The Journal of Continuing Education in Nursing

Original Article 

Scientific Research Capability and Continuing Education Needs for Nurses With Master's Degrees in China

Xiao-Dan Li, MSN, RN; Hui-Juan Chen, MSN, RN; Ling Wang, MSN, RN, ET; Xiang Yan Kong, BSN, RN; Jusu Ying, MSN, RN

Abstract

Background:

This study investigated the scientific research capacity and related factors of nurses with Master of Science in Nursing (MSN) degrees to provide information on hierarchical management and continuing education of nurses in China.

Method:

This multi-center cross-sectional study included 221 MSN hospital nurses in China.

Results:

Ninety-one percent of MSN nurses had good or excellent research capacity. Continuing education requirements existed regarding research practice and design. Research time, teamwork, leadership support, and retraining opportunities influenced research capacity, which decreased with increasing age and years of work, especially at 3 to 5 years after initial employment.

Conclusion:

Clinical managers should pay attention to factors that influence nurses' research capacity and continuing education requirements. Multiple incentives should be used for MSN nurses, especially for those with 3 to 5 years of employment, to provide more chances for self-actualization, to take advantage of their talents, and to promote the development of clinical nursing. [J Contin Educ Nurs. 2019;50(2):61–68.]

Abstract

Background:

This study investigated the scientific research capacity and related factors of nurses with Master of Science in Nursing (MSN) degrees to provide information on hierarchical management and continuing education of nurses in China.

Method:

This multi-center cross-sectional study included 221 MSN hospital nurses in China.

Results:

Ninety-one percent of MSN nurses had good or excellent research capacity. Continuing education requirements existed regarding research practice and design. Research time, teamwork, leadership support, and retraining opportunities influenced research capacity, which decreased with increasing age and years of work, especially at 3 to 5 years after initial employment.

Conclusion:

Clinical managers should pay attention to factors that influence nurses' research capacity and continuing education requirements. Multiple incentives should be used for MSN nurses, especially for those with 3 to 5 years of employment, to provide more chances for self-actualization, to take advantage of their talents, and to promote the development of clinical nursing. [J Contin Educ Nurs. 2019;50(2):61–68.]

Scientific research capacity encompasses graduate students' comprehensive ability to conduct scientific research. This capacity is an important factor when evaluating the core competencies of graduate nursing students in China (Sheng-Nan & Lan-Zhen, 2010). It is also one of the training objectives of Master of Science in Nursing (MSN) degrees established by China's Office of Academic Degrees Committee of the State Council (China Academic Degrees & Graduate Education Information, 2018). In recent years, with the gradual expansion of enrollment into MSN degree programs at universities in China, the number of postgraduate students engaged in clinical nursing work has increased significantly. Research shows that 59.6% of individuals with an MSN degree choose to be clinical nurses after graduation (Jiang, Peili, Lin, & Meng-Ke, 2016). Therefore, the issues of how to extend the scientific research capacity of MSN nurses from academic education to the applied work of a specific clinical department and how to achieve a successful transformation from theoretical research methods to practical applications are significant.

Outside of China, higher education in nursing tends to be more clinically oriented, and the main goal is to cultivate a variety of clinical nursing specialists (Ashforth, Harrison, & Corley, 2008) who can prescribe. These degree programs have clear specifications regarding training objectives and curricula. An MSN education is closely linked with senior practice nurses' professional qualifications, and the employment opportunities for MSN nurses are clearer (McCauley, Bixby, & Naylor, 2006; Mengshi, Lingjun, & Shen, 2006). In addition, MSN nurses are associated with managerial and supervisory roles in clinical and evidence-based practice (Gerrish et al., 2011; Zahran, 2013).

In China, nursing graduate education started in 1992 (Zheng, Yan, & Jian, 2006), which was relatively late, and the development of nursing graduate programs in China lagged behind those in Western countries. At present, there are two types of MSN programs in mainland China: research, which focuses on research training, and clinical, which emphasizes advanced clinical practice (Zou, Li, & Arthur, 2012).

