Table 3. The specialties of Dr. Hsu are in women’s health and cancer nursing. with at … P3 and P4, both community nurses with more than 30 years’ experience, said: ‘It’s having the courage to have a voice’, and ‘… having the courage to say “No” to them’. Twelve qualified nurses were interviewed in depth about their understanding of courage in professional practice. If you have access to a journal via a society or association membership, please browse to your society journal, select an article to view, and follow the instructions in this box. Hsieh PC, Su HF: Retention and attrition of certified care assistants in the long-term care industry from the Taipei area: An interview survey. Factors influencing job satisfaction and anticipated turnover among nurses in Sidama Zone public health facilities, South Ethiopia, Future intentions of registered nurses employed in the western New York labor market: Relationships among demographic, economic, and attitudinal factors, Career Commitment in human service professionals: A biographical study, Predictors of married female nurses’ health, The impact of children on women managers’ behavior and organizational commitment, Nurse empowerment, job-related satisfaction, and organizational commitment, Job attitudes and turnover intentions among professionals in different work settings, Applying non-synchronized E-learning to the nursing clinical ladder system, Reliability and validity of nurses’ job satisfaction scale and nurses’ professional commitment, The relationship of role-related variables to job satisfaction and commitment to the organization in a restructured hospital environment, Job satisfaction among hospital nurses revisited: A systematic review, Job satisfaction among nurses: A literature review, The relationships among turnover intentions, professional commitment, and job satisfaction of hospital nurses, The measurement of organizational commitment, Motivational factors of hospital employees: Evidence from North Cyprus, Work-related stress and associated factors among nurses working in public hospitals of Addis Ababa, Ethiopia: A Cross-Sectional Study, Job emotions and job cognitions as determinants of job satisfaction: The moderating role of individual differences in need for affect, Moderating effects of professional commitment on hospitals in Taiwan, Relationships among organizational commitment, job satisfaction, and turnover intention: A meta-analysis, The influence of intrinsic and extrinsic satisfaction on organizational exit (voluntary turnover): Evidence from a correctional setting, From nurse to nurse: The influence of age and gender on professional socialization and career commitment of advanced practice nurses, Impact of organizational structure on nurses’ job satisfaction: A questionnaire survey, The study on motivation attitude, job satisfaction and turnover intention for non-physician formal and temporary employees in a public hospital, American Association of Occupational Health Nurses, Exploring the Relationship Between Professional Commitment and Job Satisfaction Among Nurses, Kuokkanen, Leino-Klipi, & Katajisto, 2003. A serious nursing shortage is creating a crisis in the nation’s health care system. Items in this section include statements such as, “the way my job provides for steady employment” (Cronbach’s α = .72). European Journal of Cancer Care 17(6): 524 – … The impacts of career ladder system for nurses in hospital, Herzberg, F., Mausner, B., Snyderman, B. This cross-sectional study recruited nurses from a northern Taiwan hospital. Data from a single medical center hospital do not guarantee the applicability of results to nurses employed in other medical centers; results may be subject to regional limitations. Two of them were European (Swedish and Danish), namely Lindh et al (2010), who conducted a hermeneutical enquiry into moral strength, and Thorup et al (2012), whose interpretative study explored courage specific to vulnerability, suffering and ethics. This theme suggests that nurses are prepared to face discomfort, stay in situations when they are needed, and will face their fears, even though it is difficult and may require them to tolerate personal discomfort. Despite the NMC’s (2015a) expectation that nurses will challenge and question changes in the traditional hierarchy of the NHS, and a proposed new style of leadership (King’s Fund 2012), participants found that it can be difficult to speak up and to have a voice. Nursing Management. Lindh et al (2010) state that, despite courage being identified as a fundamental component of nursing (Spence 2004, Cummings and Bennett 2012), there is a lack of knowledge about nurses’ courage in practice. Willingness to make an effort, appraisal in continuing one’s career, and belief in goals and values together explained 32% of the variance in inner and external satisfaction. In summary, the present study found that marital status, job level, and working shifts were associated with professional commitment; however, work sector (department) and marital status were associated with inner satisfaction. (2007) found that job satisfaction predicted turnover intention for nurses who had either high commitment or low commitment. Barchard ,Fiona., Sixsmith Judith, Neill Sarah, and Meurier Clency"6Cs and ten commitments: nurses’ understanding and use of courage", Barchard ,Fiona., Judith Sixsmith , Sarah Neill , and Clency Meurier "6Cs and ten commitments: nurses’ understanding and use of courage", Nursing and Midwifery Council (NMC) 2015a,,, Improving the patient’s experience of cancer-related fatigue, What you need to know about running a shift, Using change in nursing practice: a case study approach. (2000). 