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International Journal of Nursing Practice 2014; :

RESEARCH PAPER

Effects of the professional identity development


programme on the professional identity,
job satisfaction and burnout levels of nurses:
A pilot study
Selma Sabancogullari PhD RN
Associate Professor, Department of Psychiatric Nursing, Susehri High School of Health, Cumhuriyet University, Sivas, Turkey

Selma Dogan PhD RN


Professor, Department of Psychiatric Nursing, Faculty of Health Sciences, Uskudar University, Istanbul, Turkey

Accepted for publication November 2013


Sabanciogullari S, Dogan S. International Journal of Nursing Practice 2014; :
Effects of the professional identity development programme on the professional identity,
job satisfaction and burnout levels of nurses: A pilot study
The aim of this study was to evaluate the effects of the Professional Identity Development Program on the professional
identity, job satisfaction and burnout levels of registered nurses. This study was conducted as a quasi-experimental one
with 63 nurses working in a university hospital. Data were gathered using the Personal Information Questionnaire, the
Professional Self Concept Inventory, Minnesota Job Satisfaction Inventory and the Maslach Burnout Inventory. The
Professional Identity Development Program which consists of ten sessions was implemented to the study group once a
week. The Program significantly improved the professional identity of the nurses in the study group compared to that
of the control group. During the research period, burnout levels significantly decreased in the study group while those
of the control group increased. The programme did not create any significant differences in the job satisfaction levels of
the nurses. The programme had a positive impact on the professional identity of the nurses. It is recommended that the
programme should be implemented in different hospitals with different samples of nurses, and that its effectiveness
should be evaluated.
Key words: burnout, job satisfaction, professional identity, professional identity development education programme,
registered nurses.

INTRODUCTION
The nursing shortage has become an internationally
important issue, because most of the experienced nurses

Correspondence: Selma Sabanciogullari, Cumhuriyet University,


Faculty of Health Sciences, Department of Psychiatric Nursing, 58140
Sivas, Turkey. Email: selma.ssabanci@gmail.com
doi:10.1111/ijn.12330

now leave their career, and young people do not prefer


nursing as a career.1 According to the data released by the
Ministry of Health of the Republic of Turkey in 2010,
the number of the nurses per 1000 people is 1.56.2 The
majority of the nurses working in Turkey are under 30
years old.3 There are many factors causing nurses to leave
the profession. One reason is the nurses perceptions of
professional identity. Nurses professional identity and
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commitment to the profession are a strong factor influencing nursing shortage


Professional identity is fundamental to nursing practice
and sets basis for the professionalization of nursing.4,5,6,7
Along with its core meaning as identification with the
profession, professional identity is the comprehension by
the nurse him/herself of acting as a nurse and what being
a nurse means.8 Professional identity is defined as the
attitudes, values, knowledge, beliefs and skills that are
shared with others within a professional group in the work
place.9,10
The development of professional identity in nursing
begins when a student enters nursing education, and continues throughout his/her working life. Members of the
profession who have a strong professional identity provide
effective service and high quality patient care in the healthcare team, develop competency in clinical expertise, and
contribute to patient satisfaction.7,11,12 In addition, a positively developed professional identity, contributes to
increases in personal satisfaction, and decreases in
burnout levels and resignations.13
The worldwide problem regarding nurse retention and
shortage of qualified nurses is linked to nurses job dissatisfaction and burnout levels. Health care organizations are
now trying to find a solution to this problem.7,12 In order to
retain nurses in the profession and prevent nurse shortages,
graduate nursing programmes, a supportive work environment and educational opportunities are being provided,
and organizational strategies are being developed in institutions especially in the USA, England, Australia and the
European countries.14 However, Siebens et al. (2006)12
report that there is no significant decrease in premature
departures from the work force or in career changes in
nurses, despite various financial and organizational precautions undertaken. Sharbaugh (2009)15 emphasized the
importance of the level of development of professional
identity in nurses in relation to their retention levels at the
workplace and their commitment to the profession, while
Gregg & Magilvy (2001)11 determined that nurses with a
strong sense of professional identity had higher levels of job
satisfaction.
The development of professional identity may help
nursing to attain professional status by increasing professional commitment, improving nursing practices,
enhancing job satisfaction and reducing burnout levels
of registered nurses.7,12,16 In several studies, it has
been determined that members of a profession with a
strong professional identity have higher levels of work
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S Sabancogullari and S Dogan