Because there is no clear training mode, career orientation, or advanced practice nursing programs, the main goal of graduate nursing education in mainland China focuses on elevating students' scientific research capacity so that all graduate nursing students can engage in clinical work without any significant difference (Xiaoqiong & Xianlan, 2014; Zou et al., 2012). Although MSN programs have a clinical focus in China, no specialized clinical training is available for these students. Therefore, MSN students who choose to be frontline nurses have a certain grasp of scientific research methods, but they lack clinical experience and specialty practice. For this reason, many hospitals in mainland China choose to train their MSN nurses in clinical work, and the majority still work in clinical nursing. Specific positions that can take full advantage of MSN education are lacking. Moreover, there is essentially no difference in job content and working modes between MSN nurses and nurses with a baccalaureate nursing (BSN) degree, a college degree, or other relatively low-level academic qualifications, which seriously affects the value of an MSN degree as well as the job enthusiasm for MSN nurses.

Compared with the quality of clinical nurse specialists' jobs and clinical nurse research consultants' jobs in developed countries, China has a long way to go (Currey, Considine, & Khaw, 2011). For a long time, MSN nurses in China have been tired of their daily nursing work, and because the advantages of their educational background and scientific research capacity are not fully realized, their value in the workplace cannot be fully realized. These reasons have led to a decline in job enthusiasm and a waste of human resources (Ying & Guohua, 2013). This is an important and difficult problem related to the current deployment of human resources, in terms of the rational utilization of highly educated nurses and advanced development of practical nursing care in hospitals in China.

For hospital nurses, scientific research based on the practice of clinical phenomena and problems is the basis of the development of specialist nursing practice and the key to high-quality nursing (Jeffs, Smith, Beswick, Maoine, & Ferris, 2013). Consequently, there are deep questions regarding how to focus on appropriate career orientation for MSN nurses after their initial employment and how to formulate the most useful training program. Methods that maximize MSN nurses' scientific research leadership and allow them to become academic leaders also are needed. Based on the reasons above, we conducted a multicenter survey on the research capability and job satisfaction among nurses who obtained MSN degrees in China and formulated guidance for clinical management and continuing education of clinical nurses in the future.

Method

Study Participants

From December 28, 2017, to January 4, 2018, a total of 221 MSN nurses in 21 provinces and municipalities from 43 medical key universities were enrolled in this study. The mean age of participants was 31.21 ± 4.92 years. Participants had been engaged in clinical work for a mean of 6.08 ± 5.99 years and worked in the following departments: 66 (29.86%) worked in internal medicine, 44 (19.91%) worked in surgery, 16 (7.24%) worked in obstetrics and gynecology, seven (3.17%) worked in pediatrics, 20 (9.05%) worked in outpatient and emergency, 13 (5.88%) worked in the operating room, and 55 (24.89%) worked in other departments. The majority of participants worked in tertiary hospitals (n = 196; 88.69%), followed by secondary hospitals (n = 8; 3.62%) and communities or other (n = 17; 7.69%). Other characteristics of the participants are listed in Table 1.

Participant Demographics

Table 1:

Participant Demographics

Questionnaire

Data were collected using a three-part questionnaire. The first part (32 items) included general information: age, number of years of work, workplace, MSN school, graduate degree category (academic or professional) and type (full-time or on-the-job), level of hospital workplace, position, professional title, department, job post, scientific research motivation, access to knowledge, factors that influenced their scientific research, job satisfaction, whether they had conducted scientific research while engaging in clinical work, and the most important issues they currently faced regarding scientific research.

