Copyright © eContent Management Pty Ltd. Contemporary Nurse (2014) 49: 96–102.
A study of nursing competency, career self-efficacy and professional commitment among nurses in Taiwan Chao-Wen Tsai, Shieunt-Han Tsai*, Ying-Ying Chen+ and Wei-Lun Lee! Department of Nursing, Meiho University, Pingtung, Taiwan; *Department of Finance and Banking, Kun Shan University, Tainan, Taiwan; +Department of Nursing, Pao-Chien Hospital, Pingtung, Taiwan; !Center of General Education, Tajen University, Pingtung, Taiwan
Abstract: Background: Professional commitment, maintaining nursing competency, and improving self-efficacy
could be necessary to enhance the quality of care service in Taiwan. Aim: The purpose of this study was to investigate the relationships among nursing competency, career self-efficacy, and professional commitment in hospital nurses. Methods/ Design: We used a stratified cluster random sampling method for the selection. To take 762 nurses with work experience of more than 6 months were selected from 2 regional hospitals and 3 district hospitals in Taiwan. The nurses answered a self-report questionnaire, which was categorized into four sections: Personal background data, nursing competency, career self-efficacy, and professional commitment. Results/Findings: The results indicate that nursing competency and career selfefficacy of nurses were at a high level, whereas professional commitment was at a medium level. Nursing competency, career self-efficacy, and professional commitment were significantly positively correlated. Conclusion: The career self-efficacy and professional commitment of medical and nursing personnel can help to increase nursing competency and to improve the quality of medical and nursing care.
Keywords: nurses, nursing competency, career self-efficacy, professional commitment
T
he shortage of nursing personnel is a serious problem that threatens the quality of care and may lead to poor patient care outcomes, ineffective team building, and diminished work performance. Professional commitment, main taining nursing competency, and increasing selfefficacy are necessary to enhance the quality of nursing care services (Ironside, 2008). In Taiwan, the perceptions and attitudes of nurses regarding their work are crucial. They have a high turnover, which can disrupt the continuity of care and increase costs. Numerous studies have focused on work stress and burnout among nursing personnel because they work in high-stress environments. This has detrimental effects on their mental and physical health, productivity, and work efficacy, and may lead to absenteeism (Halm et al., 2005; Vahey et al., 2004). However, career selfefficacy can help professionals to address strenuous challenges, which creates a higher demand on practicing nurses to show their capabilities when caring for patients (Whelan, 2006). Conversely, Memarian, Salsali, Vanaki, Ahmadi, and Hajizadeh (2007) determined factors that influence nursing competency, including effective self-management and professional commitment. Low commitment to a job results in various 96
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organizational outcomes such as high dropout rates, low job satisfaction, and low performance (Heponiemi et al., 2008). By contrast, nurses with high professional commitment have a higher job satisfaction than those with low professional commitment (Teng, Shyu, & Chang, 2007). Another study reported that nurses with high levels of self-efficacy were guided more by their internal objectives for their careers than nurses with low levels of self-efficacy (Baghban, Malekiha, & Fatehizadeh, 2010). They can complete practical skills or tasks and understand the rationale for completing them (Rischel, Larsen, & Jackson, 2008). This can help hospital administrators to retain their nurses (Schmidt, 2007). When nurses continue promoting work competence to show their professional commitment and preferences regarding career attainment, the self-evaluation of their nursing careers improves (Huang, Kuo, Huang, & Chiang, 2011; Lindrooth, Bazzoli, Needleman, & Hasnain-Wynia, 2006). Several studies have concluded that knowledge, skills, attitudes, years of service, and the environment of nurses affect nursing competency (Clinton, Murrells, & Robinson, 2005; Cowan, WilsonBarnett, & Norman, 2007), and nurses must apply their professional knowledge and skills effectively
A study of nursing competency, career self-efficacy and professional to make effective career decisions, such as solve site problems for higher nursing competency (Logsdon, Foltz, Scheetz, & Myers, 2010). However, few studies have examined the relationship among the nursing competency, career self-efficacy, and professional commitment of nurses. Therefore, the purpose of this study was to investigate this interaction. In addition, we examined the differences among nursing competency, career self-efficacy, and professional commitment and their relationships. Methods Participants A cross-sectional study was designed. The study utilized stratified random sampling and cluster sampling. A total of 762 nurses were recruited from 2 regional hospitals and 3 district hospitals in Taiwan. All participants were primary level ward nurses with work experience of more than 6 months. Permission was obtained from an ethics committee (2010-IRB022) prior to beginning the study. Permission was also obtained from the head of each hospital. Instruments The questionnaire was contained four elements: Demographics, a nursing competency scale, a career self-efficacy scale, and a professional commitment scale. Demographics included hospital level, position title, age, marital status, religion, educational background, and workplace. The nursing competency scale consisted of eight subscales: Assessment plan, communication and coordination, professional growth, study, care, technology, teaching, and administration. This part of the questionnaire was included 36 items. The nursing competency scale was measured using a five point Likert scale ranging from 1 (never) to 5 (always). According to Ling (2001), 8 subscales were extracted from the 36 items. The alpha reliability coefficients of the eight subscales of the nursing competency scale was 0.94. The subscales of the nursing competency scale were as follows: Assessment plan (six items), communication and coordination (six items), professional growth (four items), study (five items), care (four items), technology (four items), teaching (four items), and administration (three items). The career self-efficacy scale consisted of 15 items and four parts: Self-assessment, target selection, plan preparation, and problem-solving. © eContent Management Pty Ltd
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The career self-efficacy scale was measured using a four point Likert scale ranging from 1 (never) to 4 (always). According to Rao (2010), 4 subscales were extracted from the 15 items. The alpha reliability coefficient of the four subscales of the career self-efficacy scale was 0.95. The professional commitment scale was 29 items questionnaire. This scale was measured using a five point Likert scale ranging from 0 (never) to 5 (always). According to Lee (2004), 4 subscales were extracted from the 29 items. The alpha reliability coefficient of the four professional commitment subscales was 0.96. These subscales included professional efforts (11 items), professional career involvement (7 items), p ositive evaluation of the career (5 items), and professional value recognition (6 items). The data obtained from the completed questionnaires were analyzed using SPSS version 15.0. Descriptive statistics, the independent t-test, analysis of variance (ANOVA), and Pearson’s correlation coefficients were used to determine correlations among nursing competence level perceptions, career self-efficacy, and professional commitment. The level of significance was 0.05. Nursing competency was dichotomized into two levels (high and low) using the mean. Nursing competency was further categorized into high competency, medium competency, and low competency groups based on quartiles. Results Demographic data and nursing competency variables for the 762 nurses who participated in this study were shown on Table 1. Among the participants, 742 nurses (97.4%) were female and 20 (2.6%) were male. The mean age was 29.88 years (SD = 6.07 years, range = 24–32). The majority of participants were unmarried (61.8%), 67.3% were registered nurses (RNs), and 56.4% had received undergraduate university education. Most of them (63.1%) worked in medical and surgical wards, and 434 nurses were engaged in continuing education (57.0%). Nursing competency The mean score of nursing competency level perception was 3.97. Among the eight nursing
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CN 141.17/22.81 143.69/20.23 147.30/17.69
207 513 42
➀ LPN
➁ RN
➂ Head nurse
Volume 49, December 2014 141.04/21.57 145.97/19.48 134.80/27.48
320 430 12
➁ Undergraduate
➂ Graduate school
138.82/19.88 144.13/21.38 144.00/19.57 142.01/22.42
100 181 434 328
➁ Maternity pediatric
➂ Special units Continuative education Yes No
T/F
1.20
3.28
5.05**
0.28
1.79
4.27
16.01***
*p < 0.05; **p < 0.01; ***p < 0.001. Special units (emergency room, intensive care unit).
