Psychological Resilience Mediates Sense of Professional Mission and Career Success in Chinese Intensive Care Unit Nurses: a Cross-sectional Study

Psychological Resilience Mediates Sense of Professional Mission and Career Success in Chinese Intensive Care Unit Nurses: a Cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychological Resilience Mediates Sense of Professional Mission and Career Success in Chinese Intensive Care Unit Nurses: a Cross-sectional Study lating zhang, Xue Jiang, Xinhui Liang, Na Cheng, Lin Han, Yao Jia, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4424988/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Sep, 2024 Read the published version in BMC Nursing → Version 1 posted 10 You are reading this latest preprint version Abstract Background The nursing industry's stability and progress are adversely affected by the high attrition rate and shortage of nurses; therefore, it is critical to investigate the variables that influence the professional stability of nurses.The sense of professional mission and career success have positive significance for reducing nurses' job burnout. The purpose of this study is to explore the potential mediating role of resilience in this relationship. Methods Self-reported questionnaires were utilized by 335 intensive care unit (ICU) nurses to assess their sense of professional mission, psychological resilience, and career success in this cross-sectional study. A structural equation model was developed to validate the indirect relationship between the variables. Results There is a correlation among professional mission, psychological resilience and career success. Significant mediating effect of resilience exists between career success and career mission. Conclusions In this study, resilience plays an intermediary role between career mission and career success, which provides support for further understanding the mechanism between career mission and career success and bolstering the case for devising comprehensive intervention strategies for resilience. Nursing managers should focus on nurses' sense of professional mission and psychological resilience, and implement strategies to enhance nurses' psychological resilience in order to boost their career success. psychological resilience career success professional mission nurse Figures Figure 1 Figure 2 Introduction With the gradual diversification of medical needs and increasing tasks, the modern medical environment is becoming increasingly complex, severe and unpredictable. Nurses are an indispensable part of the health care system, and are also recognized as high-demand and high-risk occupations[ 1 ], especially the nursing staff in intensive care unit (ICU). As we all know, ICU nurses are under high pressure and have a high turnover rate[ 2 , 3 ]. Heavy shifts, long working hours, the responsibility of taking care of patients, witnessing human suffering and uncertainty have put nurses in intensive care unit under great pressure, resulting in a high resignation rate. A research analysis indicates that the turnover rate of nurses globally varies from 15–44%[ 4 ]. The issue of nurse scarcity and high turnover is global in scope[ 5 ], and it hinders the stability and growth of the nursing industry[ 6 ]. Due to the high level of professional knowledge of ICU nurses, their training cost is higher and it is more difficult to replace them[ 7 ].The high turnover rate of such groups has an impact on the quality and safety of patient care and serves as a roadblock to nursing development. Therefore, some researchers emphasize the need to understand what prompted nurses to continue to engage in this profession in such a challenging environment[ 8 ]. At present, the research is more and more interested in exploring the factors that affect nurses' career stability. Career success is defined as "the accumulation of positive psychological feelings related to one's own career development and relative accomplishments"[ 9 , 10 ]. It is a crucial metric for assessing one's own professional development[ 11 ]. A number of studies have demonstrated that the progress that nurses make in their careers is beneficial to the promotion of creative behavior among nurses, and that it also plays a significant effect in lowering the turnover rate and enhancing the quality of nursing services[ 12 – 14 ]. Robinson GF et al. demonstrate that when an individual succeeds in his career, he is able to work harder and experience the enjoyment that comes with it, which serves as a benchmark for the sector and makes people aspire for this employment[ 15 ]. Focusing on nurses' professional skills is important, but we should also consider their psychological pursuit if we want to foster top-notch nursing talent. Career success is one of the psychological mechanisms that affect nurses' career pursuit. Improving career success can not only improve personal happiness and satisfaction, but also foster greater work motivation, reduce job burnout and improve work attitude in their daily work, thus improving work efficiency and quality, achieving higher career success and forming a virtuous circle[ 16 ]. The success of a profession can be evaluated from two different views: objective viewpoints, such as rank position, compensation, promotion, and career prestige; and subjective perspectives, such as job satisfaction, development, and well-being[ 17 ]. Subjective career success is more important to nurses than objective career success[ 18 ], it can also promote their persistence in their careers. According to earlier research, clinical nurses' perceptions of their professional success in China are on the medium side[ 19 ], with room for improvement and a dearth of information regarding the success of ICU nurses. In light of this circumstance, it is vital to further identify the elements that influence ICU nurses' career success, as well as the interaction between them, so as to provide better career development support for nurses and help nurses achieve career success more effectively. A sense of professional mission refers to a person's strong feelings and recognition of the profession he is engaged in, his belief that the profession he is engaged in can make life meaningful and the sense of meaning and value he experiences from the performance of his duties, so that he can work with passion and tenacious struggle to realize his self-worth and serve the society[ 20 ]. The "mission" of nurses is typically defined as unselfish dedication. Nurses with a strong professional mission feel more responsible for their patients' well-being and survival. They understand how important their job is to the patients, and this sense of duty and mission will immediately encourage nurses to actively participate in their work[ 21 ]. According to studies, a sense of professional mission can boost job satisfaction among nursing staff[ 22 ], promote personal career development[ 23 ],to reduce turnover intention[ 24 – 26 ]and job burnout[ 27 – 29 ]has a positive effect. ICU nurses' insistence on their career is more to follow their inner sense of mission and inner call. The existence of a sense of mission enables nurses to have a more positive psychological state, thus arousing their enthusiasm for career success. However, some studies show that although the sense of mission provides multi-dimensional benefits, it also poses great challenges[ 30 ]。The existence of a sense of mission makes people think that nurses enter this profession because they have this demand[ 31 ]so as to be disrespected by organizations and society[ 32 ]and low wages. Therefore, it is very important to explore nurses' sense of mission in a broad and fair way and realize its complex influence on nursing specialty. Psychological resilience is defined as the ability to recover and "rebound" from adversity or major stressors, and it is a personal trait that can be cultivated[ 33 ]. The protective resource experience that nurses build throughout their careers to sustain psychological dynamic balance—a comprehensive psychological process of cognition, emotion, and behavior—is referred to as psychological resilience. In the face of difficulties and stress events, excellent psychological resilience can help individuals increase their ability to successfully deal, solve problems, and keep drive for career advancement. Enhancing the psychological resilience of nurses can lead to an increased sense of professional accomplishment for them.This is also a necessary way to decreasing nurse turnover,promote their career development and ultimately improve the quality of medical services. Resilience helps ICU nurses to cope with stress effectively, which is closely linked to their career success and is the most active and important contributor to nurses' job involvement[ 34 ]. The importance of nurses' psychological resilience to the advancement of nursing specialization has been emphasized more and more in recent years as a result of the study on this topic being continuously enhanced and deepened. Research indicates that nurses who have a stronger sense of their professional mission are more likely to feel that their work can help others and contribute to society, to recognize the significance and value of the nursing profession, to be more confident, to maintain clear goals, to look forward to the future, and to bounce back from setbacks more quickly. The psychological resilience of ICU nurses has an important influence on the smooth development of their career, and how to use it to improve the enthusiasm of nurses in their work is of great significance.Promoting ICU nurses' continuous pursuit of career development and success, improving their psychological resilience and helping them learn to create positive emotions with a positive attitude to cope with the pressure of work and life are important conditions for maintaining the sustained and healthy development of nurses' career. Significance of the study and research gap Career success is the goal that nurses strive to pursue. It is of great practical significance to explore the relationship