PONE-D-19-28473

Job satisfaction of certified nurse specialists and certified nurses in cancer care centers in Japan: A large cross-sectional study

PLOS ONE

Dear Professor Arai,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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We look forward to receiving your revised manuscript.

Kind regards,

Janhavi Ajit Vaingankar

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: No

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The manuscript touches an important topic by trying to assess Job satisfaction of certified nurse specialists and certified nurses in cancer care centers in Japan. However, I have some doubts how this study was conducted:

Title:

- Your title of this study is “to assess Job satisfaction of certified nurse specialists and certified nurses in cancer care centers in Japan”. However; there is no finding in your study which shows the level of job satisfaction among these two group of nurses. Therefore, you have to either present this finding or modify your title.

Abstract:

- In the background part of abstract, information about nurses’ job satisfaction such as level of job satisfaction and burden of job dissatisfaction on patients should be presented from the available literature.

- I am not clear with your sample size calculation and sampling procedure. How 200 certified nurse specialist and 1,472 certified nurses were recruited and participated in the study?

- The authors should indicate the level of job satisfaction of both certified nurse specialist and certified nurses

- Indicate all variables associated with job satisfaction separately for certified nurse specialist and certified nurses, and mention their respective AOR with CI.

- The authors should present the conclusion of their finding in the conclusion section of the abstract

Introduction:

- Based on the available literature, the authors should present the level of job satisfaction among nurses in global, regional and local perspectives

- The authors should also show what the literature says about the burden/impact of nurses’ job dissatisfaction on cancer patients. The authors should also mention important factors influencing job satisfaction based on the available literature on this particular topic

- I recommend the authors to remove table 1 from introductory part of this manuscript, because information in the table are already mentioned in narration

- The statement “No study in the study area” don’t justify the need of your study. The authors should show gap of previous studies (global perspectives) and justify the need of your studies

Methods:

- I am not sure whether the level job satisfaction of nurses was measured in this study. If so, which tool was used to measure this job satisfaction? Was this tools validity and reliability checked?

- Why you conducted pre-test on only 4 nurses? As a rule, on how much percentage of sample size pre-test should be conducted?

- How you determined the sample size? What was your sampling procedure? The authors should describe the mechanism how participants were recruited and participated in the study

- Since the data were collected through mail, I doubt how the informed consent was obtained.

- My major issue with this research is how job satisfaction was assessed/measured and categorized as “satisfaction” and “dissatisfaction”. Therefore, the authors should clearly explain this in the methods

- Your method of analysis is not clear. Please, explain your method of analysis in detail

Results:

- Your objective is to assess Job satisfaction of certified nurse specialists and certified nurses in cancer care centers in Japan. Where is the result which indicate level of job satisfaction for certified nurse specialist and certified nurses? What percentages of certified nurse specialists and certified nurses were satisfied and dissatisfied with their job?

Discussion:

- The authors should re-write the discussion. The authors only stated and discussed their finding and didn’t compare their finding with other study findings. The authors should discuss only the key finding of their study with previous study findings.

Conclusion:

- The authors should write the conclusion of the study finding separately

Reviewer #2: Thank you for the opportunity to review this paper. This paper is novel in that it is the first to evaluate the factors associated with job satisfaction among nurses involved in cancer care in Japan, which is an important group of healthcare professionals.

Introduction

1) In Table 1, years of clinical experience to qualify for CNSs for university graduates is stated as “0” years. Please confirm this is correct.

2) Reference 22 appears to be out of context w.r.t addressing job satisfaction among nurses. Please confirm if the reference is appropriate. (line 91)

Methods

1) The interviews conducted (line 111) needs to be further clarified. E.g., with who?

2) “a logistic regression analysis was conducted with satisfaction or dissatisfaction as the dependent variable” (line 183)- please provide more information to explain how the dependent variable is being determined. Given the proposed title of the manuscript, it is also important to report on job satisfaction status as descriptive statistics in Table 3.

3) “years of experience as the control variable” (line 185) refers to years of experience after acquiring nursing license or after acquiring CN qualification?

Results:

Overall: The regression analysis for CNSs (n=200) is under-powered given the large no. of independent variables involved (which i suppose to be 20 of them).

1) “remaining participants worked at other hospitals (e.g., general hospitals or clinics)” (line 196-197). It is unclear if these participants were also involved in cancer care? This appears to contradicts the statement under section-Participants which stated that “A total of 1,696 nurses working in cancer centers and hospitals responded to the mailed questionnaire. (line 160-161)”. Please clarify.

2) “51.6% of the nurses had a position title (e.g., head or chief nurse), whereas the others were staff nurses” (line 203), is this established based on “position” in Table 3 where managers are “head or chief nurse”? If so, the reported % does not seem to be correct.

3) I noticed significant differences in 5 (not 3) items with cancer team care for Table 5. Please correct text under results accordingly (line 208 and line 211).

4) “The results of the χ2 test were used in a logistic regression analysis to identify variables particularly important to job satisfaction among CNSs and CNs.” (line 228-229). This needs to be highlighted in the methodology and it is unclear how results from chi square tests were used to identify variables for inclusion in logistic regressions?

