Abstract
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Purpose
The study was to develop a Clinical Nurses' Job Crafting Scale (CN-JCS) and examines its validity and reliability.
-
Methods
Data were collected from 423 clinical nurses working in general hospitals. The CN-JCS was developed according to DeVellis’s step sclae development guidelines. The CN-JCS was assessed for content validity, construct validity, item convergence/discrimination, convergent validity, and internal consistency.
-
Results
In the exploratory factor analysis, five factors and 20 items were selected. Construct validity was examined using confirmatory factor analysis, and the model fit was good. The Conceptual reliability was greater than .70 and average variance extracted value was greater than .50, indicating discriminant validity. Convergent validity was confirmed through correlations between the CN-JCS, psychological empowerment and work engagement. The scale’s reliability was established with a Cronbach's alpha of .90. The CN-JCS employs a 5-point Likert scale across 20 questions, gauging aspects such as giving meaning to work, changing the structure of work, exploring and communicating, pursuing relationship change, and positive attitude toward change.
-
Conclusion
The CN-JCS can be used to accurately assess the job craft of clinical nurses, and the measured level can be used as baseline data to improve awareness and education of nurses’ job craft.
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Key Words: Nurses; Psychometric; Working condition; Workplace
INTRODUCTION
The globalization of the healthcare environment and rapid technological advances have led to areas of work that cannot be detailed or captured in job descriptions [
1]. This situation requires organizational members to try to acquire new medical skills and knowledge and change the nature of their job by themselves [
2]. Job crafting has emerged as a concept that set of activities in which organizational members shape, transform, and redefine their jobs by physically and cognitively changing their job boundaries [
3].
The nursing workplace is a place of diversity, complexity, and control, with limited time to complete tasks, requiring nurses to perform work with professionalism and rationality [
4,
5]. Therefore, nurses engage in self-directed behaviors to reconfigure their work environment and meaning to suit their preferences and capabilities [
6]. The voluntary behavioral changes that nurses make to integrate their work with purpose are referred to as job crafting [
7]. In doing so, they seek organizational support, feedback and training [
8]. This process of nurses responding to the demands of the workplace, redesigning their jobs, and changing elements of their work is important both personally and organizationally [
9]. Active job crafting is based on autonomous changes in work and nursing practice perceptions, increasing retention intentions [
10]. Furthermore, job crafting has been reported to contribute to nurses' health by preventing fatigue and burnout [
9,
11] and improving organizational outcomes such as work engagement [
12], quality of care [
9], organizational commitment, and job satisfaction [
5]. Therefore, its practical value is high [
6,
8].
However, although job crafting in nursing is a process of adjusting the scope of work and relationships and changing perceptions, there have been only a few studies that have identified the nature of job crafting or how it is implemented in the workplace [
6]. In order to identify, develop, and improve nurses' job crafting skills, it is necessary to first identify nurses' job crafting. The scales used to measure nurses’ job crafting in Korea have been adapted from scales developed by Slemp and Vella-Brodrick [
13] and Tims et al. [
14] for general workers in foreign countries. However, these scales have the problem that they do not reflect the characteristics of the nursing field and the work of nurses. A previous study [
15], which carried out a validation study with nurses using the Tims et al.’s scale [
14], also showed that there was a limitation in not being able to measure the cognitive crafting area of nurses. Recently, a scale was developed in Korea to measure nurses’ job crafting that reflects clinical practice [
16]. However, this scale used a conceptual framework that combined the job crafting constructs of Wrzesniewski and Dutton [
3] with the constructs of the job demand-resource theory, so there is a problem in that items considered important in job crafting, such as doing extra work and reflecting interest and ability in the work, were excluded. Therefore, it is necessary to explore the nature and properties of nurses' job crafting in domestic clinical practice, and based on this, it is necessary to develop a measurement tool with demonstrated reliability and validity. This study aims to clarify the concept and properties of job crafting for nurses, develop a job crafting scale for nurses, and evaluate its validity and reliability according to the scale development guidelines of DeVellis [
17]. The results of the study can be used to establish strategies for the development and promoting job crafting for clinical nurses.
METHODS
Study Design
This study developed a scale to measure job crafting by clinical nurses. It is a methodological study to verify its validity and reliability.
Study Procedure
This study was conducted based on the 8-step scale development and validation procedure suggested by DeVellis [
17], which was largely divided into the scale development phase and the scale validation phase.
