Study On The Model,measurement And Mechanism Of Nurses’ Career Growth

Background Nowadays,nursing human resources are faced with serious situation: insufficient number of nurses and low quality of nurses.By the end of 2019,there were 4.445 million registered nurses in China.The number of nurses per 1000 population was 3.18 in China,which was far lower than the global average level reported by the World Health Organization(4.06).Even worse,the high turnover rate of nurses further exacerbated the shortage,resulting in the contradiction between the shortage of nurses and the increasing demand for health services becoming much sharper.The literature suggested that 51.67% of the nurses believed that the limited growth opportunities were the main reason for their turnover.Previous studies suggested that career growth could improve job satisfaction,performance,competency,organizational commitment and reduce turnover intention.It is high time to carry out scientific research on nurses’ career growth to maintain the number of nurses and improve quality of nurses.Understanding the conception of nurses’ career growth comprehensively,measuring career growth accurately,and identifying influencing mechanism of career growth precisely are the cornerstone and premise to implementing intervention strategies to promote career growth efficiently.However,the literature that exploring the conception of nurses’ career growth has not been seen so far,and there is no effective tool to measure career growth for nurses specifically.The research on influencing factors of nurses’ career growth was limited,which only focused on single level(only individual or only organizational).The interaction mechanism between organizational factors and individual factors in career growth has not been discussed.There was no research that revealed the internal mechanism of career growth from the perspective of motivation psychology,leading to the fact that the existing researches were not enough to guide the excavation of nurses’ human resources deeply.In addition,the methods to identify the influencing factors in nursing field were almost guided by the perspective of “theory-driven”.Machine learning method has not been used to identify the influencing factors of nurses’ career growth.Group Method of Data Handing(GMDH)deep neural network analysis is one of the common methods in machine learning,which can minimize human interference.This method has not been applied to identify influencing factors of nurses’ career growth.The aims of this study are to understand the conception of nurses’ career growth,and further to develop a scale to measure nurses’ career growth.Then to identify the influencing factors from the perspective of motivation psychology,and to develop the theoretical model for nurses’ career growth.Finally,further to identify the priorities of influencing factors using GMDH neural network analysis.This study will provide a scientific basis for accelerating nurses’ career growth and proming sustainable development of talents effectively.Objective 1.To understand nurses’ perceptions of career growth,further to explore the conception and influencing factors of career growth,and then to develop a theoretical model of nurses’ career growth.2.To develop the career growth scale for nurses on the basis of theoretical model of nurses’ career growth,and to evaluate the quality of this scale.3.To explore the mechanism of influencing factors on nurses’ career growth,and to verify the theoretical model of nurses’ career growth,and further to clarify the priorities of the influencing factors,so as to provide theoretical basis for future intervention strategies to promote nurses’ career growth.Methods Explanatory sequential mixed methods were used in this study which included three phases.1.Developing a theoretical model of nurses’ career growth.Thirty-one nurses from 8 tertiary hospitals and 10 secondary hospitals were purposively and conveniently selected to participate the semi-structured interviews.The interview questions list was formed on the basis of Benner’s "from novice to expert" theory,Mc Clelland’s iceberg model,Weng’s conceptual framework of enterprise employees’ career growth,and literature review,which focused on “What” and “Why”.Pilot interviews were conducted to revise and test the interview questions.Directed content analysis was used to analyze the data.The coding process followed the standardized flow of content analysis recommended by Hsieh and Elo.The software Nvivo 12 was used to conduct coding.2.Developing the career growth scale for nurses This phase consisted of four steps: Firstly,establishing the item pool.The item pool was established based on the literature review,relevant theories,and theoretical model of nurses’ career growth which formed in the previous phase.Secondly,a two-rounds Delphi study was used to form the initial scale by selecting and optimizing items.Thirty-three experts from 24 provinces in China meeting the inclusion and exclusion criteria participated the Delphi study.Experts scored and evaluated all the items.Thirdly,a cross-sectional survey was conducted to form the final scale.Eight hundred and fifty-eight nurses from 6 tertiary hospitals and 6 secondary hospitals were selected by multistage stratified cluster sampling to participate the survey.Initial scale was used to investigate the career growth among the selected nurses.Items in initial scale were screened and optimized again to form the final scale based on classical test theory and item response theory.Fourthly,evaluating the quality of scale.Cronbach’α coefficient,split-half reliability,test-retest reliability,content validity,construct validity and completion time were used to evaluate the reliability,validity and feasibility of the scale.SPSS 26.0,amos 23.0 and Multilog 7.03 software were used to analyze the data.3.The mechanism of influencing factors on nurses’ career growth A cross-sectional survey was conducted enrolling 1866 nurses from 8 tertiary hospitals and 7 secondary hospitals with multistage stratified cluster sampling in Sichuan Province.The selection of independent variables was identified on the basis of previous qualitative research.A total of 5 scales with good reliability and validity were used,which were nurses’ career growth scale developed in the second phase,perceived organization support questionnaire,the Basic Needs Satisfaction in General Scale,individual career