Journal of Psychosocial Nursing and Mental Health Services

CNE Article Supplemental Data

Psychological Capital and Perceived Professional Benefits: Testing the Mediating Role of Perceived Nursing Work Environment Among Chinese Nurses

Hongzhen Zhou, PhD; Yafang Zhu, MS; Xiaomei Zhang, BS; Juan Peng, MS; Qingdong Li, MS; Xiaoyan Wang, BS; Lihui Wang, BS; Xiaohui Cai, BS; Limei Lan, BS

Abstract

The current descriptive cross-sectional study aimed to explore the mediating role of perceived nursing work environment (PNWE) in the relationship between psychological capital (PsyCap) and perceived professional benefits among Chinese nurses. Participants (N = 351) working in two large general hospitals in Guangdong, China completed self-report questionnaires from March to May 2017. Linear regression analyses and structural equation modeling were performed to explore the mediating effect. PsyCap (particularly for hope and optimism) had a positive effect on perceived professional benefits, and PNWE was a mediator in this relationship among Chinese nurses. A good working environment can be regarded as a mediator variable, increasing staff's competence and sense of belonging to a team. For successful implementation, nurse managers should use effective strategies to increase nurses' confidence and hope while providing a comfortable work environment. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx–xx.]

Abstract

The current descriptive cross-sectional study aimed to explore the mediating role of perceived nursing work environment (PNWE) in the relationship between psychological capital (PsyCap) and perceived professional benefits among Chinese nurses. Participants (N = 351) working in two large general hospitals in Guangdong, China completed self-report questionnaires from March to May 2017. Linear regression analyses and structural equation modeling were performed to explore the mediating effect. PsyCap (particularly for hope and optimism) had a positive effect on perceived professional benefits, and PNWE was a mediator in this relationship among Chinese nurses. A good working environment can be regarded as a mediator variable, increasing staff's competence and sense of belonging to a team. For successful implementation, nurse managers should use effective strategies to increase nurses' confidence and hope while providing a comfortable work environment. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx–xx.]

Nurses are the largest group of health care service providers (Laschinger & Fida, 2014). However, nursing is a high-pressure, high-risk, and labor-intensive occupation, making nurses an at-risk population for high turnover rates (Lake, 2002). Based on the current working environment and global shortage of nurses, many recent studies have been performed regarding nurses' job stress, burnout, and turnover (Labrague et al., 2017; Luan, Wang, Hou, Chen, & Lou, 2017; Saedpanah, Salehi, & Moghaddam, 2016). However, this grim situation has not been addressed effectively. Therefore, Hu and Liu (2013) introduced the concept of “nurses' perceived professional benefits” and suggested examining the positive experience of nurses' perceived professional benefits to formulate effective strategies to solve the “brain drain” (i.e., the movement of highly skilled and qualified individuals to a country where they can work in better conditions and earn more money) of nurses.

Perceived professional benefits is a cognitive adaptation defined as “the benefits and gains nurses perceived from their job,” demonstrating “that being a nurse can promote personal development” (Hu & Liu, 2013, p. 1). Perceived professional benefits belongs to the category of emotional experience, which includes two aspects: actual benefits and spiritual benefits. In addition, nurses' perceived professional benefits is not only conducive to the formation of a positive professional identity but also has an important influence on nurse retention. Studies have shown that nurses experience benefits in their work, and these perceived professional benefits can be enhanced by cognitive intervention (Fillion et al., 2009; Hyrkas & Shoemaker, 2007; Mao, Hu, Liu, Chen, & Liu, 2016).

One important factor that affects nurses' perceived professional benefits is perceived nursing work environment (PNWE). PNWE refers to all factors that affect the nursing system directly or indirectly, including the surrounding environment, other individuals, and nursing work. In 2004, the PNWE instrument, a measure of the work environment as perceived by nurses, was reported to exhibit sound psychometric properties and represented the latest version of the Nursing Work Index-Revised (Choi, Bakken, Larson, Du, & Stone, 2004). PNWE consists of professional practice, staffing and resource adequacy, nursing management, nursing process, nurse/physician collaboration, nursing competence, and positive scheduling climate. The nursing work environment has been shown to have a significant effect on the attitude of nurses and professional nursing practice (Lake, 2002). Moreover, a significant positive correlation was found between PNWE and nurses' perceived professional benefits (Wang et al., 2016).