Development of preliminary items and scale
As a first step in scale development, we conducted preliminary research. This research involved a concept analysis of job crafting. As a result, the concept of job crafting among Korean nurses was defined as a set of self-directed activities that nurses engage in to reshape their jobs according to their capabilities [
6]. This concept has five attributes: “understanding the job,” “positive attitude toward attempting change,” “self-directed response,” “changing the structure of work,” and “giving meaning to job.”
To verify the concept of job crafting in the field, face-to-face interviews were conducted, asking questions about changes in nurses’ beliefs, skills, attitudes and values regarding job crafting during clinical practice. We directly contacted participants using a snowball sampling. Eight participants with various clinical experiences were selected for the interview. The careers of the eight nurses were as follows: one nurse with 1 year’ experience, two with 1–10 years' experience, three with 10–20 years' experience, and two with more than 20 years of experience. The in-depth interviews were conducted individually, once per person, in a quiet place. The interviews lasted 40 to 60 minutes. All interviews were recorded and then transcribed. The organization and analysis of the data from the participants' statements were carried out until no new information or insights about the research topic emerged (category saturation). While reading these transcripts, we extracted items that were consistent with the concept of job crafting. These transcripts were analyzed by content analysis. The results of the content analysis showed that the nurses had an “understanding of their job” that was patient-centered and clearly distinguished the tasks they had to perform. The interviews also showed that the nurses had a “positive attitude toward attempting changes” at work. In particular, the nurses were motivated by the realization that they were responsible themselves for changing their jobs according to the nursing situation. “Self-directed response” was also revealed in the in-depth interviews. For instance, the nurses actively participated in their work, expressed their opinions, and performed self-directed tasks such as sharing their work and asking for help. Under “changing the structure of work,” nurses were found to take actions to improve and change their jobs. “Giving meaning to work” was reflected through the nurses mentioning about developing self-esteem and experiencing changes in the meaning and perception of nursing. We compared and analyzed the results of the literature review in the theoretical stage and of the data collected in the field interviews. The results showed that the five factors of nurses' job crafting identified in the literature review were reflected in the nurses' interview statements. A total of 174 items consistent with the concept of job crafting were identified in the transcribed manuscripts and the literature review. Following the recommendation that the initial item pool should be three to four times larger than the final instrument [
17], the number of items for each of the five factors presented in the research findings was set at this ratio after overlapping content was arranged among these 174 items. Consequently, the pool of items for measuring job crafting for nurses comprised 53 potential items. This study used a 5-point Likert scale widely used in the social sciences. The range of scores for each question was set from 1 point for “not at all” to 5 points for “very much,” with a median value.
Content validity testing
Content validity and item vocabulary checks were done twice for the derived initial questions. In the first step of the expert panel content validity assessment, whether the 53 initial questions were well communicated and asked was discussed in a face-to-face discussion between the researcher and an expert in job crafting research and scale development. This process resulted in 43 valid items. The second step was carried out by a total of seven experts, including three professors of nursing with experience in scale development research, job crafting, and job competency research, and four clinical experts with more than 10 years of clinical experience, a master's degree or higher, and experience as a nurse manager. The item content validity index of the 43 questions ranged from 0.86 to 1.00, thus meeting the criteria of 0.78 or higher [
18]. Although all items were duplicated in the criteria, those that were considered redundant were deleted. For example, “I think that working methods can change to enhance nursing professionalism.” was considered redundant with “I think that working changes are necessary to expand the field of nursing.” and was therefore deleted. “I analyze my areas of interest by incorporating them into my work.” was similar to “I consider whether my skills and areas of interest are helpful to my work.” and was therefore removed. Items lacking meaning and inappropriate words were modified through expert review, and redundant or ambiguous items were removed. A final set of 36 items was then selected.
Vocabulary revision
An initial version of this tool was improved through linguistic refinement by a PhD Korean language professor, who advised on improving sentence flow and terminology accuracy, as well as correcting ambiguous expressions.
