Nurse Media Journal of Nursing e-ISSN: 2406-8799, p-ISSN: 2087-7811 https://ejournal.
id/index.
php/medianers 11.
:210-218.
August 2021 https://doi.
org/10.
14710/nmjn.
ORIGINAL RESEARCH
Work Index and Contextual Variables as Predictors of Emergency NursesAo Career Success Ali Mohammadzadeh1.
Elnaz Asghari1.
Mansour Ghafourifard1 1Faculty of Nursing and Midwifery.
Tabriz University of Medical Sciences.
Iran Article Info Abstract Article History:
Received: 18 April 2021 Revised: 24 July 2021 Accepted: 3 August 2021 Online: 27 August 2021 Keywords:
Career success.
Corresponding Author:
Elnaz Asghari Faculty of Nursing and Midwifery.
Tabriz University of Medical Sciences.
Iran Email: asghari.
elnaz@gmail.
Background: The stressful work environment of emergency departments needs competent nurses to be successful in their careers.
Although the work environment significantly affects nursesAo quality of care and job satisfaction, studies on the relationship between the work environment and career success are still limited.
Therefore, it is imperative to investigate how individual and environmental factors predict the career success of nurses in the emergency department.
Purpose: This study was conducted to identify the predictors of career success of emergency nurses based on work index and contextual variables.
Methods: This cross-sectional study was conducted in eight university hospitals in Tabriz.
Iran.
The career success scale and the Nursing Work Index (PES-NWI) were completed by 193 emergency nurses selected using a stratified random sampling Data were analyzed using a multivariate regression analysis.
Results: The mean and standard deviation of nursesAo scores were 168.
59A15.
54 for the career success scale .
ange: 39-.
64A0.
48 for the PES-NWI .
ange: .
According to multiple linear regression analysis, nursing work index and hospital type were significant predictors of nursesAo career success (R2=0.
17, adjusted R2=0.
11, p<.
Conclusion: Nursing work index and hospital type were significant predictors of nursesAo career success.
Nursing managers and leaders should provide healthy work environments to help nurses increase their career success.
How to cite: Mohammadzadeh.
Asghari.
, & Ghafourifard.
Work index and contextual variables as predictors of emergency nursesAo career success.
Nurse Media Journal of Nursing, 11.
, 210-218.
https://doi.
org/10.
14710/nmjn.
Introduction Career success refers to the accomplishment and success of people in their careers (Asghari et al.
, 2.
Career success is an important concept that leads to the improved professional behavior and outcomes (Han & Wang, 2.
Successful employees usually do a better job, need less supervision and guidance, have less absenteeism, are role models for novice employees, and make fewer mistakes while working (Asghari et al.
, 2.
Career success is a multidimensional concept (Li et al.
, 2.
Zamanzadeh et al.
, in a qualitative study, defined career success in nursing with the dimensions of providing high quality care, being an exemplary employee, embarking on career growth, having positive personal attributes, and being internally satisfied.
Moreover, the evidence shows that nursesAo career success is related to important outcomes like job satisfaction, burnout, and quality of nursing care (Dan et al.
, 2018a.
Elmi et al.
, 2.
The evidence suggests that career success is related to and influenced by individual and environmental factors (Spurk et al.
, 2.
Innovative behavior, self-efficacy (Dan et al.
, 2018.
, personality traits, gender, race (Spurk et al.
, 2.
are personal characteristics related to career In a qualitative study to define the concept of career success in nursing, having positive personal attributes was one of the themes of this study (Zamanzadeh et al.
, 2.
In another study to develop a scale for nursesAo career success, it was found that nursesAo individual abilities, such as specialized knowledge and skills, had the most important load in the structure of the scale.
Effective self-regulation personality trait was also another subscale in this scale (Asghari et al.
Existing studies show that not only individual factors but also work-related factors affect career success.
Societal norms like salary, job level, promotion history, or job prestige (Spurk et , 2.
and environmental factors like relationship with co-workers and having the necessary equipment and facilities to do the job are among work-related factors that impact career success Copyright A 2021.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 11.
, 2021, 211 (Synmez et al.
, 2.
In addition, resources that support coping with expected and unexpected challenges and harms are considered critical to achieving career success (Spurk et al.
, 2.