Psychological capital (PsyCap), a positive state of mind exhibited during the growth and development of an individual (Luthans, Luthans, & Luthans, 2004; Luthans & Youssef, 2004; Luthans, Youssef, & Avolio, 2007), includes four component resources: self-efficacy, hope, resilience, and optimism. Self-efficacy refers to the self-confidence in being able to perform a task and succeed in the face of challenges. Hope is defined as the positive motivational state that is based on the realization of the desired objectives through unremitting efforts. Optimism refers to the ability to respond positively to events and hold a positive attitude toward current and future success. Resilience means the capacity to “bounce back” from adversity or even dramatic positive changes (Ding et al., 2015). The capacities of all dimensions of PsyCap are measurable, representing “one's positive appraisal of circumstances and probability for success based on motivated effort and perseverance” that can predict goal attainment and performance (Luthans, Avolio, Avey, & Norman, 2007, p. 550). In addition, research has shown that PsyCap, as a type of individual character, will change with the change of working environment (Zhao & Liu, 2013).

Perceived professional benefits is a cognitive assessment of chronic work-related feelings. The feelings result from the interactive relationship between the internal psychology and external environment. Theoretically, PsyCap plays an important role in creating a positive psychological atmosphere for nurses (Estiri, Nargesian, Dastpish, & Sharifi, 2016). Furthermore, providing a satisfactory work environment will inevitably enhance nurses' performance (Estiri et al., 2016). Therefore, positive and negative psychology may play an important role in perceived professional benefits.

The main goals of the current study were to: (a) assess the levels of PNWE, PsyCap, and perceived professional benefits among Chinese nurses; (b) examine the impact of work environment and PsyCap on perceived professional benefits; and (c) explore the mediating role of PNWE on the relationship between PsyCap and perceived professional benefits. The study hypotheses are as follows:

  • Hypothesis 1: PNWE and PsyCap are positively associated with perceived professional benefits.
  • Hypothesis 2: PNWE is a mediator in the relationship between PsyCap and perceived professional benefits.

Method

Study Design

A descriptive cross-sectional study using questionnaires was performed. To test the effect of the survey, a pre-investigation was conducted among 31 nurses.

Recruitment and Data Collection

A convenience sample of staff nurses (N = 351) was recruited from two large general hospitals from March to May 2017 in Guangzhou, China. Recruitment of participants was conducted by the author (Y.Z.), who distributed questionnaires at the meetings of each hospital department. Participants were told about the aim of the study and that they could withdraw at any time. Participants were offered a small gift for their time and effort once their questionnaires were completed.

Inclusion criteria were a certificate of nurse qualification granted by the Ministry of Health PR China and employment as an RN in a hospital for at least 6 months.

Ethical Considerations

The research was approved by the Ethics Committee of the Nanfang Hospital, Southern Medical University (China). Before the survey, all participants signed informed consent, and researchers explained the research goals and related information to participants. To ensure participants' privacy, the study was conducted in an anonymous manner. The completed questionnaires were put into a sealed envelope by participants to ensure confidentiality. All envelopes in each hospital were collected and returned to the research team.

Measures

The research questionnaire comprised four parts: demographic characteristics, PNWE Scale, PsyCap Questionnaire, and Perceived Professional Benefits Questionnaire.

Participant demographics collected included age, gender, position, marital status, education, and work experience.

Nurses' perceived professional benefits was measured using the Chinese Perceived Professional Benefits Questionnaire, which was developed by Hu and Liu (2013). The questionnaire comprises five dimensions: (a) positive professional perception (seven items); (b) good patient–nurse relationship (six items); (c) recognition from families and friends (six items); (d) sense of belonging to the work team (six items); and (e) personal growth (eight items). Each item was scored using a 5-point Likert-type scale ranging from 1 (totally disagree) to 7 (totally agree). The Chinese Perceived Professional Benefits Questionnaire had high reliability and validity (Hu, 2013; Hu & Liu, 2013). Cronbach's alpha of the questionnaire ranged from 0.828 to 0.963, and split-half reliability ranged from 0.799 to 0.925.