satisfaction but lower levels of burnout and occupational


turnover.7,8,16 Despite this, with the exception of one particular study,17 there are no other programmes aiming at
developing and strengthening professional identities of
nurses or experimental studies evaluating the efficiency of
such programmes. In her study of 21 registered nurses
(1993), Segesten investigated the effects of professional
group counselling on strengthening nurses professional
self and determined that their professional self levels
significantly improved after consulting sessions. There
are also a few applied studies in current literature, though
not directly aimed at developing professional identity.
These studies were carried out by institutions for the
retention of new graduates.18,19,20 It was determined that
of the nurses, those participating in the consultation
process experienced increases in their willingness to stay
at work, self confidence and professional satisfaction,18
those participating in the career planning and development programme improved their compliance with the
work environment19 and those participating in the training
programme held to increase the compliance with the
work environment experienced role deprivation less20
compared to those not participating in. On the other
hand, there are no studies conducted to develop nurses
professional identity or to investigate its effects on job
satisfaction and burnout.
Considering this deficiency, it was thought that the
Professional Identity Development Training Programme
for working nurses should be improved and that the effectiveness of this programme should be evaluated. The
purpose of this study is to determine the effects of the
Professional Identity Development Training Program for
Nurses on professional identity, job satisfaction and
burnout levels in nurses.

METHODS
Study design and participants
The study is a quasi-experimental one. The study population consisted of 310 registered nurses working at a university hospital. Of these 310 nurses who were informed
about the study, 216 agreed to participate in the study and
the Professional Self-Concept Inventory (PSCI) was
administered to them. The scores obtained from the PSCI
by the 216 nurses were assessed and sorted from the
lowest to the highest (min 39, max 96). Eighty nurses
(study group 40, control group 40) who achieved the
lowest scores were included in the sample. Subjects in the

Professional identity development in nurses

310 nurses

The implementation of PSCI to 216 nurses who


agreed to participate in the study

Determination of the 80 nurses with the lowest


PSCI scores

Study group 40

The implementation of the


questionnaire and inventories

Control group 40

5 withdrew
Study group 35

6 refused

10-week Professional Identity


Development Training Program
Implementation

2 excluded

Study group 33

Control group 34
The implementation of the
inventories

Follow-up 6 months
33 completed (study group)

4 refused

30 completed (control group)

The implementation of the


inventories

Figure 1. Flow diagram of the study participants.

study and control groups were matched by age, sex, education level, length of service and PSCI scores. In the
study group, 97.2% the subjects were female, 90.9% had
bachelors degrees, and their mean age and length of
service were 27.51 3.34 years and 5.03 3.99 years
respectively. In the control group, 93.3% were female,
60% had bachelors degrees, and their mean age and
length of service were 29.63 5.12 years and 7.43
6.33 years respectively. Aside from the education level
(2 = 8.276, P = 0.01), there were no statistically significant differences in the main variables of the two
groups. The nurses in the study group were asked not to
share any information related to the topics discussed in the
group sessions and they signed a group contract.
There were 5 withdrawals from the study group before
the onset of the research and the sample of this group
comprised 35 nurses. During the group studies, one
subject was absent from the meetings for more than two
weeks in a row and another withdrew from the study due
to medical reasons, thus, the group studies were completed with a final sample of 33 nurses. While the control

group consisted of 40 subjects initially, only 34 subjects


participated in the second evaluation in 10 weeks (four
nurses did not want to complete the evaluation forms
again and two nurses were excluded from the sample
since their forms were incomplete). The follow- up evaluation in six months was finalized with 33 subjects in the
study group and with 30 in the control group since two
declined to fill in the forms, one was out of the town on
maternity leave and the other subject was on medical
leave. The flow diagram in Figure 1 depicts the changes in
the number of participants after recruitment.

