Five factors exacerbate occupational alienation among nurses: development and application of Clinical Nurse Occupational Alienation Scale

Against the backdrop of a persistent global shortage of nursing human resources and prominent job stress and retention difficulties among Chinese nurses, some nurses have exhibited occupational alienation characterized by psychological detachment and decreased engagement despite remaining in their positions, while existing measurement tools have limitations in cultural adaptability and structural stability. This study aims to develop a reliable and valid Clinical Nurse Occupational Alienation Scale (NOAS) that is applicable to the Chinese cultural context, and to conduct preliminary application research to provide a scientific basis for assessment and intervention.

A cross-sectional study design was adopted. From June to October 2025, clinical registered nurses were recruited from 6 hospitals in Chongqing through multistage stratified convenience sampling. In the scale development and validation phase, an initial NOAS item pool was constructed based on literature review, and a pilot version of the NOAS was formed after Delphi consultation, cognitive interviews, and a preliminary survey. The participants were divided into Group A (n=441) and Group B (n=318). Group A was used for item analysis and exploratory factor analysis (EFA), and Group B was employed for confirmatory factor analysis (CFA) and reliability/validity testing. Group C (a random subsample from Group B, n=78) was utilized for test-retest reliability testing. In the scale application phase, a general information questionnaire and the final version of the NOAS were used for cross-sectional status surveys to analyze the current status of occupational alienation among clinical nurses and its influencing factors.

The final version of the NOAS consisted of 53 items across 6 dimensions: work overload, powerlessness, emotional exhaustion, loss of professional meaning, relational isolation, and value conflict. EFA extracted 6 common factors with a cumulative variance explanation rate of 69.45%, and factor loadings ranging from 0.69 to 0.81. CFA indicated good fit for the 6-factor model (χ²/df=2.27), with a comparative fit index (CFI) of 0.92, a Tucker-Lewis index (TLI) of 0.92, a root mean square error of approximation (RMSEA) of 0.06, and a standardized root mean square residual (SRMR) of 0.06. The average variance extracted (AVE) for each dimension ranged from 0.49 to 0.61, and composite reliability (CR) ranged from 0.88 to 0.92. The total NOAS score was significantly positively correlated with the emotional exhaustion dimension of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) (r=0.74) and significantly negatively correlated with the total score of the Utrecht Work Engagement Scale (UWES-17) (r=-0.69). The Cronbach’s α coefficient for the total scale was 0.96, and the test-retest intraclass correlation coefficient (ICC) was 0.85. The cross-sectional survey revealed the total occupational alienation score of 16.80±4.20 among clinical nurses, and 56.65% of nurses had the total score exceeding the theoretical median. Night shift frequency had the greatest impact on occupational alienation (β=0.33), followed by department type (β=0.19), average monthly income (β=-0.16), hospital grade (β=0.14), and gender (β=0.13). The model explained 34.10% of the total variance in occupational alienation among clinical nurses.

The 6-dimensional NOAS developed in this study demonstrates good reliability, validity, and cultural adaptability, and can effectively assess the level of occupational alienation among nurses. High night shift frequency, working in acute/critical care departments, working in tertiary hospitals, being male, and low income are risk factors for increased alienation, providing evidence-based support for nursing management interventions.