The PsyCap Questionnaire (PCQ-24), which was originally developed by Luthans, Avolio, et al. (2007), was used to measure the four dimensions of PsyCap: self-efficacy, hope, resilience, and optimism. Each of the four dimensions included six items, scored from 1 (totally disagree) to 6 (totally agree). The Chinese version of the PCQ-24 is widely used in measuring PsyCap and demonstrated excellent reliability and validity (Zhang, Zhang, & Dong, 2010). In the current study, Cronbach's alpha of the PCQ-24 was 0.943.

The Chinese version of the PNWE Scale (PNWE-C), revised by Chen, Lin, and Zhao (2011), was used to measure the PNWE. The PNWE-C included 41 items and six dimensions: (a) professional development and decision making (12 items); (b) staffing and resource adequacy (five items); (c) nursing management (five items); (d) professional practice (four items); (e) nurse/physician collaboration (three items); and (f) clinical work system assurance and scheduling climate (12 items). Each item was scored using a 4-point Likert-type scale, ranging from 1 (totally disagree) to 4 (totally agree). The reliability and validity of this scale are sufficient to assess the situation of nursing work environment among Chinese nurses (Chen et al., 2011). In the current study, Cronbach's alpha for the PNWE-C was 0.956.

Statistical Analysis

SPSS 20.0 was used for data analysis. One-way analysis of variance was used to examine the differences among nurses' age, work experience, position, and education. Independent t tests were performed to analyze the differences in gender, marital status, and employment type. Pearson's correlation coefficient was used to examine the correlations among PNWE, PsyCap, and perceived professional benefits. Baron and Kenny's (1986) analysis technique was used to examine the mediating effects of the dimensions of PNWE in the relationship between PsyCap and perceived professional benefits. The criteria were as follows: (a) the dimensions of PsyCap are significantly related to the dimensions of perceived professional benefits; (b) PsyCap is significantly associated with the mediator (i.e., PNWE); and (c) the mediator is significantly associated with perceived professional benefits, with the influence of the independent variable on the dependent variable becoming smaller (partial mediator) or not statistically significant (full mediator) after the addition of the dimensions of the mediation variable to the model.

A hierarchical linear regression analysis was performed of each dimension of perceived professional benefits to test mediating effects. In Step 1, the dimensions of PsyCap (i.e., self-efficacy/hope/resilience/optimism) were added. In Step 2, the dimensions of the PNWE (i.e., professional development and decision making/staffing and resource adequacy/nursing management/professional practice/nurse and physician collaboration/clinical work system assurance and scheduling climate) were added, respectively. Each mediation hypothesis was tested based on the previous method.

Structural equation modeling (SEM) was used to test the hypothesis about the mediating effects of PNWE in the relationship between PsyCap and perceived professional benefits. First, the measurement model was tested to assess its construct validity, then the structural models were tested. All analyses were performed in AMOS 22.0. The root-mean-square error of approximation (RMSEA), Tucker-Lewis Index (TLI), normed fit index (NFI), comparative fit index (CFI) and chi-square goodness-of-fit statistic were used to assess model fit. The cut-off criteria were as follows: RMSEA values <0.05 indicate excellent fit and ≤0.08 indicate acceptable fit; TLI values >0.90 indicate acceptable fit; NFI values >0.95 indicate excellent fit and ≥0.90 are interpreted as good fit; and CFI values close to 0.95 indicate excellent fit and ≥0.90 are interpreted as good fit (Bentler, 2007). Finally, according to the revised index, the model had acceptable fit.

Results

Participant Characteristics

A total of 400 questionnaires were distributed and 364 were completed and returned. Thirteen questionnaires were excluded due to lack of reliability. The final number of evaluated questionnaires was 351, and the response rate for the survey was 87.8%. Demographic distributions of each dimension of perceived professional benefits are presented in Table 1. Mean age of participants was 29.42 years (SD = 7.69 years [range = 18 to 47 years]). Approximately 97.2% of participants were female, and more than one half of participants were married (n = 183, 52.1%) and worked for more than 5 years in the hospital (n = 182, 51.9%). Most participants were undergraduates (n = 254, 72.4%), with the following titles: 44% (n = 155) were nurses, 39.8% (n = 140) were primary nurses, and 15.9% (n = 56) were head nurses.

