Korean Journal of Occupational Health Nursing Vol. 27 No. 3, 139-151, August 2018 pissn 2287-2531 eissn 2466-1856 https://doi.org/10.5807/kjohn.2018.27.3.139 강경화 1 채영란 2 박수연 3 한림대학교간호학부 간호학연구소교수 1, 강원대학교간호학과교수 2, 강원대학교간호학과대학원생 3 Job Embeddedness of Korean Clinical Nurses: A Literature Review Kang, Kyeonghwa 1 Chae, Young Ran 2 Park, Suyoun 3 1 Professor, Division of Nursing, Hallym University, Gangwon 2 Professor, College of Nursing, Kangwon National University, Gangwon 3 Graduate Student, Department of Nursing, Graduate School, Kangwon National University, Gangwon, Korea Purpose: This review aimed to integrate the results of studies related to job embeddedness of clinical nurses and suggest directions for future research. Methods: A search for relevant studies was conducted using six databases according to the predetermined index terms nurse and job embeddedness. A total of 28 studies that met the inclusion criteria were selected and analyzed. Results: The definition of job embeddedness was consistent in the articles, but the terms, scope, and use of tools to determine job embeddedness were not. In addition, no article suggested a theoretical framework. In all the studies except one, the tool used to measure job embeddedness was one revised from Mitchell et al. (2001). In 15 articles, a negative correlation was found between job turnover and turnover intention. Job embeddedness was also found to be associated with nurses work environment, organizational citizenship behavior, and organizational commitment, and it had a positive impact on these variables. Conclusion: Job embeddedness can be used as a major variable to explain nurses s turnover intention. Job embeddedness is multidimensional, and a theoretical framework is needed to explain the job embeddedness of clinical nurses. Tools specific to Korea should be developed to measure the job embeddedness of Korean clinical nurses. Key Words: Nurse, Job Embeddedness, Review 서론 1. 연구의필요성 간호인력의안정적유지관리는간호서비스의질을유지하는데에큰영향을미치므로매우중요함에도불구하고우리나라간호사의이직률은상당히높은편이다. 2018년현재간호사의이직률은 12.4% 이며, 이중신규간호사 1년내이직률은 경우 33.9% 의높은이직률로숙련된장기근속인력부족을나타내고있다 (Korean Hospital Nurses Association, 2018). 간호사의이직은조직적인면에서는새로운인력의선발과훈련에필요한비용의손실을초래하며간호사자신에게도경력의단절또는업무환경의변화등으로인한스트레스를유발하게되어결국간호의질을떨어뜨린다 (Han, Moon, & Yun, 2009). 더불어구성원의지속적인변화로구성원간의협동성, 역할구분및상호지지적분위기등을저해받게되어간호업무의연 주요어 : 간호사,, 고찰 Corresponding author: Chae, Youngran https://orcid.org/0000-0002-8523-0395 Department of Nursing, College of Nursing, Kangwon National University, 1 Ganwondaehak-gil, Chuncheon 24341, Korea. Tel: +82-33-250-8886, Fax: +82-33-242-8840, E-mail: suyoun2419@gmail.com Received: Apr 5, 2018 Revised: May 21, 2018 Accepted: Aug 22, 2018 This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. c 2018 Korean Academic Society of Occupational Health Nursing http://www.ksohn.or.kr