144.18/20.56
481
➀ Medical surgical
Workplace
Scheffe’s test ➁ > ➀
143.38/19.78 142.92/21.51
291 471
➀ Junior college
144.44/19.39 141.49/22.56
642 120
Religion Yes No Marital status Married Unmarried Education background
154.28/17.47 132.39/18.03
M/SD
370 392
N
Nursing competence
Hospital level Regional hospital District hospital Position title
Variable
45.67/7.15 44.83/6.64
44.96/6.74
45.59/7.53
45.36/6.92
Scheffe’s test ➁ > ➀
47.20/7.98
46.20/7.00
44.56/6.80
45.70/7.18 45.04/6.78
45.59/6.85 45.03/6.96
45.60/7.55
45.57/6.93
44.61/6.84
46.35/7.20 44.28/6.53
M/SD
T/F
1.56
0.19
4.85**
1.20
1.05
3.65
3.93***
Career self-efficacy
102.74/17.10 99.59/18.66
101.45/19.73
99.50/18.31
101.62/17.17
86.20/10.73
100.72/18.61
102.19/17.07
103.15/18.27 100.09/17.69
102.33/18.12 99.88/17.76
Scheffe’s test ➂ > ➁
108.02/14.53
100.23/18.29
101.91/17.73
103.89/13.93 98.78/20.79
M/SD
2.26*
0.82
2.32
2.15*
1.75
3.95*
3.76***
T/F
Professional commitment
Table 1: Nurse demographic data, nursing competence variables, career self-efficacy variables and professional commitment (N = 762)
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A study of nursing competency, career self-efficacy and professional competency subscales, technology was rated highest (M = 4.37, SD = 0.63), followed by communication and coordination (M = 4.30, SD = 0.62), care (M = 4.24, SD = 0.69), assessment plan (M = 4.08, SD = 0.72), administration (M = 4.02, SD = 0.81), professional growth (M = 3.79, SD = 0.72), teaching (M = 3.72, SD = 0.65), and study (M = 3.25, SD = 0.81). The t-test results indicated that nursing competency level perception and hospital level items showed a significant difference (T = 16.01, p = 0.001). Scores at the regional hospital were higher than those at district hospitals. The results of the one-way ANOVA of nursing competency level perception and each demographic item indicated that a significant difference existed between nurses with or without university education (F = 5.05, p = 0.01). The results of a Scheffe’s test indicated that nurses who had an undergraduate university education perceived nursing competency to be of higher value than those who attended junior college did. Career self-efficacy Most staff had 1–3 years of nursing experience (43.1%) who’s the mean score of career self-efficacy was 3.02. Among the four career self-efficacy subscales, self-assessment was rated highest (M = 3.11, SD = 0.42), followed by problem-solving (M = 3.09, SD = 0.48), target selection (M = 3.03, SD = 0.52), and plan preparation (M = 2.87, SD = 0.62). The results of the t-test indicated that career self-efficacy and hospital level items showed a significant difference (T = 3.93, p = 0.001). Scores at regional hospitals were higher than those at district hospitals. The results of the one-way ANOVA of career self-efficacy and each demographic item indicated that educational background showed a significant difference (F = 4.85, p = 0.01). The results of a Scheffe’s test show that nurses who had an undergraduate university education perceived nursing competency to be of a higher value than those who attended junior college did. Professional commitment The mean score of professional commitment was 3.49. Among the four professional commitment subscales, professional value recognition was rated highest (M = 3.68, SD = 0.60), followed by professional efforts (M = 3.46, SD = 0.68),
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professional career involvement (M = 3.43, SD = 0.73), and positive evaluation of the career (M = 3.39, SD = 0.75). The results of the t-test indicated that professional commitment and hospital level items showed a significant difference (T = 3.76, p = 0.001). Scores at regional hospitals were higher than those at district hospitals; and nurses were undergoing continuing education (T = 2.26, p = 0.05) to show a significant variance regarding continuing education. The results of the one-way ANOVA of professional commitment and each demographic item indicated that position title showed a significant difference (F = 3.95, p = 0.05). The results of a Scheffe’s test indicated that head nurses perceived professional commitment to be of a higher value than did RNs. We examined relationships among nursing competency, career self-efficacy, and professional commitment using the Pearson correlation coefficients test. Eight of the subscales of nursing competency positively correlated with career selfefficacy and professional commitment (Table 2). This result indicated that nursing competency results was higher than career self-efficacy and professional commitment. Among the four subscales, professional commitment correlated positively with career self-efficacy (Table 3). These results indicated that the majority of nurses with greater professional commitment had higher career selfefficacy. The nurses were grouped into high level, medium level, and low level by nursing competency as Table 4. Career self-efficacy and professional commitment significantly differed among high nursing competency, medium nursing competency, and low nursing competency groups. Discussion Demographic data and nursing competency variables The results showed that nurses at the regional hospital had higher scores of nursing competency than those at district hospitals did. It was reasonable to assume that hospitals at various levels offered dissimilar career development programs to nurses in Taiwan. This study took sample of more undergraduate university nurses than junior college. The results showed that nurses with an undergraduate university education perceived nursing competency
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*p < 0.05; **p < 0.01; ***p < 0.001. Nursing competence: AP, assessment plan; CC, communication and coordination; PG, professional growth; S, study; C, care; TE, technology; T, teaching; A, administration. Career self-efficacy: SA, self-assessment; TS, target selection; PP, plan prepared; PS, problem-solving. Professional commitment: PE, professional efforts will; PI, professional career involved in the will; PEC, positive evaluation of the career; PVR, professional value recognition.