The second part consisted of The Nursing Postgraduates' Scientific Research Capacity Questionnaire, which was compiled in 2013 by Zhengzhou University (Jinxin, 2013). This questionnaire is composed of 25 items and six dimensions, and the accumulating contribution rate of six factors is 67.04%. The six dimensions include ability to discover a problem, ability to consult and evaluate the literature, ability to design an experiment, ability to conduct research, ability to conduct statistical analysis, and paper writing and disseminating ability. The Cronbach's alpha coefficient for the questionnaire is .93. The Cronbach's alpha coefficients for the dimensions range from .75 to .94, and the retest reliability is .92. The scale-level content validity index average of the questionnaire is 0.95. A total score <50 indicates poor or no research capacity, a score of 50 to 74 indicates moderate research capacity, a score of 75 to 99 indicates good research capacity, and a score of 100 or higher indicates excellent research capacity

The third part of the questionnaire was designed to collect data on the nurses' experiences of scientific research, including projects approved, published papers or dissertations, published books, and patents obtained after the participants had earned their MSN degree and began working in a clinical setting.

Investigation Methods

The questionnaire was converted into an electronic questionnaire form with a Quick Response (QR) code and was sent (using multiple methods) to the managers of the nursing department in different hospitals. Nurses in each hospital participated in the questionnaire by scanning the QR code. A total of 224 questionnaires were collected, and three invalid questionnaires were excluded. The percentage of valid questionnaires was 98.7%.

Statistical Analysis

Excel® was used for data entry, and SPSS® version 21.0 was used for data processing and analysis. Descriptive statistical methods were used to summarize the general information. Variance analysis was applied to compare the impact of different career identities on nurses' research capacity. Spearman rank correlation was used to analyze the correlation between number of years of work and research capacity. A p value < .05 was considered statistically significant.

Results

General information for the participants is summarized in Table 1. The mean total research capacity score of the 221 nurses was 95.79 ± 11.27, and the research capacity of 91% of the nurses was good or excellent (Table 2). Further analysis of the dimension-specific research capacity scores of the 221 nurses was performed; findings are summarized in Table 3 and Figure 1.

Distribution of Scientific Research Capabilities

Table 2:

Distribution of Scientific Research Capabilities

Dimension-Specific Scientific Research Capacity Scores

Table 3:

Dimension-Specific Scientific Research Capacity Scores

Radar chart of dimension-specific scientific research capability scores.

Figure 1.

Radar chart of dimension-specific scientific research capability scores.

Item-specific scientific research capacity scores also were ranked using the 25 items in the research capacity questionnaire according to the nurses' scores. The lowest five items are shown in Table 4. Factors that influenced the scientific research capacity of MSN nurses and the current status of clinical research factors also were examined by using the multiple-choice and open-ended questions in the questionnaire (Table 5).

Five Items with the Lowest Scientific Research Capacity Scores

Table 4:

Five Items with the Lowest Scientific Research Capacity Scores

Self-Assessment of Factors That Influence Scientific Research Capacity

Table 5:

Self-Assessment of Factors That Influence Scientific Research Capacity

A variance analysis was conducted on the scientific research capacity scores of nurses according to their satisfaction with current clinical work and the application of the advantages in scientific research. The results showed statistically significant differences (Table 6).

Variance Analyses of the Research Capacity Scores of Nurses with Master of Science in Nursing Degrees

Table 6:

Variance Analyses of the Research Capacity Scores of Nurses with Master of Science in Nursing Degrees

Finally, the clinical research behaviors of MSN nurses were examined. Based on the differences between the levels of professional identity and scientific research capacity scores, a correlation analysis of the number of years of work and scientific research capacity scores was conducted. The findings indicate there was a significant negative correlation (Table 7). The nurses' scientific research behavior (including project, articles published, books published, and patents obtained) while engaging in clinical work based on the number of years of work also was analyzed. The results demonstrated the following trends: scientific research behavior was higher 1 to 2 years after being employed, decreased at 3 to 5 years after being employed, and then gradually increased (Figure 2).

Pearson's Correlation for Years of Work and Scientific Research Capacity Scores

Table 7:

Pearson's Correlation for Years of Work and Scientific Research Capacity Scores

Line graph of scientific research behavior of nurses by number of years of work.

Figure 2.

Line graph of scientific research behavior of nurses by number of years of work.