The work environment has a significant impact on the career success of nurses in the emergency department in Han and WangAos .
Furthermore.
Wang et al.
indicated that career success is related to the work environment in nurses with a masterAos or doctoral degree.
their study, hierarchical regression analysis showed that the work environment positively correlates with career success for three of the four subscales.
The working environment of the emergency department is more complicated than that of ordinary departments, with a wide range of patients, many severe illnesses, rapid changes in patientAos conditions, and a heavy nursing workload.
It is necessary to rescue critically ill patients and deal with emergencies, which leads to high mental stress and a long-term overload of nursing staff (Chang et al.
, 2020.
Fitriana et al.
, 2.
The turn-over rate is high, and patientsAo conditions are usually complex (Han & Wang, 2.
In addition, heavy workload and shortage of emergency nurses are among the most common stressors in this department (Alahmadi & Alharbi, 2018.
Portero de la Cruz et al.
, 2.
NursesAo interest in work and job satisfaction is affected in these departments, leading to burnout and reduced satisfaction (Han & Wang, 2.
A study in Iran showed that more than 60% of emergency nurses have moderate levels of burnout, stress, and job dissatisfaction (Tavakoli et al.
, 2.
In addition, research has shown that there is a higher incidence of secondary traumatic stress symptoms in emergency nurses.
Its identified risk factors include repeated exposure to trauma, death, chronic stressors, and work pressure (Vand Tamadoni et al.
, 2.
On the other hand, the stressful work environment of emergency departments needs competent nurses to be successful in their careers.
Improving nursesAo work environment has been recommended as an effective strategy to increase the opportunity to provide quality care and remedy nursing shortages by promoting nursesAo job satisfaction (Albashayreh et al.
, 2019.
Portero de la Cruz et al.
, 2020.
Tavakoli et al.
Although the nursing work environment has been reported to affect nursesAo job satisfaction significantly, studies on the relationship between the work environment and career success are still limited (Wang et al.
, 2.
Therefore, it is imperative to increase our understanding of how individual and environmental factors predict the career success of nurses in the emergency department, so research into career success can expand, and, with this, organizational shift into helping nursing staff achieve career success in their practice.
This study was conducted to identify the predictors of career success among emergency nurses based on work index and contextual Methods 1 Research design A cross-sectional study was conducted to identify the predictors of career success among emergency nurses based on work index and contextual variables.
2 Setting and samples The study population was nurses working in the emergency departments of eight university hospitals in Tabriz.
Iran.
Inclusion criteria were nurses having at least six months of experience in the emergency department and providing direct care to the patients.
Scales with Ou10% missing answers to survey questions were excluded from the study (Grove et al.
, 2.
It should be noted that in Tabriz, nurses should have at least a bachelorAos degree to work in a hospital.
At the time of the study, the total numbers of nurses working in the emergency department of the studied hospitals were 278, of whom 270 were eligible.
Using Krejcie and MorganAos table (Adam, 2.
, the minimum sample size was 159 people.
We considered a 30% probability of attrition rate.
hence, the research tools were distributed among 207 nurses.
The sampling was conducted using a stratified random method.
All hospitals were included in the study, and each hospital was considered one stratum.
The sample size of each stratum was proportionate to the population size of the stratum.
The nursesAo code was then written, and the samples were selected randomly.
In this study, from the 207 distributed questionnaires, however, 14 questionnaires were not completely filled .
ith more than 10% incomplete item.
therefore, they were not included in the Thus, finally, 193 questionnaires were included in the data analysis.
Copyright A 2021.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 11.
, 2021, 212 3 Measurement and data collection Data collection lasted from February to April 2021.
After obtaining permission from the authorities, the researcher introduced himself to the nurses and explained the studyAos objectives.
Next, the researcher asked nurses to complete pen-and-paper questionnaires with enclosed sealable envelopes including background characteristics, the NursesAo Career Success Scale, and the Practice Environment Scale of the Nursing Work Index (PES-NWI).
Those are free to the The nursesAo career success scale developed by Asghari et al.
was used to measure nursesAo career success.
It consists of 39 items and four subscales: Expected Career Progress with 15 items.
Providing Quality Care with 10 items.
Effective Self-Regulation with 9 items, and Person-Organization Fit with 5 items.
The response to each item was based on a 5-point Likert scale ranging from 1 = never to 5 = always.
