Shanghai Jiao Tong University School of Nursing, 227 South Chongqing Road Huangpu District, Shanghai, China.
University of Wisconsin-Madison School of Nursing, 701 Highland Avenue, Madison, WI, USA.
Int J Nurs Stud. 2019 Nov;99:103332. doi: 10.1016/j.ijnurstu.2019.03.022. Epub 2019 Apr 5.
Newly graduated nurses have comparatively high levels of occupational stress. Previous studies have evaluated stress across this population as a whole; however, little is known about potentially different occupational stress responses among new nurses and the impact of demographic and work-related characteristics on occupational stress responses.
To determine differences in occupational stress levels of newly graduated nurses at different time points during the first 3 years of practice; to identify potential subgroups of nurses who perceive different occupational stress levels over time; and to evaluate differences in identified subgroups based on demographic and work-related characteristics.
An observational longitudinal study.
Four tertiary hospitals in Shanghai were selected randomly using a computer-generated random number table.
All 343 newly graduated nurses employed in the selected hospitals were invited to participate. The inclusion criteria were (1) newly graduated without nursing experience, excluding nursing internship; (2) current employment in in-patient departments/ICU/operation room; and (3) consented to participate. A total of 152 participants met criteria and completed all four points of data collection.
Participants completed an annual paper survey. Occupational stress levels were measured using the Job Stress Scale for Newly Graduated Nurses. Occupational stress scores at different time points were compared using latent growth modeling. Group-based trajectory modeling was performed to identify subgroups of occupational stress trajectory. ANOVA and Fisher's exact test were conducted to examine the differences of demographic characteristics between classes.
The entire sample of newly graduated nurses experienced a significant decrease in occupational stress during the first three years. The best-fitting group-based trajectory model described three distinctive trajectories: low occupational stress (19.1% of sample); medium occupational stress (67.1%) and high occupational stress (13.8%). The low occupational stress subgroup had a higher proportion of nurses from Shanghai, and the majority were employed as contact- based nurses. In comparison, the high occupational stress subgroup had the largest proportion of nurses from other provinces (outside of Shanghai), almost half of participants were employed as "bianzhi" nurses, and the majority reported to be assigned preceptor by shift.
Newly graduated nurses perceived occupational stress differently over time. Identified subgroups with different demographic characteristics have significantly different perceptions of occupational stress over the first three years of practice and future intervention programs such as peer-support programs or a standardized preceptorship should be tailored to meet the unique needs of these different subgroups.
新毕业护士的职业压力水平相对较高。以往的研究已经评估了整个群体的压力情况；然而，对于新护士潜在的不同职业压力反应以及人口统计学和工作相关特征对职业压力反应的影响知之甚少。
确定新毕业护士在实践的头 3 年内不同时间点的职业压力水平差异；确定随时间感知不同职业压力水平的潜在护士亚组；并根据人口统计学和工作相关特征评估已确定亚组的差异。
观察性纵向研究。
使用计算机生成的随机数表随机选择上海的 4 家三级医院。
邀请所有在选定医院工作的 343 名新毕业护士参加。入选标准为：（1）无护理经验的应届毕业生，不包括护理实习；（2）目前在住院部/ICU/手术室工作；（3）同意参加。共有 152 名参与者符合标准并完成了全部 4 次数据采集。
参与者每年完成一次纸质调查。使用新毕业护士工作压力量表测量职业压力水平。使用潜在增长建模比较不同时间点的职业压力得分。进行基于群组的轨迹建模以确定职业压力轨迹的亚组。进行方差分析和 Fisher 精确检验，以检查不同类别之间人口统计学特征的差异。
新毕业护士在头 3 年中职业压力显著降低。最佳拟合的基于群组的轨迹模型描述了 3 种不同的轨迹：低职业压力（样本的 19.1%）；中等职业压力（67.1%）和高职业压力（13.8%）。低职业压力亚组中来自上海的护士比例较高，大多数从事接触式护士工作。相比之下，高职业压力亚组中来自其他省份（上海以外）的护士比例最大，近一半的参与者被聘为“编外”护士，且大多数人报告按班次分配导师。
新毕业护士在不同时间对职业压力的感知不同。具有不同人口统计学特征的已识别亚组在实践的头 3 年内对职业压力的感知有显著差异，未来的干预计划，如同伴支持计划或标准化导师制，应根据这些不同亚组的独特需求进行定制。
