논문개요
종합병원 간호사의 의료기관 인증제 인식이
간호업무성과에 미치는 영향
제출자 : 이보람
지도교수 : 하윤주

본 연구는 종합병원 간호사를 대상으로 의료기관 인증제 인식이 간호업무성과에 미치는 영향을 파악하기 위한 서술적 조사연구이다.
연구대상은 G광역시에 소재한 K종합병원에 근무하는 간호사 중 의료기관 인증제를 한번 이상 경험한 간호사로 본 연구의 취지를 이해하고 자발적으로 참여할 것을 동의한 간호사를 대상으로 하였으며, 자료 수집은 구조화된 설문지를 통해 2018년 7월 16일부터 2018년 7월 31일까지 이루어졌으며, 최종분석에는 202명의 자료를 사용하였다.
연구도구로 의료기관 인증제 인식은 Choi(2011)가 사용한 도구를 Kim(2015)이 수정?보완한 도구로 측정하였고, 간호업무성과는 Ko, Lee & Lim(2007)이 간호사를 대상으로 개발한 도구로 측정하였다. 수집된 자료는 SPSS/WIN 25.0 프로그램을 이용하여 기술통계, t-test, One-way ANOVA, Scheffe''s test, Pearson correlation coefficients, Hierarchical Multiple regression으로 분석하였다.

본 연구의 결과는 다음과 같다.

1. 본 연구 대상자의 평균연령은 37.18세로, 30～39세가 39.6%로 가장 많았으며, 결혼 상태는 기혼이 57.9%, 미혼이 42.1%이었다. 최종학력은 학사가 66.3%로 가장 많았으며, 다음으로 석사이상이 24.3%, 전문학사가 9.4%순이었다. 평균 총 임상근무경력은 14.78년이었으며 21년 이상이 27.7%, 10년 이하가 40.6%, 11～20년이 31.7%순이었다. 평균 현부서 근무경력은 4.12년이었으며 2년 미만이 39.6%, 2～4년 미만, 4년 이상이 30.2%이었다. 근무부서는 일반병동이 52.5%로 가장 많았고, 중환자실 17.3%, 수술실 10.9%, 외래 및 기타가 19.3%순이었다. 근무형태는 3교대가 62.4% 가장 많았고, 상근 21.3%, 기타 16.3%순이었다. 직위는 일반간호사가 79.7%로 대부분을 차지하였고, 책임간호사와 수간호사이상이 20.3%이었다. 월수입은 200만원 이상～300만원 미만이 39.6%로 가장 많았고, 300만원 이상이 40.6%, 200만원미만이 19.8%순이었다. 인증제 경험 횟수는 평균 1.89회이었으며 2회가 59.9%로 가장 많았고, 1회 25.7%, 3회 이상이 14.4%순이었다. 인증제로 인한 연장 근무 경험은 ‘있다’라고 응답한 대상자가 98.5%로 대부분을 차지하였으며, ‘없다’라고 응답한 대상자가 1.5%로 대상자 대부분이 연장 근무 경험이 있다고 응답하였다.

2. 종합병원 간호사의 의료기관 인증제 인식은 5점 만점에 평균 2.90±0.56점이었으며, 하위영역별 평균은 인지도 3.24±0.61점, 운영성과 2.95±0.63점, 질 향상 2.83±0.68점, 구성원만족 2.57±0.66점의 순이었고, 간호업무성과는 5점 만점에 평균 3.84±0.53점이었고 하위영역별 평균은 업무수행능력 3.94±0.60점, 업무수행태도 3.83±0.58점, 업무수준향상 3.79±0.62점, 업무간호과정적용 2.20±0.38점의 순이었다.

3. 종합병원 간호사의 일반적 특성에 따른 의료기관 인증제 인식의 차이를 분석한 결과 연령(F=5.32, p<.006) 최종학력(F=7.19, p<.001), 총 임상근무경력(F=11.43, p<.001), 근무형태(F=3.81, p<.024), 직위(F=-4.28, p<.001)에서 통계적으로 유의한 차이가 있었다.

