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Original Article

The use of Career Growth Scale in Chinese nurses:

Validity and reliability

Jingying Liu a, Jipeng Yang b, Yanhui Liu a,*, Yang Yang a, Hongfu Zhang a
a
School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
b
School of Acupuncture, Tianjin University of Traditional Chinese Medicine, Tianjin, China

article info abstract

Article history: Purpose: To test the validity and reliability of a modified Career Growth Scale (CGS) to assess
Received 11 September 2014 nurse career growth.
Received in revised form Method: A cross-sectional design was used to analyze the use of the CGS to survey 600 full-
27 January 2015 time registered nurses from Grade A hospitals in Tianjin.
Accepted 29 January 2015 Results: A modified scale we called Career Growth of Nurse Scale (CGNS) is acceptable, valid,
Available online 10 March 2015 and reliable for the evaluation of nurse career growth in Chinese hospitals. This scale
measured three main factors (career goal, career capacity, and career opportunity) and
Keywords: showed that nurse career growth differed across age, work seniority, and professional title.
Career growth Conclusions: A three-dimensional scale of nurse career growth was presented. The results
Nurses revealed CGNS has good validity and reliability.
Factor analysis Copyright 2015, Chinese Nursing Association. Production and hosting by Elsevier
Validity (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://
Reliability creativecommons.org/licenses/by-nc-nd/4.0/).

have reported that numerous nurses do not have career goals

1. Introduction
Nurses, comprising the largest group of health providers in
most hospital settings [1], have a particularly important effect
in the quality of care in the healthcare system. They play a
significant role in ensuring patient safety and recovery, while
providing timely, effective, and efficient medical care, there-
fore affecting the overall quality of healthcare organizations
[2,3]. The shortage of registered nurses is a serious global
problem that has also presented in China [4] and is predicted
to negatively affect the healthcare system. Previous studies
or a plan for their professional development and proposed
that that could be why they abandon their career before they
become eligible for retirement [5]. Lack of career growth, to
some extent, may preclude the development of a nursing
team [6], threatening nurses' health and leading to high
turnover. Therefore, it is extremely important to solve the
shortage of registered nurses by attracting potential candi-
dates to join this career and by increasing nurse job
satisfaction.
Numerous studies have focused on the role that career
growth plays on nurse retention in the healthcare system [7].

