Academic Journal of Science and Technology ISSN: 2771-3032 | Vol. 9, No. 2, 2024 283 Research on the Impact and Countermeasures of the Three Child Policy on the Career Planning of Nurses who Have Given Birth to One Child Qian Lv1, Na Zhang2, Ziyi Li3, Shali Wu4, *, Yifang Zhu5, * 1Hunan Normal University, Changsha, 410081, China 2Tangdu Hospital, Air Force Military Medical University, Xi’an 710038, China 3Shaanxi University of Chinese Medicine, 712046, China 4The First Hospital Affiliated with Hunan Normal University (Hunan Provincial People`s Hospital, Changsha, 410005, China 5Tangdu Hospital, Air Force Military Medical University, Xi’an 710038, China * Corresponding author: Shali Wu (Email: wsl787@163.com), Yifang Zhu (Email: wjtm1981@163.com) Abstract: To understand the current status of nursing career planning and explore the influencing factors of the three child policy on the career planning of nurses who have given birth to one child, in order to provide a basis for the management of nursing human resources. Method: Cluster sampling was used to select 515 clinical nurses from a tertiary hospital in Xi'an from August 2021 to September 2022 as the research subjects. A general information questionnaire and a career status evaluation scale were used for the questionnaire survey. The result of the nurse career status evaluation scale was (81.84 ± 15.16) points. There were differences in scores for education level, hospital attributes, job position, nursing years, per capita annual income of the family, whether they had given birth, age of the first child, working time during pregnancy, and planned years of continuing nursing work after giving birth to three children (all P<0.05).The age of the first child and the planned duration of nursing work after giving birth to a third child are the main influencing factors for the career planning of nurses. Conclusion: The three child policy has had a significant impact on the career status of nurses and the allocation of nursing human resources. It is recommended that nursing managers take targeted intervention measures to promote the development of nursing teams. Keywords: Three child policy; Career planning for nurses; Influencing factors; human resources. 1. Object and Method 1.1. Object Using convenience sampling method, 515 nurses from a tertiary hospital in Xi'an from August 2021 to September 2022 were selected for a questionnaire survey.515 questionnaires were successfully distributed and 515 were collected, with a 100% effective response rate. Inclusion criteria: ① Registered nurses; ② Married; ③ Has already given birth to one child; ④ Voluntarily participate in this survey. Exclusion criteria: ① Internship, regular training, and further training nurses; ② Nurses who are unwilling to participate in the survey; ③ Suffering from serious physical and mental illnesses. 1.2. Research Tools 1.2.1. General Information Survey Form This includes department, professional title, education level, gender, age, position, nursing years, per capita annual income of the family, marital status, type of family living together, age of the first child, willingness to have a second child, willingness to have a third child, working hours during pregnancy, night shifts during pregnancy, and planned nursing years. 1.2.2. Career Status Evaluation Scale Developed by Tong Tian et al[1] in the enterprise and widely used by Lin Shangping et al. [2] among nursing staff, the internal consistency coefficient of the scale is good, with a retest reliability of 0.82 and validity of 0.83, which can be used to evaluate the career status of nurses.This scale consists of 23 items and four dimensions: occupational identity, occupational satisfaction, organizational commitment, and turnover intention.This scale adopts the Likert five point scoring method, where "1 represents disagreement, 2 represents comparative disagreement; 3 represents uncertainty, 4 represents comparative agreement, and 5 represents agreement". The four items are reverse scored, with a total score of 23-115 points. The higher the score, the more comprehensive and planned the career planning. 1.3. Research Methods 1.3.1. Questionnaire survey method After obtaining the consent of the survey hospital, an electronic questionnaire was distributed using QuestionStar in the research contact group of our hospital, explaining the purpose of this study. With the help of the nursing department staff, a unified guidance language was used to fill out the questionnaire. After 24 hours, the questionnaire was completed and collected. All questionnaires were voluntarily filled out by nurses anonymously. After the questionnaire collection was completed, the researchers personally checked and screened, and a total of 515 valid questionnaires were collected. 