Demographic Distributions of Dimensions of Perceived Professional BenefitsDemographic Distributions of Dimensions of Perceived Professional Benefits

Table 1:

Demographic Distributions of Dimensions of Perceived Professional Benefits

Mean recognition from families and friends score (p < 0.05) and mean personal growth score (p < 0.05) differed across positions (i.e., nurses, primary nurses, and head nurses). Mean recognition from families and friends score (p < 0.005) also differed across marital status. Mean scores of different dimensions of perceived professional benefits were not significantly different across the remaining demographics (p > 0.05).

Correlations Among PsyCap, PNWE, and Perceived Professional Benefits

Results of Pearson's correlation analysis are presented in Table 2. The dimensions of PsyCap (self-efficacy/hope/resilience/optimism) had a significant positive relationship with the dimensions of perceived professional benefits (positive professional perception/good patient–nurse relationship/recognition from families and friends/sense of belonging to the work team/personal growth) (p < 0.01). Therefore, the current study satisfies the primary condition for applying the techniques of Baron and Kenny to test the mediating role of PNWE. In addition, a significant positive correlation was also found between the dimensions of PsyCap and PNWE (professional development and decision making/staffing and resource adequacy/nursing management/professional practice/nurse and physician collaboration/clinical work system assurance and scheduling climate) (p < 0.01). The second requirement of the Baron and Kenny technique was also satisfied.

Mean (SD) and Correlations of Continuous Variables

Table 2:

Mean (SD) and Correlations of Continuous Variables

Mediating Role of PNWE in the Relationship Between PsyCap and Positive Professional Perception

Results of the hierarchical multiple regression model of perceived professional benefits are shown in Table A (available in the online version of this article). Before the dimensions of the PNWE were entered into block 2 of the model, PsyCap was first added to block 1. The effects of the dimensions of the PNWE on positive professional perception were all significantly positive, respectively. In the regression equation, hope and optimism were positively correlated with positive professional perception.

Hierarchical linear regression analysis results.Hierarchical linear regression analysis results.Hierarchical linear regression analysis results.Hierarchical linear regression analysis results.Hierarchical linear regression analysis results.

Table A:

Hierarchical linear regression analysis results.

After adding the dimensions of the PNWE in the regression model, the regression coefficients for optimism diminished as shown in the final model (p < 0.001). However, after adding professional development and decision making in the regression model, the effect of hope on positive professional perception became statistically insignificant. Based on the third requirement of Baron and Kenny's technique, the dimensions of the PNWE were all partial mediators in the relationship between optimism and positive professional perception. Professional development and decision making were full mediators in the relationship between hope and positive professional perception.

Mediating Role of PNWE in the Relationship Between PsyCap and Good Patient–Nurse Relationship

As shown in Table A, the effects of staffing and resource adequacy and nurse/physician collaboration on good patient–nurse relationship were statistically insignificant (β = −0.050, p > 0.05; β = 0.160, p > 0.05). The effect of the remaining dimensions of PNWE were all significantly positive (p < 0.001).

After adding professional development and decision making/staffing and resource adequacy/nursing management in the regression model, respectively, the regression coefficient for self-efficacy diminished as shown in the final model step-by-step. However, after adding clinical work system assurance and scheduling climate in the regression model, the effect of self-efficacy on good patient–nurse relationship became statistically insignificant. Based on the third requirement of Baron and Kenny's technique, professional development and decision making/staffing and resource adequacy/nursing management were partial mediators in the relationship between self-efficacy and good patient–nurse relationship. Clinical work system assurance and scheduling climate was a full mediator in the relationship between self-efficacy and good patient–nurse relationship.

Mediating Role of PNWE in the Relationship Between PsyCap and Recognition From Families and Friends

As shown in Table A, the effect of staffing and resource adequacy on recognition from families and friends was not statistically significant (β = 0.110, p > 0.05). The effect of the remaining dimensions of PNWE were all significantly positive (p < 0.05).

After adding the dimensions of the PNWE in the regression model, the regression coefficient for optimism diminished as shown in the final model step-by-step. Based on the third requirement of Baron and Kenny's technique, each of the dimensions of the PNWE was a partial mediator in the relationship between optimism and recognition from families and friends.