between the three and put forward targeted suggestions to promote the career success of ICU nurses, so that they can better devote themselves to nursing patients and realize their personal and social values. Looking back at the existing research, it is evident that both psychological resilience and a sense of professional mission have a substantial positive influence on career success, but their joint impact on career success needs to be explored. This study examines how a career mission impacts career success and explores the mediating function of psychological resilience. This paper talks about how psychological factors like psychological resilience and a sense of professional mission can affect professional successand puts forward targeted suggestions to improve nurses' negative state at work,put them in a more positive state at work, stimulate their sense of mission to realize their personal values, provide them with necessary and effective support, and help their professional healthy development. Theoretical Framework and Hypothesis Formulation The career success model from the perspective of mission[ 35 ]reveals that persons who have a strong mission are extremely clear about the goals they pursue on their road forward,and they will strive to pursue their own goals to achieve career success in the individual sense. Simultaneously, they will attain tangible career accomplishments, such as advancement, recognition, and enhancement of their skills. El-Gazar HE[ 1 ]has demonstrated that people have the perception that their career is a mission, and this perception is favorably associated to the success that they have in their career. At present, the body of research examining the correlation between psychological resilience and professional mission is relatively scarce. Liu [ 21 ] provides evidence supporting a positive correlation between the psychological resilience of nurses and their sense of professional mission. This suggests that as nurses' psychological resilience increases, so does the strength of their sense of professional mission. However, there is a wealth of research on the sense of professional mission and psychological capital, and a vast number of studies in related domains suggest that psychological resilience is a measurement indicator (sub-dimension) of psychological capital with reference value. Studies have shown that nurses' sense of professional mission can have a positive impact on their psychological capital. Today, researchs indicate that resilience helps nurses achieve professional success and satisfaction[ 36 ]. Some studies show that interventions to enhance psychological capital can improve nurses' sense of professional success. H1: ICU nurses' sense of professional mission will be significantly and positively associated with career success H2: ICU nurses' sense of professional mission will be significantly and positively associated with psychological resilience H3: Psychological resilience of ICU nurses will mediate the association between professional mission and career success Our proposed conceptual model demonstrates the correlation between psychological resilience, career success, and a sense of professional mission, as shown in Fig. 1. Objective of the research The study intended to explore how psychological resilience mediates the connection between a feeling of professional mission and career success among ICU nurses. The goal of our research are threefold. First, our goal will to assess the professional success of ICU nurses. Second, we aimed to determine the relationship betweenthe sense of professional mission among nurses, mental resilience and professional success. Thirdly, we intend to investigate how psychological resilience acts as a mediator in this relationship. Materials and Method Research design In this cross-sectional quantitative investigation, data were gathered by a questionnaire. To avoid receiving duplicate questionnaires, we have configured the back end of the questionnaire program to only accept each IP address once. In addition, intelligent logic is built in the back end to recognize and validate invalid replies( all questions are answered the same, which is not consistent with reality: for example, "the number of night shifts is 300" etc.) Finally, it was excluded that the questionnaire could be completed in less than 10 minutes, and two researchers independently verified the questionnaire's validity to ensure the accuracy of the data. Participants From January 2024 to March 2024, eight tertiary level A hospitals were chosen in four provinces: Shaanxi, Shanxi, Gansu, and Henan. Clinical nurses were issued an anonymous electronic questionnaire link with the assistance and support of hospital administrators. Inclusion criteria include : (1) nurses who have acquired a professional qualification certificate in the People's Republic of China (PRC); (2) nurses who have completed their rotation and worked in the ICU; (3)informed consent and participated voluntarily. Exclusion criteria:(1) individuals who are absent from their duties throughout the investigation period (due to maternity leave, sick leave, etc.); (2) Short-term shift change due to pregnancy or other reasons Sample size We calculate the sample size in accordance with Kendall(1975)[ 37 ]. The total number of questionnaire items used in this study is 55, and the 20% increase on this basis is due to the consideration of the potential sample size loss caused by unfinished work, so the sample size is calculated as N=[(8 + 11 + 11 + 25)x5x(1 + 10%)] = 330, which means at least 330 participants are needed, the survey ultimately gathered 335 questionnaires. The research was carried out and the results were documented in adherence to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations. Research tool Use structured questionnaires to collect data, the first component of the questionnaire is the demographic data of the participants. Mainly consist of gender, age, education level, professional title, marital status, average monthly income, the average monthly number of night shifts, and whether the hospital performs decompression activities on a regular basis. Dependent variable:career success The Career Success Scale assesses the positive psychological and rational emotions acquired by individuals in the workplace and their professional accomplishments[ 38 ]. The survey includes 11 items categorized into two dimensions: career competition (six items) and career satisfaction (five items). Examples include statements such as 'I am content with the advancement I have achieved towards my promotion objectives' and 'My department is confident in my ability to contribute value to the organization due to my expertise and experience'.A scale of the Likert type with five points was used. From completely disagreeing to completely agreeing, each answer gets a score ranging from one to five. With a maximum score of 55, higher scores indicate greater professional success.The scale in question has been widely applied in research at the national level and has established robust validity and reliability [ 19 , 39 , 40 ]. In this research, Cronbach's alpha was found to be 0.89. Independent variable: Professional mission. The professional mission scale [ 41 ]assesses the extent of employees' professional mission through 11 items divided into three dimensions:altruism (4 things), guidance (4 items), and relevance and worth (3 items). The respondents were asked to rate their level of alignment with a professional mission on a 5-point Likert scale ranging from "not at all in line" to "completely in line" The cumulative score was 11–55; higher scores indicated a stronger sense of professional mission. The scale is highly reliable and valid, making it widely used in domestic research[ 21 , 42 ]。In current study, the Cronbach’s α was 0.88. Mediator: psychological resilience The Resilience Scale[ 43 ] is primarily used to assess individuals' psychological resilience when encountering hardships and stressful events. The assessment has 25 items categorized into three distinct dimensions: resilience (13 items), strength (8 items), and optimism (4 items). It has been extensively utilized in national research studies[ 21 , 34 , 44 ]。On a 5-point scale, 0 means "not true at all" and 4 means "true all the time." The total score is between 0 and 100. Increased scores correlate with elevated levels of psychological resilience. In this investigation, Cronbach's alpha is calculated to be 0.95. Moral recognition This study is based on the Helsinki Declaration[ 45 ], which establishes the ethical standards required in. There is no connection between this study and clinical trials involving humans or investigations using animals. The Independent Ethics Committee of the Second Affiliated Hospital of Air Force Military Medical University gave their approval to the study, and all of the participants were required to obtain written informed consent that was anonymous. Additionally, they were apprised of their prerogative to decline involvement in the research or to discontinue their involvement at any juncture throughout the study. The questionnaire is completed in an anonymous manner. Data analysis To begin, we utilize exploratory factor analysis to examine the possibility of combination method deviation, classify each questionnaire item, and do exploratory factor analysis using SPSS 26.0. Throughout the analysis, we discovered that the explanatory rate for the primary common factor was 33.8%, falling below the critical threshold of 40%. Then, we analyze the descriptive statistics and internal consistency of each variable. Following that, we utilize the Pearson correlation coefficient to examine the association between career success, sense of professional mission, and psychological resilience. Finally, we employ the two-step structural equation model to investigate the mediating influence of resilience between professional mission and career success. We use IBM AMOS 24.0 to create and measure the structural model to test our hypothesis. With 2000 bootstrapping