Determinants and Association of Work Readiness with Work-Related Outcomes in New Graduate Nurses

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O R I G I N A L A R T I C L E

Work readiness: Its determinants and association with work- related outcomes among new graduate nurses

Jiaying Li RN, PhD candidate

¹

| Yanyi Huang RN, Bachelor

²

|

Daniel Yee Tak Fong PhD, Associate professor

¹

| Jieya Chen RN, Master

³

| Yang Song PhD, Professor

²

1Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Hong Kong

2School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China

3Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

Correspondence

Daniel Yee Tak Fong, Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Hong Kong.

Email:[email protected]

Yang Song, School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China.

Email:[email protected]

Funding information

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Abstract

Aims:

This study aimed to identify determinants of work readiness and to assess the influences of work readiness on work-related outcomes in graduate nurses.

Background:

Higher work readiness facilitates smoother role transitions of new graduate nurses. However, determinants of work readiness had not been fully examined. In addition, the relationships between work readiness and work-related outcomes, such as coping self-efficacy and occupational commitment, are also crucial but had not been assessed.

Methods:

We recruited 794 graduate nurses and assessed their work readiness before working as nurses. After they commenced their work, we assessed their occupational commitment, coping self-efficacy and intention to remain. All assessments were conducted online.

Results:

There were 728 (92%) female respondents. The mean scores and standard deviation (SD) of work readiness, coping self-efficacy, occupational commitment and intention to remain were 261.51 (SD: 45.40), 30.30 (SD: 6.13), 81.65 (SD: 11.56) and 11.01 (SD: 2.36), respectively. Based on a regression analysis, determinants of work readiness were positive school climate, student leadership experience, nursing as the primary choice of discipline and perceived influences of COVID-19 on the honorabil- ity of being a nurse and the willingness to be a nurse (p < .001). Moreover, after adjusted by all demographics and characteristics variables, higher work readiness would result in higher coping self-efficacy (estimated coefficient

=

0.06,

p

< .001), occupational commitment (estimated coefficient

=

0.06,

p

< .001) and intention to remain (estimated coefficient

=

0.01,

p=

.002).

Conclusion:

Work readiness is a composite concept affected by psychosocial and environmental factors, which can predict new graduate nurses

’

future self-efficacy, occupational commitment and intention to remain.

Implications for Nursing Management:

The management of new graduate nurses when they begin to work could target their work readiness. Transition programmes that consider our identified determinants can be provided to those who show lower work readiness.

DOI: 10.1111/jonm.13691

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K E Y W O R D S

determinants, graduate nurse, quantitative survey, work outcomes, work readiness

1 | B A C K G R O U N D

The turnover rate of graduate nurses during their first year of employment could be as high as 30% (Kovner et al.,2014). In China, this rate was 17.5% (Wu et al.,2016), and 71.8% of graduate nurses reported intention to leave at 12 months of work (Zhang et al.,2017). The turnover rate has continued to reduce nurse workforce stability, increase the costs for hospital recruitment and training and even negatively affect patients’ outcomes (Kim & Han, 2018; Zhao et al., 2019).

Although graduate nurses have finished 3 or 4 years of professional courses in a university and undergone at least 10 months of internship in the hospital before entering the workplace, they still reported inadequate preparedness (You et al., 2015; Zhang et al., 2019).

In hospitals, they were usually required to work independently within 4 to 6 months (Zhang et al.,2019). The role transition from students to clinical nurses can be challenging and stressful, which may under- mine their physical and mental health, threaten their professional identity, lead to work adaptation barriers (Su et al.,2021) and even trigger their intention to leave (Maria et al.,2020).

This raises concerns about new graduate nurses’ role adaption and transition and whether they are ready for the work (Caballero &

Walker,2010). Work readiness is defined as a level of preparedness for future work. In our target population, it manifests as the degree to which graduate nurses meet the expectations of employers when entering the nursing workforce (Walker et al.,2015). The operational conceptual framework of work readiness encompasses work competence, social intelligence, organisational acumen and personal work characteristics (Caballero & Walker,2010). Based on this framework, the Work Readiness Scale for Graduate Nurses (WRS-GN) was developed and shown to be reliable and valid for assessing the work readiness of new graduate nurses (Walker et al.,2015). This scale was later shown to have a five-factor structure, with the original organisational acumen separating out a new dimension called organisational hierarchy (Li et al.,2020).

Recognizing factors that facilitate or hinder work readiness can inform educators and hospital administrators of the essential compo- nents for formulating effective strategies to support new graduate nurses. Several studies have reported determinants of work readiness among graduate nurses, including emotional intelligence, psychological capital (Masole & van Dyk, 2016), interpersonal communication, self-adjustment (Tentama et al., 2019), students’perceptions of the clinical education environment (Dudley et al., 2020), interpersonal relationships, leadership experience, award of academic scholarship, prior work experience, willingness to be a nurse (Li et al., 2020), child-care experience, length of the nurse residency programme (Hayter,2017), professional passion, clinical confidence, class size, the applicability of school education in work and perceived quality of education and practice training (Ergun & Beyhan, 2017). However,

previous studies separately focused on personal, educational or clinical factors, without considering such factors simultaneously.

Moreover, environmental factors, including those assessed at the community and societal levels, also affect the transition process (Meleis,2010). In particular, the potential influence of the COVID-19 pandemic is also worth investigating. However, whether or the extent such environmental factors may impact graduate nurses’ work readiness has not been assessed.

