Different perspectives on the craftibility of the nursing job in Dutch hospitals; a qualitative study

Different perspectives on the craftibility of the nursing job in Dutch hospitals; a qualitative 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 Different perspectives on the craftibility of the nursing job in Dutch hospitals; a qualitative study Elke Huntink, Dewi Stalpers This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7737938/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Job crafting involves modifying one's role to increase meaning, job satisfaction, and well-being. In nursing, key challenges include workforce issues, particularly retention and sustainability. This study explores the perspectives of different types of nurses on the ability to craft their current job. Aim To explore the perceptions of nurses, nursing assistants, nurse practitioners, and team leaders in Dutch hospitals regarding the opportunities and challenges of job crafting and what is needed in the (near) future. Method An explorative qualitative study across five hospitals and one medical service center in the Netherlands, using focus groups. Inductive thematic analysis was applied to explore various perspectives. Results Thirteen focus groups with 73 healthcare professionals revealed four main themes: (1) (No) desire for job crafting, (2) Team capacity for job crafting, (3) Balancing between being ambitious and setting the bar too high, and (4) The importance of job crafting. Nurses have various perspectives on job crafting. In general, nursing assistants and vocational-educated nurses are satisfied with their current tasks. Bachelor-educated nurses and nurse practitioners are more eager to craft their jobs, but struggle with how to implement new roles effectively in practice. Conclusion The need to craft the job differs between nurses, and various challenges in its application are present. Recognizing these challenges, removing key barriers and facilitating enough time, resources, and support are essential for team leaders to encourage job crafting among nurses. Creating a (team) culture that supports job crafting can enhance job satisfaction, professional growth, and nurse retention. Trial registration: In UMC Utrecht, an independent quality check has been carried out to ensure compliance with legislation and regulations (UMC Utrecht: 21–051/C). job crafting hospital clinical ward nurses nurse practitioner Introduction Shortages of healthcare professionals will increase over the next ten years due to the fact that the number of healthcare professionals needed is increasing faster than the number entering the labor market [Bruyneel et al., 2023 ; Kroczek, 2024 ]. Nurses represent 17.8% of this shortage, making them the largest group within the overall healthcare professionals shortage [van Essen., 2022]. Investing in career development and improving nursing positions could contribute to encouraging nurses to work and retain in clinical practice [WHO, 2020]. In the Netherlands, the last few years hospitals are focusing more on initiatives to attract and retain nurses. Among which professionalization programs to promote nurses' involvement in policymaking and support nursing leadership [Van Oostveen & Vermeulen, 2017]. This is done by redesigning tasks and responsibilities in order to make best use of capacities [Van Kraaij et al., 2021]. Team leaders play a key role in supporting nurses and guiding them through organizational transformation [Lalleman et al., 2016 ] and encouraging proactive job crafting by fostering a supportive work environment and designing resourceful jobs [Wang et al., 2016 ]. How craftable a nurse's job is can be further explored. Job crafting could play a constructive role in addressing nursing professionalization. In contrast to the classic approach of job design, in which all nurses have the same job description, carrying out identical tasks and responsibilities, job crafting is a more proactive approach which enables nurses to use their own specific interests and qualities in the execution of their work [Rai, 2018 ]. Job crafting is defined as: “a process where employees self-initiate sculpting and altering their jobs to create a meaningful process” [Wrzesniewski & Dutton, 2001 ]. Previous studies have shown that job crafting positively affects work engagement, job satisfaction, individual well-being and health [Wrzesniewski & Dutton, 2001 ; Tims et al., 2013 ]. In nursing, similar findings are described in relation to improved job satisfaction, reduced burnout, and enhanced emotional well-being among nurses [Han, 2023 ]. More research about what is needed in the future of the sustainable employability of nurses could be helpful [Tims et al., 2012 ; Bakker, 2017]. Due to the developments in Dutch hospitals regarding nursing roles, it would be interesting to examine the perspective of nurses working in various roles regarding their ability to craft their current job. Methods Aim The aim is to explore the perception of nurses, nursing assistants, nurse practitioners and team leaders in Dutch hospitals on the opportunities and challenges to craft the nursing job, and what is needed in the near future. Design and setting This research describes a multicenter explorative qualitative study in five hospitals and one medical service center in the Netherlands. In total thirteen focus groups with a sample of various nurses were conducted between January 2022 and June 2024. This research was part of the RN2Blend project [Lalleman et al., 2020]. The Consolidated criteria for reporting qualitative research (COREQ) guideline was used [Tong et al., 2007]. Sample Purposive sampling was used to explore perspectives on the craftibility of nursing roles. Various nurses were approached: bachelor-educated nurses (European Qualifications Framework (EQF) 5 or 6), vocational-educated nurses (EQF 4), nursing assistants (EQF 2 or 3), nurse practitioners (EQF 7) and team leaders. Nurses and nursing assistants were recruited through their team leaders. Nurse practitioners were invited by mail by the researcher. Team leaders were invited by the researcher through their managers. The participants were eligible for participation if they were working as a nurse professional in daily practice. Before starting the focus group all participants were asked for their written informed consent. Procedure and instrumentation Each focus group met for 1-2 hours at a convenient time. Twelve focus groups were in person, and one was via Microsoft Teams. All were audio-recorded for analysis. An independent researcher led the sessions, with another researcher observing, taking notes, and managing time. The researchers were familiar with the Dutch healthcare system and the observing researchers had experience with focus groups. The topic lists were derived from the theoretical frameworks of job crafting, with topics for example: subjective experience of work and how nurses actively influence their work environment, adjusting the work content (task crafting), adjusting work relationships (relational crafting), adjusting perceptions of the work (cognitive crafting), motivation and nurses well-being [Wrzesniewski & Dutton, 2001], and the balance between job demands and job resources [Tims & Bakker, 2010]. Minor adjustments were made to the topic list after each session. Demographic data (age, work experience, education) were collected from the participants prior to the focus group. Ethical considerations This study does not fall under the scope of the Dutch Medical Research Involving Human Subjects Act (WMO). It therefore does not require approval from an accredited medical ethics committee in the Netherlands. However, in UMC Utrecht, an independent quality check has been carried out to ensure compliance with legislation and regulations (UMC Utrecht: 21-051/C). The audio-recordings were transcribed verbatim and pseudonymized. Data were stored on a secure drive. Audio recordings were deleted after transcripts were made. The transcripts of the audio recordings will be archived for 10 years. A codebook was created to ensure that the data collected in this research is traceable. Data analysis Inductive thematic analyses was conducted on this data to provide an exploration of different perspectives on the craftibility of the nursing job [Braun and Clarke, 2006]. The data analysis process started with reading and re-reading the transcripts to get in touch with the data. This was followed up with the initial coding of the focus groups, followed by sorting these codes and merging them into sub-themes and themes. To reduce subjectivity, inter-coder agreement on codes and themes was assessed by having each researcher independently analyze one focus group per nursing group, followed by discussion among the researchers. One researcher analyzed the remaining focus groups, with a second researcher reviewing this process. Data analysis was an iterative process because focus groups were held during coding the first transcripts. During the analyzing process, the researchers met on regular basis to discuss the codebook, even so with the research team. Discrepancies were resolved through discussion. Supportive software was used for data analysis: MAXQDA Plus 2022 was used to analyze data of nurses (EQF 4), nursing assistants and team leaders, and Atlas.ti (version 22 and 23) was used to analyze data of nurses (EQF 5 or 6) and nurse practitioners. Results Thirteen focus groups were conducted (see Table 1) in five hospitals and one medical service center. In the first, a medical service center, 19 participants were recruited: seven nursing assistants, seven vocational-educated nurses, and five bachelor-educated nurses. Most were female (n=18), averaging 37 years old, and had 14.6 years of work experience. Focus groups lasted about 90 minutes. The focus group involving 11 team leaders was held in three hospitals: four team leaders from a top-clinical hospital (I), three from the general hospital, and four from an academic hospital. Most were female (n=10), aged 37 on average. Focus groups lasted about 90 minutes. The 17 nurse practitioners joined from three hospitals: six each from top-clinical hospital I and from top-clinical hospital II, and five from top-clinical hospital III. Most were female (n=14), aged 43 on average. These sessions lasted around 45 minutes. Lastly, 26 vocational-educated nurses and bachelor-educated nurses participated in four focus groups, two focus groups with each six participants in the general hospital, and two focus groups with six and eight participants from top-clinical hospital I. Most were female (n=24), aged 38 on average. Focus groups lasted about 89 minutes. Insert table 1 Four main themes were identified in the analyses: (1) (No) desire for job crafting, (2) Team capacity for job crafting, (3) Balancing between being ambitious and setting the bar too high, and (4) The importance of job crafting. (No) desire for job crafting The first theme is about the various perspectives of nurses on the necessity of job crafting and the extent to which this takes place in current practice. Nursing assistants emphasized their role in patient well-being by performing a variety of tasks involving direct patient contact. While highlighting their empathy, they expressed a need for more time with patients and suggested they could assist with triage if given additional training—a view shared by most vocational- educated nurses. The majority of nursing assistants stated they were satisfied with performing their duties as outlined in their job description. They generally described themselves as less ambitious, preferring non-complex tasks and no additional responsibilities. “I ‘am not ambitious at all. I get satisfaction from my current work as nursing assistant. I do not need more or bigger tasks”. (Nurse assistant) Vocational-educated nurses felt their role should focus on nursing tasks that require their expertise, such as triage, advising distressed patients, and monitoring vital signs. They believe this focus allows them to make a significant contribution to patient care. While they are content with their current tasks and do not seek a more challenging role, they express a desire to deepen their knowledge of the symptoms and diseases they encounter. Vocational-educated nurses believe this would enhance their job satisfaction by adding value to their work and improving patient care. ‘More in-depth knowledge of what we encounter. For example, more knowledge about heart failure or COPD, which you can use directly in the services the call center delivers