Mediating Role of PNWE in the Relationship Between PsyCap and Sense of Belonging to the Work Team

As shown in Table A, the effect of staffing and resource adequacy on a sense of belonging to the work team was not statistically significant (β = 0.093, p > 0.05). The effect of the remaining dimensions of PNWE were all significantly positive (p < 0.001).

After adding the dimensions of the PNWE in the regression model, the regression coefficient for optimism diminished as shown in the final model step-by-step. However, after adding professional development and decision making in the regression model, the effect of self-efficacy on sense of belonging to the work team became statistically insignificant. Based on the third requirement of Baron and Kenny's technique, each of the dimensions of the PNWE was a partial mediator in the relationship between optimism and a sense of belonging to the work team. Professional development and decision making was a full mediator in the relationship between self-efficacy and sense of belonging to the work team.

Mediating Role of PNWE in the Relationship Between PsyCap and Personal Growth

As shown in Table A, the effect of staffing and resource adequacy on personal growth was not statistically significant (β = 0.004, p > 0.05). The effect of the remaining dimensions of PNWE were all significantly positive (p < 0.001).

After adding the dimensions of the PNWE in the regression model, the regression coefficient for optimism diminished as shown in the final model step-by-step. However, after adding professional development and decision making in the regression model, the effect of self-efficacy on personal growth became statistically insignificant. Based on the third requirement of Baron and Kenny's technique, each of the dimensions of the PNWE was a partial mediator in the relationship between optimism and personal growth. Professional development and decision making was a full mediator in the relationship between self-efficacy and personal growth.

Assessment of Structural Model

The relationships and path values for each variable are shown in the Figure. The path coefficients among the three latent variables are all positive numbers and reach statistical significance. The index values of the study were as follows: RMSEA = 0.125, NFI = 0.905, RFI = 0.885, IFI = 0.918, TLI = 0.901, and CFI = 0.918, which were all within acceptable limits, showing the model was well suited and the revised model was established.

Mediation model.

Figure.

Mediation model.

Discussion

The current study explored the relationship between PsyCap and perceived professional benefits and the mediating effect of PNWE in this relationship among Chinese nurses in two general hospitals. The mean PsyCap score in the current study (4.33 [SD = 0.87]; range = 1 to 6) is consistent with previous studies (Shen et al., 2014; Wang, Liu, Wang, & Wang, 2012; Zhou et al., 2017). The findings show that Chinese nurses in general hospitals have a positive mental state. Among the four dimensions of PsyCap, optimism scored the highest, whereas hope scored the lowest, which was consistent with previous findings (Liu et al., 2013; Zhou et al., 2017). The results showed that the average score of staffing and resource adequacy was the lowest among the five dimensions of the PNWE. The results indicate that hospital nurses are poorly satisfied with staffing and equipment support. Staffing and resource adequacy in the nursing field include multiple factors, such as the ratio of nurses to patients, the ratio of beds to nurses, comprehensive skilled personnel, and the mode of nursing, in addition to the number of staff. However, the shortage of domestic hospital nurses and the problem of nurse staffing pose a challenge to hospitals operating in the market economy mode.

China is gradually becoming an aging society, and the shortage of medical resources and number of individuals engaged in nursing work are insufficient to meet the needs of this changing society. As nurses are overloaded, the number of nurses who change careers increases, which is detrimental to the development of quality nursing work. Therefore, nursing work should receive additional supports and guarantees from the aspects of human, financial, and material resources. In this respect, it is necessary to reduce the time and amount of non-nursing work for ward nurses and improve the efficiency of nursing work.

