Influence of Previous Work Experience on Self and Team Efficacy of Nurses in Small and Medium Sized Hospitals

Introduction : Nurses have always been in high demand in Japan due to the advancement of aging society with falling child birthrates and decline of population of people. A growing need for nursing workforce has brought about the increase in male nurses and foreign nurses, and the introduction of entrance examination systems for adults working in society. Hence, nursing teams currently comprise nurses with various backgrounds. In particular, the number of new graduates with previous work experience has increased. With an increment in non-first career nurses, they are attracting attention, and contributing team medical care and the development of nurse organizations based on their diverse experiences. According to self-efficacy theory (Bandura, 1977) 1) , self-efficacy and team efficacy are essential to develop closely-knit organization. In this study, we aimed to clarify the influence of previous work experiences on self-efficacy and team efficacy of nurses. Methods : To clarify the influence of previous work experience on self-/team efficacy from the viewpoint of age, gender, and job position, a self-reported questionnaire was distributed to 784 nurses at 18 hospitals less than 300 beds in 2016. Valid responses were obtained from 417 nurses (valid response rate: 53.2%), 37 of which were head nurses and the others were staff nurses. They were all female nurses. The mean age was 37.89 years old (SD = 9.31). The questionnaire consisted of two sections, the first of which was a face sheet. The second section was designed to assess the degree of self-/team efficacy using the scale developed by Takahashi et al. (2010) based on CEQS scale. Results and Future study : We hypothesized that staff nurses with previous work experience have high self-efficacy and head nurses with previous work have high team efficacy. However, contrary to our hypothesis, the results did not support this hypothesis (see Figure). In the field of sports research, it was found that high team effectiveness is positively correlated with team performance. However, for nurses with other professional experience, we think that there is a possibility that team performance cannot be fully achieved by high level of individual self-efficacy. In further endeavor, we need to proceed to research on factors enhancing the teamʼs effectiveness consisted of diverse background.


Introduction
Nurses have always been in high demand in Japan due to the advancement of aging society with falling child birthrates and decline of population of people. A growing need for nursing workforce has brought about the increase in male nurses and foreign nurses, and the introduction of entrance examination systems for adults working in society. Hence, nursing teams currently comprise nurses 48 Original Articles Juntendo Medical Journal 2018. 64 (Suppl 1), 48-51 with various backgrounds. In particular, the number of new graduates with previous work experience has increased. With an increment in non-first career nurses, they are attracting attention, and contributing team medical care and the development of nurse organizations based on their diverse experiences. According to self-efficacy theory (Bandura, 1977(Bandura, , 1986, self-efficacy and team efficacy are essential to develop closely-knit organization. In this study, we aimed to clarify the influence of previous work experiences on selfefficacy and team efficacy of nurses.

Methods
To clarify the influence of previous work experience on self-/team efficacy from the viewpoint of age, gender, and job position, a self-reported questionnaire was distributed to 784 nurses at 18 hospitals less than 300 beds in 2016. Valid responses were obtained from 417 nurses (valid response rate: 53.2%), 37 of which were head nurses and the others were staff nurses. They were all female nurses. The mean age was 37.89 years old (SD = 9.31). The questionnaire consisted of two sections, the first of which was a face sheet. The second section was designed to assess the degree of self-/team efficacy using the scale developed by Takahashi  The questionnaire was consisted of 20 items, self-evaluated and answered with 6 points from"completely applicable to" "completely inapplicable"to each question item.

2) Nurse team efficacy scale
Based on the CEQS scale developed by Short (2005), we used the"Nurse Team Efficacy Scale" created by Takahashi et al. which is composed of a reply with 5 points of"I am very confident" from"one with no confidence" .

Self-efficacy feeling without professional experience
At the self-efficacy scores, t-tests were conducted for nurses with no other career profession and nursing experience, and t (418)= 0.8, p = 0.41, meaning no significant difference was observed. At the average point there was a high result with other work experience with 65.5, without 64.5 ( Figure-1).

Experience with work, Team-efficacy
A t-test was conducted to nurses with no other professional experience and who did not have a professional sense of team, but no significant difference was found at t (418)= 0.58, p = 0.56. At the average point, there were other professional experience 62.4, none 63.0 and none was high ( Figure-2).

Sense of self-efficacy by age and team efficacy by years of experience
One factor in each age category according to the analysis of variance, in the 20s and 50s, a significant difference was observed at 1% (Figure-3). A significant difference was observed at the 5% level in the 20s and 30s, and in the 20s and 40s. In  self-efficacy by years of experience, a significant difference of less than 3 years, 11 to 20 years, and 20% or more was found at 5%. Furthermore, a significant difference of 5% was observed between 3 to 5 years, 11 to 20 years, and over 20 years. Also, a significant difference of 5% was observed between 6 to 10 years and 11 to 20 years, over 20 years (Figure-4).

Discussion
Self-efficacy is the social cognitive theory advocated by Bandura. The belief of efficacy influences peopleʼ s way of thinking, feeling, motivation, and action. The central point of this concept is about the problem of causality. Such a belief contributes significantly to human motive and accomplishment (Bandura, 1992a) 2) ．In addition, the psychological processes of humans in executing things can be confirmed (results expectation) that such results can be obtained if an action is taken and the actions necessary for realizing the result. It is made up of two elements of confidence that we can do (efficacy expectation). I think that nurses who experienced other occupations have recognized self-efficacy in the process. In the field of sports research, the effectiveness of the high team was found to be positively correlated with the performance of the team. However, according to a study, the team of nurses is different from the group in business organizations. That is to achieve the task within the organization after obtaining approval from the team first. That is, the order is reverse to that of a company. This means that for nurses with other professional experience, we think that there is a possibility that team performance cannot be fully achieved by high level of individual self-efficacy. In addition, it is thought that the lower levels of the middle class in nursing organization feel "uncertainty about the future of career" 3) which should be called"career mist"of the concept that Yamamoto advocates in the course of his experience."From the psychological point of view, it should be to deal with that the weight of responsibility, the lack of confidence, feeling of anxiety, and suffering that the position changes, the feeling of insufficiency accompanying promotion approved by others in addition to the original work as professionals such as feeling hard to get realized, feeling disagreement between self evaluation and others evaluation (Matsushita, 2016)" 4) , because role will also occur as a middle-ranking existence within the team, it is thought that it is related to the environmental factor which makes it difficult to raise self-efficacy, but rather decreases it. From the results of this study, it was suggested that high level of self-efficacy of nurses with other professional experience does not necessarily lead to the team effectiveness. In the field of sports research, it was found that high team effectiveness is positively correlated with team performance. Nurses are professionals working as a team, and their work demands highly trained professionals. Therefore, it is necessary to further examine factors which enhance the sense of team effectiveness for constructing nursing organizations based on diverse experiences.

Conclusion
Self-efficacy was higher for nurses with other professional experience. However, the sense of team effectiveness was revealed to be low. In this study, it was not necessariliy successful to clarify the detail factors. In further endeavor, we need to proceed to research on factors enhancing the teamʼs effectiveness consisted of diverse background.