Abstract
To explore the relationship between social status perception, professional identity, and work engagement among nurses involved in blood purification, and to provide a theoretical basis for improving the professional identity and work engagement of blood purification nurses. A convenient sampling method was used to distribute questionnaires to 81 nurses specializing in blood purification in Beijing. The MacArthur scale was used to verify the social status perception of the study subjects. General situation questionnaires, nurse professional identity rating scales, and work engagement scales were used to investigate the study subjects. The higher the level of the hospital where the nurse works, the higher their perception of their social status; social status perception has a positive correlation with professional identity among nurses involved in blood purification; social status perception plays a partial mediating role between work engagement and professional identity among nurses involved in blood purification. Attention should be paid to the psychological care of nurses specializing in blood purification, and at the same time, positive publicity should be raised for the profession of nursing specializing in blood purification, to enhance nurses’ professional pride and social status perception, thereby improving the professional cognition and work recognition of nurses involved in blood purification, and providing better nursing services for patients.
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Introduction
Social status perception is a psychological feeling determined by an individual’s resource possession, influenced by their perceived economic and educational status, as well as by psychological resources such as life satisfaction, self-esteem, trust, dominance, and control1. Among patients with end-stage renal disease, blood purification treatment is one of the main alternative treatments, which is highly specialized and requires higher requirements for nurses. The environment in which blood purification specialist nurses work is complex, and they are more sensitive to social information from others, with greater and stronger behavioral changes2. Secondly, blood purification specialist nurses are exposed to high-risk professional exposures such as chemical agents, machine alarms, contact with patients’ bodily fluids and blood, and needle stick injuries, which can accelerate their resource loss or depletion, resulting in low social status perception and significantly reduced psychological resources such as self-worth3.
With the advancement of human resource management in nursing, more and more researchers are focusing on the positive emotions and behaviours of nurses at work. Professional identity is the self-concept of professionals, which is the recognition of the professional role given by the society, the acceptance of the profession from the heart, and the positive perception and positive evaluation of it4. Work engagement refers to a positive, satisfying emotional and cognitive state related to work5. Work engagement has a positive impact on the physiological, psychological, behavioural and organisational development of individual nurses, such as reducing negative psychology, reducing work errors, and improving work innovation, work efficiency and quality of care6. In recent years, there have been a number of studies on the professional identity and work engagement of nurses in general hospitals, paediatrics, and oncology7,8, and the results suggest that professional identity is one of the main endogenous factors for the reduction of individual work engagement. It has also been found that a good perception of social status promotes professional identity, while a bad perception of social status reduces professional identit9. Nurses’ professional identity and social status perception have a positive effect on their work engagement, but there is little research on modelling the relationship between the three10.Currently, nurses have a low subjective social status, which can lead to health problems, work burnout, and reduced self-worth, which in turn can lead to a decrease in their professional identity-11,12,13. However, there has been no research on the impact of social status perception on professional identity and work engagement among blood purification nurses. Therefore, this study conducted a correlation study between social status perception, professional identity, and work engagement among blood purification specialist nurses, in order to provide better nursing services for patients and provide psychological care and management for future specialist nurses.
Data and methods
Investigation object
A survey was conducted on blood purification specialist nurses in 16 hospitals in Beijing using convenience sampling method. Using work engagement as the main outcome measure, calculate the formula based on sample size \({\text{n}} = \left( {\frac{{Z_{\alpha /2} \sigma }}{\delta }} \right)^{2}\), Z is the confidence interval, σ is the standard deviation, δ is the permissible error. Based on previous studies14,15, the values taken in this study are Z = 1.96, σ = 1.44, and δ = 0.32, respectively. 78 study subjects were calculated, and considering dropout factors, 90 specialized blood purification nurses were ultimately selected for investigation. The head of blood purification specialty nurses from each hospital selects nurses who have passed the blood purification specialty certification to participate in the survey on a voluntary basis. Inclusion criteria: ① Informed consent of the respondents. ② Obtain a nursing professional qualification certificate and carry out nursing work in blood purification clinical practice or clinical practice in the investigated department Engaged in specialized nursing for blood purification or clinical nursing in the investigated department for at least 1 year. Exclusion criteria: ① Interns, learners. ② Nurses who were not on duty during the investigation period.
