The moderating effect of working years on nurses’ medical narrative ability and empathy ability: a cross-sectional survey study

The content of the questionnaire was imported into the questionnaire Star with unified instructions, and the survey was conducted online. Before the survey, the researcher contacted the head nurses of each department, and the head nurses served as investigators and received unified training. The link of the questionnaire was sent to the clinical nursing staff through the head nurses of each department to fill in, and the inclusion criteria and filling requirements were explained. Each device or ID account is limited to fill in once, and the questionnaire is open from April to May 2022. After the questionnaire was collected, two people checked and excluded those who were valid for less than 3 min or selected the same option for 10 consecutive items.

A total of 1920 questionnaires were collected in this study, and 1852 valid questionnaires were collected, with an effective recovery rate of 96.46%. A total of 1852 subjects were clinical nurses from 12 hospitals of different levels in 7 cities in Hunan Province, including 51 males (2.8%) and 1801 females (97.2%)(According to the 2022 China Health Statistics Yearbook, male nurses constitute merely 3.4% of the total registered nurse population in China). Their age ranged from 18 to 54 years, with an average of (33.10 ± 6.67) years. Their working years ranged from 1 to 36 years, with an average of (11.61 ± 7.31) years. The age and working years were divided into 5 years and 10 years as a unit, and the scores of medical narrative ability and empathy ability were compared. The results showed that there were statistically significant differences in the scores of marital status, with or without children, position, education background, and whether the unit had carried out narrative training (P < 0.05), see Tables 1 & 2 for details.

Pearson correlation analysis showed that medical narrative ability was positively correlated with empathy ability (r= -0.007-0.314, P < 0.01). Spearman correlation analysis showed that working years was positively correlated with medical narrative ability (r = 0.047, P < 0.05). There was no correlation between working years and the total score of empathy ability (P > 0.05), as shown in Table 3.

This study used multiple linear regression analysis to detect the moderating effect of working years. Assuming that nurses’ working years was the moderating variable, moderator variables were categorized into two groups: the high group, where the moderator variable score was ≥ (mean + standard deviation), and the low group, where the moderator variable score was ≤ (mean - standard deviation), medical narrative ability was taken as the independent variable, empathy ability was taken as the dependent variable, the independent variable was decentralized, and the product term was constructed with the moderating variable. Model 1 introduced the control variable, model 2 introduced the independent variable, model 3 introduced the moderating variable, and model 4 introduced the interaction term “medical narrative ability × working years”. The results showed that medical narrative ability could affect empathy alone, and the interaction term had a statistically significant effect on empathy. The standardized coefficient β=-0.174 (P < 0.01), ΔR² = 0.003 (P < 0.01), indicating that working years had a moderating effect between medical narrative ability and empathy ability. See Table 4 for more information. Meanwhile, as shown in Fig. 1, compared with nurses with high working years, the empathy ability of nurses with low working years increases more obviously with the medical narrative ability.

In order to get further understand the moderating effect of working years, group regression analysis was then performed. As shown in Table 5, nurses with different working years had different levels of influence of medical narrative ability on empathy ability, which gradually decreased from high to low (0.077 > 0.036 > 0.019), indicating that medical narrative ability could partially compensate for empathy ability to some extent. The regression coefficient difference test showed that there was no statistically significant difference in the regression coefficient of the effect of medical narrative ability on empathy ability between nurses with working years ≤ 5 years and those with working years 6–15 years (P > 0.05). There was a statistically significant difference in the regression coefficient of the effect of medical narrative ability on empathy ability between nurses with working years ≤ 5 years and those with working years > 15 years (P < 0.05). There was no statistically significant difference in the regression coefficient of the effect of medical narrative ability on empathy ability between nurses with 6–15 years of working experience and nurses with more than 15 years of working experience (P > 0.05). See Table 6.

The total score of nurses’ medical narrative ability in this survey was (153.95 ± 17.10) points. Referring to Ma et al. ‘s study [18], the reference value of medical narrative ability was divided as follows: < 145 points were weak, 145–163 points were medium, > 163 points were strong, and the nurses’ medical narrative ability in this study was at a medium level. In addition, in this study, the score of empathy ability of nurses was (85.97 ± 12.83), which was significantly lower than the results of previous studies [20]. Considering that the reason for the difference may be that the subjects of previous studies were medical students in school, while the subjects of this study included nurses from secondary and tertiary hospitals. The differences between hospital levels and individuals have a certain impact on the research results. On the other hand, the empathy ability of nurses still needs to be improved.