for different customers. It would be nice for ourselves and meaningful for the patient if you get the opportunity to gain more in-depth knowledge on the personal topic you desire”. (Vocational- educated nurse) Bachelor-educated nurses believe their role should primarily focus on patient-related nursing tasks but differ in their approach. Rather than strictly following their job description, they emphasize reflection on quality improvement and personal growth. They prefer dynamic roles without rigid protocols and find fulfillment in exploring "why" questions, improving processes, and engaging in broader responsibilities beyond direct nursing care. Compared to nursing assistants and vocational- educated nurses, bachelor-educated nurses seek tasks and opportunities that align with their education. They show a strong interest in continuous learning and professional development, actively pursuing educational opportunities. Many also find fulfillment in teaching and mentoring other nurses, with some identifying coaching as a key strength and an essential part of their role. “Exploring why questions and finding answers to those why questions with multiple justifications. I feel great when that occurs. I get energy from overarching tasks and variation in my work. I can get very happy when I have a shift in the call center where I get an urgent request for admission to a nursing home, multiple triages, and a consultation about a service we deliver with a customer of the MCC (medical coordination center). If my day looks like that, I could not be happier”. (Bachelor-educated nurse) Nurse practitioners are pioneers who readily embrace new initiatives, whether projects or challenges. They have a keen ability to identify necessary changes in their work and clearly articulate the reasons behind them, reflecting their entrepreneurial mindset, ambition, intrinsic motivation, and strong determination. Nurse practitioners (and bachelor-educated nurses) seeking challenging tasks may find opportunities in supervisory roles, contributing to improved quality of care. These nurses value teaching and mentoring, seeing it as a key aspect of their role. “There has to be something in return, and essentially, you need to make yourself indispensable. That was the task from the beginning. I succeeded in doing that, but then it also has to bring in enough revenue so that they can pay me. Otherwise, the cost factor outweighs the role”. (Nurse practitioner) Team capacity for job crafting The second theme reflects on job crafting as an individual proactive behavior that, in nursing, occurs within the context of teams. This highlights the importance of interaction, which is influenced by factors such as team size and generational differences. All participants emphasized the importance of leveraging each other's strengths. Building and maintaining trust among team members, along with understanding each other's strengths and weaknesses were identified as essential prerequisites for effective collaboration and support within the team. In smaller teams, members can more easily delegate tasks and take on those they enjoy or excel at, as frequent interactions foster better understanding among colleagues. Individual preferences and competencies are considered for specific tasks, such as project work, research, planning, coordination, and administrative duties. Nurses described job crafting as enjoyable and emphasized the open culture within their wards. In larger teams, care becomes more individualistic, with tasks reduced to only what is necessary, making job crafting more challenging due to a lack of familiarity with each other's strengths. However, in wards that allow more time and space for job crafting, nurses experience greater job satisfaction, which in turn leads to improved patient care outcomes. “One person is about coordination; another is about sensing and feeling a person. At a certain moment you get to know each other and then you know what a person’s strengths are. (…) And then you have to, because that is the beauty of it, play into each other strengths.” (Bachelor-educated nurse) Another key factor in job crafting within teams is the generation gap. Nurses perceive younger colleagues as ambitious, eager to specialize and self-oriented, while the older nurses prioritize teamwork and connections with colleagues. Despite having equal knowledge, older nurses often seek help with technology, which can frustrate younger nurses. Both groups approach job crafting differently: bachelor-educated nurses actively develop their skills and seek more coordinating and coaching roles, while nurse practitioners are still defining their new roles and interests. Additionally, older nurses observe that younger colleagues are more willing to switch employers for better training opportunities or higher salaries. This is illustrated by the following quotes: “Well, the younger generation is more focused on their career, and they go for it”. (Team leader) “Well, if I look at my team, the older generation would like more connectedness, more the feeling of really being in a team together”. (Team leader) Balancing between being ambitious and setting the bar too high The third theme emphasizes that team leaders play a crucial role in facilitating and encouraging nurses to actively engage in job crafting. Nurse practitioners also often face increased workloads and work-related stress due to added consultation hours, production demands, or covering for colleagues, making it difficult to maintain a healthy work-life balance. Reducing tasks is challenging, as some feel responsible for taking on extra duties, partly due to expectations from medical specialists who are ultimately responsible for their position and salary. Nurse practitioners believe they must remain indispensable, advocating for themselves and continuously demonstrating their value. However, effectively defining and delegating tasks remains a significant challenge, making it harder for them to manage their workload efficiently. These obstacles prevent them from optimally job crafting. Team leaders feel they encourage ambitious nurses who seek to expand their roles by joining workgroups, creating development plans, and taking on tasks beyond their prescribed duties. When given opportunities to use their expertise, these nurses are more energetic and effective. Nurses with greater ambitions should proactively communicate their goals to team leaders, colleagues, and medical specialists to explore potential opportunities together. Gaining trust from the team and medical specialists is crucial for job crafting, as is effective knowledge-sharing within teams, management, and the organization. A “flattened” structure, where nurses feel their work matters, can motivate them to develop professionally and actively craft their job. Nurse practitioners view managers as key enablers of job crafting by empowering them. Managers can either support or hinder this process: managers with a clear vision and appreciation for job crafting empower nurses, while those who do not recognize its value can hinder the process. “By letting my manager and other colleagues know, you do get more chances or actually you create more chances“. (Bachelor-educated nurse) Yes, I do think that, when I look at our situation, it really depends on having a good manager with a clear vision. Indeed, we have a lot of turnovers in this regard. Although each manager has emphasized the possibilities and the importance of nurse practitioners, they often lack decisiveness due to budget constraints or a lack of available positions”. (Nurse practitioner) Team leaders observe that nurses who take on too many responsibilities may experience declining mental and physical health. As a result, they sometimes discourage job crafting efforts, such as pursuing further education. One respondent suggests that using job crafting to address labour shortages blurs the boundaries of nurses' responsibilities. Nurses need to reclaim autonomy by selectively choosing tasks. While some team leaders believe job crafting can positively impact nurses’ mental health —allowing them to focus on tasks that bring them joy and energy—this, in turn, could lead to greater motivation and dedication to their work. “I think that if it is properly integrated and enough time is spent on facilitating it once it is implemented, it will contribute to reducing the workload, but the path towards it demands more time”. (Team leader) The importance of job crafting The fourth theme explores the impact of job crafting when nurses do apply this in practice, and the outcomes it can lead to. Team leaders emphasize the positive impact of job crafting on nurses' well-being. Applying newly learned skills during shifts can improve job satisfaction. Nurses often take on additional or different tasks beyond their usual routine, which patients greatly appreciate, contributing to the quality of care. When nurses' strengths are recognized, they feel more energized and enthusiastic. This sense of fulfilment enhances their well-being and work-life balance. “Yes, when you leave work with a fulfilled feeling. Off course there are days when you think this could have been better or different. But going home with such a nice feeling of satisfaction and fulfillment”. (Bachelor-educated nurse) All nurses identify recognition and validation as key factors to craft and excel in their job. They seek appreciation through learning opportunities that support their development, ultimately improving the quality of care, job satisfaction, and efficiency. Financial incentives are also mentioned as a gesture of appreciation. Salary discrepancies between bachelor-educated nurses and vocational-educated nurses, despite similar responsibilities, can create feelings of inequity. This discourages some nurses from pursuing additional skills, such as project management, due to limited financial rewards. However, nurses emphasize that the issue is not just about financial reward but also the lack of access to opportunities for general nurses. “When you look at the industry (…) there are people there with a little number of diplomas, but they do have a high position. In the industry they do not say ‘Sorry, you didn’t follow the University Business Training’. No, someone can just start working and create career advancements for themselves. Why is this impossible in healthcare?”. (Nurse) Nurse turnover in hospitals is influenced by career growth opportunities, such as moving to different wards (e.g., intensive care units or ambulance roles), or office positions, which team leaders view as positive advancements. Reasons for job changes include high workload, physical and emotional demands, and irregular shifts. Some nurses leave for other healthcare organizations where they have more autonomy and ownership of their work. When nurses take on additional or different tasks, they find greater job satisfaction, which can lead to increased fulfilment and potentially reduce the likelihood of quitting their job. “I also felt very strongly that people would like to have much more control over the interpretation of their tasks. They have become self-employed in a small nursing home setting”. (Team leader) Discussion This qualitative study provides valuable insights into the perceptions of nurses, nursing assistants, nurse practitioners and team leaders in hospitals regarding crafting of the nursing job whereby the following main topics were found: (1) (No) desire for job crafting, (2) Team capacity for job crafting, (3) Balancing between being ambitious and setting the bar too high, and (4) The importance of job crafting. Job crafting allows nurses to develop in their desired direction, enhance personal skills, and gain a deeper understanding of their role. This can improve patient care quality and benefit nurses by increasing engagement, job satisfaction, and work enjoyment, which could potentially aid in nurse retention. As far as we know, this is the first study to provide insights from different perspectives on crafting the nursing job. Our research shows that nursing assistants and vocational-educated nurses are less engaged in job crafting. They are generally satisfied with their current tasks as assigned, and do not actively seek more challenging roles. Nursing assistants prefer to have more time with patients, while vocational-educated nurses express a desire to gain more in-depth knowledge about symptoms and diseases they encounter. Although patient care is a priority for bachelor-educated nurses and nurse practitioners, they are also interested