Study design

This cross-sectional study was conducted across a large hospital group in Ireland that serves a population of 380,000 people.

Study setting

The hospital group, which is partnered with a local university, comprises six hospitals in total, one Model 4 hospital (bed capacity 535 inpatient beds), two Model 2 hospitals (bed capacity 50 inpatient beds and 52 inpatient beds respectively), one Model 2-S hospital (bed capacity 89 inpatient beds), and two specialty hospitals (one maternity, bed capacity 83 and 19 cots in Neonatal and one orthopedic, bed capacity 44 inpatient beds). The study took place across five individual sites: one Model 4 hospital, two Model 2 hospitals, one Model 2-S hospital and one specialty hospital (orthopedic). All nurses working across the hospital group were invited to participate in the study. At the time of data collection there were 2,040 whole time equivalent (WTE) nurses and midwives employed within the hospital group [40]. Please note that all Health Service Executive (HSE) (Ireland’s public health system, created under the Health Act 2004 to bring hospitals, community services, and social care under one national structure) workforce publications combine nurses and midwives into a single category. Data for this study was only collected from the nursing cohort.

Variables

The data collected in this study included both demographic variables (such as age, level of employment, length of service within the hospital group, country where their initial nursing qualification was obtained) and preexisting scales which were used to enhance the reliability and validity of these findings.

Demographic characteristics

Data on respondents age, length of service, educational level, and whether the nurse was an international or domestic nurse was collected.

Career aspirations

O’ Brien’s [41] Career Aspiration Scale was used in this research as the dependent variable. The scale comprises 8 items on a 5-point Likert-type scale. Participants were asked to indicate how true each statement is for them on a scale ranging from 1 (not at all true of me) to 5 (very true of me). Four items are reverse scored, and items are summed to obtain a total score, with a higher score indicating greater aspiration within a given career.

The scales for predictor variables included:

Resilience

Connor-Davidson Resilience Scale 10 item scale five-point Likert scale (from 1 “not at all descriptive,” to 5 “very descriptive”) (CD-RISC-10) developed by Campbell-Sills and Stein [18] was used to measure an individual’s resilience indicating how well equipped one is to bounce back after stressful events, tragedy, or trauma that can arise throughout one’s life.

Employee engagement, job satisfaction and affective organizational commitment

In measuring Happiness at Work, the shortened form of Salas-Vallina and Alegre (42) happiness at work scale was used to measure employee engagement (3 items), job satisfaction (3 items), and affective organizational commitment (3 items) using a 5-point Likert scale for each item. On these scales, higher scores indicate, higher levels of engagement, satisfaction and organizational commitment [42].

Psychological safety

Edmondson's (1999) seven-item five-point Likert scale (from 1 “not at all descriptive,” to 5 “very descriptive”) is the most widely used indicator of psychological safety. The questions are designed to gauge a person's belief that they can take risks with their team [30].

Ethical approval

This study was approved by the ethics and research committees of the hospital group (REC REF:104/2021) and home university (KBS Research Ethics Application: 2021_12_KBS_15). All procedures performed in this study involving human participants were conducted in accordance with the ethical standards of the hospital groups and home university research committee and with the 1964 Helsinki Declaration ethical standards. Participants were provided with a subject information sheet at the start of the questionnaire, outlining details of the project. Prior to completing the questionnaire participations were provided with an information sheet outlining the purpose of the study, their right to withdraw at any stage without penalty, the opportunity to ask questions prior to participating in the study, and assurance that information provided would remain confidential and anonymous. Participants were then asked for consent to participate in the study by ticking “yes” or “no” to the following statement “I agree to give consent”. Each response was anonymized using a number key to maintain confidentiality.

Data collection

Data collection took place between 12/09/2022 and 14/10/2022. Both hard and soft copies of the questionnaire were distributed. To inform nurses about the study, posters and flyers with a QR code to access the questionnaire were distributed across the 5 sites, details of the questionnaire were included in the Hospital Groups Newsletter for Nurses, Midwives and Health Care Assistants, and finally, nurses were contacted via internal email detailing the research and a link to the online questionnaire. The research team had a physical presence across the five sites during the roll out of the questionnaire to inform nurses of the study and to manually distribute questionnaires for completion.