*
Corresponding author.
E-mail addresses: 15102295393@163.com (J. Liu), y516942713@yeah.net (J. Yang), yh_liu888@163.com (Y. Liu), 782926472@qq.com
(Y. Yang), 962903239@qq.com (H. Zhang).
Peer review under responsibility of Chinese Nursing Association.
http://dx.doi.org/10.1016/j.ijnss.2015.01.010
2352-0132/Copyright 2015, Chinese Nursing Association. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
 i n t e r n a t i o n a l j o u r n a l o f n u r s i n g s c i e n c e s 2 ( 2 0 1 5 ) 8 0 e8 5
Career growth measures the speed of the employee career
development [8]. Many researchers have measured both
objective and subjective career growth within the employee's
current organization [9,10]. Weng and McElroy [11] focused on
individual career growth in their current organization by
measuring four factors: career goal, career ability, promotion
speed, and salary increase.
The terms career growth, career development, and
career success have been used interchangeably [12,13];
however, important differences exist among them. Career
growth can be used to assess how fast employees progress in
their current organization. Career growth is a consequence of
career success, which combines employee's positive feelings
towards their job and career accomplishment [14]. Career
development takes into account organizational perspectives,
which include personal career growth and career success by
promoting individual development as a means to increase
organizational achievement [15].
Increasingly, turnover is considered more normal than
before [16]. Career growth has been proven to have a positive
effect on career outcome and intent to remain in the current
organization [17,18]. Previous studies have investigated the
relationship between career growth and occupational
commitment [19]. Furthermore, researchers have noted that
career growth plays a role on turnover intentions and indi-
vidual attitudes [20,21]. These studies suggest that nurse job
stability could be increased by improving their career growth.
Therefore, appropriate measures should be taken to accel-
erate nurse career growth. To promote the quality of nurse
teams and decrease turnover, healthcare services are required
to implement a process for evaluating clinical nurse career
growth within their organization.
Unfortunately, whereas many studies have explored the
process of employee career growth itself, relatively insuffi-
cient research has been devoted to the study of the methods
used for measuring career development and advancement
[22e24]. Therefore, the development and validation of a
method for measuring nurse career growth is necessary.
Weng and Xi [8] developed the original Career Growth Scale
(CGS), which measures career goal, career ability, promotion
opportunity, and salary increase to assess career growth. The
CGS has been broadly applied to evaluate employee career
development; however, it has never been used to study Chi-
nese nurses. In the present study, we assessed the psycho-
metric properties of the Chinese version of the CGS and
developed a new scale for assessing nurse career growth,
which we named Career Growth of Nurses Scale (CGNS). The
CGNS fills a gap and provides policy makers, administrators,
nurse leaders, and educators with indications on how to
improve nurse career growth in their current organization,
promoting nurse job satisfaction and retention.
2. Methods
2.1. Aim
The aim of this study was to test the validity and reliability of
the Chinese version of the CGS for assessing nurse career
growth.
81
2.2. Design
A cross-sectional design was used in the present study.
2.3. Sample and participants
A convenience sample of 600 full-time registered nurses from
Grade A hospitals in Tianjin was surveyed between October
2013 and March 2014. A total of 526 questionnaires were
returned, out of which 74 were rejected due to incomplete
responses (effective response rate 87.7%). For factor anal-
ysis, an acceptable participant to item ratio is 1:10, indicating
that, for our study, a minimum of 150 subjects were required.
Our sample of 526 participants therefore met the sample size
requirement. The total number of participants was divided in
two samples. Exploratory factor analysis (EFA) was conducted
on the first sample (n 300) and confirmatory factor analysis
(CFA) was conducted on the second sample (n 226). Four
weeks after the initial analyses, a convenience subsample of
30 nurses was recruited for measuring the test-retest reli-
ability (effective response rate 100%).
2.4. Instruments
Nurse demographic data included personal details, such as
gender, age, marital status, work seniority, and professional
title. These variables potentially influence career growth.
The original CGS is a questionnaire developed by Weng and
Xi [8] containing 15 items, each of which is rated on a 5-point
Likert scale ranging from strongly disagree (1) to strongly
agree (5). The scale includes four sub dimensions: career
goal, career capacity, promotion speed, and salary in-
crease. The total CGS score, ranging from 15 to 75, is obtained
by adding the values for the four sub dimensions. A higher
score on the scale denotes a higher level of career growth. For
the original version of the scale, the Cronbach's a coefficients
of the four sub dimensions were 0.86, 0.85, 0.80, and 0.78.
Two language experts were involved in our translation
process, providing support for the Chinese version of the
CGNS regarding content, semantic, and conceptual
equivalence.
2.5. Ethical considerations
Before completing the questionnaire, the purpose of the study
was explained to the participants. To ensure anonymity,
names were omitted. The participants were included in the
study voluntarily. Ethical approval was obtained from the
relevant hospitals' ethics committees.
2.6. Statistical analysis
Data were analyzed using SPSS for Windows (version 15) and
AMOS (Analysis of Moment Structures, version 15; Chicago, IL,
USA). Descriptive statistics were used to summarize sample
characteristics. One-way analysis of variance tests were used
to assess the relationship between certain characteristics of
nurses. Item-total score correlation and test-retest reliability
were assessed using the Pearson's correlation coefficient.
Content validity index (CVI) was used to describe content
82 i n t e r n a t i o n a l j o u r n a l o f n u r s i n g s c i e n c e s 2 ( 2 0 1 5 ) 8 0 e8 5

validity. Six nurse specialists, including three nurses, two

Table 2 e Career Growth Scale scores and internal
teachers, and one nurse administrator, were invited to form a
correlation analysis between career growth and four sub
committee for assessing the CVI. The internal consistency dimensions of the scale.
reliabilities of the CGNS were estimated using the Cronbach's
Score Correlation coefficient
a coefficient. The factor structure of the instrument was tested
by EFA and CFA. All statistical tests were two-sided (a 0.05). Mean SD (1) (2) (3) (4) (5)
(1) Career growth 2.34 0.52 1.00
(2) Career goal 2.53 0.69 0.80* 1.00
(3) Career capacity 3.01 0.59 0.58* 0.46* 1.00
3. Results (4) Promotion speed 1.85 0.71 0.86* 0.48* 0.17* 1.00
(5) Salary increase 1.94 0.87 0.73* 0.37* 0.10* 0.90* 1.00
3.1. Participant characteristics *p < 0.01.