Pilot survey
The 36 items checked for content validity were subjected to a face validity test and an item check with 20 clinical nurse specialists working in general hospitals. The participating nurses were recruited using snowball sampling for a face validity test and item check. The age of the participants in the item review ranged from 40 to 49 years (mean, 36.90; standard deviation [SD], 8.19). Sixteen participants (80.0%) were women, and 14 (70.0%) had a bachelor's degree. Regarding clinical experience, eight individuals (40.0%) reported 1 to less than 5 years. The type of work was full-time in 16 cases (80%) and in special departments (including operating, intensive care, emergency, and artificial kidney unit) in 10 cases (50%). The average response time for the scale was 9.26 minutes (SD, 5.30), and item comprehension was 3.15 (SD, 0.37) out of 5 points, indicating that there were no ambiguous or difficult to understand items. In addition, the structure of the questionnaire was 3.35 (SD, 0.60) out of 5 and the item length was 3.40 (SD, 0.50). The feedback from this pilot survey was used to evaluate and adjust the appropriateness of the items. It was concluded that there were no difficulties with item comprehension and completion.
New Scale Validation Process
Participants
Nurses working in a general hospital for more than 6 months were included in the study. Nurses were excluded if they did not agree to participate or if they had less than 6 months of experience. When developing a scale, it is recommended to distinguish between exploratory and confirmatory factor analysis subjects, and the number of subjects was determined based on evidence that a minimum of 150 subjects is appropriate for exploratory and confirmatory factor analysis [
19]. Taking into account the dropout rate, a total of 450 participants were recruited. The data collected were divided into 225 each for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and 22 insufficient response data were excluded, so that data from 205 and 218 participants were used for EFA and CFA, respectively.
Research scale
To determine convergent validity, the correlation coefficient between the Clinical Nurses' Job Crafting Scale (CN-JCS) developed in this study and the Psychological Empowerment Instrument (PEI) [
20] and the work engagement scale [
21] was checked.
Psychological Empowerment Instrument
The PEI [
22], which has been adapted to the domestic hospital environment [
20], which has confirmed its reliability and validity. The PEI consists of 12 questions. Each item is rated on a 5-point Likert scale, ranging from 1 (“not at all”) to 5 (“very much”). The total score ranges from 12 to 60 points, with higher scores indicating greater psychological empowerment. In a previous study [
20] the Cronbach's alpha value was 0.92; in this study the Cronbach's alpha value was 0.93.
Work Engagement Scale (UWES-9)
The work engagement scale [
21], which adapted from the Dutch Utrecht Work Engagement Scale-9 (UWES-9) developed by Schaufeli et al. [
23] was used to confirm validity and reliability. The UWES-9 consists of nine questions, with three questions each for “vitality,” “commitment,” and “involvement.” Each item consists of a 7-point Likert scale ranging from 1 (“not at all”) to 7 (“very much”). The total score ranges from 7 to 63 points, with higher scores indicating greater engagement at work. Cronbach's alpha was 0.93 and 0.92 in a previous study [
21,
23] and 0.93 in this study. All scales used in this study were previously approved by the original author or translator by e-mail.
This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Konyang University (KYU 2022-01-016-001). The data collection period for October 8 to 28, 2022. A combined online and offline method was used to collect the data. A large number of research subjects were needed, and both online and offline methods were used to recruit subjects working in diverse environments. Off-line data collection was carried out in two institutions. Hospital A had over 900 beds and 500 nurses. Hospital B had approximately 300 beds and 150 nurses. After explaining the research topic and method to the nursing departments of both institutions and getting the approval of the heads of the institutions, a questionnaire was used. The online survey system of the G-portal website was used to collect online data using the snowball sampling method. Snowball sampling was carried out by sending a letter explaining the study to nurses across the city who were associated with the researchers and asking them to inform their colleagues. After agreeing to participate in the study through written and web-based consent forms, participants could answer the questionnaire. The data collected were statistically coded to prevent the disclosure of personal information. They were stored in a double-locked location and the participants were informed that the data would be destroyed 3 years after the end of the study. Personal information collected for participant payment was permanently deleted.
