中国科技论文统计源期刊 中文核心期刊
美国《化学文摘》《国际药学文摘》
《乌利希期刊指南》
WHO《西太平洋地区医学索引》来源期刊
日本科学技术振兴机构数据库（JST）
第七届湖北十大名刊提名奖
美国《化学文摘》《国际药学文摘》
《乌利希期刊指南》
WHO《西太平洋地区医学索引》来源期刊
日本科学技术振兴机构数据库（JST）
第七届湖北十大名刊提名奖
, 乔丽娟, 黄惠涛, 杜书章
, QIAO Lijuan, HUANG Huitao, DU Shuzhang,
目的 探讨河南省二、三级医院药师工作满意度的影响因素及其与职业满意度的相关性。方法 通过课题组前期构建的医院药师工作满意度量表调查河南省二、三级医院药师的工作满意度及职业满意度,用问卷星系统编制问卷,通过医院药师工作群发放并回收,用Excel 2010和SPSS 23.0版软件进行统计。结果 回收了472份有效问卷,问卷的工作满意度及职业满意度的Cronbach's Alpha系数分别为0.977,0.718,效度系数分别为0.976(
Objective To explore the factors influencing hospital pharmacist's job satisfaction and its correlation with career satisfaction in the secondary and tertiary hospitals in
开放科学(资源服务)标识码(OSID)
药师工作的满意度通常在广义上泛指某个当事人在特定的组织或者医疗机构内进行药师工作的时间和过程中,对药师工作本身及其密切相关的因素(包括工作环境、工作状态、工作方式、工作压力、挑战性、复杂人际关系等)有良性感受的心理状态。对工作的不满意会影响精神心理健康,增加员工的压力和焦虑感,最终影响医院药师工作的效率、缺勤率、跳槽率等[1]。药师职业满意度在国外的定义为“人们对药师职业的整体感知与满意程度”,在国内的定义还未统一,但大多包括对职业取得的薪酬、地位、成就、晋升速度及职业生涯等的满意程度[2]。职业满意度过低可能会增加药师转变行业的意向[3]。职业满意度与工作满意度的含义是不同的。前者偏重药师对“职业”整体的满足感,而后者则更偏重当前“工作”现状的满意程度。两者也有相似的地方,都与人所从事工作的幸福感有关[4]。
近年来,有一些关于药师工作满意度[3,5-6]及职业满意度[7,8]的研究。自2017年以来,国家级卫生行政主管部门及其他地方卫生行政主管部门陆续颁布了多项医药行业的相关政策和行政命令。2017年公立医院全面取消了药品加成,国家卫生计生委发布《关于加强药事管理转变药学服务模式的通知》,2019年底全国范围内推广国家组织药品集中采购和使用试点集中带量采购模式等,目前医院药师的工作及职业满意度情况及影响因素研究较少。MURAWSKI等[9]研究发现,对于社区药师来说,工作满意度能预测职业满意度,证实了两者存在相关性,但对于医院药师来说,工作满意度与职业满意度的相关性研究并无报道,医院药师工作满意度能否在一定程度上预测职业满意度,引起我们的兴趣。
本研究目的是调查影响河南省二三级医院药师的工作满意度和职业满意度的人口统计学及工作相关因素,并探索工作满意度与职业满意度的相关性,以求能帮助医院药学部发现相关问题,并实施有效干预措施来提高医院药师的工作满意度及职业满意度。
以课题组前期研究制定的医院药师工作满意度量表为基础,在问卷星网站编制调查问卷,调查问卷总共分为三个部分,一共56题,包括被调查者基本情况,对医院药师工作的满意度以及对药师职业的满意度。题干尽量简洁,表达明确。在问卷星中设定仅能使用微信回答问卷并仅能回答一次。答题选项根据题干的内容设定,正式部分的选项采用Likert5级评分法,从“非常不满意”到“非常满意”;“非常不愿意”到“非常愿意”;“非常不看好”到“非常看好”,分别赋值1~5分。最后一题“如果有更好的收入和生活保障,您是否考虑改变职业?”属于逆向变量,对答题进行反向计分。
经医院领导联络,于2020年2月通过各医院药学部门领导的认同后,经医院药师工作群发布问卷,问卷星回收问卷。问卷中附有调查问卷的意义、目的、要求和方法,并注明对填写的内容保密,不影响正常工作或绩效评估。
使用问卷星导出到Excel 2010和SPSS23.0版统计软件进行分析,计算每个指标的平均值±标准差。计算满意度评分>3(总分>条目数*3)的评分所占百分比,即为满意度比例;计算满意度评分<3(总分<条目数*3)的评分所占百分比,即为不满意度比例,信度系数用Cronbach's Alpha表示,效度系数用Kaiser-Meyer-Olkin (KMO)表示。用非配对