Total scores were generated by summing the scores of all items.
The range of scores on this scale was between 39 and 195.
the higher scores indicate a higher level of career success.
The validity and reliability of this scale have been assured in a previous study by Asghari et al.
with a CronbachAos alpha coefficient of 0.
93 and excellent average content validity (CVI=0.
Range: 0.
The PES-NWI was used to measure nursing work environment conditions.
This tool consists of 31 items with 5 subscales: Nurse Participation in Hospital Affairs .
Nursing Foundations for Quality of Care .
Nurse Manager Ability.
Leadership and Support of Nurses .
Staffing and Resource Adequacy .
, and Collegial NurseAa Physician Relations .
The answer to each item is scored based on the 4 points Likert scale ranging from completely agree .
to completely disagree .
The average score of items was calculated for each subscale and the total score.
The range of scores in each subscale and the scale was 1 to 4 (Lake, 2.
The validity and reliability of the Persian version of this scale have already been assessed in a past study.
In which.
Cronbach and Pearson alpha coefficient for the whole instrument and the extracted factors was 0.
70 to 0.
(Elmi et al.
, 2.
4 Data analysis Data analysis was performed by SPSS version 16 (SPSS Inc Chicago.
IL.
USA).
The normal distribution of data was confirmed by Kolmogorov Ae Smirnov test.
The relationship between career success with contextual variables and PES-NWI was investigated by the t-test.
ANOVA, and Pearson correlation coefficient.
A p-value <0.
05 was considered statistically significant.
An initial simple linear regression analysis was also performed to evaluate the potential factors associated with nursesAo career success.
Furthermore, the potential independent variables .
<0.
(Kleinbaum et al.
, 2.
such as work experience in nursing, work experience in the current unit, hospitals, and total score of PES-NWI were put into a multiple linear regression 5 Ethical considerations This study was conducted after obtaining ethical approval from the Regional Ethics Committee of Tabriz University of Medical Sciences (Ref.
IR.
TBZMED.
REC.
The purpose of the study, voluntary participation and confidentiality of data were explained to nurses, and the participants signed a paper informed consent form.
Results 1 Characteristics of the respondents The mean age of nurses was 32.
43A5.
97 years .
anged from 22-54 year.
The nursesAo work experience in the nursing profession and the emergency department was 8.
73A5.
97 and 62A4.
20 years, respectively.
Nurses worked an average of 28.
80A4.
22 shifts per month.
Table 1 shows other background characteristics of the participants.
2 The relationship between career success and other variables The mean and standard deviation of nursesAo scores were 168.
59A15.
54 from the career success scale and 2.
64A0.
48 from PES-NWI.
The mean scores of each subscale are shown in Table Copyright A 2021.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 11.
, 2021, 213 Table 1.
The personal and occupational characteristics of nurses .
Variable Gender Male Female Marital Status Single Married Education Bachelor Masters Shift Fixed Rotational Hospital General 1 General 2 Pediatric Cardiac Gynecology 1 Gynecology 2 Ophthalmology 1 Ophthalmology 2 Psychiatric Orthopedic Table 2.
Career success and PES-NWI subscales .
Scale
Subscales Career Success
Expected Career Progress
Providing Quality Care
Effective Self-Regulation Person-Organization Fit
Total Career Success
PES-NWI
Nurse Participation in Hospital Affairs Nursing Foundations for Quality of Care Nurse Manager Ability.
Leadership, and Support of Nurses Staffing and Resource Adequacy Collegial NurseAaPhysician Relations Total PES-NWI Mean Range of Score Min Max The relationship between career success with contextual variables and the PES-NWI is presented in Table 3.
According to the results, career success showed a statistically significant relationship with the variables of age .
<0.
, type of hospital .
<0.
, and subscale of Nursing Foundations for Quality of Care of the PES-NWI scale .
<0.
3 Predictors of emergency nurseAo career success Multiple regression analysis was used to predict the career success of nurses.
By controlling for independent variables such as demographic and work-related characteristics, factors including PES-NWI and type of hospital were significant predictors of the nursesAo career success (R2=0.
17, adjusted R2=0.
11, p<0.
The results showed that 19% of the variance changes in nursesAo career success could be explained by the total score of the PES-NWI (=0.