23, 10, 26-31. Six studies 8, 22, 23, 28-30 investigated job satisfaction among nurses implementing the team nursing model of care. Revalidation supports reflective practice, and could enhance retention if nurses use it to unpick some of the difficulties they face (NMC 2015b). Nurses’ professional commitment was strongly related to job satisfaction. P7 talked about dealing with distressing emotional situations in acute settings: ‘…it’s a situation you don’t want to be in, that you wouldn’t have chosen to be in, so yeah, I think that’s courage definitely’, while P10 spoke in general terms about her understanding of courage in the community: ‘I guess, perhaps being out of your comfort zone from your every day to day, sort of work.’, P9, also a community nurse, spoke of the personal-safety aspect of courage and how she faced situations and stayed in them, but also knew when to remove herself: ‘Yes, so, so it’s courage in the, the true sense of bravery, as in I need to save myself, from, from the situation as it were.’, These participants described various situations they had had to stay in, when they would have rather not, including dealing with challenging families or patients, managing unexpected deaths, and walking into unknown situations, such as when starting to work with new patients in the community. the 6Cs - I have read and accept the terms and conditions, View permissions information for this article. Four more discussion and opinion papers that met the search criteria were identified. Data held were anonymised, password protected and securely stored. Not only do we require recruitment of nurses who can challenge and take risks, we need to retain them by ensuring there are adequate preparation, training, support and opportunities to enable them to reflect on using courage in practice. A significant difference was found among nurses’ willingness to make an effort by their marital status. Fang and Hung (2014) investigated 233 married female nurses and discovered that job stress and over commitment to work were significant determinants of their health status. This study involved a mix of acute and community nurses, but findings are presented as one. Most participants had not considered these as courageous acts until they were asked to reflect on them, after which they agreed with the sentiment expressed by P7: ‘Actually lots of things that we do were courageous but we don’t really think of it like that.’. Based on a systematic review of 100 studies measuring the sources and effects of hospital nurses’ job satisfaction, H. Lu et al. Many experienced nurses are leaving the field and young people are not selecting nursing as a potential career. The 26 items addressed the three main categories of professional commitment: willingness to make an effort, appraisal of continuing one’s career, and belief in goals and values. The themes described above indicate something of nurses’ understanding of courage. Description of Age, Professional Commitment, and Job Satisfaction Subconcepts. (, Kuokkanen, L., Leino-Klipi, H., Katajisto, J. Peate’s (2015) article, entitled Without courage the other Cs will crumble, is supported by the notion that courage enables other virtues (Walston 2004). Cummings and Bennett (2012) define courage as the attribute that ‘enables us to do the right thing for the people we care for, be bold when we have good ideas, and to speak up when things are wrong’. This study suggests that even experienced nurses can find using courage demanding, and this should inform recruitment and retention policies. nursing management - Ethical concerns including anonymity, confidentiality, informed consent, withdrawal, briefing and debriefing, and protection from harm, were all addressed, ethical approval was granted, and recommendations were followed. These leaders have the ability to reduce nursing turnover intention by improving nurses’ job satisfaction. This finding supported the results of previous studies (Cherniss, 1999; Korabik & Rosin, 1996). She previously worked in New York City as an assistant director in hospitals. NVivo software, which encourages data analysis during collection (Bringer et al 2006, Bazeley 2007, Hutchinson et al 2010), was used.The 12 interviews raised 86 codes related to nurses’ understanding and use of courage. grounded theory - Again, this relationship was too weak to demonstrate a significant post hoc difference by group. The researchers adopted a previously validated Job Satisfaction Scale by Yeh, Liu, Ke, and Chen (2004) for this study. Professional commitment and job satisfaction have more influence on nurses remaining in the profession than other forms of commitment (K. Y. Lu et al., 2002). This has implications for the retention of nurses who may need support, for example through guided reflection or clinical supervision (Rolfe 2002), to enable them to continue to face these challenges. A total of 132 registered nurses were recruited from a hospital in northern Taiwan. Google Scholar Johansson, A. , & Ekebergh, M. ( 2006 ). However, the implications for practice are becoming clear. Items in this section included statements such as, “the chance to work alone on the job” (Cronbach’s α = .90). This study had several limitations, including a small sample size. Teng, Shyu, and Chang (2007) investigated how professional commitment moderates the effects of burnout, providing nurse managers with strategies to reduce the impact of burnout on staff. This finding confirmed the results of several previous studies (Brewer & Nauenberg, 2003; Kuokkanen et al., 2003; Lopopolo, 2002). Their mean scores on professional commitment and job satisfaction were 2.54 and 3.81, respectively (Table 2). For more information view the SAGE Journals Sharing page. The nature of the study means it was limited in terms of time and participant numbers, so it might be difficult to realise true theoretical saturation (Charmaz 2014). THERE ARE FEW professions in which the ramifications of poor... We use cookies on this site to enhance your user experience. Therefore, professional commitment appears to be a crucial predictor of job satisfaction. The results showed that willingness to make an effort correlated significantly and positively with appraisal in continuing one’s career (r = .77, p < .01), belief in goals and values (r = .71, p < .01), inner satisfaction (r = .36, p < .01), and external satisfaction (r = .39, p < .01). All participants in this study were volunteers. Commitment 6, that ‘we will actively respond to what matters most to our staff and colleagues’, implies that nurses need courage to find their voices, as does commitment 9, that ‘we will have the right staff in the right places and at the right time’. Nursing is a dynamic and challenging profession requiring engaging and inspiring role models and leaders. Team nursing compared with other models. J Contin Educ Nurs 2015 ; 46(8): 349 – 355 . 