Data Analysis Method
The study data were analyzed using IBM SPSS version 25.0 and AMOS 27.0. The item analysis confirmed the normality and appropriateness of the collected data. The mean and standard deviation, skewness and kurtosis, and the correlation coefficient between the item and the total score were calculated for each item. Structural validity was tested using EFA and CFA. A good model fit should meet the following criteria:
χ2/df ratio ≤3; goodness of fit index (GFI) ≥0.90; and the simple adjustment index root mean square error of approximation (RMSEA) ≤0.08. In addition, the comparative fit index (CFI) of the relative fit indices were assessed using the criterion of .80 or higher. Verification of item convergent validity was based on a standardization coefficient lambda (λ) value of .50 or higher, an average variance extracted (AVE) value of .50 or higher, and construct reliability (CR) value of .70 or higher [
24]. To test for discriminant validity, the correlation coefficient between the extracted factors was checked to see if it was smaller than the square root value of the AVE [
24]. The Pearson correlation coefficient values of the CN-JCS developed in this study, the PEI [
20], and the work engagement scale [
21] were used to verify concurrent validity. The concurrent validity criterion was met if the correlation coefficient was between .60 and .80. Reliability was analyzed using Cronbach's alpha value, which represents homogeneity reliability, and Guttman's half coefficient, which represents split-half reliability.
RESULTS
Participant Characteristics
The participants were 388 women (91.7%), the mean age was 34.38±9.29, and 172 (40.7%) nurses were under 29. Additionally, 295 nurses (69.7%) had a bachelor's degree, 254 nurses (60.0%) were unmarried, and the average clinical experience was 9.36±8.33 years. The majority of nurses (79.7%) were general nurses. In terms of the distribution of wards, 162 (38.3%) nurses worked in special wards, 108 (25.5%) in other wards (including outpatients), 66 (15.6%) in internal medicine (including pediatrics) wards, 41 (9.7%) in surgical (including obstetrics) wards, and 46 (10.9%) in the integrated nursing service ward. For job satisfaction, the mean score was 6.13±1.75, ranging from 1–10 points, and 194 participants (45.9%) scored between 7 and 10 points (
Table 1).
Construct validity
Items analysis
The mean and standard deviation of the 36 data items used for the EFA were 3.15±1.04–4.53±0.61. The absolute value of skewness was 0.01–1.13, and kurtosis was 0.03–2.02. All items were judged to meet the normality assumption without serious bias problems. In addition, the correlation coefficient (r) between the items and the total score ranged from 0.31 to 0.71; therefore, 36 items were considered suitable data [
25].
Exploratory factor analysis
The EFA was carried out with 36 items. The KMO value was 0.87 and the Bartlett's test value was
χ2=3617.60 (
p<.001), suitable for factor analysis. Items with factor loadings less than .40 were removed from the factor analysis. An EFA was conducted by deleting items that did not load on any factor or loaded on two or more factors simultaneously. After the fifth EFA was performed, five factors with 20 items that met all the conditions were extracted (
Table 2). As a result of the EFA, the cumulative variance in the five factor model was 68.0%, and five factors were confirmed to have eigenvalues of 1.0 or greater. The explanatory variance ratios and factors are named as follows: Factor 1 “giving meaning to work.” (6 items, explanatory power=35.18%); Factor 2 “changing the structure of work” (4 items, explanatory power=13.28%); Factor 3 “exploring and communicating.” (4 items, explanatory power=7.21%); Factor 4 “pursuing relationship change” (3 items, explanatory power=6.67%); Factor 5 “positive attitude toward change.” (3 items, explanatory power=5.71%) (
Table 2).
Confirmatory factor analysis
The mean and standard deviation of the 20 EFA derived items ranged from 3.11±0.99 to 4.35±0.60, and the absolute values of skewness and kurtosis were 0.01–0.86 and 0.03–2.26, respectively. Twenty items were judged to meet the normality assumption without serious bias problems. In addition, the correlation coefficients (r) between the items and the total score ranged from 0.33 to 0.70; therefore, all items were judged to be suitable data [
25], and CFA was performed. The results of the CFA showed that
χ2/df, GFI, CFI, RMSEA were 2.001, 0.87, 0.92 and 0.06 (confidence interval, 0.05–0.08), respectively. This indicated a reasonable fit to the data [
26,
27].
Discriminant and convergent validity of the items
The standardized estimate of the latent variable for each question was .49–.88; AVE was .59–.73; and CR was .84–.93, confirming that the items belonging to the factor measured the same trait [
24]. In addition, the discriminant validity test of the constitutive model confirmed that the square root value of the AVE for the construct factors of this scale was .77–.83. This exceeded the correlation coefficient value of each factor, .34–.73, and thus met the criteria for discriminant validity verification. Therefore, the five factors of the 20 items were separated from each other and properly extracted (
Table 3).
