Work experiences among nurses and physicians in the beginning of their professional careers – analyses using the effort–reward imbalance model

Scand J Caring Sci; 2013; 27; 36–43 Work experiences among nurses and physicians in the beginning of their professional careers – analyses using the effort–reward imbalance model The aim of the study was to scrutinise how nurses and physicians, employed by the county councils in Sweden, assess their work environment in terms of effort and reward at the start of their career. The aim was also to estimate associations between work satisfaction and the potential outcomes from the effort–reward imbalance (ERI) questionnaire. The study group, 198 nurses and 242 physicians who graduated in 1999, is a subsample drawn from a national cross‐sectional survey. Data were collected in the third year after graduation among the nurses and in the fourth year after graduation among registered physicians. The effort–reward imbalance questionnaire, together with a question on work satisfaction, was used to evaluate psychosocial factors at work. The results reveal that nurses scored higher on effort, lower on reward and experienced higher effort–reward imbalance, compared with physicians. Women scored higher on work‐related overcommitment (WOC) compared with men. Among the physicians, logistic regression analysis revealed a statistically significant association between WOC and ERI, sex, effort and reward. Logistic regression analysis also revealed a statistically significant association between WOC and ERI and between WOC and effort among the nurses. Dissatisfaction with work was significantly higher among those who scored worst on all three ERI subscales (effort, reward and WOC) and also among those with the highest ERI ratios compared with the other respondents. In conclusion, to prevent future work‐related health problems and work dissatisfaction among nurses and physicians in the beginning of their professional careers, signs of poor psychosocial working conditions have to been taken seriously. In future work‐related stress research among healthcare personnel, gender‐specific aspects of working conditions must be further highlighted to develop more gender‐sensitive analyses.     

The relationship between the levels of nurses’ competence and the length of their clinical experience: a tentative model for nursing competence development

Aims and objectives. To explore the relationship between the levels of nurses’ competence and the length of their clinical experience, in order to provide a tentative model of the continuing competence of nurses. Background. The professional development of employees has attracted great interest. This interest has led to the development of various models that illustrate how employees develop their competence throughout their careers. However, little is known of how nurses maintain and develop their competence throughout their career pathways. Design. A cross‐sectional design was used. Methods. Using a survey method, five dimensions of self‐assessed nursing competence and the length of the nurses’ clinical practice were measured (n = 325). Each dimension of competence was plotted against the length of their clinical experience using locally weighted scatterplot smoothing. Then, the shapes of the plots were analysed by fractional polynomial regression analysis. Results. Overall, the relationships between the levels of nursing competence and the length of clinical experience were illustrated by curves with a rapid increase in competence levels at the early stage of the nursing career and a slower increase later. These curves were modelled by either a logarithmic, square‐root function or its reciprocal. The results supported the learning curve model. Conclusions. The competence development of nurses may be characterised by two distinctive periods: a rapid growth period followed by stable periods. However, the modality of the growth may be different depending on which dimension of nursing competence is in focus. Relevance to clinical practice. The level of nursing competence directly affects the quality of care provided to patients. The findings of the study enable healthcare organisations to take proactive approaches to enhance nurses’ competence by identifying when and how to assist nurses.