共回收问卷479份,其中有2份答卷为满分210分及1份209分,作为无效问卷删除,由于一级及以下等级的医院的问卷只有4份,过少,与现实状况存在偏差,不具有统计的必要性,亦作为无效问卷删除。以472份有效问卷(占98.53%)作为研究样本进行分析。所调查医院药师均来自于河南省,在基本资料中,有开放性答题项目,根据问卷答题情况,将医院等级统一分为三级医院和二级医院。在工作性质中,将“其他”中的营养药师合并到临床药师项,静脉用药调配中心合并到调剂药师,最终“其他”项中包含有科研、库房、科室主任、配送、药事管理与药学服务等。被调查医院药师的基本情况见
表1 药师基本情况
Tab.1
Basic information of pharmacist
工作满意度每个维度以及职业满意度的Cronbach's Alpha信度系数见
表2 职业满意度、工作满意度及其各维度的信度系数
Tab.2 Reliability coefficients of career satisfaction,job satisfaction and its dimensions
表3 工作满意度、职业满意度的效度系数
Tab.3 Validity coefficient of job satisfaction and career satisfaction
最终得到了工作满意度、职业满意度每个条目及总的平均值和标准差。工作满意度5个得分最低与5个得分最高的条目、职业满意度各条目的平均值和标准差,满意度与不满意度比例及所属维度见
表4 工作满意度与职业满意度条目平均得分排名、满意度比例与总分情况①
Tab.4 Ranking of average level and satisfaction proportion about indicators in job satisfaction and career satisfaction
表5 工作满意度各维度与职业满意度的相关性分析
Tab.5
The correlation analysis in each dimension of job satisfaction and career satisfaction $\overline{x}$±
在职业满意度中,大多数医院药师期待获得个人成就并对自己从事的药师职业比较满意,有一半的药师对目前的生活品质感到满意且认可医院药师的职业前景,但是只有43.49%药师会推荐亲朋好友从事药师职业。如果可以重新选择,56.72%药师仍然会选择药师职业,但是在有更好的收入和保障的前提下,仅有23.11%药师表示完全不会考虑改变职业。
单因素方差分析结果见
工作满意度和职业满意度在基础资料中的差异,主要体现在以下几个方面:①年龄,26岁以下药师的工作满意度明显大于46岁以上(
表6 基本属性对工作满意度及职业满意度的影响
Tab.6 Effect of basic information on job and career satisfaction
为了更细致的研究工作满意度与职业满意度直接的相关性,将工作满意度每个维度与职业满意度做了相关性分析,相关系数
相关性分析结果显示,工作满意度各维度与职业满意度之间存在相关性,进一步使用逐步多元回归分析的方法研究其中的线性关系,线性回归分析摘要见
表7 工作满意度各维度对职业满意度的逐步多元回归分析
Tab.7 Stepwise multiple regression analysis career satisfaction from each dimension of job satisfaction
影响医院药师工作满意度的因素可以分为个人因素与工作因素。个人因素主要有年龄、职称、最高学历、婚姻状态和子女情况。工作因素主要有医院等级、工作性质、轮班制度和每周工作时间(含加班)。个人因素中,26岁以下药师工作满意度大于46岁以上的药师,这与文献[6]的研究相反;职称为药士和初级药师的药师工作满意度要高于主管药师和副主任药师及以上,这与赵杰等[8]研究一致;专科学历药师的满意度大于硕士及博士学历。年龄较低的药师一般刚刚进入医院工作,工作干劲较强,精力旺盛,求知欲强,对所从事的工作富有热情。职称不高的药师、职称晋升相对容易,而主管药师,副主任药师再进一步晋升时,不仅有发表论文的需要,对药学相关知识掌握程度的要求也更高。硕士、博士学历药师工作满意度比较低,而且当前很多医院在招聘中更倾向于硕士、博士,他们如果认为自己的技能没有得到充分利用,可能会不满意。在婚姻状态中,未婚、无需负担子女生活的药师满意度大于已婚以及需要负担1位子女的药师。