the 95% confidence interval does not contain 0, which represents a significant mediation effect. Results Social and demographic attributes There were a total of 335 nurses who took part in the research study. Of those nurses, 316 (94.33%) were female, and 291 (86.86%) of them had earned bachelor's degrees 60.60% of the nurses, or 203 of them, admitted that they did not regularly participate in decompression training. As shown in Table 1. Mean, standard deviation, and correlation among variables The overall scores for professional mission, resilience, and career success are 38.53 ± 6.976, 63.21 ± 14.32, and 38.67 ± 6.234, as indicated in Table 2. Person correlation analysis reveal strong positive association between the variables, with a strong positive relationship between professional mission, resilience, and career success (r = 0.742, 0.715, p < 0.01). Additionally, there is a significant correlation between career mission and resilience (r = .0.614, p < 0.01). Model Test The structural equation is created using AMOS 24.0, which also incorporates the independent variable's sense of professional mission, the dependent variable's career success, and the intermediate variable's psychological resilience, Then we fit and fix the initial model using maximum likelihood. As shown in Table 3, the model's fitting results are:χ 2 /df = 2.465, CFI = 0.988, TLI = 0.980, SRMR = 0.020, RMSEA = 0.066. All indexes are within the desired range, indicating good model fitting data[ 46 ]. Table 4 shows that occupational mission has a significant impact on career success (β = 0.935, p < 0.01). Additionally, the sense of career mission was directly positively correlated with career success(β = 0.651, p < 0. 01), and positively correlated with mental resilience(β = 0.704, p < 0. 01), Psychological resilience was also positively correlated with career success(β = 0.403, p < 0.01). The mediating role of psychological resilience in occupational mission and occupational success (indirect path multiplication) was 0.283, 95% confidence interval excluding 0 (0.213 to 0.335). The results show that the sense of occupational mission has a significant indirect effect on occupational success through psychological resilience. The mediating effect of mental resilience accounted for 30.27% of the total effect. Our findings explain this hypothesis. Figure 2 depicts the mediation effect model. Discussion Level of three variables This study is the first multi-center research utilizing Structural Equation Modeling (SEM) to examine the determinants of career success among ICU nurses. Drawing on the career success model from the perspective of mission, this study links career success with career mission and discusses psychological resilience's mediating effect. This study fills a gap in the research and has important reference value for improving nurses' psychological and social working environment. This novel view emphasizes that a series of positive consequences may occur when nurses' sense of mission is enhanced[ 47 ]. At the same time, it is emphasized that we should pay attention to the cultivation of nurses' sense of mission when training nurses. The results of this study show that the professional mission of ICU nurses is at a medium level. As shown in table 5, the sense of mission of nurses increases with age. This is because experienced nurses will regard nursing as a profession more. By comparing the professional title with the sense of mission, it is found that the sense of mission of nurses with professional titles senior nurse is lower than that of nurses, but overall, the higher the professional titles, the stronger the sense of mission of nurses. The reason for this result may be that most nurses get married when they become senior nurses and need to play another role[ 25 , 48 ], to a certain extent, weakened the role of nurses. After that, with the balance between family and work, his sense of mission gradually rose. Considering that in a person's career, the existence of a sense of mission may change and may be affected by various factors[ 30 ]. It is necessary for nursing managers to continuously cultivate this concept among nurses. But Meleis[ 49 ] pointed out that the traditional image of nurses as altruistic women has a strong influence on nurses' professional identity, which hinders them from critical thinking. Therefore, hospital administrators should pay attention to the working conditions and rights of nurses while cultivating their sense of mission. The research shows that career success, as an important protective factor for nurses' career development, plays a positive role in reducing the brain drain of nursing talents and ensuring the quality of nursing services[ 50 ]. In this study, the score of ICU nurses' sense of professional success is 38.67 ± 6.234, which is at a medium level, indicating that there is still room for improvement. Similar to Wu's research results on the career success of clinical nurses in northwest China[ 19 ]. But lower than Xue's research on the career success of clinical nurses in Central China[ 36 ]. The career success scores of clinical nurses in China are generally not high, which is related to job burnout, social environment and nurse-patient relationship of clinical nurses in China[ 51 – 53 ]. Yamadad mentioned in a summary that work resources and environment are external factors that affect nurses' career success[ 54 ]. In China, clinical nurses not only undertake high-intensity work, but also face the mental pressure brought by the increasingly tense conflict between doctors and patients. At the same time, nursing work in the perception of the vast majority of Chinese people is only a mechanical repetitive work carried out by following the doctor's medical advice, and the social status is far lower than that of doctors. As a consequence, it is of great significance to actively explore the current situation and influencing factors of nurses' career success and improve their professional success level. The total score of ICU nurses' resilience is 63.21 ± 14.32, indicating a moderate level. This score is lower than Xue's research findings on the psychological resilience of clinical nurses in Central China[ 36 ]. Given their critical role in the hospital, nurses endure a substantial workload and high work intensity. Moreover, 94.33% of the survey participants are female nurses who are responsible for caring for their families in addition to fulfilling their hospital duties. The persistent stress they experience can result in negative emotions and hinder the healthy psychological development of individuals. As shown in table 6, the study revealed that organizing group decompression activities for medical staff can significantly enhance ICU nurses' professional mission, psychological resilience, and career success score. Hospital managers should prioritize scheduling regular decompression activities. The Interconnection of Professional Mission, Resilience, and Career Success This study found that a sense of professional mission can positively predict career success. Confirm our hypothesis H1, which is consistent with previous findings. When ICU nurses have a high degree of recognition of their profession, they can devote themselves to their work from the heart and spend a lot of energy and time trying to do their best, accumulate more positive subjective and objective labor results, so that they can feel successful, and the accumulated experience and knowledge will also contribute to the improvement of their internal and external competitiveness and gain more success. This shows that if hospitals and relevant health departments formulate policies to improve nurses' sense of mission, it will help promote nurses to achieve their career success. Consistent with previous research findings, this study discovered a positive correlation between career success and psychological resilience. Nurses with higher psychological resilience can effectively maintain the individual's physical and mental balance when suffering from adversity and pressure, and they have stronger resilience and resilience, so they are more likely to be competent for their work and achieve professional success[ 36 ]. Therefore, nursing managers should actively pay attention to the psychological status of nurses, enhance their anti-frustration ability through flexible scheduling, organize group decompression activities and psychological counseling, so that nurses can maintain a positive and healthy psychological state, have a high level of psychological recovery, promote their good working conditions, and achieve career success. The study found a significant positive correlation between the professional mission sense of ICU nurses and their mental resilience. Confirm our hypothesis H2. This shows that if nurses are more active in their work, love their work, and are willing to pay for their work and their patients,And putting more time and energy into their work will enable them to better maintain their physical and mental balance.Therefore, hospitals and nursing administrators can help nurses enhance their sense of professional mission to improve their psychological resilience. Resilience mediates the relationship between professional mission and career success The hypothesis H3 of this study is confirmed by empirical research results, which further provides theoretical basis for promoting the career success of clinical nurses. The results show that the sense of professional mission directly or indirectly affects the career success of nurses through psychological resilience. The research results clarify the underlying mechanism and show that psychological resilience is the key factor to explain why the sense of professional mission will affect career success.Specifically, the stronger the sense of professional mission of nurses, the higher their psychological resilience, thus increasing their professional success. Nurses with a strong sense of professional mission are more enthusiastic, dedicated and devoted to their work, and have a higher degree of professional