In Japan, the demand for nursing professionals is expanding due to an aging population and advances in medical care. According to a survey by the Japan Nurses Association, the average total years of experience for Experienced Newcomer Nurses (hereinafter referred to as “mid-career hires”) is 14.5 years, placing them in a career stage generally considered mid-level within the nursing profession [1]. Mid-career hires are presumed to learn more quickly than new graduates [2] and are valuable assets who can contribute immediately and help revitalize the organization. Consequently, the organizations that hire them have established unique training and support systems tailored to the diversity of their work histories, aiming to help them settle into the organization [3]-[5]. However, while the attrition rate within the first year of employment was 7.9% for new graduate nurses, it rose to 17.9% for mid-career hires (more than double) due to difficulties in adapting to unspoken rules and informal customs, as well as challenges in building relationships with existing staff [6].

Research examining how new entrants adapt to the workplace and organization is referred to as organizational socialization research. Schein defines organizational socialization as “the process by which new entrants learn and adapt to the value systems, norms, and behavioral patterns required by the organization, society, or group” [7]. Ashforth et al. [8] conducted a comprehensive review of organizational socialization research and developed a framework for organizational socialization, positing that various forms of learning influenced by both organizational interventions and individual agency lead to improved job performance, high achievement, and enhanced job attitudes. Within this framework, the outcomes of organizational socialization are “newcomer learning” as a direct or primary outcome, and “newcomer adaptation” as an indirect or secondary outcome. Much of this research on organizational socialization focuses on the “secondary outcomes (adaptation)” of socialization, such as job satisfaction and turnover intention, while the process leading to socialization—particularly the learning aspect—has not been sufficiently examined.

Furthermore, a review of previous domestic studies on mid-career hires revealed that most research has been conducted at the single-facility level, focusing on the support sought by mid-career hires and factors influencing job retention [9]-[12]. However, there is no mention of what mid-career hires learn or the extent to which they learn during the organizational socialization process. Therefore, there is a need to develop a scale that quantitatively measures the “learning” aspect of organizational socialization among Experienced Newcomer Nurses.

By developing a scale focused on learning for organizational socialization, clinical managers can assess the extent to which mid-career hires learn and consider continuing education and organizational support. For mid-career hires, self-assessment of their learning level provides an opportunity for reflection and promotes further learning. Furthermore, by using the learning scale to facilitate reflection, which in turn promotes organizational socialization, we can expect improvements in job satisfaction and organizational commitment among mid-career hires as well as better adaptation to and retention within the new organization. This will not only help secure human resources but also improve the quality of nursing practice.

The purpose of this study was to develop a “Learning Scale for the Organizational Socialization of Experienced Newcomer Nurses” and to evaluate its face and content validity.

We sent explanatory materials to participants regarding the purpose of the study and ethical considerations, including the research objectives, methods, protection of participants’ human rights, protection of personal information, and disclosure of results. Consent was obtained from participants upon return of the questionnaire. This study was approved by the Research Ethics Committee of our affiliated institution. When publishing the results, we used anonymized data to ensure that individuals could not be identified.

Fourteen self-administered questionnaires were returned (response rate: 93.3%). Lynn recommended five to ten raters for the I-CVI; however, noted that the maximum number of raters has not been established [16]. Ogasawara [17] stated that among nursing professionals, it is rare for nurses to have experience in scale development, and because they are unfamiliar with terms such as “concepts” and “conceptual definitions”, they find them extremely difficult to understand. Therefore, in this study, it was considered that involving a larger number of experts in evaluating the I-CVI would contribute to ensuring validity. Accordingly, the 14 individuals who agreed to participate were included as raters, and this was judged to be an appropriate approach. The breakdown of participants consisted of seven clinical nursing managers involved in the education and support of mid-career hires (holding positions of Head Nurse or higher, with a master’s degree or higher, or certified nursing manager qualifications), and seven researchers in nursing management who were well-versed in scale development.

Table 1 presents the I-CVI results for the 75 items extracted from the interview surveys and a literature review of the learning processes for organizational socialization of Experienced Newcomer Nurses. Of the 75 items, 48 met the criterion with an I-CVI of 0.78 or higher. Twenty-seven items were excluded based on the exclusion criteria. The detailed process of item-level refinement is described below.

For Concept 1: Acquire the necessary knowledge and skills in the newly established department, which initially consisted of 16 items, items 11, 12, and 13 were first removed due to I-CVI values below 0.78. Although the remaining items met the I-CVI criterion, several were considered redundant based on expert feedback. Accordingly, items 6, 9, and 10 were integrated into item 4; item 7 was integrated into item 8; and item 15 was integrated into item 5. In addition, based on their content, items 14 and 16 were reassigned to Concept 2.

