Practice environment, psychological flexibility, and their association with career adaptability in junior nurses: A cross-sectional study

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This study aims to explore the relationships between the practice environment, psychological flexibility, and career adaptability among junior nurses, with the goal of informing strategies to enhance adaptability and mitigate turnover. Methods A multi-center, cross-sectional study was conducted across four hospitals in China, utilizing an online-based survey, recruiting junior nurses between February to October 2023. Data were collected using a general information questionnaire, Career Adapt-Abilities Scale, Practice Environment Scale and Personalized Psychological Flexibility Index. Hierarchical regression analysis was employed to identify factors associated with career adaptability. Results A total of 825 valid responses were analyzed. The total score for the junior nurses’ career adaptability was (89.04±16.11), the career adaptability of junior nurses were at a moderate level. Higher career adaptability was observed among junior nurses with junior college education, regular employment status, first-year work experience, day-shift pattern, fewer than four times of monthly night shift, and less than 10 hours of weekly overtime. Spearman correlation analysis showed that practice environment(r=0.506), psychological flexibility(r=0.220) were all correlated with the career adaptability of junior nurses(all P<0.05). Multiple linear regression analysis indicated that practice environment and psychological flexibility influenced career adaptability in junior nurses(all P<0.05). Conclusions The practice environment and psychological flexibility are critical determinants of career adaptability in junior nurses. Nurse managers should prioritize fostering a supportive practice environment and implementing psychological training programs to improve psychological flexibility and career adaptability among junior nurses, thereby addressing workforce retention challenges. Junior nurses Career adaptability Practice environment Psychological flexibility Influencing factors Nursing management Introduction The escalating global demand for healthcare services has highlighted a pressing and pervasive shortage within the nursing workforce [1]. As essential contributors to the healthcare system, junior nurses are particularly susceptible to elevated turnover intentions, which pose significant challenges to workforce stability [2, 3]. Among the multifactorial determinants of this phenomenon, career adaptability has been identified as a critical construct. Career adaptability not only fosters positive occupational outcomes, such as enhanced job performance, increased employability, and greater job satisfaction, but also serves as a protective factor against occupational stress and turnover propensity [4, 5]. Conversely, deficits in career adaptability may compromise the professional development of nurses, undermine patient safety, and disrupt organizational efficiency within healthcare institutions [6]. The operational definition of junior nurses varies across the literature, with most studies characterizing them as nurses within three to five years post-graduation [7, 8]. In the Chinese context, junior nurses typically undergo a structured three-year training program, which includes comprehensive clinical rotations followed by specialized skill development in their designated departments. This training is designed to facilitate their transition from novice to competent practitioners [9]. Despite these systematic efforts, junior nurses face substantial professional and personal challenges. Research highlights that they often struggle to cope with stress and crisis management in high-pressure and adverse work environments, which can impede their professional growth [10]. Furthermore, inadequate transition experiences are linked to elevated rates of clinical errors, diminished job satisfaction, and increased turnover intentions [11]. The rotational nature of nursing practice exacerbates these challenges, as it hinders their ability to adapt to evolving social roles and establish stable interpersonal relationships with colleagues, patients, and families. These difficulties can adversely affect their clinical performance and contribute to psychological distress, including anxiety and depression [12]. Collectively, these issues underscore the critical importance of fostering career adaptability to support their professional adjustment and enhance the quality of patient care. Given these challenges, fostering career adaptability emerges as a critical strategy to support junior nurses in navigating their professional journey. Career adaptability, initially conceptualized by Super and Knasel [13] and further refined by Savickas [14], denotes an individual’s capacity to manage current and anticipated occupational tasks, transitions, and challenges. It encompasses psychosocial resources that enable individuals to navigate societal changes and achieve alignment with their professional environment [15]. This construct is structured hierarchically into four dimensions: concern, control, curiosity, and confidence [16]. Research among nursing students has demonstrated that those with higher levels of career adaptability exhibit greater proficiency in translating theoretical knowledge into clinical practice, which in turn enhances their professional motivation and commitment to career advancement [17]. Zhang et al. [18] found that newly graduated nurses with elevated career adaptability experience fewer negative emotions and are less affected by transition-related shocks, highlighting the potential of adaptability to mitigate early career challenges. These findings underscore the importance of fostering career adaptability to support professional development. Despite studies indicating that Chinese junior nurses generally exhibit moderate levels of career adaptability, significant gaps remain, necessitating ongoing assessment and targeted interventions to improve their adaptive capacities [19]. In the nursing context, career adaptability is particularly crucial, as it enables nurses to navigate the dynamic and often unpredictable nature of healthcare environments, ensuring both well-being and high-quality patient care. The quality of the nursing practice environment plays a pivotal role in shaping nurse retention and professional development [20, 21]. A supportive practice environment has been shown to enhance organizational commitment and job satisfaction while reducing burnout and turnover intentions among nurses [22]. This influence is particularly pronounced for junior nurses, who rely heavily on a supportive work environment to navigate frequent rotations and new responsibilities [23]. Research on newly graduated nurses has revealed that the practice environment’s impact on job outcomes is significantly mediated by occupational self-efficacy, with personal growth initiative moderating this relationship [24]. However, limited research has explicitly examined how practice environments influence the career adaptability of junior nurses, highlighting a critical gap in the literature. Psychological flexibility, defined as the ability to remain fully present and adapt behaviors in alignment with valued goals [25], serves as a key personal resource. It enables individuals to persist in value-driven actions despite discomfort or adversity [26]. Such adherence to personal and professional values often leads to effective performance, positive feedback, enhanced engagement, and a strengthened sense of career fulfillment, thereby reducing burnout [27]. By leveraging beneficial resources within their work environment, employees with high psychological flexibility demonstrate enhanced adaptability to workplace demands [28]. Even during high-stress events, such as the COVID-19 pandemic, psychological flexibility has been shown to act as a protective factor, enabling individuals to maintain effective functioning [29]. Additionally, psychological flexibility has been identified as a partial mediator between fatigue and depressive symptoms in nurses [30]. Our prior research further established that psychological flexibility negatively correlates with burnout among junior nurses, suggesting its potential role in mitigating adverse occupational outcomes [31]. These findings collectively emphasize the need for further exploration of how psychological flexibility influences the career adaptability of junior nurses. Despite these valuable insights, existing studies have predominantly examined practice environment, psychological flexibility, and career adaptability in isolation, with limited exploration of their synergistic effects on junior nurses’ professional outcomes. This multi-center cross-sectional study aims to investigate the interrelationships among practice environment, psychological flexibility, and career adaptability in junior nurses, utilizing hierarchical regression analysis to identify key predictors of adaptability. The findings will provide a robust evidence base for the design of targeted interventions to enhance the career adaptability and overall professional development of junior nurses. Methods Study design and participants A multi-center cross-sectional design was used for this study. Participants from four tertiary-A hospitals were asked to fill out online questionnaires from February to October 2023. The inclusion criteria were as follows: (1) aged 18 years or older; (2) working in a hospital for less than five years; and (3) volunteered to participate in the study. The exclusion criteria included nurses with psychological diseases and those who were on a long leave of absence. The G*Power 3.1.9.7 software was used for the sample size calculation. The fixed effect model and R 2 deviation from zero were the methods used for the calculation. Given α = 0.05, effect size = 0.1, power (1-β) = 0.95, and a predictive factor of 8, the required sample size was 236, and 260 nurses were selected after calculating the invalid questionnaire rate (10%). Measures General information questionnaire Drawing upon literature reviews and expert input, the research team crafted a questionnaire on general information. This encompassed demographics such as age, sex, education, marital status, mumber of children, department, employment status, work experience, shift patterns, monthly night shift, weekly overtime hours, monthly income. Assessment of career adaptability Participants’ career adaptability was measured using the Career Adapt-Abilities Scale (CAAS), originally developed by Savickas and Porfeli [14]. The scale consists of 24 items organized into four dimensions, with each item rated on a 5-point Likert scale (ranging from 1 = not strong to 5 = strongest). Higher total scores reflect a greater level of career adaptability. The Chinese version of the CAAS was revised by Hou, and its Cronbach’s alpha was 0.89 [32]. Assessment of practice environment The nursing practice environment was evaluated using the Practice Environment Scale (PES), developed by Lake [33]. The Chinese version of the PES, also validated by Lake [33], includes 29 items grouped into five subscales. Each item is rated on