0.360*** 0.326*** 0.361*** 0.350*** 0.316** 0.305** 0.329** 0.335*** 0.322** 0.334*** 0.357*** 0.359*** 0.316*** 0.337*** 0.360*** 0.356* 0.369* 0.370* 0.399** 0.387* 0.352*** 0.348*** 0.368*** 0.378*** 0.380*** 0.388*** 0.290*** 0.300*** 0.306*** 0.321*** 0.326*** 0.429*** 0.344*** 0.364*** 0.360***
0.388* 0.322*** 0.398** 0.327*** 0.332***
0.361*** 0.348*** 0.346*** 0.418*** 0.399*** 0.434*** 0.450*** 0.425*** 0.424*** 0.472*** 0.351*** 0.308*** 0.303*** 0.331*** 0.324*** 0.409*** 0.398*** 0.363*** 0.413*** 0.427*** 0.426*** 0.541*** 0.580*** 0.494*** 0.571*** 0.597*** 0.626*** 0.562*** 0.604*** 0.554*** 0.461*** 0.397*** 0.342*** 0.391*** 0.403***
Career self-efficacy SA 4.15*** TS 0.413*** PP 0.403*** PS 0.386*** Total 0.439*** Professional commitment PE 0.304** PI 0.309*** PEC 0.323*** PVR 0.338*** Total 0.334**
A T TE C AP
CC
PG
S
Nursing competence r
Item
Table 2: Pearson correlation coefficients for nursing competence, career self-efficacy variables and professional commitment (N = 762)
100
0.496*** 0.513*** 0.476*** 0.501*** 0.542***
Chao-Wen Tsai et al.
Total
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and career self-efficacy more higher than junior college. This finding was similar to be obtained by Chang and Wang (2008). Head nurses perceived that professional commitment was more valuable than RNs. The long-term work competence and leadership in the nursing profession of head nurses are significantly higher than those of other nurses. This finding was similar to be obtained by Khomeiran, Yekta, Kiger, and Ahmadi (2006). The results indicated that married nurses have more professional commitment than unmarried nurses. This was possibly because married nurses played multiple roles of both their families and their careers. They also exhibited professional dedication and self-dedication to promote professional development through professional value recognition, which helped married nurses with professional commitment and self-actualization (Chang & Wang, 2008; Chou, Chang, Yen, & Cheng, 2011). Nurses who engaged in continuing education to show a higher level of professional commitment than the other nurses did not take continuing education. Thus, support systems were crucial when nurses did study and research the concepts of health guidance, independent functions, leadership, and other aspects of nursing care. It may be useful to examine case discussions and issues related to training and education to increase the professional commitment of nurses (Clarke, 2005; Issel, Baldwin, Lyons, & Madamala, 2006; Tsai, Chuang, & Chien, 2009). Nursing competency was also positively related to career self-efficacy and professional commitment. These findings were consistent with those of previous studies (Huang et al., 2011; Ironside, 2008; Memarian et al., 2007). In addition, overall work values and professional commitment area significantly positively were correlated (Wang, Chou, & Huang, 2010). Therefore, self-assessment of career self-efficacy can
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A study of nursing competency, career self-efficacy and professional Table 3: Pearson correlation coefficients for professional commitment and career self-efficacy (N = 762) Item
Professional commitment r PE
PI
PEC
PVR
Total
CN
commitment may not be generalized to other healthcare workers in the private health care sector or healthcare workers outside Taiwan.