Concurrent validity of the items
The CN-JCS showed a positive correlation with the PEI (r=.65,
p<.001), indicating concurrent validity. The CN-JCS also showed a positive correlation with the UWES-9 (r=.63,
p<.001), confirming concurrent validity. The level of correlation of the PEI and the UWES-9 with the sub-domains of the CN-JCS was 0.3–0.62, indicating that it secured a level of significance higher than the minimum level [
27]. Concurrent validity was therefore ensured (
Table 4).
The CN-JCS had a Cronbach's alpha of .90. Looking at each factor, the value for the first factor (6 questions) was .85, second factor (4 questions) was .83, third factor (4 questions) was .81, fourth factor (3 questions) was .73, fifth factor (3 questions) was .75. Regarding split-half reliability, the Spearman-Brown coefficient was .75 and Guttman split-half coefficient was .74 (
Table 2). The internal consistency of CN-JCS was confirmed and each item measured the same concept.
DISCUSSION
The KCN-JCS with 20 items across five factors was developed in this study to measure job crafting among clinical nurses in Korea; the scale’s validity and reliability were also examined. The first factor included “I reflect on the positive impact my work has had on my life.” and “I am reminded that providing patient-centered care is about increasing my self-esteem as a nurse.” and was named “giving meaning to work.” If members are interested in their work, they are more likely to adapt actively to their responsibilities [
3]. In particular, the meaning of work in this study included the concept of self-esteem, changes in the meaning of care and changes in the perception of care. In a previous study [
9], the fact that the quality of care improved when nurses performed job crafting well showed that the change in the meaning of care was a property of job crafting. This factor is a unique contribution of this study. This scale can be seen as a tool that incorporates nurses' job crafting attributes that give meaning to nursing work by improving patient outcomes and quality of care.
The second factor included “I change and carry out the order or procedure of work according to the situation in which I work.” and “I use products and adapt procedures to suit the work environment.” and was named “changing the structure of work.” It occurs when nurses practice nursing behaviors independently and creatively while adhering to work standards [
28]. The item in this factor that relates to nurses investing extra time and effort for patients and caregivers when needed is not included in existing scales that measure job crafting for general workers. This scale is therefore a good measure of nurses' job crafting. In addition, this scale reflects the job characteristics that require nurses to complete their work within their working hours before passing it on to the next nurse. The items in this factor are meaningful because they identify how nurses attempt to change the structure of their work by prioritizing their work within their working hours and by adapting time and procedures to their work environment. The “changing the structure of work“ factor found in this study can be considered similar to the ‘exercise of job autonomy’ of the scale developed by Lee [
16]. However, we believe that it is logically unreasonable to include job autonomy as a sub-domain of the job crafting scale because it is believed to affect job crafting [
6]. Previous studies have also reported that individuals' ability to change jobs varies depending on job autonomy [
29]. Consequently, job autonomy is considered a prerequisite for job crafting. For this reason, rather than classifying job autonomy as an attribute of nurses' job crafting, the “work structure change” factor in this tool can be seen as more accurately reflecting nurses' job crafting.
The third factor included “I suggest better ways of working to improve the quality of care.” and “I seek out knowledge and information on my own that is useful for my work.” and was named “exploring and communicating.” This is similar to the 'better work' item proposed when measuring job crafting in other professions [
29,
30], but nurses were found to engage in job crafting by actively suggesting better ways of working to improve the quality of care. What distinguishes our scale from existing scales is that it captures the fact that nurses engage in job crafting with the explicit aim of improving the quality of care. In other words, clinical nurses engage in job crafting to express their opinions about better patient-centered work and to explore better ways of providing care. Therefore, this scale is meaningful in that it suggests that nurses' job crafting involves exploration and communication for work improvement with the clear goal of patient-centered care.
The fourth factor included “I share and discuss my work-related thoughts with my colleagues.” and “I tell my coworkers or senior (supervisor) when I am having difficulty with my work and ask for advice.” and was named “pursuing relationship change.” This is similar to existing tools that involve building relationships with others to solve work problems [
3]. It also provides the same context of balancing resources and work demands according to individual capabilities and needs [
14]. Previous studies have highlighted that nurses, due to the nature of their work, have to complete assigned tasks within a limited time [
2], that the degree of job crafting is influenced by the support of their supervisors [
31], and that nurses seek relationship change by sharing common goals with and seeking advice from their colleagues [
3]. Therefore, it is significant that the scale in this study included finding beneficial relationships by sharing and discussing work-related ideas with colleagues and mentors.
