병원간호사의 근무표에 대한 인식: Q 방법론 적용

Abstract

국문 요약

경제성장 및 산업의 발달과 함께 현대사회는 전문직과 서비스직이 늘어남에 따라 교대근무 종사자도 늘어나고 있다. 그중에 간호사는 대표적인 교대근무 직종이며, 간호사의 직무스트레스를 유발하는 요인으로 근무표가 매우 중요한 영향을 미치는 것으로 나타났다. 이에 본 연구자는 Q˗방법론을 적용해 근무표에 대한 병원간호사의 인식 유형과 특성을 발견하여, 근무표를 작성하는 간호관리자들의 이해를 돕고 근무표로 인한 현장에서의 갈등을 감소시킴으로써, 간호사들의 근무표에 대한 만족도를 향상시킬 수 있는 중재 개발에 유용한 기초자료를 제공하고자 본 연구를 시도하였다.

Q˗방법론을 통한 본 연구의 구체적인 과정 및 내용은 다음과 같다. 첫째, Q˗모집단은 근무표 및 근무표 작성 등과 관련된 문헌 및 선행연구와 심층 면담과 개방형 질문지를 통해 총 403개의 Q˗진술문을 표집 하였다. 둘째, 표집 된 403개의 진술문 중 내용의 중복과 표현의 명확성 등을 고려하여 수정한 후 의미와 주제별로 3개의 범주로 분류한 다음 각 범주에서 대표적이거나 상이한 의미의 Q˗진술문 40항목을 최종 선정하였다. 셋째, P˗표본은 서울시 소재 1개 상급종합병원에서 3교대근무를 하고 있는 간호사 30명을 편의표집방법으로 선정하였다. 넷째, 40개의 진술문은 5x8cm 카드에 인쇄하여 코팅한 후 연구 대상자들로 하여금 강제 정규분포가 되도록 각자의 의견의 중요도에 따라 9점 척도 상에 Q˗분류하도록 하였고, 양극단에 분류한 진술과 관련하여 대상자와의 면담을 시행하였다. 다섯째, Q˗분류된 결과를 PC-QUANL 프로그램에 맞는 data-file을 작성한 후 Q˗요인분석(Q˗factor analysis)하였다. 연구결과 병원간호사의 근무표에 대한 주관적 인식구조는 다음과 같이 4개의 유형으로 발견되었다.

제 1유형은 '적극적인 개인배려 주장형'으로, 대상자들은 오랜 근무경력의 간호사들로 근무표에 대해 대부분 긍정적으로 인식하고 있었다. 또한 개인별 요구 및 선호도를 충분히 반영하여 근무표가 작성되어지기를 원하며 배려 받고 싶은 자신의 생각에 대해 적극적으로 표현하였다. 제 2유형은 '소심한 스트레스 내재형'으로, 평상시 자신의 생각을 적극적으로 표현하지는 않으나 근무표 작성은 원칙에 맞게 공정해야 하며 일관성이 있어야 하고 잘못 작성된 근무표는 업무 효율성 및 부서원의 사기를 저하 시킨다고 생각하였다. 또한 개인이 요구한 휴무에 대해서는 근무표 작성 시 꼭 반영해주기를 원하고 있었다. 제 3유형은 '전문직 갈등형'으로, 부서원 전체의 이익도 중요하게 생각하지만 개인의 취미활동 및 자기계발의 욕구를 강하게 표현하였다. 또한 다른 유형에 속한 간호사들과 비교할 때 근무경력이 가장 짧았으며, 함께 일하는 동료나 인수인계 대상이 누구인지에 큰 영향을 받고 있었다. 제 4유형은 '긍정적 순응형'으로, 모든 부서원들에게 공정하고 일관성 있게 적용되는 근무표에 순응하며 긍정적으로 받아들이는 태도를 보였다. 업무의 적당한 긴장과 휴식을 즐길 수 있는 근무표가 바람직하다고 생각하는 것으로 나타났다. 이상의 연구결과를 토대로 간호관리자들은 각 유형에 따른 특성을 이해하고 중재하여 근무표 작성 시 이를 반영함으로써, 근무표로 인한 만족도를 증가시키고 직무스트레스를 감소시켜 간호업무성과에도 긍정적 영향을 미칠 수 있도록 조력해야 주어야 할 것이다. | ABSTRACT