Instruments
Data were gathered by employing one questionnaire and
three inventories.

Personal information form


The questionnaire consists of 10 questions relevant to the
age, marital status, education, length of employment,
assignment type and similar information.
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S Sabancogullari and S Dogan

Professional Self Concept Inventory (PSCI)


PSCI was developed by Sabancogullari, Dogan, & Bircan
(2011)21 within the sample of hospital nurses employed in
Turkey. PSCI was developed for evaluating the development of professional self-concept in nurses. The inventory
is a 4-point Likert type assessment inventory consisting of
36 items with three subscales. These subscales are called
professional satisfaction, professional competence and
professional attitude and skill. Total Cronbachs alpha
coefficient of the inventory is 0.87, and it is 0.80 for the
professional satisfaction and professional attitude and
skill subscales and 0.82 for the professional competence
scale. Re-test reliability is 0.76. While the professional
satisfaction subscale consists of 5 items, the professional
competence scale has 7 and the professional attitude and
skills scale has 24. In the PSCI, 8 items have negative
statements, and 28 items have positive statements.
Positive items are scored as 1 I totally disagree, 2 I
disagree, 3 I agree and 4 I totally agree. Negative
statements are scored reversely. The possible total score is
obtained by summing the scores of 36 items and it varies
between 36 and 144. The higher the score is the better
and advanced the professional self-concept is.

Maslach Burnout Inventory (MBI)


In this study, the Turkish version of the MBI, which was
translated and validated by Ergin in 1992,22 was used. The
MBI is a 22-item self-administered questionnaire. It has
three subscales: emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA). Higher
scores on the EE and DP scales indicate more burnout,
while higher scores on the PA scale indicate less burnout.

Minnesotta Satisfaction Questionnaire (MSQ)


MSQ was developed by Dawis et al. and its reliability and
validity of the Turkish version was established by Baycan
(1985).23 The individuals are asked to rate their level of
satisfaction with each of 20 work-related needs on a
5-point scale ranging from not satisfied (1) to extremely
satisfied (5). The responses to all 20 items can be
summed to produce the general satisfaction score. Additionally, intrinsic and extrinsic components of satisfaction
can be examined. As the score increases so does job
satisfaction.

Ethics
This research was conducted after getting the permission
of the Directorate of Head Physician and Nursing Services
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of the university hospital. The nurses were requested to


participate in this study after the purpose and procedures
of the study were explained to them orally. Nurses were
specifically informed that participation in the study was on
the voluntary basis and were assured that all the information would be kept confidential. They were also told that
they had a right to terminate their participation at any
time.

Implementationa pilot study


Before the onset of the study, the contents of the Professional Identity Awareness Development Education Programme were developed. The programme is a semistructured programme prepared by the researchers based
on the Professional Self Image model developed by
Strasen (1992)13 and using the literature on the
issue.11,16,24,25,26,27,28,29 Strasens (1992) Professional Self
Image Model focuses on positive thinking, professional
goal setting, and professional self-image development
plan. The professional self- image development plan
includes the following subtitles: professional goal setting,
assessment of professional self, developing short-term professional goals, brain programming in line with professional targets, professional image, developing success
strategies to increase job satisfaction, professional satisfaction and professional contributions to the profession. The
programme used in this study was based on Strasens model
and in order to enhance the programme, information
obtained from other sources in the literature11,16,24,25,26,27
and given in the following sentences were added to some
parts of the programme. Professional values, professional
philosophy, professional qualifications of nursing and
ethical codes which contribute to the formation of professional self were added to the programme in detail. In
addition, the concept of healthcare, professional organizations, professional image and the effects of the professional
image on the formation of professional self were added to
the programme to be discussed in detail. The relationship
between personal self image and professional self image
was also included in the programme in detail. When the
programme was implemented, not only did the researchers
provide information but they also used the principles of
group therapy and psychodrama.28,29 In addition, three
professionals (2 psychiatrists, 1 psychiatric nurse) who
were experts in their fields were consulted about the
programme. The programme consists of 10 sessions and
eight main topics. The topics of the sessions are: publics
perception of the nursing profession; personal self-image/