Conclusion The results showed that the expe0.361*** 0.497*** 0.326*** 0.339*** riences of nurses must be used 0.397*** 0.526*** 0.441*** 0.408*** in career self-efficacy and profes0.327*** 0.462*** 0.480*** 0.383*** sional commitment to increase 0.491*** 0.504*** 0.394*** 0.433*** nursing competency. High career 0.323*** 0.554*** 0.471*** 0.357*** self-efficacy and professional com***p < 0.001. Career self-efficacy: SA, self-assessment; TS, target mitment of hospital nurses influselection; PP, plan prepared; PS, problem-solving. Professional enced their nursing competency. commitment: PE, professional efforts will; PI, professional career involved in the will; PEC, positive evaluation of the career; PVR, professional value Nurses engaged in continuing edurecognition. cation understood more research concepts related to health guidTable 4: Career self-efficacy and professional commitment ance, independent functions, and among nursing competence (high-low) group leadership than did those who not Item N Career self-efficacy Professional commitment engaged in continuing education. Head nurses placed a greater value Nursing competence on nursing competency. Moreover, Low 151 41.40 (6.38)*** 95.50 (19.85)*** those nurses who had undergradu Medium 213 44.59 (5.87)*** 101.36 (18.14)*** ate university education qualifica High 398 47.12 (6.99)*** 104.08 (15.77)*** tions showed nursing competency ***p < 0.001, significantly different from the low group by Scheffe’s test. than junior college. Married nurses had higher nursing competency influence the professional commitment of nurses in than unmarried nurses and exhibited a significant Taiwan hospitals. The participants had higher career variance regarding professional commitment. self-efficacy and professional commitment, which Nursing competency was positively related enabled nurses to develop the competence required to career self-efficacy and professional committo manage nursing care problems. Therefore, ment. We recommend that nurses with high enhancing the professional commitment of nurses nursing competency maintained high career was necessary for improving positive evaluations of self-efficacy and professional commitment. In their careers. In addition, higher professional com- general, nurses tended to have low career selfmitment and career self-efficacy was associated with efficacy and professional commitment in work higher nursing competency scores. This finding was for which they had low nursing competency. consistent with the results reported by Memarian Considering the crucial aspects of this study, et al. (2007). teaching and professional growth were recomThis study had a number of limitations. First, mended. These findings were directed toward the cross-sectional nature of the data restricted hospital administrators and appointed officials from determining causality. It may be useful to to enable them to provide continuing education collect longitudinal data regarding the examined in the work place and formulate suitable policies variables. Second, we did not gather data from for all staff members. owners, who may also be affected by competence, career self-efficacy, and professional commitment. Acknowledgments Finally, the results were based on a sample from The original data for this study were collected and Taiwan. Therefore, the findings regarding nursing provided by the regional hospital and district hoscompetency, career self-efficacy, and professional pital nurses. Career self-efficacy SA 325*** TS 0.323*** PP 0.313*** PS 0.396*** Total 0.349***
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References
Baghban, I., Malekiha, M., & Fatehizadeh, M. (2010). The relationship between work–family conflict and the level of self-efficacy in female nurses in Alzahra Hospital. Iran Journal of Nursing Midwifery Research, 15(4), 190–194. Chang, Y. I., & Wang, M. H. (2008). Subjective nursing competence and the related factors of nurses in a medical center. Veterans General Hospital Nursing, 25, 334–341. Chou, Y. C., Chang, P. L., Yen, H. Y., & Cheng, F. C. (2011). The influences of career needs and career development programs on the work attitude of hospital nurses. Journal of Healthcare Management, 11(2), 112–130. Clarke, S. P. (2005). The policy implications of staffingoutcomes research. Journal of Nursing Administration, 35, 17–19. Clinton, M., Murrells, T., & Robinson, S. (2005). Assessing competency in nursing: A comparison of nurses prepared through degree and diploma programmer’s. Journal of Clinical Nursing, 14, 82–94. Cowan, D. T., Wilson-Barnett, J., & Norman, I. J. (2007). A European survey of general nurses’ self assessment of competence. Nurse Education Today, 27, 452–458. Halm, M., Peterson, M., Mandels, M., Sabo, J., Blalock, M., Braden, R., et al. (2005). Hospital nurse staffing and patient mortality, emotional exhaustion, and job dissatisfaction. Clinical Nursing Specialist, 19, 241–251. Heponiemi, T., Kouvonen, A., Vänskä, K., Halila, H., Sinervo, T., Kivimäki, M., et al. (2008). Health, psychosocial factors and retirement intentions among Finnish physicians. Occupational Medicine, 58, 406–412. Huang, M. H., Kuo, C. L., Huang, S., & Chiang, F. M. (2011). The study of career self-efficacy and career barriers among female nursing staff. Chang Gung Nursing, 22(1), 15–25. Ironside, P. M. (2008). Safeguarding patients through continuing competence. Journal of Continuing Education in Nursing, 39(2), 92–94. Issel, L. M., Baldwin, K. A., Lyons, R. L., & Madamala, K. (2006). self-reported competency of public health nurses and faculty in Illinois. Public Health Nursing, 23(2), 168–177. Khomeiran, R. T., Yekta, Z. P., Kiger, A. M., & Ahmadi, F. (2006). Professional competence: Factors described by nurses as influencing their development. International Nursing Review, 53(1), 66–72. Lee, R. H. (2004). A study of the nurse professional commitment and work values of public health nurses in Taitung county (Unpublished Master dissertation). Graduate Institute of the Nursing, Tzu Chi University, Hualien, Taiwan.
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Lindrooth, R. C., Bazzoli, G. J., Needleman, J., & Hasnain-Wynia, R. (2006). The effect of changes in hospital reimbursement on nurse staffing decisions at safety net and non safety net hospitals. Health Services Research, 41(3), 701–720. Ling, C. L. (2001). The influence of clinical ladders on nursing staff (Unpublished Master dissertation). Graduate Institute of the Human Resource Management, Sun Yat-Sen University, Kaohsiung, Taiwan. Logsdon, M. C., Foltz, M. P., Scheetz, J., & Myers, J. A. (2010). Self-efficacy and postpartum depression teaching behaviors of hospital-based perinatal nurses. The Journal of Perinatal Education, 19(4), 10–16. Memarian, R., Salsali, M., Vanaki, Z., Ahmadi, F., & Hajizadeh, E. (2007). Professional ethics as an important factor in clinical competency in nursing. Nursing Ethics, 14(2), 203–214. Rao, W. C. (2010). A study on the relationship between the work values and the career self-efficacy of students of University of Education (Unpublished Master dissertation). Graduate Institute of Social Development, National Pintung University of Education, Pingtung, Taiwan. Rischel, V., Larsen, K., & Jackson, K. (2008). Embodied dispositions or experience? Identifying new patterns of professional competence. Journal of Advanced Nursing, 61(5), 512–521. Schmidt, T. H. (2007). Organizational commitment: A further moderator in the relationship between work stress and strain? International of Journal Stress Management, 14, 26–40. Teng, C. I., Shyu, Y. I., & Chang, H. Y. (2007). Moderating effects of professional commitment on hospital nurses in Taiwan. Journal of Professional Nursing, 123(1), 47–54. Tsai, S. F., Chuang, C. M., & Chien, T. C. (2009). Evaluating nursing competency of newly employed nurses and related effects in a medical center. Cheng Vhing Medical Journal, 5(1), 8–12. Vahey, D. C., Aiken, L. H., Sloane, D. M., Sochalski, J., Busse, R., Clarke, H., et al. (2004). Nurse burnout and patient satisfaction. Medical Care, 42(2), 57–66. Wang, K. Y., Chou, C. C., & Huang, J. L. (2010). A study of work values, professional commitment, turnover intention and related factors among clinical nurses. The Journal of Nursing, 57(1), 22–34. Whelan, L. (2006). Competency assessment of nursing staff. Orthopedic Nursing, 25(3), 198–202. Received 17 February 2013
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A study of nursing competency, career self-efficacy and professional commitment among nurses in Taiwan Chao-Wen Tsai, Shieunt-Han Tsai*, Ying-Ying Chen+ and Wei-Lun Lee! Department of Nursing, Meiho University, Pingtung, Taiwan; *Department of Finance and Banking, Kun Shan University, Tainan, Taiwan; +Department of Nursing, Pao-Chien Hospital, Pingtung, Taiwan; !Center of General Education, Tajen University, Pingtung, Taiwan
Abstract: Background: Professional commitment, maintaining nursing competency, and improving self-efficacy
could be necessary to enhance the quality of care service in Taiwan. Aim: The purpose of this study was to investigate the relationships among nursing competency, career self-efficacy, and professional commitment in hospital nurses. Methods/ Design: We used a stratified cluster random sampling method for the selection. To take 762 nurses with work experience of more than 6 months were selected from 2 regional hospitals and 3 district hospitals in Taiwan. The nurses answered a self-report questionnaire, which was categorized into four sections: Personal background data, nursing competency, career self-efficacy, and professional commitment. Results/Findings: The results indicate that nursing competency and career selfefficacy of nurses were at a high level, whereas professional commitment was at a medium level. Nursing competency, career self-efficacy, and professional commitment were significantly positively correlated. Conclusion: The career self-efficacy and professional commitment of medical and nursing personnel can help to increase nursing competency and to improve the quality of medical and nursing care.