involvement. They are good at coping with pressure and adjusting negative emotions in their work, so as to perform better in their work and achieve more objective and subjective success. Restriction The limitations of this study are as follows: our research is based on a self-report questionnaire, so the results may be subjective. Additionally, our study is only conducted among ICU nurses, so different departments may have different results. Finally, this study is cross-sectional, so there is no longitudinal study to observe the changing trend of several variables and no intervention.In the future, psychological intervention measures should be initiated among front-line nurses, and best practices should be improved to improve nurses' resilience to stress. Further qualitative research is needed to understand the environment and conditions conducive to cultivating resilience. Conclusion This study validates the mediating role of resilience in ICU nurses' career mission and career success, providing theoretical support for further understanding the mechanism between professional mission and career success and implementing comprehensive interventions to improve resilience.The study highlights that psychological resilience is the key mediator between nurses' professional mission and career success. Nursing managers should focus on nurturing nurses' professional mission and enhancing their psychological resilience to boost their professional success. Enlightenment for nursing managers Hospitals and nursing managers should improve the sense of professional mission of clinical nurses so as to promote their career success, because this will not only help nurses achieve their job success, but also stabilize the team of nurses. Nursing managers should provide more substantial rewards and support of material resources, pay attention to the innovation and concept of nursing work, adopt the opinions of different nursing staff reasonably, ensure the autonomy of nurses, stimulate their enthusiasm in work and help them achieve professional success. Nursing managers can also help nurses with poor psychological conditions by setting up a seminar room for mental health education, a mental health consultation website and a psychological reading room, and at the same time provide nurses with a "decompression package" to organize decompression activities for nurses from time to time to improve their psychological resilience. Hospitals should pay attention to cultivating nurses' ability to cope with problems and help them improve their emotional control ability. At the same time, it is necessary to consolidate the professional of nurses, improve their problem-solving ability, and thus promote their professional success. Abbreviations ICU intensive care unit SEM Structural Equation Modeling χ 2 /df Chi-square/degree of freedom CFI Comparative fit index TLI Tucker–Lewis index RMSEA Root-mean-square error of approximation SRMR Standardized root mean square residual M:Mean SD Standard deviation CI Confidence interval Declarations Funding This study was supported by the Innovation Project of Military Nursing Innovation and Cultivation Special Program of Air Force Military Medical University. Project No. 2021HL041 Conflict of interest declaration It was declared that the authors have no conflicts of interest. Acknowledgement Research for this paper was partially supported by Air Force Military Medical University. For their encouragement, support, and research assistance would like to thank other authors, who have contributed substantially to the completion of this paper. The contributions of authors All authors participated in formulating and designing the research. ZLT and LXH conducted material preparation, data collecting, and analysis. ZLT and CN authored the first draft of the study. WRH, WW, FHY and JY provided critical comments on the work and made substantial revisions to enhance its intellectual substance. JX and HL reviewed and endorsed the final draft. Data Availability Due to the privacy of the study participants, the data generated in the course of this study will not be made public, but can be made available to the corresponding author upon reasonable request. Ethics approval and consent to participate This study was performed in line with the principles of the Declaration of Helsinki. All the participants consent to participate and providing written informed consent. Approval was granted by the Independent Ethics Committee of the Second Affiliated Hospital of Air Force Military Medical University. Consent for publication Not applicable. References El-Gazar HE, Taie ES, Elamir H, Abou Zeid MAG, Magdi HM, Zoromba MA. 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Career Success Criteria Clarity as a Predictor of Employment Outcomes. Front Psychol. 2020;11:540. https://doi.org/10.3389/fpsyg.2020.00540 . Li ZK, You LM, Lin HS, Chan SW. The career success scale in nursing: psychometric evidence to support the Chinese version. J Adv Nurs. 2014;70(5):1194–203. https://doi.org/10.1111/jan.12285 . Zhang CY. Occupational Purpose: Structure, measurement, and its connection to happiness [D]2015.(in Chinese). Cheng C, Song MQ, Cheng EH. An analysis of the chain mediating effect between the sense of vocation and the delayed satisfaction of occupation in proactive personality and nurses' self-career planning. J Nurs. 2020;26(4):37–42. (in Chinese). Xiaonan Y, Jianxin Z. A comparison between the Chinese version of Ego-resiliency scale and Connor-Davidson resilience scale. Psychological Science (China); 2007. Yan J, Wu C, He C, Lin Y, He S, Du Y, et al. The social support, psychological resilience and quality of life of nurses in infectious disease departments in China: A mediated model. J Nurs Manag. 2022;30(8):4503–13. https://doi.org/10.1111/jonm.13889 . Issue Information-Declaration of Helsinki. J Bone Min Res. 2019;34(2). https://doi.org/10.1002/jbmr.3489 . BM i-BM ii. Koo B, Lee K-S, Khojasteh J. Review of An Introduction to Multilevel Modeling Techniques. Taylor & Francis; 2021. Ehrhardt K, Ensher E. Perceiving a calling, living a calling, and calling outcomes: How mentoring matters. J Couns Psychol. 2021;68(2):168–81. https://doi.org/10.1037/cou0000513 . Chen IH, Brown R, Bowers BJ, Chang WY. Work-to-family conflict as a mediator of the relationship between job satisfaction and turnover intention. J Adv Nurs. 2015;71(10):2350–63. .https://doi.org/10.1111/jan.12706 . Meleis AI. Theoretical nursing: Development and progress. Lippincott Williams & Wilkins; 2011. Sönmez B, Gül D, İspir Demir Ö, Emiralioğlu R, Erkmen T, Yıldırım A. Antecedents and Outcomes of Nurses' Subjective Career Success: A Path Analysis. J Nurs Scholarsh. 2021;53(5):604–14. https://doi.org/10.1111/jnu.12660 . Huang H, Liu L, Yang S, Cui X, Zhang J, Wu H. Effects of job conditions, occupational stress, and emotional intelligence on chronic fatigue among Chinese nurses: a cross-sectional study. Psychol Res Behav Manag. 2019;12:351–60. https://doi.org/10.2147/prbm.S207283 . Wang Y, Zhang L, Tian S, Wu J, Lu J, Wang F, Wang Z. The relationship between work environment and career success among nurses with a master's or doctoral degree: A national cross-sectional study. Int J Nurs Pract. 2019;25(4):e12743. https://doi.org/10.1111/ijn.12743 . Zhou H, Jiang F, Rakofsky J, Hu L, Liu T, Wu S, et al. Job satisfaction and associated factors among psychiatric nurses in tertiary psychiatric hospitals: Results from a nationwide cross-sectional study. J Adv Nurs. 2019;75(12):3619–30. .https://doi.org/10.1111/jan.14202 . Yamada M, Asakura K, Sugiyama S, Takada N. Insights from defining nurses' career success: An integrative review. Nurs Open. 2024;11(1):e2040. https://doi.org/10.1002/nop2.2040 . Tables Tables 1 to 6 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.png Table2.png Table3.png Table4.png Table5.png Table6.png Cite Share Download PDF Status: Published Journal Publication published 02 Sep, 2024 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 03 Jul, 2024 Reviews received at journal 02 Jul, 2024 Reviews received at journal 01 Jul, 2024 Reviewers agreed at journal 29 Jun, 2024 Reviewers agreed at journal 12 Jun, 2024 Reviewers agreed at journal 26 May, 2024 Reviewers invited by journal 25 May, 2024 Editor assigned by journal 23 May, 2024 Submission checks completed at journal 23 May, 2024 First submitted to journal 15 May, 2024 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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Nurses are an indispensable part of the health care system, and are also recognized as high-demand and high-risk occupations[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], especially the nursing staff in intensive care unit (ICU). As we all know, ICU nurses are under high pressure and have a high turnover rate[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Heavy shifts, long working hours, the responsibility of taking care of patients, witnessing human suffering and uncertainty have put nurses in intensive care unit under great pressure, resulting in a high resignation rate. A research analysis indicates that the turnover rate of nurses globally varies from 15\u0026ndash;44%[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The issue of nurse scarcity and high turnover is global in scope[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and it hinders the stability and growth of the nursing industry[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Due to the high level of professional knowledge of ICU nurses, their training cost is higher and it is more difficult to replace them[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].The high turnover rate of such groups has an impact on the quality and safety of patient care and serves as a roadblock to nursing development. Therefore, some researchers emphasize the need to understand what prompted nurses to continue to engage in this profession in such a challenging environment[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. At present, the research is more and more interested in exploring the factors that affect nurses' career stability.