Discussion

This study essentially gathered data on the current status of scientific research capacity of MSN nurses in mainland China. It involved 127 (57.47%) general duty nurses and 151 (68.33%) frontline nurses (who frequently had contact with patients). In addition, the nurses were graduates of 43 key medical colleges, and they worked at hospitals (including tertiary, secondary, and community hospitals) in 21 provinces, municipalities, and autonomous regions across China.

Table 2 shows the mean total research capacity score of the MSN nurses was 95.79 ± 11.27, slightly lower than that of third-year graduate students (99.65 ± 15.58) and higher than that of second-year graduate students (91.52 ± 16.18) (Jinxin, 2013). Nurses with good or excellent scientific research capacity accounted for 91%. The fact that the participants' research capacity was good in general indicates that the MSN education of nurses in China has a significant influence in providing high-quality training for conducting scientific research.

Regarding the six dimensions of the scientific research capacity questionnaire, the scores for three dimensions (paper writing and disseminating ability, ability to consult and evaluate the literature, and ability to discover a problem) were relatively high. In contrast, the scores for ability to conduct scientific research, ability to design an experiment, and ability to conduct statistical analysis were relatively low. The results revealed that MSN nurses have a good theoretical knowledge of scientific research and a good grasp of reviewing published papers, paper writing, and research dissemination. However, they lack the ability to select appropriate clinical research projects, design experiments and interventions, and conduct advanced statistical analysis with many interference factors. These shortcomings need to be rectified in practice through continued training.

Hong-Mei, Yue-Hua, and Qiu-Ling (2016) also found, through interviews, that MSN nurses have already realized the importance of continuing education. These MSN nurses hold the opinion that scientific research concepts are updated quickly, and if they do not change with the times and broaden their horizons, they worry that they will not keep up with the pace of change. Therefore, we propose that managers should conduct continuing education and team cooperation exercises after initial employment, based on the abilities of their employed MSN nurses, as assessed via a survey (Lee, Lin, Tseng, Tsai, & Lee-Hsieh, 2017). Taking advantage of positive guidance, teamwork, and complementary capabilities, managers should aim to further enhance nurses' scientific research capacity and promote the conduct of high-quality, cutting-edge research.

Based on this study, the main motivations for conducting clinical research are to fulfill a requirement for promotion, self-actualization, and requirements from leaders (Table 5). The main influencing factors were time for research, support from leaders, and opportunities to attend training. Similarly, O'Byrne and Smith (2011) noted that strong leadership, organizational need, and a supportive management structure were essential elements for building research capacity in clinical nurses and that these factors should not be underestimated. For individual nurses, demand for positioning and self-actualization is still high, and they expect to be able to obtain scientific guidance through academic conferences, lectures, and expert guidance. In fact, the biggest obstacles that they encountered in conducting scientific research were being too busy with clinical work to spend time on scientific research, difficulties in the construction of a research team, and lack of continuing training regarding clinical research project selection and statistical methods.

Job satisfaction can reflect the emotion and attitude of postgraduate nurses regarding work related to nursing. We collected data on the current job satisfaction of nurses (based on self-evaluation) and found that 52% of nurses had a neutral or unsatisfied attitude regarding their current job and 68% did not take advantage of scientific research capacity in work, which is inconsistent with the expectations of hospitals when they employ MSN nurses.

An analysis of the reasons showed that China does not have a clear professional orientation and specific plan for MSN nurses, which reduces job satisfaction and enthusiasm (Wisur-Hokkanen, Glasberg, Mäkelä, & Fagerström, 2015). Although MSN degrees are divided into academic and professional programs, there is no uniform training program or opportunity for specialist certification of advanced nursing practice.