In the current study, the mean perceived professional benefits score was 131.98 (SD = 23.74), which was similar to the results of Mao et al. (2016) (131.05 [SD = 16.96]). Among the subcategories of perceived professional benefits, personal growth scored highest, whereas recognition from families and friends scored lowest, which is in agreement with a previous study (Mao et al., 2016). The high scoring of personal growth indicated that nurses in the investigated hospitals were able to grow in five aspects: professional ability, psychological quality, personality characteristics, life attitude, and interpersonal ability (Wang et al., 2016). The professional ability of nurses improves continuously, making them more confident in their work. According to Xiao et al. (2014), nurses have good psychological quality and coping ability when they meet sudden or emergency situations. The characteristics of nursing work promote nurses to be more patient, serious, rigorous, and responsible. Nurses have a better mentality, especially when they see patients experiencing illness and pain, as they cherish their own healthy body and satisfaction with their present life (Xiao et al., 2014). When nurses interact with patients of different ages, occupations, and social class, their interpersonal ability improves (Xiao et al., 2014). However, in the current study, “recognition from families and friends” scored the lowest, indicating that nurses in the investigated hospitals were not able to meet the medical needs or provide health assistance to their hospitalized relatives and friends because of their professional relationships, lack of the latest and most accurate medical information, and the quality of medical resources.

In the current study, all dimensions of nurses' PsyCap were found to be positively associated with perceived professional benefits. Preliminary experimental results validated the hypotheses. Earlier research also showed that nurses with high levels of PsyCap may have higher perceived professional benefits, such as job satisfaction and increased wages (Laschinger & Grau, 2012). However, PsyCap has not only direct but also indirect effects on perceived professional benefits. All dimensions of the PNWE were mediators in the relationship between PsyCap and perceived professional benefits. Professional development and decision making was found to mediate the relationship between hope and positive professional perception and between self-efficacy and sense of belonging to the work team and personal growth. Nurses who have higher scores on hope might have high professional development and decision making, which would lead to higher levels of positive professional perception, and nurses who have higher scores on self-efficacy might have high professional development and decision making, which would lead to higher levels of sense of belonging to the work team and personal growth. In addition, it was found that each dimension of the PNWE was a partial mediator in the relationship between optimism and the dimensions of perceived professional benefits. Nurses who have higher scores on optimism might have high PNWE, which would lead to higher levels of perceived professional benefits. And in the SEM, the importance of PNWE in the relationship between PsyCap and perceived professional benefits was confirmed. The direct path between PsyCap and perceived professional benefits was maintained in the mediation model. This result confirmed the influence of PNWE in the relationship between PsyCap and perceived professional benefits.

Implications for Nursing Management

The findings of the current study prompted hospital administrators to consider the improvement of nurses' PsyCap and work environment. Previous studies suggest that to improve hope, nurse managers should help nurses develop appropriate, specific, and challenging work goals and create multiple pathways to achieve these goals (Zhou et al., 2017). To improve optimism, nurses should develop a positive attitude style to cope with past failures and setbacks, and face each day with an active, generous, or magnanimous and confident attitude. Related studies show that internet-delivered cognitive-behavioral therapy and a standard cognitive behavioral framework can help nurses develop new models of thinking and behavior (Klein, Richards, & Austin, 2006; Spek et al., 2007). Nurse managers can use the psychological capital intervention training model that has been created to develop PsyCap for online participants (Luthans, Avey, Avolio, Norman, & Combs, 2006; Luthans, Avey, & Patera, 2008). In addition, research shows that the PNWE is positively related to the dimensions of nurses' perceived professional benefits, indicating that the better the organizational support in nurses' practical work environments, the higher the perceived professional benefits of nurses. For example, nurses who participate in the management of hospital affairs will have some decision-making power and their innovative thinking will be reflected in the work; therefore, they are more willing to work hard, achieve self-growth, and affirm their life value.

Limitations

The current study had the following limitations. First, a cross-sectional rather than a longitudinal design was used. Second, the study included a small sample, so the results may not be representative of all Chinese nurses. Finally, only nurses in large general hospitals with better working environments were investigated. Additional research will focus on nurses from other hospitals.

Conclusion

PsyCap had effects on perceived professional benefits and PNWE was a mediator in this relationship among Chinese nurses. Guided by positive psychology and a good working environment, nurses can appreciate their professional benefits and gradually improve their professional emotions to better deal with work pressure and occupational burnout. Therefore, PNWE and PsyCap are important factors for successful improvement of perceived professional benefits.