a 4-point Likert scale (ranging from 1 = strongly disagree to 4 = strongly agree). Higher scores indicate a more favorable practice environment as perceived by participants. The Cronbach’s α coefficient of the Chinese version of the PES was 0.91 [34]. Assessment of psychological flexibility Psychological flexibility was assessed using the Personalized Psychological Flexibility Index (PPFI), developed by Kashdan et al. [25]. The scale measures psychological flexibility across three domains and comprises 15 items rated on a 7-point Likert scale (ranging from 1 = strongly disagree to 7 = strongly agree). Higher scores denote a greater degree of psychological flexibility. The Chinese version of the PPFI was revised by Fang, and its Cronbach’s alpha was 0.86 [35]. Data collection Data collection was conducted using the online platform Wenjuanxing ( https://www.wjx.cn/ ). The study team first established collaborative agreements with the nursing departments of each participating hospital. Subsequently, the research objectives, along with the inclusion and exclusion criteria, were thoroughly communicated to the nursing department administrators at each site. These administrators were then tasked with distributing survey invitations to eligible participants via WeChat, based on induction and attendance records. To ensure data completeness, all questionnaire items were set as mandatory, and submissions were only permitted after all questions were answered. Additionally, technical restrictions were implemented to allow only one submission per IP address. Initially, 906 survey questionnaires were distributed, with 843 responses returned to the first author. After quality control checks, 825 valid responses were retained, yielding a response rate of 91.1%. Ethics approval and consent to participate This study received ethical approval from the Clinical Research Ethics Committee of Peking University First Hospital (approval no. 2022 yan 415-002). Prior to commencement, all participants were clearly informed about the voluntary nature of the study and the confidentiality of their data, following the acquisition of permissions from the participating hospitals. The study was conducted in accordance with ethical standards established in the 1964 Declaration of Helsinki and its later amendments. To ensure confidentiality, all questionnaires were completed anonymously, and the collected data were used exclusively for the purposes of this study. Strict measures were implemented to safeguard the privacy and confidentiality of all participants. Statistical analysis Data analyses were conducted independently by two researchers. Data processing and analysis were performed using SPSS version 25.0 (SPSS Inc., Chicago, IL, USA). Categorical variables were summarized using frequencies and percentages, while continuous variables were expressed as means and standard deviations. Univariate analyses were conducted using one-way ANOVA and independent sample t-tests for normally distributed data, and the Kruskal-Wallis test was applied for non-normally distributed data. Correlations between variables were assessed using Spearman’s correlation analysis. Hierarchical multiple regression models were employed to identify factors associated with career adaptability. Multicollinearity among independent variables was evaluated using variance inflation factors (VIF), with no evidence of multicollinearity observed (all VIF values < 1.50). As all questionnaire items were mandatory, no missing data were present. Statistical significance was defined as a two-sided p-value < 0.05 [36]. Results Descriptive characteristics The demographic characteristics of the study participants are shown in Table 1. A total of 825 junior nurses completed the survey, with an average age of 26.17±2.85 years. The majority of participants were female (93%), and 78% held a bachelor’s degree or higher. Only 12% were regular employees, while 15.4% worked stable day shifts without night shifts. Univariate analysis revealed that several factors significantly influenced career adaptability, including years of work experience, employment status, shift patterns, Monthly night shift, and weekly overtime hours (p < 0.05) (Table 1). Table 1 Demographic characteristics of participants and the results of the univariate analysis of career adaptability (N = 825) Items n (%) Career adaptability score(x±s) Z/H P Sex Male 58 (7.0) 90.75 ± 16.64 −0.631 0.528 Female 767 (93.0) 88.91 ± 16.07 Education Junior college 182 (22.1) 92.34 ± 16.38 8.518 0.014 Undergraduate 612 (74.2) 88.09 ± 16.16 Postgraduate 31 (3.7) 88.35 ± 10.34 Marital status Single 582 (70.5) 89.31 ± 15.94 1.523 0.467 Married 239 (29.0) 88.26 ± 16.47 Other 4 (0.5) 94.75 ± 20.08 Number of children 0 707 (85.7) 89.19 ± 16.17 −0.878 0.380 ≥ 1 118 (14.3) 88.09 ± 15.75 Department Geriatrics 286 (34.7) 89.01 ± 17.52 0.981 0.913 Surgery 140 (17.0) 89.52 ± 15.67 Gynecology and pediatrics 220 (26.7) 89.42 ± 14.52 Emergency and ICU 74 (9.0) 88.33 ± 17.43 Other 105 (12.6) 88.16 ± 15.09 Employment status Regular employee 99 (12.0) 93.2 ± 14.36 19.825 < 0.001 Contract system 581 (70.4) 87.32 ± 15.54 Labor dispatch 145 (17.6) 93.06 ± 18.21 Work experience 1 year 175 (21.2) 91.81 ± 16.59 11.489 0.022 2 years 212 (25.7) 90.27 ± 15.36 3 years 194 (23.5) 87.92 ± 14.75 4 years 143 (17.3) 86.04 ± 16.15 5 years 101 (12.2) 88.01 ± 18.37 Shift patterns Day shift 127 (15.4) 92.66 ± 15.91 10.621 0.014 Night shift 52 (6.3) 90.82 ± 18.34 Alternate day and night 501 (60.7) 88.77 ± 15.37 Random 145 (17.6) 86.13 ± 17.38 Monthly night shift 8 222 (26.9) 87.36 ± 17.50 Weekly overtime hours < 10 hours 497 (60.2) 91.71 ± 16.03 17.411 15 hours 140 (17.0) 83.08 ± 14.65 Monthly income ≤ 5000 yuan 313 (37.9) 88.67 ± 16.55 5.162 0.076 5001–9999 yuan 409 (49.6) 88.51 ± 15.81 ≥ 10000 yuan 103 (12.5) 92.24 ± 15.71 Scores of career adaptability, practice environment, and psychological flexibility The overall and subscale scores for career adaptability, practice environment, and psychological flexibility are presented in Table 2. The results indicated that junior nurses demonstrated moderate levels of career adaptability (M = 89.04, SD = 16.11), practice environment satisfaction (M = 3.09, SD = 0.48), and psychological flexibility (M = 64.93, SD = 10.48). Table 2 Scores of career adaptability, practice environment, and psychological flexibility (N = 825) Variables Score Range Average Score Average Score of Each Item Career adaptability 24~120 89.04 ± 16.11 3.71 ± 0.80 Concern 6~30 21.33 ± 4.53 3.55 ± 0.83 Control 6~30 22.78 ± 4.26 3.80 ± 0.81 Curiosity 6~30 22.33 ± 4.32 3.72 ± 0.78 Confidence 6~30 22.60 ± 4.21 3.77 ± 0.76 Practice environment 1~4 3.09 ± 0.48 3.09 ± 0.48 Nurse Participation in Hospital Affairs 1~4 3.00 ± 0.54 3.00 ± 0.54 Nursing Foundations for Quality of Care 1~4 3.15 ± 0.46 3.15 ± 0.46 Nurse Manager Ability, Leadership, and Support of Nurses 1~4 3.11 ± 0.50 3.11 ± 0.50 Staffing and Resource Adequacy 1~4 3.06 ± 0.53 3.06 ± 0.53 Collegial Nurse-Physician Relations 1~4 3.13 ± 0.50 3.13 ± 0.50 Psychological flexibility 15~105 64.93 ± 10.48 4.33 ± 1.47 Avoidance 5~35 20.91 ± 6.88 4.18 ± 1.50 Acceptance 5~35 22.72 ± 6.18 4.54 ± 1.44 Harnessing 5~35 21.29 ± 6.29 4.26 ± 1.46 Correlation analysis As shown in Table 3, spearman’s correlation analysis revealed a moderate positive correlation between career adaptability and practice environment (r = 0.506, p < 0.001), as well as a weak positive correlation between career adaptability and psychological flexibility (r = 0.220, p < 0.001). Additionally, a weak positive correlation was observed between practice environment and psychological flexibility (r = 0.182, p < 0.01) Table 3 Correlation of variables (N = 825) Variable r P Education -0.090 0.010 Employment status 0.011 0.753 Work experience -0.107 0.002 Shift patterns -0.113 0.001 Monthly night shift -0.103 0.003 Weekly overtime hours -0.197 < 0.001 Practice environment ② 0.506 < 0.001 Nurse Participation in Hospital Affairs 0.444 < 0.001 Nursing Foundations for Quality of Care 0.536 < 0.001 Nurse Manager Ability, Leadership, and Support of Nurses 0.497 < 0.001 Staffing and Resource Adequacy 0.486 < 0.001 Collegial Nurse-Physician Relations 0.525 < 0.001 Psychological flexibility ③ 0.220 < 0.001 Avoidance 0.344 < 0.001 Acceptance 0.085 0.015 Harnessing 0.032 0.362 Factors influencing career adaptability As shown in Table 4, hierarchical regression analysis was conducted in three sequential steps. Demographic factors were entered in the first step, followed by the practice environment in the second step, and psychological flexibility in the third step. In the first step, shift patterns and overtime hours were significantly associated with career adaptability. However, these associations were no longer significant after the inclusion of the practice environment in the second step. When comparing Models 2 and 3, psychological flexibility emerged as a statistically significant predictor of career adaptability, even after accounting for the practice environment. Furthermore, the adjusted R² values for the three models indicated that they explained 5.6%, 39.2%, and 40.0% of the variance in career adaptability, respectively. Table 4 Hierarchical multiple regression models for explaining junior nurses’ career adaptability (N = 825) Variables Model 1 Model 2 Model 3 B (SE) β (p) B (SE) β (p) B (SE) β (p) Independent variable Education −2.147 (1.271) −0.63 (0.092) 0.787 (1.029) 0.023 (0.445) 0.839 (1.023) 0.025 (0.820) Employment status −0.477 (1.097) −0.016 (0.664) −0.156 (0.880) −0.177 (0.843) −0.112 (0.875) −0.004 (0.898) Work experience −0.760 (0.432) −0.062 (0.079) −0.188 (0.348) −0.015 (0.589) −0.159 (0.345) −0.013 (0.645) Shift patterns −1.413 (0.711) −0.079 (0.047) −1.03 2(0.570) −0.058 (0.071) −1.066 (0.567) −0.060 (0.061) Monthly night shift −0.685 (0.986) −0.028 (0.488) 0.164 (0.792) 0.005 (0.877) 0.177 (0.787) 0.007 (0.822) Weekly overtime hours −3.768 (0.744) −0.179 (< 0.001) 0.296 (0.626) 0.014 (0.637) 0.240 (0.623) 0.011 (0.700) Practice environment 21.056 (0.988) 0.630 (< 0.001) 20.295 (1.008) 0.607 (< 0.001) Psychological flexibility 0.143 (0.043) 0.093 (0.001) Model diagnosis and fit F value ( p value) 9.137 (< 0.001) 77.013 (< 0.001) 69.629 (< 0.001) Variance inflation factor 1.067–1.419 1.073–1.423 1.062–1.423 R 2 (Adjusted R 2 ) 0.063 (0.056) 0.398 (0.392) 0.406 (0.400) rR 2 0.063 0.335 0.002 B = unstandardized regression coefficient; SE = standard error; β = standardized regression coefficient; significant values are reported in bold. Discussion This cross-sectional study investigated the associations between practice environment, psychological flexibility, and career adaptability among junior nurses. The findings revealed that junior nurses exhibited moderate levels of career adaptability, with shift patterns, overtime hours, practice environment, and psychological flexibility emerging as significant influencing factors. These results not only align with existing literature but also provide new insights into the mechanisms underlying career adaptability in the nursing profession. By integrating external environmental factors and internal psychological resources, this study offers a comprehensive framework for understanding and improving the professional development of junior