1.4. Statistical analysis methods Statistical analysis was conducted using SPSS 22.0.Quantitative data are described using mean ± standard deviation, sample mean comparison is conducted using t-test and analysis of variance, and multivariate stepwise regression analysis is used for multivariate analysis. 284 Table 1. Comparison of Career Status of Nurses with Different Demographic Characteristics (N=515) project group Example count Composition ratio (%) Career status score F/t value P Department internal medicine 155 30.1% 80.57 ± 15.88 1.588 0.125 surgery 117 22.72% 80.68 ± 15.14 Obstetrics and Gynecology 8 2.14% 81.36 ± 17.39 Pediatrics 31 6.02% 86.23 ± 10.79 ICU 39 7.57% 80.15 ± 15.69 operating room 32 6.21% 79.28 ± 14.27 Emergency department 29 5.63% 82.28 ± 16.22 outpatient service 15 2.91% 90.13 ± 11.46 other 86 16.7% 84.33 ± 15.16 Professional title nurse 83 16.12% 78.76 ± 15.83 8.066 <0.001 Nurse 366 71.07% 81.38 ± 15.24 Supervisor Nurse 66 12.82% 88.29 ± 11.93 Deputy Chief Nurse or above 0 0% educational background junior college 117 22.72% 82.62 ± 15.85 0.242 0.785 undergraduate course 392 76.12% 81.64 ± 15.00 Graduate or above 6 1.17% 79.83 ± 13.47 Gender male 6 1.17% 76.33 ± 21.70 -0.895 0.371 female 509 98.83% 81.91 ± 15.09 20-25 30 5.83% 79.33 ± 17.37 5.667 <0.001 Age (years) 26-30 185 35.92% 79.40 ± 15.21 31-35 213 41.36% 81.69 ± 15.82 36-40 76 14.76% 87.78 ± 12.46 41-45 11 2.14% 91.64 ± 8.31 nurse 496 96.31% 81.46 ± 15.18 -1.404 0.161 position Nurse head 19 3.69% 91.84 ± 10.87 Nursing age <2 10 1.94% 88.11 ± 14.30 7.089 <0.001 2-5 111 21.55% 76.23 ± 16.49 6-10 219 42.52% 80.91 ± 15.22 11-20 171 33.20% 86.04 ± 12.91 ＞ 21 4 0.78% 94.50 ± 5.26 Per capita annual income of households (10000 yuan) <3 118 22.91% 79.51 ± 15.83 8.296 <0.001 3-5 60 11.65% 78.17 ± 14.61 5-7 160 31.07% 79.84 ± 14.76 7-10 69 13.40% 83.00 ± 16.32 ≥ 10 108 20.97% 88.67 ± 12.35 marital status unmarried 59 11.46% 79.25 ± 16.31 1.181 0.308 married 449 87.18% 82.12 ± 14.97 other 7 1.36% 85.86 ± 17.33 Category of family members living together spouse 81 15.73% 79.25 ± 16.31 5.371 <0.001 Couples and Children 130 25.24% 82.12 ± 14.97 Couples and Parents 35 6.8% 85.86 ± 17.33 Husband and wife, children, and parents 269 52.23% 81.84 ± 15.16 Have you given birth yes 398 77.28% 82.85 ± 14.66 2.804 0.005 no 117 22.72% 78.41 ± 16.35 Age of first child (years) <1 140 27.18% 77.63 ± 16.28 6.487 <0.001 1-3 44 8.54% 78.80 ± 16.01 3-6 135 26.21% 81.92 ± 14.59 6-12 68 13.20% 86.96 ± 12.27 ≥ 13 128 24.85% 84.70 ± 14.30 Working hours during pregnancy Full rest 30 5.83% 75.80 ± 22.44 2.717 0.044 Rest for the first three months 43 8.35% 81.60 ± 14.28 Half day working day 46 8.93% 78.65 ± 16.13 Persist in working normally 396 76.89% 82.70 ± 14.36 Night shift during pregnancy Not working night shifts throughout pregnancy 161 31.26% 79.73 ± 16.58 1.688 0.173 According to national regulations 159 30.87% 82.97 ± 14.32 Not up in the first three months 21 4.08% 84.62 ± 14.92 Based on Kori's manpower situation 174 33.79% 82.44 ± 14.46 Plan to continue nursing work after giving birth to three children 1 year or less 63 12.23% 73.08 ± 16.10 15.330 <0.001 2-3 years 47 9.13% 71.21 ± 12.48 4-6 years 49 9.51% 79.57 ± 13.35 7-10 years 22 4.27% 85.59 ± 13.71 11 years or longer 121 23.5% 87.65 ± 13.38 Not planning to have a third child 213 41.36% 83.62 ± 14.64 285 2. Results 2.1. Comparison of Career Status of Nurses with Different Demographic Characteristics The age range of 515 nurses participating in this study was between 23 and 44 years old, with an average age of (31.61 ± 3.97) years. They worked for (9.33 ± 4.69) years and had an average annual income of (6.37 ± 571) yuan per capita. Among them, 77.28% of nurses had given birth, 58.64% of nurses were willing to have a second child, and 10.29% of nurses were willing to have a third child.The univariate analysis of nurse career status based on different demographic characteristics shows that there are differences (all P<0.05) in the scores of nurse career status, including professional title, age, nursing years, per capita annual income of the family, type of family living together, whether they have given birth, age of the first child, working time during pregnancy, and planned length of nursing work. However, there are differences (all P<0.05) in the scores of nurse career status, such as department, education level, gender, position, and marital statusThere was no statistically significant difference in the career status scores of night shift nurses during pregnancy (P>0.05), as shown in Table 1. 