강경화 채영란 박수연 속성과전문성에심각한문제를발생시킨다 (Kim, 2004). 이러한이유로그동안선행연구에서는직무만족이나조직몰입등의직무태도에초점을두어간호사의이직과관련된연구들이진행되어왔다 (Lee, Sin, Baeck, & Heo, 2014). 그러나일부연구에서는이러한직무태도가구성원의잔류와이직에상대적으로작은영향을미친다는결과를보여주고있어 (Griffeth, Hom, & Gaertner, 2000; Reitz, Anderson, & Hill, 2010), 연구의방향이이직이아닌어떻게하면간호조직에오래남아있는가에더관심을가지게되었다. 즉직장을떠나는원인에대한예측변인이아닌이들을포괄하면서일련의사건들과무관하게조직에잔류하도록붙잡아주는차별적예측변인에대한연구의필요성이제시되었다 (Mitchell, Holtom, Lee, Sablynski, & Erez, 2001; Kim & Ryu, 2016). (job embeddedness) 은바로그러한관점에서대두된개념이다. 이란직무와관련하여조직에뿌리를내리고있는정도를의미하며, Mitchell 등 (2001) 에의해처음제시하였다. 이는조직에서함께일하는동료나집단또는그들과의관계에대한애정을의미하는직무내적요인과가족의압력이나지역사회에대한몰입등과같은요소들이구성원으로하여금조직에잔류하게끔하는직무외적요인의 2가지상위요인으로구분되며, 각요인은개인이조직과지역사회커뮤니티에잘맞는다고지각하는정도 ( 적합성, fit) 와개인의업무나상호작용하는동료등으로제시되는조직내네트워크와지역사회네트워크 ( 연계, link), 조직이나지역사회를떠남으로써얻게되는손해 ( 희생, scarifice) 를포함하는총 6개의범주로구분하여설명하였다 (Mitchell et al., 2001). 에대한국내연구는 2002년경영학, 심리학분야에서이직의도와잔류에대한연구로시작되었고 (Kim, 2002), Kim (2010) 의논문에서병원조직구성원의일부로간호사를대상으로한연구가시도되었다. 이후여러간호학자들에의해연구 (Kim, 2017; Kang & Kwon, 2017; Song & Choi, 2017) 되어이직의도또는재직의도를설명하는중요변수로부각되고있다. 뿐만아니라은조직특성, 간호업무수행변수와이직의도간의관계에서매개변수로작용하고 (Kim & Lee, 2014; Yoo & Kim, 2016), 전문직자아개념과조직성과간의관계를조절하는개념 (Jeon, 2014) 이기도하여다양한변수들과연결된다. 현재까지에관한국내간호학연구가 40편이상보고되고있음에도불구하고국내에서는 또는 라는용어로연구자에따라서로다르게소개하고있으며두개의용어차이를명확하게구분하여사용하고있 지않다. 따라서개념적정의와측정에한계가있을수있으며 (Lee et al., 2014), 현시점에서기존연구에서의이러한혼재의현상을객관적으로파악해보고향후합의된개념과측정을위한연구방향성을제시할필요가있다. 또한, 측정에있어다수의연구에서연구자의의도에따라 Mitchell 등 (2001) 의도구를일부분만사용하고있으며, 좀더최근에개발된 Reitz (2014) 도구의사용은아직미비한수준으로도구사용과관련된국내연구의동향을심도있게분석할필요가있다고판단된다. 이에본연구는국내간호학연구에서개념의명료성이부족하고사용된연구도구들이일관되지않으며, 관련변수들이다양하므로이를분석하여통합하는과정을통해, 국내임상간호사를대상으로한연구의방향과연구결과에대해고찰하고자한다. 2. 연구목적본연구에서는현재까지진행된국내임상간호사를대상으로한관련연구들을분석함으로써, 주요결과를정리하고동향을파악하여이를토대로과관련된특성을알아보고, 도구의측정과이에관련된주요변수들을확인하고자한다. 구체적목적은다음과같다. 국내임상간호사의과관련된연구의특성을고찰한다. 국내임상간호사의을측정하기위해사용된도구들을분석한다. 국내임상간호사의과상관성있는주요변수들을분류하고그변수들간의관계를규명한다. 연구방법 1. 연구설계 본연구는임상간호사를대상으로한이직연구에서관련국내연구논문을통합적고찰방법으로분석한문헌고찰연구이다. 2. 연구진행본연구에서다루는주제인간호사의의특성을고려하여 Whittemore와 Knafl (2005) 의통합적고찰방법에 140 Korean J Occup Health Nurs
따라 5단계로진행하였다. 구체적인과정은 1단계문제규명, 2 단계문헌검색및자료수집, 3단계자료평가, 4단계자료분석, 5단계자료제시의순이었다. 1) 문제규명문제규명단계에서는개인이조직에머무르거나떠나려는결정을할때영향을미치는통합된변인이라는 Mitchell 등 (2001) 의정의와국외연구에관한문헌고찰결과이이직의도또는재직의도에큰영향을미침을근거하여문제를단계적으로규명하였다. 첫째, 국내연구에서임상간호사의과관련된연구는무엇인가? 둘째, 국내연구에서임상간호사의을측정하는도구는무엇인가? 셋째, 국내연구에서임상간호사의과관련된요인은무엇인가? 등세가지문제를도출하였다. 2) 문헌검색및자료수집 (1) 문헌검색방법문헌검색을위해한국학술정보 (KISS), 국립중앙도서관 (National Library of Korea), 국회도서관 (National Assembly Library), 한국학술연구정보서비스 (RISS), 누리미디어 (DBpia), 국가과학기술정보센터 (NDSL) 의 6개검색엔진을이용하였다. 검색어는,, 간호사 를사용했고, 자료의수집을위해검색기간은 2010년 1월부터 2017년 12월까지 ( 총 8년 ) 를검색기간으로하였다. 추가문헌을확인하기위해주요검색어를사용하여 2018년 1월부터 2018년 2월까지 ( 총 2 개월 ) 눈덩이표집방법 (snowball method) 을사용하였다. 선정기준 1 2017년까지국내간호학및관련분야학술지에게재된연구 2 임상간호사를대상으로한연구 3 양적연구 : 직접측정된변수로을포함한연구 제외기준 1 임상간호사외병원구성원을포함하여연구결과에서분리하여제시하지않은경우 2 간호사를대상으로한도구의타당도검증연구 (2) 문헌선정 1단계에서본연구의연구자 3인이문헌을각각검색한결과총 139개의문헌이검색되었다. 연구자 3인이 139개문헌을각각검토하여문헌의제목이본연구의주제와부합하는지검토 한후논의를거쳐부적합하거나중복출판된문헌 99개를배제하여 40개의문헌이 1차적으로선택되었다. 2단계에서는 40개의문헌의초록을검토한후논의를거쳐학위논문과학술지의제목및내용이동일한문헌 7개, 임상간호사가대상이아닌문헌 2개, 병원조직구성원전체를대상으로한문헌 1개, 도구개발 1개문헌을배제하였고, 선택된 29개문헌이선정기준에부합하는지재검토하였다. 학위논문과학술지의제목및내용이동일한경우에는학술지로선정하였다. 마지막 3단계에서는선택된 29개문헌의참고문헌을참조하여추가문헌이있는지확인하고, 추가문헌이없음을확인한후 29개의문헌의전문을자세히확인하여주요어로포함되어있으나직접측정하지않은 1개의논문을배제한총 28개의연구가선택되었다 (Figure 1). 3) 자료평가자료평가단계에서는최종적으로선택된 28개의문헌을 Hawker, Payne, Kerr, Hardey와 Powell (2002) 이제시한문헌평가지를사용하여평가하여자료분석에포함시킬논문을결정하였다. Hawker 등 (2002) 의문헌의질평가지는 9개의항목으로구성되어있으며 Likert 4점척도로 good=4점, fair=3 점, poor=2점, very poor=1점으로평가하도록하고있다. 