工作因素对医院药师工作满意度的影响分以下几点:在三级医院工作的药师,工作满意度大于二级;调剂科的药师工作满意度大于临床药师,这与邓勋等[7]的研究一致;弹性排班的药师工作满意度大于行政班;每周工作时长越短,满意度越高。原因可能在于三级医院相对来说,工作发展机会较好,工作制度较合理,工作环境比较舒适,医院药师的工作划分相对比较细致,药师对本职业以后的发展趋势有相对清晰的了解,有助于提高自身能力。临床药师的工作专注于患者,在与医护患沟通的过程中,所需要的知识储备较多,压力更大,相对更难以满足。另外,弹性排班的药师每周工作的时间比行政班相对减少,工作弹性大,调休也比较方便。这提示应该关注行政岗位药师的工作满意度。
在职业满意度方面,大多数受访药师想在药师职业获得个人成就,并认可目前所从事的职业前景,如果可以重新选择的话,有一半以上的药师仍会选择药师职业,但是如果能够有更好的收入和保障,只有少部分的药师完全不会考虑改变职业。影响职业满意度的基本因素只有工作因素,分别为医院等级、工作性质和轮班制度。
MURAWSKI等[9]的研究发现,对于社区药师来说,工作满意度能预测职业满意度,同样的,在本研究中发现医院药师工作满意度各个维度与职业满意度可以形成一个标准化回归方程:职业满意度=0.362×薪酬与福利+0.254×成长和发展+0.125×被称赞和认可的机会+0.105×排班。医院药师职业满意度与药师的薪酬和福利待遇相关性最高,这与国内外很多研究结果类似[1,3,10]。另一方面,很多药师比较关注薪酬的发放是否公平,如果在与其他同事对比时发现薪酬有所差别,可能会感到不满。
医院药师的成长和发展也与药师的职业满意度相关性较高[11],成长和发展属于药师工作满意度的内部影响因素[3],医院药师的成长和发展需求如果未满足期望,工作会变得无聊、沮丧或自满[6],工作满意度降低,进而降低工作的投入。而且,医药科学快速发展,所有医疗行业人员需要努力更新专业知识和技能,才能跟上国际发展水平的步伐。本次调查中,成长和发展包括公平晋升的机会、工作有关的技能培训、工作的挑战性、职业发展的机会以及科研的机会。只有49.58%的受访药师对自己参与科研的机会感到满意。这主要由于医院药师的科研关系着职称的晋升,但是科研压力较大,许多药师只能利用业余时间进行科研,难以平衡工作与生活,容易降低药师的职业满意度。另一方面,在药师面临药学服务转型的时代,医院药师需要提供高质量药学服务,这迫切需要与本人工作有关的技能培训,使得自己更加胜任工作所需。
3.3.1 健全薪酬公平分配体系 薪酬分配的公平性对于医院内部的稳定性和发挥工作积极性有重要意义[12]。加快薪酬制度改革,做到多劳多得、同工同酬,提高医院药师薪酬分配体系的公平透明度,同时实行绩效考核的模式[13],对药师工作进行量化指标,加强医院内部薪酬信息的沟通和传播机制,对每位药师所得工资奖金进行公示,使每位药师的工作价值得以体现。让医院药师参与到绩效的制定工作中[14],使得绩效更加贴近实际工作,更加合理。绩效管理模式的实施,有利于达到薪酬分配体系的公平、透明及合理性,进而增加医院药师的工作满意度与职业满意度。
3.3.2 加强医院药师的临床实践 本次调查的医院药师中,调剂药师最多,占73.5%,临床药师只有16.5%,在各个医院的药师中,临床药师占比较少,难以做到每个病区均有临床药师。目前我国临床药师大多为非临床药学专业出身,而临床药学工作需要丰富的临床实践能力,如采集病史、用药史、药物过敏史的能力,制定药物治疗方案的能力,与医患的沟通技能和职业精神等,专业性很强。临床药师的工作满意度受到较大重视[15]。通过促进调剂药师转型为临床药师,加强调剂药师的临床训练,推动药师自主学习,增加用药经验,有利于医院药师开展医院药学服务及科研工作,增加医院药师工作的挑战性及成就感。医院药师的临床实践能力得到提高,有助于提高工作及职业满意度[6]。
3.3.3 优化医院药师工作环境 在本次调查的医院药师中,有17.02%药师对目前工作所需的设施或工具,与人员配置情况不满意,且12.82%药师对目前的工作环境不满意。提示我们应该尽可能的优化医院药师的工作环境与人员配置。
本研究调查了河南省内二、三级医院药师对工作和职业的满意度,样本量过少(
本研究调查了中国河南地区二级、三级医院药师的工作满意度水平及其与职业满意度的相关性,发现医院药师的年龄、最高学历、职称、婚姻状况、子女情况、医院等级、工作性质、轮班制度和每周工作时间均会对药师的工作满意度造成影响,而医院等级、工作性质及轮班制度会影响医院药师的职业满意度。医院药师的外部回报中的薪酬和福利与内部因素中的成长和发展是影响医院药师职业满意度的最主要因素。下一步通过健全薪酬公平分配体系,并加强医院药师的临床实践,优化医院药师工作环境有望会提升医院药师的工作满意度及职业满意度。
