Organisational support linked to training willingness in Chinese hospital nurses

Nurses who perceived stronger organisational support for training and professional development were more willing to undertake further diabetes-related training in a cross-sectional survey of 337 clinical nurses at a three-campus tertiary hospital group in China. The study found that support for training and competency development was independently associated with greater learning willingness, as were opportunities for professional development. Years of clinical practice, professional title and diabetes liaison nurse status were not independently associated with learning willingness after adjustment for these organisational factors. The findings identify workplace resources as potential subjects for future intervention research, but the survey design cannot establish that organisational support causes stronger learning motivation, improved clinical competence or better patient outcomes.

The research focused on the concrete structures surrounding a hospital-wide diabetes nursing team system rather than on nurses’ general feelings about employer support or their objectively demonstrated diabetes knowledge. In the participating system, 87 unit-based diabetes liaison nurses—one in each of 77 clinical departments and 10 emergency or outpatient units—worked alongside eight central quality-control members. Liaison nurses remained in their primary departments while helping implement diabetes-related nursing procedures, disseminate training information, provide patient education, communicate with the central team and supervise relevant quality-control requirements. They received additional structured training organised by hospital nursing administration and the diabetes nursing team and were required to participate in diabetes-related training at least once per quarter.

The hospital group’s campuses at Jianhua, Fanxilu and Fangbei operated under unified nursing governance, shared clinical protocols and coordinated training and quality-control processes. Registered nurses providing direct patient care in endocrinology and non-endocrinology departments were eligible, including nurses working in internal medicine, surgery, intensive care, outpatient services and other clinical units. Trainee nurses, student nurses and administrative staff without direct patient-care responsibilities were excluded. Of the 337 participants, 41.2% worked in endocrinology and 58.8% in non-endocrinology departments. Nearly half were senior-level N3–N4 nurses, while 70.9% held supervisor nurse titles. Mean clinical experience was 13.0 ± 6.1 years, and 56 participants, or 16.6%, were diabetes liaison nurses.

Nurses generally rated the organisational system favourably. The mean total score was 79.1 ± 17.1 out of 100, with scores across five conceptually defined domains ranging from 15.5 to 16.0 out of 20. These covered system construction and standardisation, training and competency support, communication and collaboration, resources and incentives, and organisational culture and professional development. Self-assessed diabetes knowledge averaged 16.9 ± 4.6 out of 20, while willingness to engage in further systematic diabetes training averaged 4.2 ± 1.2 on a five-point scale. These results describe nurses’ perceptions rather than verified clinical competence. Although the survey included a supplementary 10-item objective knowledge questionnaire, the study did not formally test agreement between that measure and self-assessed knowledge.

Endocrinology and non-endocrinology nurses reported broadly similar perceptions. There were no significant differences between the groups in overall system satisfaction, any of the five organisational domains, self-assessed diabetes knowledge or willingness to learn, with all p values above 0.05. Because the study was cross-sectional, this similarity cannot show that the hospital-wide model caused equal perceptions or eliminated departmental differences. One possible explanation proposed by the researchers is that unified training and coordination offered comparable support across departments, but that interpretation remains provisional. A clearer role difference appeared for liaison nurses: their training and competency support score was 16.6 ± 3.8, compared with 15.7 ± 3.7 among non-liaison nurses, a statistically significant difference with p = 0.032. Perceived professional development support also differed across professional-title groups, with p = 0.012.

Correlation analysis identified close statistical relationships among organisational perceptions, perceived knowledge and learning willingness. Overall system satisfaction was positively correlated with self-assessed diabetes knowledge, with Spearman’s r = 0.683 and p < 0.001. Training and competency support was positively correlated with willingness to learn, with r = 0.641 and p < 0.001, while organisational culture and professional development support had a similar association, with r = 0.622 and p < 0.001. These coefficients show that nurses reporting greater support also tended to report greater perceived knowledge or willingness to train; they do not establish the direction of those relationships.

Multivariable ordinal logistic regression tested whether the organisational associations remained after accounting for professional characteristics. For each one-point increase in the training and competency support score, the odds of reporting greater willingness to engage in further diabetes training were 1.54 times higher, with a 95% confidence interval of 1.36–1.76 and p < 0.001. Each one-point increase in perceived professional development support was associated with 1.40 times the odds, with a 95% confidence interval of 1.22–1.60 and p < 0.001. By comparison, each additional year of clinical practice had an odds ratio of 1.01, with a 95% confidence interval of 0.95–1.06 and p = 0.844. Professional title was not independently associated with the outcome, and neither was diabetes liaison nurse status, for which the odds ratio was 0.64, with a 95% confidence interval of 0.33–1.24 and p = 0.183.

The assessment tool itself limits how confidently its domain scores can be interpreted. Researchers created it for this organisational context through a literature review, institutional policy review, consultations with senior nursing managers, diabetes specialist nurses and frontline nurses, and three pilot rounds involving 62, 31 and 39 nurses. The final core scale contained 20 items across five conceptually defined domains, with one negatively worded item per domain reverse-scored. Internal consistency was high for the complete scale, with Cronbach’s alpha of 0.917, but only low to questionable for the individual four-item domains, with alpha values from 0.54 to 0.61. Exploratory factor analysis did not reproduce a clear structure matching the five proposed domains; several items overlapped across domains, and reverse-worded items tended to cluster together, suggesting a possible wording effect.

Other study limitations restrict generalisation and causal interpretation. The single-group, online survey captured perceptions at one point in time, and the number of eligible nurses who saw the invitation was not known, so a formal response rate could not be calculated. Voluntary participation may have introduced self-selection, while self-reporting can create social-desirability and common-method effects. The integrated governance and staffing structure of this hospital group may differ from settings with other organisational models, limiting external validity. Most importantly, reverse causation cannot be excluded: nurses who are already motivated to learn may evaluate support more positively, while supportive organisational environments may also encourage learning. The domain-level findings should therefore be regarded as exploratory, and broader use of the instrument would require independent validation, test–retest assessment, confirmatory factor analysis, measurement-invariance testing and cross-cultural evaluation.

Within those bounds, the study’s main contribution is to separate organisational resources from individual role labels when examining continued diabetes learning. The results show that perceived training support and professional development opportunities were associated with nurses’ willingness to undertake further training, whereas the professional characteristics included in the model were not. They also show that the absence of a significant endocrinology–non-endocrinology difference in this hospital group should not be interpreted as proof that specialist influence has been made unnecessary. Instead, the findings provide a testable proposition for longitudinal and implementation research: future studies could examine whether strengthening training pathways, support for professional development and other system resources is followed by measurable changes in objectively assessed nursing competence, care processes and patient outcomes.

Subject of Research: Cross-sectional study of organisational support, self-assessed diabetes knowledge and training willingness among hospital nurses in China

Article Title: Organisational Support for Diabetes Nursing Teams, Self‐Assessed Knowledge, and Training Willingness: A Cross‐Sectional Study

Article References: Si, Y., Liu, J., Zhang, D., Wang, X., Xu, X., & Liu, S. (2026). Organisational Support for Diabetes Nursing Teams, Self‐Assessed Knowledge, and Training Willingness: A Cross‐Sectional Study. Nursing Open, 13(10), Article e70918. https://doi.org/10.1002/nop2.70918

Image Credits: AI Generated

DOI: 10.1002/nop2.70918

Keywords: diabetes nursing, organisational support, continuing education, nursing workforce, professional development, liaison nurses, self-assessed knowledge, cross-sectional study, hospital management, Organisational, Support, Diabetes