in additional tasks, such as supervising roles and improving the quality of care. However, taking on these additional responsibilities requires stepping away from direct patient care, which can lead to role conflict [Yun et al., 2024 ]. Bachelor-educated nurses have a strong interest in continuous learning and professional development. Bachelor-educated nurses and nurse practitioners mentioned that they are eager to take on mentorship and supervisory roles and contribute to quality improvement initiatives. Nurse practitioners are exploring how to define and fulfill their roles but face significant challenges, such as high workloads due to added consultation hours, production demands, or covering colleagues. In their effort to remain indispensable, nurse practitioners take on many extra tasks, which leads to work-life imbalance. They experience difficulties by taking on too many tasks and making themselves indispensable, which leads to a disrupted work-life balance. Although previous research has explored task reduction as a solution [Lazarazza et al., 2020], the nurses in our focus groups did not consider this a viable option. Generally, bachelor-educated nurses and nurse practitioners are more aware of job crafting and intend to apply this. This aligns with existing research [Bakker and Demerouti, 2018 ; Lazazzara et al., 2020 ], which shows that employees can redesign the context of their job in a way that allows them to use their skills optimally and develop professionally. The present study's findings indicate that bachelor-educated nurses and nurse practitioners actively engage in job crafting to enhance patient care, pursue challenges, and express passion for their work, consistent with previous research [Harbridge et al., 2022 ]. Team leaders play a key role in supporting ambitious nurses who seek to expand their roles and recognize the positive impact of job crafting on nurse engagement and professional development. For example, providing job crafting opportunities can increase nurses’ happiness and job satisfaction [Van Emmerik et al., 2009 ]. The team leaders in our study demonstrated a strong understanding of job crafting by actively encouraging nurses to engage in job crafting activities and expressing trust in them, which aligns with findings in other literature [Baghdadi et al., 2021 ; Déry et al., 2021]. It is also important to consider different perspectives in professionalization programs on how team leaders can best guide nurses and create an environment where nurses feel empowered to explore new tasks, refine their skills, and take ownership of their professional growth. For instance, nurse practitioners approach things differently and require a different form of guidance than vocational-educated nurses. A one-size-fits-all leadership approach may not be effective while a more personalized approach could potentially lead to better results [Kooij et al., 2017 ] and team leaders should be equipped with the knowledge and skills to adapt their support strategies accordingly. Nurses report various challenges with applying job crafting in daily practice, particularly in terms of interactions within teams. This involves, for example, generational differences. As older nurses tend to prioritize teamwork and value close relationships with colleagues, younger nurses are more focused on their individual goals. Additionally, older nurses place greater emphasis on hard work, while younger nurses are more conscious of maintaining a healthy work-life balance [Han, 2023 ]. While older colleagues often seek technical assistance from younger nurses, because they are generally less digitally skilled, knowledge transfer in the opposite direction appears to be less common, as younger nurses have less need for this since they adapt to new technology more quickly. Additionally, younger nurses are more conscious of maintaining a healthy work-life balance [Han, 2023 ]. These differences in perspectives and priorities highlight the need for a more structured approach to job crafting that considers generational strengths and challenges. For example, older nurses could focus on mentorship and coaching, while younger nurses could drive digital innovation initiatives, leveraging each group's strengths [Kooij et al., 2017 ]. It is also the responsibility of team leaders to recognize generational differences within nursing teams, and to create understanding of these generational differences and similarities and develop strategies to build partnerships among nurses [Han, 2023 ; Tussing et al., 2024 ]. Regarding the importance of job crafting, our findings align with existing literature, which highlights positive associations between job crafting, autonomy, and job satisfaction across various professions (Rudolph et al., 2017 ; Wang et al., 2020 ; Li et al., 2023 ; Harbridge et al., 2022 ). Whereby job crafting is related to emotional well-being, social well-being and psychological well-being [Han, 2023 ], which can enhance job performance and create a greater sense of value in the workplace [Rudolph et al., 2017 ; Simpkin et al., 2019 ; Topa & Aranda-Carmena, 2022 ]. In our study, nurses who engage in job crafting reported improved work-life balance, well-being, and job satisfaction, which may contribute to lower nurse turnover in hospitals. Encouraging more nurses to participate in job crafting could be beneficial, for instance, by offering them education on job crafting and encouraging them to reflect on their work activities or providing weekly motivation over a four-week period to engage in specific job crafting activities [Knight et al., 2021 ]. Additionally, nurses expressed a desire for greater appreciation, including financial recognition, to enhance job satisfaction and staff retention. Providing nurses with opportunities to craft their roles to better match job demands and resources may help prevent the outflow of nurses. Addressing the nursing shortage is crucial, as 67% of nurses are considering leaving their positions within three years [Ulrich et al., 2022 ]. Nurses can take proactive steps, such as seeking mentorship opportunities, participating in quality improvement initiatives, or proposing for role adjustments that align with their skills and interests. They can also work with team leaders to explore leadership opportunities. By taking these initiatives, nurses can craft their job in a way that enhances both their professional satisfaction and the overall quality of care. Practical Implications Our findings suggest that while job crafting offers significant benefits, its success depends on several factors. Based on our research, we propose several practical implications. First , nurses need to develop a greater awareness of what job crafting entails and how to implement it effectively in their workplace. They can support one another by engaging in discussions and identifying opportunities for job crafting collectively. It is also important that nurses actively seek out opportunities for job crafting. Second , for managers, nurses are largely capable of managing job crafting independently on the ward, as it is driven by intrinsic motivation – provided they are given the necessary opportunities and support. If a bachelor-educated nurse is assigned non-care tasks, it is essential to maintain this arrangement, as it can contribute to long-term retention in the profession. Additionally, nursing assistants and vocational- educated nurses should be encouraged to support this approach. Furthermore, investments in both time and financial resources should be made available to nurses who wish to further develop their skills and advance their careers. Third , team leaders can encourage and facilitate job crafting for nurses in a more coordinated manner, with organizational-level agreements to support these efforts. Team leaders can adopt strategies to promote job crafting, provide training, and implement intervention programs, particularly for bachelor-educated nurses, who, as shown in other research, often aspire a supervising or mentoring role [Harbridge et al., 2022 ; Han, 2023 ]. It may be beneficial to discuss nurse’s preferences during their annual reviews or or have them complete a self-assessment of their strengths [Macfarlane, 2019 ]. Team leaders must be aware that a one-size-fits-all approach may not be effective and that tailored support strategies are needed, as well as a continuous learning approach. Fourth , nurse practitioners require more support in defining their roles and sustaining their enthusiasm. Team leaders and medical specialists should foster an open culture where nurse practitioners can clearly communicate which tasks are essential for their profession and how to achieve a sustainable balance. Opportunities to reduce tasks should be considered as an alternative where applicable. Above all, nurses play a crucial role in transforming healthcare and should be actively involved in shaping and developing changes, rather than merely implementing them [van Kraaij et al., 2022 ]. This can be achieved by actively listening and considering the perspectives of all nurses while acknowledging their unique insights from daily practice. Further research is needed to explore how nurses can effectively apply job crafting in daily practice and how this can contribute to healthcare transformation, ultimately leading to better outcomes for nurses and improving retention. In future studies, it is essential to explore how team leaders’ approach impact nurses' well-being, job satisfaction, ability to balance their ambitions, and the quality of patient care regarding job crafting. Strength and limitations As far as we know, this is the first study using focus groups to investigate how job crafting is applied among different types of nurses. Additionally, the focus groups were homogenous, which created a safer environment where nursing assistants, vocational-educated nurses, bachelor- educated nurses, nurse practitioners, and team leaders felt comfortable sharing their opinions and honest thoughts and experiences. However, a limitation of this approach is the lack of interaction between the different groups, which could have provided additional insights and potentially sparked more discussion. Another limitation is that the results are based on self-reported data, which may be subject to response bias and subjectivity. Furthermore, the study focused solely on nursing assistants, nurses, nurse practitioners, and team leaders in the Netherlands, making it difficult to generalize the findings to similar healthcare professionals in other countries. Conclusion Crafting of the nursing job provides opportunities to engage in more varied work and further development of personal skills. The findings of the present study indicate that nursing assistants and vocational- educated nurses have less interest in altering their jobs and do not desire additional or other tasks. Instead, they prefer to gain more in-depth knowledge about the symptoms and diseases they encounter. In contrast, bachelor-educated nurses and nurse practitioners are more aware of the value of job crafting. They actively seek diverse tasks and opportunities for professional development and show a strong interest in teaching and mentoring. Team leaders play an important role in facilitating and encouraging nurses in the process of job crafting, which they can do in a more coordinated way. Sufficient time, resources, and support to utilize nurses’ qualities are essential for effectively realizing the positive outcomes of job crafting in daily practice. Additionally, fostering a team culture that encourages job crafting towards strengths could contribute significantly to nurse retention by increasing job satisfaction, enhancing professional growth, and promoting a better work-life balance. Declarations Ethics approval and consent to participate This study does not fall under the scope of the Dutch Medical Research Involving Human Subjects Act (WMO). It therefore does not require approval from an accredited medical ethics committee in the Netherlands. However, in UMC Utrecht, an independent quality check has been carried out to ensure compliance with legislation and regulations (UMC Utrecht: 21-051/C) in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and material Data were stored on a secure drive. Audio recordings were deleted after transcripts were made. The transcripts of the audio recordings will be archived for 10 years. Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article. Funding This work was supported by the Dutch Ministry of Health, Welfare and Sport, as part of the National programme RN2Blend. Authors' contributions DS designed the study, DS and EH collected data and analyzed data. EH wrote the draft of the manuscript and is responsible for the overall content. The manuscript was reviewed by DS. Both authors critically assessed and approved this paper and met authorship criteria. Acknowledgements We would like to thank all master students and healthcare professionals who participated. Authors' information (optional) Not applicable. Clinical trial number Not applicable. References Baghdadi NA, Farghaly Abd-El Aliem SM, Alsayed SK. The relationship between nurses' job crafting behaviours and their work engagement. J Nurs Manag. 2021 Mar;29(2):214-219. doi: 10.1111/jonm.13141. Epub 2020 Sep 17. PMID: 32867009. Bakker AB. Job crafting among health care professionals: The role of work engagement. J Nurs Manag. 2018 Apr;26(3):321-331. doi: 10.1111/jonm.12551. Epub 2017 Oct 9. PMID: 28990295. Bakker AB & Demerouti E (2018). Multiple levels in job demands-resources theory: Implications for employee well-being and performance. In E. Diener, S. Oishi, & L. Tay (Eds.), Handbook of wellbeing. Salt Lake City, UT: DEF Publishers. doi:nobascholar.com. Braun V & Clarke V (2006). 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Curr Psychol 42, 11155–11169 (2023). https://doi.org/10.1007/s12144-021-02390-3. Macfarlane J. (2019). Exploring how awareness of character strengths can benefit mental health nurses. British Journal of Mental Health Nursing, 8(3), 145–152. https://doi.org/10.12968/bjmh.2019.8.3.145. van Oostveen CJ, Mathijssen E, Vermeulen H. Nurse staffing issues are just the tip of the iceberg: a qualitative study about nurses' perceptions of nurse staffing. Int J Nurs Stud. 2015 Aug;52(8):1300-9. doi: 10.1016/j.ijnurstu.2015.04.002. Epub 2015 Apr 8. PMID: 25943413. Rai A. (2018). Job crafting intervention: fostering individual job redesign for sustainable organisation. Industrial and Commercial Training, 50(4), 200-208. Rudolph CW, Katz IM, Lavigne KN, Zacher H. Job crafting: A meta-analysis of relationships with individual differences, job characteristics, and work outcomes. J Vocat Behav. 2017 Oct; 102:112–38. https://doi.org/10.1016/j.jvb.2017.05.008. Simpkin AL, Chang Y, Yu L, Campbell EG, Armstrong K, Walensky RP. Assessment of Job Satisfaction and Feeling Valued in Academic Medicine. JAMA Intern Med. 2019 Jul 1;179(7):992-994. doi: 10.1001/jamainternmed.2019.0377. PMID: 31058983; PMCID: PMC6503555. Tims M & Bakker AB (2010). Job crafting: Towards a new model of individual job redesign. SA Journal of Industrial Psychology, 36(2), 1-9. DOI: https://doi.org/10.4102/sajip.v36i2.841. Tims M, Bakker AB, Derks D (2012). Development and validation of the job crafting scale. Journal of Vocational Behavior, 80(1), 173–186. https://doi.org/10.1016/j.jvb.2011.05.009. Tims M, Bakker AB, Derks D. The impact of job crafting on job demands, job resources, and well-being. J Occup Health Psychol. 2013 Apr;18(2):230-40. doi: 10.1037/a0032141. Epub 2013 Mar 18. PMID: 23506549. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007 Dec;19(6):349-57. doi: 10.1093/intqhc/mzm042. Epub 2007 Sep 14. PMID: 17872937. Topa G, Aranda-Carmena M. Job Crafting in Nursing: Mediation between Work Engagement and Job Performance in a Multisample Study. Int J Environ Res Public Health. 2022 Oct 5;19(19):12711. doi: 10.3390/ijerph191912711. PMID: 36232011; PMCID: PMC9566469. Tussing TE, Chipps E, Tornwall J. Generational Differences in the Nursing Workforce: Strategies for Nurse Leaders. Nurse Leader. 2024;22 (5): 602-608. ISSN 1541-4612. https://doi.org/10.1016/j.mnl.2024.03.007. Ulrich B, Cassidy L, Barden C, Varn-Davis N, Delgado SA (2022). National Nurse Work Environments: A Status Report. Crit Care Nurse 1 October 2022; 42 (5): 58–70. doi: https://doi.org/10.4037/ccn2022798. Wang HJ, Demerouti E, & Bakker AB (2016). A review of job crafting research: The role of leader behaviors in cultivating successful job crafters. In S. K. Parker & U. K. Bindl (Eds.), Proactivity at work (Series in Organization and Management). Routledge. Wang H, Li P, Chen S. The Impact of Social Factors on Job Crafting: A Meta-Analysis and Review. Int J Environ Res Public Health. 2020 Oct 30;17(21):8016. doi: 10.3390/ijerph17218016. PMID: 33143286; PMCID: PMC7662365. World Healthcare Organization (WHO) (2020). State of the world’s nursing 2020: Investing in education, jobs and leadership [Internet]. Available from: https://www.who.int/ publications/i/item/9789240003279. Accessed May 31, 2024. Wrzesniewski A, Dutton JE. Crafting a Job: Revisioning Employees as Active Crafters of Their Work. Acad Manage Rev. 2001 Apr;26(2):179. https://doi.org/10.5465/amr.2001.4378011. Yun MS, Lee M, Choi EH. Job crafting, positive psychological capital, and social support as predictors of job embeddedness among clinical nurses- a structural model design. BMC Nurs. 2024 Mar 22;23(1):192. doi: 10.1186/s12912-024-01845-9. PMID: 38515086; PMCID: PMC10958854. Table Table 1: Characteristics of the focus groups Top-clinical hospital I General hospital Academic hospital Top-clinical hospital II Top- clinical hospital III Medical service center Team leaders 4 participants. Wards: ICU, internal medicine, geriatrics & dialysis. In person. 3 participants. Wards: neurology & lung, internal medicine & MPU, cardiology & surgery. Via teams. 4 participants. Wards: ICU, head and neck oncology, gynecology & neurology, surgery. In person. Bachelor nurses 6 participants. Ward: cardiology (n=3) and nephrology/dialysis (n=3). In person 8 participants. Ward: cardiology (n=4) and nephrology & dialysis (n=4). In person 6 participants. Ward: Lung & neurology (n=3), orthopedics & gynecology & surgery & ENT & oral and maxillofacial surgery (n=3) 6 participants. Ward: Lung & neurology (n=3), orthopedics & gynecology & surgery & ENT & oral and maxillofacial surgery (n=3) 5 participants. Ward: medical coordination center. In person. Vocational nurses 7 participants. Ward: medical coordination center. In person. Nursing assistants 7 participants. Ward: medical coordination center. In person Nurse practitioners 6 participants. Wards: gastroenterology, vascular medicine, heart failure, cardiology heart failure, nephrology, surgical oncology. In person. 6 participants. Wards: pediatric diabetes, neurology, orthopedics & traumatology, geriatrics, internal medicine, palliative care. In person. 5 participants. Wards: dermatology, rheumatology, oncology-hematology, infectious diseases, traumatology. In person. Additional Declarations No competing interests reported. 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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-7737938","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":603150611,"identity":"30af1476-cd00-43a9-b899-e345460cb600","order_by":0,"name":"Elke Huntink","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYJACZhDBxsDG+ABFhI+AFgmgFmYDEI8HLJIAMoSAFqASNgmitPAzcCcwF7bdqeOTbkur5s2xS9wvffjg58IfDHm4tEg28G5gntn2TIJN5tix27zbkhN7+NKSpWckMBTj0mJwAKiFt+2wBJtEehtQy4HEHh4eM2aeBIbENhxa7JG1FEO08H/Dq8WAAa4l7Rgz1BY2vFokDvNuOMxz7rBkm0RasuTcbcnGPWfYjKV50iRwauFv7934mKfsML/8jDTDD2+32cm29zA//MxjY5PYj0MLKFIOYLUel4ZRMApGwSgYBUQAAMzPSd6sN91GAAAAAElFTkSuQmCC","orcid":"","institution":"University Medical Center Utrecht","correspondingAuthor":true,"prefix":"","firstName":"Elke","middleName":"","lastName":"Huntink","suffix":""},{"id":603150612,"identity":"2fd54191-4f11-4fa1-90d0-19055881e41f","order_by":1,"name":"Dewi Stalpers","email":"","orcid":"","institution":"University Medical Center Utrecht","correspondingAuthor":false,"prefix":"","firstName":"Dewi","middleName":"","lastName":"Stalpers","suffix":""}],"badges":[],"createdAt":"2025-09-29 04:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7737938/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7737938/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104808500,"identity":"c28a6ff8-6262-489f-87fb-a57a2799bdb0","added_by":"auto","created_at":"2026-03-17 12:38:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":385662,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7737938/v1/c11623a8-4740-4816-acb2-e338a1bc1cc0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Different perspectives on the craftibility of the nursing job in Dutch hospitals; a qualitative study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eShortages of healthcare professionals will increase over the next ten years due to the fact that the number of healthcare professionals needed is increasing faster than the number entering the labor market [Bruyneel et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Kroczek, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e]. Nurses represent 17.8% of this shortage, making them the largest group within the overall healthcare professionals shortage [van Essen., 2022]. Investing in career development and improving nursing positions could contribute to encouraging nurses to work and retain in clinical practice [WHO, 2020].\u003c/p\u003e \u003cp\u003eIn the Netherlands, the last few years hospitals are focusing more on initiatives to attract and retain nurses. Among which professionalization programs to promote nurses' involvement in policymaking and support nursing leadership [Van Oostveen \u0026amp; Vermeulen, 2017]. This is done by redesigning tasks and responsibilities in order to make best use of capacities [Van Kraaij et al., 2021]. Team leaders play a key role in supporting nurses and guiding them through organizational transformation [Lalleman et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2016\u003c/span\u003e] and encouraging proactive job crafting by fostering a supportive work environment and designing resourceful jobs [Wang et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2016\u003c/span\u003e]. How craftable a nurse's job is can be further explored.\u003c/p\u003e \u003cp\u003eJob crafting could play a constructive role in addressing nursing professionalization. In contrast to the classic approach of job design, in which all nurses have the same job description, carrying out identical tasks and responsibilities, job crafting is a more proactive approach which enables nurses to use their own specific interests and qualities in the execution of their work [Rai, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2018\u003c/span\u003e]. Job crafting is defined as: \u0026ldquo;a process where employees self-initiate sculpting and altering their jobs to create a meaningful process\u0026rdquo; [Wrzesniewski \u0026amp; Dutton, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2001\u003c/span\u003e]. Previous studies have shown that job crafting positively affects work engagement, job satisfaction, individual well-being and health [Wrzesniewski \u0026amp; Dutton, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Tims et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2013\u003c/span\u003e]. In nursing, similar findings are described in relation to improved job satisfaction, reduced burnout, and enhanced emotional well-being among nurses [Han, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e]. More research about what is needed in the future of the sustainable employability of nurses could be helpful [Tims et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Bakker, 2017].\u003c/p\u003e \u003cp\u003eDue to the developments in Dutch hospitals regarding nursing roles, it would be interesting to examine the perspective of nurses working in various roles regarding their ability to craft their current job.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eAim\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe aim is to explore the perception of nurses, nursing assistants, nurse practitioners and team leaders in Dutch hospitals on the opportunities and challenges to craft the nursing job, and what is needed in the near future.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDesign and setting\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis research describes a multicenter explorative qualitative study in five hospitals and one medical service center in the Netherlands. In total thirteen focus groups with a sample of various nurses were conducted between January 2022 and June 2024.\u0026nbsp;This research was part of the RN2Blend project [Lalleman et al., 2020].