총합산점수는최소 9점에서최대 36점이며, 9개평가항목은 (1) 제목과초록, (2) 서론및연구목적, (3) 연구방법, (4) 연구대상, (5) 자료분석, (6) 윤리적고려, (7) 연구결과, (8) 전이및일반화의가능성, (9) 연구의의의이다. 본연구의경우본연구의연구자 3인이최종적으로선택된 28개논문을평가한결과 28개논문이 28~35점의분포를보이며, 평균 29.0점으로논문모두를자료분석단계에포함하는것으로하였다. 4) 자료분석최종적으로분석에포함된자료는임상간호사를대상으로을측정한연구들가운데선정기준에충족하는국내논문총 28편이었다. 본연구에서는분석에포함된연구의특성을기술하고각연구에서사용한도구와연구결과를분석하였다. 이를위해문제규명단계에서제시된내용들이포함될수있도록자료분석틀에들어갈항목을연구자 3인이합의하여결정하였다. 자료분석틀에는저자, 게재년도, 제목, 용어의사용, 연구설계, 표본크기, 병상규모, 측정도구, 변수형태, 과관련하여분석된변수및상관관계결과등을별도로분류하여테이블로정리하였다. Vol. 27 No. 3, 2018 141
강경화 채영란 박수연 Identification Potential articles related to job embeddedness (in Korea) (n=139) Initial exclusions from title and abstract or duplicate publication (n=99) Screening Articles initially selected (n=40) Exclusions based on selected criteria (n=11) Eligibility Records screened by criteria of selections & exclusions (n=29) Further exclusions based on criteria (n=1) Included Studies included in the review (n=28) Figure 1. Flow diagram of study selection. 5) 자료제시자료제시단계에서는문헌고찰의마지막과정으로자료분석단계에서만든자료분석틀에맞게정리하여연구결과에제시하였다. 연구결과 1. 임상간호사의 연구의특성 임상간호사의과관련된특성을분석한결과, 각연구들의설계유형이모두서술적조사연구임을확인하였다. 이들의표본크기는최소 110명에서최대 653명이었으며, 병상규모는 200병상이하에서 1,000병상이상, 자료수집기관은중소병원에서상급종합병원에이르기까지다양하였다. 은 18편의연구에서독립변수로, 7편의연구에서는종속변수로, 2편의연구에서는매개변수로작용하였다. 그외 1편의연구에서는을독립변수이면서매개변수로써측정하였다. 또한, Job embeddedness에대한국내에서의용어사용은명확한구분없이단순번안하거나비유적표현을적용한것으로서 16편, 12편이었다 (Table 1). 에대한개념적정의는총 28편의논문가운데 28편모두에서제시하고있었다. 에서 embeddedness 의사전적뜻은 ( 마음속에 ) 깊숙이박다, 파묻다 등을의미하는것으로어느한곳에깊이파묻히고박힐정도로연관성이높음을표현한다. 분석된 28편모두에서은 자발적이직을결정하는데중요한요소중의하나로서구성원이현재직무와조직에계속해서머무르게하는종합적이고광범위한연결망 으로적합성, 연계, 희생의세가지영역을포함개념으로정의되었다. 그러나 3편을제외한대부분의연구들은을직무내적요인인조직관련배태성에국한되어정의하였다. 직무내적요인의조직관련과직무외적요인의지역사회관련모두를포괄하는개념으로제시한논문은 3편이었으며, 이중 1편의연구에서는 자신의직무와관련하여개인이조직에깊이뿌리를내리고있는정도 를지칭하는개념으로조직적합성, 지역사회적합성, 기득혜택, 업무팀, 가족및친구의다섯가지측면으로구분되었다. 2. 임상간호사의 측정을위해사용된도구을평가하기위해기존에개발된도구들가운데 2종의도구들이임상간호사의을측정하는데사용되었다 (Table 2). 가장많이사용된도구는 Mitchell 등 (2001) 에의해개발된도구로, 조직적합성, 조직연계, 조직희생, 지역 142 Korean J Occup Health Nurs
Table 1. Description of Included Studies Article code Study design Subject (n) Hospital size Variable type Title Korean M1 385 Small & medium hospitals 15 sites Independent The effects of job embeddedness and leader-member exchange on job satisfaction, organizational commitment, and turnover intention among the nurses in small and midium size hospitals M2 241 600 2 sites & 800 3 sites Independent Mediation effect of organizational citizenship behavior between job embeddedness and turnover intention in hospital nurses M3 217 Small & medium hospitals 5 sites Independent The relationship among career plateau, self-efficacy, job embeddedness and turnover intention of nurses in small and medium sized hospitals M4 263 <500 6 sites, 500~999 5 sites & 1,000 2 sites Dependent Effects of general hospital nurses` work environment on job embeddedness and burnout M5 653 200 2 sites, 600 2 sites & 800 3 sites Mediator Mediation and moderation effects of job embeddedness between nursing performance and turnover intention of nurses M6 490 General & University hospitals 6 sites (300~399, 