4. 종합병원 간호사의 일반적 특성에 따른 간호업무성과의 차이를 분석한 결과 연령(F=26.80, p<.001), 결혼상태(F=-4.99, p<.001), 최종학력(F=6.80, p<.001), 총 임상근무경력(F=20.55, p<.001), 현 부서근무경력(F=3.54, p<.001), 근무병동(F=4.84, p<.001), 직위(F=-6.14, p<.001), 월수입(F=22.14, p<.001), 인증제 경험 횟수(F=10.08, p<.001)에서 통계적으로 유의한 차이가 있었다.

5. 종합병원 간호사의 의료기관 인증제 인식, 간호업무성과 간의 상관관계를 분석한 결과 의료기관 인증제 인식은 간호업무성과(r=.25, p<.001)와 통계적으로 유의한 양의 상관관계가 있었다.

6. 종합병원 간호사의 의료기관 인증제 인식이 간호업무성과에 미치는 영향에 대하여 통제변수인 일반반적 특성만 포함된 1단계 위계에서 현 부서 근무경력이 4년 이상(B=-0.26, p<.05), 근무하는 병동이 수술실인 경우(B=0.26, p<.05) 간호업무성과에 유의한 영향을 주었으며, 회귀모형은 통계적으로 유의하였고(F=5.225, p<.001), 통제변수가 간호업무성과를 설명하는 설명력은 27%로 나타났다. 독립변수들이 포함된 위계적 회귀분석을 실시한 결과 최종 회귀모형의 적합도는 통계적으로 유의하였고(F=10.832, p<.001), 의료기관 인증제 인식을 투입한 2단계에서 설명력은 32%로 나타나 1단계에 비하여 5.0%p(p<.001) 증가하였으며, 일반적 특성을 통제한 상태에서 의료기관 인증제 인식은 간호업무성과에 유의한 영향을 주었다(B=0.22, p<.001). 즉, 근무병동, 현 부서근무경력, 의료기관인증제 인식이 간호업무성과에 영향을 미치는 것으로 확인되었다.


이상의 결과 의료기관 인증제 인식이 간호업무성과에 영향을 미치는 것으로 나타났다. 따라서 의료기관 인증제에 대해 정확한 정보 제공 및 체계적인 교육을 실시하여 간호업무성과를 향상시킬 수 있는 방안을 고안해야 할 것이다. 그러므로 의료기관 인증제에 대한 인식을 강화하기 위해서는 인증 준비에 대한 보상제도의 설계가 필요하다. 간호부서는 인증기간 동안 많은 준비를 해야 하는 부서이며, 업무가 가중되어 많은 간호사가 인증에 부정적 태도를 보이고 있으므로 인증준비에 따른 적절한 보상제도의 마련도 필요하다고 본다. 또한 간호사의 경력이 높아질수록 의료기관 인증제 대한 인식과 간호업무성과가 높게 나타났으며, 이는 간호조직의 발전과 의료의 질 향상을 위해서는 장기 근속자에 대한 특별 관리를 위한 제도적인 개선방안을 모색해야 함을 시사해준다.


























주요어 : 종합병원, 간호사, 인증, 인식, 간호업무성과

Abstract

The Effects of General Hospital Nurse’s Perception of Healthcare Accreditation on Nursing Performance

Lee, Bo Ram
Directed by Professor Ha, Yun Ju
Department of Nursing
Graduate School Honam University Gwangju. Korea


This study is a descriptive research on nurses at a general hospital to identify the effects of nurses’ perception of health care accreditation on nursing performance.
This study was conducted on nurses who understood the purpose of this study and voluntarily agreed to participate. They worked in K General Hospital located in G City and had experienced health care accreditation at least once. Data collection was from July 16 to 31, 2018 through structured questionnaires. Data from 202 respondents were used for the final analysis.
Perception of the health care accreditation system was measured with a tool used by Choi (2011) and then revised and supplemented by Kim (2015). Nursing performance was measured with a tool developed by Ko and colleagues (2007) for nurses. Collected data were analyzed with the SPSS/WIN 25.0 program using descriptive statistics, t-test, One-way ANOVA, Scheffe''s test, Pearson correlation coefficients, and Hierarchical Multiple regression.
The study results are as follows