Ethical approvals
In accordance with the Declaration of Helsinki. This study was approved by the Ethics Committee of China-Japan Friendship Hospital (KY2023-289-01). And after obtaining informed consent, each subject volunteered to participate in the study, and subjects were anonymised when completing the contents.
Survey tools
General information questionnaire
The questionnaire was designed by the researchers themselves, and included questions about gender, age, education, professional title, work experience, years of experience in blood purification nursing, hospital level, and employment method.
MacArthur scale
Subjective social class emphasizes the perceived hierarchy of individuals relative to others in society. The most representative measurement tool is the MacArthur scale of subjective socioeconomic status16. The Cronbach’s α coefficient of this scale is 0.80. CFA = 1.00, RMSEA = 0.03, and SRMR 0.03, suggesting good scale validity. And the specific content of the scale is as follows: the research participants will see a ladder with 10 levels, each level representing a different level of income, education, and professional prestige. The higher the level of the ladder, the higher the social status. The participants are asked to indicate how much status they feel at this moment, with "1" indicating no status at all and “10” indicating a very high social status.
Work engagement scale for specialized nurses
Compiled by Qin Hui et al.17, it includes 5 dimensions: work attitude, work value, work recognition, work motivation, work enthusiasm and focus, with a total of 32 items. The Cronbach’s alpha coefficient of the scale is 0.958, and the split-half reliability is 0.895, the scale’s content validity index, S-CVI is 0.842. The scale uses Likert 5 scoring method, with higher scores indicating that the specialist nurses are more engaged in their work.
Professional identity rating scale
The scale was developed by Liu Ling18 and colleagues, encompassing five dimensions: professional cognitive evaluation, professional social support, professional social skills, professional frustration coping, and professional self-reflection, with a total of 30 items. The Cronbach’s alpha coefficient of the scale is 0.94, and the split-half reliability is greater than 0.88. The KMO value of the scale was 0.930, and the χ2 value of the Bartlett’s test of sphericity was 5734.434 (df = 990, P < 0.001), and the relevant data suggested that the validity of the scale is high. The scale uses Likert 5 scoring method, with higher scores indicating higher professional identity for nurses. A total score of 30–60 indicates a low level of professional identity, 61–90 indicates a low level of professional identity, 91–120 indicates a medium level of professional identity, and 121–150 indicates a high level of professional identity18.
Investigation method
After obtaining the consent of the leader of the blood purification specialist nurse and the research subjects in each hospital, the online questionnaire survey method was adopted: using the work WeChat group, distributing the Questionnaire Star Connection to conduct the survey, and following up on the questionnaire filling situation. Firstly, the general information of the research subjects was investigated, and then the MacArthur score of the research participants was evaluated. Nine research participants did not fill out the MacArthur scale and were directly excluded from the study. 45 cases with a MacArthur score of ≥ 5 were considered to have a high social status, and 36 cases with a MacArthur score of < 5 were considered to have a low social status. Finally, follow-up questionnaires were taken for 81 cases of blood purification nurses who successfully triggered the perception of social status. Eventually, 81 nurses from 16 blood purification centres participated in the survey and 81 valid questionnaires were returned, with a valid recovery rate of 100%.
Quality control
The quality control of the questionnaires distributed and collected from the research participants mainly includes: (1) only one account can answer the question once; (2) setting a reasonable answer time to avoid participants answering the question hastily or perfunctorily; (3) setting logical jumps and required questions to ensure the logical integrity of the questionnaire and the integrity of the data; (4) the research group has fixed two members to collect and export the Excel after 24 h of distribution; (5) After recovery, the data were checked and invalid responses removed by 2 other members of the research team.
Statistical methods
SPSS20.0 statistical software was used for data analysis, with frequency descriptive counting data used for frequency data and mean ± standard deviation (X ± S) used for measurement data. Independent sample t-tests or one-way ANOVA were used for comparison between the two groups. Pearson analysis was used to examine the correlation between social status perception and professional identity and work engagement, and model 4 and Bootstrap confidence intervals in the Process plugin were used to test the mediating effect of social status perception. P < 0.05 was considered statistically significant.
Regression analysis was used to verify the mediating role of social status perception between professional identity and work engagement. In the first step, professional identity was taken as the independent variable and work engagement as the dependent variable to construct model 1. In the second step, professional identity was taken as the independent variable and social status perception as the dependent variable to construct model 2. In the third step, work engagement was taken as the dependent variable and professional identity and social status perception were taken as the independent variables to construct model 3.