400~499, 500) Mediator Structural equation model of clinical nurses professional self-conception, jobembededness, organizational citizenship behavior and organizational performance M7 224 300 3sites & 450 1site Independent Roles of empowerment and emotional intelligence in the relationship between job embeddedness and turnover Intension among general hospital nurses M8 207 700 Independent Influence of job embeddedness and organizational commitment on organizational citizenship behavior in general hospital nurse M9 318 400~720 Independent Effects of self-efficacy, career plateau, job embeddedness, and organizational commitment on the turnover intention of nurses M10 245 General hospital 1 site Independent The effects of job embeddedness and leader-member exchange on organization commitment of hospital nurses M11 216 500 Independent Effect of job embeddedness and job satisfaction on turnover intention in nurses M12 283 800 Independent Structural relationships among job embeddedness, emotional intelligence, social support and turnover intention of nurses M13 244 500 3 sites Independent Role of self-leadership and social support in the relationship between job embeddedness and job performance among general hospital nurses Vol. 27 No. 3, 2018 143
강경화 채영란 박수연 Table 1. Description of Included Studies (Continued) Article code Study design Subject (n) Hospital size Variable type Title Korean M14 136 General hospital 10 sites Dependent Influence of professionalism, role conflict and work environment in clinical nurses with expanded role on job enbeddedness M15 293 600~900 2 sites Dependent Impact of nursing organizational culture types on innovative behavior and job embeddedness perceived by nurses M16 229 General hospital Independent Effect of hospital nurse s professionalism, job embeddedness, and nursing organizational culture on intention of retention M17 389 General hospital 2 sites Independent & Mediator A structural model of hospital nurses" turnover intention : focusing on organizational characteristics, job satisfaction, and job embeddedness M18 202 Tertiary general hospital 3 sites & general hospital 1 site Dependent The effects of nursing practice environment and psychological capital on job embeddedness among clinical nurses M19 188 General hospital 3 sites Dependent A convergence study about influences of trust in supervisor, customer badness behavior, turnover intention behavior on job embeddedness in clinical nurses M20 283 <200~300 6 sites Independent Effects of job embeddedness and emotional intelligence on performance of nurses in medium and small sized hospital M21 276 <200 4 site & 200~400 2 sites Independent Effects of nurses' practice environment and job embeddedness on turnover intention in medium-small sized hospital M22 479 200 10 sites Independent Influences of fatigue, emotional labor and job embeddedness on nurses turnover intention M23 158 500 4 sites Dependent The effects of communication ability and ego-resiliency on job embeddedness of the experienced nurse M24 110 700 1 site Independent A convergence study