This paper reports the development and preliminary validation of the brief Nurses’ Perceived Professional Benefits Questionnaire (NPPBQ), which was derived from a conceptual framework established by Hu J. and Liu X. H.12]. The psychometric evaluations provided an initial assessment of the NPPBQ across clinical samples. The four steps provided promising evidence to support the NPPBQ as a factorially stable and psychometrically sound brief measure of NPPB (the final version of the NPPBQ see the additioanl file: the English version and the Chinese version of the NPPBQ).
Across the studies, the reliability (internal consistency Cronbach’s alpha, Guttman split-half reliability), factor structure, and convergent validity of the NPPBQ were examined. Psychometric analyses of the NPPBQ provided support for the good internal consistency, stability, and validity of the instrument. The NPPBQ has a simple five-factor structure that showed good validity and can be described as follows: (1) positive occupational perception; (2) good nurse-patient relationship; (3) recognition from family, relatives, and friends; (4) sense of belonging to a team; and (5) self-growth. The Cronbach’s alpha of every sub-questionnaire of the NPPBQ were 0.84, 0.83, 0.74, 0.79, and 0.85, respectively. And the Guttman split-half were 0.795，0.826，0.674，0.725，and 0.877, respectively. The five dimensions revealed good consistency with the components of J. Hu and X. H. Liu’s model and the current literature on NPPB [4, 7, 8, 9, 12, 14]. The results suggest that the NPPBQ is theoretically and empirically valid.
The current research has provided promising evidence to support the 5-factor NPPBQ model and suggests that the solution is robust across Chinese samples, recognizing that additional validation in other cultures is a required future research direction. The results suggest that the factor structure for the NPPBQ is stable and clear. The five-factor model showed good fit in terms of both the relative fit indices (e.g., TLI, CFI, and NFI) and absolute fit indices (e.g., 2/df, RMR, and RMSEA). Importantly, the 5-factor structure fits the conceptual framework that underlies the NPPBQ . The NPPBQ supports NPPB as a multidimensional construct and the foundational role of cognitive evaluation processes in the generation and maintenance of reasonable vocational cognition and evaluation; it also indicates that NPPB has an intermediate regulating effect on the relationship between job stress and job burnout. The five dimensions of the NPPBQ represent professional benefits in terms of both the material and non-material benefits of being a nurse. Thus, the NPPBQ contributes significantly not only by providing a valuable instrument measuring NPPB but also by assessing the unique aspects of this construct, such as nurses’ perceived nurse-patient relationships and support from important others. Therefore, targeted measures can be taken to improve those relevant aspects.
Concurrent validity analyses found that the NPPBQ was significantly negatively correlated with the emotional exhaustion and depersonalization dimensions’ scores (measured by the MBI). These results were anticipated given the strong relationship between the degree of nursing burnout and NPPB [15, 16]. Thus, the findings provide further support for the validity of the newly developed instrument.
According to a previously published study, the sense of occupational benefit can explain 31.6%, 13.1%, and 9.5% of the variance in emotional exhaustion, depersonalization and reduced personal achievement . Similar to results from the present study, it has also been shown that NPPB is significantly positively associated with reduced personal accomplishment scores on the MBI. It seems plausible that nurses low in NPPB might tend to lack motivation and initiative in their work, resulting in a lower sense of job satisfaction and personal accomplishment. Moreover, a cognitive intervention program for nurses’ sense of occupational benefit can improve the level of professional benefit of nurses and alleviate their burnout . Conversely, a nurse with a higher sense of professional benefit will have a higher sense of personal accomplishment. Accordingly, it is well established that NPPB is associated with self-efficacy and reduced nursing burnout.
