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Article(id=1322929601403560822, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.15.014, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1760803200000, receivedDateStr=2025-10-19, revisedDate=1778169600000, revisedDateStr=2026-05-08, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340595818, onlineDateStr=2026-10-30, pubDate=1786291200000, pubDateStr=2026-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340595818, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340595818, creator=13701087609, updateTime=1793340595818, updator=13701087609, issue=Issue{id=1322929431592972373, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='15', pageStart='2577', pageEnd='2768', issueExtLink='null', onlineDate='null', pubDate='1786291200000', pubDateStr='2026-08-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793340555332, creator='13701087609', updateTime=1793343107287, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940135335145743, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940135335145744, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2681, endPage=2687, ext={EN=ArticleExt(id=1322929601630053239, articleId=1322929601403560822, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Clinical work experiences and expectations of nurses with doctoral degrees: a qualitative study, columnId=1220689488284668633, journalTitle=Chinese Nursing Research, columnName=Comprehensive Study, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the experience and expectations of clinical work in nursing with doctoral degree in China,and to provide a basis for further improving the clinical work experience of highly educated talents and giving full play to the professional value of nurses with a doctoral degree.

Methods

A descriptive qualitative study was conducted.Fourteen clinical nurses holding doctoral degrees were recruited for semi-structured in-depth interviews.The interview data were analyzed by using content analysis to extract key themes.

Results

Three main themes and nine sub-themes were identified:dilemmas and professional identity under role conflict(including work conflicts under multiple roles,research challenges stemming from disciplinary characteristics,and evolving professional identity),retention motivations and coping under pressure(including work challenges under multiple pressures,retention motivations based on comprehensive advantages,and coping strategies in response to stress),and needs and expectations in career development(including the need for clear career path planning,equitable allocation of research resources,and expectations for administrative empowerment).

Conclusions

Clinical institutions should establish clear career development pathways,optimize evaluation systems,and provide targeted support in research resources and administrative empowerment.At the hospital level,talent positioning should be redefined to eliminate disciplinary bias and improve resource allocation.These measures are essential to fully develop the professional value of nurses with doctoral degrees and promote the high-quality development of the nursing discipline.

, authors=Qi ZHANG1, Shuman WANG2, Ke ZHANG1, Wanchen ZHAO3, Huijuan QIAN1, Dan HE1, Qunfeng LU1, authorsList=Qi ZHANG, Shuman WANG, Ke ZHANG, Wanchen ZHAO, Huijuan QIAN, Dan HE, Qunfeng LU, authorCompany=null, correspAuthors=Qunfeng LU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322929602036900728, articleId=1322929601403560822, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=博士研究生学历护士临床工作体验及期望的质性研究, columnId=1220689488938980091, journalTitle=护理研究, columnName=综合研究, runingTitle=null, highlight=null, articleAbstract=
目的

了解我国博士研究生学历护士临床工作的体验及期望，为进一步提高高学历人才临床工作体验、发挥博士研究生学历护士的专业价值提供依据。

方法

采用描述性质性研究方法，招募14名具有博士研究生学历的临床护士进行半结构化深度访谈，采用内容分析法对访谈资料进行分析并提炼主题。

结果

最终提炼出3个主题及9个亚主题，分别为角色冲突下的困境与职业认同（多元角色下的工作冲突 、学科特色下的科研困境以及动态演变下的职业认同）、压力负荷下的留职动因与应对（多重压力下的工作挑战 、综合优势下的留职动因以及压力负荷下的应对策略）、职业发展中的需求与期望（职业路径的清晰规划、科研资源的公平配置以及行政管理的赋权期望）。

结论

临床相关部门应建立高学历护理人才的职业发展路径，优化评价体系，并给予科研资源与管理赋权的针对性支持，并从医院层面重构人才定位，破除学科偏见，完善资源配置，以充分发挥博士研究生学历护士的专业价值，推动护理学科的高质量发展。

, authors=张琪1, 王姝曼2, 张珂1, 赵婉辰3, 钱会娟1, 何丹1, 陆群峰1, *, *, authorsList=张琪, 王姝曼, 张珂, 赵婉辰, 钱会娟, 何丹, 陆群峰, authorCompany=null, correspAuthors=陆群峰, authorNote=