Professional identity development in nurses

1st SESSION

2nd SESSION

3rd SESSION

4th SESSION

5th SESSION

6th SESSION

7th SESSION

8th SESSION

9th SESSION

Figure 2. Flow diagram of professional

10th SESSION

Meeting and warming up / determining the expectations from the programme /


explaining the contents of the programme / preparing a group contract

Perception of the nursing profession / the professional image / effects of


the members of the profession on professional image

Self Image / Self-Awareness / self-esteem / personal and professional


worthiness

Professional Image I: professional self / relationship between personal self


and professional self / professional philosophy / professional values

Professional Image II: codes of ethics in nursing / care concept / professional


qualifications

Professional-Self assessment and development plan

Professional image/ Attitudes and Communication / effective


communication / active listening

Features of assertive behaviors-awareness-raising to develop assertive


behaviors

Professional contributions to the occupation / power of professional


knowledge / professional organization

Strategies to increase professional satisfaction-general evaluation-end of the


programme

identity development training programme.

self-knowing; professional image; evaluation and development of professional identity; professional look, attitudes
and communication; developing assertive behaviour;
contributions to the profession and the power of professional knowledge; increasing professional satisfaction. The
flow diagram in Figure 2 depicts the 10 sessions of the
programme.
Forms and scales were applied to both groups before
the training programme (Time 1), after the training

programme (Time 2) and 6 months later (Time 3). Professional Identity Development Education Programme
was applied to the study group in ten sessions once a week
(two hours each).
Meetings were held with the nurses in the control
group three times: time 1, time 2, time 3. During these
meetings, only the forms and scales used in the study were
filled out. No interventions were performed in the
control group. During the period from the start to the end
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S Sabancogullari and S Dogan

of the study process, the nurses in the control group


continued their normal working at the hospital. The subjects were divided into two groups. There were 16 people
in one group and 17 in the other. Group sessions were
held in the Nursing School separately for each group. The
sessions were conducted in ten sessions once a week (two
hours each). The basic training materials used were
flipcharts, computer, overhead projector, bulletin boards,
printed material related to the topics studied and self
evaluation checklists.
In the first group session, each group took on a name
and established group rules. Every session was started
with warm up exercises followed by a coverage of the
session topics using different training techniques i.e. narration, debate, envisaging, role play, take home assignments, self evaluation checklists and psychodrama. The
researcher actively participated in all the activities of the
groups while conducting the sessions. The majority of
the subjects participated in the group activities voluntarily
and shared their feelings and thoughts about the topic after
each application. The researcher provided information on
some issues when necessary and set the ground for further
debate through definitions and explanations. At the end of
each session, the nurses were given take-home tasks
geared towards providing cognitive preparation to accomplish the goals of the following session. Moreover, the
discussions and results of the previous session were
reviewed at the beginning of each session to establish
continuity and connection between sessions.

Statistical analysis
Data were evaluated using the SPSS 16.0 package programme. In comparing the groups with respect to their
identifying characteristics; the chi square, fisher chi square
and kolmogorov- simirnov tests were employed. In order
to compare the mean scores the nurses obtained from the
inventories at time 1, time 2 and time 3, the evaluation t
test was used in independent groups, and the Repeated
Measures Anova and Borferroni tests were used in the
inner comparison of the mean scores the groups received
from the inventories in three measurements.