The fifth factor, which included “I think we can change the way we work to improve patient satisfaction.” and “I think the order of work can be changed according to the nursing situation,” was named “positive attitude toward change.” Positive attitude to change is the first factor in the circular structure of the job crafting model. When organizational members have a desire to make work enjoyable, improve their own image, and develop good relationships with colleagues at the workplace, they are motivated to increase psychological fit [
3]. Individuals who experience self-efficacy and responsibility at work are motivated to make positive changes beyond the boundaries of their work [
32]. In this study, the “positive attitude toward change” factor included the nurses’ belief that they could change their work order and methods to improve patient satisfaction. Although other scales have included motivation for work efficiency [
29,
30], the scale in this study is different in that it can measure positive attitudes towards change through different nursing situations.
The CN-JCS consists of questions that reflect the job characteristics of clinical nurses, including work, relationships, and cognitive crafting [
13], which are elements of job crafting. Moreover, the CS-JCS showed correlations with the PEI and UWES-9. Since psychological empowerment has been identified as an antecedent of job crafting and work engagement as an outcome factor [
33], the positive associations with them may suggest that the concepts measured by the CS-JCS reflect nurses’ job crafting. Existing measurement scales had limitations in reflecting the job characteristics of nurses. Moreover, they were developed without clearly defining the concept. By contrast, the scale in this study was developed after analyzing the concept of nurses' job crafting [
6] and by empirically identifying the attributes and content of nurses' job crafting through a literature review. Thus scale consists of only 20 questions; therefore, it has the advantage of being simple and usable compared to existing scales.
However, this study has several limitations. It was a cross-sectional study, and a retest questionnaire was not administered. In the data analysis process, responses with missing values were excluded, but potential careless responses were not identified. Items were deleted based on statistical results when deriving the preliminary questions. As most of the nurses participating in this study were women, it was not possible to confirm whether the CN-JCS could be interpreted in the same way for men. Also, as the scale was developed for clinical nurses who providing direct patient care in general hospitals level and above, the results cannot be generalized to all clinical nurses. The scale did not reflect the job crafting attributes of nurses working in other settings. Therefore, the CN-JCS needs to be revised and improved for nurses working in different settings and in hospitals of different sizes.
Despite these limitations, our study has important implications for nursing management. The CN-JCS will enable research into the degree and type of job crafting nurses perform. Depending on the factors of the measurement scale, it is possible to identify which items of nurses' characteristics have high or low scores. Nursing organizations will be able to assess what nurses lack and figure out what they need to achieve in job crafting. Specific examples include improving organizational culture to help them develop positive attitudes towards change, developing educational programs to improve communication skills, developing strategies to create supportive relationships, and developing job crafting programs that give meaning to their work. Therefore, the results of this study can provide guidance on possible approaches such as individual counseling, educational programs, and organizational culture improvement strategies to improve the skills of clinical nurses according to the job crafting factors performed by nurses.
CONCLUSION
This study developed a scale to measure the job crafting of clinical nurses and verified its validity and reliability. The scale has five factors with a total of 20 items scored on a 5-point Likert scale and can be used for nurses working in general and tertiary general hospitals. The instrument's structural validity was confirmed using EFA and CFA, and the concurrent validity was verified by showing a static correlation with instruments measuring psychological empowerment and work engagement. The reliability was confirmed using Cronbach's alpha value and half-value coefficients. The CN-JCS can be used as a useful tool for measuring and evaluating job crafting in the nursing field and can contribute to the preparation of job crafting interventions.
Article Information
-
Author Contributions
Conceptualization: EJ, SH. Methodology: EJ. Formal analysis: EJ, SH. Data curation: EJ. Visualization:EJ, SH. Funding acquisition: SH. Writing - original draft: EJ. Writing - review & editing: EJ, SH. All authors read and agreed to the published version of the manuscript. All authors read and agreed to the published version of the manuscript.
-
Conflict of Interest
None.
-
Funding
This study was financially supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Science and ICT (NRF-2021R1F1A104803412).
-
Data Availability
Please contact the corresponding author for data availability.
-
Acknowledgments
None.
