分类号:

R181.3⁺1

周冰倩, 王爱, 曹虹. 临床护士职业倦怠与资质过剩感及心理契约破裂的相关性分析. [J]职业与健康, 2024, 40(16): 2161-2166.

ZHOU Bingqian, WANG Ai, CAO Hong. Analysis of correlation between overqualification,psychological contract breach and job burnout in clinical nurses. [J]OCCUPATION AND HEALTH, 2024, 40(16): 2161-2166.

参考文献

[1] YANG J S,HAO D J.Dilemmas for nurses in China[J].Lancet,2018
392(10141):30.
[2] LI I W,DUFFIELD C,DOLEMAN G.Overqualification and underemployment for nursing graduates in Australia:A retrospective observational study[J].Int J Nurs Stud,2022,136:104376.
[3] PASKARINI I,DWIYANTI E,SYAIFUL D A,et al.Burnout among nurses:Examining psychosocial work environment causes[J].J Public Health Res,2023,12(1):22799036221147812.
[4] ZHANG W,MIAO R,TANG J,et al.Burnout in nurses working in China:A national questionnaire survey[J].Int J Nurs Pract,2021,27(6):e12908.
[5] FISCHER R,MATTOS P,TEIXEIRA C,et al.Association of burnout with depression and anxiety in critical care clinicians in Brazil[J].JAMA Netw Open,2020,3(12):e2030898.
[6] XIE C,ZENG Y,LV Y,et al.Educational intervention versus mindfulness-based intervention for ICU nurses with occupational burnout: A parallel,controlled trial[J].Complement Ther Med,2020,52:102485.
[7] SHOORIDEH F A,ASHKTORAB T,YAGHMAEI F,et al.Relationship between ICU nurses' moral distress with burnout and anticipated turnover[J].Nurs Ethics,2015,22(1):64-76.
[8] WASSERMANN M,FUJISHIRO K,HOPPE A.The effect of perceived overqualification on job satisfaction and career satisfaction among immigrants:Does host national identity matter?[J].Int J Intercult Relat,2017,61:77-87.
[9] GUO Y F,FAN J Y,LAM L,et al.Associations between perceived overqualification,transformational leadership and burnout in nurses from intensive care units:A multicentre survey[J].J Nurs Manag,2022,30(7):3330-3339.
[10] RODWELL J,GULYAS A.The impact of the psychological contract,justice and individual differences:nurses take it personally when employers break promises[J].J Adv Nurs,2013,69(12):2774-2785.
[11] QADRI S U,LI M,MA Z,et al.Unpaid leave on COVID-19:The impact of psychological breach contract on emotional exhaustion: The mediating role of job distrust and insecurity[J].Front Psychol,2022, 13:953454.
[12] 李霞,刘海真,李强.资质过剩感和工作满意度的关系:心理契约违背与情绪耗竭的中介作用[J].中国临床心理学杂志,2021,29(3):562-566.
[13] 倪平,陈京立,刘娜.护理研究中量性研究的样本量估计[J].中华护理杂志,2010,45(4):378-380.
[14] MICHAELS C E,SPECTOR P E."Causes of employee turnover:A test of the mobley,griffeth,hand,and meglino model":Correction to michaels and spector[J].J Appl Psychol,1983,68(4):583.
[15] 李超平,时勘.分配公平与程序公平对工作倦怠的影响[J].心理学报,2003,35(5):677-684.
[16] MAYNARD D C,JOSEPH T A,MAYNARD A M.Underemployment,job attitudes,and turnover intebtions[J].J Organ Behav,2006,27(4):509-536.
[17] 杨纯. 资质过剩对员工工作形塑及工作脱离行为影响研究[D].杭州:浙江大学,2014.
[18] 陈芙蓉. 护士心理契约结构维度及相关因素研究[D].福州:福建医科大学,2008.
[19] 贺涛涛,黄静,宋彩妮,等.护士心理资本及工作场所暴力与职业倦怠的相关分析[J].职业与健康,2023,39(14):1905-1910.
[20] SOUSA-RIBEIRO M,LINDFORS P,KNUDSEN K.Sustainable working life in intensive care:A qualitative study of older nurses[J].Int J Environ Res Public Health,2022,19(10):6130.
[21] ALACACIOGLU A,YAVUZSEN T,DIRIOZ M,et al.Burnout in nurses and physicians working at an oncology department[J].Psychooncology,2009,18(5):543-548.
[22] DEMIR A,ULUSOY M,ULUSOY MF.Investigation of factors influencing burnout levels in the professional and private lives of nurses[J].Int J Nurs Stud,2003,40(8):807-827.
[23] 李森,王硕,马俊杰,等.临床护士职业偏差行为与组织支持感、亚健康状态的相关性分析[J].职业与健康,2023,39(8):1066-1071.
[24] 姚海欣,李文玉,徐晓微,等.组织支持感对研究生护士资质过剩感的影响研究[J].中华全科医学,2022,20(3):503-506.
[25] 胡家星,束余声,窦英茹,等.护士资质过剩、心理契约破裂与情绪劳动相关性研究[J].军事护理,2023,40(4):36-39.
[26] LI W,XU A,LU M,et al.Influence of primary health care physicians' perceived overqualification on turnover intention in China[J].Qual Manag Health Care,2020,29(3):158-163.
[27] DENG Y.The silver lining of perceived overqualification: examining the nexus between perceived overqualification,career self-efficacy and career commitment[J].Psychol Res Behav Manag,2023,16:2681-2694.
[28] ZHANG M,WANG F,LI N.The Effect of perceived overqualification on creative performance:person-organization fit perspective[J].Front Psychol,2021,12:582367.
[29] TOPA G,ARANDA-CARMENA M,DE-MARIA B.Psychological contract breach and outcomes: a systematic review of reviews[J].Int J Environ Res Public Health,2022,19(23):15527.
[30] 胡家星,束余声,白璐,等.心理契约破裂在护士情绪劳动与情感承诺间的中介作用[J].职业与健康,2023,39(13):1797-1802.
[31] SUI M,YU Z,ZHOU M.The Impact of psychological contract,physical and mental health on burnout in grassroots civil servants:Evidence from China[J].Psychol Res Behav Manag,2023,16:3461-3476.
[32] RODWELL J,JOHNSON D.The State of the psychological contract,justice and engagement drive nurses' performance behaviors[J].Int J Environ Res Public Health,2022,19(20):13505.
[33] 朱玥,汪张毅,方治平,等.456名临床护士工作场所灵性现状及影响因素分析[J].护理学报,2023,30(5):7-11.
[34] COLQUITT J A.On the dimensionality of organizational justice:A construct validation of a measure[J].J Appl Psychol,2001,86(3):386-400.