權力與專業自主性：護理人員專業地位現況之探討
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2005
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Abstract
本研究旨在探討醫院護理人員專業地位之現況，研究問題主要放在什麼是護理專業？護理人員在工作場所上專業自主性為何？研究者嘗試從權力取向的觀點，透過權力和專業自主性的概念，從專業化的五個面向：重新定義護理專業、專業自主性、進階教育、證照制度、健保給付切入。以個案醫院醫師、護理人員為研究對象，採用質性研究的個別深度訪談法、焦點團體訪談法及文件分析法，作一分析探討。
本研究發現，護理人員不論從專業知識教育的提升、照護專業的自主、專業組織及專業倫理，比起以往皆有長足的進步，但是其勞動條件，不論從薪資減少、人力緊縮、遇缺不補、常態性的延遲下班、福利變差等觀之，其專業地位反而下降，這使我們發現專業概念的界定並不重要，權力的運作、權力的取得才是重點，專業化即是一種政治過程的負面特質，以取得特權與威望，達到專業地位。符合本研究假設：專業對社會的影響是偏向負面的。
護理人員要提升專業地位，在專業化的過程中，更應參與政治，在醫院內部爭取護理角色定位，對外爭取政策改革，要求健保納入合理護理費的給付。
The purpose of this study is to explore current professional status of nurses in hospitals. It focuses on the nature of nursing as a profession and the professional autonomy of nurses in workplace. To address these issues, the researcher takes a power-oriented perspective and examines t five dimensions of professionalization, i.e., redefining nursing profession, professional autonomy, advanced education, license system and coverage of National Health Insurance. The researcher also adopts individual interviewing, focus group discussions and secondary data analysis methods. Doctors and nurses in a selected hospital are the major objects of interviewing. Results indicate that nurses have made much progress in terms of advancement of professional education, professional autonomy, professional organization and professional ethic. In contrast, labor conditions such as salary reduction, human resource downsizing, restriction on recruitment, constant after-hour work and decreasing benefits, are degrading nurses’ professional status. These results demonstrate that it is not important to redefine the concept of professionalism. Instead, mobilization and gaining of power is more essential. In other words, professionalism is negative output of political process. Its aim is to obtain privilege and prestige of professional position. This result verifies the hypothesis that the influence of professionalism on society tends to be negative. To promote their status in the process of professionalization, nurses need to engage more in politics, to struggle for nurses’ roles inside hospitals, to push national policy reforms and to claim for National Health Insurance’s coverage of nurses’ service.
The purpose of this study is to explore current professional status of nurses in hospitals. It focuses on the nature of nursing as a profession and the professional autonomy of nurses in workplace. To address these issues, the researcher takes a power-oriented perspective and examines t five dimensions of professionalization, i.e., redefining nursing profession, professional autonomy, advanced education, license system and coverage of National Health Insurance. The researcher also adopts individual interviewing, focus group discussions and secondary data analysis methods. Doctors and nurses in a selected hospital are the major objects of interviewing. Results indicate that nurses have made much progress in terms of advancement of professional education, professional autonomy, professional organization and professional ethic. In contrast, labor conditions such as salary reduction, human resource downsizing, restriction on recruitment, constant after-hour work and decreasing benefits, are degrading nurses’ professional status. These results demonstrate that it is not important to redefine the concept of professionalism. Instead, mobilization and gaining of power is more essential. In other words, professionalism is negative output of political process. Its aim is to obtain privilege and prestige of professional position. This result verifies the hypothesis that the influence of professionalism on society tends to be negative. To promote their status in the process of professionalization, nurses need to engage more in politics, to struggle for nurses’ roles inside hospitals, to push national policy reforms and to claim for National Health Insurance’s coverage of nurses’ service.
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Keywords
護理人員, 專業, 專業地位, 權力, 專業自主性, Nurses, Professionism, Professional Status, Power, Professional Autonomy