\u003c/p\u003e \u003cp\u003eCareer success is defined as \"the accumulation of positive psychological feelings related to one's own career development and relative accomplishments\"[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. It is a crucial metric for assessing one's own professional development[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A number of studies have demonstrated that the progress that nurses make in their careers is beneficial to the promotion of creative behavior among nurses, and that it also plays a significant effect in lowering the turnover rate and enhancing the quality of nursing services[\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Robinson GF et al. demonstrate that when an individual succeeds in his career, he is able to work harder and experience the enjoyment that comes with it, which serves as a benchmark for the sector and makes people aspire for this employment[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Focusing on nurses' professional skills is important, but we should also consider their psychological pursuit if we want to foster top-notch nursing talent. Career success is one of the psychological mechanisms that affect nurses' career pursuit. Improving career success can not only improve personal happiness and satisfaction, but also foster greater work motivation, reduce job burnout and improve work attitude in their daily work, thus improving work efficiency and quality, achieving higher career success and forming a virtuous circle[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The success of a profession can be evaluated from two different views: objective viewpoints, such as rank position, compensation, promotion, and career prestige; and subjective perspectives, such as job satisfaction, development, and well-being[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Subjective career success is more important to nurses than objective career success[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], it can also promote their persistence in their careers. According to earlier research, clinical nurses' perceptions of their professional success in China are on the medium side[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], with room for improvement and a dearth of information regarding the success of ICU nurses. In light of this circumstance, it is vital to further identify the elements that influence ICU nurses' career success, as well as the interaction between them, so as to provide better career development support for nurses and help nurses achieve career success more effectively.\u003c/p\u003e \u003cp\u003eA sense of professional mission refers to a person's strong feelings and recognition of the profession he is engaged in, his belief that the profession he is engaged in can make life meaningful and the sense of meaning and value he experiences from the performance of his duties, so that he can work with passion and tenacious struggle to realize his self-worth and serve the society[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The \"mission\" of nurses is typically defined as unselfish dedication. Nurses with a strong professional mission feel more responsible for their patients' well-being and survival. They understand how important their job is to the patients, and this sense of duty and mission will immediately encourage nurses to actively participate in their work[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. According to studies, a sense of professional mission can boost job satisfaction among nursing staff[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], promote personal career development[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e],to reduce turnover intention[\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]and job burnout[\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]has a positive effect. ICU nurses' insistence on their career is more to follow their inner sense of mission and inner call. The existence of a sense of mission enables nurses to have a more positive psychological state, thus arousing their enthusiasm for career success. However, some studies show that although the sense of mission provides multi-dimensional benefits, it also poses great challenges[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]。The existence of a sense of mission makes people think that nurses enter this profession because they have this demand[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]so as to be disrespected by organizations and society[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]and low wages. Therefore, it is very important to explore nurses' sense of mission in a broad and fair way and realize its complex influence on nursing specialty.\u003c/p\u003e \u003cp\u003ePsychological resilience is defined as the ability to recover and \"rebound\" from adversity or major stressors, and it is a personal trait that can be cultivated[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The protective resource experience that nurses build throughout their careers to sustain psychological dynamic balance\u0026mdash;a comprehensive psychological process of cognition, emotion, and behavior\u0026mdash;is referred to as psychological resilience. In the face of difficulties and stress events, excellent psychological resilience can help individuals increase their ability to successfully deal, solve problems, and keep drive for career advancement. Enhancing the psychological resilience of nurses can lead to an increased sense of professional accomplishment for them.This is also a necessary way to decreasing nurse turnover,promote their career development and ultimately improve the quality of medical services. Resilience helps ICU nurses to cope with stress effectively, which is closely linked to their career success and is the most active and important contributor to nurses' job involvement[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The importance of nurses' psychological resilience to the advancement of nursing specialization has been emphasized more and more in recent years as a result of the study on this topic being continuously enhanced and deepened. Research indicates that nurses who have a stronger sense of their professional mission are more likely to feel that their work can help others and contribute to society, to recognize the significance and value of the nursing profession, to be more confident, to maintain clear goals, to look forward to the future, and to bounce back from setbacks more quickly. The psychological resilience of ICU nurses has an important influence on the smooth development of their career, and how to use it to improve the enthusiasm of nurses in their work is of great significance.Promoting ICU nurses' continuous pursuit of career development and success, improving their psychological resilience and helping them learn to create positive emotions with a positive attitude to cope with the pressure of work and life are important conditions for maintaining the sustained and healthy development of nurses' career.\u003c/p\u003e \u003cp\u003eSignificance of the study and research gap\u003c/p\u003e \u003cp\u003eCareer success is the goal that nurses strive to pursue. It is of great practical significance to explore the relationship between the three and put forward targeted suggestions to promote the career success of ICU nurses, so that they can better devote themselves to nursing patients and realize their personal and social values. Looking back at the existing research, it is evident that both psychological resilience and a sense of professional mission have a substantial positive influence on career success, but their joint impact on career success needs to be explored.\u003c/p\u003e \u003cp\u003eThis study examines how a career mission impacts career success and explores the mediating function of psychological resilience. This paper talks about how psychological factors like psychological resilience and a sense of professional mission can affect professional successand puts forward targeted suggestions to improve nurses' negative state at work,put them in a more positive state at work, stimulate their sense of mission to realize their personal values, provide them with necessary and effective support, and help their professional healthy development.\u003c/p\u003e \u003cp\u003eTheoretical Framework and Hypothesis Formulation\u003c/p\u003e \u003cp\u003eThe career success model from the perspective of mission[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]reveals that persons who have a strong mission are extremely clear about the goals they pursue on their road forward,and they will strive to pursue their own goals to achieve career success in the individual sense. Simultaneously, they will attain tangible career accomplishments, such as advancement, recognition, and enhancement of their skills. El-Gazar HE[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]has demonstrated that people have the perception that their career is a mission, and this perception is favorably associated to the success that they have in their career. At present, the body of research examining the correlation between psychological resilience and professional mission is relatively scarce. Liu [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] provides evidence supporting a positive correlation between the psychological resilience of nurses and their sense of professional mission. This suggests that as nurses' psychological resilience increases, so does the strength of their sense of professional mission. However, there is a wealth of research on the sense of professional mission and psychological capital, and a vast number of studies in related domains suggest that psychological resilience is a measurement indicator (sub-dimension) of psychological capital with reference value. Studies have shown that nurses' sense of professional mission can have a positive impact on their psychological capital. Today, researchs indicate that resilience helps nurses achieve professional success and satisfaction[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Some studies show that interventions to enhance psychological capital can improve nurses' sense of professional success.