about influences of emotional intelligence and job embeddedness on turnover intention in general hospital nurses M25 193 Tertiary general hospital 3 sites Dependent Factors affecting clinical nurses' job embeddedness M26 177 General hospital Independent Relationships among nursing work environment, job embeddedness, and turnover intention in nurses M27 333 200~399 10 sites Independent Influence of job embeddedness factors on turnover intention of nurses in small and medium sized general hospitals R1 242 General hospital 4 sites (<400, 400) Independent Effects of job embeddedness and nursing professionalism on intent to stay in clinical nurses 144 Korean J Occup Health Nurs
Table 2. Tools for Measuring Job Embeddedness in Clinical Nurse Used tools Sub-dimension No. of articles Article code No. of items Cronbach's Used Korean version of job embeddedness Authors (year) Mitchell, T. R., Holtom, B., Lee, T. W., & Erez, M. (2001) Fit-organization Links-organization Sacrifice-organization 25 M1 15.78 Mitchell et al. (2001) Lee, S. Y. (2011) M2 18.87 Mitchell et al. (2001) Kim, E. H., Lee, E. J., & Choi, H. J. (2012) M3 18.87 Kim, Lee, & Choi. (2012) Kim, Y. M. & Kang, Y. S. (2013) M4 19.91 Kim (2010) Kim, J. K., Kim, M. J., Kim, S. Y.,Yu, M., & Lee, K. A. (2014) M5 18.87 Mitchell et al. (2001) Kim, E. H., & Lee, E. J. (2014) M6 18.92 Kim, Lee, & Choi. (2012) Jeon, K. D. (2014) M7 18.76 Kim, Lee, & Choi. (2012) Jeon, J. H., & Yom, Y. H. (2014) M8 16.90 Kim (2010) Jo, J. S. (2014) M9 20.91 Mitchell et al. (2001) Kim, Y. M., & Kang, Y. S. (2015) M10 18.84 Kim, Lee, & Choi. (2012) Park, Y. M. (2015) M11 15.89 Lee (2011) Son, S. Y., & Choi, J. S. (2015) M12 26.86~.88 Mitchell et al. (2001) Lee, S. J., & Woo, H. J. (2015) M13 18.91 Kim, Lee, & Choi (2012) Lee, H. S., & Yom, Y. H. (2015) M14 16.86 Choi (2014) Kang, K. H., & Lim, Y. J. (2016) M15 20.91 Kim (2015) Mun, M. Y., & Hwang, S. Y. (2016) M16 18.89 Kim, Lee, & Choi (2012) Baek, G. R. (2016) M17 22.63~.81 Kim (2014) Yoo, M. J., & Kim, J. K. (2016) M18 18.91 Kim, Lee, & Choi (2012) Choi, H. W. (2016) M19 16.90 Kim (2010) Kang, J. M., & Kwon, J. O. (2017) M20 17.75~.88 Kim (2010) Kwon, S. B., Park, M. J., Song, H. M., & Moon, J. S. (2017) M21 18.90 Kim, Lee, & Choi (2012) Kim, M. J., Lee, J. W., & Park, S. J. (2017) M22 18.88 Kim, Lee, & Choi (2012) Kim, Y. N. (2017) M23 15.82 Lee (2011) Seo, Y. M. (2017) M24 16.88 Kim (2010) Song, M. J., & Choi, S. Y. (2017) M25 19.85 Kim (2010) Hyun, Y. S. (2017) Reitz (2014) Fit-organization Links-organization Sacrifice-organization Fit-community Links-community Sacrifice-community Organization match Community match Vesting Work teams 2 M26 31.92 Kim (2014) Ko, H. J., & Kim, J. H. (2016) M27 33.61~.89 Organization: Kim (2010) Community: Mitchell et al. 2001) Kim, Y. S., & Ryu, S. A. (2016) 1 R1 17.89 Choi (2016) Choi, S. Y. (2017) Vol. 27 No. 3, 2018 145