Keywords: nurses, nursing competency, career self-efficacy, professional commitment
T
he shortage of nursing personnel is a serious problem that threatens the quality of care and may lead to poor patient care outcomes, ineffective team building, and diminished work performance. Professional commitment, main taining nursing competency, and increasing selfefficacy are necessary to enhance the quality of nursing care services (Ironside, 2008). In Taiwan, the perceptions and attitudes of nurses regarding their work are crucial. They have a high turnover, which can disrupt the continuity of care and increase costs. Numerous studies have focused on work stress and burnout among nursing personnel because they work in high-stress environments. This has detrimental effects on their mental and physical health, productivity, and work efficacy, and may lead to absenteeism (Halm et al., 2005; Vahey et al., 2004). However, career selfefficacy can help professionals to address strenuous challenges, which creates a higher demand on practicing nurses to show their capabilities when caring for patients (Whelan, 2006). Conversely, Memarian, Salsali, Vanaki, Ahmadi, and Hajizadeh (2007) determined factors that influence nursing competency, including effective self-management and professional commitment. Low commitment to a job results in various 96
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organizational outcomes such as high dropout rates, low job satisfaction, and low performance (Heponiemi et al., 2008). By contrast, nurses with high professional commitment have a higher job satisfaction than those with low professional commitment (Teng, Shyu, & Chang, 2007). Another study reported that nurses with high levels of self-efficacy were guided more by their internal objectives for their careers than nurses with low levels of self-efficacy (Baghban, Malekiha, & Fatehizadeh, 2010). They can complete practical skills or tasks and understand the rationale for completing them (Rischel, Larsen, & Jackson, 2008). This can help hospital administrators to retain their nurses (Schmidt, 2007). When nurses continue promoting work competence to show their professional commitment and preferences regarding career attainment, the self-evaluation of their nursing careers improves (Huang, Kuo, Huang, & Chiang, 2011; Lindrooth, Bazzoli, Needleman, & Hasnain-Wynia, 2006). Several studies have concluded that knowledge, skills, attitudes, years of service, and the environment of nurses affect nursing competency (Clinton, Murrells, & Robinson, 2005; Cowan, WilsonBarnett, & Norman, 2007), and nurses must apply their professional knowledge and skills effectively
A study of nursing competency, career self-efficacy and professional to make effective career decisions, such as solve site problems for higher nursing competency (Logsdon, Foltz, Scheetz, & Myers, 2010). However, few studies have examined the relationship among the nursing competency, career self-efficacy, and professional commitment of nurses. Therefore, the purpose of this study was to investigate this interaction. In addition, we examined the differences among nursing competency, career self-efficacy, and professional commitment and their relationships. Methods Participants A cross-sectional study was designed. The study utilized stratified random sampling and cluster sampling. A total of 762 nurses were recruited from 2 regional hospitals and 3 district hospitals in Taiwan. All participants were primary level ward nurses with work experience of more than 6 months. Permission was obtained from an ethics committee (2010-IRB022) prior to beginning the study. Permission was also obtained from the head of each hospital. Instruments The questionnaire was contained four elements: Demographics, a nursing competency scale, a career self-efficacy scale, and a professional commitment scale. Demographics included hospital level, position title, age, marital status, religion, educational background, and workplace. The nursing competency scale consisted of eight subscales: Assessment plan, communication and coordination, professional growth, study, care, technology, teaching, and administration. This part of the questionnaire was included 36 items. The nursing competency scale was measured using a five point Likert scale ranging from 1 (never) to 5 (always). According to Ling (2001), 8 subscales were extracted from the 36 items. The alpha reliability coefficients of the eight subscales of the nursing competency scale was 0.94. The subscales of the nursing competency scale were as follows: Assessment plan (six items), communication and coordination (six items), professional growth (four items), study (five items), care (four items), technology (four items), teaching (four items), and administration (three items). The career self-efficacy scale consisted of 15 items and four parts: Self-assessment, target selection, plan preparation, and problem-solving. © eContent Management Pty Ltd
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The career self-efficacy scale was measured using a four point Likert scale ranging from 1 (never) to 4 (always). According to Rao (2010), 4 subscales were extracted from the 15 items. The alpha reliability coefficient of the four subscales of the career self-efficacy scale was 0.95. The professional commitment scale was 29 items questionnaire. This scale was measured using a five point Likert scale ranging from 0 (never) to 5 (always). According to Lee (2004), 4 subscales were extracted from the 29 items. The alpha reliability coefficient of the four professional commitment subscales was 0.96. These subscales included professional efforts (11 items), professional career involvement (7 items), p ositive evaluation of the career (5 items), and professional value recognition (6 items). The data obtained from the completed questionnaires were analyzed using SPSS version 15.0. Descriptive statistics, the independent t-test, analysis of variance (ANOVA), and Pearson’s correlation coefficients were used to determine correlations among nursing competence level perceptions, career self-efficacy, and professional commitment. The level of significance was 0.05. Nursing competency was dichotomized into two levels (high and low) using the mean. Nursing competency was further categorized into high competency, medium competency, and low competency groups based on quartiles. Results Demographic data and nursing competency variables for the 762 nurses who participated in this study were shown on Table 1. Among the participants, 742 nurses (97.4%) were female and 20 (2.6%) were male. The mean age was 29.88 years (SD = 6.07 years, range = 24–32). The majority of participants were unmarried (61.8%), 67.3% were registered nurses (RNs), and 56.4% had received undergraduate university education. Most of them (63.1%) worked in medical and surgical wards, and 434 nurses were engaged in continuing education (57.0%). Nursing competency The mean score of nursing competency level perception was 3.97. Among the eight nursing
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CN 141.17/22.81 143.69/20.23 147.30/17.69
207 513 42
➀ LPN
➁ RN
➂ Head nurse
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320 430 12
➁ Undergraduate
➂ Graduate school
138.82/19.88 144.13/21.38 144.00/19.57 142.01/22.42
100 181 434 328
➁ Maternity pediatric
➂ Special units Continuative education Yes No
T/F
1.20
3.28
5.05**
0.28
1.79
4.27
16.01***
*p < 0.05; **p < 0.01; ***p < 0.001. Special units (emergency room, intensive care unit).