Perceptions of the Hospital Nurses towards Duty Schedule using Q Methodology

In contemporary society the number of professional and service workers is increasing along with economic growth and industrial development. Among this segment of the workforce, nurses are representative shift workers, and their duty schedule has been found to have a crucial impact on their job stress. The present researcher thus carried out a study with the object of identifying hospital nurses’ perceptions of duty schedules by applying the Q methodology in order to improve the understanding of nurse managers who make these schedules and to reduce conflicts over the schedules in the field. Ultimately, this work will provide useful information to develop interventions for enhancing nurses’ satisfaction with their duty schedules. The process of research through the Q methodology is as follows. First, the Q population was 403 Q statements collected from the literature and previous studies on duty schedules, including research on making duty schedule, and from in-depth interviews and an open-ended questionnaire survey. Second, the collected 403 statements were revised in consideration of redundancy of content and clarity of expression, and were classified into three categories according to meaning and theme, and finally 40 statements that were representative or with distinguished meaning were selected for each category. Third, P sample was 30 nurses engaged in three-shift work at a tertiary hospital in Seoul and who were selected through convenience sampling. Fourth, the 40 statements were printed on 5x8cm cards and coated, and then the subjects were instructed to Q-classify the cards on a 9-point scale of importance according to their subjective opinion such that the results form a normal distribution, and they were interviewed with regard to statements classified into the two extremes. Fifth, the Q-classified results were converted into a data file suitable for the PC-QUANL program, and a Q-factor analysis was performed. From the results four types of subjective perceptions held by hospital nurses regarding duty schedules were identified.

Type 1 is ‘active demand for individual consideration.’ Subjects of this type were mostly nurses with lengthy work experience and they regarded the duty schedule as positive. In addition, they wanted the duty schedule to reflect individuals’needs and preferences, and they expressed actively their desire to be considered. Type 2 is ‘passive tolerance of stress.’ Subjects of this type did not express their thoughts actively, but they believed that the duty schedule should be made fairly and consistently and that a mistakenly prepared duty schedule might impair work efficiency and department members’morale. In addition, they wanted the duty schedule to reflect individuals’ requests for leave. Type 3 is ‘professional conflict.’ Subjects of this type had a strong desire for hobby activities and self-development, although they also regarded the department members’interests as important. Compared to the nurses of other types, moreover, they tended to have less work experience and were influenced greatly by their colleagues and whom they took over from or handed over to. Type 4 is ‘positive compliance.’ Subjects of this type showed an attitude of being fair to all the department members and complying with duty schedules applied consistently and accepting them positively. They thought that a desirable duty schedule was one that afforded both appropriate tension and rest.

Based on these results, it is suggested that nurse managers should intervene in duty schedules with proper understanding of the characteristics of each type so that the duty schedule, by reflecting such characteristics, may improve nurses’satisfaction, reduce their job stress, and ultimately have a positive effect on their nursing performance.; ABSTRACT

Perceptions of the Hospital Nurses towards Duty Schedule using Q Methodology

In contemporary society the number of professional and service workers is increasing along with economic growth and industrial development. Among this segment of the workforce, nurses are representative shift workers, and their duty schedule has been found to have a crucial impact on their job stress. The present researcher thus carried out a study with the object of identifying hospital nurses’ perceptions of duty schedules by applying the Q methodology in order to improve the understanding of nurse managers who make these schedules and to reduce conflicts over the schedules in the field. Ultimately, this work will provide useful information to develop interventions for enhancing nurses’ satisfaction with their duty schedules. The process of research through the Q methodology is as follows. First, the Q population was 403 Q statements collected from the literature and previous studies on duty schedules, including research on making duty schedule, and from in-depth interviews and an open-ended questionnaire survey. Second, the collected 403 statements were revised in consideration of redundancy of content and clarity of expression, and were classified into three categories according to meaning and theme, and finally 40 statements that were representative or with distinguished meaning were selected for each category. Third, P sample was 30 nurses engaged in three-shift work at a tertiary hospital in Seoul and who were selected through convenience sampling. Fourth, the 40 statements were printed on 5x8cm cards and coated, and then the subjects were instructed to Q-classify the cards on a 9-point scale of importance according to their subjective opinion such that the results form a normal distribution, and they were interviewed with regard to statements classified into the two extremes. Fifth, the Q-classified results were converted into a data file suitable for the PC-QUANL program, and a Q-factor analysis was performed. From the results four types of subjective perceptions held by hospital nurses regarding duty schedules were identified.

Type 1 is ‘active demand for individual consideration.’ Subjects of this type were mostly nurses with lengthy work experience and they regarded the duty schedule as positive. In addition, they wanted the duty schedule to reflect individuals’needs and preferences, and they expressed actively their desire to be considered. Type 2 is ‘passive tolerance of stress.’ Subjects of this type did not express their thoughts actively, but they believed that the duty schedule should be made fairly and consistently and that a mistakenly prepared duty schedule might impair work efficiency and department members’morale. In addition, they wanted the duty schedule to reflect individuals’ requests for leave. Type 3 is ‘professional conflict.’ Subjects of this type had a strong desire for hobby activities and self-development, although they also regarded the department members’interests as important. Compared to the nurses of other types, moreover, they tended to have less work experience and were influenced greatly by their colleagues and whom they took over from or handed over to. Type 4 is ‘positive compliance.’ Subjects of this type showed an attitude of being fair to all the department members and complying with duty schedules applied consistently and accepting them positively. They thought that a desirable duty schedule was one that afforded both appropriate tension and rest.

Based on these results, it is suggested that nurse managers should intervene in duty schedules with proper understanding of the characteristics of each type so that the duty schedule, by reflecting such characteristics, may improve nurses’satisfaction, reduce their job stress, and ultimately have a positive effect on their nursing performance.