nurses. The moderate level of career adaptability observed in this study is consistent with previous research [37, 38], suggesting that this phenomenon may be a common challenge among junior nurses globally. This finding can be attributed to the inherently complex and dynamic nature of the healthcare industry, where high workloads, unpredictable patient needs, and rapid technological advancements create a demanding environment for early-career nurses [37]. Such conditions often limit their capacity to respond effectively to career-related pressures and adapt to evolving practice environments. Furthermore, career adaptability is not a static trait but rather a dynamic process influenced by multiple factors, including individual characteristics and organizational support [39]. For instance, junior nurses with higher career adaptability are better equipped to make informed decisions, navigate workplace challenges, and recognize the value of their nursing roles. However, this study highlights that adaptability is not solely an individual trait but is also shaped by external factors such as shift patterns and overtime hours. Specifically, night shifts and excessive overtime were found to significantly impair career adaptability, likely due to the physical and psychological burdens they impose. These findings are supported by prior research, which has consistently demonstrated the detrimental effects of irregular shifts and long working hours on nurses’ well-being, job performance, and retention [39, 40]. Therefore, nursing managers should prioritize optimizing scheduling practices, reducing overtime, and implementing flexible work arrangements to mitigate these challenges and enhance junior nurses’ career adaptability. Building on these findings, the study also revealed a strong positive correlation between the practice environment and career adaptability. A supportive practice environment not only enhances job satisfaction and reduces burnout but also fosters a sense of belonging and commitment among nurses [22]. However, the perception of the practice environment is not uniform, even within the same institution. Junior nurses, due to their limited experience and professional networks, often have fewer opportunities to engage in management-related activities or voice their opinions. This was reflected in the low scores for the "Nurse Participation in Hospital Affairs" subscale, which aligns with previous studies [23, 41–43]. A positive practice environment encompasses not only job content but also satisfaction with the work setting, which is crucial for fostering professional growth and adaptability. Research has shown that personal growth initiatives, such as mentorship programs and leadership training, can enhance newly graduated nurses’ ability to leverage their practice environment [24]. Therefore, nursing departments should adopt inclusive management practices, encourage junior nurses’ participation in hospital affairs, and implement hierarchical management strategies to improve their organizational commitment, sense of achievement, and belonging [44–46]. By creating an environment that values the contributions of junior nurses, healthcare institutions can facilitate their transition from novice to competent practitioners. While the practice environment represents an external factor, the role of psychological flexibility as an internal factor is equally critical. This study demonstrated that junior nurses with higher psychological flexibility exhibited greater career adaptability. Psychological flexibility, defined as the ability to remain present and adapt behaviors in alignment with one’s values, even in the face of discomfort or adversity [25], serves as a key personal resource for navigating workplace challenges. Multiple studies have shown that individual factors have an impact on the adaptability of most nurses early in their careers [39,47]. Although no prior studies have directly explored the relationship between psychological flexibility and career adaptability, recent literature suggests that nurses with greater psychological flexibility are better able to allocate psychological resources toward value-based actions, such as demonstrating initiative and creativity in overcoming obstacles [48, 49]. For example, during the COVID-19 pandemic, nurses with high psychological flexibility were more likely to adapt to rapidly changing conditions and maintain effective functioning [29]. Interventions such as acceptance and commitment therapy (ACT) have been shown to enhance psychological flexibility, alleviate negative emotions (e.g., anxiety and depression), and improve career adaptation [50]. Hospital managers should prioritize supporting junior nurses with low psychological flexibility, helping them align with their professional values, and fostering a sense of mission to enhance their adaptability and resilience in the workplace. By integrating psychological flexibility training into professional development programs, healthcare institutions can empower junior nurses to thrive in demanding environments. A key strength of this study is its multicenter design, which enhances the generalizability of the findings. By focusing on junior nurses within five years of graduation, the study provides novel insights into the relationship between career adaptability and two critical factors—practice environment and psychological flexibility. However, several limitations should be acknowledged. First, the use of a convenience sampling method may limit the representativeness of the findings. Second, the reliance on self-reported measures for career adaptability, practice environment, and psychological flexibility may introduce response bias. Third, the cross-sectional design precludes the establishment of causal relationships among the variables. Future longitudinal studies are needed to explore the causal mechanisms underlying these associations and to evaluate the long-term impact of interventions targeting practice environment and psychological flexibility. Conclusions Junior nurses consistently face challenges related to career adaptability, which can significantly impact their professional growth and job performance. This study highlights the critical roles of practice environment and psychological flexibility in shaping adaptability. Nursing managers should strive to create supportive practice environments that promote inclusivity and belonging, particularly for junior nurses. Additionally, interventions such as ACT should be implemented to enhance psychological flexibility, enabling junior nurses to navigate workplace challenges effectively and contribute meaningfully to their organizations. By addressing these factors, healthcare institutions can foster a resilient and adaptable nursing workforce, ultimately improving both nurse well-being and patient outcomes. Declarations Acknowledgments We gratefully acknowledge all junior nurses that participated in this study. Authors’ contributions YZ and ZZ contribute equally to this study, they share co-first author. They were responsible for the study design and data analysis. They also drafted the first version of the manuscript. MZ and MZ contributed to data collection and literature review. ZT revised the paper. All authors read and approved the final manuscript. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content. Funding This work was supported by the National High Level Hospital Clinical Research Funding (Scientific Research Seed Fund of Peking University First Hospital) [grant number 2022SF75, 2022SF60]. Data Availability The data used to support the findings of this study are available from the corresponding author upon request. Competing interests The authors declare that there are no conflicts of interest regarding the publication of this paper. Ethics approval This study received ethical approval from the Clinical Research Ethics Committee of Peking University First Hospital (approval no. 2022 yan 415-002). The study was conducted in accordance with ethical standards established in the 1964 Declaration of Helsinki and its later amendments. Consent for publication Not applicable. References Yatsu H, Saeki A. Current trends in global nursing: A scoping review. Nursing Open. 2022;9(3):1575-1588. Kim JH, Shin HS. 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Understanding psychological flexibility: A multimethod exploration of pursuing valued goals despite the presence of distress. Psychological Assessment. 2020;32(9):829-850. Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies - Republished article. Behavior Therapy. 2016;47(6):869-885.27. Yuexia W, Ruijie Q, Huifang W, Chao D. A study on the correlation between job exuberance and workplace adjustment among junior nurses. Evidence-Based Nursing. 2024;10(1):177-180. Ost LG. The efficacy of Acceptance and Commitment Therapy: An updated systematic review and meta-analysis. Behaviour Research and Therapy. 2014;61:105-121. Landi G, Pakenham KI, Crocetti E, Tossani E, Grandi S. The trajectories of anxiety and depression during the COVID-19 pandemic and the protective role of psychological flexibility: A four-wave longitudinal study. Journal of Affective Disorders. 2022;307:69-78. Yao Y, Tang J, Meng H, Li Y, Du H, Li Z. The mediating effect of psychological flexibility on fatigue and depressive symptoms among nursing staff. International Journal of Occupational Medicine and Environmental Health. 2023;36(4):563-574. Zhang X, Chen S, Zheng Z, Zhao M, Song L, Zhao Y, et al. The relationship between psychological capital, burnout and perceived stress in junior nurses: A latent profile analysis. Frontiers in Public Health. 2024;12:1374941. Hou ZJ, Leung SA, Li X, Li X, Xu H. Career adapt-abilities scale—China form: Construction and initial validation. Journal of Vocational Behavior. 2012;80(3):686-691. Lake ET. Development of the practice environment scale of the nursing work index. Research in Nursing and Health. 2002;25(3):176-188. Wang L, Li L. Reliability and validity of Chinese version of the practice environment scale. Chinese Journal of Nursing. 2011;46(2):121-123. Fang S, Huang M, Wang Y. Reliability and validity of the Chinese version of personalized psychological flexibility index (C-PPFI) in college students. Journal of Contextual Behavioral Science. 2023;28:23-32. Vatcheva KP, Lee M, McCormick JB, Rahbar MH. Multicollinearity in regression analyses conducted in epidemiologic studies. Epidemiology. 2016;6(2):227. Awad NHA, Zabady HAH, Elbialy GG, Ashour HMAA. Entrepreneurial leadership, nurses’ proactive work behavior, and career adaptability: A structural equation model. BMC Nursing. 2024;23(1):140. Chen J, Zhang X. The impact of career calling on higher vocational nursing students’ learning engagement: The mediating roles of career adaptability and career commitment. Frontiers in Psychology. 2023;14:1111842. Zhang H, Jiang JX, Zhong MH, Yu C, Pang QY, Mao YL, et al. Career adaptability of newly graduated nurses at an obstetrics and gynaecology hospital in China: A qualitative study. Journal of Nursing Management. 2022;30(6):2046-2053. Ma W, Dai Z, Liang T, Zhang H, Liu Y. The transition issue among new nurses in China: A mediation model analysis. International Nursing Review. 