At the same time, through the analysis of the general characteristics of the research objects, marital status, whether there are children, position, education background and whether the unit has carried out narrative training are the influencing factors of nurses’ medical narrative ability and empathy ability, which is consistent with the conclusions of previous studies [21,22]. The empathy ability score of nurses with junior college degree or below was 86.55 ± 12.98, 86.00 ± 12.88 for those with bachelor’s degree and 81.31 ± 9.53 for those with master’s degree. Among them, the higher the education level, the lower the empathy ability score, which is mainly affected by perspective taking. It may be that the higher the education level of the nurses, their sense of autonomy is stronger, and they are not susceptible to the influence of others’ views. At the same time, the score of geriatric medical narrative ability of nurses was higher than that of ordinary nurses, the mean scores for nurses and head nurses were 153.56 ± 17.53 and 157.02 ± 12.95, respectively, which was mainly affected by the two dimensions of understanding response and reflection representation. Yu Y [23] et al. demonstrated that higher-ranking nurses exhibit superior medical narrative abilities, which aligns with the findings of this study. This correlation can be attributed to the increased clinical learning opportunities and deeper understanding of humanistic care associated with higher positions, fostering a positive attitude towards narrative nursing. Additionally, married nurses with children scored higher in both medical narrative ability and empathy compared to their unmarried counterparts without children. Specifically, the scores for medical narrative ability and empathy were 159.08 ± 10.49 and 86.52 ± 13.19 for married nurses, respectively, versus 119.85 ± 12.99 and 82.33 ± 9.45 for unmarried nurses. Similarly, nurses with children achieved scores of 164.40 ± 8.23 and 88.52 ± 14.32 for medical narrative ability and empathy, respectively, compared to 141.06 ± 16.41 and 82.82 ± 9.87 for those without children. These results are consistent with the research by Ozdemir et al. [24], suggesting that married nurses with children possess greater experience in interpersonal interactions, enabling them to better empathize and communicate emotionally. In addition, there were statistically significant differences in the scores of medical narrative ability and empathy ability of nurses who had carried out narrative nursing training (P < 0.05), and the scores of nurses who had carried out narrative nursing training were significantly higher than those who had not received training. The mean scores for medical narrative ability and empathy ability among nurses who underwent narrative training were 153.94 ± 15.26 and 87.22 ± 14.90, respectively. In contrast, the mean scores for those who did not undergo narrative training were 152.00 ± 17.55 and 85.46 ± 11.84, respectively. These findings align with the conclusions drawn by Xue et al. [25]. It is necessary to receive relevant training centered on empathy for medical staff to cultivate their empathy ability, nursing managers should consider its influencing factors and pay attention to personalized training when formulating training programs.

The results of this study show that medical narrative ability is positively correlated with empathy ability (r=-0.007∼0.314, P<0.01), which is consistent with the conclusions of previous studies [16, 26], suggesting that medical narrative ability can reflect empathy ability to a certain extent. However, the correlation coefficient between working years and medical narrative ability was 0.047–0.063, and the correlation coefficient was very low. It may be because some nurses’ units in this study had carried out narrative training, which had a certain degree of influence on the results of correlation test. In addition, this study demonstrated that there was no significant correlation between working years and empathy ability (P > 0.05). Another study [27] found that although nurses with varying lengths of work experience had different empathy scores, there was no direct relationship between work experience and empathy ability. This suggests that without standardized training, empathy scores do not necessarily increase with longer working years [27, 28]. Compared with previous studies [26], the correlation coefficient between medical narrative ability and empathy ability in this study ranged from 0.175 to 0.314, which was relatively low. It may be that only 27.5% of nurses in the units where the respondents worked in this study had carried out narrative nursing related training, and most nurses had not received relevant training, suggesting that we, Most nurses have not received relevant training, suggesting that there is still a lot of room for improvement in nurses’ empathy and medical narrative ability. Although empathy is an innate trait, it can be increased through training [28, 29]. Chen et al. found that the cultivation of medical narrative ability can promote the improvement of empathy ability of medical staff [30, 31]. Some studies have used medical narrative or key event writing as an intervention method to promote the empathy ability of medical staff [31, 32]. At the same time, the cultivation of medical narrative ability enables medical staff to gradually develop their self-exploration and reflection ability and improve their awareness of professional identity [32, 33]. It suggests that it is necessary for nursing managers to carry out narrative nursing related training for nurses.

This study not only further confirmed the direct relationship between medical narrative ability and empathy ability, but also verified for the first time the moderating effect of working years on the relationship between medical narrative ability and empathy ability. The results showed that the coefficient of the interaction term medical narrative ability and working years was significantly negative(β=-0.174, P = 0.023), indicating that working years weakened the positive effect of medical narrative ability on empathy ability as a whole. According to the results in Fig. 1, when the working years are lower than the average level, the positive effect of medical narrative ability on empathy is more obvious. However, when the working years are higher than the average level, the positive effect of medical narrative ability on empathy is relatively weakened. In addition, the results of this study showed that when the working years were divided into different levels, the regression coefficient of medical narrative ability on empathy ability gradually decreased from high to low (0.077 > 0.036 > 0.019), indicating that medical narrative ability could partially compensate for empathy ability to some extent, but with the increase of working years, the positive effect of medical narrative ability on empathy ability was relatively weakened. The compensation effect of medical narrative ability on empathy ability is gradually reduced, that is, the positive effect is gradually weakened. As can be seen from Table 6, the regression coefficient of medical narrative ability on empathy ability of nurses with working experience ≤ 5 years and working experience > 15 years was significantly different, with statistical significance (P < 0.05), indicating that the effect of medical narrative ability on empathy ability was mainly affected by nurses with working experience ≤ 5 years and working experience > 15 years. This may be attributed to the fact that junior nurses lack experience in complex clinical tasks, leading to feelings of depression and other negative emotions that diminish work quality and empathy, which aligns with the findings of Zhang et al. [33]. Over time, as nurses accumulate more clinical experience, they become better equipped to promptly identify patients’ narrative needs and empathize with their experiences of illness. However, after reaching a certain number of years in practice, due to the continuous advancement of China’s medical system and increasingly stringent requirements for higher-level nurses, the high-intensity work environment can lead to physical and mental burnout, fostering a sense of counteraction and ultimately resulting in a decline in empathy. This is consistent with the research by Li et al. [34]. In addition, nurses are exposed to the suffering of patients for a long time and repeatedly [35]. In addition to high workload, nurses in this period are often faced with the pressure of supporting their parents and raising the next generation, and are more likely to show passive behavior and emotional exhaustion [13]. It can be observed that while the number of working years increases, nurses’ empathy ability also improves; however, this improvement may be influenced by other factors, which could potentially weaken the positive impact of medical narrative competence on empathy. Therefore, nursing managers should pay attention to the characteristics of nurses with different working years and adopt a hierarchical training method when carrying out narrative nursing related training.