In addition, the association between work readiness and work- related outcomes among graduate nurses has not been adequately studied. Although work readiness has been shown to be correlated with job satisfaction and work engagement (Walker &

Campbell,2013), other work-related variables have not been examined. For instance, coping self-efficacy and occupational commitment are critical outcomes that reflect graduate nurses’ perceived stress, attitudes and behaviours towards work (Molero Jurado et al.,2019;

Numminen et al.,2016; Pisanti et al.,2015), but whether they are affected by work readiness remains unknown. Moreover, intention to remain is another essential work outcome that can be influenced by work readiness. Examining the association between work readiness and the above three work-related outcomes can provide nursing managers with a better understanding of graduate nurses’future work performance.

Therefore, this study aimed to identify determinants of work readiness and examine the association of work readiness with occupational commitment, coping self-efficacy and intention to remain in new graduate nurses.

2 | M E T H O D S 2.1 | Design

This was a prospective cohort study of 794 new graduate nurses before they started to work as nurses who were followed for around 1 month when they had started working in hospitals.

2.2 | Participants

Eligible participants were those who (1) studied nursing in Mainland China, (2) had completed their coursework and clinical internship, (3) were ready to start working in a hospital and (4) were able to read Chinese. Part-time students were excluded. These criteria were developed to recruit the target group of new graduate nurses before they entred the clinical workplace in China.

We first calculated the sample size required to identify factors associated with work readiness. The rule of thumb of at least

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10 events per predictor has been widely advocated for developing a prediction model (Riley et al.,2020). Considering 17 predictors in our regression model, we needed 170 subjects. Then, for examining the association of work readiness with work-related outcomes, we used an expected correlation of at least 0.1. To detect such a correlation with a 5% false positive error rate and 80% power, we needed 783 subjects (Hulley et al., 2013). Hence, we planned to recruit 783 subjects.

2.3 | Measurements

2.3.1 | Demographics and characteristics

Demographics included gender, the only one child in the family and educational level. Other characteristics assessed covered four catego- ries: experience and performance in university, clinical internship, family support and COVID-19. For experience and performance in university, we included school climate, sense of belonging at school, got along with classmates, student leadership experience, part-time work experience, had nursing as the primary choice of study discipline, willingness to be a nurse and awarded scholarship during study. For clinical internship, we assessed expected monthly salary, duration of clinical internship, average daily working hours during internship and medical disturbance experience during internship. For COVID-19, we asked for the perceived influences of COVID-19 on the nursing profession. All variables had a potential association with work readiness.

2.3.2 | Work readiness

The Chinese version of the WRS-GN comprised 37 items, with each item answered on a 10-point Likert scale (Li et al., 2020). A higher total score indicated better work readiness. The Cronbach’s alphas for the overall Chinese version scale, Work Competence, Social Intelli- gence, Organisational Acumen, Organisational Hierarchy and Personal Work Characteristics were .96, .93, .94, .94, .94 and .79, respectively (Li et al.,2020).

2.3.3 | Work-related outcomes

We assessed coping self-efficacy, occupational commitment and intention to remain by the self-reported Chinese versions of the Occupational Coping Self-Efficacy Questionnaire for Nurses (OCSE-N), Nurses’ Occupational Commitment (NOC) and the Intention to Remain (IR), respectively.

The OCSE-N was developed to evaluate nurses’ coping self- efficacy beliefs (Pisanti et al., 2008). It comprised nine items, each responded on a 5-point Likert scale, under two dimensions, namely, coping with occupational burden and relational burden. A higher score indicated a greater level of coping self-efficacy. The Chinese version

of the OCSE-N had a satisfactory psychometric performance with Cronbach’s alpha for the overall scale as 0.88 (Zhai et al.,2021).

The Chinese version of NOC contained 24 items and five dimensions, including the affective occupational commitment, normative occupational commitment, economic costs occupational commitment, emotional costs occupational commitment and limited alternatives occupational commitment. Each item responded on a 5-point Likert scale, and a higher total score represented a higher occupational commitment. It has been tested in a Chinese population with sound psychometric performance with Cronbach’s alpha for the overall scale as .92 (Pei et al.,2007).

The IR scale included four items (Robinson,1996). Each question was rated on a 4-point Likert scale. The questions were (1)‘To what extent do you prefer a job other than your present one?’; (2)‘Since you started working for a hospital, to what extent have you considered changing hospitals?’; (3)‘If you have a way, will you work in a hospital in three years?’and (4)‘How long do you plan to remain in your hospital?’. Robinson reported a Cronbach’s alpha value of .86, and a higher score indicated a stronger willingness to remain.

2.4 | Data collection

Data were collected using online questionnaires created by the So jump software (Changsha Ranxing Information Technology Limited Liability Company, Changsha, China). In June 2021, before the graduate nurses started their work, the Deans of 11 nursing schools that covered 21 provinces in Mainland China were contacted and agreed to distribute an online questionnaire electronically via official WeChat groups to their students. All nursing schools belonged to a national public university, except one that came from a private university. The questionnaire collected telephone numbers, demographics, clinical characteristics and work readiness. In July, when the graduate nurses had started working in a hospital, we distributed another online questionnaire that assessed the work-related outcomes. Variables collected from the first questionnaire could then be used to predict work-related outcomes assessed by the second questionnaire.

