1 INTRODUCTION

The rapid development of internet technology and with an investment from the Chinese government, the National Health Commission issued a pilot program named “Internet + Nursing Services” in February 2019.1 The program identified 6 provinces and/or municipalities as pilot areas for “Internet + Nursing Services,” to encourage the exploration of nurse lead services. The goal was to rely on the new technologies and achievements to establish a new innovative internet model of nursing services, and to potentially show unique advantages of the platform.2 The perceived professional benefit is a positive experience related to professional emotions produced by continuous development based on positive psychology. The sense of perceived professional benefit of nurses refers to the positive emotional experience of nurses when they feel the benefits of the profession of nursing and the recognition that the profession of nurses can promote their all-round growth.3

This study explored the perceived professional benefit of nurses dedicated to online nursing, analyzed the influence of diverse factors on nurses' perceived professional benefit, and provided basis for the intervention to improve the level of internet nurses' perceived professional benefit.

2 PARTICIPANTS AND METHODS 2.1 Participants

This is a cross-sectional study conducted from a network of Internet cooperative hospitals in Nanjing City, Jiangsu Province. A total of 310 nurses were invited to complete the online survey voluntarily, but 10 did not respond (96% response rate). A total of 300 surveys were included in this research. Nurses surveys were included if the nurse: (a) Had a nurse qualification certificate and was registered for the job; (b) Had working experience ≥1 year; (c) Voluntarily participated in the study. Nurses were excluded if they were: (a) Interns or (b) Nurses in non-nursing positions.

2.2 Research method 2.2.1 Survey questionnaire

The questionnaire consisted of two parts: (a) the general information questionnaire and (b) the nurses' perceived professional benefit questionnaire.

(a) The general information questionnaire was designed based upon available literature, which was combined with the advice of experts. The questionnaire included gender, age, education level, department status, frequency of night shifts, marital status, children status, position, personnel relations, scientific research status, number of working years, working hours engaged in Internet + nursing, monthly income, hospital level, leadership support. In addition, the willingness of the nurse to participate in Internet + nursing work was also assessed.

(b) The nurses' perceived professional benefits questionnaire was developed by Hu in 2013.4 It consists of 29 items mainly includes five categories: positive professional perception, team effort, family and friend identification, nurse-patient relationship, and self-growth. The Cronbach's α coefficient of complete questionnaire and each dimension was between 0.821 and 0.958, and the split-half reliability coefficient was between 0.813 and 0.938, making the questionnaire reliable and valid. The Likert 5-level scoring method was used in the questionnaire: 1 point means “very disagree”; 2 points means “relatively disagree”; 3 points means “uncertain”; 4 points means “relatively agree”; 5 points means “very agree.” The total score of the questionnaire is between 29 and 145 points; the higher the score, the stronger the sense of professional benefits of nurses.

2.2.2 Data collection procedure

We obtained permission from the Nanjing Nursing Association, the nursing deans and nursing department directors of various Internet hospitals, and Internet nurses, prior to distributing the questionnaire using the Questionnaire Star platform, which relies on WeChat. After agreeing to informed consent, the purpose and confidentiality of the study and data outcome were explained. Each participant was recorded using a unique IP address. A total of 310 questionnaires were collected, including 300 used in this study, an effective recovery rate of 96%.

2.2.3 Data analysis

Excel was used to sort out the collected data, and spss22.0 software was used for statistical analysis. Descriptive statistics such as x¯±s, frequency and constituent ratio were used for the measurement data. T-test and analysis of variance were used to compare the scores of nurses' occupation acquisition. Multiple linear regression analysis was used to analyze the factors influencing the occupation benefit of nurses working in Internet plus nursing. P < .05 was deemed statistically significant.

3 RESULTS 3.1 Participants characteristics

The 300 Internet nurses surveyed had an average of 12.9 ± 7.2 (years) of clinical nursing work, of which the minimum was 1 year and the maximum was 38 years, and Internet + nursing service time varied from 1 month to 5 years. 90.7% of nurses showed no extra income, and only 6.9% of nurses had increased extra income (100-1000 yuan), while 2.6% of nurses had a monthly extra income greater than 1000 yuan (see Table 1).