19, p<0.
The findings also showed that working in some specialty hospitals (Gynecology.
Neurology, and Orthopedi.
was associated with higher career success (Table .
Copyright A 2021.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 11.
, 2021, 214 Table 3.
The relationship between career success with background characteristics and PES-NWI .
Predictors Nurse participation in hospital affairs Nursing foundations for quality of care Nurse manager ability, leadership and support of nurses Staffing and resource adequacy Collegial nurseAaphysician relations Total PES-NWI Gender Marital status Education Shift Hospital Age Work experience Work experience in emergency department Number of shift per month Statistics r=0.
r=0.
r=0.
r=0.
r=0.
r=0.
t=-1.
t=-1.
t=-0.
t=1.
F=2.
21***
r=-0.
r=0.
r=-0.
r=0.
p-value * Pearson.
** t-test.
*** ANOVA
Table 4.
Results from multivariate regression analysis of nursesAo career success .
Independent variables Beta () p-value (Constan.
Work experience in nursing .
Work experience in the current unit .
Hospital General 1 General 2 Pediatric Cardiac Gynecology 1 Gynecology 2 Ophthalmology 1 Ophthalmology 2 Psychiatric Total score of PES-NWI <0.
95% CI for B Lower Upper Note.
R2=0.
17, adjusted R2=0.
SE=14.
F .
, .
=2.
99, p<0.
Dependent variable: Nurses career success.
PES-NWI=Practice Environment Scale of Nursing Work Index, *p<0.
Discussion This study aimed to identify the predictors of career success among emergency nurses based on the work environment index and contextual variables.
The mean and standard deviation of nursesAo career success in this study was 168.
59A15.
ange: 39-.
Since no cut-off point has been set for the nursesAo career success scale (Asghari et al.
, 2.
, this number cannot be judged However, this finding probably indicates that the samples in this study are not far from ideal career success.
For example, in a study by Asghari et al.
, who used the same scale to evaluate the career success of 530 nurses, the mean and standard deviation of work success was 139.
14A12.
In another study in China, the average career success scores of 848 emergency nurses from 12 hospitals was 31.
42A5.
ange:18-.
(Han & Wang, 2.
Comparison of these findings shows that in studies whose research population was nurses working in all clinical wards, career success is less than the present studyAos findings, the target group of which is nurses working in the emergency department.
In other words, the career success of emergency nurses seems to be higher than the average of nurses working in other settings.
NursesAo scores on all subscales of career success were higher than the median score except for the Effective Self-Regulation subscale.
In another study on nurses of all clinical wards with the Copyright A 2021.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 11.
, 2021, 215 same instrument, participantsAo scores in all fields except Providing Quality Care were lower than the median (Asghari et al.
, 2.
Although it is not possible to make a more accurate judgment due to the lack of a cut-off point for subscales, it seems that emergency nurses meet Expected Career Progress and Person-Organization Fit of career success more than other wards.
Since the work environment of the emergency department is special and complex, it is necessary for the nurses who work there to have special competencies, knowledge, and skills (Shahbazi et al.
, 2.
In other words.
Providing Quality Care and having Expected Career Progress are of the essential characteristics of emergency nurses, which also enriches the criteria for career success.
The results of the current study showed that the average score of the PESAaNWI was 2.
ange: 1-.
This relatively moderate score indicates the unsatisfactory working conditions of the nurses working in the university hospitals.
Similar to these results, the score of PESAaNWI for 327 nurses was about the median .
59A0.
(Kapucu et al.
, 2.
In a systematic review, this score for non-magnetic hospitals was 2.
92, for emerging/aspiring magnet was 2.
and for magnet hospitals were 2.
00 (Swiger et al.
, 2.
This about the median scores of PESAaNWI highlights the need for authorities to provide urgent treatment to improve nursesAo working environment, especially in critical wards such as the emergency department.
In the current study, the highest score obtained in the PES-NWI was related to the subscale of Collegial NurseAaPhysician Relations .
77A0.
, and the lowest score was related to the subscale of Staffing and Resource Adequacy .
53A0.
In other words, nurses perceive collegial nurse-physician relations and the foundation for quality of care as the most desirable dimensions of the work index.
This is consistent with a similar study in Oman (Albashayreh et al.
and United Arab Emirates (AlAaMaaitah et al.