Was it that only items with p<0.05 at univariate analysis were selected as explanatory variables in the logistic regressions? If so, why is “presence of CN in radiation therapy nursing” included and remained significant in the regression analysis for CNS (Table 6) when it was reported as “n.s” in the univariate analysis for CNS. Please clarify. I have concern on the over-loading of the model, particularly given the small sample in CNS analysis. Is correction for multiple testing considered?

5) Table 6 shows only variables that remain significant in regression models? If so, please state this as legend in the Table.

6) “when a CN was involved in radiation therapy nursing within the same institution” (line 242-243); please clarify if this is a factor related to activity or facilities? It is reported as a factor for facilities.

7) Suggest to use the terms “presence” or “absence” of job satisfaction instead of “higher” or “lower” level of job satisfaction when reporting the results.

Discussion

1) “a high number of respondents (1,404) were affiliated with a single ward” (line 294). Figure 2 shows that less than 700 (based on bar height) were involved in ward department. Please clarify.

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6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

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Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-19-28473R1

Factors affecting job satisfaction of certified nurse specialists and certified nurses in cancer care in Japan: Analysis based on the Basic Plan to Promote Cancer Control Programs

PLOS ONE

Dear Professor Arai,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

ACADEMIC EDITOR:

Please consider the comments by the third reviewer pertaining to data analysis. You may wish to revise your analysis or justify your analytical approach in the light of these comments.

=============================

We would appreciate receiving your revised manuscript by Apr 10 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled 'Manuscript'.

Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out.

We look forward to receiving your revised manuscript.

Kind regards,

Janhavi Ajit Vaingankar

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: (No Response)

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

Reviewer #3: No

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

Reviewer #3: No

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

Reviewer #3: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

Reviewer #3: No

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: The authors have adequately addressed most of comments except one:

1) "when a CN was involved in radiation therapy nursing within the same institution” (line 248-252 in the clean version);

please clarify if this is a factor related to activity or facilities? The author replied in his/her comment that this is a factor related to facilities which is confusing and it does not tally with information presented in the tables. I did not also see any change in the text.

Others:

1) Line 217 to 218. All reported numbers should be updated. 20->21, 30->32, 10->11

Reviewer #3: The use of the abbreviations is not consistent. For example, CN or CNs, CNSs. I would suggest to remove all acronyms from the abstract in the least and standardize their use throughout the manuscript. The use of the acronyms has to be grammatically correct i.e. used in singular or plural forms. Consider using ‘certified nurse or nurse specialists’ in the sentences. Please spell chi-square in full.

Since this is a cross-sectional study, refrain from using terms such as ‘predictive’. Change these to ‘association’ instead.

State all proportions with upto one decimal points and other estimates upto 2 or 3 (keep it consistent).

Please state full p values instead of asterisks in the tables.

I am unable to understand the significant of having the analysis based on the Basic Plan to Promote Cancer Control Programs. Perhaps in the introduction this should be described and its relevance to this study should be highlighted. It may also be necessary to state why it was of interest to study CN and CNS groups separately. Just stating there were no previous studies may not be enough.

The discussion is not informative and needs to be clearly focused on the main findings of the study and the distinctions between the two groups and their practice implications.

In terms of analysis, some of the groups are highly skewed eg. Proportions working in radiotherapy, wards with lower bed capacity. Years of clinical nurse experience also needs to be carefully looked at since this has been used as control variable in the logistic regression. Although authors justify using 5 year cut off, I believe this again would be very skewed population given the mean duration was 19 years in the sample. The univariate analysis need to relooked at carefully before presenting multivariable findings. On that note, the correct term would be ‘multivariable’ instead of ‘multivariate’

Overall, I found this article quite difficult to follow. Given that it is currently quite long, authors need to edit the content carefully after considering the above comments. This could be achieved by shortening the introduction, avoiding repetitions between the tables and text in the results and trimming the discussion. Parts of the manuscript also need better flow and focus. For example, why is the statement ‘The study adheres to the STROBE checklist’ included in the job satisfaction questionnaire section? The intent of mentioning ‘Basic Plan to Promote Cancer Control Programs’ is not clear. Analysis needs to be reviewed thoroughly and reanalyzed as necessary to be eligible for publication.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step.

Factors associated with the job satisfaction of certified nurses and nurse specialists in cancer care in Japan: Analysis based on the Basic Plan to Promote Cancer Control Programs

PONE-D-19-28473R2

Dear Dr. Arai,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication.

Shortly after the formal acceptance letter is sent, an invoice for payment will follow. To ensure an efficient production and billing process, please log into Editorial Manager at https://www.editorialmanager.com/pone/, click the "Update My Information" link at the top of the page, and update your user information. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

With kind regards,

Janhavi Ajit Vaingankar

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: (No Response)

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: (No Response)

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: (No Response)

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: (No Response)

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: (No Response)

Reviewer #3: My comments to the revisions have been adequately addressed. I would recommend proof reading the article to ensure there are no grammatical errors.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

Reviewer #3: No