144.18/20.56
481
➀ Medical surgical
Workplace
Scheffe’s test ➁ > ➀
143.38/19.78 142.92/21.51
291 471
➀ Junior college
144.44/19.39 141.49/22.56
642 120
Religion Yes No Marital status Married Unmarried Education background
154.28/17.47 132.39/18.03
M/SD
370 392
N
Nursing competence
Hospital level Regional hospital District hospital Position title
Variable
45.67/7.15 44.83/6.64
44.96/6.74
45.59/7.53
45.36/6.92
Scheffe’s test ➁ > ➀
47.20/7.98
46.20/7.00
44.56/6.80
45.70/7.18 45.04/6.78
45.59/6.85 45.03/6.96
45.60/7.55
45.57/6.93
44.61/6.84
46.35/7.20 44.28/6.53
M/SD
T/F
1.56
0.19
4.85**
1.20
1.05
3.65
3.93***
Career self-efficacy
102.74/17.10 99.59/18.66
101.45/19.73
99.50/18.31
101.62/17.17
86.20/10.73
100.72/18.61
102.19/17.07
103.15/18.27 100.09/17.69
102.33/18.12 99.88/17.76
Scheffe’s test ➂ > ➁
108.02/14.53
100.23/18.29
101.91/17.73
103.89/13.93 98.78/20.79
M/SD
2.26*
0.82
2.32
2.15*
1.75
3.95*
3.76***
T/F
Professional commitment
Table 1: Nurse demographic data, nursing competence variables, career self-efficacy variables and professional commitment (N = 762)
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A study of nursing competency, career self-efficacy and professional competency subscales, technology was rated highest (M = 4.37, SD = 0.63), followed by communication and coordination (M = 4.30, SD = 0.62), care (M = 4.24, SD = 0.69), assessment plan (M = 4.08, SD = 0.72), administration (M = 4.02, SD = 0.81), professional growth (M = 3.79, SD = 0.72), teaching (M = 3.72, SD = 0.65), and study (M = 3.25, SD = 0.81). The t-test results indicated that nursing competency level perception and hospital level items showed a significant difference (T = 16.01, p = 0.001). Scores at the regional hospital were higher than those at district hospitals. The results of the one-way ANOVA of nursing competency level perception and each demographic item indicated that a significant difference existed between nurses with or without university education (F = 5.05, p = 0.01). The results of a Scheffe’s test indicated that nurses who had an undergraduate university education perceived nursing competency to be of higher value than those who attended junior college did. Career self-efficacy Most staff had 1–3 years of nursing experience (43.1%) who’s the mean score of career self-efficacy was 3.02. Among the four career self-efficacy subscales, self-assessment was rated highest (M = 3.11, SD = 0.42), followed by problem-solving (M = 3.09, SD = 0.48), target selection (M = 3.03, SD = 0.52), and plan preparation (M = 2.87, SD = 0.62). The results of the t-test indicated that career self-efficacy and hospital level items showed a significant difference (T = 3.93, p = 0.001). Scores at regional hospitals were higher than those at district hospitals. The results of the one-way ANOVA of career self-efficacy and each demographic item indicated that educational background showed a significant difference (F = 4.85, p = 0.01). The results of a Scheffe’s test show that nurses who had an undergraduate university education perceived nursing competency to be of a higher value than those who attended junior college did. Professional commitment The mean score of professional commitment was 3.49. Among the four professional commitment subscales, professional value recognition was rated highest (M = 3.68, SD = 0.60), followed by professional efforts (M = 3.46, SD = 0.68),
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professional career involvement (M = 3.43, SD = 0.73), and positive evaluation of the career (M = 3.39, SD = 0.75). The results of the t-test indicated that professional commitment and hospital level items showed a significant difference (T = 3.76, p = 0.001). Scores at regional hospitals were higher than those at district hospitals; and nurses were undergoing continuing education (T = 2.26, p = 0.05) to show a significant variance regarding continuing education. The results of the one-way ANOVA of professional commitment and each demographic item indicated that position title showed a significant difference (F = 3.95, p = 0.05). The results of a Scheffe’s test indicated that head nurses perceived professional commitment to be of a higher value than did RNs. We examined relationships among nursing competency, career self-efficacy, and professional commitment using the Pearson correlation coefficients test. Eight of the subscales of nursing competency positively correlated with career selfefficacy and professional commitment (Table 2). This result indicated that nursing competency results was higher than career self-efficacy and professional commitment. Among the four subscales, professional commitment correlated positively with career self-efficacy (Table 3). These results indicated that the majority of nurses with greater professional commitment had higher career selfefficacy. The nurses were grouped into high level, medium level, and low level by nursing competency as Table 4. Career self-efficacy and professional commitment significantly differed among high nursing competency, medium nursing competency, and low nursing competency groups. Discussion Demographic data and nursing competency variables The results showed that nurses at the regional hospital had higher scores of nursing competency than those at district hospitals did. It was reasonable to assume that hospitals at various levels offered dissimilar career development programs to nurses in Taiwan. This study took sample of more undergraduate university nurses than junior college. The results showed that nurses with an undergraduate university education perceived nursing competency
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*p < 0.05; **p < 0.01; ***p < 0.001. Nursing competence: AP, assessment plan; CC, communication and coordination; PG, professional growth; S, study; C, care; TE, technology; T, teaching; A, administration. Career self-efficacy: SA, self-assessment; TS, target selection; PP, plan prepared; PS, problem-solving. Professional commitment: PE, professional efforts will; PI, professional career involved in the will; PEC, positive evaluation of the career; PVR, professional value recognition.