Our study found that the difference in scientific research capacity between academic and professional programs was not statistically significant. Therefore, on the one hand, we should learn from other countries about their experiences in education and take into account social needs and international trends-oriented methods to ensure that nursing develops gradually from a one-direction approach to a plural approach. In particular, we should increase training opportunities for clinical graduate students to promote advanced practices among nurses, nurse scientists, and nursing faculty to adapt to the social development (Gao, Chan, & Cheng, 2012). On the other hand, hospitals presently should address relevant current issues: high clinical workload in each department, low status of nursing, and failure to reasonably realize nurses' self-value. A decentralized management and training system should be set up from different angles. To provide more opportunities for the self-realization of highly educated nurses, the highly educated and talented nursing resources must be matched with clinical development needs.

Among the 221 nurses surveyed, 44.8% have presided over a scientific research project (at national, provincial, municipal, and hospital levels); 100% have participated in projects as research group members; 25 (11.3%) have published a Science Citation Index paper as the first or corresponding author; 138 (62.4%) have published a paper in a Chinese scientific or technological periodical on statistics; 40 (18.1%) have attended an international academic conference; 139 (62.9%) have participated in a national academic conference; 112 (50.7%) have edited or coedited a book; and 24 (10.9%) held a patent for an invention. These data show that the output of clinical research among MSN nurses is considerable, but there is scope for much improvement. For example, only 62.4% of the nurses published papers in the key Chinese periodicals on technology, which is far below our expectations for MSN nurses.

In this study, the research capacity of nurses gradually decreased as the number of years of work increased, and this correlation was significant. This may be caused by the high clinical workload, decreased self-actualization regarding scientific research, and lack of training in hospitals. Working years were divided into 1 to 2, 3 to 5, 6 to 10, and ≥11 years, and a line graph of scientific research behavior was plotted. We found that at 3 to 5 years after first employment is the lowest point for scientific research; this period of 3 to 5 years after first employment is an important turning point with respect to marriage or childbearing and value recognition. During this period, the research activities of nurses may be disturbed by many factors. Positive attitudes toward work, self-actualization, and professional self-identity are prone to decrease if inner expectations are not achieved after several years of hard work. Therefore, in this crucial period, managers should pay attention to increasing humanistic care, and they should take various measures to retrain and strengthen nurses' scientific research capacity to enhance their professional self-identity (Xiaoxiao & Yuling, 2017; Xijuan, Yuxia, & Qian, 2018).

Conclusion

This survey revealed that the scientific research capacity of 91% of MSN nurses was good or excellent. However, there also were some deficiencies regarding some aspects of scientific research. Continuing education should be maintained after initial employment. Ambiguous career orientation, lack of time for scientific research, poor teamwork, and lack of support and retraining opportunities were the main factors that affected scientific research capacity and enthusiasm for work among nurses. Joint effort among nurses, employers, and colleges is needed to explore nurses' potential to a greater extent. Moreover, the research capacity of nurses decreases in the number of years worked increases. In particular, 3 to 5 years after being employed is the point at which nurses are least likely to engage in scientific research. During this period, hospital managers should enact various methods for motivation, conduct appropriate vocational development planning and retraining of nurses, and take into account their value as leaders of nursing management or teaching and research, which would enable MSN nurses to develop their clinical nursing capability.

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Participant Demographics

DemographicParticipants (N = 221)

n%
Type of graduate
  Academic13460.63
  Professional8739.37
Type of graduate student
  Full-time18684.16
  On-the-job3515.84
Position
  General duty nurse12757.47
  Teaching nurse4620.81
  Head nurse or above4821.72
Professional title
  Nurse2611.77
  Nurse practitioner10145.70
  Supervisor nurse7634.39
  Associate chief nurse or above188.14
Position
  Frontline nurse with frequent patient contact15168.33
  Non-frontline nurse with less frequent patient contact209.05
  Nurse manager5022.62
Satisfaction with current working environment
  Very unsatisfied73.17
  Unsatisfied3013.57
  Neutral7734.84
  Satisfied9141.18
  Very satisfied167.24
Application of scientific research advantage
  Poor209.05
  Fair4821.72
  Moderate8337.56
  Good6127.60
  Excellent94.07

