The effects of work readiness, organizational justice and professional identity on the work performance of new nurses: a cross-sectional survey

The World Health Organization estimates that a global shortage of nurses and midwives will be around 7.6 million by 2030 [1]. At the end of 2023, the National Health Commission showed that the national shortage of nurses was close to 2.8 million, and the proportion of new nurses in China is about 5% [2]. The nurse shortage has become an ongoing and urgent problem worldwide [3], as an important part of medical and health human resources, clinical nurses are a basic link that cannot be ignored in the daily operation of medical institutions [4]. As the turnover rate of clinical nursing staff increases, it hurts nursing professions, medical institutions, and high-quality nursing services [5‐7]. New nurse refers to the working time of less than a year after graduation nurses [8]. Compared with nurses with work experience, new nurses are more likely to leave the nursing profession, and studies have shown that the turnover rate of new nurses (29.0%) is 2.1 times that of experienced nurses (13.9%) [9]. According to the Transition Shock Theory [10], new nurses face more difficulties and challenges in clinical work due to its professional nature, high risk, and heavy workload [11], which affects their work enthusiasm and may lead to relatively low work performance [12, 13]. Work performance can directly affect employees’ job stability, enhance personal happiness, and stimulate work enthusiasm and responsibility [14‐16]. As the new nurses are the fresh blood of the clinical nursing team, they are the reserve force of a new generation of nursing talents [17]. Therefore, exploring the influencing factors affecting new nurses’ work performance to realize the sustainable development of the hospital is a problem that cannot be ignored and must be solved.

Work performance refers to work behavior that perfectly matches the work objectives of the organization [18], and its essence is the result that the organization expects [19]. Borman and Motowidle [20] divide work performance into task performance and relationship performance, the task performance mainly refers to the completion of work content and tasks; relationship performance refers to the improvement of organizational operation efficiency under the influence of external factors. Work performance is influenced by the personal characteristics of employees, such as gender, education, working years, professional title [21, 22], and also related to the working environment [23‐25] and the style of the manager [26, 27]. Studies show that organizational resilience, social support, organizational commitment, job satisfaction, and burnout also affect employees’ work performance [28‐30]. The above research shows that many factors can affect the work performance of industrial workers, but the research on the factors affecting the work performance of new nurses needs to be supplemented. At present, the relationship between work readiness and work performance has attracted more and more attention from scholars. For new nurses, the degree of professional identity is related to their love and devotion to nursing work, and organizational justice affects their perception and evaluation of the working environment. Exploring professional identity and organizational justice’s roles in work readiness and work performance of new nurses is helpful to understand the working status and development needs of new nurses, and provides new ideas and methods for improving their job performance and stabilizing the nursing team.

Work readiness is seen as an indicator of a graduate’s future job performance, promotion, and career development potential [31, 32]. Due to the gap between theory and practice in nursing education, work readiness is often used to indicate whether new nurses can immediately enter the role [33], whether they can seamlessly connect with clinical practice [34], and whether they can independently conduct clinical nursing practice at the initial stage of work [35]. Nurses with good work readiness can greatly shorten the time they grow to become clinical nursing backbone, and can predict long-term work ability [36]. Job demands-resources theory believes that work resources help to achieve work goals and stimulate personal growth and development [37], so when work readiness is a work resource, recruits gain more motivation and enthusiasm for work, thus increasing work engagement [38]. Studies have shown that work readiness is positively correlated with job satisfaction and job engagement [39] and that employees’ high engagement in work can achieve high work performance [40]. Given this, this study proposes hypothesis 1: The work readiness of new nurses is positively correlated with work performance.

Professional identity, as a variable beneficial to both individuals and organizations [41, 42, 43], is defined as the individual’s view of the goals, attitudes, values, and other related factors of the profession that are consistent with society’s evaluation and expectations of the profession [44]. There is literature indicating that good readiness to work helps nurses affirm their professional roles and professional values [43], when a person affirms his professional value, it will promote his professional identification [44]. Studies have shown that professional identity affects work performance [45, 46], and social identity theory suggests that individuals’ actions are based on their recognition of the group [47]. When employees identify with their group, they may identify more with their profession; this may affect their work attitudes and behaviors [43] thereby affecting their work performance. Hall and Chandler [48] have pointed out that professional identity will give employees a heartfelt sense of mission, which will bring them positive feedback on work performance. Therefore, this study proposes hypothesis 2: Professional identity plays a mediating role in the relationship between work readiness and the work performance of new nurses.

