Decent work perception among PICU nurses: current status and influencing factors

Decent work is conceptualized as an individual’s entitlement to dignified, autonomous, equitable, and secure employment opportunities that are predicated on the preservation of personal dignity [1]. Scholarly research underscores that the core of the decent work construct is the realization of an individual’s capacity to secure employment rights, ensure job equality, and partake in work protections and social dialogue [2]. The extant literature delineates that the perception of decent work is encapsulated by the individual’s assessment of job salary, job positions, career progression, professional acknowledgment, and the work environment, all of which are determinants of career selection [3]. In the contemporary context, the full-scale adoption of China’s “two-child” policy has led to an escalation in the clinical workload for pediatric nurses and has exacerbated the existing dearth of nursing personnel [4]. Consequently, the imperative to enhance the work quality of pediatric nurses and mitigate staff attrition has emerged as a pivotal area of inquiry within the realm of nursing management research [5].

Previous studies have consistently identified the pediatric intensive care unit (PICU) nursing profession as being characterized by significant occupational stress, challenging environmental conditions, suboptimal safety metrics, inadequate financial compensation, and limited opportunities for professional advancement [6, 7]. These factors have been empirically linked to high levels of dissatisfaction among pediatric nursing staff. Such dissatisfaction can lead to a decline in professional enthusiasm or even result in staff turnover. The consequences of this dissatisfaction are manifold, potentially leading to increased patient-nurse conflicts, medical errors, and exacerbating the existing shortage of pediatric nursing personnel [8]. Understanding the perception of decent work among pediatric nurses is crucial, as it can inform strategic interventions designed to enhance the quality of nursing work and reduce the likelihood of nurses seeking employment elsewhere [9]. However, the current understanding of decent work experienced by PICU nurses remains limited. Therefore, this study aims to elucidate the prevailing state and determinants of the sense of decent work experienced by PICU nurses. This knowledge would provide empirical evidence and relevant directives that contribute to the improvement of pediatric nursing care and improvement of pediatric care rates.

This investigation was conducted as a cross-sectional survey, which was granted ethical clearance by the Institutional Review Board of the Children’s Hospital of Nanjing Medical University (Approval Number: 202502008-1). Prior to participation, written informed consent was secured from all enrolled nursing professionals, ensuring compliance with ethical standards and participant autonomy.

This study has identified that PICU nurses generally perceive their work and profession as lacking in decent work conditions. Previous research has highlighted the importance of workers having the right to express their wishes and participate in democratic management within their workplace [16]. At present, the emphasis on nurses’ participation in hospital or departmental management and their rights to make decisions on patient medical behavior is gradually increasing in most hospitals, and pediatric nurses have a certain sense of ownership towards their work and unit [17, 18]. Furthermore, our investigation revealed that the aspects of job rewards and career development are particularly undervalued, attributed to the comparatively modest welfare and salary that pediatric nursing professionals receive, coupled with limited avenues for career advancement. Currently, within the Chinese hospital system, nurses are generally accorded lower compensation and benefits across the board, including but not limited to salaries, welfare, opportunities for advancement, vacation entitlements, and the availability of professional title promotions, when juxtaposed with their medical counterparts [19, 20]. Extant research underscores that the majority of pediatric nurses contend with average economic earnings and encounter significant obstacles in the pursuit of professional advancement, which in turn diminishes their perception of dignified l work in terms of career progression and the salary they receive [21]. Therefore, it is urgent to enhance the decent work perception among PICU nurses.

The finding that PICU nurses with older age perceive their work as more decent aligns with broader trends observed in healthcare professions. As nurses age, they often accumulate more experience and expertise, which can lead to increased job satisfaction and a higher perception of decent work. This is supported by research indicating that job satisfaction among nurses tends to improve with age, as they become more proficient in their roles and gain greater autonomy [22]. Additionally, senior nurses may have had more opportunities to influence their work environment and advocate for better working conditions, further enhancing their perception of decent work [23]. This aligns with the broader concept of decent work, which encompasses not only financial compensation but also job security, respect, and opportunities for professional development. Therefore, implementing a performance-based compensation system that rewards experience and expertise may help bridge the gap in job satisfaction between younger and older nurses [24]. This approach has been shown to increase work enthusiasm and satisfaction, particularly among nurses with more experience. By linking compensation to performance and experience, younger nurses may feel more motivated to develop their skills and advance in their careers. Additionally, fostering a supportive work environment that values and recognizes the contributions of all nurses, regardless of age, is crucial [25]. This can be achieved through regular feedback sessions and recognition programs that acknowledge the diverse skills and experiences of the nursing staff.