2024;71(1):108-114. Liu XM, Wang J, Xin X, Li JQ, Liu Y, Gao JL, et al. Investigation on the current situation of nurse practice environment in Shaanxi Province and analysis of influencing factors. Chinese Health Quality Management. 2023;30(1):44-48. Yang L. Investigation on the current situation of nurse practice environment in a tertiary care hospital in northern Jiangsu. Contemporary Nurses. 2022;29(5):129-133. Liu X, Zheng J, Liu K, Baggs JG, Liu J, Wu Y, et al. Hospital nursing organizational factors, nursing care left undone, and nurse burnout as predictors of patient safety: A structural equation modeling analysis. International Journal of Nursing Studies. 2018;86:82-89. Wenxia Z, Feifei C, Min H, Li C, Aihong L, Xingfeng L. The status and associated factors of junior nurses’ transition shock: A cross-sectional study. Journal of Nursing Management. 2022;30(3):716-723. Cao J, Jia Z, Zhu C, Li Z, Liu H, Li F, et al. Nurses’ turnover intention and associated factors in general hospitals in China: A cross-sectional study. Journal of Nursing Management. 2021;29(6):1613-1622. Ma W, Jiang Y, Liang T, Zhang H, Ma F. Newly graduated nurses’ perceptions of work environment: A cross-sectional study in China. International Journal of Nursing Practice. 2021;27(6):e12929. Rottinghaus PJ, Day SX, Borgen FH. The career futures inventory: A measure of career-related adaptability and optimism. Journal of Career Assessment. 2005;13(1):3-24. Chong YY, Frey E, Chien WT, Cheng HY, Gloster AT. The role of psychological flexibility in the relationships between burnout, job satisfaction, and mental health among nurses in combatting COVID-19: A two-region survey. Journal of Nursing Scholarship. 2023;55(5):1068-1081. Doorley JD, Goodman FR, Kelso KC, Kashdan TB. Psychological flexibility: What we know, what we do not know, and what we think we know. Social and Personality Psychology Compass. 2020;14(12):1-11. Lu Y, Li Y, Huang Y, Zhang X, Wang J, Wu L, et al. Effects and mechanisms of a web- and mobile-based acceptance and commitment therapy intervention for anxiety and depression symptoms in nurses: Fully decentralized randomized controlled trial. Journal of Medical Internet Research. 2023;25:e51549. Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterial1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6352500","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":463203338,"identity":"bd732968-16cb-442f-9f11-4f42cca05ddc","order_by":0,"name":"Yue Zhao","email":"","orcid":"","institution":"Peking University First Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yue","middleName":"","lastName":"Zhao","suffix":""},{"id":463203339,"identity":"f276b739-e1a6-471f-be56-52ee325d810e","order_by":1,"name":"Ziling Zheng","email":"","orcid":"","institution":"Peking University First Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ziling","middleName":"","lastName":"Zheng","suffix":""},{"id":463203340,"identity":"dfcb51ad-6d51-4854-b46c-1d57c399f889","order_by":2,"name":"Meng Zhang","email":"","orcid":"","institution":"Peking University First Hospital","correspondingAuthor":false,"prefix":"","firstName":"Meng","middleName":"","lastName":"Zhang","suffix":""},{"id":463203342,"identity":"6d43fb62-5b5d-41b7-bc6b-d5847781eaac","order_by":3,"name":"Mi Zhao","email":"","orcid":"","institution":"Peking University First Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mi","middleName":"","lastName":"Zhao","suffix":""},{"id":463203344,"identity":"95c049ce-94b7-4457-b1a6-40ae808c9924","order_by":4,"name":"Zhenhui Tao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIie2PvQrCMBRGUwPtckvWBgRfIeAgQrCvUhAyifgADgFBF3Wu6HM4pxR08WcV3J0cWgriIKKpk0t0FMwZPu6F73AThCyWn4UFQBAghRAHQqS5DGX2eJXKUhFVGqtvlExwpsox5UxGZiX0JqcCWAp0tE3SXn8PDCknyzuGK7Cuz7VCoBul8eoIDSwxnS0NSiAwLq/EOt0jNKVysW9SaqeXwg467ztgKvqgBK5WxEvxh+oLZSOws2Ac6LjzVKbt5wuTgfEv3miF0fkWhMTb1Au4tEJCBkmWGxRNBd53R5r7unL9WLFYLJa/5gEX10nXKQnLHwAAAABJRU5ErkJggg==","orcid":"","institution":"Peking University First Hospital","correspondingAuthor":true,"prefix":"","firstName":"Zhenhui","middleName":"","lastName":"Tao","suffix":""}],"badges":[],"createdAt":"2025-04-01 11:08:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6352500/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6352500/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91149110,"identity":"2bdb137a-f119-4356-8df4-ad65bba62d3a","added_by":"auto","created_at":"2025-09-12 06:46:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":880791,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6352500/v1/1cd3a392-67ac-4a49-9fb2-39e93eaa6400.pdf"},{"id":83661013,"identity":"3c21594d-e08f-43c0-90c8-d23e87ed66a6","added_by":"auto","created_at":"2025-05-30 09:59:34","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":13566,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6352500/v1/bbaa6d6478087b2031dca649.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Practice environment, psychological flexibility, and their association with career adaptability in junior nurses: A cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe escalating global demand for healthcare services has highlighted a pressing and pervasive shortage within the nursing workforce [1]. As essential contributors to the healthcare system, junior nurses are particularly susceptible to elevated turnover intentions, which pose significant challenges to workforce stability [2, 3]. Among the multifactorial determinants of this phenomenon, career adaptability has been identified as a critical construct. Career adaptability not only fosters positive occupational outcomes, such as enhanced job performance, increased employability, and greater job satisfaction, but also serves as a protective factor against occupational stress and turnover propensity [4, 5]. Conversely, deficits in career adaptability may compromise the professional development of nurses, undermine patient safety, and disrupt organizational efficiency within healthcare institutions [6].\u003c/p\u003e\n\u003cp\u003eThe operational definition of junior nurses varies across the literature, with most studies characterizing them as nurses within three to five years post-graduation [7, 8]. In the Chinese context, junior nurses typically undergo a structured three-year training program, which includes comprehensive clinical rotations followed by specialized skill development in their designated departments. This training is designed to facilitate their transition from novice to competent practitioners [9]. Despite these systematic efforts, junior nurses face substantial professional and personal challenges. Research highlights that they often struggle to cope with stress and crisis management in high-pressure and adverse work environments, which can impede their professional growth [10]. Furthermore, inadequate transition experiences are linked to elevated rates of clinical errors, diminished job satisfaction, and increased turnover intentions [11]. The rotational nature of nursing practice exacerbates these challenges, as it hinders their ability to adapt to evolving social roles and establish stable interpersonal relationships with colleagues, patients, and families. These difficulties can adversely affect their clinical performance and contribute to psychological distress, including anxiety and depression [12]. Collectively, these issues underscore the critical importance of fostering career adaptability to support their professional adjustment and enhance the quality of patient care. Given these challenges, fostering career adaptability emerges as a critical strategy to support junior nurses in navigating their professional journey.\u003c/p\u003e\n\u003cp\u003eCareer adaptability, initially conceptualized by Super and Knasel [13] and further refined by Savickas [14], denotes an individual\u0026rsquo;s capacity to manage current and anticipated occupational tasks, transitions, and challenges. It encompasses psychosocial resources that enable individuals to navigate societal changes and achieve alignment with their professional environment [15]. This construct is structured hierarchically into four dimensions: concern, control, curiosity, and confidence [16]. Research among nursing students has demonstrated that those with higher levels of career adaptability exhibit greater proficiency in translating theoretical knowledge into clinical practice, which in turn enhances their professional motivation and commitment to career advancement [17]. Zhang et al. [18] found that newly graduated nurses with elevated career adaptability experience fewer negative emotions and are less affected by transition-related shocks, highlighting the potential of adaptability to mitigate early career challenges. These findings underscore the importance of fostering career adaptability to support professional development. Despite studies indicating that Chinese junior nurses generally exhibit moderate levels of career adaptability, significant gaps remain, necessitating ongoing assessment and targeted interventions to improve their adaptive capacities [19].\u0026nbsp;In the nursing context, career adaptability is particularly crucial, as it enables nurses to navigate the dynamic and often unpredictable nature of healthcare environments, ensuring both well-being and high-quality patient care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe quality of the nursing practice environment plays a pivotal role in shaping nurse retention and professional development [20, 21]. A supportive practice environment has been shown to enhance organizational commitment and job satisfaction while reducing burnout and turnover intentions among nurses [22]. This influence is particularly pronounced for junior nurses, who rely heavily on a supportive work environment to navigate frequent rotations and new responsibilities [23]. Research on newly graduated nurses has revealed that the practice environment\u0026rsquo;s impact on job outcomes is significantly mediated by occupational self-efficacy, with personal growth initiative moderating this relationship [24]. However, limited research has explicitly examined how practice environments influence the career adaptability of junior nurses, highlighting a critical gap in the literature.\u003c/p\u003e\n\u003cp\u003ePsychological flexibility, defined as the ability to remain fully present and adapt behaviors in alignment with valued goals [25], serves as a key personal resource. It enables individuals to persist in value-driven actions despite discomfort or adversity [26]. Such adherence to personal and professional values often leads to effective performance, positive feedback, enhanced engagement, and a strengthened sense of career fulfillment, thereby reducing burnout [27]. By leveraging beneficial resources within their work environment, employees with high psychological flexibility demonstrate enhanced adaptability to workplace demands [28]. Even during high-stress events, such as the COVID-19 pandemic, psychological flexibility has been shown to act as a protective factor, enabling individuals to maintain effective functioning [29]. Additionally, psychological flexibility has been identified as a partial mediator between fatigue and depressive symptoms in nurses [30]. Our prior research further established that psychological flexibility negatively correlates with burnout among junior nurses, suggesting its potential role in mitigating adverse occupational outcomes [31]. These findings collectively emphasize the need for further exploration of how psychological flexibility influences the career adaptability of junior nurses.