The first Chinese Nursing Association committee meeting in 1914 has set the foundation of nursing care in China (Wong and Zhao, 2012). With the fast economic development taking place in China, demand in health care
increases. Nursing role in China has evolved from merely implementing doctor’s orders in hospital to providing services to all people who need them, in clinical environments and communities (Wang, 2016). According to The Chinese MOH, in 2012, the number of registered nurse in China has reached 3.49 million, which equals about 1.85 nurses per 1,000 populations in both urban and rural China (OECD, 2012). 98.2% of registered nurses in China are female, 66.5% of whom are aged between 25 to 44. Only 0.1% of all registered nurses have a postgraduate degree, 8.7% have a university degree, 43.5% have a college degree, 46% have a technical secondary school qualification (NHFPC, 2012). The number of nurses with undergraduate and postgraduate degrees in China has been on the rise since 1900, for the first time in 2004, a doctoral education in nursing was introduced (Tao et al., 2012). One unique feature of Chinese health personnel is that China has more doctors than nurses, and the vast majority of nurses in China work in public sector hospitals.
In 1914, at the first Chinese Nursing Association committee meeting, Zhong Maofang suggested translating the English word ‘Nurse’ to hushi (护士). It was then approved at the meeting and the word hushi has been in use since. In China, the term ‘nurse’ refers to one who holds a Qualification Certificate of Speciality and Technology (《专业技术资格证书》) and a Nurse Practicing Qualification Certificate (《护士执业证书》). In 1996, the Chinese MOH introduced and implemented an exam for Nurse Practicing Qualification Certificate (《中华人民共和国护士执业证书》考试), anyone who wished to
Speciality and Technology is issued by the Chinese Ministry of Human Resources and Social Security, and the Chinese MOH, to those who pass the exam, and only with this certificate can one go on to apply to become a registered nurse, and subsequently receive the Nurse Practicing Qualification Certificate, issued by local government health authorities (Wong and Zhao, 2012; Wang, 2016). Unregistered personnel are not allowed to take up nursing jobs in China.
The aim of the exam is to evaluate whether candidates possess nursing knowledge as well as work capability. The exam adopts a national exam system, whereby it follows a unified outline and examination paper, as well as a unified passing standard. Nurse Qualification Certificate is an essential document required by Chinese health organisations during recruitment. The certificate is issued by the relevant government authorities once candidates pass the exam. The exam consists of two parts: professional knowledge practice and practical ability. Candidates have to pass both parts in one sitting to qualify. Candidates can only apply to take the exam if they hold as a minimum a diploma from a recognised General Secondary Health (Nursing) School. Nurse Practicing Qualification Certificate (《护士执业证书》) is a legal document in China (MOH, 2008c). It is only possible to gain employment after the certificate is issued and registered (MOH, 2005b). Findings from You et al. (2013) provide empirical support for China to increase the number of baccalaureate prepared nurses. It is important to provide ongoing access to higher education since many nurses attained more education over time. Most of the gain was from initial secondary
education to highest education as associate degree. Graduating half of new nurses from secondary school programs is not a quick way to qualify more baccalaureate-prepared nurses (Aiken et al., 2009). Whereas moving basic nursing education to postsecondary levels would allow more nurses to obtain baccalaureate qualifications over time. With the rises of complexity of hospital care and the expansion of nurses’ roles in community care, a more educated nurse workforce becomes even more crucial (You et al., 2015).
The China Social Welfare Foundation, the Nurse Caring Plan along with a number of groups jointly released a White Paper on the current development of the Chinese nursing group in May, 2017 (The White Paper, 2017, China). The White Paper published findings from questionnaires, interviews and on- site visits. The report received 51,046 valid questionnaires from in-service nurses, 168 valid questionnaires from retired nurses, and 1,008 valid questionnaires form the public. The report also included findings from twenty- two on-site visits and interviews, and thirty-six face-to-face interviews, telephone interviews. The aim of this study was to gain a thorough understanding of the current situation of Chinese nurses in relation to their general work conditions, their health, their psychological state, and their occupational development. Through analysing the differences and factors of nurses by, for example, sex, age, qualification and the type of hospitals they work in, the study wished to find the main causes behind low retention among nursing staff.
The report found that about 79% of nurses working in health organisations suffer injuries from sharp tools and over half have psychological trauma, the two leading occupational hazards. It showed that violence against medical workers and occupational injuries are top concerns among them. Some 68.5% of those who left the occupation had the same experiences. In addition to mental scars (51.2%), other hazards identified include noise, exposure to ultraviolet light, dust pollution and infection. The report said 38% of employers do not provide effective preventive supplies for nurses and 44.6% pay little or no attention to risks posed to nurses. It also found that 41.2% of nurses have been the target of aggressive behaviour from patients or their family members in the past year. According to the report, 80.7% said they highly value being respected and 92% thought they have low social status. Over 83% said they did not feel they were respected by patients and 90% saw their job as not appreciated by society. Managers need to pay more attention to the psychological requirements of nurses and should help them better cope with mental stress, it was added.
Most studies (Loher et al., 1985; Lu, White and Barriball, 2007; Sun et al., 2009; Liu et al., 2012; Chen et al., 2015;) concerning attitudes of health personnel have emerged from the fields of mental health and geriatrics. Not many studies have looked at the attitudes of health professionals towards the nursing process. Bowman et al. (1983) looked at nurses’ attitudes towards the nursing process suggested strongly that special training of nurses, through a structured educational programme, improves the attitudes of nursing staff towards the nursing process. It has been shown that attitudes
may be changed in a positive direction with education for relatively short periods of time (Morrison and Mclntyre, 1969). It can be assumed that repeated confirmation of the values accepted within groups due to the primary education is necessary if a positive attitude to changes such as the nursing process is to be maintained. The maintenance of the values underlying this particular change is dependent on the attitude and involvement of the group leader, such as nursing officer or charge nurse. Other elements that may affect attitude changes include: workers recognising problems happening in their work activity and wanting to change it, the social system within any unit (Kelman, 1969), organisational development (Adam and Bond, 2000), leadership patterns of unit heads (Ribelin, 2003; Curtis and O’Connell, 2011; Tennant, 2015) and intervention techniques within smaller groups in the unit (Back, 1974; Bowman, Thompson and Sutton, 1983). It is also found that the institutional influences do play a big part in affecting nurses’ attitudes (Bendall, 1971, Tzeng, 2002; Aly and El-Shanawany, 2016).