0.360*** 0.326*** 0.361*** 0.350*** 0.316** 0.305** 0.329** 0.335*** 0.322** 0.334*** 0.357*** 0.359*** 0.316*** 0.337*** 0.360*** 0.356* 0.369* 0.370* 0.399** 0.387* 0.352*** 0.348*** 0.368*** 0.378*** 0.380*** 0.388*** 0.290*** 0.300*** 0.306*** 0.321*** 0.326*** 0.429*** 0.344*** 0.364*** 0.360***
0.388* 0.322*** 0.398** 0.327*** 0.332***
0.361*** 0.348*** 0.346*** 0.418*** 0.399*** 0.434*** 0.450*** 0.425*** 0.424*** 0.472*** 0.351*** 0.308*** 0.303*** 0.331*** 0.324*** 0.409*** 0.398*** 0.363*** 0.413*** 0.427*** 0.426*** 0.541*** 0.580*** 0.494*** 0.571*** 0.597*** 0.626*** 0.562*** 0.604*** 0.554*** 0.461*** 0.397*** 0.342*** 0.391*** 0.403***
Career self-efficacy SA 4.15*** TS 0.413*** PP 0.403*** PS 0.386*** Total 0.439*** Professional commitment PE 0.304** PI 0.309*** PEC 0.323*** PVR 0.338*** Total 0.334**
A T TE C AP
CC
PG
S
Nursing competence r
Item
Table 2: Pearson correlation coefficients for nursing competence, career self-efficacy variables and professional commitment (N = 762)
100
0.496*** 0.513*** 0.476*** 0.501*** 0.542***
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and career self-efficacy more higher than junior college. This finding was similar to be obtained by Chang and Wang (2008). Head nurses perceived that professional commitment was more valuable than RNs. The long-term work competence and leadership in the nursing profession of head nurses are significantly higher than those of other nurses. This finding was similar to be obtained by Khomeiran, Yekta, Kiger, and Ahmadi (2006). The results indicated that married nurses have more professional commitment than unmarried nurses. This was possibly because married nurses played multiple roles of both their families and their careers. They also exhibited professional dedication and self-dedication to promote professional development through professional value recognition, which helped married nurses with professional commitment and self-actualization (Chang & Wang, 2008; Chou, Chang, Yen, & Cheng, 2011). Nurses who engaged in continuing education to show a higher level of professional commitment than the other nurses did not take continuing education. Thus, support systems were crucial when nurses did study and research the concepts of health guidance, independent functions, leadership, and other aspects of nursing care. It may be useful to examine case discussions and issues related to training and education to increase the professional commitment of nurses (Clarke, 2005; Issel, Baldwin, Lyons, & Madamala, 2006; Tsai, Chuang, & Chien, 2009). Nursing competency was also positively related to career self-efficacy and professional commitment. These findings were consistent with those of previous studies (Huang et al., 2011; Ironside, 2008; Memarian et al., 2007). In addition, overall work values and professional commitment area significantly positively were correlated (Wang, Chou, & Huang, 2010). Therefore, self-assessment of career self-efficacy can
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A study of nursing competency, career self-efficacy and professional Table 3: Pearson correlation coefficients for professional commitment and career self-efficacy (N = 762) Item
Professional commitment r PE
PI
PEC
PVR
Total
CN
commitment may not be generalized to other healthcare workers in the private health care sector or healthcare workers outside Taiwan.
Conclusion The results showed that the expe0.361*** 0.497*** 0.326*** 0.339*** riences of nurses must be used 0.397*** 0.526*** 0.441*** 0.408*** in career self-efficacy and profes0.327*** 0.462*** 0.480*** 0.383*** sional commitment to increase 0.491*** 0.504*** 0.394*** 0.433*** nursing competency. High career 0.323*** 0.554*** 0.471*** 0.357*** self-efficacy and professional com***p < 0.001. Career self-efficacy: SA, self-assessment; TS, target mitment of hospital nurses influselection; PP, plan prepared; PS, problem-solving. Professional enced their nursing competency. commitment: PE, professional efforts will; PI, professional career involved in the will; PEC, positive evaluation of the career; PVR, professional value Nurses engaged in continuing edurecognition. cation understood more research concepts related to health guidTable 4: Career self-efficacy and professional commitment ance, independent functions, and among nursing competence (high-low) group leadership than did those who not Item N Career self-efficacy Professional commitment engaged in continuing education. Head nurses placed a greater value Nursing competence on nursing competency. Moreover, Low 151 41.40 (6.38)*** 95.50 (19.85)*** those nurses who had undergradu Medium 213 44.59 (5.87)*** 101.36 (18.14)*** ate university education qualifica High 398 47.12 (6.99)*** 104.08 (15.77)*** tions showed nursing competency ***p < 0.001, significantly different from the low group by Scheffe’s test. than junior college. Married nurses had higher nursing competency influence the professional commitment of nurses in than unmarried nurses and exhibited a significant Taiwan hospitals. The participants had higher career variance regarding professional commitment. self-efficacy and professional commitment, which Nursing competency was positively related enabled nurses to develop the competence required to career self-efficacy and professional committo manage nursing care problems. Therefore, ment. We recommend that nurses with high enhancing the professional commitment of nurses nursing competency maintained high career was necessary for improving positive evaluations of self-efficacy and professional commitment. In their careers. In addition, higher professional com- general, nurses tended to have low career selfmitment and career self-efficacy was associated with efficacy and professional commitment in work higher nursing competency scores. This finding was for which they had low nursing competency. consistent with the results reported by Memarian Considering the crucial aspects of this study, et