Distribution of Scientific Research Capabilities

Scientific Research Capacity Score CategoryDistribution

n%
Poor00
Moderate209
Good10648
Excellent9543

Dimension-Specific Scientific Research Capacity Scores

Dimension (Ranked)Mean ScoreSD
Ability to conduct scientific research3.6930.676
Ability to design an experiment3.7140.643
Ability to conduct statistical analysis3.7900.729
Ability to discover a problem3.8480.702
Ability to consult and evaluate the literature3.8730.745
Ability to write paper and disseminate information3.9760.636

Five Items with the Lowest Scientific Research Capacity Scores

ItemScore MeanSD
9. Methods and precautions for qualitative research3.250.893
16. Master the preparation and testing of a scale3.450.969
17. Skilled interviewing of participants3.510.892
11. Skilled use of a formula to calculate the appropriate sample size3.550.926
2. Identify the gaps or deficiencies in previous studies in the literature and conduct research3.620.852

Self-Assessment of Factors That Influence Scientific Research Capacity

ItemParticipants (N = 221)

n%
Motivations for scientific research on nursing
  Fulfilling requirement for promotion16675.11
  Self-actualization15369.23
  Requirement from leaders10848.87
  Improvement of nursing quality10748.42
  Personal interest9643.44
  Financial incentives3817.19
Ways to obtain scientific knowledge
  Academic conference16474.21
  Lecture series14967.42
  Expert guidance13761.99
  Reading/self-study12657.01
  Classes on a specific topic of study12054.30
  Further study10346.61
  Regular report6027.15
  Qualification upgrade5826.24
  Lectures5123.08
Factors affecting self-learning
  Time for research18985.52
  Support from leaders15670.59
  Opportunities to attend training15168.33
  Financial incentives8538.46
  Family-related factor7533.94
Biggest obstacle to conducting scientific research while engaging in clinical work
  Lack of time13561.09
  Difficulties in the construction of a research team3616.29
  Lack of continuing training (regarding clinical project selection and statistical methods)3214.48
  Lack of support from leaders188.14
  Other (funding and lack of clinical ability)104.52

Variance Analyses of the Research Capacity Scores of Nurses with Master of Science in Nursing Degrees

ClassificationParticipants (N = 221)Scientific Research Score (M ± SD)Fp

n%
Satisfaction with current job
  Very unsatisfied73.1784.00 ± 23.854.556.001
  Unsatisfied3013.5789.90 ± 13.52
  Neutral7734.8494.04 ± 13.97
  Satisfied9141.1896.63 ± 14.04
  Very satisfied167.24105.63 ± 14.38
Application of research advantages in clinical work
  Poor209.0588.15 ± 14.157.471.000
  Fair4821.7290.17 ± 16.01
  Moderate8337.5693.76 ± 14.58
  Good6127.60101.16 ± 11.27
  Excellent94.07107.22 ± 13.15

Pearson's Correlation for Years of Work and Scientific Research Capacity Scores

FactorYears of WorkScientific Research Capacity
Years of work
   r1.000−0.174
   p.01
Scientific research capacity
   r−0.1741.000
   p.01
Authors

Ms. Li is Associate Chief Nurse and Deputy Director, Nursing Department, Ms. Chen is Senior Nurse, Orthopedics and Traumatology, Ms. Wang is Chief Superintendent Nurse and Director, Nursing Department, Ms. Kong is Associate Chief Nurse and Deputy Director, Nursing Department, and Ms. Ying is Associate Chief Nurse and Deputy Director, Nursing Department, Peking University People's Hospital, Beijing, China.

This study was supported by the Peking University People's Hospital, Beijing, China.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Ms. Li and Ms. Chen contributed equally to this work and should be considered as equal first authors.

Address correspondence to Ling Wang, MSN, RN, ET, Chief Superintendent Nurse and Director, Nursing Department, Peking University People's Hospital, No.11 Xizhimen South St. Xicheng District, 100044 Beijing, China; e-mail: 1003240724@qq.com.

Received: March 26, 2018
Accepted: September 09, 2018

10.3928/00220124-20190115-05

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