There were 1,155 nursing students who received the message, and 794 completed the questionnaire. The response rate was 69%. All questions in the online questionnaires were made mandatory.

Therefore, we have a 100% completion rate with no missing data. The follow-up rate was 100%. Participants’phone number was used to link the data collected from the two surveys.

2.5 | Ethical considerations

The online questionnaires started with information about the study purpose, procedures and value. After a graduate nurse read the details, he/she had to consent to the participation by clicking a button to confirm. Questionnaire data were kept strictly confidential by storing them in a password-protected computer. This study was approved by a hospital ethics committee (No. 2021.26).

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2.6 | Data analysis

Response data collected in the So jump software were exported into SPSS format, and all analyses were conducted in SPSS for Windows version 21.0. Descriptive statistics were used to summarize the demographic and clinical characteristics. Specifically, continuous variables conforming to the normal distribution were summarized by mean and standard deviation, while categorical variables were described by fre- quency. After normality check, t test and the analysis of variance (ANOVA) were used to assess the differences of work readiness across groups by demographics and clinical characteristics. Determi- nants of work readiness were identified by multiple linear regression.

The presence of multicollinearity was checked by a variance inflation factor (VIF)≥2.5 (Johnston et al.,2018). The effects of work readiness on work-related outcomes were examined by multiple linear regres- sions, with and without adjusting all the demographics and clinical characteristics. Adequacy of all regression models was assessed by examining the standardized residuals. Statistical significance was set atp< .05.

3 | R E S U L T S

3.1 | Characteristics of respondents

During June–July, 2021, a total of 794 graduate nurses from 21 provinces in China completed our questionnaires. Given all questions were mandatory, there were no missing values. Table 1 summarizes their characteristics. The sample predominantly included 728 (92%) female nurses, 701 (88%) who were the only child in the family, 722 (91%) who received family support and 766 (97%) who got along with classmates. Regarding the influences of COVID-19, 450 (57%) agreed that the pandemic has made nurses more honourable, and 533 (67%) would not become unwilling to be a nurse because of the pandemic. Table 2shows a descriptive summary of WRS-GN, OCSE-N, NOC and IR.

3.2 | Determinants of work readiness

Table1also compares the differences in work readiness by characteristics. Those who had a significantly higher WRS-GN total score were male (t =2.02,p= .044), had a lower educational level (t= 2.60, p=.009), had family support (t=3.36,p=.001), had positive school climate (F = 44.92,p = .001), had a sense of belonging at school (t= 5.25,p< .001), got along with classmates (t= 2.78,p=.010), possessed student leadership experience (t=5.32,p< .001), had part- tome work experience (t=3.26,p< .001), had nursing as the primary choice (t = 7.56,p< .001), were willing to be a nurse (t = 14.18, p< .001), were awarded scholarship during study (t=2.96,p=.003) and considered COVID-19 had made nurses more honourable (t= 6.30,p< .001) or had not made them unwilling to be a nurse (t= 13.39,p< .001).

Results from a multivariable regression are shown in Table3. For brevity, only variables that were significantly associated with the corresponding outcomes were reported. The variance inflation factor values of all independent variables were 1.0 to 1.5 only. The perceived influences of the COVID-19 pandemic were associated with the WRS-GN total score and also generally with its five subscales. Graduate nurses who considered the COVID-19 has made nurses more honourable (estimated coefficient=6.57,p= .023) or did not make them unwilling to be a nurse (estimated coefficient

= 20.52,p< .001) had higher work readiness. Moreover, positive school climate (estimated coefficient=14.42, p < .001) and being willing to be a nurse were (estimated coefficient=25.00,p< .001) significantly associated with higher WRS-GN total. They also associated with all subscale scores, except for the Personal Work Characteristics subscale. Student leadership experience also significantly increased the WRS-GN total score (estimated coefficient

=9.36, p = .001), as well as the Work Competence and Social Intelligence subscales’scores. In addition, selecting nursing major as primary choice positively associated with WRS-GN in total (estimated coefficient=7.78,p=.017) and the Organisational Acumen subscale (estimated coefficient=2.68,p=.003). Furthermore, part-time work experience significantly increased the scores of the Social Intelligence subscale (estimated coefficient=2.73,p=.010), while more average internship daily working hours was a positive determinant of Personal Work Characteristics (estimated coefficient=0.65,p=.027). Other estimated coefficients and p values for variables in subscale regression model are contained in Table3.

3.3 | Association of work readiness with work- related outcomes

Table 4 shows the effects of work readiness on work-related outcomes, with and without adjusting the demographics and clinical characteristics. Apart from the Personal Work Characteristics subscale, the WRS-GN total and other subscales generally predicted all work-related outcomes. WRS-GN total predicted OCSE-N total (adjusted estimated coefficient=0.06,p< .001), NOC total (adjusted estimated coefficient=0.06, p < .001) and IR total (adjusted estimated coefficient=0.01,p=.002). The only exceptions were the IR which was not predicted by the Work Competence (adjusted estimated coefficient=0.01,p=.302) and Social Intelligence subscales (adjusted estimated coefficient=0.00, p = .574), as well as the Accumulate Emotional Costs Commitment of the NOC, which was not predicted by the Organisational Hierarchy subscale (adjusted estimated coefficient=0.02, p = .080). The Personal Work Characteristics subscale predicted the IR (adjusted estimated coefficient=0.04, p < .001), Normative Occupational Commitment (adjusted estimated coefficient= 0.04, p = .006), Accumulated Economic Costs Commitment (adjusted estimated coefficient