Organizational justice is the fair feelings of people in the organization or unit to the organizational system and policies and measures related to individual interests [49]. The core view of fairness theory [50] is that employees’ satisfaction with distribution fairness affects their working enthusiasm. When a person is in a fair environment, it will have an impact on work performance. Some scholars believe that organizational justice is related to work performance [51‐53]. As for the relationship between work readiness and organizational justice, Walker et al. [31] divide work readiness into five dimensions, two of which are organizational acuity and social competence. The research of Firestone-Howard et al. holds that when organizational acuity is relatively high, it is conducive to an individual’s understanding of fair behaviors such as distribution within the organization [54], thus affecting an individual’s organizational justice [55]. Walker et al. [31] maintain that social interaction has a positive predictive impact on interpersonal justice (a dimension of organizational justice) and strong personal social competence means more sufficient social interaction. This shows that the strength of personal social competence may influence interpersonal justice. Some scholars also believe that when nurses are fully prepared for their careers, they are more likely to take a positive and healthy attitude to view things [56], which in the process deepens their perception and experience of fairness [57]; thus, forming a virtuous cycle. Social identity theory [47] holds that if the distribution of labor results meets the internal needs of employees, this distribution makes them feel fair, and they are easy to derive a sense of identity. There are also studies verifying that organizational justice will affect an individual’s professional identity [44, 58]. So, this study proposes hypothesis 3: organizational justice plays a mediating role in the relationship between work readiness and the work performance of new nurses, and hypothesis 4: professional identity plays a mediating role in the relationship between organizational justice and the work performance of new nurses.

Based on the above reasoning and literature review, the existing literature on nurses’ work performance mainly focuses on the exploration of the relationship between two variables, and research on the potential influence mechanism of work performance is still insufficient. This study hopes to provide some theoretical guidance certain theoretical guidance for nursing managers to improve the work performance of new nurses, help them formulate more scientific and reasonable human resource management strategies, better train and manage new nurses, and improve the overall performance level of the nursing team. This study will not only explore the relationship between work readiness and work performance but also further discuss whether professional identity and organizational justice play a mediating role between work readiness and work performance. The theoretical framework is shown in Fig. 1.

In this study, the work readiness scores were higher than the results of the survey of newly graduated nurses by Li et al. [31]. The difference may be because most of the respondents in this study work in tertiary hospitals with higher levels of professional management. Before the entry of new nurses, hospital managers will conduct induction training for them. In this process, the managers pay more attention to the cultivation of practical skills and social abilities of new nurses, so the participants have a relatively high degree of work readiness. Participants’ professional identity scores were slightly higher than the findings of Zhou et al. who sampled more experienced nurses [69]. This may be because new nurses are more likely to get help from colleagues and clinical leaders in the early stages of their employment, and after experiencing the epidemic, the new generation of nurses may be more aware of the importance of the nursing profession [70]. In addition, this may be related to the education level of the study subjects, 67.2% of the nurses in this study were undergraduates. The higher the educational and cultural background of new nurses, the more specialized knowledge they will have. When facing complex nursing work, they can solve problems more calmly by applying the knowledge they have learned, showing higher professional qualities. This can not only provide patients with better quality nursing services but also help them maintain their love for this profession and improve their professional identity. The participants’ organizational justice scores were slightly lower than the findings of Viseu et al. who sampled Hotel staff [71], and the difference in results may be due to differences in who was studied. First of all, the research object of this study is new nurses. Due to many work contents, complex interpersonal relationships, and low wages, they may feel unfair when facing great pressure and challenges in work. Secondly, the research samples of Viseu et al. are hotel staff. The nursing industry and the hospitality industry differ in job content, management system, and wage ratio, so their levels of organizational justice are different. Work performance scores were lower than in the study by Li et al. who sampled more senior nurses [72], which may be because new nurses are not familiar with the department environment, rules and regulations, and work habits, and lack rich work experience and problem-solving ability, so their work performance is slightly lower.