\u003c/p\u003e \u003cp\u003eH1: ICU nurses' sense of professional mission will be significantly and positively associated with career success\u003c/p\u003e \u003cp\u003eH2: ICU nurses' sense of professional mission will be significantly and positively associated with psychological resilience\u003c/p\u003e \u003cp\u003eH3: Psychological resilience of ICU nurses will mediate the association between professional mission and career success\u003c/p\u003e \u003cp\u003eOur proposed conceptual model demonstrates the correlation between psychological resilience, career success, and a sense of professional mission, as shown in Fig.\u0026nbsp;1.\u003c/p\u003e \u003cp\u003eObjective of the research\u003c/p\u003e \u003cp\u003eThe study intended to explore how psychological resilience mediates the connection between a feeling of professional mission and career success among ICU nurses. The goal of our research are threefold. First, our goal will to assess the professional success of ICU nurses. Second, we aimed to determine the relationship betweenthe sense of professional mission among nurses, mental resilience and professional success. Thirdly, we intend to investigate how psychological resilience acts as a mediator in this relationship.\u003c/p\u003e"},{"header":"Materials and Method","content":"\u003cp\u003eResearch design\u003c/p\u003e \u003cp\u003eIn this cross-sectional quantitative investigation, data were gathered by a questionnaire. To avoid receiving duplicate questionnaires, we have configured the back end of the questionnaire program to only accept each IP address once. In addition, intelligent logic is built in the back end to recognize and validate invalid replies( all questions are answered the same, which is not consistent with reality: for example, \"the number of night shifts is 300\" etc.) Finally, it was excluded that the questionnaire could be completed in less than 10 minutes, and two researchers independently verified the questionnaire's validity to ensure the accuracy of the data.\u003c/p\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003eFrom January 2024 to March 2024, eight tertiary level A hospitals were chosen in four provinces: Shaanxi, Shanxi, Gansu, and Henan. Clinical nurses were issued an anonymous electronic questionnaire link with the assistance and support of hospital administrators. Inclusion criteria include : (1) nurses who have acquired a professional qualification certificate in the People's Republic of China (PRC); (2) nurses who have completed their rotation and worked in the ICU; (3)informed consent and participated voluntarily.\u003c/p\u003e \u003cp\u003eExclusion criteria:(1) individuals who are absent from their duties throughout the investigation period (due to maternity leave, sick leave, etc.); (2) Short-term shift change due to pregnancy or other reasons\u003c/p\u003e \u003cp\u003eSample size\u003c/p\u003e \u003cp\u003eWe calculate the sample size in accordance with Kendall(1975)[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The total number of questionnaire items used in this study is 55, and the 20% increase on this basis is due to the consideration of the potential sample size loss caused by unfinished work, so the sample size is calculated as N=[(8\u0026thinsp;+\u0026thinsp;11\u0026thinsp;+\u0026thinsp;11\u0026thinsp;+\u0026thinsp;25)x5x(1\u0026thinsp;+\u0026thinsp;10%)]\u0026thinsp;=\u0026thinsp;330, which means at least 330 participants are needed, the survey ultimately gathered 335 questionnaires. The research was carried out and the results were documented in adherence to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations.\u003c/p\u003e \u003cp\u003eResearch tool\u003c/p\u003e \u003cp\u003eUse structured questionnaires to collect data, the first component of the questionnaire is the demographic data of the participants. Mainly consist of gender, age, education level, professional title, marital status, average monthly income, the average monthly number of night shifts, and whether the hospital performs decompression activities on a regular basis.\u003c/p\u003e \u003cp\u003eDependent variable:career success\u003c/p\u003e \u003cp\u003eThe Career Success Scale assesses the positive psychological and rational emotions acquired by individuals in the workplace and their professional accomplishments[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The survey includes 11 items categorized into two dimensions: career competition (six items) and career satisfaction (five items). Examples include statements such as 'I am content with the advancement I have achieved towards my promotion objectives' and 'My department is confident in my ability to contribute value to the organization due to my expertise and experience'.A scale of the Likert type with five points was used. From completely disagreeing to completely agreeing, each answer gets a score ranging from one to five. With a maximum score of 55, higher scores indicate greater professional success.The scale in question has been widely applied in research at the national level and has established robust validity and reliability [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. In this research, Cronbach's alpha was found to be 0.89.\u003c/p\u003e \u003cp\u003eIndependent variable: Professional mission.\u003c/p\u003e \u003cp\u003eThe professional mission scale [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]assesses the extent of employees' professional mission through 11 items divided into three dimensions:altruism (4 things), guidance (4 items), and relevance and worth (3 items). The respondents were asked to rate their level of alignment with a professional mission on a 5-point Likert scale ranging from \"not at all in line\" to \"completely in line\" The cumulative score was 11\u0026ndash;55; higher scores indicated a stronger sense of professional mission. The scale is highly reliable and valid, making it widely used in domestic research[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]。In current study, the Cronbach\u0026rsquo;s α was 0.88.\u003c/p\u003e \u003cp\u003eMediator: psychological resilience\u003c/p\u003e \u003cp\u003eThe Resilience Scale[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e] is primarily used to assess individuals' psychological resilience when encountering hardships and stressful events. The assessment has 25 items categorized into three distinct dimensions: resilience (13 items), strength (8 items), and optimism (4 items). It has been extensively utilized in national research studies[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]。On a 5-point scale, 0 means \"not true at all\" and 4 means \"true all the time.\" The total score is between 0 and 100. Increased scores correlate with elevated levels of psychological resilience. In this investigation, Cronbach's alpha is calculated to be 0.95.\u003c/p\u003e \u003cp\u003eMoral recognition\u003c/p\u003e \u003cp\u003eThis study is based on the Helsinki Declaration[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], which establishes the ethical standards required in. There is no connection between this study and clinical trials involving humans or investigations using animals. The Independent Ethics Committee of the Second Affiliated Hospital of Air Force Military Medical University gave their approval to the study, and all of the participants were required to obtain written informed consent that was anonymous. Additionally, they were apprised of their prerogative to decline involvement in the research or to discontinue their involvement at any juncture throughout the study. The questionnaire is completed in an anonymous manner.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eTo begin, we utilize exploratory factor analysis to examine the possibility of combination method deviation, classify each questionnaire item, and do exploratory factor analysis using SPSS 26.0. Throughout the analysis, we discovered that the explanatory rate for the primary common factor was 33.8%, falling below the critical threshold of 40%. Then, we analyze the descriptive statistics and internal consistency of each variable. Following that, we utilize the Pearson correlation coefficient to examine the association between career success, sense of professional mission, and psychological resilience. Finally, we employ the two-step structural equation model to investigate the mediating influence of resilience between professional mission and career success.\u003c/p\u003e \u003cp\u003eWe use IBM AMOS 24.0 to create and measure the structural model to test our hypothesis. With 2000 bootstrapping the 95% confidence interval does not contain 0, which represents a significant mediation effect.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eSocial and demographic attributes\u003c/p\u003e \u003cp\u003eThere were a total of 335 nurses who took part in the research study. Of those nurses, 316 (94.33%) were female, and 291 (86.86%) of them had earned bachelor's degrees 60.60% of the nurses, or 203 of them, admitted that they did not regularly participate in decompression training. As shown in Table\u0026nbsp;1.