, 2.
Such findings may be attributed to the availability of multidisciplinary teamwork encouragement standards and the existence of quality systems recognized by health care quality accreditation in study settings (Albashayreh et al.
In contrast, nurses perceive staffing and resource scarcity as the least desirable aspects, which agrees with a recent systematic review of 46 studies from 28 countries (Swiger et al.
, 2.
suggesting that in Iran, the global problem of nursing shortage is a problem.
Using regression analysis to predict nursesAo career success showed that 19% of nursesAo career success variance could be explained by the total score of the PES-NWI (=0.
19, p<0.
A study by Wang et al.
, using hierarchical regression analysis, showed that the work environment has a positive relationship with the career success of nurses with a postgraduate degree in three out of four subscales (Wang et al.
, 2.
Thus, an appropriate work environment is a determining factor for career success and the quality of care (Copanitsanou et al.
, 2.
Among the contextual variables, only the type of hospital .
ynecology and ophthalmolog.
could predict the variance of career success.
Since all employment and wage conditions are similar in all hospitals.
this finding strengthens the relationship between work index and career success.
It shows how important is the work index in nursesAo career success.
Similar to our results, another study conducted in Iran to predict nursesAo career success showed that none of the demographic characteristics could predict nursesAo career success (Asghari et al.
, 2.
This finding contradicts the results of previous studies, which believed that both individual and environmental factors affect career success (Spurk et al.
, 2.
For example, age is one of the demographic characteristics that is considered an important variable related to career success (Synmez et al.
Spurk et al.
, 2.
In this study, age could not predict changes in career success variance.
However, the age range of our sample was wide .
anged from 22-54 year.
Remarkably, it was found that the elderly population is exposed to age-related stereotypes and assesses their abilities .
nd consequently career succes.
lower than young people (Praskova & Johnston, 2.
Further.
AubeginnersAy address the development of professional and task-related skills as key elements in increasing their employability, while older workers understand that their employment increases with opportunities to expand expertise in adjacent / different fields (Zamanzadeh et al.
, 2.
This may influence the definition of career success for adults in different stages of age.
Although career success is important at every stage of adult life, the focus and motivation of a career may depend on whether one is preparing for the future career or it is the transition to another stage (Praskova & Johnston, 2.
Future studies are needed to explore this in more detail.
Copyright A 2021.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 11.
, 2021, 216 Implications and limitations The findings of the study have several implications for nursing.
About the implications of the study for nursing research, this study highlights the importance of the work index in nursesAo career success in health care organizations.
Moreover, this study constitutes the primary data for future local and national studies.
In addition, it reinforces the research findings if future research involves a qualitative approach that examines other health care professionalsAo readiness for improving work index and increasing career success.
For practical implications, this study provides information to health care policymakers and leaders seeking to improve emergency departmentsAo work index and respond to organizational change efforts.
Nursing managers are the key to improve the workplace of healthcare centers to promote positive outcomes for organizations, patients, and nurses.
Future efforts to improve career success in nurses of emergency departments need to improve the practice environment and reduce harassment in the In terms of social implications, it is important to know how well health care professionals, especially nurses, understand the impact of the work index on career success and why a particular work index is important in implementing change to increase career success.
Although this is one of the first studies in this field, it also has some limitations.
One of the limitations of the study was the length of scales that had to be completed.
Accordingly, it is recommended that a shortened form of these tools be developed in future research.
Another limitation is the nature of the concept of career success.
Career success is a multidimensional concept that in this study has been examined only with a self-report.
It is suggested that other methods of data collection be used in future research, such as observing or asking officials and Conclusion According to the findings, although nurses showed acceptable career success, they perceived the workplace condition unsatisfactory.
In addition, the study showed that nursesAo work index could influence nursesAo career success.
Therefore, nurse managers and leaders should improve work environments to help nurses obtain a higher level of career success.
Moreover, this study indicates the need for further studies on the career success of emergency nurses and changes in the work environment to increase the career success of nurses, especially emergency nurses.
Acknowledgment We thank all nurses who participated in this study.
Author contribution EA: Study design, study supervision, manuscript writing.
AM: Data collection, manuscript MG: Data analysis, manuscript writing.
Conflict of interest The authors declare no conflicts of interest.
References