Sample size considerations were based on recommended guidelines of at least 10–20 observations per predictor variable for the planned analyses [44] and a sample size of 260 met these requirements. Additionally, it provided adequate power (≥80%) to detect small-to-moderate effect sizes at a significance level of 0.05.

Data measurement and statistical methods

All analyses were undertaken using IBM SPSS V29, using a 5% level of significance throughout. Descriptive statistics summarize categorical variables as number (percentage). Cronbach’s alpha was used to examine the internal reliability of the scales. Pearson correlations summarized the bivariate associations between career aspiration and the scales measuring individual, job related and organizational factors. Multiple linear regression was used to develop the three models for career aspiration informed by the study framework (Fig 1). All numeric predictor variables were standardized prior to inclusion in the regression models, and results are reported as standardized regression coefficients (β) with corresponding 95% confidence intervals. Multicollinearity was assessed using variance inflation factors (VIFs). All included variables had VIF values below 5, indicating that multicollinearity was not a concern in the regression models. Model assumptions were assessed using residual diagnostic plots, including a histogram of the residuals and a scatterplot of predicted values versus standardized residuals. These diagnostics found no evidence of outliers or departures from the assumptions of normality or homoscedasticity. Regression analyses were conducted using listwise deletion, such that cases with missing data on any variable included in the model were excluded. The scales used in our questionnaire are preexisting scales, which have been widely used and tested within the literature. The reliability of each scale is outlined in Table 1. Lower Cronbach’s alpha values for some scales (job satisfaction and employee engagement) may be attributable to their limited number of items, given the influence of scale length on internal consistency. The psychological safety measure also yielded an alpha below 0.70; however, similar variability was reported by Rathert et al. [45] when using a shortened 6-item version of Edmondson's scale. Nonetheless we acknowledge these scores are below the commonly cited α = 0.70 criterion and acknowledge this as a limitation to our study and caution the interpretation of these results accordingly. This is discussed in greater detail in the limitations section.

Download:

• PNG
  larger image
• TIFF
  original image

Table 1. Reliability statistics for scales.

https://doi.org/10.1371/journal.pone.0355484.t001

Potential bias

To mitigate the effects of common method bias several steps were taken. Anonymity was assured to all respondents, doing so reduced the respondents urge to provide socially desirable, expected or accommodating answers [46]. Furthermore, independent and dependent variables were placed in different sections of the questionnaire, decreasing the likelihood that respondents would artificially answer each question in the same way [46].

Theoretical implications

From a theoretical perspective, studies to date have identified individual factors that can impact career aspirations. However, these variables were primarily examined in isolation, and as a result fail to identify whether other factors from the individual, job, or organization were likely to have an impact on career aspirations, as evidenced in this study. At a bivariate level, Pearson’s correlations identify statistically significant relationships between career aspirations and resilience, job satisfaction, psychological safety, employee engagement, organizational citizenship behavior, and organizational commitment. However, the findings from our multiple linear regression show that when individual level, job related, and organizational variables were controlled for, only resilience and the completion of a postgraduate qualification were statistically significant predictors of career aspirations. This finding can be explained by the fact that organizations are multifaceted and as such every outcome is tied to multiple organizational layers such as individuals, job, and the overall organization [47]. It is therefore important that any future research on predictors of career aspirations takes into consideration the interplay of factors across multiple domains such as the individual, their job, and the organization to unpack the underlying predictors of career aspirations.

Practical implications

From a practical perspective, the shortage of nurse managers has been clearly documented within the literature [5,6], as well as the need to build a strong and sustainable workforce [1]. The findings from this study highlight the need to promote continuous learning and professional development, to build a more educated and resilient workforce, which in turn should lead to a workforce with higher career aspirations. Furthermore, the future of nursing and nursing managers is depended on robust succession planning [6]. Due to the impending shortage of nurse managers [48] organizations need to invest in education so that (1) talented and knowledgeable candidates are available to fill these roles, and (2) based on the results of this study, to develop a cohort of internal candidates interested in applying for promotional opportunities. Interestingly, and within the context of the findings from this study, studies to date have shown that nurses with higher educational attainment show higher workplace resilience [21,49]. While there is an established line of enquiry within the nursing literature linking resilience to job satisfaction, self-esteem, self-efficacy, enhanced patient satisfaction, and favorable patient outcomes, and negatively correlating resilience with depression, anxiety, stress, burnout and turnover intention [21,49,50], the findings from this study add to this literature creating a further link between resilience and career aspirations. The Harvard Business Review define a resilient workforce as “a group of employees who not only are dedicated to the idea of continuous learning but also stand ready to reinvent themselves to keep pace with change; who take responsibility for their own career management; and, last but not least, who are committed to the company’s success” [51]. Within this context, each employee must recognize the key skills and behaviors their employer will require for future roles, as well as being aware of one’s own skills and knowledge, to ensure they have the necessary skills to adapt to future roles that will help them progress their career.

