摘 要：目的 调查杭州市农村基层卫生人员职业稳定性的现状，分析影响其职业稳定性的因素，为 提高其职业稳定性提供参考。方法 基于 Price-Muller（2000）模型和由台湾学者李经远等翻 译并修订的离职意愿量表设计调查问卷，对杭州市 500 名农村基层卫生人员进行调查。采用 单因素方差分析和非参数检验比较不同人口学特征的卫生人员职业稳定性差异，采用多重线 性回归分析影响职业稳定性的因素，利用结构方程模型分析工作状况各维度对职业稳定性的 影响效应。结果 （1）不同年龄的农村基层卫生人员职业稳定性存在显著差异（P<0.05）；

（2）影响职业稳定性的主要因素有回报公平性、领导支持程度、工作努力程度（P<0.05）；

（3）结构方程模型显示，工作结构对农村基层卫生人员辞职意愿、获得外部工作的动机和 可能性、留职意愿的总效应分别为-0.472、-0.380、0.250（P<0.05）；工作环境对农村基层卫 生人员辞职意愿、获得外部工作的动机和可能性、留职意愿的总效应分别为-0.382、-0.380、 0.500（P<0.05）；个体对农村基层卫生人员辞职意愿、获得外部工作的动机和可能性、留职 意愿的总效应分别为 0.157、0.156、-0.205（P<0.05）。结论 杭州市农村基层卫生人员的职 业稳定性总体处于中等水平；良好的工作状况不仅能正向提高留职意愿，还能负向抑制离职 意愿；由此对提升农村基层卫生人员职业稳定性提出以下建议：完善农村定向培养政策，提 高职业认同感；提高农村基层卫生人员收入，注重分配公平；改善农村基层医疗机构工作环 境。

关键词：农村基层；卫生人员； 工作状况； 职业稳定性

Abstract：Objective:To investigate the status of occupational stability of medical staffs in rural areas in Hangzhou, analyze the factors that affect their occupational stability, and provide references for improving their occupational stability. Methods:Basing on the Price-Muller (2000) model and questionnaires translated and revised by the Taiwan scholar Li Jingyuan, etc., investigate 500 medical staffs in rural areas in Hangzhou. Univariate analysis of variance and non-parametric tests are used to compare differences in the occupational stability of medical staffs with different demographic characteristics. Multiple linear regression is used to analyze the factors affecting occupational stability. Structural equation model is used to analyze the effects of various  dimensions  of  working  status  on  occupational  stability.  Results:  (1) The occupational stability of medical staffs in rural areas with different ages is significantly different (P<0.05); (2) The main factors affecting occupational stability are return fairness, leadership support, and work hard (P<0.05). (3) The structural equation model shows that the total effect of the work structure on the resignation intention of medical staffs in rural areas, the motivation and possibility of obtaining external work, and the willingness to stay are -0.472, -0.380, and 0.250, respectively (P<0.05); The total effect of the resignation of medical staffs in rural areas, the motivation and possibility of obtaining external work, and the willingness to stay   are

-0.382, -0.380, and 0.50, respectively (P <0.05). The inpidual feels the motivation for the resignation of medical staffs in rural areas and the motivation for obtaining external work. The total effects of the likelihood and willingness to stay is 0.157, 0.156, and -0.205, respectively (P<0.05). Conclusions: The occupational stability of medical staffs in rural areas in Hangzhou is generally at a medium level. Good working conditions can not only positively increase the willingness to stay, but also negatively inhibit the intention to leave the job. The following suggestions are made to improve the occupational stability of medical staffs in rural areas: Rural oriented training policy, improve the sense of professional identity; improve the income of medical staffs in rural areas, pay attention to distribution fairness; improve the work environment of medical staffs in rural areas.