\u0026nbsp;The\u0026nbsp;Consolidated criteria for reporting qualitative research (COREQ) guideline was used [Tong et al., 2007]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSample \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePurposive sampling\u003cem\u003e\u0026nbsp;\u003c/em\u003ewas used to explore perspectives on the craftibility of nursing roles. Various nurses were approached: bachelor-educated nurses (European Qualifications Framework (EQF) 5 or 6), vocational-educated nurses (EQF 4), nursing assistants (EQF 2 or 3), nurse practitioners (EQF 7) and team leaders. Nurses and nursing assistants were recruited through their team leaders. Nurse practitioners were invited by mail by the researcher. Team leaders were invited by the researcher through their managers. The participants were eligible for participation if they were working as a nurse professional in daily practice. Before starting the focus group all participants were asked for their written informed consent. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eProcedure and instrumentation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEach focus group met for 1-2 hours at a convenient time. Twelve focus groups were in person, and one was via Microsoft Teams. All were audio-recorded for analysis. An independent researcher led the sessions, with another researcher observing, taking notes, and managing time. The researchers were familiar with the Dutch healthcare system and the observing researchers had experience with focus groups. The topic lists were derived from the theoretical frameworks of job crafting, with topics for example: subjective experience of work and how nurses actively influence their work environment, adjusting the work content (task crafting), adjusting work relationships (relational crafting), adjusting perceptions of the work (cognitive crafting), motivation and nurses well-being [Wrzesniewski \u0026amp; Dutton, 2001], and the balance between job demands and job resources [Tims \u0026amp; Bakker, 2010]. Minor adjustments were made to the topic list after each session. Demographic data (age, work experience, education) were collected from the participants prior to the focus group.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthical\u0026nbsp;\u003c/em\u003e\u003cem\u003econsiderations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study does not fall under the scope of the Dutch Medical Research Involving Human Subjects Act\u0026nbsp;(WMO). It therefore does not require approval from an accredited medical ethics committee in the Netherlands. However, in UMC Utrecht, an independent quality check has been carried out to ensure compliance with legislation and regulations (UMC Utrecht:\u0026nbsp;21-051/C).\u003c/p\u003e\n\u003cp\u003eThe audio-recordings were transcribed verbatim and pseudonymized. Data were stored on a secure drive. Audio recordings were deleted after transcripts were made. The transcripts of the audio recordings will be archived for 10 years. A codebook was created to ensure that the data collected in this research is traceable. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData analysis\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInductive thematic analyses was conducted on this data to provide an exploration of different perspectives on the craftibility of the nursing job [Braun and Clarke, 2006]. The data analysis process started with reading and re-reading the transcripts to get in touch with the data. This was followed up with the initial coding of the focus groups, followed by sorting these codes and merging them into sub-themes and themes. To reduce subjectivity, inter-coder agreement on codes and themes was assessed by having each researcher independently analyze one focus group per nursing group, followed by discussion among the researchers. One researcher analyzed the remaining focus groups, with a second researcher reviewing this process. Data analysis was an iterative process because focus groups were held during coding the first transcripts. During the analyzing process, the researchers met on regular basis to discuss the codebook, even so with the research team. Discrepancies were resolved through discussion. Supportive software was used for data analysis: MAXQDA Plus 2022 was used to analyze data of nurses (EQF 4), nursing assistants and team leaders, and Atlas.ti (version 22 and 23) was used to analyze data of nurses (EQF 5 or 6) and nurse practitioners.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThirteen focus groups were conducted (see Table 1) in five hospitals and one medical service center. In the first, a medical service center, 19 participants were recruited: seven nursing assistants, seven vocational-educated nurses, and five bachelor-educated nurses. Most were female (n=18), averaging 37 years old, and had 14.6 years of work experience. Focus groups lasted about 90 minutes.\u003c/p\u003e\n\u003cp\u003eThe focus group involving 11 team leaders was held in three hospitals: four team leaders from a top-clinical hospital (I), three from the general hospital, and four from an academic hospital. Most were female (n=10), aged 37 on average. Focus groups lasted about 90 minutes.\u003c/p\u003e\n\u003cp\u003eThe 17 nurse practitioners joined from three hospitals: six each from top-clinical hospital I and from top-clinical hospital II, and five from top-clinical hospital III. Most were female (n=14), aged 43 on average. These sessions lasted around 45 minutes.\u003c/p\u003e\n\u003cp\u003eLastly, 26 vocational-educated nurses and bachelor-educated nurses participated in four focus groups, two focus groups with each six participants in the general hospital, and two focus groups with six and eight participants from top-clinical hospital I. Most were female (n=24), aged 38 on average. Focus groups lasted about 89 minutes.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInsert table 1\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFour main themes were identified in the analyses: (1) (No) desire for job crafting, (2) Team capacity for job crafting, (3) Balancing between being ambitious and setting the bar too high, and (4) The importance of job crafting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(No) desire for job crafting \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe first theme is about the various perspectives of nurses on the necessity of job crafting and the extent to which this takes place in current practice.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u003cem\u003eNursing assistants\u003c/em\u003e emphasized their role in patient well-being by performing a variety of tasks involving direct patient contact. While highlighting their empathy, they expressed a need for more time with patients and suggested they could assist with triage if given additional training—a view shared by most vocational- educated nurses. The majority of nursing assistants stated they were satisfied with performing their duties as outlined in their job description. They generally described themselves as less ambitious, preferring non-complex tasks and no additional responsibilities.\u003c/p\u003e\n\u003cp\u003e“I ‘am not ambitious at all. I get satisfaction from my current work as nursing assistant. I do not need more or bigger tasks”. (Nurse assistant)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eVocational-educated\u003c/em\u003e nurses felt their role should focus on nursing tasks that require their expertise, such as triage, advising distressed patients, and monitoring vital signs. They believe this focus allows them to make a significant contribution to patient care. While they are content with their current tasks and do not seek a more challenging role, they express a desire to deepen their knowledge of the symptoms and diseases they encounter. Vocational-educated nurses believe this would enhance their job satisfaction by adding value to their work and improving patient care.\u003c/p\u003e\n\u003cp\u003e‘More in-depth knowledge of what we encounter. For example, more knowledge about heart failure or COPD, which you can use directly in the services the call center delivers for different customers. It would be nice for ourselves and meaningful for the patient if you get the opportunity to gain more in-depth knowledge on the personal topic you desire”. (Vocational- educated nurse)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBachelor-educated nurses\u003c/em\u003e believe their role should primarily focus on patient-related nursing tasks but differ in their approach. Rather than strictly following their job description, they emphasize reflection on quality improvement and personal growth. They prefer dynamic roles without rigid protocols and find fulfillment in exploring \"why\" questions, improving processes, and engaging in broader responsibilities beyond direct nursing care. Compared to nursing assistants and vocational- educated nurses, bachelor-educated nurses seek tasks and opportunities that align with their education. They show a strong interest in continuous learning and professional development, actively pursuing educational opportunities. Many also find fulfillment in teaching and mentoring other nurses, with some identifying coaching as a key strength and an essential part of their role.\u003c/p\u003e\n\u003cp\u003e“Exploring why questions and finding answers to those why questions with multiple justifications. I feel great when that occurs. I get energy from overarching tasks and variation in my work. I can get very happy when I have a shift in the call center where I get an urgent request for admission to a nursing home, multiple triages, and a consultation about a service we deliver with a customer of the MCC (medical coordination center). If my day looks like that, I could not be happier”. (Bachelor-educated nurse)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNurse practitioners\u003c/em\u003e are pioneers who readily embrace new initiatives, whether projects or challenges. They have a keen ability to identify necessary changes in their work and clearly articulate the reasons behind them, reflecting their entrepreneurial mindset, ambition, intrinsic motivation, and strong determination.\u0026nbsp;Nurse practitioners (and bachelor-educated nurses) seeking challenging tasks may find opportunities in supervisory roles, contributing to improved quality of care. These nurses value teaching and mentoring, seeing it as a key aspect of their role.\u003c/p\u003e\n\u003cp\u003e“There has to be something in return, and essentially, you need to make yourself indispensable. That was the task from the beginning. I succeeded in doing that, but then it also has to bring in enough revenue so that they can pay me. Otherwise, the cost factor outweighs the role”. (Nurse practitioner)\u003c/p\u003e\n\u003cp\u003eTeam capacity for job crafting \u0026nbsp;\u003cbr\u003e\u0026nbsp;The second theme reflects on job crafting as an individual proactive behavior that, in nursing, occurs within the context of teams. This highlights the importance of interaction, which is influenced by factors such as team size and generational differences.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;All participants emphasized the importance of leveraging each other's strengths. Building and maintaining trust among team members, along with understanding each other's strengths and weaknesses were identified as essential prerequisites for effective collaboration and support within the team. In smaller teams, members can more easily delegate tasks and take on those they enjoy or excel at, as frequent interactions foster better understanding among colleagues. Individual preferences and competencies are considered for specific tasks, such as project work, research, planning, coordination, and administrative duties. Nurses described job crafting as enjoyable and emphasized the open culture within their wards. In larger teams, care becomes more individualistic, with tasks reduced to only what is necessary, making job crafting more challenging due to a lack of familiarity with each other's strengths. However, in wards that allow more time and space for job crafting, nurses experience greater job satisfaction, which in turn leads to improved patient care outcomes.\u003c/p\u003e\n\u003cp\u003e“One person is about coordination; another is about sensing and feeling a person. At a certain moment you get to know each other and then you know what a person’s strengths are. (…) And then you have to, because that is the beauty of it, play into each other strengths.” (Bachelor-educated nurse)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnother key factor in job crafting within teams is the generation gap.