\u003c/p\u003e \u003cp\u003eMean, standard deviation, and correlation among variables\u003c/p\u003e \u003cp\u003eThe overall scores for professional mission, resilience, and career success are 38.53\u0026thinsp;\u0026plusmn;\u0026thinsp;6.976, 63.21\u0026thinsp;\u0026plusmn;\u0026thinsp;14.32, and 38.67\u0026thinsp;\u0026plusmn;\u0026thinsp;6.234, as indicated in Table\u0026nbsp;2. Person correlation analysis reveal strong positive association between the variables, with a strong positive relationship between professional mission, resilience, and career success (r\u0026thinsp;=\u0026thinsp;0.742, 0.715, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Additionally, there is a significant correlation between career mission and resilience (r\u0026thinsp;=\u0026thinsp;.0.614, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003eModel Test\u003c/p\u003e \u003cp\u003eThe structural equation is created using AMOS 24.0, which also incorporates the independent variable's sense of professional mission, the dependent variable's career success, and the intermediate variable's psychological resilience, Then we fit and fix the initial model using maximum likelihood. As shown in Table\u0026nbsp;3, the model's fitting results are:χ\u003csup\u003e2\u003c/sup\u003e/df\u0026thinsp;=\u0026thinsp;2.465, CFI\u0026thinsp;=\u0026thinsp;0.988, TLI\u0026thinsp;=\u0026thinsp;0.980, SRMR\u0026thinsp;=\u0026thinsp;0.020, RMSEA\u0026thinsp;=\u0026thinsp;0.066. All indexes are within the desired range, indicating good model fitting data[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;4 shows that occupational mission has a significant impact on career success (β\u0026thinsp;=\u0026thinsp;0.935, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Additionally, the sense of career mission was directly positively correlated with career success(β\u0026thinsp;=\u0026thinsp;0.651, p\u0026thinsp;\u0026lt;\u0026thinsp;0. 01), and positively correlated with mental resilience(β\u0026thinsp;=\u0026thinsp;0.704, p\u0026thinsp;\u0026lt;\u0026thinsp;0. 01), Psychological resilience was also positively correlated with career success(β\u0026thinsp;=\u0026thinsp;0.403, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The mediating role of psychological resilience in occupational mission and occupational success (indirect path multiplication) was 0.283, 95% confidence interval excluding 0 (0.213 to 0.335). The results show that the sense of occupational mission has a significant indirect effect on occupational success through psychological resilience. The mediating effect of mental resilience accounted for 30.27% of the total effect. Our findings explain this hypothesis. Figure\u0026nbsp;2 depicts the mediation effect model.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eLevel of three variables\u003c/p\u003e \u003cp\u003e This study is the first multi-center research utilizing Structural Equation Modeling (SEM) to examine the determinants of career success among ICU nurses. Drawing on the career success model from the perspective of mission, this study links career success with career mission and discusses psychological resilience's mediating effect. This study fills a gap in the research and has important reference value for improving nurses' psychological and social working environment.\u003c/p\u003e \u003cp\u003eThis novel view emphasizes that a series of positive consequences may occur when nurses' sense of mission is enhanced[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. At the same time, it is emphasized that we should pay attention to the cultivation of nurses' sense of mission when training nurses. The results of this study show that the professional mission of ICU nurses is at a medium level. As shown in table 5, the sense of mission of nurses increases with age. This is because experienced nurses will regard nursing as a profession more. By comparing the professional title with the sense of mission, it is found that the sense of mission of nurses with professional titles senior nurse is lower than that of nurses, but overall, the higher the professional titles, the stronger the sense of mission of nurses. The reason for this result may be that most nurses get married when they become senior nurses and need to play another role[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], to a certain extent, weakened the role of nurses. After that, with the balance between family and work, his sense of mission gradually rose. Considering that in a person's career, the existence of a sense of mission may change and may be affected by various factors[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. It is necessary for nursing managers to continuously cultivate this concept among nurses. But Meleis[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e] pointed out that the traditional image of nurses as altruistic women has a strong influence on nurses' professional identity, which hinders them from critical thinking. Therefore, hospital administrators should pay attention to the working conditions and rights of nurses while cultivating their sense of mission.\u003c/p\u003e \u003cp\u003eThe research shows that career success, as an important protective factor for nurses' career development, plays a positive role in reducing the brain drain of nursing talents and ensuring the quality of nursing services[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. In this study, the score of ICU nurses' sense of professional success is 38.67\u0026thinsp;\u0026plusmn;\u0026thinsp;6.234, which is at a medium level, indicating that there is still room for improvement. Similar to Wu's research results on the career success of clinical nurses in northwest China[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. But lower than Xue's research on the career success of clinical nurses in Central China[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The career success scores of clinical nurses in China are generally not high, which is related to job burnout, social environment and nurse-patient relationship of clinical nurses in China[\u003cspan additionalcitationids=\"CR52\" citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Yamadad mentioned in a summary that work resources and environment are external factors that affect nurses' career success[\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. In China, clinical nurses not only undertake high-intensity work, but also face the mental pressure brought by the increasingly tense conflict between doctors and patients. At the same time, nursing work in the perception of the vast majority of Chinese people is only a mechanical repetitive work carried out by following the doctor's medical advice, and the social status is far lower than that of doctors. As a consequence, it is of great significance to actively explore the current situation and influencing factors of nurses' career success and improve their professional success level.\u003c/p\u003e \u003cp\u003eThe total score of ICU nurses' resilience is 63.21\u0026thinsp;\u0026plusmn;\u0026thinsp;14.32, indicating a moderate level. This score is lower than Xue's research findings on the psychological resilience of clinical nurses in Central China[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Given their critical role in the hospital, nurses endure a substantial workload and high work intensity. Moreover, 94.33% of the survey participants are female nurses who are responsible for caring for their families in addition to fulfilling their hospital duties. The persistent stress they experience can result in negative emotions and hinder the healthy psychological development of individuals.\u003c/p\u003e \u003cp\u003eAs shown in table 6, the study revealed that organizing group decompression activities for medical staff can significantly enhance ICU nurses' professional mission, psychological resilience, and career success score. Hospital managers should prioritize scheduling regular decompression activities.\u003c/p\u003e \u003cp\u003eThe Interconnection of Professional Mission, Resilience, and Career Success\u003c/p\u003e \u003cp\u003eThis study found that a sense of professional mission can positively predict career success. Confirm our hypothesis H1, which is consistent with previous findings. When ICU nurses have a high degree of recognition of their profession, they can devote themselves to their work from the heart and spend a lot of energy and time trying to do their best, accumulate more positive subjective and objective labor results, so that they can feel successful, and the accumulated experience and knowledge will also contribute to the improvement of their internal and external competitiveness and gain more success. This shows that if hospitals and relevant health departments formulate policies to improve nurses' sense of mission, it will help promote nurses to achieve their career success.\u003c/p\u003e \u003cp\u003eConsistent with previous research findings, this study discovered a positive correlation between career success and psychological resilience. Nurses with higher psychological resilience can effectively maintain the individual's physical and mental balance when suffering from adversity and pressure, and they have stronger resilience and resilience, so they are more likely to be competent for their work and achieve professional success[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Therefore, nursing managers should actively pay attention to the psychological status of nurses, enhance their anti-frustration ability through flexible scheduling, organize group decompression activities and psychological counseling, so that nurses can maintain a positive and healthy psychological state, have a high level of psychological recovery, promote their good working conditions, and achieve career success.\u003c/p\u003e \u003cp\u003eThe study found a significant positive correlation between the professional mission sense of ICU nurses and their mental resilience. Confirm our hypothesis H2. This shows that if nurses are more active in their work, love their work, and are willing to pay for their work and their patients,And putting more time and energy into their work will enable them to better maintain their physical and mental balance.Therefore, hospitals and nursing administrators can help nurses enhance their sense of professional mission to improve their psychological resilience.