강경화 채영란 박수연 사회적합성, 지역사회연계, 지역사회희생의 6개영역, 40문항으로이루어져있으며 5점 Likert 척도로측정한다. 28편의연구들가운데, Mitchell 등 (2001) 의도구는국내연구 27편에서번안및수정하여사용되었다. 하위영역별사용에서 25편의연구가직무내적요인에국한된조직적합성, 조직연계, 조직희생의 3개하위영역만을사용 (Cronbach s =.63~.92, 수정된문항수 15~26문항 ) 하여을측정하였으며다른 2편의연구에서만 6가지하위영역모두를사용 (Cronbach s =.61~.92, 수정된문항수 31~33문항 ) 하였다. 조직내적요인에초점을둔연구 25편중 9편에서 Kim, Lee와 Choi (2012) 의도구를, 6편에서는 Kim (2010) 의도구를사용하여을측정하였으나대부분의연구에서수정이나삭제한문항이있어연구마다도구의측정문항수가상이하였다. 다음으로 Reitz (2014) 에의해개발된도구로, 앞선 Mitchell 등 (2001) 의도구를기반으로하였다. 원도구의지역사회희생영역을제외하고조직적합성, 지역사회적합성, 기득혜택 ( 근무혜택 ), 업무팀, 가족및친구의 5가지하위영역을측정하며, 23 문항, 5점 Likert 척도로이루어져있다. 이도구를사용한 1편의연구에서는하위영역중 가족및친구 을다소집단주의적동양사회와개인주의적서양사회간의문화차이를고려하여수정한한국어판 (Choi, S. M., 2016) 도구를사용 (Cronbach s =.89, 17문항 ) 하였다. 28편의연구모두에서매우그렇지않다 (1점), 그렇지않다 (2점), 그저그렇다 (3점), 그렇다 (4점), 매우그렇다 (5점) 의 5점 Likert 척도로측정하였다. 3. 임상간호사의 과관련변수와의관계임상간호사의을설명하기위해조사된변수들을분석에서가장많이연구된변수는이직의도, 재직의도였다. 이와관련된 15편의연구에서과이직의도간의양의상관관계를보였으나, Kim과 Kang (2013) 의연구에서는이직의도가하위영역인조직연계와는뚜렷한상관관계가없음이확인되었고, Ko와 Kim (2016) 의연구에서는하위영역인지역사회연계를제외한나머지영역에서만상관관계를보였다. 또한, 이직의도와반대되는개념인재직의도와의관계를확인한 2편의연구에서도음의상관관계가확인되어동일한결과를나타냈다 (Table 3). 다음으로많이확인된변수는간호업무환경으로, 6편의연구에서과양의상관관계를보고하였으나 Ko와 Kim (2016) 의연구에서는하위영역인지역사회 연계와는뚜렷한상관관계가없음이확인되었다. 조직몰입, 조직시민행동, 감성지능변수는각 4편의연구에서양의상관관계를보였으나감성지능의경우 2편의연구에서는음의상관관계가확인되어상반된결과를나타냈다. 직무만족변수는 3편의연구에서양의상관관계를보였으며, 간호업무성과, 전문직업성, 간호조직문화유형, 자기효능감, 사회적지지, 상사-구성원교환관계의변수들은각 2편씩의연구에서양의상관관계보였다. 경력정체의변수는 2편의연구에서는음의상관관계가확인되었고, 감정노동은 2편에서연구되었는데 Kim (2017) 의연구에서는음의상관관계를보였으나 Hyun (2017) 의연구에서과감정노동의내면행위는양의상관관계로나타났다. 그밖에도소진, 역할갈등, 피로도의변수가각 1편씩의연구에서과음의상관관계를보였으며, 임파워먼트, 조직성과, 셀프리더쉽, 조직공정성, 변혁적리더쉽, 혁신행동, 상사신뢰, 간호업무수행, 심리적자본, 간호전문직관, 전문직자아개념, 의사소통능력, 자아탄력성의변수는각 1편씩의연구에서과양의상관관계로확인되었다. 마지막으로임상간호사과의연구결과중, 고객불량행동은과유의하지않은상관관계를보였으나, 하위요소인조직희생과는음의상관관계가확인되었다. 논의 본연구에서는현재까지진행된국내임상간호사의에관한연구를분석하여의개념및측정도구의특성을분석하고, 과관련된변수들을확인하여과의관계를규명하고자하였다. 먼저, 의개념적정의는개인을조직에머무르게하는통합된영향력 (Mitchell & Lee, 2001) 으로분석된연구들에서일관되게설명하고있었다. embeddedness 의용어는사회적관계가경제적활동에영향을미치게된다는사회학이론에서처음시작된개념이며 (Uzzi, 1997), 사회학자들이분석의단위나종속변수로서배태성의구성요소를좀더광범위하게개인이나집단, 조직, 다양한경제활동까지도포함시켰다. 이러한맥락에서 Michell 등 (2001) 이제시한도구에서도직무내적요인과직무외적요인으로구분하였다. 직무내적요인에는조직에서의헌신이나동료와의네트워크, 애착등이포함되며, 직무외적요인에는가족이나지역사회에서의관계망, 취미활동, 종교활동등을포함하고있다. 146 Korean J Occup Health Nurs
Table 3. Variables Studied regarding Job Embeddedness in Clinical Nurses Variables Results Relations Direction No. of articles Article code Turnover intention Yes Negative 15 M1, M2, M3, M5, M7, M9, M11, M12, M17, M19, M21, M22, M24, M26, M27 Retention intention Yes Positive 2 M16, R 1 Nurses' work environment Yes Positive 6 M4, M14, M17, M18, M21, M26 Organizational fairness Yes Positive 1 M17 Organizational citizenship behavior Yes Positive 4 M2, M6, M8, M17 Job satisfaction Yes Positive 3 M1, M11, M17 Motivation Yes Positive 1 M17 Organizational commitment Yes Positive 4 M1, M8, M9, M10 Nursing performance Yes Positive 1 M5 Organizational performance Yes Positive 1 M6 Job performance in general Yes Positive 2 M13, M20 Influence of professionalism, Yes Positive 2 M14, M16 Nursing professionalism Yes Positive 1 R1 Professional self-concept Yes Positive 1 M6 Nursing organizational culture types Yes Positive 2 M15, M16 Innovative behavior Yes Positive 1 M15 Self-efficacy Yes Positive 2 M3, M9 Ego-resiliency Yes Positive 1 M23 Empowerment Yes Positive 1 M7 Social support Yes Positive 2 M12, M13 