\u003c/p\u003e\n\u003cp\u003eDespite these valuable insights, existing studies have predominantly examined practice environment, psychological flexibility, and career adaptability in isolation, with limited exploration of their synergistic effects on junior nurses\u0026rsquo; professional outcomes. This multi-center cross-sectional study aims to investigate the interrelationships among practice environment, psychological flexibility, and career adaptability in junior nurses, utilizing hierarchical regression analysis to identify key predictors of adaptability. The findings will provide a robust evidence base for the design of targeted interventions to enhance the career adaptability and overall professional development of junior nurses.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edesign\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA multi-center cross-sectional design was used for this study. Participants from four tertiary-A hospitals were asked to fill out online questionnaires from February to October 2023.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe inclusion criteria were as follows: (1) aged 18 years or older; (2) working in a hospital for less than five years; and (3) volunteered to participate in the study. The exclusion criteria included nurses with psychological diseases and those who were on a long leave of absence. The G*Power 3.1.9.7 software was used for the sample size calculation. The fixed effect model and R\u003csup\u003e2\u003c/sup\u003e deviation from zero were the methods used for the calculation. Given \u0026alpha; = 0.05, effect size = 0.1, power\u0026nbsp;(1-\u0026beta;)\u0026nbsp;= 0.95, and a predictive factor of 8, the required sample size was 236, and 260 nurses were selected after calculating the invalid questionnaire rate (10%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral information questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDrawing upon literature reviews and expert input, the research team crafted a questionnaire on general information. This encompassed demographics such as age, sex, education, marital status, mumber of children, department, employment status, work experience, shift patterns, monthly night shift, weekly overtime hours, monthly income.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssessment of career adaptability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants\u0026rsquo; career adaptability was measured using the Career Adapt-Abilities Scale (CAAS), originally developed by Savickas and Porfeli [14]. The scale consists of 24 items organized into four dimensions, with each item rated on a 5-point Likert scale (ranging from 1 = not strong to 5 = strongest). Higher total scores reflect a greater level of career adaptability. The Chinese version of the CAAS was revised by Hou, and its Cronbach\u0026rsquo;s alpha was 0.89 [32].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssessment of practice environment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe nursing practice environment was evaluated using the Practice Environment Scale (PES), developed by Lake [33]. The Chinese version of the PES, also validated by Lake [33], includes 29 items grouped into five subscales. Each item is rated on a 4-point Likert scale (ranging from 1 = strongly disagree to 4 = strongly agree). Higher scores indicate a more favorable practice environment as perceived by participants. The Cronbach\u0026rsquo;s \u0026alpha; coefficient of the Chinese version of the PES was 0.91\u0026nbsp;[34].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssessment of psychological flexibility\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePsychological flexibility was assessed using the Personalized Psychological Flexibility Index (PPFI), developed by Kashdan et al. [25]. The scale measures psychological flexibility across three domains and comprises 15 items rated on a 7-point Likert scale (ranging from 1 = strongly disagree to 7 = strongly agree). Higher scores denote a greater degree of psychological flexibility. The Chinese version of the PPFI was revised by Fang, and its Cronbach\u0026rsquo;s alpha was 0.86 [35].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData collection was conducted using the online platform Wenjuanxing (\u003ca href=\"https://www.wjx.cn/\" target=\"https://chat.deepseek.com/a/chat/s/_blank\"\u003ehttps://www.wjx.cn/\u003c/a\u003e). The study team first established collaborative agreements with the nursing departments of each participating hospital. Subsequently, the research objectives, along with the inclusion and exclusion criteria, were thoroughly communicated to the nursing department administrators at each site. These administrators were then tasked with distributing survey invitations to eligible participants via WeChat, based on induction and attendance records. To ensure data completeness, all questionnaire items were set as mandatory, and submissions were only permitted after all questions were answered. Additionally, technical restrictions were implemented to allow only one submission per IP address. Initially, 906 survey questionnaires were distributed, with 843 responses returned to the first author. After quality control checks, 825 valid responses were retained, yielding a response rate of 91.1%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received ethical approval from the Clinical Research Ethics Committee of Peking University First Hospital (approval no. 2022 yan 415-002). Prior to commencement, all participants were clearly informed about the voluntary nature of the study and the confidentiality of their data, following the acquisition of permissions from the participating hospitals. The study was conducted in accordance with ethical standards established in the 1964 Declaration of Helsinki and its later amendments. To ensure confidentiality, all questionnaires were completed anonymously, and the collected data were used exclusively for the purposes of this study. Strict measures were implemented to safeguard the privacy and confidentiality of all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analyses were conducted independently by two researchers. Data processing and analysis were performed using SPSS version 25.0 (SPSS Inc., Chicago, IL, USA). Categorical variables were summarized using frequencies and percentages, while continuous variables were expressed as means and standard deviations. Univariate analyses were conducted using one-way ANOVA and independent sample t-tests for normally distributed data, and the Kruskal-Wallis test was applied for non-normally distributed data. Correlations between variables were assessed using Spearman\u0026rsquo;s correlation analysis. Hierarchical multiple regression models were employed to identify factors associated with career adaptability. Multicollinearity among independent variables was evaluated using variance inflation factors (VIF), with no evidence of multicollinearity observed (all VIF values \u0026lt; 1.50). As all questionnaire items were mandatory, no missing data were present. Statistical significance was defined as a two-sided p-value \u0026lt; 0.05 [36].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDescriptive characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe demographic characteristics of the study participants are shown in Table 1. A total of 825 junior nurses completed the survey, with an average age of 26.17\u0026plusmn;2.85 years. The majority of participants were female (93%), and 78% held a bachelor\u0026rsquo;s degree or higher. Only 12% were regular employees, while 15.4% worked stable day shifts without night shifts. Univariate analysis revealed that several factors significantly influenced career adaptability, including years of work experience, employment status, shift patterns, Monthly night shift, and weekly overtime hours (p \u0026lt; 0.05) (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1 Demographic characteristics of participants and the results of the univariate analysis of career adaptability (N = 825)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"641\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 288px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCareer adaptability score(x\u0026plusmn;s)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eZ/H\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e58 (7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e90.75 \u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e 16.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026minus;0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e767 (93.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e88.91 \u0026plusmn; 16.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e182 (22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e92.34 \u0026plusmn; 16.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e8.518\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e612 (74.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e88.09 \u0026plusmn; 16.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e31 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e88.35 \u0026plusmn; 10.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e582 (70.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e89.31 \u0026plusmn; 15.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e1.523\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e239 (29.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e88.26 \u0026plusmn; 16.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e4 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e94.75 \u0026plusmn; 20.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eNumber of children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e707 (85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e89.19 \u0026plusmn; 16.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026minus;0.878\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.380\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026ge; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e118 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e88.09 \u0026plusmn; 15.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eDepartment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eGeriatrics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e286 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e89.01 \u0026plusmn; 17.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.913\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eSurgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e140 (17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e89.52 \u0026plusmn; 15.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eGynecology and pediatrics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e220 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e89.42 \u0026plusmn; 14.