Table 1.General Characteristics of Participants
|
Characteristics |
Category |
n (%) |
|
Total (n=423) |
EFA (n=205) |
CFA (n=218) |
|
Gender |
Women |
388 (91.7) |
191 (93.2) |
197 (90.4) |
|
Men |
35 (8.3) |
14 (6.8) |
21 (9.6) |
|
Age (yr) |
≤29 |
172 (40.7) |
87 (42.4) |
85 (39.0) |
|
30~39 |
131 (31.0) |
66 (32.2) |
65 (29.8) |
|
40~49 |
83 (19.6) |
40 (19.5) |
43 (19.7) |
|
≥50 |
37 (8.7) |
12 (5.9) |
25 (11.5) |
|
Education level |
Diploma |
62 (14.7) |
25 (12.2) |
37 (17.0) |
|
Bachelor’s degree |
295 (69.7) |
140 (68.3) |
155 (71.1) |
|
≥Master’s degree |
66 (15.6) |
40 (19.5) |
26 (11.9) |
|
Marital status |
Single |
254 (60.0) |
122 (59.5) |
127 (58.3) |
|
Married |
169 (40.0) |
83 (40.5) |
91 (41.7) |
|
Clinical experience (yr) |
6 mo~<1 |
48 (11.3) |
20 (9.8) |
28 (12.8) |
|
1~<5 |
110 (26.0) |
57 (27.8) |
53 (24.3) |
|
5~<10 |
95 (22.5) |
44 (21.5) |
51 (23.4) |
|
10~<15 |
58 (13.7) |
34 (16.6) |
31 (14.2) |
|
15~<20 |
44 (10.4) |
16 (7.8) |
21 (9.6) |
|
≥20 |
68 (16.1) |
34 (16.5) |
34 (15.7) |
|
Position |
Staff nurse |
337 (79.7) |
165 (80.5) |
172 (78.9) |
|
Charge nurse |
39 (9.2) |
23 (11.2) |
16 (7.3) |
|
≥Unit managers |
47 (11.1) |
17 (8.3) |
30 (13.8) |
|
Working department |
Medicine |
66 (15.6) |
31 (15.1) |
35 (16.0) |
|
Surgical |
41 (9.7) |
19 (9.3) |
22 (10.1) |
|
Comprehensive |
46 (10.9) |
19 (9.3) |
27 (12.4) |
|
Special |
162 (38.3) |
74 (36.1) |
88 (40.4) |
|
Others |
108 (25.5) |
62 (30.2) |
46 (21.1) |
|
Hospital type |
General |
357 (84.4) |
175 (85.4) |
182 (83.5) |
|
Tertiary general |
66 (15.6) |
30 (14.6) |
36 (16.5) |
|
Job satisfaction |
1~3 |
36 (8.5) |
21 (10.2) |
15 (6.9) |
|
4~6 |
193 (45.6) |
86 (42.0) |
107 (49.1) |
|
7~10 |
194 (45.9) |
98 (47.8) |
96 (44.0) |
Table 2.Exploratory Factor Analysis (Final Stage)
|
Item No. |
Factor loading |
|
F1 |
F2 |
F3 |
F4 |
F5 |
|
Factor 1: Giving meaning to work |
|
34 |
I reflect on the positive impact that my work has had on my life. |
.84 |
-.01 |
.09 |
-.04 |
-.08 |
|
32 |
I am reminded that providing patient-centered care is about increasing my self-esteem as a nurse. |
.83 |
-.18 |
.11 |
-.01 |
-.06 |
|
33 |
I see my work as related to my purpose in life. |
.83 |
-.09 |
-.11 |
.01 |
.14 |
|
35 |
I think it is worthwhile to make patients and guardians happy with my work. |
.74 |
.03 |
.11 |
-.10 |
.02 |
|
31 |
I think I grow as a nurse through my work. |
.68 |
.05 |
-.20 |
.23 |
.06 |
|
36 |
I remind myself that my mission is to improve the health of my patients through my work. |
.63 |
.31 |
-.04 |
-.08 |
-.05 |
|
Factor 2: Changing the structure of work |
|
23 |
I change and carry out the order or procedure of work according to the situation in which I work. |
.07 |
.83 |
-.15 |
-.15 |
.18 |
|
24 |
I use products and adapt procedures to fit the work environment. |
-.02 |
.82 |
.06 |
.13 |
-.27 |
|
25 |
I set and follow my own priorities for work. |
-.10 |
.72 |