Managerial implications

From a management perspective, a recent meta synthesis of lifelong learning and nurses’ continuing professional development recommended that access to continuing professional development within the nursing profession should be made more attainable, realistic and relevant [52], with a need to ensure more funding and accessibility to nurses to engage in professional development. From the perspective of nurse managers shortages, continued professional development initiatives can contribute to both the attraction and attainment of nurses [52,53]. However, it is critical that the organizational culture is one that supports and encourages continued professional development [54]. For example, flexible off-duty patterns should allow time for nurses to study, financial support to cover the cost of attaining a postgraduate qualification, and practical support from the organization in the form of adequate time to participate in further education, as well as arranging suitable staff cover when colleagues are away engaging in further education [52]. Those in nursing management roles should encourage and mentor staff that do not have postgraduate qualifications to pursue further qualifications. Nurses should not be deferred from pursuing postgraduate qualifications due to barriers outside of their control, such as poor staffing levels, heavy workloads, lack of funding, and lack of study time [52].

Healthcare organizations ought to engage in, and promote, resilience training programs for their staff. Organizations should host courses, seminars, conferences and workshops that enable nurses to develop strategies to become more resilient. For example, workshops could be organized that enable nurses to express their concerns, share their workplace experiences and problems, and work together to develop methods to alleviate these concerns and problems [55]. Developing a resilient workforce will have positive effects on nurses’ attitudes towards the profession, their future within the profession, and their work outputs [55].

Limitations

The following limitations should be taken into consideration when interpreting the findings of this study. Firstly, while the findings of this study are relevant to the hospital group in which the study was conducted, these findings may not be generalizable across all healthcare settings, therefore we recommend replica studies be carried out across multiple healthcare settings to determine generalizability. The moderate R² values indicate that the models explain a meaningful but incomplete proportion of variance in the outcomes, suggesting that additional unmeasured factors may be relevant. Although residual plots were examined to assess model assumptions, reliance on visual inspection may introduce subjectivity and reduce the sensitivity for detecting minor deviations from assumptions. Some scales demonstrated lower internal consistency, which may have attenuated observed associations. Measurement errors arising from lower reliability may weaken the strength of some of the relationships recorded in our regression analysis. Future studies would benefit from using full scales for job satisfaction and employee engagement as the shortened version of these scales may have limited capacity to achieve internal consistency. In addition, the cross-sectional design limits the ability to establish temporal relationships or draw causal inferences. With these limitations in mind, the methods employed in this study provide new insights into factors which influence nurses’ career aspirations to become nurse managers. Secondly, with a response rate of 12.9% the study is subject to potential non-response and self-selection bias, meaning the views of respondents may not fully represent the wider nursing workforce. Therefore, the findings from this study should be interpreted in the context of the response profile of respondents. Thirdly, the information gathered was self-reporting; yet, due to the nature of the data, no other method could have been used to get this amount of information. To reduce the impact of common method bias, several measures were implemented as outlined earlier in our potential bias section. To avoid common process variance, respondents were guaranteed anonymity. Finally, the results of this study are quantitative in nature. Follow up focus groups or interviews would enrich the data by providing a narrative to the results recorded here. Furthermore, focus groups with international nurses would be useful to capture their career aspirations as the Irish healthcare sector relies heavily on international nurses to overcome current shortages. This is against the backdrop of previous studies [10] that have indicated only a few international nurses had advanced into managerial grades, noting that perhaps this had stemmed from their reluctance to apply for such roles. However, our findings show that being an international nurse does not influence career aspirations. Future studies could unearth the reasons behind the low rate of international nurses in managerial roles.