This study found that new nurses’ work readiness had a significant positive impact on work performance, consistent with the expectation of hypothesis 1. This is because when new nurses enter the workforce with a higher level of work readiness, they will have a more comprehensive work ability, which helps to boost their confidence and become more enthusiastic about their work [30, 73], thus improving work performance. The above results show that we should strengthen the awareness of the importance of work readiness for new nurses. First, schools should continuously optimize the curriculum setting of nursing majors according to the development needs of the nursing industry and the requirements of actual job positions. Arrange training courses that simulate real work scenarios, such as simulated first aid drills and discussions on complex cases, and conduct intensive training for nursing students, such as venous puncture and wound care, to improve students’ work readiness. Schools should strengthen cooperation with hospitals to provide students with more internship opportunities. Second, internship hospitals should arrange experienced clinical instructors to guide the internship of nursing students and provide nursing students with more clinical operation opportunities. For example, nursing students can be arranged to participate in patients’ daily care, basic care, and specialized care work so that they can improve their work readiness by completing practical nursing operations.

This study found that professional identity was a mediating variable for work readiness and work performance of new nurses, consistent with the expectation of hypothesis 2. The mediating pathway found in this study fills the gap of previous studies. After new nurses are well prepared for work, it is conducive to the formation and strengthening of their professional values and role cognition [61]. When they recognize their vocation, their personal value is reflected in the vocation for which they are willing to work [74, 75]. Professional identity can help nurses actively participate in clinical work and have a positive impact on work performance. This result suggests that we should strengthen the fostering of new nurses’ professional identity. First, school teachers should cultivate the professional ethics and qualities of nursing students through formal classroom teaching and extracurricular communication. They should transmit professional values to students and strengthen their recognition of the nursing profession. Additionally, schools should organize communication and sharing sessions between nursing students and outstanding alumni. This way, nursing students can intuitively see the development prospects of the nursing major and enhance their professional identity. Second, nursing managers should formulate personalized career planning plans for each new nurse. They should also set up a special reward fund for new nurses and give material and spiritual rewards to those who perform excellently in professional skills, patient satisfaction, and other aspects. Third, hospitals should establish a special nursing culture publicity team. Through speech contests, essay contests and reports on the internet platform and other forms, we can promote the nursing professional spirit and enhance the professional identity of new nurses.

This study found that organizational justice was a mediating variable for work readiness and work performance of new nurses, consistent with the expectation of hypothesis 3. This is the first time to verify the mediating role of organizational justice in work readiness and work performance and provide a new theoretical framework and guidance for improving the work performance of new nurses. When new nurses have a high level of work readiness, it helps them to understand fair behavior within the organization [76] and be more adaptable and flexible in interacting with patients and colleagues, thereby enhancing interpersonal justice [77]. Nurses with a high organizational justice are more inclined to invest and contribute, more focused on their jobs, and pay more attention to personal growth and work performance [53]. When nurses sense unfair treatment, they are likely to have doubts and may even distrust the organization [51], thus harming their work passion and work performance. This study found that professional identity was a mediating variable of organizational justice and work performance of new nurses, consistent with the expectation of hypothesis 4. According to the cognitive-emotional theory, individual cognition and emotional response mainly come from the role of situational information, and then activate individual behavior decisions [78], This implies that open and transparent decision-making and management will assist individuals in fully understanding the distribution process [61]. Not only does it strengthen an individual’s trust and sense of identity in the organization, making them willing to contribute to it, but it can also enhance employees’ professional thinking and correct the tendency of employees’ bad behavior [79], which positively affect the staff’s work performance. To improve new nurses’ organizational justice, first, nursing managers should create a fair working atmosphere for new nurses, treat every new nurse fairly in daily work, and provide them with fair training and development opportunities. Second, hospitals should formulate reasonable and transparent salary standards, performance appraisal systems, and promotion systems. A nurse representative committee can be established or staff feedback meetings can be held regularly to encourage new nurses to put forward suggestions and participate in the performance appraisal process. For the unfair issues raised by new nurses, investigations and handling should be carried out promptly. This will help to enhance the organizational justice of new nurses.

This study examined work readiness, work performance, professional identity, and organizational justice among new nurses. The process and mechanism by which the work readiness of new nurses influenced work performance was explored. The study found that professional identity and organizational justice play a chain mediating role in the effect of work readiness on the work performance of new nurses. It provided some theoretical support and guidance for the research and intervention of the work performance of new nurses and also helped the hospital to maintain and cultivate the new generation of nursing talents and constantly improve the development prospect of the nursing industry.