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BACKGROUND: To date there has been no published research on the link between job satisfaction and intentions to quit the profession among pharmacists. OBJECTIVE: To explore job satisfaction, intentions to quit the profession, and actual quitting among pharmacists on the Royal Pharmaceutical Society of Great Britain Register. METHODS: Job satisfaction of pharmacists was measured as part of a workforce census using a validated satisfaction scale. Pharmacists were asked about their intentions to quit pharmacy within the next 2 years and follow-up was done using secondary analysis to see if they had quit within this timescale. Mean values for the satisfaction scale items were recorded and regression techniques were used to explore factors affecting job satisfaction and intentions to quit. The workforce census questionnaire was completed by 32,181 pharmacists (response rate=76.6%). This article considers the job satisfaction and intentions to quit of pharmacists under state pension age who were working in the community, hospital, and primary care sectors (n=21,889). RESULTS: Overall, pharmacists appeared to be satisfied with their work, although female pharmacists were more satisfied than their male counterparts. Pharmacists working in the community sector were less satisfied than those in other sectors. Remuneration was consistently ranked as 1 of the aspects of their work that pharmacists found least satisfying, regardless of age, sex, or sector of practice. Strength of desire to practice pharmacy was a predictor of both job satisfaction and intentions to quit pharmacy. CONCLUSIONS: Several factors were found to affect pharmacists' intentions to quit the profession including sex, age, job satisfaction, and strength of desire to practice pharmacy. However, only a relatively small proportion of pharmacists who expressed an intention to leave the profession appeared to have done so, suggesting that intentions may not be translated into action in this group of pharmacists.