TABLE 1. Demographic information of internet nurses in this study (n = 300) Items Numbers Proportion (%) Items Numbers Proportion (%) Gender Other 89 29.7 Female 291 97.0 Organizational affiliation Male 9 3.0 Contract 210 70.0 Age Establishment 86 28.7 <29 71 23.7 Temporary employment 4 1.3 30–39 172 57.3 Positional title 40–49 46 15.3 Junior 131 43.6 ≥50 11 3.7 Intermediate 142 47.3 Marital status Senior 27 9.0 Unmarried 67 22.3 Number of night shifts per month Married 233 77.7 No 133 44.3 Children's education 1–2 73 24.3 No 76 25.3 3–4 44 14.7 Preschool 102 34.0 ≥5 50 16.7 Primary school 72 24.0 What do you want to improve most Middle school 28 9.3 Working ability 122 40.7 University 14 4.7 Income 94 31.3 Other 8 2.7 Promotion opportunities 25 8.3 Education Nurse–patient relationship 26 8.7 Junior College 29 9.7 Working conditions 18 6.0 Undergraduate 265 88.3 No night shift 15 5.0 Postgraduate 6 2.0 Leaders' attitudes towards Internet + nursing work Hospital level Very supportive 118 39.3 Municipal 158 52.7 Support 136 45.3 County 73 24.3 General 45 15.0 Community 69 23.0 Not support 1 0.3 Department Your attitude towards internet + nursing work Internal 116 38.7 Very supportive 119 39.7 Surgery 60 20.0 Support 154 51.3 Gynaecology 22 7.3 General 27 9.0 Pediatrics 13 4.3 Not support 0 0 3.2 The scores of internet nurses' perceived professional benefits

The results of this study showed that the total score of the professional benefit of nurses engaged in Internet + nursing work was 121.21 ± 14.97 points, and the items were equally divided into 4.18 ± 0.51 points. The scores of each dimension are shown in Table 2.

TABLE 2. The scores of internet nurses' perceived professional benefits Dimension Score range Dimensional average score ( x¯±s) Item average score ( x¯±s) Total score 67–145 121.2 ± 14.97 4.18 ± 0.52 Positive career perception 6–30 23.2 ± 4.08 3.86 ± 0.68 Good nurse–patient relationship 9–25 22.2 ± 2.84 4.45 ± 0.57 Family and friends identification 10–30 24.6 ± 3.78 4.09 ± 0.63 Sense of belonging 10–25 21.1 ± 2.99 4.21 ± 0.60 Own growth 14–35 30.2 ± 3.97 4.32 ± 0.57 3.3 Comparison of perceived professional benefit scores of Internet nurses with different characteristics

The following measures significantly (P < .05) influenced score: age, marital status, children's education, organizational affiliation, positional title, monthly night shift, leaders' attitudes toward Internet + nursing work, and personal attitude toward internet + nursing work, while hospital level, department, education level, gender, and scientific research had no statistically significant effect (P > .05). Single-factor analysis of the perceived professional benefit of nurses working in Internet + nursing is summarized in Table 3.