\u0026nbsp;Nurses perceive younger colleagues as ambitious, eager to specialize and self-oriented, while the older nurses prioritize teamwork and connections with colleagues. Despite having equal knowledge, older nurses often seek help with technology, which can frustrate younger nurses. Both groups approach job crafting differently: bachelor-educated nurses actively develop their skills and seek more coordinating and coaching roles, while nurse practitioners are still defining their new roles and interests.\u0026nbsp;Additionally, older nurses observe that younger colleagues are more willing to switch employers for better training opportunities or higher salaries. This is illustrated by the following quotes:\u003c/p\u003e\n\u003cp\u003e“Well, the younger generation is more focused on their career, and they go for it”. (Team leader)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e“Well, if I look at my team, the older generation would like more connectedness, more the feeling of really being in a team together”. (Team leader)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBalancing between being ambitious and setting the bar too high\u003cbr\u003e\u0026nbsp;The third theme emphasizes that team leaders play a crucial role in facilitating and encouraging nurses to actively engage in job crafting.\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003eNurse practitioners also often face increased workloads and work-related stress due to added consultation hours, production demands, or covering for colleagues, making it difficult to maintain a healthy work-life balance.\u0026nbsp;Reducing tasks is challenging, as some feel responsible for taking on extra duties, partly due to expectations from medical specialists who are ultimately responsible for their position and salary. Nurse practitioners believe they must remain indispensable, advocating for themselves and continuously demonstrating their value. However, effectively defining and delegating tasks remains a significant challenge, making it harder for them to manage their workload efficiently. These obstacles\u0026nbsp;prevent them from optimally job crafting.\u003c/p\u003e\n\u003cp\u003eTeam leaders feel they encourage ambitious nurses who seek to expand their roles by joining workgroups, creating development plans, and taking on tasks beyond their prescribed duties. When given opportunities to use their expertise, these nurses are more energetic and effective. Nurses with greater ambitions should proactively communicate their goals to team leaders, colleagues, and medical specialists to explore potential opportunities together. Gaining trust from the team and medical specialists is crucial for job crafting, as is effective knowledge-sharing within teams, management, and the organization. A “flattened” structure, where nurses feel their work matters, can motivate them to develop professionally and actively craft their job.\u0026nbsp;Nurse practitioners view managers as key enablers of job crafting by empowering them. Managers can either support or hinder this process: managers with a clear vision and appreciation for job crafting empower nurses, while those who do not recognize its value can hinder the process.\u003c/p\u003e\n\u003cp\u003e“By letting my manager and other colleagues know, you do get more chances or actually you create more chances“. (Bachelor-educated nurse)\u003c/p\u003e\n\u003cp\u003eYes, I do think that, when I look at our situation, it really depends on having a good manager with a clear vision. Indeed, we have a lot of turnovers in this regard. Although each manager has emphasized the possibilities and the importance of nurse practitioners, they often lack decisiveness due to budget constraints or a lack of available positions”. (Nurse practitioner)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTeam leaders observe that nurses who take on too many responsibilities may experience declining mental and physical health. As a result, they sometimes discourage job crafting efforts, such as pursuing further education. One respondent suggests that using job crafting to address labour shortages blurs the boundaries of nurses' responsibilities.\u0026nbsp;Nurses need to reclaim autonomy by selectively choosing tasks.\u0026nbsp;While some team leaders believe job crafting can positively impact nurses’ mental health\u0026nbsp;—allowing them to focus on tasks that bring them joy and energy—this, in turn, could lead to greater motivation and dedication to their work.\u003c/p\u003e\n\u003cp\u003e“I think that if it is properly integrated and enough time is spent on facilitating it once it is implemented, it will contribute to reducing the workload, but the path towards it demands more time”. (Team leader)\u003c/p\u003e\n\u003cp\u003eThe importance of job crafting\u003cbr\u003e\u0026nbsp;The fourth theme explores the impact of job crafting when nurses do apply this in practice, and the outcomes it can lead to.\u003c/p\u003e\n\u003cp\u003eTeam leaders emphasize the positive impact of job crafting on nurses' well-being. Applying newly learned skills during shifts can improve job satisfaction. Nurses often take on\u0026nbsp;additional or different tasks beyond their usual routine, which patients greatly appreciate, contributing to the quality of care.\u0026nbsp;When nurses' strengths are recognized, they feel more energized and enthusiastic. This sense of fulfilment enhances their well-being and work-life balance.\u003c/p\u003e\n\u003cp\u003e“Yes, when you leave work with a fulfilled feeling. Off course there are days when you think this could have been better or different. But going home with such a nice feeling of satisfaction and fulfillment”. (Bachelor-educated nurse)\u003c/p\u003e\n\u003cp\u003eAll nurses identify recognition and validation as key factors to craft and excel in their job. They seek appreciation through learning opportunities that support their development, ultimately improving the quality of care, job satisfaction, and efficiency.\u0026nbsp;Financial incentives are also mentioned as a gesture of appreciation.\u0026nbsp;Salary discrepancies between bachelor-educated nurses and vocational-educated nurses, despite similar responsibilities, can create feelings of inequity. This discourages some nurses from pursuing additional skills, such as project management, due to limited financial rewards. However, nurses emphasize that the issue is not just about financial reward but also the lack of access to opportunities for general nurses.\u003c/p\u003e\n\u003cp\u003e“When you look at the industry (…) there are people there with a little number of diplomas, but they do have a high position. In the industry they do not say ‘Sorry, you didn’t follow the University Business Training’. No, someone can just start working and create career advancements for themselves. Why is this impossible in healthcare?”. (Nurse)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNurse turnover in hospitals is influenced by career growth opportunities, such as moving to different wards (e.g., intensive care units or ambulance roles), or office positions, which team leaders view as positive advancements. Reasons for job changes include high workload, physical and emotional demands, and irregular shifts. Some nurses leave for other healthcare organizations where they have more autonomy and ownership of their work. When nurses take on additional or different tasks, they find greater job satisfaction, which can lead to increased fulfilment and potentially reduce the likelihood of quitting their job.\u003c/p\u003e\n\u003cp\u003e“I also felt very strongly that people would like to have much more control over the interpretation of their tasks. They have become self-employed in a small nursing home setting”. (Team leader)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis qualitative study provides valuable insights into the perceptions of nurses, nursing assistants, nurse practitioners and team leaders in hospitals regarding crafting of the nursing job whereby the following main topics were found: (1) (No) desire for job crafting, (2) Team capacity for job crafting, (3) Balancing between being ambitious and setting the bar too high, and (4) The importance of job crafting. Job crafting allows nurses to develop in their desired direction, enhance personal skills, and gain a deeper understanding of their role. This can improve patient care quality and benefit nurses by increasing engagement, job satisfaction, and work enjoyment, which could potentially aid in nurse retention.\u003c/p\u003e \u003cp\u003eAs far as we know, this is the first study to provide insights from different perspectives on crafting the nursing job. Our research shows that nursing assistants and vocational-educated nurses are less engaged in job crafting. They are generally satisfied with their current tasks as assigned, and do not actively seek more challenging roles. Nursing assistants prefer to have more time with patients, while vocational-educated nurses express a desire to gain more in-depth knowledge about symptoms and diseases they encounter. Although patient care is a priority for bachelor-educated nurses and nurse practitioners, they are also interested in additional tasks, such as supervising roles and improving the quality of care. However, taking on these additional responsibilities requires stepping away from direct patient care, which can lead to role conflict [Yun et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2024\u003c/span\u003e]. Bachelor-educated nurses have a strong interest in continuous learning and professional development. Bachelor-educated nurses and nurse practitioners mentioned that they are eager to take on mentorship and supervisory roles and contribute to quality improvement initiatives. Nurse practitioners are exploring how to define and fulfill their roles but face significant challenges, such as high workloads due to added consultation hours, production demands, or covering colleagues. In their effort to remain indispensable, nurse practitioners take on many extra tasks, which leads to work-life imbalance. They experience difficulties by taking on too many tasks and making themselves indispensable, which leads to a disrupted work-life balance. Although previous research has explored task reduction as a solution [Lazarazza et al., 2020], the nurses in our focus groups did not consider this a viable option. Generally, bachelor-educated nurses and nurse practitioners are more aware of job crafting and intend to apply this. This aligns with existing research [Bakker and Demerouti, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Lazazzara et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e], which shows that employees can redesign the context of their job in a way that allows them to use their skills optimally and develop professionally.\u003c/p\u003e \u003cp\u003eThe present study's findings indicate that bachelor-educated nurses and nurse practitioners actively engage in job crafting to enhance patient care, pursue challenges, and express passion for their work, consistent with previous research [Harbridge et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e]. Team leaders play a key role in supporting ambitious nurses who seek to expand their roles and recognize the positive impact of job crafting on nurse engagement and professional development. For example, providing job crafting opportunities can increase nurses\u0026rsquo; happiness and job satisfaction [Van Emmerik et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2009\u003c/span\u003e]. The team leaders in our study demonstrated a strong understanding of job crafting by actively encouraging nurses to engage in job crafting activities and expressing trust in them, which aligns with findings in other literature [Baghdadi et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; D\u0026eacute;ry et al., 2021]. It is also important to consider different perspectives in professionalization programs on how team leaders can best guide nurses and create an environment where nurses feel empowered to explore new tasks, refine their skills, and take ownership of their professional growth. For instance, nurse practitioners approach things differently and require a different form of guidance than vocational-educated nurses. A one-size-fits-all leadership approach may not be effective while a more personalized approach could potentially lead to better results [Kooij et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e] and team leaders should be equipped with the knowledge and skills to adapt their support strategies accordingly.