1. The mean age of the participants was 37.18 years, with ages in the 30?39 years range being the most common. Of the participants, 57.9% were married and 42.1%, unmarried. The final education level was most commonly a Bachelor’s degree (66.3%), followed by Master’s or higher (24.3%) and Technical Bachelor’s (Associate’s) degree (9.4%). The mean total clinical work experience was 14.78 years, with 27.7% of the participants reporting having worked 21 years or more, 40.6% having worked less than 10 years, and 31.7% having worked between 11 and 20 years. The average work experience in the current department was 4.12 years, with 39.6% having worked less than two years; 30.2%, between two and four years, and another 30.2%, more than four years. The participants’ work department was most commonly regular wards (52.5%), followed by intensive care (17.3%), operating room (10.9%), and outpatient or other (19.3%). The shift type was most commonly three shifts (62.4%), followed by full-time (21.3%) and other types (16.3%). Most of the participants were regular nurses (79.7%); 20.3% held a position higher that managing nurses and chief nurses. The participants’ monthly income was most commonly between KRW 2 million and 3 million (39.6%); 40.6% made more than KRW 3 million, whereas 19.8% made less than KRW 2 million. The was 1.89 times on average, with two times being the most common (59.9%), followed by one time (25.7%) and more than three times (14.4%). Nearly all (98.5%) of the participants responded that they had experience working extended hours owing to the health care accreditation system .

2. The perception of general hospital nurses regarding the health care accreditation system was, on average, 2.90±0.56 points out of 5. By sub-area, the averages were in the following order: 3.24±0.61 points for awareness, 2.95±0.63 points for management progress, 2.83±0.68 points for increase in quality, and 2.57±0.66 points for satisfaction with one’s team. Nursing performance was, on average, 3.84±0.53 points out of 5. By sub-area, the averages were in the following order: 3.94±0.60 points for job performance, 3.83±0.58 points for job performing attitude, 3.79±0.62 points for increase in performance, and 2.20±0.38 points for applying nursing processes.

3. The analysis results on the differences in perception of the health care accreditation system by the general characteristics of general hospital nurses showed statistically significant differences in age (F=5.32, p<.006), final education level (F=7.19, p<.001), total clinical work experience (F=11.43, p<.001), shift type (F=3.81, p<.024), and position (F=-4.28, p<.001).

4. The analysis results on the differences in nursing performance by the general characteristics of general hospital nurses showed statistically significant differences in age (F=26.80, p<.001), marital status (F=-4.99, p<.001), final education level (F=6.80, p<.001), total clinical work experience (F=20.55, p<.001), work experience in the current department (F=3.54, p<.001), ward in which they work (F=4.84, p<.001), position (F=-6.14, p<.001), monthly income (F=22.14, p<.001), and number of experiences with the health care accreditation system (F=10.08, p< .001).
5. The analysis results of the correlation between nurses’ perception of the health care accreditation system and nursing performance showed that perception had a statistically significant positive correlation with nursing performance (r=.25, p<.001).

6. In the first-level hierarchy that included only general characteristics, which is a control variable on the effects that perception of the health care accreditation system of general hospital nurses have on nursing performance, cases of work experience in the current department being greater than four years (B=-0.26, p<.05) and ward in which they work being the operating room (B=0.26, p<.05) had a significant impact on nursing performance. The regression model was statistically significant (F=5.225, p<.001), and the control variable was found to explain 27% of the variance in nursing performance. The results of the hierarchical regression model including the independent variables revealed that the accuracy of the final regression model was statistically significant (F=10.832, p<.001), In the second-level that included perception of the health care accreditation system, the explanatory power was found to be 32%, which was higher by 5.0% compared with the first level (p<.001). When controlling for general characteristics, perception of the health care accreditation system had a significant effect on nursing performance (B=0.22, p<.001). In other words, the ward in which they work, work experience in the current department, and perception of the health care accreditation system influenced nursing performance.

These results evinced that perception of the health care accreditation system affected nursing performance. Therefore, it is necessary to devise measures for improving nursing performance by providing accurate information and systematic education on the health care accreditation system. To strengthen awareness of the health care accreditation system, it is necessary to design a compensation system for nurses preparing for accreditation. Nursing units are departments that must prepare during the accreditation period, and many nurses are showing a negative attitude toward accreditation owing to the increase in workload. Therefore, it is necessary to establish a proper compensation system for the preparation for accreditation. In addition, a longer nursing career was associated with better perception about the health care accreditation system and higher nursing performance, suggesting the need for institutional improvement measures for implementing special, long-term management aimed at the advancement of the nursing organization and improvement in the quality of medical care provided.


Key words: General hospital, Nurse, Accreditation, Perception,
Nursing performance.