2.2. Overall status of nursing professional career and scores in various dimensions The total score of the career status evaluation of 515 nurses surveyed in this survey is (81.84 ± 15.16), which is generally at a moderate level. The scores of each dimension are ranked in descending order: career, organizational commitment, career attitude, and career satisfaction.Among them, the willingness to stay has the highest score and the occupational satisfaction score rate is the lowest, as shown in Table 2. 2.3. Results of multiple linear regression analysis on the influencing factors of the three child policy on the professional career status of nurses Using the career status score of nurses as the dependent variable and statistically significant demographic characteristics of nurses as the independent variable, introducing level α= 0.05, excluding levelsα= 0.10, an equation was introduced for multiple regression analysis, and the research results showed that the age of the first child and the planned time of continuing nursing work after giving birth to the third child were the most important influencing factors on the career status of nurses.The results are detailed in Table 3. Table 2. Overall and Dimension Scores of the Nurse Professional Career Evaluation Scale (N=515) dimension Number of entries Total score Score range Result of percentage conversion sort Professional attitude 8 28.84 ± 6.40 5-40 72.1 3 Career satisfaction 5 15.81 ± 4.72 5-25 63.24 4 organizational commitment 9 32.60 ± 6.538 5-45 72.44 2 Resignation intention 1 4.59 ± 0.86 1-5 91.8 1 Career total score 23 81.84 ± 15.16 23-115 71.16 / Table 3. Multiple stepwise regression analysis of influencing factors on the professional career status of nurses constant regression coefficient Standard error Standardized regression coefficients T-value P constant 66.235 1.966 33.686 <0.001 First Birth Age 1.760 0.411 0.178 4.285 <0.001 Plan to continue nursing work after giving birth to three children 2.390 0.348 0.286 6.873 <0.001 3. Discussion 3.1. Analysis of the Current Situation of Nurse Career Planning The results of this study showed that the career status score of 515 nurses was (81.84 ± 15.16), which is at a moderate level, which is basically consistent with the research results of Cai Yuanyuan [3] on the career planning of 293 ICU nurses.This may be related to the late start and slow implementation of career courses in China, which has resulted in nurses having a low awareness of their own career planning. The score rate of occupational satisfaction dimension is the lowest, which is basically the same as the research results of Shang Linping et al. [2]. Among them, income, occupational reputation, and promotion have the lowest scores.A study [4] shows that nurses after the three child policy have lower educational qualifications, further education, and promotion willingness compared to before the three child policy.The score rate of the retention intention dimension is the highest, which is basically consistent with the survey results of Tang Tingwei [5], that is, assuming that the organization will do its best to meet the needs of nurses, the longer the nurses continue to work, it is considered to be related to the nurses' desire to achieve self-worth through work.In a survey of 521 nurses in Henan Province, Wang Junmin et al. found that 80.99% of nurses had a willingness to resign, and some studies [7] showed that a sense of organizational fairness and support had an impact on the willingness of nurses to resign.This indicates that nursing managers should establish a fair and supportive organizational environment to strengthen the stability of the nursing team. 286 3.2. Analysis of the influencing factors of the three child policy on the career planning status of nurses 3.2.1. Emphasize the professional development of nurses who have given birth to their first child The results of this study indicate that the age of the first child is the main influencing factor on the career status of nurses. The survey results show that the age of the first child is less than 1 year old, and the career status of nurses is (77.63 ± 16.28) points. The older the age, the better the career status.Considering that the 4-year period from birth to kindergarten for nurses to conceive the next generation will have a significant impact on their career, at this stage, due to physiological characteristics, nurses bear the primary responsibility of taking care of children;When the first child is between the ages of 3 and 6, nurses, as mothers, also hope to provide their children with more