RESULTS
Change in professional
self-concept levels
The comparison of the PSCI scores within and between
the study and the control groups are given in the Table 1.
There were no statistically significant differences between
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Table 1 Comparison of the general PSCI score means of the study


and control group at Time 1, Time 2 and Time 3
PSCI
general

Time 1
Time 2
Time 3
Test
F
P

Study group
(N = 33)

Control group
(N = 30)

Test

Mean SD

Mean SD

114.3 11.2
121.5 7.2
115.2 10.7

110.2 12.7
111.6 9.0
108.4 10.2

1.36
4.79
2.55

0.177
0.000
0.013

15.476
0.000
Post hoc
12, P = 0.000
23, P = 0.003

1.427
0.248

PSCI, Professional Self Concept Inventory.

the mean PSCI scores of the study and control groups at


time 1 (t = 1.36, P = 0.17). At time 2 and time 3, the
general mean of the PSCI grades of the nurses in the study
group was significantly higher than was that of the nurses
in the control group (t = 4.79, P < 0.001; t = 2.55,
P = 0.01 respectively).
In the study group, the mean PSCI scores significantly
increased at time 2 (121.5 7.2) and decreased
(115.2 10.7) at time 3 (F = 15.47, P = 0.00). The
mean PSCI scores of the subjects in the control group did
not change at time 2 compared to those at time 1, yet they
showed a decrease at time 3, though this decrease was not
statistically significant (F = 1.42, P = 0.24).

Change in burnout levels


The comparison of the mean scores for the MBI subscales
within and between the study and control groups are
given in Table 2. At time 1, no significant difference was
determined between the mean MBI depersonalization and
personal accomplishment scores of the study and control
groups (t = 0.22, P = 0.82; t = 1.99, P = 0.06 respectively). However, the mean MBI emotional exhaustion
scores of the control group were significantly higher than
were those of the study group at time 1 (t = 3.58,
P = 0.00). At time 2, the emotional exhaustion and
depersonalization scores of the study group were found
to be significantly lower than the control group, but

Professional identity development in nurses

Table 2 Comparison of the MBI subscale score means of the study and control groups at Time 1, Time 2 and Time 3
MBI

Time 1
Emotional exhaustion
Depersonalization
Personal accomplishment
Time 2
Emotional exhaustion
Depersonalization
Personal accomplishment
Time 3
Emotional exhaustion
Depersonalization
Personal accomplishment
Test

Study group (N = 33)

Control group (N = 30)

Test

Mean SD

Mean SD

*14.0 4.8
**4.6 3.7
***21.6 2.4

*18.8 5.8
**4.8 3.2
***19.8 4.3

3.58
0.22
1.99

0.001
0.827
0.061

*12.8 4.0
**4.3 2.8
***23.0 2.4

*19.0 6.0
**6.2 4.5
***20.5 4.1

4.68
1.94
2.88

0.000
0.044
0.004

3.02
0.42
1.43

0.004
0.671
0.157

*14.8 5.1
**5.8 3.3
***21.5 3.0
*F = 2.94, P = 0.060
**F = 3.59, P = 0.033
Post hoc
23, P = 0.016
***F = 6.58, P = 0.003
Post hoc
12, P = 0.003
23, P = 0.009

*19.3 6.7
**6.1 3.1
***20.3 3.4
*F = 0.12, P = 0.880
**F = 3.45, P = 0.042
Post hoc
12, P = 0.033
13, P = 0.046
***F = 0.40, P = 0.67

*Time 1 Time 2 Time 3; emotional exhaustion. **Time 1 Time 2 Time 3; depersonalization. ***Time 1 Time 2 Time 3;
personal accomplishment. MBI, Maslach Burnout Inventory.