\u003c/p\u003e \u003cp\u003eResilience mediates the relationship between professional mission and career success\u003c/p\u003e \u003cp\u003e The hypothesis H3 of this study is confirmed by empirical research results, which further provides theoretical basis for promoting the career success of clinical nurses. The results show that the sense of professional mission directly or indirectly affects the career success of nurses through psychological resilience. The research results clarify the underlying mechanism and show that psychological resilience is the key factor to explain why the sense of professional mission will affect career success.Specifically, the stronger the sense of professional mission of nurses, the higher their psychological resilience, thus increasing their professional success. Nurses with a strong sense of professional mission are more enthusiastic, dedicated and devoted to their work, and have a higher degree of professional involvement. They are good at coping with pressure and adjusting negative emotions in their work, so as to perform better in their work and achieve more objective and subjective success.\u003c/p\u003e \u003cp\u003eRestriction\u003c/p\u003e \u003cp\u003eThe limitations of this study are as follows: our research is based on a self-report questionnaire, so the results may be subjective. Additionally, our study is only conducted among ICU nurses, so different departments may have different results. Finally, this study is cross-sectional, so there is no longitudinal study to observe the changing trend of several variables and no intervention.In the future, psychological intervention measures should be initiated among front-line nurses, and best practices should be improved to improve nurses' resilience to stress. Further qualitative research is needed to understand the environment and conditions conducive to cultivating resilience.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study validates the mediating role of resilience in ICU nurses' career mission and career success, providing theoretical support for further understanding the mechanism between professional mission and career success and implementing comprehensive interventions to improve resilience.The study highlights that psychological resilience is the key mediator between nurses' professional mission and career success. Nursing managers should focus on nurturing nurses' professional mission and enhancing their psychological resilience to boost their professional success.\u003c/p\u003e \u003cp\u003eEnlightenment for nursing managers\u003c/p\u003e \u003cp\u003eHospitals and nursing managers should improve the sense of professional mission of clinical nurses so as to promote their career success, because this will not only help nurses achieve their job success, but also stabilize the team of nurses. Nursing managers should provide more substantial rewards and support of material resources, pay attention to the innovation and concept of nursing work, adopt the opinions of different nursing staff reasonably, ensure the autonomy of nurses, stimulate their enthusiasm in work and help them achieve professional success. Nursing managers can also help nurses with poor psychological conditions by setting up a seminar room for mental health education, a mental health consultation website and a psychological reading room, and at the same time provide nurses with a \"decompression package\" to organize decompression activities for nurses from time to time to improve their psychological resilience. Hospitals should pay attention to cultivating nurses' ability to cope with problems and help them improve their emotional control ability. At the same time, it is necessary to consolidate the professional of nurses, improve their problem-solving ability, and thus promote their professional success.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eICU intensive care unit\u003c/p\u003e\u003cp\u003eSEM Structural Equation Modeling\u003c/p\u003e\u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e /df Chi-square/degree of freedom\u003c/p\u003e\u003cp\u003eCFI Comparative fit index\u003c/p\u003e\u003cp\u003eTLI Tucker\u0026ndash;Lewis index\u003c/p\u003e\u003cp\u003eRMSEA Root-mean-square error of approximation\u003c/p\u003e\u003cp\u003eSRMR Standardized root mean square residual M:Mean\u003c/p\u003e\u003cp\u003eSD Standard deviation\u003c/p\u003e\u003cp\u003eCI Confidence interval\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Innovation Project of Military Nursing Innovation and Cultivation Special Program of Air Force Military Medical University. Project No. 2021HL041\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt was declared that the authors have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch for this paper was partially supported by Air Force Military Medical University. For their encouragement, support, and research assistance would like to thank other authors, who have contributed substantially to the completion of this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe contributions of authors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors participated in formulating and designing the research. ZLT and LXH conducted material preparation, data collecting, and analysis. ZLT and CN authored the first draft of the study. WRH, WW, FHY and JY provided critical comments on the work and made substantial revisions to enhance its intellectual substance. JX and HL reviewed and endorsed the final draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the privacy of the study participants, the data generated in the course of this study will not be made public, but can be made available to the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. All the participants consent to participate and providing written informed consent. Approval was granted by the Independent Ethics Committee of the Second Affiliated Hospital of Air Force Military Medical University.\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\u003cli\u003e\u003cspan\u003eEl-Gazar HE, Taie ES, Elamir H, Abou Zeid MAG, Magdi HM, Zoromba MA. Does the presence of calling relate to career success? The role of strengths use and deficit correction among nurses. Int Nurs Rev. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/inr.12924\u003c/span\u003e\u003cspan address=\"10.1111/inr.12924\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGensimore MM, Maduro RS, Morgan MK, McGee GW, Zimbro KS. 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Nurs Open. 2024;11(1):e2040. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/nop2.2040\u003c/span\u003e\u003cspan address=\"10.1002/nop2.2040\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 6 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"psychological resilience, career success, professional mission, nurse","lastPublishedDoi":"10.21203/rs.3.rs-4424988/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4424988/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe nursing industry's stability and progress are adversely affected by the high attrition rate and shortage of nurses; therefore, it is critical to investigate the variables that influence the professional stability of nurses.The sense of professional mission and career success have positive significance for reducing nurses' job burnout. The purpose of this study is to explore the potential mediating role of resilience in this relationship.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eSelf-reported questionnaires were utilized by 335 intensive care unit (ICU) nurses to assess their sense of professional mission, psychological resilience, and career success in this cross-sectional study. A structural equation model was developed to validate the indirect relationship between the variables.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere is a correlation among professional mission, psychological resilience and career success. Significant mediating effect of resilience exists between career success and career mission.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn this study, resilience plays an intermediary role between career mission and career success, which provides support for further understanding the mechanism between career mission and career success and bolstering the case for devising comprehensive intervention strategies for resilience. Nursing managers should focus on nurses' sense of professional mission and psychological resilience, and implement strategies to enhance nurses' psychological resilience in order to boost their career success.\u003c/p\u003e","manuscriptTitle":"Psychological Resilience Mediates Sense of Professional Mission and Career Success in Chinese Intensive Care Unit Nurses: a Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-07 19:07:55","doi":"10.21203/rs.3.rs-4424988/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-03T04:40:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-02T11:36:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-01T17:45:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"268871365946738914780961632069136979607","date":"2024-06-29T18:44:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"101705402950821334283469868044653000811","date":"2024-06-12T23:26:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296914477884157882288335305605582393739","date":"2024-05-26T04:11:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-25T16:32:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-23T10:08:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-23T09:15:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2024-05-15T11:56:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a348e554-1cd6-4815-8f1c-0d5e2c23ef64","owner":[],"postedDate":"June 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-09T16:11:40+00:00","versionOfRecord":{"articleIdentity":"rs-4424988","link":"https://doi.org/10.1186/s12912-024-02271-7","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2024-09-02 16:05:17","publishedOnDateReadable":"September 2nd, 2024"},"versionCreatedAt":"2024-06-07 19:07:55","video":"","vorDoi":"10.1186/s12912-024-02271-7","vorDoiUrl":"https://doi.org/10.1186/s12912-024-02271-7","workflowStages":[]},"version":"v1","identity":"rs-4424988","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4424988","identity":"rs-4424988","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}