組織轉型對臺北市健康服務中心護理人員影響之研究

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2013

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本研究主要瞭解臺北市健康服務中心經組織轉型後,對基層公共衛生護理人員所帶來的影響,以進一步提出探究的結果與建議,提供未來臺北市進行組織內部再造或其他縣市基層公共衛生單位進行組織轉型之參考。本研究以臺北市健康服務中心護理人員為研究對象,以個案訪談的方式進行質性研究,共訪談十二位受訪對象。主要研究目的為:(1)瞭解臺北市健康服務中心於組織轉型過程對組織運作的衝擊與因應;(2)探討臺北市健康服務中心公共衛生護理人員對於組織轉型目標的認知程度;(3)瞭解臺北市健康服務中心於組織轉型後,對公共衛生護理人員自我期待專業角色的影響;(4)探討組織轉型對於臺北市健康服務中心公共衛生護理人員職涯發展的影響。經訪談資料的歸納及分析後,提出以下研究發現: 一、受訪者對於組織轉型對組織運作的衝擊與因應看法如下: (一)受訪者表示在個人層面上,包含:個人工作模式、角色功能、護理專業、業務的質與量及升遷管道等方面已造成改變或影響。 (二)受訪者表示在組織層面上,包含:組織結構、人員分配、業務內容與執行、行政作業及組織氣氛等方面已造成改變或影響。 (三)受訪者認為轉型後所提供給市民的健康服務內容有了轉變。且民眾對於服務內容所傳達的感受,其接受度仍是高的。惟對於機構名稱改變的認同度是不高的。 (四)部分受訪者認為轉型後所推動的健康促進活動對於民眾健康知識與行為是有改變的,且可促使社區共同活動,並增加社區凝聚力。 二、對於受訪者而言,組織進行轉型的原由及宗旨目標是不清楚的,但認同組織以「健康促進」為目標的轉型,惟在實務推動的內容以致身心不勝負荷,無多餘心力去服務需要照護的民眾。另大多數受訪者期待與上位者有更多元的雙向溝通方式。 三、受訪者認為面對龐雜的業務及承受的壓力,對於自我專業角色已模糊不清,期待上級單位針對角色功能重新定位。另大多數的受訪者也表示除了護理專業知識不斷充實外,應具備自發性的學習態度,面對多元化的工作內容及問題,並獨立自主的尋求解決方式及學習,以具備全方位的技能配備,打造一個具有通才的專業人才。 四、多數受訪者可能受限於資格而無法轉換,卻仍專心於工作上,貫徹各項健康政策的推動,接受各種挑戰。但也有些護理人員因組織內部的影響,迫於無奈,進而提早選擇轉換其他職場的決定。但九成受訪者針對未來目標或是目前工作推動需要都有計畫性的學習。 依據研究者所蒐集資料及研究發現,提出下列建議:(一) 強化核心功能及角色的重新定位,以創造自我生存的價值;(二) 增強組織內資源整合的功能,並建置與強化社區網絡功能;(三) 持續推動組織內部各項增能工作,並建立新工作模式及系統性思維;(四)積極拓展護理人員職涯管道,提升整體工作士氣;(五)強化衛生局與健康服務中心之溝通平台。
The purpose of this study is to understand the impact on public health nurses after the organizational transformation of Taipei City Health Centers. This study is a qualitative case study. Interviews were conducted with twelve nurses of Taipei City Health Centers. The main objectives are: (1) To understand the Impact of organizational transformation processes on Taipei City Health Centers and how to cope with this impact; (2) To investigate the public health nurses’ awareness for the objectives of organizational transformation of Taipei City Health Centers; (3) To understand the influence of organizational transformation on the public health nurses’ self-expectations of their professional role; (4) To Investigate the effects of organizational transformation on the career development of public health nurses in Taipei City Health Centers. After induction and analysis of the interviews, this study made the following findings: 1. Respondents’ view on the impact of organizational transformation processes on Taipei City Health Centers and how to cope with this impact are as follows: (1) Respondents said that on a personal level: individual work patterns, role function, nursing profession, and the quality and quantity of works and ways of promotion have changed or under influence of the change. (2) Respondents indicated that on the organizational level: organizational structure, staff assignments, business content and execution, administrative operations, shortage of trained personnel and mood around the organization has changed or been affected. (3) Respondents believed that this restructuring changed the health services they have provided to the public. Public conveyed the feeling that the public’s acceptance of the restructure was high except for the change of the name of the organization. (4) Some respondents believed that after the organizational transformation, the health promotion activities promoted and changed the public’s knowledge and behavior on health issues. The community can contribute to the common activities and increase community cohesion. 2. For the respondents, the organizational transformation’s content was unclear. The respondents only had a general understanding that the organization will be restructured. The respondents agreed that health promotion should be the goal for the organizational restructure. Yet in practice, this restructure process resulted in an overloading of work and exhaustion in mind and body. Therefore, the respondents could not afford to make extra effort to serve people in need of care. Majority of the respondents expected to have more two-way communication with their higher rank officers. 3. Respondents believed that they face complex operations and pressure. Also, their self-images of their professional roles have blurred. Therefore, they looked for higher-level superiors to reposition the function of their roles. Majority of respondents also said that in addition to continuously enrich the knowledge of their nursing profession, they shall have the spontaneity of learning attitude to face a wide range of work contents and seek solutions and independent learning. Thus, they can have a full range of skills equipped and become a generalist of their professions. 4. Most respondents were unable to change their occupation because they are under-qualified for other jobs. Yet, they still concentrated on their work, and implemented policies to promote the health of the public. However, some nurses were impacted by the internal organizational restructure and forced to change their professional career. 90% of respondents had further study plan for current work and future goals. According to the researcher’s collected data and research findings, the following recommendations are made: (1) To reposition and to strengthen the role of the core functions in order to create value for the organization to survive; (2) To enhance the ability of integration of resources within the organization and to build and strengthen the community networks; (3) To promote the work of increasing the ability of the organization and to build a new working model and a new way of systemic thinking. (4) Actively expand the nursing career development and improve the overall morale; (5) Strengthen the communication platforms between the Department of Health and health centers.

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健康服務中心, 組織轉型, 公共衛生護理人員, 轉型衝擊, 專業角色, health centers, organizational transformation, public health nurses, impacts of transformation, professional role

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