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eEmergency and ICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e74 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e88.33 \u0026plusmn; 17.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e105 (12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e88.16 \u0026plusmn; 15.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eEmployment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eRegular employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e99 (12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e93.2 \u0026plusmn; 14.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e19.825\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eContract system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e581 (70.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e87.32 \u0026plusmn; 15.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eLabor dispatch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e145 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e93.06 \u0026plusmn; 18.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eWork experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e175 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e91.81 \u0026plusmn; 16.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e11.489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e212 (25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e90.27 \u0026plusmn; 15.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e3 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e194 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e87.92 \u0026plusmn; 14.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e4 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e143 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e86.04 \u0026plusmn; 16.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e101 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e88.01 \u0026plusmn; 18.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eShift patterns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eDay shift\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e127 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e92.66 \u0026plusmn; 15.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e10.621\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eNight shift\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e52 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e90.82 \u0026plusmn; 18.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eAlternate day and night\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e501 (60.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e88.77 \u0026plusmn; 15.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003eRandom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e145 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e86.13 \u0026plusmn; 17.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eMonthly night shift\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026lt; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e202 (24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e92.51 \u0026plusmn; 15.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e7.742\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e4\u0026ndash;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e401 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e88.76 \u0026plusmn; 15.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026gt; 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e222 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e87.36 \u0026plusmn; 17.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eWeekly overtime hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026lt; 10 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e497 (60.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e91.71 \u0026plusmn; 16.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e17.411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e10\u0026ndash;15 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e188 (22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e86.41 \u0026plusmn; 15.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026gt; 15 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e140 (17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e83.08 \u0026plusmn; 14.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eMonthly income\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026le; 5000 yuan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e313 (37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e88.67 \u0026plusmn; 16.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e5.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e5001\u0026ndash;9999 yuan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e409 (49.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e88.51 \u0026plusmn; 15.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026ge; 10000 yuan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e103 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e92.24 \u0026plusmn; 15.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eScores of career adaptability, practice environment, and psychological flexibility\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall and subscale scores for career adaptability, practice environment, and psychological flexibility are presented in Table 2. The results indicated that junior nurses demonstrated moderate levels of career adaptability (M = 89.04, SD = 16.11), practice environment satisfaction (M = 3.09, SD = 0.48), and psychological flexibility (M = 64.93, SD = 10.48).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 Scores of career adaptability, practice environment, and psychological flexibility\u0026nbsp;(N = 825)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"594\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 251px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScore Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage Score of Each Item\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 251px;\"\u003e\n \u003cp\u003eCareer adaptability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e24~120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e89.04\u0026nbsp;\u0026plusmn;\u0026nbsp;16.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e3.71 \u0026plusmn; 0.80\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 251px;\"\u003e\n \u003cp\u003eConcern\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e6~30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e21.33\u0026nbsp;\u0026plusmn;\u0026nbsp;4.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e3.55 \u0026plusmn; 0.83\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 251px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e6~30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e22.78\u0026nbsp;\u0026plusmn;\u0026nbsp;4.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e3.80 \u0026plusmn; 0.81\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 251px;\"\u003e\n \u003cp\u003eCuriosity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e6~30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e22.33\u0026nbsp;\u0026plusmn;\u0026nbsp;4.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e3.72\u0026nbsp;\u0026plusmn;\u0026nbsp;0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 251px;\"\u003e\n \u003cp\u003eConfidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e6~30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e22.60\u0026nbsp;\u0026plusmn;\u0026nbsp;4.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e3.77\u0026nbsp;\u0026plusmn;\u0026nbsp;0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 251px;\"\u003e\n \u003cp\u003ePractice environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1~4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e3.09\u0026nbsp;\u0026plusmn;\u0026nbsp;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e3.09\u0026nbsp;\u0026plusmn;\u0026nbsp;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 251px;\"\u003e\n \u003cp\u003eNurse Participation in Hospital Affairs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1~4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e3.00\u0026nbsp;\u0026plusmn;\u0026nbsp;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e3.00 \u0026plusmn; 0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 251px;\"\u003e\n \u003cp\u003eNursing Foundations for Quality of Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1~4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e3.15\u0026nbsp;\u0026plusmn;\u0026nbsp;0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e3.15\u0026nbsp;\u0026plusmn;\u0026nbsp;0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 251px;\"\u003e\n \u003cp\u003eNurse Manager Ability, Leadership, and Support of Nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1~4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e3.11\u0026nbsp;\u0026plusmn;\u0026nbsp;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e3.11\u0026nbsp;\u0026plusmn;\u0026nbsp;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 251px;\"\u003e\n \u003cp\u003eStaffing and Resource Adequacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1~4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e3.06\u0026nbsp;\u0026plusmn;\u0026nbsp;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e3.06\u0026nbsp;\u0026plusmn;\u0026nbsp;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 251px;\"\u003e\n \u003cp\u003eCollegial Nurse-Physician Relations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1~4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e3.13\u0026nbsp;\u0026plusmn;\u0026nbsp;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e3.13\u0026nbsp;\u0026plusmn;\u0026nbsp;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 251px;\"\u003e\n \u003cp\u003ePsychological flexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e15~105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e64.93\u0026nbsp;\u0026plusmn;\u0026nbsp;10.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e4.33 \u0026plusmn; 1.47\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 251px;\"\u003e\n \u003cp\u003eAvoidance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e5~35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e20.91\u0026nbsp;\u0026plusmn;\u0026nbsp;6.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e4.18\u0026nbsp;\u0026plusmn; 1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 251px;\"\u003e\n \u003cp\u003eAcceptance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e5~35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e22.72\u0026nbsp;\u0026plusmn;\u0026nbsp;6.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e4.54 \u0026plusmn; 1.44\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 251px;\"\u003e\n \u003cp\u003eHarnessing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e5~35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e21.29\u0026nbsp;\u0026plusmn;\u0026nbsp;6.