= 0.07, p < .001), Accumulated Emotional Costs Commitment (adjusted estimated coefficient= 0.13, p < .001) and Limited Alternatives Occupational Commitment (adjusted estimated

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TABLE1Demographicsandclinicalcharacteristicsofrespondentsandtheirdifferencesinworkreadiness(n=794) VariablesN(%)

Mean(SD) Totalscore (37–370)

Work competence (8–80) Social intelligence (9–90) Organisational acumen(9–90) Organisational hierarchy (7–70)

Personalwork characteristics (4–40) Gender Male66(8.30)272.27(43.34)64.38(14.53)67.35(13.82)64.05(11.78)58.15(10.29)18.35(8.07) Female728(91.70)260.53(45.49)59.90(13.00)61.47(14.10)61.12(12.56)57.40(11.14)20.64(7.59) tvalue/pvalue2.02/.0442.65/.0083.25/.0011.82/.0690.529/.5972.34/.020 Theonlychildinthefamily Yes701(88.30)261.88(44.96)60.42(13.15)61.85(14.07)61.57(12.33)57.60(10.94)20.44(7.52) No93(11.70)258.73(48.82)59.20(13.43)62.78(14.88)59.77(13.81)56.43(12.04)20.54(8.63) tvalue/pvalue0.63/.5300.83/.4040.60/.5511.20/.2360.96/.3400.12/.907 Expectedmonthlysalary(RMB) <5,000261(32.90)261.46(45.03)59.96(12.85)61.38(13.87)61.60(12.25)57.84(11.16)20.68(7.74) 5,001–7,000339(42.70)261.11(45.61)60.32(13.44)61.96(14.15)61.19(12.85)57.37(10.86)20.28(7.58) 7,001–9,000113(14.20)266.45(42.33)61.42(12.51)63.41(14.45)62.91(11.37)59.01(10.07)19.70(7.56) 9,001–11,00036(4.50)250.47(46.67)57.81(13.02)59.67(13.32)57.89(12.60)53.78(12.84)21.33(6.55) >11,00045(5.70)261.20(52.29)60.89(14.97)63.58(15.85)60.09(14.01)55.04(12.43)21.60(8.75) Fvalue/pvalue0.87/.4800.59/.6690.79/.5331.28/.2752.18/.0700.75/.559 Educationallevel Higherdiploma522(65.70)264.52(46.28)61.02(13.67)62.84(14.65)62.44(12.95)58.21(11.17)20.01(8.10) Bachelordegree272(34.30)255.72(43.17)58.85(12.08)60.28(13.02)59.29(11.40)56.01(10.75)21.29(6.63) tvalue/pvalue2.60/.0092.30/.0222.42/.0163.39/.0012.67/.0082.39/.017 Durationofclinicalinternship 10months707(89.00)261.77(45.46)60.37(13.28)62.02(14.18)61.46(12.57)57.59(11.12)20.32(7.70) 11months71(8.90)262.01(45.39)60.31(12.90)61.68(14.31)61.11(11.88)57.00(10.09)21.92(7.33) 12months16(2.00)247.88(43.40)55.75(8.90)60.50(13.33)58.00(13.31)53.81(13.10)19.81(6.40) Fvalue/pvalue0.74/.4790.96/.3820.11/.8990.61/.5420.98/.3761.47/.232 Averagedailyworkinghoursduringinternship <7.5h25(3.10)259.36(50.47)59.52(15.72)63.32(16.96)61.48(13.54)55.88(11.79)19.16(6.41) 7.5–8h264(33.20)260.52(47.16)60.44(13.73)62.09(14.74)60.92(12.64)57.12(11.22)19.95(7.99) 8–8.5h314(39.50)259.88(44.30)59.42(12.99)60.87(13.66)61.18(12.29)57.91(10.95)20.49(7.27) 8.5–9h143(18.00)262.35(43.93)60.86(12.07)62.20(14.03)61.17(12.83)56.87(11.16)21.24(7.78) >9h48(6.00)276.27(43.47)63.60(12.98)66.96(12.16)65.44(11.66)59.02(10.55)21.25(8.38) Fvalue/pvalue1.43/.2221.20/.3102.04/.0871.38/.2380.66/.6210.98/.419 (Continues)

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TABLE1(Continued) VariablesN(%)

