Relationship between competency inventory, perceived career benefits, and professional identity among pediatric nurses

Convenience sampling was used to select a total of 444 pediatric nurses from 10 grade-A tertiary hospitals in Hebei Province between June 2023 and August 2023. Pediatric nurses provided their signed informed consent to participate in this study.

The inclusion criteria were as follows: (1) registered nurses currently in service; (2) nurses with a minimum of one year of work experience in pediatrics; and (3) no prior history of psychiatric disorders or alcohol abuse.

The exclusion criteria were as follows: (1) nurses from other hospitals participating in in-house training; (2) nurses involved in practice or training programs; (3) those who returned to work and had less than one year of experience in pediatric nursing; (4) temporary hired personnel; (5) nurses who were not on duty during the survey period; and (6) Nurses transferred from clinical nursing posts.

(1) Competency inventory: The competency inventory of pediatric nurses was assessed using the Competency Inventory for Registered Nurses (CIRN) [11]. This 58-item scale consists of seven dimensions, including critical thinking, clinical care, and leadership ability. Each item is scored from 0 to 4 points, and the total score is the sum of the scores of each item, ranging from 0 to 232. The higher the score, the stronger the core ability. This scale’s Cronbach’s α coefficient was 0.915, and its validity coefficient was 0.893.

(2) Perceived career benefits: The Nurses’ Perceived Career Benefits Questionnaire (NPCBQ) [12] was used to assess the perceived career benefits of pediatric nurses. The questionnaire assesses three dimensions: occupational security, occupational affordability, and occupational value, with a total of 15 items. Each item was scored between 1 and 5 points, and the total score was the sum of the scores of each item, ranging from 15 to 75. The higher the score, the more significant the perceived career benefits. The scale had a Cronbach’s α coefficient of 0.896 and a validity coefficient of 0.887.

(3) Professional identity: The Professional Identity Scale for Nurses (PISN) [13] was used to assess pediatric nurses’ professional identity. The PISN consists of five dimensions, including occupational cognitive evaluation, occupational social support, and occupational social communication skills, with 1 to 5 points for each item. The total score is the sum of the scores of each item and ranges from 30 to 150. The higher the score, the higher the sense of value identification with one’s profession. The Cronbach’s alpha coefficient was 0.873 and the validity was 0.824.

The survey was conducted on September 15, 2023, during the morning meetings of each department. Nurses who were not on duty that day were surveyed when they returned to work. The researchers distributed the CIRN, NPCBQ, and PISN questionnaires to 444 pediatric nurses included in the study. A total of 444 questionnaires were distributed. The time required for filling out the questionnaire was 30 min, and the questionnaires were collected back on the spot. All 444 questionnaires were completed and returned, with a successful recovery rate of 100%.

SPSS 25.0 software was used for data processing. Measurement data were expressed as mean ± standard deviation. Enumeration data were expressed as percentages. Bivariate Pearson correlation was used to analyze the relationship between competency inventory, perceived career benefits, and professional identity. Mediation effect analysis and structural equation modeling were used to examine the mediating effect of professional identity between competency inventory and perceived career benefits among pediatric nurses. Linear regression analysis was used to examine the relationship between professional identity, pediatric nurses’ competency inventory, and perceived career benefit. The significance level for all tests was set at α = 0.05.

Among the 444 nurses included in the study, 49 (11.04%) were males and 395 (88.96%) were females. They were aged 25 to 41 years, with a mean age of (29.10 ± 3.15) years. The nurses’ work experience ranged from 5 to 14 years, with a mean experience of (9.60 ± 1.57) years. With respect to their education: 309 (69.59%) were college students and 135 (30.41%) held undergraduate degrees or higher. As per their professional titles, 85 (19.14%) were nurses, 209 (47.07%) were senior nurses, 129 (29.05%) were nurses in-charge, and 21 (4.73%) were associate chief nurses. Regarding their marital status, 327 (73.65%) were married, 89 (20.05%) were unmarried, and 28 (6.31%) were divorced.

The Competency Inventory for Registered Nurses (CIRN), Nurses’ Perceived Career Benefit Questionnaire (NPCBQ), and Professional Identity Scale for Nurses (PISN) scores of 444 pediatric nurses were moderate, with scores of (176.40 ± 24.19), (51.82 ± 11.56), and (102.90 ± 16.55), respectively (Table 1).

There were no significant differences in the scores for competency, perceived career benefit, and professional identity among nurses with different gender, years of work experience, job title, education level, marital status, or parental status (P > 0.05, Table 3).

Bivariate Pearson correlation analysis revealed a positive correlation between the core competency of pediatric nurses and their competency inventory, perceived career benefits, and professional identity (r > 1, P < 0.001) (Table 4).

The mediation effect analysis revealed that professional identity accounted for 29.08% of the total effect in the relationship between competency inventory and perceived career benefits (contribution rate of mediating effect to the total effect: ab/c × 100% = 29.08%) (Table 4; Fig. 1).