The demographic characteristics of the participants are

summarized in Table 1. Five hundred and twenty (99%) nurses
were female. Two hundred and eighty-seven (73%) nurses
were between 20 and 29 years old. Three hundred and forty-
seven (58%) nurses were unmarried. One hundred and
ninety-seven (56%) nurses had 1e5 years of working experi-
ence. Two hundred and fifteen (41%) nurses had no additional
professional title and 209 (40%) nurses were nurse practi-
tioners. Nurse career growth differed across age (F 2.721,
p < 0.01), work seniority (F 4.139, p < 0.01), and professional
title (F 5.703, p < 0.01), as shown in Table 1. (F homogeneity
test of variance).
3.2. Internal correlation
Internal correlation analysis for the CGS is shown in Table 2.
In general, the score for career growth and those for the four
sub dimensions (career goal, career capacity, promotion
speed, and salary increase) were positively correlated with
each other (r 0.10e0.90, p < 0.01).
3.3. Content validity
The content validity index (CVI) of the scale was computed by
counting the number of experts who were in agreement about
the relevance of each item included in the questionnaire. The
average CVI was 0.947, which is acceptable.
3.4. Construct validity
The Kaiser-Meyer-Olkin (KMO) value was 0.871 and the Bar-
tlett's test of sphericity revealed a c2 value of 1661.612
(p < 0.001), indicating that CGNS data met the psychometric
criteria to proceed with factor analysis. The original CGS
included four factors: career goal (items 1e4), career ca-
pacity (items 5e8), promotion speed (items 9e12), and
salary increase (items 13e15). In our study, all items loaded
on three factors. Items 1e4 loaded on factor 1 (career goal),
with factor coefficients ranging from 0.769 to 0.849. Items

Table 1 e Demographic characteristics of the participants and career growth score.

Variables Number Percentage Career growth (mean sd) F Post-hoc analysis
Gender 0.419
Female 520 0.99 2.44 0.53
Male 6 0.01 2.18 0.41
Age (yr) 2.721* a
(1) < 20 3 0.01 2.56 0.60
(2) 20e30 287 0.73 2.48 0.52
(3) 30e40 162 0.24 2.42 0.54
(4) > 40 74 0.02 2.29 0.48
Marital status 0.335
Married 179 0.42 2.47 0.51
Unmarried 347 0.58 2.43 0.53
Work seniority (yr) 4.139* b
(1) < 1 37 0.06 2.30 0.37
(2) 1e6 197 0.56 2.51 0.54
(3) 6e11 132 0.24 2.43 0.58
(4) 11e20 88 0.12 2.44 0.45
(5) > 20 72 0.02 2.34 0.48
Professional title 5.703* c
(1) Nurse 215 0.41 2.52 0.51
(2) Nurse practitioner 209 0.40 2.42 0.54
(3) Nurse-in-charge 99 0.19 2.28 0.49
(4) Professor of nursing 3 0.00 2.84 0.30
*
p < 0.01; a (4) significantly different from (2); b (4), (5) significantly different from (1), (2); c (1), (2), (3) significantly different from each other.
sd standard deviation.
 i n t e r n a t i o n a l j o u r n a l o f n u r s i n g s c i e n c e s 2 ( 2 0 1 5 ) 8 0 e8 5 83

5e8 loaded on factor 2 (career capacity), with factor co-

efficients ranging from 0.757 to 0.846. Items 9e15 loaded on
factor 3 (career opportunity), with factor coefficients ranging
from 0.679 to 0.817. After factor analysis, the three factors
were identified accounting for 63.015% of the variance, with
all 15 items factor loading coefficients above 0.60. Table 3
shows factor coefficients for CGNS items after varimax
rotation.
The CFA modified data indexes were as follows:
c2 59.983; c2/df ratio 0.811; GFI (goodness-of-fit
index) 0.966; AGFI (adjusted goodness-of-fit index) 0.945;
NFI (normed fit index) 0.964; CFI (comparative fit
index) 1.000; TLI (tacker-lewis index) 1.013; and RMSEA
(root mean square error of approximation) 0.000. All path
loadings were significant at p < 0.001. The parameter esti-
mates of the CFA are shown in Fig. 1.

Fig. 1 e Standard path and parameter estimation for the

3.5. Reliability Career Growth of Nurses Scale.

The Cronbach's a coefficients for the CGNS scores for the sub
dimensions ranged from 0.832 to 0.871, indicating good in-
ternal consistency reliability. Four weeks after the initial
assessment, the same CGNS was applied to 30 nurses who
were willing to join the study for measuring the testeretest
reliability. The high positive correlation (r 0.870, p < 0.01)
suggests that the CGNS is stable.
4. Discussion
In this work, we showed that the CGNS is an appropriate
method for assessing career growth in nurses from Grade A
hospitals from Tianjin, China. With a CVI score of 0.947, the
content of the CGNS is acceptable (a CVI score of 0.80 has been
previously considered to indicate good content validity) [25].
Cronbach's a coefficients for the three sub dimensions of the
scale ranged from 0.832 to 0.871, which were similar to those
found in previous studies [8,26], indicating good internal
consistency reliability. In addition, our test-retest analysis
showed that the CGNS was stable (r 0.870, p < 0.01).
Internal correlation analysis showed that career growth
and the four CGS sub dimensions were positively correlated
with each other (r 0.10e0.90, p < 0.01), demonstrating that
the CGS has good construct validity. In the first stage of our
study, EFA supported a 15-item scale with a three factors
model: Factor 1 (career goal), containing four items; factor 2
(career capacity), containing four items; and factor 3 (career
opportunity), containing seven items. The EFA showed that all
15 items had a factor loading coefficient > 0.60. We named this
new scale Career Growth of Nurses Scale (CGNS). Career goal
reflects the consistency between the individual's career goal
and the goal of the organization. Career goal provides direc-
tion, giving nurses motivation to engage in their work. Career
capacity reflects how much ability employees acquire in the
current organization and estimates the extent of knowledge