Personalwork characteristics (4–40) Medicaldisturbanceexperienceduringinternship Yes323(40.70)261.86(43.90)60.33(12.37)62.16(13.91)61.45(12.20)57.40(10.86)20.53(7.38) No471(59.30)261.27(46.45)60.24(13.72)61.82(14.34)61.30(12.75)57.50(11.23)20.40(7.84) tvalue/pvalue0.18/.8570.09/.9310.33/.7420.16/.8730.12/.9020.23/.818 Familysupport Yes722(90.90)263.21(45.41)60.66(13.26)62.34(14.23)61.83(12.49)57.84(10.92)20.55(7.55) No72(9.10)244.46(41.96)56.43(11.73)58.21(12.95)56.67(11.90)53.65(11.92)19.50(6.53) tvalue/pvalue3.36/.0012.61/.0092.37/.0183.36/.0013.08/.0021.27/.206 Schoolclimate Positive389(49.00)276.03(41.14)64.08(12.15)65.69(13.31)65.07(10.99)60.27(9.40)20.92(8.00) Neutral391(49.20)248.28(44.60)56.75(13.18)58.52(13.87)58.01(12.79)55.08(11.64)19.92(7.25) Negative14(1.80)227.36(52.18)52.79(10.30)54.50(18.31)51.86(14.11)45.86(14.99)22.36(7.93) Fvalue/pvalue44.92/<.00135.26/<.00128.91/<.00138.41/<.00131.48/<.0012.10/.124 Senseofbelongingatschool Yes593(74.70)266.67(42.90)61.74(12.47)63.18(13.54)62.63(11.86)58.41(10.30)20.72(7.69) No201(25.30)246.27(49.14)55.96(14.26)58.36(15.33)57.62(13.6)54.66(12.70)19.67(7.49) tvalue/pvalue5.25/<.0015.12/<.0013.96/<.0014.64/<.0013.78/<.0011.67/.095 Gotalongwithclassmates Yes766(96.50)262.56(44.67)60.49(13.08)62.23(13.92)61.61(12.33)57.74(10.91)20.49(7.69) No28(3.50)232.86(55.97)54.50(14.82)54.57(18.47)54.57(15.78)49.93(12.80)19.29(6.57) tvalue/pvalue2.78/.0102.37/.0182.17/.0052.33/.0273.69/<.0010.82/.412 Studentleadershipexperience Yes401(50.50)269.86(44.41)62.66(12.93)64.98(14.03)63.10(12.06)58.41(10.59)20.70(8.32) No393(49.50)252.99(44.88)57.84(13.00)58.88(13.63)59.59(12.74)56.49(11.48)20.19(6.91) tvalue/pvalue5.32/<.0015.24/<.0016.21/<.0013.99/<.0012.46/.0140.94/.347 Part-timeworkexperience Yes606(76.30)264.41(45.18)61.05(13.15)63.00(14.05)62.19(12.43)57.75(11.00)20.43(7.91) No188(23.70)252.14(44.97)57.77(13.01)58.63(14.02)58.69(12.46)56.53(11.28)20.53(6.76) tvalue/pvalue3.26/.0013.00/.0033.72/<.0013.37/.0011.33/.1860.17/.866 (Continues)

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TABLE1(Continued) VariablesN(%)

Personalwork characteristics (4–40) Nursingastheprimarychoice Yes559(70.40)269.14(43.07)61.97(13.04)63.92(13.96)63.57(11.57)59.18(10.09)20.50(8.04) No235(29.60)243.36(45.75)56.24(12.66)57.30(13.55)56.10(13.13)53.38(12.21)20.34(6.63) tvalue/pvalue7.56/<.0015.71/<.0016.16/<.0017.58/<.0016.42/<.0010.27/.784 Willingtobeanurse Yes482(60.71)277.94(39.94)64.34(12.38)66.26(13.27)65.84(10.55)60.79(8.90)20.72(8.54) No312(39.29)236.13(41.53)54.00(11.87)55.32(12.89)54.45(12.19)52.32(12.10)20.04(6.01) tvalue/pvalue14.18/<.00111.68/<.00111.48/<.00113.55/<.00110.64/<.0011.30/.192 Awardedscholarshipduringstudy Yes246(31.00)268.59(45.50)62.56(13.27)63.88(14.52)62.83(11.82)58.58(10.03)20.74(8.62) No548(69.00)258.33(45.04)59.25(13.02)61.10(13.92)60.70(12.78)56.96(11.48)20.32(7.18) tvalue/pvalue2.96/.0033.29/.0012.57/.0012.23/.0262.01/.0450.70/.512 COVID-19hasmadenursesmorehonourable Agree450(56.68)270.29(42.21)61.28(12.55)63.08(13.77)63.91(11.39)60.59(9.20)21.44(7.41) Disagree344(43.32)250.02(46.92)58.97(13.88)60.50(14.55)58.03(13.15)53.37(11.95)19.16(7.78) tvalue/pvalue6.30/<.0012.43/.0162.55/.0116.61<.0019.30/<.0014.19/<.001 COVID-19hasmademeunwillingtobeanurse Agree261(32.87)233.66(42.66)53.93(11.67)55.09(12.91)53.61(12.16)50.43(12.22)20.59(5.88) Disagree533(67.13)275.15(40.21)63.38(12.77)65.32(13.53)65.16(10.84)60.90(8.58)20.38(8.39) tvalue/pvalue13.39/<.00110.07/<.00110.16/<.00113.02/<.00112.43/<.0010.41/.679

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T A B L E 2 The level of work readiness and work-related outcomes among graduate nurses (n=794)

Scales and subscales Plausible range Minimum Maximum Mean (SD)

WRS-GN

Total score 37–370 114 370 261.51 (45.40)

Work competence 8–80 19 90 60.28 (13.18)

Social intelligence 9–90 11 90 61.96 (14.16)

Organisational acumen 9–90 23 80 61.36 (12.52)

Organisational hierarchy 7–70 21 70 57.46 (11.07)

Personal work characteristic 4–40 4 40 20.45 (7.65)

OCSE-N

Total score 9–45 9 45 30.30 (6.13)

Occupational burden 6–30 3 15 20.04 (4.12)

Relational burden 3–15 6 30 10.26 (2.30)

NOC

Total score 24–120 34 116 81.65 (11.56)

Affective occupational commitment 6–30 6 30 22.25 (4.12)

Normative occupational commitment 5–25 5 25 18.22 (3.55)

Accumulated economic costs commitment 4–20 4 20 14.24 (2.58)

Accumulated emotional costs commitment 5–25 5 25 15.49 (3.91)

Limited alternatives occupational commitment 4–20 4 20 11.44 (2.87)

IR 4–16 4 16 11.01 (2.36)

Abbreviations: IR, intention to remain; NOC, Nurses Occupational Commitment; OCSE-N, Occupational Coping Self-Efficacy Questionnaire for Nurses;

WRS-GN, Work Readiness Scale for Graduate Nurse.

