Research on the Sense of Coherence (SOC) of Newly Graduated Nurses in Japan within Their First Sixth Month of Employment

Monday, 28 July 2014: 7:00 AM

Yasue Yamazumi, MSN, RN1
Akira Kitagawa, MSN, RN1
Chie Ikoma, RN2
Fumiko Yasukata, RN, PhD1
(1)Division of Nursing, National Defense Medical College, Saitama, Japan
(2)Faculty of Nursing, Fukuoka Prefectural University, Fukuoka, Japan


According to the Japanese Nursing Association, the newly graduated nurse’s turnover rate continued to decrease between 2008 and 2012. The turnover rate of newly graduated nurses in 2012 was 7.5%.

7.5% of newly graduated nurse’s amounts to 3900 graduates from 50 nursing colleges all over Japan in 2013.The total number of graduates from all colleges and universities in Japan who started working in 2013 was 50,200.

Compared to the turnover rate of 11.4% for all new hires who graduated from college in 2009 this turnover rate for nurses is not particularly high. However, considering that one in nine new employees in the specialized profession of nursing leaves his or her job, measures designed to prevent nurses leaving their jobs are clearly necessary.

The reason of this is not only the support system in the workplace, but also more complex causes such as stressors and a lack of stress coping abilities in individuals.

To research the status of newly graduated nurses in terms of SOC (sense of coherence), stressors, and social support six months after starting employment, and to identify factors that influence the SOC of newly graduated nurses.


Survey requests were made to directors of the nurses at accredited hospitals of the Japan Council for Quality Health Care Hospital Evaluation Program with 300 beds or more in the Tokyo metropolitan area, Osaka and Fukuoka Prefectures. 

Self-administered questionnaires were distributed to 914 novice nurses hired in 2012 at 37 facilities from which consent was obtained. Returning the questionnaire constituted consent to participate in the study, and responses were collected from 283 individuals by mail (response rate 30.9%). After excluding the questionnaires of three individuals due to missing data, 280 individuals were subjected to analysis (valid response rate 98.9%).

The questionnaire surveyed basic attributes such as age, sex, and basic educational background, comprised the 13 items in the simplified Japanese sense of coherence scale and the Brief Job Stress Questionnaire.

The 13 question items from the sense of coherence involved selecting 1 of 7 answers from “I completely agree” to “I completely disagree,” with the lowest possible score being 13 points and the highest score 91 points. The sense of coherence is composed of the three subordinate concepts of meaningfulness, comprehensibility, and manageability. The Cronbach's alpha was 0.78.

The Brief Job Stress Questionnaire comprises the following nine stressors: “the psychological strain from work (volume),” “the psychological strain from work (quality),” “subjective degree of physical stress,” “stress in interpersonal relationships in the workplace,” “stress caused by work environment,” “degree of control in your job,” “degree of utilization of technical skills,” “perceived adequacy of your job” and “job satisfaction.” The Cronbach's alpha was 0.75.

An additional scale measured the following four stress relaxation factors: support from from “family and friends,” “colleagues”, “superiors,” and “social support.” The Cronbach's alpha was 0.78.

Multiple linear regression analysis was performed using SOC as the dependent variables and basic attributes, Job Stress and stress relaxation factors as independent variables.

In regard to ethical considerations, we explained the following to subjects:  responding to the questionnaire constituted consent to participate in the study; subjects would not suffer any disadvantages by refusing to participate; and identities would be protected by making questionnaires anonymous.

This survey was conducted with the approval of the ethics committee of Fukuoka Prefectural University.


I think there are three reasons why the survey questionnaire recovery rate is low.

1)            There are 16 pages of questions, which is probably too many.

2)            Subjects may not have answered the high number of personal questions out of concern for their privacy.

3)            The survey objectives may not have been communicated clearly to the respondents.

Subjects’ mean age was 25.6±6.0 (mean ± S.D.), ranging from 20 to 49 years old. Males comprised 5.7% while females comprised 94.3%. Basic education was obtained from universities 30%, junior colleges 61% and other 9%.

The average SOC score for all respondents was 50.4±10.6. Four factors that influenced SOC were extrapolated as follows:

1)            “perceived adequacy of your job (β=0.290***)”,

2)            “job satisfaction (β=-0.232***)”,

3)            “satisfaction with job and life balance (β=0.249***)”

4)            “the degree of utilization of technical skills (β=0.101**)”. (Adjusted R-square= 0.341) (***p<0.001, **p<0.01, *p<0.05)


Based on this research, it was ascertained that in the current study the respondents’ ability to cope with stress was high.

Data from respondents with high sense of coherence (SOC) scores was compared to those with low scores. It was considered that those with higher scores were able to deal well with stress and were better at acquiring support from workplace colleagues as they were highly capable at seeking help.

Newly graduated nurses tend to be in the early stages of adulthood, which is the period when SOC is formed and developed.

Further, it was felt that they were able to smoothly establish an occupational identity and had a strong sense of self-efficacy. The formation and development of sense of coherence (SOC) is important in preventing resignations and workplace burnout, so going forward it is necessary to enhance workplace support for this group, to carry out a phased expansion of their discretionary powers, and to conduct measures to encourage them to have successful experiences of coping with stress.


This work was supported by JSPS KAKENHI Grant Number 24593237.