Table 3 e Factor loading coefficients for the Career Growth of Nurses Scale items after varimax rotation.
No. Item description F1 F2 F3
1 Current job makes me closer to my career goals 0.849
2 Current job was related to my career goals, career ideal 0.845
3 Current job lays a foundation for my career objective 0.769
4 Current job provides me with good development opportunities 0.772
5 Current job facilitates me to learn new work-related skills 0.845
6 Current job facilitates me to learn new work-related knowledge 0.831
7 Current job facilitates me to accumulate abundant experience 0.846
8 I feel my career ability enhanced and improved 0.757
9 In current work unit, my position improves faster 0.755
10 In current work unit, my position is likely to move up 0.817
11 In current work unit, my position is more ideal than original unit 0.706
12 Compared with my colleagues, my position improves faster 0.784
13 In current work unit, my salary raises faster 0.679
14 In current work unit, my present salary is likely to raise 0.770
15 Compared with my colleagues, my salary raises faster 0.712

F1 career goal; F2 career capacity; F3 career opportunity. All values are significant and greater than 0.05.
84 i n t e r n a t i o n a l j o u r n a l o f n u r s i n g s c i e n c e s 2 ( 2 0 1 5 ) 8 0 e8 5
and skills they learn. In our CGNS, the items that previously
loaded into promotion speed and salary increase in the
CGS were combined into only one factor (career opportunity)
after varimax rotation. Career opportunity relates to the
feedback nurses receive regarding the growth of their career
and reflects their perception of promotion speed and salary
increase. Job satisfaction is positively correlated with career
opportunity [27,28]. The amount of effort employees put into
their work increases when they attain career opportunity. The
study of Weng and McElroy [11] estimated that promotion
speed and salary increase were highly correlated, providing
powerful support for our results. Salary and promotion data
were obtained by observing daily work performance. Nurses
were satisfied after getting a promotion and salary increase
after striving for a long time [29].
Using CFA, we confirmed that the CGNS fitted well into a
three factor model and that all items were found to contribute
significantly to their respective latent constructs, providing
powerful support for construct validity of the Chinese version
of the scale [30]. Therefore, the CGNS is more appropriate than
the CGS to assess nurse career growth in China.
Regarding demographic characteristics, we found that
nurse career growth differed across age, work seniority, and
professional title. The level of career growth was higher for
young nurses (<20 years old) and for nurses with work
seniority of under one year. During this period, they try their
best to pursue their career goals and their career capacity is
improved by persistently practicing their skills so that they
can grow professionally. Moreover, career growth was at the
highest level in nurses that were professors of nursing. Pro-
fessors of nursing make a significant contribution to hospitals
and grow professionally during this process, achieving
enough room for development within their organization;
therefore, their career growth is higher than that of nurses
who have other professional titles. This observation indicates
that administrators should take appropriate measures so that
people who have longer working experience can increase their
career growth, in this way avoiding high turnover. In addition,
they should pay more attention to nurses with professional
titles other than professor, providing opportunities for them
to practice and grow.
Further studies are recommended to explore new scales
that could assess nurse career growth to compare to the
CGNS, providing a better understanding of nurse career
growth. A profound analysis of the characteristics influencing
nurse career growth should also be conducted. Overall, our
study indicates that the CGNS is an acceptable, valid, and
reliable scale for the evaluation of nurse career growth in
China.
5. Limitations
This study has limitations. Self-reported data may be less
accurate than data provided by external observers, so it would
be worth performing the same test using external observers.
Participants were limited to Grade A hospitals in Tianjin and
may not be representative of all general nurses in China. The
samples should therefore be extended to other hospitals and
other cities.
6. Conclusion
In this study, we used the Chinese version of the CGNS in a
large number of nurses from Grade A hospitals. Our results
support a 15-item, three-dimensional scale to measure career
growth that evaluates career goal, career capacity, and career
opportunity as a valid and reliable scale to study Chinese
nurses. The CGNS can be therefore recommended as a tool to
measure nurse self-perceived career growth.
Funding statement
Financial support for this research was received from the
National Ministry of Education (11YJCZH112).
Conflict of interest
No conflict of interest has been declared by the authors.
Acknowledgements
The authors gratefully acknowledge the supervisors and 600
nurses who participated in this study for their assistance, as
well as all the experts and members of our group for their help
and advice.
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