al. (2007). teaching and professional growth were recomThis study had a number of limitations. First, mended. These findings were directed toward the cross-sectional nature of the data restricted hospital administrators and appointed officials from determining causality. It may be useful to to enable them to provide continuing education collect longitudinal data regarding the examined in the work place and formulate suitable policies variables. Second, we did not gather data from for all staff members. owners, who may also be affected by competence, career self-efficacy, and professional commitment. Acknowledgments Finally, the results were based on a sample from The original data for this study were collected and Taiwan. Therefore, the findings regarding nursing provided by the regional hospital and district hoscompetency, career self-efficacy, and professional pital nurses. Career self-efficacy SA 325*** TS 0.323*** PP 0.313*** PS 0.396*** Total 0.349***
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References
Baghban, I., Malekiha, M., & Fatehizadeh, M. (2010). The relationship between work–family conflict and the level of self-efficacy in female nurses in Alzahra Hospital. Iran Journal of Nursing Midwifery Research, 15(4), 190–194. Chang, Y. I., & Wang, M. H. (2008). Subjective nursing competence and the related factors of nurses in a medical center. Veterans General Hospital Nursing, 25, 334–341. Chou, Y. C., Chang, P. L., Yen, H. Y., & Cheng, F. C. (2011). The influences of career needs and career development programs on the work attitude of hospital nurses. Journal of Healthcare Management, 11(2), 112–130. Clarke, S. P. (2005). The policy implications of staffingoutcomes research. Journal of Nursing Administration, 35, 17–19. Clinton, M., Murrells, T., & Robinson, S. (2005). Assessing competency in nursing: A comparison of nurses prepared through degree and diploma programmer’s. Journal of Clinical Nursing, 14, 82–94. Cowan, D. T., Wilson-Barnett, J., & Norman, I. J. (2007). A European survey of general nurses’ self assessment of competence. Nurse Education Today, 27, 452–458. Halm, M., Peterson, M., Mandels, M., Sabo, J., Blalock, M., Braden, R., et al. (2005). Hospital nurse staffing and patient mortality, emotional exhaustion, and job dissatisfaction. Clinical Nursing Specialist, 19, 241–251. Heponiemi, T., Kouvonen, A., Vänskä, K., Halila, H., Sinervo, T., Kivimäki, M., et al. (2008). Health, psychosocial factors and retirement intentions among Finnish physicians. Occupational Medicine, 58, 406–412. Huang, M. H., Kuo, C. L., Huang, S., & Chiang, F. M. (2011). The study of career self-efficacy and career barriers among female nursing staff. Chang Gung Nursing, 22(1), 15–25. Ironside, P. M. (2008). Safeguarding patients through continuing competence. Journal of Continuing Education in Nursing, 39(2), 92–94. Issel, L. M., Baldwin, K. A., Lyons, R. L., & Madamala, K. (2006). self-reported competency of public health nurses and faculty in Illinois. Public Health Nursing, 23(2), 168–177. Khomeiran, R. T., Yekta, Z. P., Kiger, A. M., & Ahmadi, F. (2006). Professional competence: Factors described by nurses as influencing their development. International Nursing Review, 53(1), 66–72. Lee, R. H. (2004). A study of the nurse professional commitment and work values of public health nurses in Taitung county (Unpublished Master dissertation). Graduate Institute of the Nursing, Tzu Chi University, Hualien, Taiwan.
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CN
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Lindrooth, R. C., Bazzoli, G. J., Needleman, J., & Hasnain-Wynia, R. (2006). The effect of changes in hospital reimbursement on nurse staffing decisions at safety net and non safety net hospitals. Health Services Research, 41(3), 701–720. Ling, C. L. (2001). The influence of clinical ladders on nursing staff (Unpublished Master dissertation). Graduate Institute of the Human Resource Management, Sun Yat-Sen University, Kaohsiung, Taiwan. Logsdon, M. C., Foltz, M. P., Scheetz, J., & Myers, J. A. (2010). Self-efficacy and postpartum depression teaching behaviors of hospital-based perinatal nurses. The Journal of Perinatal Education, 19(4), 10–16. Memarian, R., Salsali, M., Vanaki, Z., Ahmadi, F., & Hajizadeh, E. (2007). Professional ethics as an important factor in clinical competency in nursing. Nursing Ethics, 14(2), 203–214. Rao, W. C. (2010). A study on the relationship between the work values and the career self-efficacy of students of University of Education (Unpublished Master dissertation). Graduate Institute of Social Development, National Pintung University of Education, Pingtung, Taiwan. Rischel, V., Larsen, K., & Jackson, K. (2008). Embodied dispositions or experience? Identifying new patterns of professional competence. Journal of Advanced Nursing, 61(5), 512–521. Schmidt, T. H. (2007). Organizational commitment: A further moderator in the relationship between work stress and strain? International of Journal Stress Management, 14, 26–40. Teng, C. I., Shyu, Y. I., & Chang, H. Y. (2007). Moderating effects of professional commitment on hospital nurses in Taiwan. Journal of Professional Nursing, 123(1), 47–54. Tsai, S. F., Chuang, C. M., & Chien, T. C. (2009). Evaluating nursing competency of newly employed nurses and related effects in a medical center. Cheng Vhing Medical Journal, 5(1), 8–12. Vahey, D. C., Aiken, L. H., Sloane, D. M., Sochalski, J., Busse, R., Clarke, H., et al. (2004). Nurse burnout and patient satisfaction. Medical Care, 42(2), 57–66. Wang, K. Y., Chou, C. C., & Huang, J. L. (2010). A study of work values, professional commitment, turnover intention and related factors among clinical nurses. The Journal of Nursing, 57(1), 22–34. Whelan, L. (2006). Competency assessment of nursing staff. Orthopedic Nursing, 25(3), 198–202. Received 17 February 2013
Accepted 18 November 2014 © eContent Management Pty Ltd
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