Communication ability Yes Positive 1 M23 Leader-member exchange Yes Positive 2 M1, M10 Trust in supervisor Yes Positive 1 M19 Transformational leadership Yes Positive 1 M17 Self-leadership Yes Positive 1 M13 Psychological capital Yes Positive 1 M18 Emotional intelligence Yes Positive 2 M20, M24 Sub-dimension result 3) Links-organization: relations (-) 26) Links-community: relations (-) 26) Links-community: relations (-) 20) Fit-organization: negative 20) Fit-organization: negative Negative 2 M7, M12 Burnout Yes Negative 1 M4 Fatigue Yes Negative 1 M22 Emotional labor Yes Negative 1 M22 Positive 1 M25 Role conflict Yes Negative 1 M14 Career plateau Yes Negative 2 M3, M9 Customer misbehavior No - 1 M19 Sacrifice-organization: negative (-): 유의하지않음. Vol. 27 No. 3, 2018 147
강경화 채영란 박수연 본연구결과에서는 28편중 25편의논문에서직무내적요인만을국한하여정의하거나도구로사용하였다. 직무내적요인만을사용한이유로도구가개발된미국의지역사회실정과다르게국내의경우지역사회와의연계가미미한점을감안하거나 (Kim et al., 2012; Kim & Kang, 2013; Jo, 2015), 직무외적요인의유의성을보고한연구가매우부족하고체계적인근거를찾을수없기때문이라고제시하였다 (Kim & Kang, 2015). 그러나대부분의연구에서는직무외적요인을배제한이유가특별히언급되지않았다. 그럼에도불구하고본연구의결과에서다수의연구가직무내적요인으로한정하여을정의하고측정하는것은의속성을고려해볼때단편적인설명력을제공할것으로보인다. 현재국내에서는일과삶의균형과개인삶의질에대한관심이고조되면서직무외적요인의중요성이부각되고있다. 그러므로국내지역사회및문화적특성을반영한도구가개발될필요가있다. 또한, 선행연구에서 에비해 을사용한연구가상대적으로많아본연구에서는 으로기술하였다. 그러나용어의혼용은혼란을야기시키거나이질적인용어로해석될수있으며, 에대한이론적이해의부족에기인하는요인이될수있으므로용어사용에있어학자간일치에대한심도있는논의가필요할것으로보인다. 국내임상간호사들의측정에사용된도구는크게 2가지범주로구분되었다. 본연구에서포함된논문들은의점수를측정하였으며점수가높을수록이높음을설명하였다. 주로사용된 Mitchell 등 (2001) 이개발한도구는식료품점직원 700명과간호사 150명을포함한병원직원 500명을대상으로연령, 성별, 결혼여부등의개인적특성과직무만족, 조직몰입, 직업선택과이직의도및실제적인이직행위를이라는새로운개념과연계하여측정하였다. 이도구는의구성요소로직무내적요인 ( 조직 ) 과직무외적요인 ( 지역사회 ) 으로나뉘고적합성, 연계, 희생이라는세가지영역의요소들로총 6가지하위영역을제시하고있다. 구성은조직적합성 9문항, 조직연계 7문항, 조직희생 10문항, 지역사회적합성 5문항, 지역사회연계 6 문항, 지역사회희생 3문항의총 40문항 (Cronbach s =.50~.86, 5점 Likert 척도 ) 으로되어있다. Mitchell 등 (2001) 의도구로국내임상간호사의을측정한연구에서는 Kim과 Ryu (2016), Ko와 Kim (2016) 만이종합병원간호사를대상으로직무내적인요인과직무외적인요인모두를측정하였고, 다수의연구에서는직무내적요인인조직에초점을둔원도구의일부만을사용하였다. Mitchell 등 (2001) 의총 40문항중에 26문항이직무내적요인 ( 조직 ) 에해당됨과는다르게 15~26문항으로다양하게수정되었으며, 경우에따라문항의일부분을선택함에있어기준을명확하게제시하지않았다 (Choi, S. M., 2016; Lee & Sin, 2017). 더불어국내에서주로사용된 Kim (2010) 과 Kim 등 (2012) 의도구에서명확한번안과정이제시되지않아도구의내용타당도가확보되지않았으며, 특히조직연계와조직희생영역의번안이상이하게나타났다. 그러므로체계적인도구번안및도구의평가검증과정을통한표준화된도구의사용이필요할것이다. 국내에서직무내적요인과직무외적요인을모두측정한연구는 2편으로미미한실정이다. 일부연구에서는일부하위영역의내적일치값 ( 조직연계.51, 와지역사회희생.57) 이낮게측정되었고이는국외도구가우리나라사정을반영하지못한것으로해석하였다 (Ko & Kim, 2016). 국외연구와비교했을때도미국간호사를대상으로한연구 (Mitchell et al., 2001; Holtom & O'Neill, 2004) 나중국의일반기업체대상으로한연구 (Tang, 2008) 의직무외적요인이국내연구와일관되지않은결과들을보여주고있으며, 이는지역사회의범위나지역간의이동거리, 특성및문화등의차이에서기인된것으로해석되기도한다 (Kim & Ryu, 2016; Ko & Kim, 2016). Reitz (2014) 이개발한도구의경우, 미국간호사를대상으로에대한요인분석을통하여 Mitchell 등 (2001) 의 지역사회희생 을제외하고조직적합성 8문항, 지역사회적합성 4문항, 기득혜택 4문항, 업무팀 4문항, 가족및친구 3 문항라는 5가지하위요소총23문항 (Cronbach s =.84, 5점 Likert 척도 ) 으로축소하여재구성하였다. 국내연구에서 Choi, S. M. (2016) 에의해상급종합병원과종합병원의간호사 258 명을대상으로이도구의신뢰도와타당도를검증하여개발되었으나이도구에서도내용타당도분석에서 60% 이하로낮게측정된문항인 내가살고있는이곳의날씨는나에게적당한가, 나의가족은이지역출신이다, 병원내에서당신이속한위원회는몇개인가 를삭제하였다. 또한미국과한국의문화적차이를고려하여 가족및친구 영역을삭제하고, 기득혜택영역을근무혜택으로재명명하여총 4가지영역 ( 조직적합성, 지역사회적합성, 근무혜택, 업무팀 ) 의총 17문항 (Cronbach s =.86, 5점 Likert 척도 ) 으로재구성되었다. 외국에서개발된측정도구에대해 Yoo와 Kim (2016) 연구에서는설문문항이국내상황에부합되지못하는부분이있어정확한측정에어려움이있음을제한점으로제시하였고, Kim 등 (2014) 과 Jeon과 Yom (2014) 등은측정시국내간 148 Korean J Occup Health Nurs
