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To assess the supply, demand, and utilisation of master's degree nurses in China's top-tier hospitals and identify recruitment and retention challenges.
A convergent parallel mixed-methods design.
From January and September 2022, eight top-tier hospitals in mainland China were selected using convenience sampling. The proportion of master's degree nurses, turnover rates, and recruitment outcomes were investigated and analysed using descriptive statistics. Concurrently, seven nursing administrators from these eight hospitals were interviewed using semi-structured interviews, and transcribed data were thematically analysed through inductive content analysis.
Among the eight hospitals surveyed, the average proportion of master's degree nurses was 3.58% (range: 0.58%–9.43%). The average ratio of planned to actual recruitment was 3.28, with four hospitals showing near parity (approximately 1:1) and three institutions failing to recruit any master's degree nurses. The annual turnover rate of master's degree nurses was 1.18%. Three themes emerged from the qualitative analysis: (1) shortages coexisting with oversupply; (2) nursing leaders' retention efforts versus limited institutional policy support; and (3) prioritisation of research and management over advanced clinical roles.
In China, even among top-tier hospitals, the proportion of master's degree nurses remains relatively low. There is an overall shortage of these nurses, juxtaposed with localised oversupply in specific institutions. Promotion to nursing supervisor or administrative roles is the only developmental pathway, while structured career progression pathways for advanced nursing practice remain conspicuously absent.
The study highlights the need to develop targeted policies that support the career advancement of master's degree nurses, particularly by expanding career options in Advanced Practice Nurses (APNs) rather than limiting roles to nursing management or education. This shift would better leverage their clinical expertise and strengthen healthcare systems through specialised practice and innovation.
What problem did the study address?: This study maps the supply–demand dynamics of master's degree nurses in leading hospitals and identifies retention, utilisation, and motivation policies and strategies from the perspective of nursing administrators. What were the main findings?: The proportion of master's degree nurses is low in China's top hospitals. There is both an oversupply and a shortage of master's degree nurses. Neither the government nor hospitals have policies in place to encourage the clinical involvement of master's degree nurses, and their career progression is limited to managerial roles. Where and on whom will the research have an impact?: Nursing administrators and other health policy makers in China and comparable global health systems will be affected. It will also influence nursing associations, nursing educators, and general nurses.
This study adhered to the Mixed Methods Article Reporting Standards.
No contributions from patients or the public were involved in this study.
Identifying the core information needs of breast cancer radiotherapy patients serves as the foundation for delivering targeted information services. The Kano model, a qualitative tool for classifying service needs, is increasingly being employed to prioritise patient needs and enhance healthcare quality.
This study aims to examine the informational needs of breast cancer patients undergoing radiotherapy using the Kano model as the analytical framework.
Between October 2024 and February 2025, 260 patients with breast cancer undergoing radiotherapy were recruited as study participants. A cross-sectional survey was conducted using the Information Needs Questionnaire. Kano analysis was applied to identify and assess the information needs of these patients. This study adhered to the STROBE guidelines.
Among the 36 items analysed, 15 items (41.7%) were classified as one-dimensional attributes, primarily related to adverse reaction identification and self-management information. 11 items (30.5%) were identified as attractive attributes, mainly concerning the impact of radiation therapy and social–emotional needs five items (13.9%) were must-be attributes, focusing on basic radiotherapy information. Five items (13.9%) were indifference attributes, including the impact of radiotherapy on breast reconstruction, and guidance on image-related concerns during radiotherapy. The quadrant chart findings revealed that 15 needs were predominant in Area I, five in Improving Area II, five in Secondary Improving Area III and 11 in Reserving Area IV.
The information needs of breast cancer radiotherapy patients are diverse. Kano model analysis aids medical staff in developing health guidance and meeting patients' informational needs.
Understanding the differentiated informational needs of patients with breast cancer undergoing radiotherapy provides valuable insights for developing targeted educational interventions, ultimately improving patient engagement and outcomes.
The contributions of patients/members of the public were limited solely to data collection.
The efficacy of radiotherapy and the satisfaction of patients can be significantly improved by adequately addressing their information needs. This process is impeded by the current lack of a comprehensive tool for assessing these needs.
To develop an Information Needs Questionnaire for patients with breast cancer undergoing radiotherapy and to assess its reliability and validity.
The initial item pool for the questionnaire was developed through a literature analysis and semi-structured interviews with 12 patients with breast cancer receiving radiotherapy. The Delphi method was employed to consult 16 experts and the questionnaire content was refined based on expert feedback and item ratings to form the first draft. A pre-investigation was conducted on 30 patients with breast cancer treated with radiotherapy to refine the item expression. From March–October 2024, item analysis, factor analyses, and reliability tests were conducted on 220 patients. This study adhered to STROBE guidelines.
The final questionnaire comprised 36 items. Exploratory factor analysis revealed 5 dimensions, with all item factor loading within their respective dimensions being ≥ 0.4 and no items exhibiting multiple loadings. These five factors accounted for 72.805% of the total variance. The overall content validity index was 0.980, with item-level content validity index ranging from 0.900 to 1.000. The Cronbach's α coefficient for the entire questionnaire was 0.959, and the coefficients for each dimension ranged from 0.786 to 0.958.
The Information Needs Questionnaire demonstrated excellent reliability and validity in patients with breast cancer undergoing radiotherapy. It can effectively guide medical staff to accurately assess the information needs of patients with breast cancer who are undergoing radiotherapy.
Identifying the authentic informational needs of breast cancer patients throughout the entire radiotherapy process is instrumental in enabling medical staff to devise personalised and targeted information support interventions.
A total of 220 participants provided perspectives on their information needs.
To compare and analyse the differences in the clinical reasoning competence of nurses with different working years and their relationship with self-directed learning competence.
A cross-sectional survey design (online investigation) was used. A total of 376 nurses were recruited from four independent hospitals in China. Online questionnaires collected data on nurses' demographic characteristics and assessed their clinical reasoning and self-directed learning competence. Pearson correlation analysis, t-test, analysis of variance (ANOVA) and multivariate regression analysis were used.
Clinical reasoning competence scores of nurses with working years >10 years were higher than those of other nurses. Self-directed learning competence scores of nurses with working years of <1 year and (from ≥1 year to <3 years) were lower than those of nurses with working years of 6–10 years and >10 years. Self-directed learning competence scores of nurses with working years of 3–5 years were lower than those of nurses with working years of >10 years. There was a positive correlation between clinical reasoning competence, self-directed learning competence and each dimension among nurses of different working years. There are differences in the influence of different dimensions of self-directed learning competence on clinical reasoning competence among different working years.
There were differences in clinical reasoning and self-directed learning competence among nurses with different working years. Self-directed learning competence is a positive predictor of nurses' clinical reasoning competence, which applied to nurses with all working years; however, the specific effect of self-directed learning competence on clinical reasoning competence differed among nurses with different working years.
Nursing managers should pay attention to the development characteristics of clinical reasoning competence and self-directed learning competence of nurses with different working years and determine effective intervention strategies according to specific influencing factors.
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