management scale,and organizational career management scale.The statistical description,independent sample t-test,one-way ANOVA were preformed by SPSS26.0.Structural equation models(SEM)were preformed by Amos23.0 to analyze the internal mechanism among different influencing factors.The bootstrap method was used to test the mediating effect.The Group Method of Data Handing(GMDH)deep neural network analysis was used to further identify the priorities of influencing factors of nurses’ career growth by MATLAB software.Results 1.The results of theoretical model for nurses’ career growth After coding,reorganization,and condensing,the theoretical model of nurses’ career growth emerged.The theoretical model consisted of two parts: 1.1 The conceptual framework of nurses’ career growth Five themes of nurses’ career growth were identified: career promotions,improving ability and competence,improving professional identity,making progress towards career planning and career goals,career influence increasing.Career promotions included four sub-themes: professional title,position,salary and education promotion.Ability and competence improving included two sub-themes: Ability improving and competence improving.Professional identity improving included three sub-themes: self-cognition,professional cognition and emotional perceptions.Career planning and career goals progress included two sub-themes: career planning and career goals.Career influence increasing included two sub-themes: popularity and recognition.1.2 The influcing factors of nurses’ career growth Three themes that influcing nurses’ career growth were: personal factors,organizational factors,and family and social factors.Personal factor was the internal driving motivation promoting nurses’ career growth,including three sub-themes: traits,behavior and demographic characteristics.Organizational factor was the external driving factors promoting nurses’ career growth,including three sub-themes: organizational support,organizational climate and patient feedback.Family and social factos were the "regulators" that influcencing nurses’ career growth,including four sub-themes: family role and family environment,social support,development of social and disciplinary,and opportunities.2.Results of nurses’ career growth scale The item pool consisted of 56 items under 6 dimensions on the basis of literature review,previous results of qualitative research,and relevant theories.The response rates of Delphi methods in two rounds were both 100%.The average authority coefficients of 33 experts were both 0.87 in two rounds,with a total of 35 people put forward suggestions.After the two-rounds Delphi methods,initial scale consisting of 43 items under 6 dimensions were formed.Based on the critical ratio method,item response theory and other methods,the final scale consisted of 17 items under three dimensions: career planning and goals(4 items),professional ability and competence(7 items),and career promotion(6 items).The Cronbach’α coefficients of the three dimensions were between 0.909 and 0.955,with a total Cronbach’α coefficients of 0.960.The split-half reliabilities of the three dimensions were between 0.922 and 0.964,with a total split-half reliability of 0.976.The two-week test-retest reliabilities of the three dimensions were between 0.798 and 0.856,with a total test-retest reliability of 0.918.The item-level content validity index was between 0.906 and 1.00,and the scale-level content validity index was 0.966.Confirmatory factor analysis showed that three-factor model of the scale was acceptable with a good model fit,and the path coefficient of each item was above 0.719.The average completion time of the scale was(5.45 ± 1.98)minutes.3.Results of the mechanism of influencing factors on nurses’ career growth 3.1 Reuslts of SEM The average score of nurses’ career growth was(4.15 ± 0.52).The perceived organization support,organizational career management,individual career management,and basic needs satisfaction were positively correlated with nurses’ career growth(P < 0.05).The total effect of perceived organizational support on career growth was 0.774,and the direct effect was 0.366.The indirect effects of basic needs satisfaction and individual career management were significant on the relationship between perceived organizational support and nurses’ career growth(SE = 0.006;bias corrected 95% CI = [0.023,0.045]).The total indirect effect was 0.408,accounting for 52.7% of the total effect that perceived organizational support affected career growth.The total effect of organizational career management on career growth was 0.734,and the direct effect was 0.231.The indirect effects of basic needs satisfaction and individual career management were significant on the relationship between organizational career management and nurses’ career growth(SE = 0.008;bias corrected 95% CI = [0.011,0.042]).The total indirect effect was 0.503,accounting for 68.5% of the total effect that organizational career management affected career growth.3.2 Results of GMDH deep neural network analysis The top three factors that affected nurses’ career growth were: continuing learning,perceived organizational support and career goals.The priority of influencing factors was different among different nurses.For nurses with working experience less than 10 years and more than 15 years,"continuing learning" ranked first or second;for nurses with working experience between 11 years and 15 years,"focusing on training" ranked first.For nurses with master’s degree or above,the top two influencing factors were career goals and relatedness needs,while organizational career management and perceived organizational support did not enter the influencing factor model;for nurses with bachelor’s degree or below,the basic needs satisfaction was less important than that of nurses with master’s degree or above.Conclusions 1.The nurses’ career growth is complex and changeable,and its conception reflected both perception and exhibition.2.The nurses’ career growth scale has a good reliability,validity and feasibility,which can be used to evaluate career growth among nurses.3.Organizational career management and perceived organizational support affect nurses’ career growth through basic needs satisfaction and individual career management.The basic needs satisfaction is the core influencing factors of career growth.The theoretical model of nurses’ career growth has been verified.