T A B L E 3 Multivariable analysis for the determinants of work readiness (n=794)

Variables Estimated coefficient Standard error tvalues pvalues

Total score of work readiness (R-squared=34.4%, adjustedR-squared=32.8%)

COVID-19 has made nurses more honourable 6.57 2.88 2.28 .023

COVID-19 has made me unwilling to be a nurse 20.52 3.40 6.03 <.001

School climate

Positive vs. neutral 14.42 2.98 4.84 <.001

Negative vs. neutral 6.60 10.91 0.60 .503

Willingness to be a nurse 25.00 3.29 7.59 <.001

Student leadership experience 9.36 2.88 3.25 .001

Nursing was the primary choice 7.78 3.25 2.40 .017

Work competence (R-squared=25.3%, adjustR-squared=23.5%) School climate

Social intelligence(R-squared=26.0%, adjustR-squared=24.2%) School climate

(Continues)

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T A B L E 3 (Continued)

Variables Estimated coefficient Standard error tvalues pvalues

Student leadership experience 4.14 0.95 4.35 <.001

Part-time work experience 2.73 1.05 2.60 .010

Organisational acumen (R-squared=33.1%, adjustR-squared=31.4%) School climate

Educational level 1.79 0.91 1.98 .048

COVID-19 has made nurses more honourable 2.27 0.80 2.84 .005

Organisational hierarchy (R-squared=30.2%, adjustR-squared=28.6%) School climate

Positive vs. neutral 2.48 0.75 3.31 .001

COVID-19 has made nurses more honourable 4.21 0.72 5.83 <.001

Personal work characteristics (R-squared=5.2%, adjustR-squared=3.0%)

Gender (female vs. male) 2.15 1.03 2.10 .036

Average internship daily working hours 0.65 0.29 2.22 .027

Educational level 1.39 0.66 2.12 .035

COVID-19 has made nurses more honourable 2.35 0.58 4.05 <.001

COVID-19 has made me unwilling to be a nurse 1.65 0.69 2.40 .017

T A B L E 4 Regression analysis of work-related outcomes on work readiness (n=794)

Variables

Unadjusted estimates Adjusted estimates^a

Estimated coefficient

95% confidence

interval pvalues

95% confidence

interval pvalues

Coping with occupational burden (6–30)

Total score of work readiness (37–370) 0.05 (0.04, 0.05) <.001 0.04 (0.04, 0.05) <.001

Work competence (8–80) 0.17 (0.15, 0.18) <.001 0.13 (0.11, 0.15) <.001

Social intelligence (9–90) 0.17 (0.15, 0.18) <.001 0.14 (0.12, 0.16) <.001

Organisational acumen (9–90) 0.15 (0.13, 0.17) <.001 0.11 (0.09, 0.14) <.001

Organisational hierarchy (7–70) 0.13 (0.10, 0.15) <.001 0.09 (0.06, 0.11) <.001

Personal work characteristics (4–40) 0.02 ( 0.06, 0.02) .255 0.02 ( 0.05, 0.02) .289

Coping with relational burden (3–15)

Work competence (8–80) 0.08 (0.07, 0.09) <.001 0.06 (0.05, 0.07) <.001

(Continues)

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T A B L E 4 (Continued)

Variables

95% confidence

interval pvalues

95% confidence

interval pvalues

Total score of occupational coping self-efficacy (9–45)

Total score of work readiness (0–370) 0.07 (0.07, 0.08) <.001 0.06 (0.05, 0.07) <.001 Affective occupational commitment (6–30)

Work competence (8–80) 0.15 (0.14, 0.17) <.001 0.07 (0.05, 0.09) <.001

Normative occupational commitment (5–25)

Work competence (8–80) 0.13 (0.12, 0.15) <.001 0.07 (0.06, 0.09) <.001

Accumulated economic costs commitment (4–20)

Work competence (8–80) 0.08 (0.06, 0.09) <.001 0.04 (0.03, 0.06) <.001

Personal work characteristics (4–40) 0.06 ( 0.09, 0.04) <.001 0.07 ( 0.09, 0.05) <.001 Accumulated emotional costs commitment (5–25)

Total score of work readiness (37–370) 0.02 (0.02, 0.03) <.001 0.01 (0.01, 0.02) .001

Work competence (8–80) 0.09 (0.07, 0.11) <.001 0.06 (0.04, 0.08) <.001

Organisational hierarchy (7–70) 0.05 (0.03, 0.08) <.001 0.02 ( 0.00, 0.05) .080

Personal work characteristics (4–40) 0.14 ( 1.17, 0.10) <.001 0.13 ( 0.16, 0.10) <.001 Limited alternatives occupational commitment (4–20)

Total score of work readiness (37–370) 0.01 ( 0.02, 0.01) <.001 0.02 ( 0.02, 0.01) <.001