\u003c/p\u003e \u003cp\u003eNurses report various challenges with applying job crafting in daily practice, particularly in terms of interactions within teams. This involves, for example, generational differences. As older nurses tend to prioritize teamwork and value close relationships with colleagues, younger nurses are more focused on their individual goals. Additionally, older nurses place greater emphasis on hard work, while younger nurses are more conscious of maintaining a healthy work-life balance [Han, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e]. While older colleagues often seek technical assistance from younger nurses, because they are generally less digitally skilled, knowledge transfer in the opposite direction appears to be less common, as younger nurses have less need for this since they adapt to new technology more quickly. Additionally, younger nurses are more conscious of maintaining a healthy work-life balance [Han, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e]. These differences in perspectives and priorities highlight the need for a more structured approach to job crafting that considers generational strengths and challenges. For example, older nurses could focus on mentorship and coaching, while younger nurses could drive digital innovation initiatives, leveraging each group's strengths [Kooij et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e]. It is also the responsibility of team leaders to recognize generational differences within nursing teams, and to create understanding of these generational differences and similarities and develop strategies to build partnerships among nurses [Han, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Tussing et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding the importance of job crafting, our findings align with existing literature, which highlights positive associations between job crafting, autonomy, and job satisfaction across various professions (Rudolph et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Wang et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Li et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Harbridge et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Whereby job crafting is related to emotional well-being, social well-being and psychological well-being [Han, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e], which can enhance job performance and create a greater sense of value in the workplace [Rudolph et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Simpkin et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Topa \u0026amp; Aranda-Carmena, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2022\u003c/span\u003e]. In our study, nurses who engage in job crafting reported improved work-life balance, well-being, and job satisfaction, which may contribute to lower nurse turnover in hospitals. Encouraging more nurses to participate in job crafting could be beneficial, for instance, by offering them education on job crafting and encouraging them to reflect on their work activities or providing weekly motivation over a four-week period to engage in specific job crafting activities [Knight et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e]. Additionally, nurses expressed a desire for greater appreciation, including financial recognition, to enhance job satisfaction and staff retention. Providing nurses with opportunities to craft their roles to better match job demands and resources may help prevent the outflow of nurses. Addressing the nursing shortage is crucial, as 67% of nurses are considering leaving their positions within three years [Ulrich et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e]. Nurses can take proactive steps, such as seeking mentorship opportunities, participating in quality improvement initiatives, or proposing for role adjustments that align with their skills and interests. They can also work with team leaders to explore leadership opportunities. By taking these initiatives, nurses can craft their job in a way that enhances both their professional satisfaction and the overall quality of care.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePractical Implications\u003c/h2\u003e \u003cp\u003eOur findings suggest that while job crafting offers significant benefits, its success depends on several factors. Based on our research, we propose several practical implications. \u003cem\u003eFirst\u003c/em\u003e, nurses need to develop a greater awareness of what job crafting entails and how to implement it effectively in their workplace. They can support one another by engaging in discussions and identifying opportunities for job crafting collectively. It is also important that nurses actively seek out opportunities for job crafting. \u003cem\u003eSecond\u003c/em\u003e, for managers, nurses are largely capable of managing job crafting independently on the ward, as it is driven by intrinsic motivation \u0026ndash; provided they are given the necessary opportunities and support. If a bachelor-educated nurse is assigned non-care tasks, it is essential to maintain this arrangement, as it can contribute to long-term retention in the profession. Additionally, nursing assistants and vocational- educated nurses should be encouraged to support this approach. Furthermore, investments in both time and financial resources should be made available to nurses who wish to further develop their skills and advance their careers. \u003cem\u003eThird\u003c/em\u003e, team leaders can encourage and facilitate job crafting for nurses in a more coordinated manner, with organizational-level agreements to support these efforts. Team leaders can adopt strategies to promote job crafting, provide training, and implement intervention programs, particularly for bachelor-educated nurses, who, as shown in other research, often aspire a supervising or mentoring role [Harbridge et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Han, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e]. It may be beneficial to discuss nurse\u0026rsquo;s preferences during their annual reviews or or have them complete a self-assessment of their strengths [Macfarlane, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e]. Team leaders must be aware that a one-size-fits-all approach may not be effective and that tailored support strategies are needed, as well as a continuous learning approach. \u003cem\u003eFourth\u003c/em\u003e, nurse practitioners require more support in defining their roles and sustaining their enthusiasm. Team leaders and medical specialists should foster an open culture where nurse practitioners can clearly communicate which tasks are essential for their profession and how to achieve a sustainable balance. Opportunities to reduce tasks should be considered as an alternative where applicable.\u003c/p\u003e \u003cp\u003eAbove all, nurses play a crucial role in transforming healthcare and should be actively involved in shaping and developing changes, rather than merely implementing them [van Kraaij et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e]. This can be achieved by actively listening and considering the perspectives of all nurses while acknowledging their unique insights from daily practice. Further research is needed to explore how nurses can effectively apply job crafting in daily practice and how this can contribute to healthcare transformation, ultimately leading to better outcomes for nurses and improving retention. In future studies, it is essential to explore how team leaders\u0026rsquo; approach impact nurses' well-being, job satisfaction, ability to balance their ambitions, and the quality of patient care regarding job crafting.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStrength and limitations\u003c/h2\u003e \u003cp\u003eAs far as we know, this is the first study using focus groups to investigate how job crafting is applied among different types of nurses. Additionally, the focus groups were homogenous, which created a safer environment where nursing assistants, vocational-educated nurses, bachelor- educated nurses, nurse practitioners, and team leaders felt comfortable sharing their opinions and honest thoughts and experiences. However, a limitation of this approach is the lack of interaction between the different groups, which could have provided additional insights and potentially sparked more discussion. Another limitation is that the results are based on self-reported data, which may be subject to response bias and subjectivity. Furthermore, the study focused solely on nursing assistants, nurses, nurse practitioners, and team leaders in the Netherlands, making it difficult to generalize the findings to similar healthcare professionals in other countries.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCrafting of the nursing job provides opportunities to engage in more varied work and further development of personal skills. The findings of the present study indicate that nursing assistants and vocational- educated nurses have less interest in altering their jobs and do not desire additional or other tasks. Instead, they prefer to gain more in-depth knowledge about the symptoms and diseases they encounter. In contrast, bachelor-educated nurses and nurse practitioners are more aware of the value of job crafting. They actively seek diverse tasks and opportunities for professional development and show a strong interest in teaching and mentoring. Team leaders play an important role in facilitating and encouraging nurses in the process of job crafting, which they can do in a more coordinated way. Sufficient time, resources, and support to utilize nurses\u0026rsquo; qualities are essential for effectively realizing the positive outcomes of job crafting in daily practice. Additionally, fostering a team culture that encourages job crafting towards strengths could contribute significantly to nurse retention by increasing job satisfaction, enhancing professional growth, and promoting a better work-life balance.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study does not fall under the scope of the Dutch Medical Research Involving Human Subjects Act\u0026nbsp;(WMO). It therefore does not require approval from an accredited medical ethics committee in the Netherlands. However, in UMC Utrecht, an independent quality check has been carried out to ensure compliance with legislation and regulations (UMC Utrecht:\u0026nbsp;21-051/C) in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and material\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData were stored on a secure drive. Audio recordings were deleted after transcripts were made. The transcripts of the audio\u0026nbsp;recordings will be archived for 10 years.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Dutch Ministry of Health, Welfare and Sport, as part of the National programme RN2Blend.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors' contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDS designed the study, DS and EH collected data and analyzed data. EH wrote the draft of the manuscript and is responsible for the overall content. The manuscript was reviewed by DS. Both authors critically assessed and approved this paper and met authorship criteria.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all master students and healthcare professionals who participated.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors' information (optional)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eClinical trial number\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBaghdadi NA, Farghaly Abd-El Aliem SM, Alsayed SK. The relationship between nurses\u0026apos; job crafting behaviours and their work engagement. J Nurs Manag. 2021 Mar;29(2):214-219. doi: 10.1111/jonm.13141. Epub 2020 Sep 17. PMID: 32867009.\u003c/li\u003e\n\u003cli\u003eBakker AB. Job crafting among health care professionals: The role of work engagement. 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FNV. https://www.fnv.nl/nieuwsbericht/sectornieuws/zorg-welzijn/2022/01/zorginfarct-dreigt-reddingsplan-is-snel-nodig#:%7E:text=Reactie%20op%20prognosecijfers%20personeelstekort%20in%20zorg%20%26%20welzijn\u0026amp;text=Uit%20de%20vandaag%20gepubliceerde%20cijfers,jaar%20is%20dat%20ruim%20140.000. Accessed October 22, 2024.\u003c/li\u003e\n\u003cli\u003eHan S. Nurses\u0026apos; job crafting, work engagement, and well-being: a path analysis. BMC Nurs. 2023 Oct 30;22(1):405. doi: 10.1186/s12912-023-01573-6. PMID: 37904210; PMCID: PMC10614409.