호사의업무환경과조직문화, 육아및출산, 결혼등과관련된문화적특성과정서를고려해야한다고하였다. 본연구에서과관련된 33개의변수중고객불량행동 (customer badness behavior) 변수를제외한 32개의변수가과유의한관련성이있었다. 이중 15편의논문에서이직의도와음의상관관계를나타내었다. 반면재직의도와는양의상관관계를보여은이직이나재직과직접적인관련이있는변수임을제시하였다. Mitchell 등 (2001) 은과이직의도간에는높은음의상관관계가존재하며, 구성원의이높을수록이직의도가낮아진다고할수있고, 특히조직과이직의도간에는높은음의상관관계를나타냈으며, 지역사회의경우는이직의도와유의하기는하지만비교적낮은상관성을보이는연구결과를제시하여본연구에서제시된연구결과와같은맥락이었다. 은본연구결과에서매개변수로서조직특성, 간호업무수행, 전문직자아개념을조절하는기능을보고하였고, 국외연구 (Dawley & Andrews, 2012) 에서도매개효과로서의기능이보고되고있었다. 은임상경력, 근무부서, 기관의규모같은조직및개인특성과도관련이있다 (Lee & Woo, 2015; Baek, 2016; Choi, 2016; Mun & Hwang, 2016). 또한활동범위가큰지역에거주하는구성원은작은지역보다일반적으로지역사회와연계된네트워크가더크게영향을미칠수있고, 조직문화의강도또는규모가크고작음에따라에차이가있을수있으므로표본의규모나거주지역의크기등의변수들과의관련이나개인및조직의특성을고려한추가적인연구가필요할것이다. 이를바탕으로임상간호사의을향상시킬수있는조직또는개인차원의중재프로그램을개발하여간호현장에적용할필요가있을것으로생각된다. 결론및제언 최근간호학에서의에관한관심은병원조직내에서가장큰전문인력인간호사들의생산성과그에관한관리의중요성이병원의손실비용문제로까지확산되는적극적경향을반영하는것이라고할수있다. 각연구들에서의미있는결과들을통합한결과, 가장중요한요인으로는대부분의연구에서간호사의이직이지적되었으며, 일부연구들은과이직의도의인과적관계를조명하고그에대한잠재적영향을제시하고있었다. 향후이러한축적을통해간호환경및인적관리에대한조직적, 정책적관심을이끌어낼수있을것 으로기대된다. 본연구에서는고찰된결과를바탕으로다음과같은제언을하고자한다. 첫째, 임상간호사의연구는직무내적요인뿐만아니라직무외적요인을포함하는다양한요소들이확인되어야하며, 이를통해임상간호사의을설명하는이론적토대를마련하여야한다. 둘째, 국내병원조직환경을고려하여의속성을충분히포함하는국내간호사를대상으로한도구가개발될필요가있다. 셋째, 현재까지연구된사실을바탕으로임상간호사에대한특수화된중재를개발하고증가로인한편익을입증하는연구를시도하여, 간호사에게보다우호적인조직환경변화를끌어내는다양한방안을모색하는것이필요하다. REFERENCES Baek, G. R. (2016). Effect of hospital nurse s professionalism, job embeddedness, and nursing organizational culture on intention of retention. Unpublished master's thesis, Sungshin University, Seoul. Becker, T. E. (1992). Foci and bases of commitment: Are they distinctions worth making. Academy of Management Journal, 35(1), 232-244. Choi, H. W. (2016). The effects of nursing practice environment and psychological capital on job embeddedness among clinical nurses. Unpublished master's thesis, Chung-Ang University, Seoul. Choi, S. M. (2016). Validity and reliability of the Korean version of the job embeddedness for Korean nurses major in global healthcare. Unpublished master's thesis, Chung-Ang University, Seoul. Choi, S. Y. (2017). Effects of job embeddedness and nursing professionalism on intent to stay in clinical nurses. Unpublished master's thesis, Dongguk University, Seoul. Cowin, L. S. (2002). The effect of nurses' job satisfaction on retention. Journal of Nursing Administration, 32(5), 283-291. Dawley, D. D., & Andrews, M. C. (2012). Staying put off-the-job embeddedness as a moderator of the relationship between on-the-job embeddedness and turnover intentions. Journal of Leadership & Organizational Studies, 19(4), 477-485. Griffeth, R. W., Hom, P. W., & Gaertner, S. (2000). A meta-analysis of antecedents and correlates of employee turnover: Update, moderator tests, and research implications for the next millennium. Journal of Management, 26, 463-488. Han, S. S., Moon, S. J., & Yun, E. K. (2009). Empowerment, job satisfaction, and organizational commitment: Comparison of Vol. 27 No. 3, 2018 149
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