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Demographic Distributions of Dimensions of Perceived Professional Benefits

Variablen(%)Mean (SD)
Positive Professional PerceptionGood Patient–Nurse RelationshipRecognition From Families and FriendsSense of Belonging to the Work TeamPersonal Growth
Age
   p0.3830.1420.0860.8280.114
   F0.9631.9622.4670.1892.187
  ≤30244(69.5)26.49 (5.48)24.74 (4.64)22.89 (5)23.65 (4.65)32.81 (6.04)
  31 to 4091 (25.9)27.32 (5.15)25.58 (4.34)23.88 (4.46)23.77 (5.01)34.05 (5.73)
  ≥4116 (4.6)27.50 (3.56)26.31 (3.28)24.94 (3.34)24.38 (3.14)34.94 (3.84)
Sex
   p0.4140.5100.5180.2030.505
  t test0.8170.6590.6471.2760.667
  Female341 (97.2)26.70 (5.37)25.04 (4.55)23.19 (4.86)23.68 (4.72)33.23 (5.93)
  Male10 (2.8)28.10 (3.60)26.00 (3.86)24.20 (5.12)25.60 (3.50)34.50 (5.10)
Position
   p0.0690.0590.0200.1190.025
   F2.6972.8463.9472.1393.711
  Nurse155 (44)26.83 (5.21)25.12 (4.61)23.26 (4.95)23.96 (4.62)33.31 (5.94)
  Primary nurse140 (39.8)26.14 (5.75)24.51 (4.67)22.61 (4.84)23.12 (4.78)32.45 (6.17)
  Head nurse56 (15.9)28.07 (4.29)26.20 (3.74)24.73 (4.15)24.50 (4.52)34.96 (4.68)
Marital status
   p0.0640.0870.0340.2580.049
   t−1.859−1.719−2.130−1.133−1.977
  Single168 (47.9)26.20 (5.44)24.61 (4.71)22.67 (4.90)23.42 (4.65)32.58 (6.14)
  Married183 (52.1)27.26 (5.18)25.44 (4.34)23.76 (4.71)23.98 (4.71)33.83 (5.62)
Education
   p0.5550.2470.4840.4030.333
   F0.5901.4030.7260.9111.104
  Junior college or less83 (23.6)26.92 (5.42)25.27 (5.09)22.96 (5.27)23.90 (4.78)33.52 (6.10)
  Undergraduate254 (72.4)26.62 (5.34)24.87 (4.37)23.25 (4.72)23.57 (4.67)33.02 (5.89)
  Graduate or higher14 (4)28.14 (4.72)26.86 (3.61)24.64 (4.01)25.21 (4.39)35.29 (4.58)
Work experience
   p0.3060.2510.1710.8490.169
   t−1.025−1.149−1.373−0.191−1.377
  ≤5 years169 (48.1)26.45 (5.13)24.76 (4.48)22.87 (4.80)23.66 (4.47)32.78 (5.92)
  >5 years182 (51.9)2 7.03 (5.51)25.31 (4.57)23.58 (4.84)23.76 (4.89)33.65 (5.88)

Mean (SD) and Correlations of Continuous Variables

VariableMean (SD)1234567891011121314
Self-efficacy (1)25.91 (5.42)
Hope (2)25.43 (5.72)0.793
Resilience (3)26.19 (5.69)0.7450.884
Optimism (4)26.43 (5.88)0.6960.8120.820
Professional development and decision making (5)33.89 (8.16)0.4790.5580.4870.563
Staffing and resource adequacy (6)12.81 (3.79)0.4060.5210.4750.5340.782
Nursing management (7)15.27 (3.51)0.4680.5250.4750.5260.7210.647
Professional practice (8)12.05 (2.65)0.4220.5080.4650.5510.6490.6210.703
Nurse/physician collaboration (9)9.62 (2.07)0.3410.4090.3940.5400.5560.4920.5880.576
Clinical work system assurance and scheduling climate (10)39.04 (6.47)0.4700.4940.4600.4680.6410.5370.6940.7010.744
Positive professional perception (11)26.75 (5.33)0.5650.6360.6060.6980.6550.6260.6540.6170.5340.678
Good patient–nurse relationship (12)25.05 (4.53)0.5450.5640.5530.6170.5380.4380.5830.5450.5170.6870.835
Recognition from families and friends (13)23.24 (4.83)0.5310.5910.5590.6330.5830.5350.5850.6000.5030.6260.8510.815
Sense of belonging to the work team (14)23.71 (4.68)0.5620.6330.5890.6780.6630.5910.7310.6740.6310.7490.8800.8340.812
Personal growth (15)33.23 (5.90)0.5450.5910.5870.6400.5390.4650.5760.5600.5340.7030.8670.9270.8450.846