TABLE 3. Single-factor analysis of the perceived professional benefit of internet nurses (n = 300, x¯±s) Items Numbers Total score Positive career perception Good nurse-patient relationship Family and friends identification Sense of belonging Own growth Age ≤29 71 117 ± 17.61 21.96 ± 4.57 22.04 ± 3.06 23.58 ± 4.35 20.37 ± 3.65 29.06 ± 4.79 30–39 172 122.26 ± 13.40 23.40 ± 3.76 22.28 ± 2.59 24.72 ± 3.60 21.33 ± 2.66 30.53 ± 3.57 40–49 46 122.17 ± 15.91 23.52 ± 4.19 22.34 ± 3.55 25.07 ± 3.51 20.83 ± 3.03 30.41 ± 3.91 ≥50 11 127.91 ± 11.23 25.64 ± 3.38 22.27 ± 1.79 26.00 ± 2.53 22.00 ± 2.49 32.00 ± 3.00 F 3.01 3.83 0.15 2.55 2.207 3.24 P 0.30 0.01 0.92 0.06 0.087 0.02 Marital status Unmarried 67 118.19 ± 18.37 22.61 ± 4.24 22.22 ± 2.92 23.84 ± 4.71 20.28 ± 3.88 29.24 ± 4.91 Married 233 122.08 ± 13.77 23.31 ± 4.02 22.24 ± 2.82 24.76 ± 3.45 21.27 ± 2.65 30.50 ± 3.61 t 3.53 1.54 0.002 3.103 5.707 5.350 P .05 .22 .967 .079 .018 .021 Children's education No 76 116.32 ± 17.88 21.88 ± 4.05 21.86 ± 2.93 23.32 ± 4.60 20.17 ± 3.86 29.08 ± 4.96 Preschool 102 120.90 ± 12.32 22.86 ± 4.00 22.28 ± 2.67 24.47 ± 3.09 21.14 ± 2.46 30.15 ± 3.43 Primary school 72 123.63 ± 12.98 23.89 ± 3.60 22.36 ± 2.52 25.15 ± 3.61 21.46 ± 2.55 30.76 ± 3.27 Middle school 28 124.64 ± 18.91 23.96 ± 5.10 22.57 ± 4.02 25.40 ± 3.93 21.54 ± 3.19 31.18 ± 4.51 University 14 128.00 ± 10.57 26.07 ± 3.02 22.57 ± 1.95 26.29 ± 3.12 21.57 ± 2.21 31.50 ± 2.68 Other 8 126.00 ± 13.45 24.50 ± 2.78 22.38 ± 3.54 25.75 ± 2.31 21.88 ± 2.95 31.50 ± 3.74 F 3.15 4.09 0.43 3.10 1.99 2.37 P .01 .01 .83 .01 .08 .04 Organizational affiliation Contract 210 120.01 ± 14.93 22.98 ± 3.92 22.14 ± 2.77 24.19 ± 3.86 20.88 ± 3.03 29.82 ± 4.02 Establishment 86 125.00 ± 13.63 24.01 ± 3.64 22.65 ± 2.71 25.52 ± 3.37 21.51 ± 2.81 31.30 ± 3.57 Temporary employment 4 102.50 ± 24.13 14.00 ± 8.64 18.25 ± 5.56 22.50 ± 5.00 20.00 ± 4.08 27.75 ± 5.32 F 6.80 13.18 5.12 4.49 1.63 5.16 P .01 .01 .01 .01 .20 .01 Position No 225 122.69 ± 13.86 23.73 ± 3.56 22.38 ± 2.70 24.86 ± 3.54 21.26 ± 2.73 30.46 ± 3.73 Yes 75 116.77 ± 17.27 21.44 ± 4.97 21.81 ± 3.19 23.63 ± 4.31 20.40 ± 3.62 29.50 ± 4.57 t 9.01 18.80 2.24 6.07 4.74 3.38 P .01 .01 .14 .01 .03 .07 Positional title Junior 112 117.16 ± 15.88 22.00 ± 4.35 21.80 ± 2.89 23.64 ± 3.89 20.47 ± 3.32 29.24 ± 4.32 Intermediate 142 123.73 ± 12.65 23.88 ± 3.58 22.50 ± 2.52 25.13 ± 3.61 21.38 ± 2.40 30.85 ± 3.38 Senior 27 123.22 ± 18.28 23.89 ± 4.69 22.07 ± 3.94 25.41 ± 3.30 21.37 ± 3.41 30.48 ± 4.44 F 4.52 5.04 1.85 3.84 2.22 3.80 P .01 .01 .14 .01 .09 .01 Monthly night shifts 0 133 123.13 ± 13.95 23.59 ± 4.11 22.38 ± 2.80 25.23 ± 3.40 21.31 ± 2.76 30.62 ± 3.57 1–2 73 122.19 ± 13.14 23.25 ± 3.90 22.47 ± 2.70 24.47 ± 2.70 21.22 ± 2.70 30.79 ± 3.59 3–4 44 118.84 ± 14.27 23.02 ± 3.09 21.70 ± 2.75 23.90 ± 3.81 20.66 ± 2.96 29.55 ± 4.16 ≥5 50 116.76 ± 19.38 21.98 ± 4.80 21.98 ± 3.20 23.44 ± 4.76 20.44 ± 3.86 28.92 ± 4.96 F 2.72 1.95 0.93 3.37 1.36 3.24 P .04 .12 .43 .02 .26 .02 Leaders' attitude Very supportive 118 126.33 ± 14.50 24.05 ± 4.00 23.08 ± 2.73 25.73 ± 3.75 22.11 ± 2.76 31.36 ± 3.97 Support 136 119.43 ± 12.47 23.07 ± 3.66 21.79 ± 2.49 24.11 ± 3.08 20.79 ± 2.46 29.68 ± 3.59