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e4.26\u0026nbsp;\u0026plusmn;\u0026nbsp;1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Table \u0026nbsp;3, spearman\u0026rsquo;s correlation analysis revealed a moderate positive correlation between career adaptability and practice environment (r = 0.506, p \u0026lt; 0.001), as well as a weak positive correlation between career adaptability and psychological flexibility (r = 0.220, p \u0026lt; 0.001). Additionally, a weak positive correlation was observed between practice environment and psychological flexibility (r = 0.182, p \u0026lt; 0.01) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3 \u0026nbsp;Correlation of variables (N = 825)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"527\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e-0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eEmployment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.753\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eWork experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e-0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eShift patterns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e-0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eMonthly night shift\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e-0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eWeekly overtime hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e-0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003ePractice environment ②\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eNurse Participation in Hospital Affairs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eNursing Foundations for Quality of Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.536\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eNurse Manager Ability, Leadership, and Support of Nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eStaffing and Resource Adequacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.486\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eCollegial Nurse-Physician Relations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003ePsychological flexibility ③\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eAvoidance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eAcceptance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 375px;\"\u003e\n \u003cp\u003eHarnessing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.362\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFactors influencing career adaptability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Table 4, hierarchical regression analysis was conducted in three sequential steps. Demographic factors were entered in the first step, followed by the practice environment in the second step, and psychological flexibility in the third step. In the first step, shift patterns and overtime hours were significantly associated with career adaptability. However, these associations were no longer significant after the inclusion of the practice environment in the second step. When comparing Models 2 and 3, psychological flexibility emerged as a statistically significant predictor of career adaptability, even after accounting for the practice environment. Furthermore, the adjusted R\u0026sup2; values for the three models indicated that they explained 5.6%, 39.2%, and 40.0% of the variance in career adaptability, respectively.\u003c/p\u003e\n\u003cp\u003eTable 4 Hierarchical multiple regression models for explaining\u0026nbsp;junior\u0026nbsp;nurses\u0026rsquo; career adaptability (N = 825)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"696\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 142px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 190px;\"\u003e\n \u003cp\u003eModel 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 184px;\"\u003e\n \u003cp\u003eModel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 181px;\"\u003e\n \u003cp\u003eModel 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cem\u003eB\u003c/em\u003e (SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026beta; (p)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cem\u003eB\u003c/em\u003e (SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026beta; (p)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cem\u003eB\u003c/em\u003e (SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026beta; (p)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 696px;\"\u003e\n \u003cp\u003eIndependent variable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026minus;2.147 (1.271)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026minus;0.63 (0.092)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e0.787 (1.029)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.023 (0.445)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e0.839 (1.023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.025 (0.820)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eEmployment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026minus;0.477 (1.097)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026minus;0.016 (0.664)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026minus;0.156 (0.880)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026minus;0.177 (0.843)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026minus;0.112 (0.875)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026minus;0.004 (0.898)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eWork experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026minus;0.760 (0.432)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026minus;0.062 (0.079)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026minus;0.188 (0.348)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026minus;0.015 (0.589)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026minus;0.159 (0.345)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026minus;0.013 (0.645)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eShift patterns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026minus;1.413 (0.711)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026minus;0.079 (0.047)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026minus;1.03 2(0.570)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026minus;0.058 (0.071)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026minus;1.066 (0.567)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026minus;0.060 (0.061)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eMonthly night shift\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026minus;0.685 (0.986)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026minus;0.028 (0.488)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e0.164 (0.792)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.005 (0.877)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e0.177 (0.787)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.007 (0.822)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eWeekly overtime hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026minus;3.768 (0.744)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026minus;0.179 (\u0026lt;\u0026nbsp;0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e0.296 (0.626)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.014 (0.637)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e0.240 (0.623)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.011 (0.700)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003ePractice environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e21.056 (0.988)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.630 (\u0026lt;\u0026nbsp;0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e20.295 (1.008)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.607 (\u0026lt; 0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003ePsychological flexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e0.143 (0.043)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0.093\u0026nbsp;(0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 696px;\"\u003e\n \u003cp\u003eModel diagnosis and fit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e value (\u003cem\u003ep\u003c/em\u003e value)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 190px;\"\u003e\n \u003cp\u003e9.137 (\u0026lt; 0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 184px;\"\u003e\n \u003cp\u003e77.013 (\u0026lt; 0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 181px;\"\u003e\n \u003cp\u003e69.629 (\u0026lt; 0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eVariance inflation factor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 190px;\"\u003e\n \u003cp\u003e1.067\u0026ndash;1.419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 184px;\"\u003e\n \u003cp\u003e1.073\u0026ndash;1.423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 181px;\"\u003e\n \u003cp\u003e1.062\u0026ndash;1.423\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eR\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e(Adjusted R\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 190px;\"\u003e\n \u003cp\u003e0.063 (0.056)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 184px;\"\u003e\n \u003cp\u003e0.398 (0.392)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 181px;\"\u003e\n \u003cp\u003e0.406 (0.400)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003erR\u003csup\u003e2\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 190px;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 184px;\"\u003e\n \u003cp\u003e0.335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 181px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eB = unstandardized regression coefficient; SE = standard error; \u003cem\u003e\u0026beta; =\u0026nbsp;\u003c/em\u003estandardized regression coefficient; significant values are reported in bold.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis cross-sectional study investigated the associations between practice environment, psychological flexibility, and career adaptability among junior nurses. The findings revealed that junior nurses exhibited moderate levels of career adaptability, with shift patterns, overtime hours, practice environment, and psychological flexibility emerging as significant influencing factors. These results not only align with existing literature but also provide new insights into the mechanisms underlying career adaptability in the nursing profession. By integrating external environmental factors and internal psychological resources, this study offers a comprehensive framework for understanding and improving the professional development of junior nurses.\u003c/p\u003e\n\u003cp\u003eThe moderate level of career adaptability observed in this study is consistent with previous research [37, 38], suggesting that this phenomenon may be a common challenge among junior nurses globally. This finding can be attributed to the inherently complex and dynamic nature of the healthcare industry, where high workloads, unpredictable patient needs, and rapid technological advancements create a demanding environment for early-career nurses [37]. Such conditions often limit their capacity to respond effectively to career-related pressures and adapt to evolving practice environments. Furthermore, career adaptability is not a static trait but rather a dynamic process influenced by multiple factors, including individual characteristics and organizational support [39]. For instance, junior nurses with higher career adaptability are better equipped to make informed decisions, navigate workplace challenges, and recognize the value of their nursing roles. However, this study highlights that adaptability is not solely an individual trait but is also shaped by external factors such as shift patterns and overtime hours. Specifically, night shifts and excessive overtime were found to significantly impair career adaptability, likely due to the physical and psychological burdens they impose. These findings are supported by prior research, which has consistently demonstrated the detrimental effects of irregular shifts and long working hours on nurses\u0026rsquo; well-being, job performance, and retention [39, 40]. Therefore, nursing managers should prioritize optimizing scheduling practices, reducing overtime, and implementing flexible work arrangements to mitigate these challenges and enhance junior nurses\u0026rsquo; career adaptability.