14, 3, 213-221. Table 4. The examples described in this article of how nurses confront and remain in difficult situations, speak out even when they fear the consequences (Francis 2013) and take risks are just some of the challenges they face in using courage. During coding, memos, including written explanations, ideas and linkages about the data, helped to strengthen and build categories (Charmaz 1983), enabling movement from description to conceptualisation (Charmaz 2012). Also, this study was cross-sectional with structured self-reported questionnaires, which may have been subject to respondent bias. Google Scholar Yousef, D. A. You can be signed in via any or all of the methods shown below at the same time. Most participants had experience of work in community and acute settings. However, literature reviews can be useful, for example in writing research proposals (Charmaz 2014), so a preliminary literature review was conducted in 2015 to determine if the subject had been explored. SPSS for Windows 17.0 (SPSS, Inc., Chicago, Illinois) was used for data archiving and statistical analysis. The three initial themes included here are as follows: being in a situation you do not want to be in, speaking up and taking risks. Recently, a critical shortage of registered nurses has developed worldwide, and this shortage is expected to worsen (H. Lu, Barriball, Zhang, & While, 2012). The review indicates that courage is seldom mentioned in nursing literature, which supports the observations of Spence (2004) and Murray (2010). The meaning of well-being and participation in the process of health and care- Women’s experiences following a myocardial infarction . FundingThe author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The author(s) would like to thank Chang Gung Memorial Hospital of Taiwan for financially supporting this research (Contract No. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Only the initial coding for the research themes presented in this article is complete, which means that at a conceptual level emergent theory has yet to be explored with further theoretical sampling. The aim was to explore how nurses’ understanding of courage can inform future practice, thus enabling preparation and support for nurses’ use of courage in practice settings, and to enhance understanding of their use of it in everyday professional practice. Bahreini M, Shahamat S, Hayatdavoudi P, Mirzaei M (2011) Comparison of the clinical competence of nurses working in two university hospitals in Iran. They were reassured that consent was voluntary, and that they could withdraw at any point before analysis, after which all data would be anonymised. Power analysis was used to calculate the appropriate sample size. Organizational commitment is a multidimensional work attitude, determined to include affective, continuance, and normative commitment. Unstructured interviews, consistent with constructionist grounded theory (Age 2011), took place in locations chosen by participants and lasted on average one hour. Access to society journal content varies across our titles. A structured questionnaire was used to collect demographic data as well as data on the factors affecting professional commitment and job satisfaction among nurses. For example, commitment 3, that ‘we will work with individuals, families and communities to equip them to make informed choices and manage their own health’, and 5, that ‘we will work in partnership with individuals, their families, carers and others important to them’, are echoed by P1: ‘Everything being a test of courage for the best patient outcome.’ Meanwhile, P3 and P4 spoke of their difficulty in finding their voices to achieve these commitments. In the management literature, career commitment was defined by Blau (1985) as one's attitude towards one's profession or vocation. Nursing can benefit by considering courage at the point of recruitment, and nurses can benefit from education, support and reflection that begin at recruitment and continue through revalidation and lifelong learning. Lean Library can solve it. [PUBMED] [CROSSREF] [Google Scholar] She also works as an internship instructor in a medical center in the Junior College of Medicine, Nursing and Management. This self-assessment scale includes 20 items addressing two subscales that measured inner satisfaction and external satisfaction. Intrinsic factors are motivating factors (i.e., personal achievement, recognition, responsibility, advancement, growth, and the work itself). Inner satisfaction is the satisfaction employees feel from the job itself, such as feelings of accomplishment and responsibility. Study results also showed that most demographic variables had no statistically significant relationship to job satisfaction. Additionally, researchers and participants belong to ‘other identities’ such as nurse, teacher or researcher, and these factors influence conclusions. The ten commitments in Leading Change, Adding Value (Cummings 2016) support the desire to deliver care of the highest standard, which requires courage, yet the evidence suggests that nurses still find this challenging. Some interpreted risk differently, for example as being exposed to emotional pain when practising compassion. Items in this section included statements such as, “I am proud to tell others that I am part of this organization” (Cronbach’s α = .74). The specialties of Dr. Lin are in evidence-based nursing, Aboriginals, and nursing education. Furthermore, researchers have reported that the concept of professional commitment includes professional concerns, involvement, loyalty, relationships, recognition, beliefs, ethics, internal satisfaction, professional growth, and job involvement (Mowday, Steers, & Porter, 1979; Tsai, 2000). understanding - The results showed that married nurses had higher willingness to make an effort scores than unmarried nurses. Based on the results of this cross-sectional study, the instrument needs refinement and further testing. The aims of the study were to explore how nurses’ understanding of courage can inform future practice, thus enabling preparation and support for nurses to use courage in practice settings, and to enhance understanding of adult nurses’ use of courage in everyday professional practice.