摘要目的:了解我国东中西部地区护理工作环境和护士职业承诺的现状，并进一步分析护理工作环境对护士职业承诺的影响。方法:2019年3—12月，采取便利抽样法，选取我国东中西部地区共8个省、直辖市、自治区的11所三级和6所二级医院的3 142名护士作为调查对象，采用一般资料调查表、中文版护理工作环境量表和中文版护士职业承诺量表进行问卷调查。结果:共累计回收问卷3 142份，剔除无效问卷124份，有效回收问卷3 018份。护士职业承诺量表总均分为（3.54±0.67）分，各维度得分由高到低依次为：规范承诺（3.83±0.84）分、情感承诺（3.78±0.87）分、经济成本承诺（3.67±0.81）分、情感代价承诺（3.40±0.94）分、机会承诺（2.88±0.85）分；护理工作环境量表总均分为（3.02±0.49）分。不同医院等级、科室、工作年限、职称、学历、聘用形式、月均夜班数、月均收入的护士职业承诺量表得分比较，差异均有统计学意义（ P<0.05），且专科护士的护士职业承诺量表得分高于非专科护士，差异有统计学意义（ P<0.01）。多重分层回归结果显示，医院等级低（β'=-0.058）、是专科护士（β'=0.069）、月均夜班数少（β'=-0.194）是护士职业承诺的影响因素（ P<0.05）；控制一般资料后，护理工作环境中的护士参与医院事务（β'=0.301）、充足的人力和物力（β'=0.260）、医护合作（β'=0.132）是护士职业承诺的影响因素（ P<0.01）。 结论:我国东中西部地区护士职业承诺整体处于中等水平，受是否为专科护士、月均夜班数、医院等级以及护理工作环境的影响，管理者应针对这些影响因素进行科学的引导和管理，以提高护士的职业承诺水平。

abstractsObjective:To understand the status quo of nursing work environment and nurses' occupational commitment in eastern, middle and western China and further analyze the effect of nursing work environment on nurses' occupational commitment.Methods:From March to December 2020, the convenient sampling method was adopted to select 3 142 nurses from 11 tertiary and 6 secondary hospitals in 8 provinces/municipalities/autonomous regions in the eastern, middle and western China as research objects. The general information questionnaire, Chinese version of Practice Environment Scale and Chinese version of Nurses' Occupational Commitment Scale were used for questionnaire surveys.Results:A total of 3 142 questionnaires were collected and 124 invalid questionnaires were excluded, and 3 018 valid questionnaires were collected. The total mean score of Nurses' Occupational Commitment Scale was (3.54±0.67) . From highest to lowest, scores of each dimension were normative commitment (3.83±0.84) , emotional commitment (3.78±0.87) , economic cost commitment (3.67±0.81) , emotional cost commitment (3.40±0.94) and opportunity commitment (2.88±0.85) . The total mean score of Practice Environment Scale was (3.02±0.49) . The scores of Nurse's Occupational Commitment Scale of nurses with different hospital levels, departments, working years, professional titles, educational backgrounds, employment forms, average monthly night shifts and average monthly income showed statistically significant differences ( P<0.05) . Moreover, the score of Nurses' Occupational Commitment Scale for specialist nurses was higher than that of non-specialist nurses, and the difference was statistically significant ( P<0.01) . The results of multiple stratified regression showed that low hospital levels (β'=-0.058) , specialized nurses (β'=0.069) and fewer average monthly night shifts (β'=-0.194) were influencing factors that affected nurses' occupational commitments. After controlling for general data, nurses' participation in hospital affairs (β'=0.301) , adequate human and material resources (β'=0.260) and medical cooperation (β'=0.132) in the nursing environment were the influencing factors of nurses' occupational commitment ( P<0.01) . Conclusions:The overall occupational commitment of nurses in eastern, middle and western China is at a medium level, which is affected by whether they are specialist nurses, average monthly night shifts, levels of hospitals and the working environment of nursing. Managers should conduct scientific guidance and management for these influencing factors to improve nurses' occupational commitment.