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OBJECTIVES: To examine the perceived benefit of job and career satisfaction among pharmacist preceptors and to explore other factors that might influence satisfaction. METHODS: A cross-sectional self-administered survey instrument was mailed to pharmacists in the South Central region of the United States who had active 2010 licenses to investigate whether being a pharmacist preceptor increases job and career satisfaction. RESULTS: Twenty-three percent of the 363 respondents were active preceptors and 62% of these reported that they had been preceptors at some point in the past. Being an active preceptor was significantly related to increased job satisfaction (p = 0.01) but not to career satisfaction. Having a perceived benefit of continuing education and being professionally challenged at work also were associated with increased job and career satisfaction (p < 0.001). CONCLUSIONS: Pharmacist preceptors have higher levels of self-reported job satisfaction.
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BACKGROUND: The myriad changes in pharmacy practice in Jordan have transformed the pharmacist's role to be more focused on the patient and his/her therapeutic needs than on just the traditional dispensing. This, in addition to other possible factors, is believed to have influenced pharmacists' job satisfaction and stress level in different practice settings in Jordan. OBJECTIVE: This study aimed to determine the level of job satisfaction and job related stress among pharmacists in Amman. Moreover, the main causes of dissatisfaction and stress-related factors affecting pharmacists at their working positions were also explored. SETTING: The study was conducted in four pharmacy practice settings: independent and chain community pharmacies as well as private and public hospital pharmacies. METHODS: The study adopted the self-administered survey methodology technique using a pre-validated pre-piloted questionnaire. The questionnaire was adapted from one previously used in Northern Ireland. Data were entered into SAS database and analysed using descriptive statistics, Chi square and regression analysis. The significance level was set at P < 0.05. MAIN OUTCOME MEASURE: The level and factors affecting job satisfaction and job related stress as reported by participating pharmacists. RESULTS: A total of 235 registered pharmacists in Amman were involved. The pharmacists' job satisfaction was significantly affected by the type of pharmacy practice settings (P = 0.038), pharmacists' registration year (P = 0.048) and marital status (P = 0.023). Moreover, job related stress situations like patient care responsibility have been associated significantly with the type of pharmacy practice settings (P = 0.043) and pharmacists' registration year (P = 0.013). Other job stressors like long working hours, lack of advancement, promotion opportunities and poor physician pharmacists' relationship have also been reported by participants. CONCLUSION: The study concluded that community pharmacists in Amman are found to be less satisfied with their jobs than their hospital counterparts. Pharmacists' job satisfaction should be enhanced to improve pharmacists' motivation and competence. Consequently, this will improve their productivity and provision of pharmaceutical care.
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This study examines the relationship between job characteristics and job outcomes of pharmacists in hospital, clinic, and community pharmacies in Taiwan. The structured questionnaires covered the items of job characteristics, job outcomes, and demographics of pharmacists, and were distributed between Feb 2004 and April 2004. Two hundred and ninety-eight pharmacists responded. Data were analyzed descriptively, and univariate analyses, factor analysis, and multiple regression analyses were used. It found the more enriched the job, the greater the job satisfaction and less intention to leave. And community pharmacists reported greater job enrichment and job satisfaction and less intention to leave than did hospital and clinic pharmacists. It suggests pharmacy managers could recognize the needs of pharmacists to redesign and enrich their work arrangements.
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DOI:10.1002/hpm.v35.1
URL
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This paper is a first examination of the development of an alternative to activity-based remuneration in public hospitals, which is currently being tested at nine hospital departments in a Danish region. The objective is to examine the process of delegating the authority of designing new incentive schemes from the principal (the regional government) to the agents (the hospital departments). We adopt a theoretical framework where, when deciding about delegation, the principal should trade off an initiative effect against the potential cost of loss of control. The initiative effect is evaluated by studying the development process and the resulting incentive schemes for each of the departments. Similarly, the potential cost of loss of control is evaluated by assessing the congruence between focus of the new incentive schemes and the principal's objectives. We observe a high impact of the effort incentive in the form of innovative and ambitious selection of projects by the agents, leading to nine very different solutions across departments. However, we also observe some incongruence between the principal's stated objectives and the revealed private interests of the agents. Although this is a baseline study involving high uncertainty about the future, the findings point at some issues with the delegation approach that could lead to inefficient outcomes.
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