Work competence (8–80) 0.06 ( 0.07, 0.04) <.001 0.06 ( 0.08, 0.05) <.001

Social intelligence (9–90) 0.06 ( 0.07, 0.04) <.001 0.06 ( 0.08, 0.05) <.001

Organisational acumen (9–90) 0.04 ( 0.06. -0.02) <.001 0.05 ( 0.07, 0.03) <.001

Organisational hierarchy (7–70) 0.02 ( 0.04, 0.00) .017 0.04 ( 0.06, 0.02) .001

Personal work characteristics (4–40) 0.08 (0.06, 0.11) <.001 0.08 (0.05, 0.10) <.001 Total score of nurses occupational commitment (24–120)

Total score of work readiness (0–370) 0.13 (0.12, 0.15) <.001 0.06 (0.04, 0.08) <.001 (Continues)

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coefficient=0.08, p < .001) work-related outcomes only. Other estimated coefficients andpvalues for subscales of work readiness in regression model are contained in Table4.

4 | D I S C U S S I O N

This is the first study that comprehensively assessed determinants of work readiness among newly graduated nurses and if work readiness predicted coping self-efficacy and occupational commitment. We found that the work readiness of new graduate nurses deserves attention for improvement. Its determinants were identified that cover demographic, educational and social and environmental characteristics. Furthermore, work readiness was shown to have influences on coping self-efficacy, occupational commitment and intention to remain when the graduate nurses just started their role as nurses.

Enhancing work readiness might be a viable approach for promoting future work performance and retention.

4.1 | Work readiness

The WRS-GN total score in our study was approximately 70% of the full score of 370, indicating room for improvement. Nevertheless, the Organisational Hierarchy subscale score reached 80% of its full score, which is the highest among the other subscales of the WRS-GN.

Organisational hierarchy refers to respecting the others on the top and humility. The highest performance might be due to that showing respect to teachers and seniors is an important culture for the Chinese. Respect in Chinese society comes from hierarchical relationships articulated in Confucianism which still have a profound impact on Chinese culture (Evans et al.,2014). The lowest subscale is the Personal Work Characteristics, which had its mean score reached merely 50% of the full score. This dimension refers to resilience and stress management, where graduate nurses usually feel overwhelmed when facing multifaceted challenges (Chesak et al.,2019). The scores

of the other three subscales were all around 80% of the corresponding full scores. Compared with a previous study (Patterson et al.,2017), graduate nurses in Australia also had a deficient score on Personal Work Characteristic, which drew international attention. It deserves both educators’ and hospital managers’ efforts to support graduate nurses.

4.2 | New determinants of work readiness

Six determinants of overall work readiness have been identified. Of which, willingness to be a nurse, had nursing as the primary choice and student leadership experience have been reported before (Li et al.,2020). The other three determinants, that is, school climate and perceived impacts of COVID-19 on the honourability of being a nurse and the willingness to be a nurse, are newly identified. School climate is the emotions that students gain about the school environment over time (Bilgin et al.,2021). The enhanced work readiness in nurses who studied under a positive school climate suggests a complex concept influenced by educational factors. Previous studies showed that a favourable school climate could promote student achievements (Berkowitz et al.,2017) and reduce their anxiety (Elhai et al.,2016). Consequently, activities that enhance the understanding and cohesiveness among people are recommended in both the universities and hospitals. Moreover, there were also influences of the COVID-19. Graduate nurses who retained the willingness to stay in the nursing profession during the COVID-19 or believed that the COVID-19 pandemic brought more honour to nurses had higher work readiness. Under the pandemic, the front-line nurses have taken heavier responsibilities and experienced higher physical fatigue.

In particular, graduate nurses had reported an increased level of depression (Patelarou et al.,2021). Those who persisted in the nursing profession without being affected by the negative effects brought by COVID-19 would carry a genuine nursing affection. Having been driven by their passion, they were more likely to actively learn in their previous study. Therefore, they generally showed higher work T A B L E 4 (Continued)

Variables

95% confidence

interval pvalues

95% confidence

interval pvalues

Intention to remain (4–16)

Total score of work readiness (37–370) 0.02 (0.01, 0.02) <.001 0.01 (0.00, 0.01) .002

Work competence (8–80) 0.05 (0.03, 0.06) <.001 0.01 ( 0.01, 0.02) .302

Social intelligence (9–90) 0.04 (0.03, 0.05) <.001 0.00 ( 0.01, 0.01) .574

Organisational acumen (9–90) 0.07 (0.06, 0.08) <.001 0.02 (0.01, 0.03) .002

Organisational hierarchy (7–70) 0.08 (0.06, 0.09) <.001 0.02 (0.01, 0.04) .002

Personal work characteristics (4–40) 0.05 (0.03, 0.07) <.001 0.04 (0.03, 0.06) <.001

aThe total and subscales of work readiness were taken as independent variables one at a time. Adjusting variables were 17 demographics and

characteristics of graduate nurses, which are the same as those in Table1. The characteristics covered experience and performance in university, clinical internship, family support and COVID-19.

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readiness. Determinants of the five subscales were generally consistent with those identified for the overall work readiness. Never- theless, additional determinants for Social Intelligence, Organisational Acumen and Personal Work Characteristics subscales are identified.