In short, a new, theory-driven measure of NPPB was developed using three samples. The findings of the studies provide support for the psychometric properties of the NPPBQ in terms of internal consistency and construct validity. The NPPBQ has five sub-questionnaires. Thus, the NPPBQ reflects important features of NPPB, such as specific career cognition, sense of support from important others and self-development and, moreover, is a brief instrument that assesses all the constructs underlying NPPB as posited by Hu and Liu’s model . Importantly, the NPPBQ is a simple assessment measure. A brief questionnaire with a reasonable number of items will solve the shortcomings of a lengthy questionnaire, such as potential, missingness, and reduced data quality and response burden.
The NPPBQ was developed as a multidimensional instrument to assess registered nurses’ perceived professional benefits. The systematic literature review revealed relatively little research on the development of tools to measure the multiple aspects of professional benefits that nurses perceive. Although there are some related tools, few have focused generally on clinical nurses’ perspectives of their professional benefits, and few have been psychometrically verified with respect to their factor structure. The 5-factor NPPBQ is consistent with a former NPPB conceptual framework and further confirmed it in theory and practice.
As the current research is the first to evaluate the psychometric properties of the 17-item NPPBQ, the present results are in need of replication in other cultural contexts for further validation. There are several areas to be considered for future work that are necessary to continue the validation of the NPPBQ. First, the three samples in the current study were all samples of convenience, which could limit the generalizability of the results, and there is sufficient evidence to warrant a subsequent evaluation within a large clinical sample. Second, an evaluation of the factor structure of the NPPBQ using different samples is warranted. Future studies using diverse populations should pursue measurement and structural invariance testing via CFA to determine if the factor structure of the NPPBQ varies for members of different sociodemographic groups (e.g., with religious beliefs vs. without religious beliefs). Third, the psychometric properties of the NPPBQ should also be assessed across different countries and languages to further evaluate its robustness as an assessment tool. Importantly, future studies should consider comparative assessments with existing measures of job satisfaction and nurses’ professional benefits and provide extended evidence of the construct validity of the NPPBQ.
Despite the aforementioned limitations, the current research represents the first substantial step toward validation of the NPPBQ. There is promising evidence to suggest that the NPPBQ is reliable and a conceptually and empirically valid measure, assessing dimensions of the construct that are congruent with the NPPB conceptual model, and could prove useful to investigators. The four steps of the study have provided initial evidence to support the NPPBQ as a factorially stable and psychometrically sound brief measure of nurses’ professional benefits perceptions, recognizing that additional validation in various cultural contexts is a required future research direction.
Implications for nursing
There is increasing acknowledgement of the significance and value of guiding nurses to fully realize the benefits of their careers and of improving NPPB in practice. Empirical research has identified significant associations between NPPB, willingness to stay, job burnout, subjective well-being, innovative behavior, work engagement, a professional commitment, and sense of calling [18–24].
The NPPBQ may assist clinical nursing managers in exploring and improving staff perceptions, evaluations, and attitudes towards professional benefits. Findings from the NPPBQ could inform the selection of topics for improving nurses’ good professional perceptions to enhance the assessment of the intensity and influencing factors of NPPB, monitoring changes in practice. Continued and increased facilitation of access to these benefits by medical institutions is vital for sustaining active involvement in the nurse role, and there is a need to improve nurses’ intent to stay against the background of the global shortage of nursing staff and the predicted shortage of nurses.
Another potential use of the NPPBQ would be as an assessment or evaluation tool in education and continuing education departments to inform the content of career development programs and evaluate the effectiveness of such training in bringing about change in attitudes, perceptions and practices.
While there are a few studies on the professional benefits perceived by nurses in specific specialties, there is no brief questionnaire with good reliability and validity to measure the general condition of the majority of nurses. Given the prevalence of positive psychology, it is important to understand how paying attention to and improving nurses’ sense of career benefit is related to their willingness to stay and can reduce job burnout, which is conducive to improving nurses’ professional mentality and professional identity. The NPPBQ is a multidimensional measure that creates an opportunity to gain further insight and identify approaches to support reasonable professional evaluation and healthy professional attitudes in nurses.