\u003c/li\u003e\n\u003cli\u003eHarbridge R, Ivanitskaya L, Spreitzer G, Boscart V. Job crafting in registered nurses working in public health: A qualitative study. Appl Nurs Res. 2022 Apr;64: 151556. doi: 10.1016/j.apnr.2021.151556. Epub 2022 Jan 5. PMID: 35307127.\u003c/li\u003e\n\u003cli\u003eKnight C, Tims M, Gawke J, Parker SK. When do job crafting interventions work? The moderating roles of workload, intervention intensity, and participation. Journal of Vocational Behavior. 2021 Feb; 124:103522.\u003c/li\u003e\n\u003cli\u003eKooij DTAM, van Woerkom M, Wilkenloh J, Dorenbosch L, Denissen JJA. Job crafting towards strengths and interests: The effects of a job crafting intervention on person-job fit and the role of age. J Appl Psychol. 2017 Jun;102(6):971-981. doi: 10.1037/apl0000194. Epub 2017 Mar 9. PMID: 28277726. \u003c/li\u003e\n\u003cli\u003eVan Kraaij J, Lalleman P, Walravens A, Van Oostveen C; RN2Blend consortium. Differentiated nursing practice as a catalyst for transformations in nursing: A multiphase qualitative interview study. J Adv Nurs. 2022 Jan;78(1):165-175. doi: 10.1111/jan.15001. Epub 2021 Aug 10. PMID: 34375011; PMCID: PMC9292649.\u003c/li\u003e\n\u003cli\u003eKroczek M. Analyzing nurses\u0026apos; decisions to leave their profession-a duration analysis. Eur J Health Econ. 2024 Apr;25(3):471-496. doi: 10.1007/s10198-023-01600-y. Epub 2023 Jun 7. PMID: 37286767; PMCID: PMC10246876.\u003c/li\u003e\n\u003cli\u003eLalleman PC, Smid GA, Lagerwey MD, Shortridge-Baggett LM, Schuurmans MJ. Curbing the urge to care: A Bourdieusian analysis of the effect of the caring disposition on nurse middle managers\u0026apos; clinical leadership in patient safety practices. Int J Nurs Stud. 2016 Nov; 63:179-188. doi: 10.1016/j.ijnurstu.2016.09.006. Epub 2016 Sep 11. PMID: 27639970.\u003c/li\u003e\n\u003cli\u003eLalleman P, Stalpers D, Goossens L, van Oostveen C, Bal R, Vermeulen H, Schoonhoven L, Wallenburg I (2020). RN2Blend: meerjarig onderzoek naar gedifferentieerde inzet van verpleegkundigen. Tijdschrift verpleegkunde. SSN online 2468-2225.\u003c/li\u003e\n\u003cli\u003eLazazzara A, Tims M, de Gennaro D. (2020). The process of reinventing a job: a meta-synthesis of qualitative job crafting research. Journal of Vocational Behavior, Vol. 116, p. 103267.\u003c/li\u003e\n\u003cli\u003eLi J, Yang H, Weng Q. Zhu L. 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Industrial and Commercial Training, 50(4), 200-208.\u003c/li\u003e\n\u003cli\u003eRudolph CW, Katz IM, Lavigne KN, Zacher H. Job crafting: A meta-analysis of relationships with individual differences, job characteristics, and work outcomes. J Vocat Behav. 2017 Oct; 102:112\u0026ndash;38. https://doi.org/10.1016/j.jvb.2017.05.008.\u003c/li\u003e\n\u003cli\u003eSimpkin AL, Chang Y, Yu L, Campbell EG, Armstrong K, Walensky RP. Assessment of Job Satisfaction and Feeling Valued in Academic Medicine. JAMA Intern Med. 2019 Jul 1;179(7):992-994. doi: 10.1001/jamainternmed.2019.0377. PMID: 31058983; PMCID: PMC6503555.\u003c/li\u003e\n\u003cli\u003eTims M \u0026amp; Bakker AB (2010). Job crafting: Towards a new model of individual job redesign. SA Journal of Industrial Psychology, 36(2), 1-9. DOI: https://doi.org/10.4102/sajip.v36i2.841.\u003c/li\u003e\n\u003cli\u003eTims M, Bakker AB, Derks D (2012). Development and validation of the job crafting scale. Journal of Vocational Behavior, 80(1), 173\u0026ndash;186. https://doi.org/10.1016/j.jvb.2011.05.009.\u003c/li\u003e\n\u003cli\u003eTims M, Bakker AB, Derks D. The impact of job crafting on job demands, job resources, and well-being. J Occup Health Psychol. 2013 Apr;18(2):230-40. doi: 10.1037/a0032141. Epub 2013 Mar 18. PMID: 23506549.\u003c/li\u003e\n\u003cli\u003eTong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007 Dec;19(6):349-57. doi: 10.1093/intqhc/mzm042. Epub 2007 Sep 14. PMID: 17872937.\u003c/li\u003e\n\u003cli\u003eTopa G, Aranda-Carmena M. Job Crafting in Nursing: Mediation between Work Engagement and Job Performance in a Multisample Study. Int J Environ Res Public Health. 2022 Oct 5;19(19):12711. doi: 10.3390/ijerph191912711. PMID: 36232011; PMCID: PMC9566469.\u003c/li\u003e\n\u003cli\u003eTussing TE, Chipps E, Tornwall J. Generational Differences in the Nursing Workforce: Strategies for Nurse Leaders. Nurse Leader. 2024;22 (5): 602-608. ISSN 1541-4612. https://doi.org/10.1016/j.mnl.2024.03.007.\u003c/li\u003e\n\u003cli\u003eUlrich B, Cassidy L, Barden C, Varn-Davis N, Delgado SA (2022). National Nurse Work Environments: A Status Report. \u003cem\u003eCrit Care Nurse\u003c/em\u003e 1 October 2022; 42 (5): 58\u0026ndash;70. doi: https://doi.org/10.4037/ccn2022798.\u003c/li\u003e\n\u003cli\u003eWang HJ, Demerouti E, \u0026amp; Bakker AB (2016). A review of job crafting research: The role of leader behaviors in cultivating successful job crafters. In S. K. Parker \u0026amp; U. K. Bindl (Eds.), Proactivity at work (Series in Organization and Management). Routledge.\u003c/li\u003e\n\u003cli\u003eWang H, Li P, Chen S. The Impact of Social Factors on Job Crafting: A Meta-Analysis and Review. Int J Environ Res Public Health. 2020 Oct 30;17(21):8016. doi: 10.3390/ijerph17218016. PMID: 33143286; PMCID: PMC7662365.\u003c/li\u003e\n\u003cli\u003eWorld Healthcare Organization (WHO) (2020). State of the world\u0026rsquo;s nursing 2020: Investing in education, jobs and leadership [Internet]. Available from: https://www.who.int/ publications/i/item/9789240003279. Accessed May 31, 2024.\u003c/li\u003e\n\u003cli\u003eWrzesniewski A, Dutton JE. Crafting a Job: Revisioning Employees as Active Crafters of Their Work. Acad Manage Rev. 2001 Apr;26(2):179. https://doi.org/10.5465/amr.2001.4378011.\u003c/li\u003e\n\u003cli\u003eYun MS, Lee M, Choi EH. Job crafting, positive psychological capital, and social support as predictors of job embeddedness among clinical nurses- a structural model design. BMC Nurs. 2024 Mar 22;23(1):192. doi: 10.1186/s12912-024-01845-9. PMID: 38515086; PMCID: PMC10958854.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 1: Characteristics of the focus groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"655\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTop-clinical hospital I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGeneral hospital\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAcademic hospital\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTop-clinical hospital II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTop- clinical hospital III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedical service center\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTeam leaders\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 participants. Wards: ICU, internal medicine, geriatrics \u0026amp; dialysis. In person.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3 participants. Wards: neurology \u0026amp; lung, internal medicine \u0026amp; MPU, cardiology \u0026amp; surgery. Via teams. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4 participants. Wards: ICU, head and neck oncology, gynecology \u0026amp; neurology, surgery. \u0026nbsp; \u0026nbsp; In person.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBachelor nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 participants.\u003c/p\u003e\n \u003cp\u003eWard: cardiology (n=3) and nephrology/dialysis (n=3). In person\u003c/p\u003e\n \u003cp\u003e8 participants.\u003c/p\u003e\n \u003cp\u003eWard: cardiology (n=4) and nephrology \u0026amp; dialysis (n=4). In person\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 participants. Ward: Lung \u0026amp; neurology (n=3), orthopedics \u0026amp; gynecology \u0026amp; surgery \u0026amp; ENT \u0026amp; oral and maxillofacial surgery (n=3)\u003c/p\u003e\n \u003cp\u003e6 participants.\u003c/p\u003e\n \u003cp\u003eWard: \u0026nbsp;Lung \u0026amp; neurology (n=3), orthopedics \u0026amp; gynecology \u0026amp; surgery \u0026amp; ENT \u0026amp; oral and maxillofacial surgery (n=3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 participants. Ward: medical coordination center. In person.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVocational nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 participants. Ward: medical coordination center. In person.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNursing assistants\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7 participants. Ward: medical coordination center. In person\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNurse practitioners\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 participants. Wards: gastroenterology, vascular medicine, heart failure, cardiology heart failure, nephrology, surgical oncology. In person.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6 participants. Wards: pediatric diabetes, neurology, orthopedics \u0026amp; traumatology, geriatrics, internal medicine, palliative care. In person.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 participants. Wards: dermatology, rheumatology, oncology-hematology, infectious diseases, traumatology. In person.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"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":"job crafting, hospital, clinical ward, nurses, nurse practitioner","lastPublishedDoi":"10.21203/rs.3.rs-7737938/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7737938/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eJob crafting involves modifying one's role to increase meaning, job satisfaction, and well-being. In nursing, key challenges include workforce issues, particularly retention and sustainability. This study explores the perspectives of different types of nurses on the ability to craft their current job.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eTo explore the perceptions of nurses, nursing assistants, nurse practitioners, and team leaders in Dutch hospitals regarding the opportunities and challenges of job crafting and what is needed in the (near) future.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eAn explorative qualitative study across five hospitals and one medical service center in the Netherlands, using focus groups. Inductive thematic analysis was applied to explore various perspectives.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThirteen focus groups with 73 healthcare professionals revealed four main themes: (1) (No) desire for job crafting, (2) Team capacity for job crafting, (3) Balancing between being ambitious and setting the bar too high, and (4) The importance of job crafting. Nurses have various perspectives on job crafting. In general, nursing assistants and vocational-educated nurses are satisfied with their current tasks. Bachelor-educated nurses and nurse practitioners are more eager to craft their jobs, but struggle with how to implement new roles effectively in practice.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe need to craft the job differs between nurses, and various challenges in its application are present. Recognizing these challenges, removing key barriers and facilitating enough time, resources, and support are essential for team leaders to encourage job crafting among nurses. Creating a (team) culture that supports job crafting can enhance job satisfaction, professional growth, and nurse retention.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003e In UMC Utrecht, an independent quality check has been carried out to ensure compliance with legislation and regulations (UMC Utrecht: 21\u0026ndash;051/C).\u003c/p\u003e","manuscriptTitle":"Different perspectives on the craftibility of the nursing job in Dutch hospitals; a qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-12 15:31:52","doi":"10.21203/rs.3.rs-7737938/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-25T04:35:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49059375018735267085365835875973684413","date":"2026-03-15T05:03:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-06T17:46:21+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-02T10:20:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-11T18:30:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-07T13:11:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-12-07T13:04:36+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":"16f0a787-d2ce-4424-89c3-869720eae563","owner":[],"postedDate":"March 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-12T15:31:52+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-12 15:31:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7737938","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7737938","identity":"rs-7737938","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}