The Bootstrap method was used to test the mediating effect of social status perception on the relationship between work engagement and professional identity among nurses specializing in blood purification. The number of samples was set to 5,000, and the confidence interval was set to 95%.
Results
Basic information of blood purification specialist nurses
In this study, a total of 81 valid samples were obtained, including 77 females and 4 males. The average age of the participants was (39.95 ± 6.41) years old. In terms of educational level, 4.9% had a college degree, 92.6% had a bachelor’s degree, and 2.5% had a master’s degree or higher. In terms of professional titles, nurses accounted for 1.2%, nurse practitioners accounted for 16.0%, chief nurse practitioners accounted for 77.8%, and deputy chief nurse practitioners and above accounted for 4.9%. In addition, community hospitals accounted for 3.7%, second-tier hospitals accounted for 3.7%, second-class hospitals accounted for 3.7%, third-tier hospitals accounted for 17.3%, and third-class hospitals accounted for 71.6%. The specific situation is shown in Table 1.
Perception of social status of nurses specializing in blood purification and single factor analysis
The score of the MacArthur Scale for high social status was (7.60 ± 1.25), which was much higher than the score of the MacArthur Scale for low social status (3.72 ± 1.50), (t = 12.411, P < 0.05). A single factor analysis was conducted on blood purification nurses with different perceptions of social status, and the results are shown in Table 2.
Professional identity and work involvement scores of blood purification specialist nurses
The total score of professional identity of blood purification specialist nurses was (111.30 ± 19.54)The total score of work engagement was (129.89 ± 19.50) points.There was no significant difference in the total scores of professional identity and work engagement among nurses with different social status (P > 0.05), but there was a statistically significant difference in their work recognition and professional cognitive evaluation (P < 0.05), as shown in Table 3.
Correlation analysis of social status perception with dimensions of professional identity and work engagement
The correlation analysis between social status and professional identity, work engagement is shown in Table 4. It indicates that social status perception is significantly positively correlated with professional identity.
The mediating effect of social status perception between work engagement and professional identity of nurses specializing in blood purification
Regression analysis was used to verify the mediating role of social status perception between professional identity and work engagement. After introducing the variable of social status perception, the regression coefficient of professional identity on work engagement changed from 0.661 to 0.542, as shown in Table 5.
The upper and lower limits of the Bootstrap 95% confidence interval for the mediating effect of social status perception did not include 0. The above results indicate that professional identity can not only directly predict the work engagement of nurses specializing in blood purification, but also predict work engagement through the mediating role of social status perception. The direct effect (0.542) and mediating effect (0.119) accounted for 81.997% and 18.003% of the total effect, respectively, indicating that social status perception plays a mediating role between professional identity and work engagement. The results are shown in Table 6.
Discussion
The professional identity and work engagement of nurses specializing in blood purification are at a moderate level
Nurses’ professional identity refers to the nurses’ own emotions and perceptions about the profession of nursing, as well as their psychological state towards professional behavior, and is an intrinsic motivating factor for nurses’ professional development19. In this study, the professional identity of 81 blood purification specialist nurses was at a medium level (111.30 ± 19.54), which is consistent with the measurement results of Song Jiao20. Li Enci21confirmed that high professional risks, psychological pressure, high work intensity, and interpersonal relationships between patients, doctors, and nurses can all have a negative impact on nurses’ professional identity. All of these factors affect the psychological state of nurses, causing them to have biased of their own social status, which in turn leads to a further decline in their level of social status perceptions. Previous studies have also confirmed that nurses’ professional identity is closely related to personal emotions, nurses’ experience, and others’ perceptions of nurses22.
Work engagement is a positive emotional and cognitive state related to work, and nurses’ work engagement can predict work satisfaction and work behavior, and improve care quality23. This research result shows that the work engagement of nurses in the blood purification specialty is above average, which is consistent with the research results of Chen Lin24. This may be related to the impact of nurses’ family, psychology, and interpersonal relationships on them25,26,27.
