Learning Objective 1: The situations where the participant novice nurses felt "I could not be assertive toward my seniors" yielded the nine categories.
Learning Objective 2: The reasons yielded the five categories: "I considered human relationships important", "I am a directee", "I wanted to avoid trouble", and other two categories.
Methods: A self-administered questionnaire was distributed to 102 novice nurses. After reading the definition of assertiveness in the questionnaire, recalling examples at work from the past year, participants were asked about situations where they felt: “I wanted to decline but could not”. A content analysis based on Krippendorff's method was performed on their described messages. The situations described were classified for each participant, and categorized based on the situation’s similarity.
Results: The number of valid responses was 81, and the mean age was 23.7 years. Situations where the participant novice nurses felt “I could not be assertive toward my seniors” yielded the following nine categories: “I cannot decline tasks assigned to me”, “I cannot say anything about my senior’s unfavorable behavior”, “I cannot say I’m confused by the instructions”, “I cannot argue against my senior’s pointing out grievances regarding my work”, “I cannot dispute my senior’s behavior toward me and novice nurses”, “I cannot declare my uneasiness about the work”, “I cannot dispute a false accusation erroneously made by my senior”, “I cannot decline private requests” and “Others”. The reasons yielded the following five categories: “I considered human relationships important”, “I am a directee”, “I wanted to avoid trouble”, “I am responsible for something” and “I wanted to hide my inexperience”.
Conclusion: Novice nurses were not able to be assertive. Situations occurred where they could not decline overtime work, were made to feel uneasy about fulfilling their duties, or were unable to communicate necessary messages; all situations could contribute to medical accidents. This study reinforced the importance of assertiveness education for novice nurses, and suggested encouraging assertive communication throughout the ward.