Using professional identity as the dependent variable, and competency inventory and perceived career benefits as independent variables, the results of the linear regression analysis show that competency inventory and perceived career benefits are significant factors influencing professional identity (Table 5).

Professional identity is the psychological foundation upon which individuals base their roles, work hard, and achieve goals. It has been found that the improvement of professional identity helps motivate employees, enabling them to fully utilize their capabilities and increase their perceived career benefits [14]. Consequently, it is important to enhance the professional identity of nurses.

In our study, the PISN score of pediatric nurses was (102.90 ± 16.55) points, indicating that they had a moderate level of professional identity. This may be related to competency inventory and perceived career benefits. In the research by Li et al. [15], it was shown that there is a correlation between the competency inventory of specialized nurses and professional identity. They found that as professional skills improve and theoretical knowledge expands, nurses can better complete their nursing tasks in daily work, thereby gaining satisfaction and enhancing their professional identity. Similarly, the research by Chen et al. [16] pointed out a correlation between perceived career benefits and spiritual care competencies. Perceived career benefits can promote self-growth and encourage nurses to invest more energy and enthusiasm into their work, thus improving their own capabilities. Therefore, it can be inferred that there is a correlation between pediatric nurses’ value identity and their core competencies as well as perceived career benefits. This phenomenon may also be related to their unique working environment in pediatrics. Pediatric nurses care for children under 14 years of age, with most of them being infants and young children, necessitating advanced nursing techniques. At the same time, the presence of parents accompanying most of the children places additional stress on nurses, especially when performing procedures such as punctures and intramuscular injections, which can lead to scrutiny and potential abuse if the families’ expectations are not met [17]. A study found that approximately 70.7% of pediatric nurses suffered workplace violence, which undermines their dignity and consequently decreases their professional identity [18].

The increasing workload is also an important cause of decreased professional identity among pediatric nurses. Data from the US Health Professional Bureau points to a nurse shortage of about 800,000 in 2020, which is projected to worsen in the next 20 years [19]. In China, the average number of nurses per 1,000 population is only 1.66, further highlighting the severe shortage and high workload of pediatric nurses.

Professional identity is an important endogenous motivator and is recognized as a coping mechanism and intervention for occupational burnout [20]. The results of our study showed that the NPCBQ score of pediatric nurses was (51.82 ± 11.56) points. Bivariate Pearson correlation analysis indicated a positive correlation between the professional identity of pediatric nurses and their perceived career benefits. Nurses with high levels of professional identity are more likely to experience positive emotions at work, find positive significance and meaningfulness in their work, attain self-growth, and develop a sense of team belonging, thereby improving their perceived career benefits.

However, a survey from Zhejiang University showed that 62.80% of caregivers lacked a perceived career benefit [21]. This may be related to the insufficient recognition of pediatric nurses and their low status within the hospital management system. Additionally, the salary levels of pediatric nurses are relatively low, and the opportunities for further professional development are limited, making their career prospects unclear. The resulting lack of psychological satisfaction in turn, decreases their perceived career benefits. Furthermore, nurses with a low professional identity may fail to recognize the significance of their own work, resulting in doubts from patients that can further impact their perceived career benefits.

With advances in pediatric care and the continuous improvement of nursing standards, there is a growing demand for pediatric nurses to improve their professional skills and theoretical knowledge to meet clinical requirements. Pediatric nurses must continuously improve their competency inventory in order to meet clinical demands [22].

In this study, the CIRN score of pediatric nurses was (176.40 ± 24.19) points, and the bivariate Pearson correlation analysis showed that the professional identity of pediatric nurses was positively correlated with their competency inventory. Nurses who perceive significant career benefits tend to recognize the value of their professional roles, identify areas for improvement in their practice, actively engage in departmental meetings and training sessions, and actively invest in addressing their skill gaps, thereby improving their competency inventory [23]. Mak et al. pointed out that professional identity and competency inventory are closely related, suggesting that professional identity influenced by personal attributes can impact competency levels [24]. This perspective aligns closely with the results of the present study.

The results from the structural equation modeling in this study revealed a mediating effect of professional identity between perceived career benefits and competency inventory among pediatric nurses. The heavy workload of pediatric nurses often leads them to work overtime, which heightens their fatigue. At the same time, given the young age of patients they work with, the frequent crying and screaming makes their working environment more challenging, and this can diminish nurses’ professional identity and their outlook on career prospects.

Effective management interventions to improve the perceived career benefits of nurses, can help them develop a more positive mindset so that they are able to better recognize their professional contributions, motivate them to engage more actively in their work, and consequently, improve their competency inventory.

Given these findings, hospital administrators should prioritize the professional identity of pediatric nurses in their management strategies. This can facilitate the provision of better working environments for nurses, a realistic alignment of their salary levels to match their workload, and reduce their work-life imbalance to foster the support of family members in order to enhance nurses’ core competencies and overall job satisfaction.