When comparing the total scores of professional identity and work engagement among blood purification nurses with different social status, it was found that although there was no significant difference in the total scores between the two groups (P > 0.05), the work recognition and professional cognitive evaluation of blood purification nurses with high social status perception were significantly higher than those of nurses with low social status perception (P < 0.05). This may be due to the fact that nurses with high social status perception have a higher recognition of their own social status, a high degree of professional identity, and a more positive feeling towards their work, which leads to positive feedback and recognition of their work. Therefore, there is a difference in the recognition of their work and professional cognitive evaluation between nurses with high social status perception and those with low social status perception. However, there was no significant association between perceived social status and total work engagement score, which may be related to the small sample size included in this study, and the sample size can be enlarged in the future to conduct an in-depth related study.
Therefore, nursing management personnel should pay attention to the professional mental health of hemodialysis nurses, strengthen the construction of psychological care for different nurses based on their psychological characteristics, and effectively improve their work engagement. Rational scheduling can fully mobilize the enthusiasm of nurses, establish a correct view of nursing, and enhance the professional identity and work engagement of specialist nurses.
The influence of social status perception on the professional identity and work engagement of nurses specializing in blood purification
This is the first study to correlate the social status perception of blood purification nurses with professional identity and work engagement. The results of the study showed that nurses with high professional identity also had high social status perception. This result suggests that a good professional identity can be beneficial to improving nurses’ social status perception by enhancing their psychological feelings, and furthermore, it is an important strategy to improve nurses’ well-being in working life and work engagement. Therefore, nursing managers should pay attention to the training of professional competence of blood purification nurses while taking into account the cultivation of positive psychological feelings, and take various effective measures to improve nurses’ professional identity, indirectly improve the social status perception, and then improve the nurses’ sense of work identity and evaluation of their own professional cognition.
The mediating role of social status perception between professional identity and work engagement of nurses specializing in blood purification
Social status perception can be regarded as a psychological resource for employees, which is determined by the possession of individual resources. Not only external resources such as an individual’s education level, economic situation, and family background can affect an individual’s social status perception, but also individual psychological resources such as self-esteem, satisfaction, and control can affect an individual’s social status perception28. When nurses believe that their specialized nursing work is needed by patients and has a positive effect, and they continue to develop their potential in specialized nursing and work hard for the development of specialized nursing, their psychological resources such as self-esteem, satisfaction, and self-worth will be satisfied, and they will naturally feel that their work or career is valuable, that is, their social status perception is high. This study found through empirical research that social status perception partially mediates the impact of nurses’ professional identity on work engagement, that is, nurses’ professional identity has a positive impact on their work engagement by triggering an increase in their social status perception. This result suggests that nursing managers should develop and utilize nurses’ psychological resources to enhance their professional identity and further improve their perceived social status, which will lead to increased work engagement and improving the quality of nursing services.
In summary, nursing management personnel should pay attention to the psychological care of blood purification specialist nurses, not only focusing on increasing professional knowledge and improving operational skills training, but also paying attention to strengthening nurses’ professional ethics and professional qualities. They should carry out more professional education on professional spirit, and focus on cultivating the innovative ability, interpersonal communication skills, psychological endurance ability, etc. of blood purification specialist nurses. At the same time, they should improve the positive publicity of the blood purification nursing profession through various channels, enhance nurses’ professional pride, promote more participation and positive feelings of blood purification nursing work, improve nurses’ perception of social status, and thus enhance their recognition of the profession and confidence in employment. Also, the results of this study may be applicable to assessing and analysing the interrelationships between nurses’ professional identity, social status perception, and work engagement in other nursing specialty areas. In the future, this research direction can be analysed and explored in depth to find out the role relationship between professional identity, social status perception, and work engagement of nurses, and ultimately to improve the quality of nurses’ care.
Data availability
The data underlying this article will be shared on reasonable request to the corresponding author.
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Acknowledgements
The authors would like to thank the reviewers for their constructive feedback and all the users who participated in this study.
Funding
Fund Project: Special Fund for Clinical Business Expenses of High-level Hospitals (2020-NHLHCRF-GLMS-28).
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Wanning Jia concept and design of research articles. WAN Dong and Xueting Fan collection datas and analysis. Liqian Gao prepared figures. Wenwen He guidance and support for research articles.
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This study was approved by the Ethics Committee of China-Japan Friendship Hospital (KY2023-289-01).
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Wanning, J., Wan, D., Xueting, F. et al. Analysis of the mediating effect of social status perception on professional identity and work engagement of blood purification nurses. Sci Rep 14, 30722 (2024). https://doi.org/10.1038/s41598-024-80120-y
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DOI: https://doi.org/10.1038/s41598-024-80120-y