\u003c/p\u003e\n\u003cp\u003eBuilding on these findings, the study also revealed a strong positive correlation between the practice environment and career adaptability. A supportive practice environment not only enhances job satisfaction and reduces burnout but also fosters a sense of belonging and commitment among nurses [22]. However, the perception of the practice environment is not uniform, even within the same institution. Junior nurses, due to their limited experience and professional networks, often have fewer opportunities to engage in management-related activities or voice their opinions. This was reflected in the low scores for the \u0026quot;Nurse Participation in Hospital Affairs\u0026quot; subscale, which aligns with previous studies [23, 41\u0026ndash;43]. A positive practice environment encompasses not only job content but also satisfaction with the work setting, which is crucial for fostering professional growth and adaptability. Research has shown that personal growth initiatives, such as mentorship programs and leadership training, can enhance newly graduated nurses\u0026rsquo; ability to leverage their practice environment [24]. Therefore, nursing departments should adopt inclusive management practices, encourage junior nurses\u0026rsquo; participation in hospital affairs, and implement hierarchical management strategies to improve their organizational commitment, sense of achievement, and belonging [44\u0026ndash;46]. By creating an environment that values the contributions of junior nurses, healthcare institutions can facilitate their transition from novice to competent practitioners.\u003c/p\u003e\n\u003cp\u003eWhile the practice environment represents an external factor, the role of psychological flexibility as an internal factor is equally critical. This study demonstrated that junior nurses with higher psychological flexibility exhibited greater career adaptability. Psychological flexibility, defined as the ability to remain present and adapt behaviors in alignment with one\u0026rsquo;s values, even in the face of discomfort or adversity [25], serves as a key personal resource for navigating workplace challenges. Multiple studies have shown that individual factors have an impact on the adaptability of most nurses early in their careers [39,47]. Although no prior studies have directly explored the relationship between psychological flexibility and career adaptability, recent literature suggests that nurses with greater psychological flexibility are better able to allocate psychological resources toward value-based actions, such as demonstrating initiative and creativity in overcoming obstacles [48, 49]. For example, during the COVID-19 pandemic, nurses with high psychological flexibility were more likely to adapt to rapidly changing conditions and maintain effective functioning [29]. Interventions such as acceptance and commitment therapy (ACT) have been shown to enhance psychological flexibility, alleviate negative emotions (e.g., anxiety and depression), and improve career adaptation [50]. Hospital managers should prioritize supporting junior nurses with low psychological flexibility, helping them align with their professional values, and fostering a sense of mission to enhance their adaptability and resilience in the workplace. By integrating psychological flexibility training into professional development programs, healthcare institutions can empower junior nurses to thrive in demanding environments.\u003c/p\u003e\n\u003cp\u003eA key strength of this study is its multicenter design, which enhances the generalizability of the findings. By focusing on junior nurses within five years of graduation, the study provides novel insights into the relationship between career adaptability and two critical factors\u0026mdash;practice environment and psychological flexibility. However, several limitations should be acknowledged. First, the use of a convenience sampling method may limit the representativeness of the findings. Second, the reliance on self-reported measures for career adaptability, practice environment, and psychological flexibility may introduce response bias. Third, the cross-sectional design precludes the establishment of causal relationships among the variables. Future longitudinal studies are needed to explore the causal mechanisms underlying these associations and to evaluate the long-term impact of interventions targeting practice environment and psychological flexibility.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eJunior nurses consistently face challenges related to career adaptability, which can significantly impact their professional growth and job performance. This study highlights the critical roles of practice environment and psychological flexibility in shaping adaptability. Nursing managers should strive to create supportive practice environments that promote inclusivity and belonging, particularly for junior nurses. Additionally, interventions such as ACT should be implemented to enhance psychological flexibility, enabling junior nurses to navigate workplace challenges effectively and contribute meaningfully to their organizations. By addressing these factors, healthcare institutions can foster a resilient and adaptable nursing workforce, ultimately improving both nurse well-being and patient outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe gratefully acknowledge all junior nurses that participated in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYZ and ZZ contribute equally to this study, they share co-first author. They were responsible for the study design and data analysis. They also drafted the first version of the manuscript. MZ and MZ contributed to data collection and literature review. ZT revised the paper. All authors read and approved the final manuscript. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National High Level Hospital Clinical Research Funding (Scientific Research Seed Fund of Peking University First Hospital) [grant number 2022SF75, 2022SF60].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used to support the findings of this study are available from the corresponding author upon request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest regarding the publication of this paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received ethical approval from the Clinical Research Ethics Committee of Peking University First Hospital (approval no. 2022 yan 415-002). The study was conducted in accordance with ethical standards established in the 1964 Declaration of Helsinki and its later amendments.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eYatsu H, Saeki A. Current trends in global nursing: A scoping review. Nursing Open. 2022;9(3):1575-1588.\u003c/li\u003e\n\u003cli\u003eKim JH, Shin HS. Exploring barriers and facilitators for successful transition in new graduate nurses: A mixed methods study. Journal of Professional Nursing. 2020;36(6):560-568. \u003c/li\u003e\n\u003cli\u003eGan L, Zhang H, Shang W, Li X, Ma X, Wu Z. Nursing turnover rate and its influencing factors. Chinese Journal of Nursing. 2020;55(2):198-203.\u003c/li\u003e\n\u003cli\u003eObschonka M, Hahn E, Bajwa NH. 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Journal of Medical Internet Research. 2023;25:e51549.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Junior nurses, Career adaptability, Practice environment, Psychological flexibility, Influencing factors, Nursing management","lastPublishedDoi":"10.21203/rs.3.rs-6352500/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6352500/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e Career adaptability is a pivotal factor influencing nurses' well-being and professional performance. This study aims to explore the relationships between the practice environment, psychological flexibility, and career adaptability among junior nurses, with the goal of informing strategies to enhance adaptability and mitigate turnover.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e A multi-center, cross-sectional study was conducted across four hospitals in China, utilizing an online-based survey, recruiting junior nurses between February to October 2023. Data were collected using a general information questionnaire, Career Adapt-Abilities Scale, Practice Environment Scale and Personalized Psychological Flexibility Index. Hierarchical regression analysis was employed to identify factors associated with career adaptability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e A total of 825 valid responses were analyzed. The total score for the junior nurses’ career adaptability was (89.04±16.11), the career adaptability of junior nurses were at a moderate level. Higher career adaptability was observed among junior nurses with junior college education, regular employment status, first-year work experience, day-shift pattern, fewer than four times of monthly night shift, and less than 10 hours of weekly overtime. Spearman correlation analysis showed that practice environment(r=0.506), psychological flexibility(r=0.220) were all correlated with the career adaptability of junior nurses(all P\u0026lt;0.05). Multiple linear regression analysis indicated that practice environment and psychological flexibility influenced career adaptability in junior nurses(all P\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e The practice environment and psychological flexibility are critical determinants of career adaptability in junior nurses. Nurse managers should prioritize fostering a supportive practice environment and implementing psychological training programs to improve psychological flexibility and career adaptability among junior nurses, thereby addressing workforce retention challenges.\u003c/p\u003e","manuscriptTitle":"Practice environment, psychological flexibility, and their association with career adaptability in junior nurses: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-30 09:59:29","doi":"10.21203/rs.3.rs-6352500/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"eceed31b-dede-4e8c-833a-758619b76551","owner":[],"postedDate":"May 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-11T05:23:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-30 09:59:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6352500","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6352500","identity":"rs-6352500","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}