companionship. As a result, many opportunities to promote career development, such as promotion, scientific research, and studying abroad, are delayed or even abandoned.This is consistent with Tang Tingwei's [5] research on the career planning status of nurses, which suggests that cohabiting children are the main influencing factor of work family conflicts.Studies [8-9] have shown that nurses aged 33 to 40, as the backbone of nursing work, have a more urgent desire to have a third child due to having given birth to their first child and having the confidence to handle conflicts between work and family. After giving birth, many women choose to learn prenatal education and parenting related knowledge, but are unwilling or unable to allocate a certain amount of time to learn and update their professional knowledge. Therefore, it is crucial to attach importance to the professional development of nurses who have given birth to their first child. 3.2.2. Provide career planning education in advance for nurses who have given birth to three children Career planning can promote nurses to form positive professional values, thereby influencing their beliefs and attitudes towards the nursing profession, and is conducive to cultivating nursing professionals in all aspects.This study shows that the length of time a nurse plans to continue nursing work after giving birth to a third child is the main influencing factor on their career status. The longer a nurse plans to continue nursing work after giving birth to a third child, the higher their career planning score. Among the 302 nurses who gave birth to three children in this study, 63 planned to continue working for "one year or less";47 plan to continue working for 2-3 years;49 plan to continue working for 4-6 years;22 plan to continue working for 7-10 years;121 individuals plan to continue working for 11 years or longer, but there is currently relatively little research on this topic in China.It may be related to the heavy workload and high pressure of nurses, low job satisfaction, and a desire to spend more time cultivating children. Nurses during the pregnancy of their third child are not only prone to physical fatigue, but also prone to negative emotions such as irritability and depression. The involvement of their husbands has a positive impact on the psychological health of pregnant women [11- 12].In addition, a considerable number of professional women aspire to work in stable jobs after giving birth, and even directly withdraw from the workplace, so as not to worry about unexpected difficulties and competition [13].Therefore, nursing managers should strengthen career planning education for nurses who give birth to three children, and take multiple effective measures to minimize the impact of the three child policy on nursing human resources. 3.3. Suggestions Improve nurse job satisfaction, enhance the quality of nursing work, and alleviate the impact of the three child policy on the career of nurses. Nursing managers should fully mobilize the work enthusiasm of nurses who have given birth to their first child and are younger in age, and guide them to have a clear understanding of their career development goals based on their different abilities; Regularly encourage them to join various development channels such as specialized nurses, scientific research, teaching, invention patents, etc., to minimize their development resistance and failure frequency as much as possible; Establish a reasonable incentive system and appropriately improve departmental welfare. The head nurse should be informed in advance of the nurse's plans to continue working in nursing after giving birth to a third child, and coordinate the smooth delivery of multiple nurses in a planned manner. Experts can be invited to offer career planning training courses in advance to increase the nurse's work enthusiasm, reduce their negative emotions, and prevent talent loss; During the period of giving birth to the third child, Kori may apply to the nursing department in advance for mobile nurses to help the nurses who plan to give birth to the third child successfully complete the production and continue to return to work. Nurses should regulate their emotions by communicating with their superiors and family members, striving to gain their husband's understanding, strengthening their career planning, and clearly positioning themselves in pursuit of their own values. They should face the difficulties under the three child policy with firm beliefs. 4. Summary The career status of nurses under the three child policy is at a moderate level. 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