Occupational Happiness of Civilian Nurses in China: a cross-sectional study

In this study, the total score of occupational happiness of civilian nurses in Chinese military hospitals (3.83 ± 0.56) was above the medium level. Other research reports from China show that the overall occupational happiness of military hospital nurses (including soldiers, civilians, and non-staff) and local hospital nurses (including staff and non-staff) is at a medium level [6, 20, 21]. The reason may be that military civilians have advantages in welfare, career choice, career stability and career development and more superiority among peers. The object of this study is civilian nurses in military hospitals, who are military personnel and have higher job stability and more career development opportunities. According to Chinese career policy, the salary and welfare benefits of civilian nurses are higher than those of nurses in local hospitals [22]. They cannot be dismissed by the hospital without gross negligence, but they still have the right to apply for resignation or terminate the employment contract independently [23]. Therefore, civilian nurses are more stable than non-staff nurses and have more career choices than military nurses. In addition, civilian nurses enjoy some of the same priority treatment as active-duty military nurses, which makes them feel honoured. The above factors make civilian nurses more satisfied with their “professional identity”, “work output”, “work environment”, “salary”, and “interpersonal relationships”. Because most civilian nurses did not graduate from military medical colleges, they have not received systematic military physical training and lack professional training in military medicine. However, they participate in military training and non-war military medical support tasks according as needed [12]. There is a gap for active-duty military nurses in physical fitness and military skills, so physical health is an issue of great pressure and challenges. Their feelings about work in military hospitals were in the lower middle level.

In this study, there were significant differences in the occupational happiness of civilian nurses of different genders. Women scored higher than men. Influenced by traditional ideas, women still dominate the nursing industry in China, and male nurses tend to have a low sense of professional identity and personal value [24]. When patients meet male nurses, they often have different degrees of prejudice and discrimination, which causes conflicts between nurses and patients [25]. This increases the psychological pressure of male nurses and reduces their occupational happiness. In this study, the older the civilian nurses were, the longer their working years were and the higher their occupational happiness was. The occupational happiness of civilian nurses over 41 years old was higher than that of civilian nurses of other ages in all dimensions. Civilian nurses who had worked for more than 10 years were more satisfied with “interpersonal relationships” and “work emotions”. The reason might be that with the increase in age and working years, the abilities of civilian nurses in all aspects were improved, which made them easier to recognize at work; furthermore, the salary was better, so their occupational happiness increased. We suggest that male nurses and civilian nurses under the age of 41 should pay more attention to their work and life. They should be encouraged to engage with the real environment, constantly improve their practical ability, communication ability and management ability, win the respect of patients with high-quality service, feel professional value, and improve their career development potential. At the same time, nursing managers can use job rotation, psychological counselling, and other ways to help nurses reduce pressure and improve their occupational happiness.

In this study, the type of city where the hospital was located was the main factor affecting the occupational happiness of civilian nurses. The occupational happiness of civilian nurses located in “prefecture-level cities” and “sub-provincial cities” was higher than that of civilian nurses in “municipalities directly under the central government”. The “prefecture level city”, “sub provincial city”, and “municipalities directly under the central government” are the administrative levels of Chinese cities. The administrative level of " municipalities directly under the central government” is higher than that of " sub-provincial cities “. The administrative level of “sub-provincial cities” is higher than that of “prefecture-level cities”. The administrative level of cities determines their different socio-economic management authorities, leading to differences in economic development levels. Therefore, the economic development level of “sub provincial cities” is higher than that of “prefecture level cities”. The reason might be that the economic development and consumption level of “prefecture-level cities” and “sub-provincial cities” are moderate. If civilian nurses can reasonably distribute their salaries, they can not only ensure a higher quality of life but also realize wealth accumulation. Therefore, their occupational happiness is naturally relatively high. However, the economic development of “municipalities directly under the central government” is relatively fast, and the consumption level is relatively high. Living in “municipalities directly under the central government” with the same wage income would produce economic pressure in education and housing, resulting in differences in the quality of life of civilian nurses [23]. Studies have shown a positive correlation between occupational happiness and quality of life, so a decline in quality of life would also be accompanied by a decrease in satisfaction with professional identity, working environment, salary, and other aspects [4, 26‐28]. However, it is worth noting that the satisfaction of civilian nurses working in municipalities was significantly higher than that of civilian nurses in the other three regions in “work emotions” and “well-being”. This might be because the four municipalities directly under the central government in China are basically superior to other types of cities regarding education, science and technology, economy, culture, and transportation and are the places where most people want to live. Civilian nurses cherish job opportunities in the military hospitals of municipalities directly under the central government and have strong positive work emotion, which promotes a virtuous cycle of physical and mental health. Therefore, the nursing managers of military hospitals in municipalities directly under the central government should pay more attention to the family and living conditions of civilian nurses, encourage them to talk about difficulties they encounter and try to help them solve their problems. At the same time, it is necessary to provide more training opportunities for civilian nurses to broaden their horizons and improve their abilities. Nurses can improve their occupational happiness by improving their sense of occupational benefits.

Based on Pearson correlation analysis, we found that “professional identity”, “work output”, “work environment”, “salary”, and “interpersonal relationships” were significantly positively correlated with occupational happiness. However, occupational happiness was not related to “work emotion” and “well-being”. The reason might be that occupational happiness mainly comes from professional identity [29]. When nurses’ efforts are recognized by patients, family members, colleagues and leaders, their occupational happiness improves, in the opposite situation, occupational happiness decreases. Civilian nurses have a solid theoretical foundation, high practical skills, and high work enthusiasm. Once they are actively involved in work, it is easy to achieve results and obtain recognition. The recognition of the people around them can encourage them to work harder. This cycle can greatly stimulate their enthusiasm and interest in work and help them to obtain a higher sense of happiness in their career. The regulations on civilian personnel by the Chinese people’s Liberation Army clearly stipulate that civilian personnel enjoy the same status and wages as active servicepeople. When nurses believe they are treated fairly, they have more trust in organizations and managers and work with hope and motivation. Equal status and stable income make civilian nurses feel recognized by the hospital, so they are highly satisfied with the professional environment.