the personal accomplishment scores were higher


(t = 4.68, P = 0.00; t = 1.94, P = 0.04; t = 2.88,
P = 0.00 respectively).
The MBI emotional exhaustion scores of the study
group were lower at time 2 (12.8 4.0) compared to
those at time 1 (14.8 5.1), and at time 3, they increased
to the level at time 1 (14.8 5.1). However, the differences between the means were not statistically significant
(F = 2.94, P = 0.06). Depersonalization scores obtained
at time 1 (4.6 3.7) and time 2 (4.3 2.8) remained
almost the same but significantly (5.8 3.3) elevated
(F = 3.59, P = 0.03) at time 3. Personal accomplishment
scores were significantly elevated at time 2 (23.0 2.4)
compared to those at time 1 (21.6 2.4) but regressed to
the level at time 1 later at the time-3 evaluation
(21.5 3.0) (F = 6.58, P = 0.00). The mean MBI emotional exhaustion and personal accomplishment scores
of the controls did not show a marked change at time
2 or time 3 (F = 0.12, P = 0.88; F = 0.40, P = 0.67,

respectively). However, the mean MBI depersonalization


scores of the nurses in the control group were significantly
elevated (6.2 4.5) at time 2 and (6.1 3.1) time 3
(F = 3.45, P = 0.04).

Change in job satisfaction levels


The comparison of the MSQ scores within and between
the study and the control groups are given in the Table 3.
The mean general and subscale MSQ scores of the study
group were significantly higher than were those of the
control group at time 1 (t = 2.81, P = 0.00; t = 2.69,
P = 0.00; t = 2.36, P = 0.02 respectively) and time 3
(t = 2.7, P = 0.00; t = 1.95, P = 0.05; t = 2.11,
P = 0.03 respectively). At time 2, while there was a significant difference between the groups in terms of the
mean general and intrinsic satisfaction MSQ scores
(t = 3.11, P = 0.00; t = 3.24, P = 0.00 respectively),
there was no difference between the mean extrinsic satisfaction scores (t = 1.55, P = 0.12).
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S Sabancogullari and S Dogan

Table 3 Comparison of the general and subscale MSQ score means of the study and control groups at Time 1, Time 2 and Time 3
MSQ general and subscale

Time 1
General
Internal
External
Time 2
General
Internal
External
Time 3
General
Internal
External
Test

Study group (N = 33)

Control group (N = 30)

Test

Mean SD

Mean SD

*3.3 0.4
**3.6 0.4
***3.0 0.6

*2.9 0.6
**3.2 0.6
***2.6 0.6

2.81
2.69
2.36

0.006
0.008
0.022

*3.5 0.4
**3.7 0.4
***3.0 0.6

*3.0 0.6
**3.2 0.7
***2.7 0.7

3.11
3.24
1.55

0.001
0.001
0.126

*3.4 0.4
**3.7 0.5
***3.0 0.5
*F = 1.20, P = 0.30
**F = 0.44, P = 0.64
***F = 0.03, P = 0.96

*3.1 0.6
**3.3 0.6
**2.6 0.7
*F = 0.27, P = 0.76
**F = 0.74, P = 0.48
***F = 0.14, P = 0.86

2.70
1.95
2.11

0.009
0.055
0.039

*Time 1 Time 2 Time 3; general. **Time 1 Time 2 Time 3; internal. ***Time 1 Time 2 Time 3; external. MSQ, Minnesotta
Satisfaction Questionnaire.

The mean general and subscale MSQ scores of the


nurses in the study group (F = 1.20, P = 0.30; F = 0.44,
P = 0.64; F = 0.03, P = 0.96 respectively) or in the
control group (F = 0.27, P = 0.76; F = 0.74, P = 0.48;
F 0.14, P = 0.86, respectively) did not show any statistically significant changes at time 1, 2 and 3.