For Concept 2: Expanding one’s nursing skills through re-employment, the concept name was revised to “Deepen your understanding of nursing knowledge and skills based on the experience you have cultivated” in order to more clearly reflect the characteristics of experienced newcomer nurses. Of the eight items included in this concept, items 18, 20, 21, 22, and 23 were removed due to I-CVI values below 0.78. Although item 24 (“By experiencing a variety of cases, you can hone your patient education skills”) had an I-CVI of 0.79, it was excluded because it was considered context-specific and lacked generalizability.

For Concept 3: Developing communication skills considerate of existing staff, which consisted of seven items, items 26 and 27 were removed due to low I-CVI values. Experts suggested that, prior to behaviors such as “Determine the timing and method for asking questions to existing staff members” (item 28) and“ Answer in a way that takes the other person’s perspective into consideration” (item 29), individuals likely observe interpersonal relationships among existing staff. Therefore, item 17 (“We are assessing the interpersonal relationships among existing staff members”) was added.

For Concept 4: Modifying previously acquired skills to align with institutional standards and procedures, all items met the I-CVI criterion; however, items 35 and 37 were considered redundant and were integrated into item 24.

For Concept 5: Strictly follow the hospital manual, all four items met the I-CVI criterion; however, items 39 and 40 were integrated and revised as item27 (“I know that there are established record-keeping standards set by the hospital”).

For Concept 6: Performing duties in accordance with hospital management policies, item 43 was removed due to an I-CVI of 0.75, and three items were retained. This concept was then integrated with Concept 5, and the concept name was revised to “Understand that rules differ from hospital to hospital and act in accordance with the hospital’s polcies”.

For Concept 7: Act based on value judgments cultivated through past practical experience, four items (51, 52, 55, and 56) were removed due to I-CVI values below the threshold.

For Concept 8: Find a compromise and accept the department’s rules, all items failed to meet the I-CVI criterion, and therefore the concept was eliminated.

For Concept 9: Accept that departmental rules cannot be changed and perform your duties accordingly, five of the nine items (61, 62, 63, 65, and 66) were removed due to low I-CVI values. However, three items—item 60 (“Accept that you can’t change the department’s unique rules.”), item 64 (“Instead of insisting on your own opinion, conform to the department’s norms.”), and item 67 (“I do my job even though I think it’s wrong and I compromise.”)—were retained after revision.

The rationale for retaining these items is as follows. Experienced newcomer nurses enter new organizations with established professional expertise and value systems; therefore, adjusting to existing organizational norms becomes an important learning task. Organizational socialization theory emphasizes the process by which newcomers understand and internalize organizational values and behavioral patterns [13], particularly in the early stages when adaptation to norms is required. Previous studies in nursing have also reported that experienced newcomer nurses often conform to workplace practices despite discomfort and prioritize maintaining interpersonal relationships [18][19]. Therefore, these items were considered essential components of the learning process.

For Concept 10: Utilize practical skills to fulfill the required role, items 68 and 73 were removed due to low I-CVI values. The retained items were revised based on expert feedback.

For Concept 11: Re-examining what nursing is in the context of re-employment, both items met the I-CVI criterion and were retained. However, due to the revision of Concept 2, it was deemed appropriate to integrate these items into Concept 2; thus, items 74 and 75 were reassigned.

Following these refinements, the scale was reorganized into eight concepts:

(1) acquire the necessary knowledge and skills in the newly established department;

(2) deepen your understanding of nursing knowledge and skills based on the experience you have cultivated;

(3) develop communication skills that are considerate of existing staff;

(4) modify acquired skills to conform to hospital operational standards and procedures;

(5) understand that rules differ from hospital to hospital and act in accordance with the hospital’s policies;

(6) act based on value judgments cultivated through past practical experience;

(7) accept that departmental rules cannot be changed and perform your duties accordingly;

(8) utilize experience to fulfill the required role.

The final scale consisted of 43 items (Table 1). The scale-level content validity index (S-CVI) was 0.89, which was slightly below the recommended threshold of 0.90 proposed by Polit and Beck; however, it was judged to indicate generally acceptable content validity [20].

Table 1. Content validity of the learning scale for organizational socialization among experienced newcomer nurses: item revision from 75 to 43 items.

Although this study examined face and content validity, the reliability and validity of the scale are not yet sufficient. In the future, it will be necessary to verify construct validity and reliability among mid-career hires to improve the accuracy of the scale.

The “Learning Scale for Organizational Socialization of Experienced Newcomer Nurses” was developed with 43 items, following an expert review of face validity and content validity indices. This resulted in the development of a scale with both face and content validity. To enhance the practicality of the scale, its reliability and validity must be verified among experienced nurses.

We would like to express our sincere gratitude to all the participants and stakeholders who cooperated in this study. This study was based on a doctoral dissertation submitted to the Graduate School of Nursing, Osaka Prefecture University, with additional revisions and modifications.