The findings of this study indicate that educational level is a determinant of the decent work perception among pediatric nurses, with higher educational qualifications correlating with a lower sense of decent work among PICU nurses. Previous research has shown that many nurses with master’s or doctoral degrees are still engaged in clinical nursing work similar to that of nurses with associate or bachelor’s degrees [26]. Hospitals have not fully valued the involvement of advanced nursing personnel in internal department management, patient treatment plan formulation, leadership or participation in nursing research, attendance at academic conferences, or participation in continuing medical education and training, which, despite offering higher income levels than those with associate or bachelor’s degrees, still fall short of salary of peers in clinical medicine [17, 27, 28]. This significantly restricts their career development and professional recognition, thereby diminishing their decent work perception. Moreover, our research revealed that the higher the professional title of pediatric nurses, the greater their sense of decent work. Nurses with higher professional titles possess extensive clinical experience, strong management capabilities, more opportunities for further education, ample room for promotion, and often take on key roles in quality control and management within their departments [29]. They have a strong sense of self-worth, which contributes to their heightened decent work perception [30]. Additionally, higher professional titles are associated with greater economic income and higher status within the hospital, which in turn enhances their decent work perception [31]. This suggests that nursing managers should fully consider the career expectations of nurses. They should establish a scientific ranking management system based on the technical level, work ability, and educational background of nurses, implement stratified management of nursing talent, and create suitable positions to expand the career development paths of nurses [32, 33]. This approach will enable them to gain a sense of value and dignity in their work, thereby improving job satisfaction and the decent work perception.

The wage income of pediatric nurses represents a fundamental goal of their work input, serving as one of the manifestations of the value of their work. Earning a higher income not only enhances the quality of life for the nurses and their families but also instills a sense of return and respect for their efforts, thereby elevating their sense of decent work [34]. Achieving a higher level of work income not only improves the living standards of the nurses and their families but also makes pediatric nurses feel that their contributions are rewarded and respected, thus enhancing their decent work perception [35]. Therefore, it is recommended that hospitals, when formulating compensation distribution plans, should take into account the value of nurses’ knowledge and skills, fully reflecting respect for the value of their work, and improve the nurses’ decent work perception in terms of salary and benefits [36, 37]. Workplace violence encompasses verbal abuse, threats, physical assaults, and sexual harassment [38]. The findings of this study indicate that the incidence rate of workplace violence among pediatric nurses is 65.34%, which is in line with the results of related studies, underscoring the concerning reality that pediatric nurses are frequently subjected to workplace violence [39, 40]. The study reveals that pediatric nurses who have experienced workplace violence exhibit a lower sense of decent work compared to those who have not, due to the psychological harm that most victims of workplace violence endure. This can lead to a range of negative emotions and behaviors, such as fear, anxiety, mental lethargy and decreased work enthusiasm, which in turn increase job burnout, turnover rates, and diminish job satisfaction and sense of achievement, directly lowering their sense of decent work [41‐43]. Currently, the nursing profession is generally characterized by high work pressure and salary standards that do not reflect the professional nature of nursing work [44]. Nurses often face verbal and behavioral workplace violence, leading to a perception of low subjective social status. Studies have found that subjective social status is a major factor affecting nurses’ job satisfaction and turnover intentions, and it positively influences their perception of decent work [45]. When an individual’s subjective social status is high, it strengthens their sense of professional identity and pride, allowing them to better appreciate the meaning and enjoyment of their work, thus gaining a sense of decent work [46, 47]. Hospital administrators should value the clinical decision-making rights of nurses, enhance their sense of ownership in their work, and increase their professional identity [48, 49]. Additionally, they should improve nurses’ emergency response capabilities to workplace violence and provide opportunities for nurses to learn and participate in academic exchanges [50]. Therefore, to enhance nurses’ perception of decent work, efforts can be made to ensure a safe professional environment, improve salary and benefits, and foster a social atmosphere that respects and cares for nurses [51].

This survey, while providing valuable insights, is not without its limitations and requires careful consideration. Firstly, the research is confined to a single-center study, which, despite its focused approach, is accompanied by a relatively modest sample size. This constraint may introduce potential biases, as the study outcomes might not fully capture the spectrum of population and regional variations that could influence the perception of decent work among pediatric nurses. Secondly, the survey has incorporated a finite set of influencing factors that are pertinent to the study’s objectives. However, it is acknowledged that the scope of these factors is limited, and there may exist additional variables that significantly impact the sense of decent work experienced by pediatric nurses. These unexplored factors could include aspects of workplace culture, interpersonal dynamics, or broader societal attitudes towards the nursing profession. Thirdly, the gender distribution in this study is significantly skewed, with only 11 men and 165 women participating. This imbalance may limit the generalizability of our findings, as it could introduce biases in the analysis. Particularly when examining salary differences, the results may be influenced by the known gender pay gap that exists in many professions. Therefore, it is important to consider this limitation when interpreting the data related to compensation disparities. In light of these considerations, future research endeavors in this domain are encouraged to substantially broaden their sample size. This expansion would enable a more comprehensive representation of the pediatric nursing workforce and its diverse experiences. Moreover, it is recommended that subsequent studies adopt a multifaceted approach to investigate the determinants of pediatric nurses’ perceptions of decent work. This could involve examining the interplay between individual, organizational, and societal factors, as well as the development and assessment of targeted intervention strategies aimed at enhancing the decent work perception.

In summary, the level of decent work perception among PICU nurses in general hospitals is relatively low and is influenced by factors such as age, educational level, professional title, average monthly income, and personal experience of assault. These findings warrant the attention of nursing administrators. Administrators should take these influencing factors into account and implement targeted measures. Concurrently, hospitals should provide organizational support to ensure a safe working environment within departments, establish and improve hospital regulations and policies, and safeguard the rights of nurses from threats, thereby enhancing the decent work perception among pediatric nurses.