Abstract:

Objective To explore the relationship between nursing practice environment and turnover rate in tertiary A public general hospitals in China，so as to improve the nursing practice environment and enhance the stability of the nursing team. Methods From 2017 to 2021，nurses in 188 tertiary A public general hospitals in China were investigated by the Nurse Practice Environment Assessment Scale，and the evaluation scores and hospital turnover rate results were analyzed by trend test and correlation analysis. Results The evaluation of nursing practice environment in 188 hospitals was from（74.31±6.66） points in 2017 to（82.62±6.59） points in 2021，and the overall evaluation and the scores of each dimension showed an upward trend（P<0.001）. Among them，the scores of ‘quality management’，‘medical cooperation’ and ‘clinical nursing professionalism’ have been in the top 3 for 5 consecutive years；the scores of ‘hospital management and participation’，‘salary’ and ‘social status’ are the last 3. The turnover rate of nurses ranged from 1.27% to 1.57%，and there was a difference among the nurses from the eastern，central and western region of the country（P<0.05）. In the nurse practice environment，the 3 dimensions of ‘quality management’，‘healthcare cooperation’，and ‘clinical nursing professionalism’ were the most significantly associated with nurse resignation（P<0.05）. Conclusion In the environment construction of nursing practice，we should base on hospital quality and organizational management，improve nursing professionalism，create a good working atmosphere for medical and nursing teams，build a participatory nursing management model，improve the nurse salary distribution plan，and ultimately improve the satisfaction of nursing practice environment and reduce the rate of nurse turnover.

Key words: Nurse, Practice Environment, Turnover Rate, Nursing Administration Research

摘要：

目的 探讨国内三级甲等公立综合医院护士执业环境与离职率的关系，为改善护士执业环境、增强护士队伍稳定性提供依据。 方法 2017年—2021年，采用护士执业环境测评量表，对国内30个省（区、市）188所三级甲等公立综合医院的护士进行调查，并将测评得分及医院离职率结果进行趋势检验和相关性分析。 结果 5年间，188所医院护士执业环境测评量表得分由2017年的（74.31±6.66）分上升至2021年的（82.62±6.59）分，总体评价及各维度得分均呈上升趋势（P<0.001）。其中“质量管理”“医护合作”和“临床护理专业性”3个维度连续5年得分始终位于前三位；“医院管理与参与”“薪酬待遇”和“社会地位”3个维度得分位于后三位。护士离职率整体较低，为1.27%~1.57%，东部、中部、西部护士的离职率存在差异（P<0.05）。护士执业环境测评量表中，“质量管理”“医护合作”和“临床护理专业性”3个维度在2018年、2019年与离职率均具有相关性（P<0.05）。 结论 在护士执业环境建设中，应立足于医院质量与组织管理，提升护理专业性，创建良好的医护团队工作氛围，同时构建共同参与式护理管理模式，完善护士薪酬分配方案，最终提升护士执业环境满意度，降低护士离职率。

关键词: 护士, 执业环境, 离职率, 护理管理研究