Foremost, part-time work experience promotes social intelligence, which was also previously reported (Li et al.,2020). During part-time work, meeting and collaborating with multiple types of people provide opportunities for graduate nurses to learn, build and improve social skills. What is more, a higher educational level was associated with a lower organisational acumen. This can be due to the weaker professional value in nurses with higher education (Fisher,2014), which may result in a lower motivation for career development (Yarbrough et al.,2017). Since career development was an essential component of organisational acumen (Walker et al.,2015), higher educated nurses would have lower organisation acumen. Finally, gender, average internship daily working hours and educational level were determinants of Personal Work Characteristics. Previous studies found that higher education (Guo et al.,2017) and being a male (Karimi Moonaghi et al.,2016) predicted a high level of resilience. Hence, they could have a higher stress management ability. Working longer provides an opportunity to increase and reinforce learning, which benefits developing the necessary skills and confidence (Lobo et al.,2018). There- fore, they developed a better capacity to control stress from the effect of the additional hours on their professional growth and senior- ity. Since stress management is a critical component of personal work characteristics, the above factors strongly correlate to this dimension.

4.3 | The influences of work readiness on work- related outcomes

This study identified the positive influence of work readiness on coping self-efficacy for the first time. This can be explained by the fact that a higher work readiness indicates more substantial work competence, higher social intelligence and more mature organisational awareness (Caballero et al., 2011). All these attributes can enhance coping self-efficacy (Hu et al.,2018; Soudagar et al.,2015). The five subscales of the WRS-GN generally showed positive influences. An exception is the Personal Characteristics subscale that showed no significant impact on coping self-efficacy. The Personal Characteristics subscales comprised four items that assessed a mix of adaptability, attitudes to work and stress management (Caballero et al.,2011). The non-specificity of the subscale may have rendered its insignificance association of coping self-efficacy. We also found an influence of work readiness on occupational commitment. Work readiness has been shown to be a predictor of work engagement previously (Caballero et al.,2011), while work engagement has also been shown to predict organisational commitment (Cao et al., 2019). Therefore, the influence of work readiness on occupational commitment may be directly or indirectly via work engagement. Again, our results show that the influences of work readiness are consistently positive in all subscales of organisational commitment, except for the Personal Characteristics subscale when a negative impact on organisational

commitment is observed. Mediators that carry a negative effect may exist and account for this negative association, which needs further exploration. In addition, the positive influence of work readiness on intention to remain has also not been identified before. The previous study that examined the relationship did not conclude a significant effect because of the small sample size (Walker & Campbell,2013).

With an adequate sample size, we were able to demonstrate a genuine influence of work readiness on intention to remain in the nursing profession. A previous study showed that the experience transition shock would increase the turnover risk among new graduate nurses (Cao et al.,2021). It is plausible that new graduate nurses who had higher work readiness may have experienced less transition shock and thus had higher intention to remain. However, more work would need to be done to assess the potential mediation effect of transition shock on the relationship between work readiness and intention to remain.

4.4 | Limitations

Despite our efforts made to ensure the study was properly designed and conducted, several limitations are worth considering. First, there are a total of 31 provincial administrative regions in the mainland of China. Although we recruited graduate nurses from 21 provinces, most were from Guangdong. Consequently, there may be a small sampling bias. Second, the questionnaires employed in this survey were self-reported. Thus, the internal validity would rely on the accuracy of participants’ responses. Third, we assessed the work- related outcomes only around 1 month after the graduate nurses started working. A longer follow-up assessment would be encouraged to examine the long-term predictive value of work readiness in the future.

5 | C O N C L U S I O N S

Work readiness among new graduate nurses in Mainland China is reasonable, but there remains room for improvement. Environmental influences play a key role in enhancing work readiness. It is essential for educators and employers to consider developing and implementing transition strategies to help new graduate nurses deliver good work outcomes.

5.1 | Implications for nursing management

There are several implications for the management of graduate nurses. First, it was hypothesized that graduate nurses with higher work readiness would have better coping self-efficacy, occupational commitment and intention to remain. We suggested that hospital administrators to assess work readiness as an employment screening tool in the future or consider it when designing the duration and intensity of transition programmes, orientation or other support programmes. Second, determinants might assist nursing managers in

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identifying graduate nurses at risk of being less ready. Continual training can thus be more targeted to enhance their preparation and avoid the occurrence of poor occupational commitment, low coping self-efficacy and high turnover rates.

A C K N O W L E D G E M E N T S

The authors thank the faculty members of the nursing school from other universities across China to help distribute the questionnaire.

E T H I C S S T A T E M E N T

This study was approved by the ethics committee of First Affiliated Hospital of Guangzhou Medical University, and the approve number is No. 2021.26.

A U T H O R C O N T R I B U T I O N S

Jiaying Li drafted the manuscript. Yang Song made this study’s design and helped with the acquisition of data. Yanyi Huang and Jieya Chen collected the data. Daniel Yee Tak Fong directed and revised the writing of the manuscript critically.

D A T A A V A I L A B I L I T Y S T A T E M E N T

The data that support the findings of this study are available from the corresponding author upon reasonable request.

ORCID

Daniel Yee Tak Fong https://orcid.org/0000-0001-7365-9146

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How to cite this article:Li, J., Huang, Y., Fong, D. Y. T., Chen, J., & Song, Y. (2022). Work readiness: Its determinants and association with work-related outcomes among new graduate nurses.Journal of Nursing Management,30(7), 2968–2981.

https://doi.org/10.1111/jonm.13691