.09 |
-.03 |
.11 |
|
26 |
I give extra time and effort to patients and care givers depending on the work situation. |
.01 |
.49 |
.17 |
-.02 |
.14 |
|
Factor 3: Exploring and communicating |
|
12 |
I suggest better ways of working to improve the quality of care. |
-.01 |
.01 |
.85 |
-.14 |
.11 |
|
13 |
I actively present opinions to improve the work. |
-.01 |
-.04 |
.78 |
.00 |
-.01 |
|
16 |
I seek out knowledge and information on my own that is useful for my work. |
.00 |
.10 |
.49 |
.21 |
-.04 |
|
17 |
I find and use things or information that help me do my work. |
.10 |
.11 |
.47 |
.21 |
.01 |
|
Factor 4: Pursuing relationship change |
|
15 |
I share and discuss my work-related thoughts with my colleagues. |
-.04 |
-.00 |
.02 |
.76 |
.02 |
|
14 |
I tell my coworkers or senior (supervisor) when I am having difficulty with my work and ask for advice. |
-.09 |
-.07 |
-.02 |
.72 |
.15 |
|
18 |
I actively seek out people to advise me on my work. |
.22 |
.02 |
.02 |
.53 |
-.05 |
|
Factor 5: Positive attitude toward change |
|
8 |
I think we can change the way we work to improve patient satisfaction. |
.09 |
-.09 |
.19 |
-.05 |
.69 |
|
9 |
I like to think that my job can change to fit the environment of the department I work in. |
-.04 |
-.01 |
-.02 |
.12 |
.66 |
|
10 |
I think the order of work can be changed according to the nursing situation. |
-.03 |
.26 |
-.06 |
.10 |
.59 |
|
Initial eigenvalues |
7.04 |
2.66 |
1.44 |
1.33 |
1.14 |
|
Initial percentage of variance |
35.18 |
13.28 |
7.21 |
6.67 |
5.71 |
|
Percentage of cumulative variance |
35.18 |
48.46 |
55.67 |
62.34 |
68.05 |
|
Cronbach’s α coefficient |
.85 |
.83 |
.81 |
.73 |
.75 |
|
Kaiser-Meyer-Olkin=0.86, Bartlett's Χ2=2,163.71 (df=190, p<.001) |
Table 3.Discriminant Validity of CN-JCS (N=218)
|
Item No. |
Correlation r2
|
AVE |
C.R. |
|
F1 |
F2 |
F3 |
F4 |
F5 |
|
F1 |
34 |
0.79*
|
|
|
|
|
.64 |
.93 |
|
32 |
|
|
|
|
|
|
|
33 |
|
|
|
|
|
|
|
29 |
|
|
|
|
|
|
|
35 |
|
|
|
|
|
|
|
31 |
|
|
|
|
|
|
|
36 |
|
|
|
|
|
|
|
F2 |
24 |
.40 |
0.85*
|
|
|
|
.73 |
.92 |
|
23 |
|
|
|
|
|
|
25 |
|
|
|
|
|
|
26 |
|
|
|
|
|
|
F3 |
12 |
.52 |
.56 |
0.76*
|
|
|
.59 |
.83 |
|
13 |
|
|
|
|
|
16 |
|
|
|
|
|
17 |
|
|
|
|
|
F4 |
15 |
.41 |
.49 |
.53 |
0.83*
|
|
.68 |
.87 |
|
14 |
|
|
|
|
18 |
|
|
|
|
F5 |
8 |
.34 |
.73 |
.53 |
.54 |
0.81*
|
.67 |
.86 |
|
9 |
|
|
|
10 |
|
|
Table 4.Concurrent Validity and Reliability (N=218)
|
Factor |
Min |
Max |
M±SD |
r (p) |
|
Psychological empowerment |
Work engagement |
|
F1 |
1.29 |
5.00 |
3.72±0.68 |
.53 (<.001) |
.61 (<.001) |
|
F2 |
2.00 |
5.00 |
4.10±0.53 |
.50 (<.001) |
.39 (<.001) |
|
F3 |
2.00 |
5.00 |
3.80±0.64 |
.62 (<.001) |
.48 (<.001) |
|
F4 |
1.67 |
5.00 |
4.15±0.57 |
.36 (<.001) |
.40 (<.001) |
|
F5 |
2.00 |
5.00 |
4.18±0.53 |
.35 (<.001) |
.30 (<.001) |
|
CN-JCS |
2.38 |
5.00 |
3.93±0.46 |
.65 (<.001) |
.63 (<.001) |
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