Hierarchical linear regression analysis results.

positive professional perceptiongood patient-nurse relationshiprecognition from families and friends

Step 1 (β)Step2 (β)Step 1 (β)Step2 (β)Step 1 (β)Step2 (β)
self-efficacy.095.069.090.072.076.080.045.201**.182**.176**.153*.159*.166**.109.113.091.103.087.094.099.070
hope.186*.044.026.024.017.024.043.047−.053−.049−.052−.061−.047−.016.194.074.064.061.049.057.073
resilience−.073.007−.007.002.003−.002.015.007.063.067.079.080.070.098−.065.002−.006.002.004−.002.012
optimism.540***.401***.388***.352***.337***.325***.290***.433***.335***.338***.291***.270***.246**.189**.450***.333***.325***.293***.263***..248**.220**
professional development and decision making.368***.230***.128*.113.099.066.261***.297***.162*.141*.113.059.310***.232***.138*.109.092.065
staffing and resource adequacy.195**.155**.136*.137*.161**−.050−.102−.127*−.127*−.088.110.074.038.038.058
nursing management.219***.171**.152**.105.290***.226***.187**.110.202***.111.087.049
professional practice.115*.096.027.154**.116*.003.218***.195**.139*
nurse/physician collaboration.080−.03 4.160−.02 7.097**.004
clinical work system.272***.444***.221**
assurance and scheduling climate
R20.505.592.606.627.633.637.658.407.451.452.489.499.514.571.423.485.489.507.528.533.547
ΔR20.500.586.600.620.624.627.648.400.443.442.478.487.501.558.416.477.480.497.517.521.534
a sense of belonging to work teampersonal growth

Step1 (β)Step2 (β)Step1 (β)Step2 (β)
.107.079.089.056.063.072.036.139*.122.122.102.108.116.054
.245*.095.086.081.071.087.107.074−.020−.021−.024−.033−.018.015
−.118−.034−.041−.024−.022−.035−.018.067.120.`120.130.132.120.150
.502***.354***.348***.281***.256***.227***.191**.427***.335***.335***.293***.269***.242**.181**
.389***.323***.132*.107.072.039.244***.242***.123.099.067.009
.093.020−.011−.010.014.004−.042−.071−.070−.028
.410***.332***.284***.237***.256***.182**.138*.055
.187***.140**.070.176**.132*.011
.196***.080.182***−.020
.275***.478***
.485.583.586.659.674.696.718.433.471.471.499.513.532.598
.479.577.579.652.667.688.710.426.463.462.489.501.519.586
Authors

Dr. Zhou is Associate Professor and Ms. Zhu is Master's Student, Department of Nursing, Ms. Zhang is Head Nurse, Department of Neurology, Ms. X. Wang is Head Nurse, Department of Neurosurgery, Ms. L. Wang is Head Nurse, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province; Ms. Cai is Head Nurse, Department of Radiotherapy, Hospital of Integrated Traditional Chinese and Western Medicine, Southern Medical University, Guangzhou City, Guangdong Province; Ms. Peng is Teacher, School of Nursing, Changsha Medical University, Changsha City, Hunan Province; Mr. Li is Master's Student, School of Mechanical Engineering, Shandong University, Jinan City, Shandong Province; and Ms. Lan is Head Nurse, Department of Neurology, Xiaolan People's Hospital of Zhongshan, Zhongshan City, Guangdong Province, China.

The authors have disclosed no potential conflicts of interest, financial or otherwise. Funding for this project was received from the Guangdong Provincial Science and Technology Project (2013B060500047, H. Zhou).

Dr. Zhou and Ms. Zhu contributed equally to this work.

Address correspondence to Hongzhen Zhou, PhD, A ssociate Professor, Department of Nursing, Nanfang Hospital Southern Medical University, Guangzhou City, Guangdong Province, 510515, China; e-mail: Zhouhz2005@126.com.

Received: September 04, 2017
Accepted: November 08, 2017
Posted Online: December 06, 2017

10.3928/02793695-20171128-01

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