DISCUSSION
This study is the first study aimed at the development of
the professional identities of nurses in Turkey. Also, in
contrast with most of the other studies in the literature, a
programme directly aimed at developing professional
identity was developed for this study and its effects on the
development of professional identity, burnout and job
satisfaction levels of nurses were investigated. The findings obtained at time 1, 2 and 3 discussed in conjunction
with the findings of other studies in the literature, taking
the levels of development both within and between the
groups into account.

Change in professional
self-concept levels
While there were no statistically significant differences
between the mean PSCI scores of the groups at time 1, the
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general mean PSCI scores of the nurses in the study group


were significantly higher than those of the control group at
time 2 and time 3. This finding is important as it indicates
that the nurses who did not sufficiently develop professional identities during their vocational education can still
develop them It can be said that the nurse managers should
organize programmes aiming at the nurses working in that
sense. A study that supports the findings of this study were
conducted with 21 registered nurses by Segesten (1993).
In the study in which Segesten provided professional
group counselling for nurses in order to help them
strengthen their professional self, he (1993) determined
that the professional identities of the nurses developed
meaningfully. Besides, there are a few studies which,
though not directly aiming at developing the professional
identities of nurses, show that the interventions aiming at
increasing the job satisfaction and the will to keep up with
the job contribute to the nurses developing their vocational skills and confirm the findings of this study.18,19,20,30
The findings of the current study support the importance
of programmes designed to develop and reinforce professional identity in nurses.
The mean PSCI scores of the nurses of the study group
significantly increased at time 2 compared to time 1, yet

Professional identity development in nurses

significantly decreased time 3. The mean PSCI scores of


the control group remained unchanged at time 2 in comparison to the scores at time 1, yet decreased at time 3,
although the difference was not statistically significant.
According to these results, it can be said that the Professional Identity Development Education Program significantly contributed to the development of professional
identity of the nurses. At the same time, the fact that the
PSCI scores of the study group decreased at time 3 can be
interpreted as an indication of the fact that the programme
did not have continuity and its positive impact reduced in
time. The decrease in the mean PSCI scores of both the
study group and the control group at time 3 may also be
attributed to the negative impact of institutional problems
experienced by both groups, i.e. increased workload and
high overtime requirements due to the shortage of the
nursing staff in the hospital.

Change in burnout levels


At Time 1, while a substantial difference was observed
between the mean MBI emotional exhaustion scores of the
nurses in the study and control groups, there were no
significant differences in mean depersonalization and personal accomplishment scores. At time 2, the emotional
exhaustion and depersonalization scores of the study
group were lower; however, their personal accomplishment scores were higher than were those of the control
group. Based on this result, we can say that the burnout
levels of the nurses who participated in the Professional
Identity Development Education Program decreased.
There are reports associating the reduction in burnout
levels with the development of positive professional identity.11,12,16 There are several studies in which different
programmes were applied, but two studies performed by
Katz et al. (2005)31 and Italia et al. (2008)32 confirm our
findings.
We found that the emotional exhaustion levels in the
study group decreased at time 2, but this finding was not
statistically significant and that depersonalization levels
remained the same and personal accomplishment levels
increased significantly at time 2 compared to those at time
1. At the time 3 assessment, the emotional exhaustion and
personal accomplishment levels regressed to the levels at
time 1 whereas depersonalization elevated in relation to
the levels at time 2. This finding shows that the Professional Identity Development Education Program had a
positive impact on nurses burnout levels and protected
them against burnout, yet lost its effectiveness over time.

While there was no change in the emotional exhaustion


and personal accomplishment levels of the nurses in the
control group at time 2 or at time 3, there was a significant increase in their depersonalization levels. This
negative result in the control group can be interpreted as
another indication that the Professional Identity Development Education Program applied to the study group positively impacted burnout levels of the nurses and protected
them against burnout. Another reason possibly attributable to the increase in burnout level of the nurses in both
the study and control groups at time 3 is the fact as
previously mentioned, that a vast number of nurses
resigned their positions at the very hospital where the
study was conducted. Due to these resignations, the
remaining nurses had to constantly take on overtime and
work intensive shifts. Arguably, external (institutional)
factors such as deficiencies in staff and equipment may also
have had a negative impact on the burnout levels of registered nurses in both groups. Existing literature indicates
that the scope of the work, weekly work-hours, attributes
of the employing institution, workload and the mode of
the work also impact burnout.33

Change in job satisfaction levels


It was determined that the mean general and subscale
MSQ scores of the study group were higher than were
those of the control group at time 1, at time 2 and at time
3. Additionally, when the internal developments of the
groups are evaluated in terms of job satisfaction, the
general and subscale MSQ mean scores of the nurses both
in the study and control groups did not indicate any significant changes time 2 and time 3. Accordingly, it can be
concluded that the Professional Identity Development
Education Program was not effective in increasing job
satisfaction levels of nurses. One possible reason for this
may be the fact that the education programme applied was
not directly aimed at increasing job satisfaction levels in
nurses. Another possible explanation is that during the
implementation period of the study, work conditions of
the nurses were challenging, as mentioned above. These
conditions may have had a negative impact on the nurses
in both groups thus decreasing the effect of the programme applied. There are other studies whose findings
indicating that nurses job satisfaction is reportedly
affected by the work environment, management style,
scope of work and reward mechanisms.34,35 Some other
studies in the current literature show results that are
consistent with our findings, while the contents of the
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10

S Sabancogullari and S Dogan

programmes applied are not identical.36,37 Conversely,


there are also studies whose results contradict our findings. A few studies in the literature show that counselling
programmes applied to nurses have a positive effect on
nurses desire to stay in their jobs and their job satisfaction
levels.19,20,38

different hospitals in different working conditions and its


effectiveness should be repeatedly evaluated. Nurses
developed professional self is important since it contributes to a qualified nursing care and increases satisfaction in
care provided.

Conclusions and recommendations

This study has several limitations. The sample group is


small. The number of the nurses both in the study and
control groups is small. It demonstrates the results related
to the nurses working in only one hospital. Therefore, the
results of this study cannot be generalized to all other
hospitals.

Limitation of the study


In this quasi-experimental study with a total of 63 nurses
(33 study, 30 controls), the Professional Identity Development Education Program had a positive impact on the
professional identities of the nurses in the study group as
compared to those of the nurses in the control group.
During the research process, while burnout levels of the
nurses in the study group significantly decreased and
remained unchanged, burnout levels of the nurses in the
control group increased further. In other words, the
intervention reduced burnout levels in nurses. However,
no significant differences were observed in job satisfaction
levels of the subjects.
As evidenced by the results, the study programme
developed was effective in improving nurses professional
identities. The content of the programme directly aims to
increase job satisfaction and to reduce burnout levels. It is
expected that the development of professional identity
will increase job satisfaction and decrease burnout levels
among nurses. Several studies in the literature have determined that members of a profession with strong professional identity have higher job satisfaction and lower
burnout levels and occupational turnover rate among
them is low.15,18,19,20,37 This programme reduced the
burnout levels due to job dissatisfaction. Therefore, it can
be considered that it may increase job satisfaction levels in
the long term. In the literature too, a positive relationship
has been determined between nurses job satisfaction and
professional self-concept. Therefore, it can be recommended that nurses should be observed more than six
months after the training programme. It is also thought
that difficult and severe working conditions at the hospital
where the study was conducted may have reduced the
impact of the programme. It is expected that the effectiveness of the programme will increase if working conditions are improved. Therefore, any modification in the
content of the training programme is not recommended.
Professional Identity Development Program was developed for this study and implemented for the first time.
Therefore, it is recommended that the programme should
be applied to different samples of nurses working in
2014 Wiley Publishing Asia Pty Ltd

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