张琪，博士研究生

, correspAuthorsNote=
陆群峰，E-mail:
LU Qunfeng, E-mail:
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language=CN, orderNo=5, keyword=质性研究)], refs=[Reference(id=1322929607443358642, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929601403560822, doi=null, pmid=null, pmcid=null, year=2024, volume=21, issue=1, pageStart=42, pageEnd=46, url=null, language=null, rfNumber=1, rfOrder=0, authorNames=温明月, 尚少梅, 贾金忠, journalName=中华护理教育, refType=null, unstructuredReference=温明月,尚少梅,贾金忠,等.护理学博士研究生导师队伍与招生情况分析[J].中华护理教育,2024,21(1):42-46., articleTitle=护理学博士研究生导师队伍与招生情况分析, refAbstract=null), Reference(id=1322929607569187763, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929601403560822, doi=null, pmid=null, pmcid=null, year=2021, volume=37, issue=1, pageStart=241, pageEnd=243, url=null, language=null, rfNumber=2, rfOrder=1, authorNames=Dunbar-Jacob J, Hravnak M, journalName=Journal of Professional Nursing, refType=null, unstructuredReference=Dunbar-Jacob J,Hravnak M.Educating PhD students in research-intensive nursing doctorate programs 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General information of respondents（n=14）

, figureFileSmall=null, figureFileBig=null, tableContent=
编号性别年龄（岁）毕业高校婚姻状况工作地区所在医院等级所在科室工作年限（年）职称职务
D1女31“985”未婚华东三级甲等骨科1中级护士长
D2女33“985”已婚华北三级甲等护理部3中级无
D3男34“985”未婚华东三级甲等心内科7中级护士长
D4女32“985”已婚西南三级甲等妇产科1中级无
D5女29“985”已婚华东三级甲等眼科2中级无
D6男41“985”已婚华东三级甲等重症医学科12高级科护士长
D7女34“985”已婚华南三级甲等感染科4高级无
D8女36“985”已婚华东三级甲等心内科9中级护士长
D9女44“985”已婚华北三级甲等神经外科20高级护士长
D10女37“海外”已婚华南三级甲等肿瘤科2中级无
D11女29“985”已婚华中三级甲等血液内科2中级无
D12女34“985”已婚华东三级甲等泌尿外科1中级无
D13女37“985”已婚华中三级甲等神经内科4中级护士长
D14女38“985”已婚华东三级甲等呼吸与危重症医学科4中级护士长
), ArticleFig(id=1322929607317529521, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929601403560822, language=CN, label=表1, caption=

受访者一般资料（n=14）

, figureFileSmall=null, figureFileBig=null, tableContent=
编号性别年龄（岁）毕业高校婚姻状况工作地区所在医院等级所在科室工作年限（年）职称职务
D1女31“985”未婚华东三级甲等骨科1中级护士长
D2女33“985”已婚华北三级甲等护理部3中级无
D3男34“985”未婚华东三级甲等心内科7中级护士长
D4女32“985”已婚西南三级甲等妇产科1中级无
D5女29“985”已婚华东三级甲等眼科2中级无
D6男41“985”已婚华东三级甲等重症医学科12高级科护士长
D7女34“985”已婚华南三级甲等感染科4高级无
D8女36“985”已婚华东三级甲等心内科9中级护士长
D9女44“985”已婚华北三级甲等神经外科20高级护士长
D10女37“海外”已婚华南三级甲等肿瘤科2中级无
D11女29“985”已婚华中三级甲等血液内科2中级无
D12女34“985”已婚华东三级甲等泌尿外科1中级无
D13女37“985”已婚华中三级甲等神经内科4中级护士长
D14女38“985”已婚华东三级甲等呼吸与危重症医学科4中级护士长
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博士研究生学历护士临床工作体验及期望的质性研究
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张琪 1 , 王姝曼 2 , 张珂 1 , 赵婉辰 3 , 钱会娟 1 , 何丹 1 , 陆群峰 1, *, *
护理研究 | 综合研究 2026,40(15): 2681-2687
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护理研究 |综合研究 2026 , 40 (15) : 2681 -2687
博士研究生学历护士临床工作体验及期望的质性研究
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张琪1, 王姝曼2, 张珂1, 赵婉辰3, 钱会娟1, 何丹1, 陆群峰1, *, *
作者信息
  • 1上海交通大学医学院附属第六人民医院，上海 200233
  • 2上海市质子重离子医院，复旦大学附属肿瘤医院， 上海市放射肿瘤学重点实验室，上海质子重离子放射治疗工程技术研究中心
  • 3中国医学科学院北京协和医院
通讯作者:
陆群峰，E-mail:
LU Qunfeng, E-mail:
作者简介:

张琪，博士研究生

Clinical work experiences and expectations of nurses with doctoral degrees: a qualitative study
Qi ZHANG1, Shuman WANG2, Ke ZHANG1, Wanchen ZHAO3, Huijuan QIAN1, Dan HE1, Qunfeng LU1
Affiliations
  • 1Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233 China
  • 2Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology, Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy
  • 3Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
出版时间: 2026-08-10 doi: 10.12102/j.issn.1009-6493.2026.15.014
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摘要
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目的

了解我国博士研究生学历护士临床工作的体验及期望，为进一步提高高学历人才临床工作体验、发挥博士研究生学历护士的专业价值提供依据。

方法

采用描述性质性研究方法，招募14名具有博士研究生学历的临床护士进行半结构化深度访谈，采用内容分析法对访谈资料进行分析并提炼主题。

结果

最终提炼出3个主题及9个亚主题，分别为角色冲突下的困境与职业认同（多元角色下的工作冲突 、学科特色下的科研困境以及动态演变下的职业认同）、压力负荷下的留职动因与应对（多重压力下的工作挑战 、综合优势下的留职动因以及压力负荷下的应对策略）、职业发展中的需求与期望（职业路径的清晰规划、科研资源的公平配置以及行政管理的赋权期望）。

结论

临床相关部门应建立高学历护理人才的职业发展路径，优化评价体系，并给予科研资源与管理赋权的针对性支持，并从医院层面重构人才定位，破除学科偏见，完善资源配置，以充分发挥博士研究生学历护士的专业价值，推动护理学科的高质量发展。

护理学博士  /  护士  /  工作体验  /  期望  /  质性研究
Objective

To understand the experience and expectations of clinical work in nursing with doctoral degree in China,and to provide a basis for further improving the clinical work experience of highly educated talents and giving full play to the professional value of nurses with a doctoral degree.

Methods

A descriptive qualitative study was conducted.Fourteen clinical nurses holding doctoral degrees were recruited for semi-structured in-depth interviews.The interview data were analyzed by using content analysis to extract key themes.

Results

Three main themes and nine sub-themes were identified:dilemmas and professional identity under role conflict(including work conflicts under multiple roles,research challenges stemming from disciplinary characteristics,and evolving professional identity),retention motivations and coping under pressure(including work challenges under multiple pressures,retention motivations based on comprehensive advantages,and coping strategies in response to stress),and needs and expectations in career development(including the need for clear career path planning,equitable allocation of research resources,and expectations for administrative empowerment).

Conclusions

Clinical institutions should establish clear career development pathways,optimize evaluation systems,and provide targeted support in research resources and administrative empowerment.At the hospital level,talent positioning should be redefined to eliminate disciplinary bias and improve resource allocation.These measures are essential to fully develop the professional value of nurses with doctoral degrees and promote the high-quality development of the nursing discipline.

doctor of nursing  /  nurses  /  work experience  /  expectation  /  qualitative study
张琪, 王姝曼, 张珂, 赵婉辰, 钱会娟, 何丹, 陆群峰. 博士研究生学历护士临床工作体验及期望的质性研究. 护理研究, 2026 , 40 (15) : 2681 -2687 . DOI: 10.12102/j.issn.1009-6493.2026.15.014
Qi ZHANG, Shuman WANG, Ke ZHANG, Wanchen ZHAO, Huijuan QIAN, Dan HE, Qunfeng LU. Clinical work experiences and expectations of nurses with doctoral degrees: a qualitative study[J]. Chinese Nursing Research, 2026 , 40 (15) : 2681 -2687 . DOI: 10.12102/j.issn.1009-6493.2026.15.014
正文
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护理学博士研究生教育是当前国际公认的最高层次的护理教育，其目标是培养兼具护理科研与教学指导双重能力并能熟练运用护理理论指导临床实践的护理科学家[1-3]。我国在“健康中国”战略深入推进背景下，对护理专业的重视程度日益加深，护理学研究生教育也朝着更加系统化、全面化的方向发展[4]。随着我国护理学博士培养点数目的增加，护理博士研究生学历毕业生数量也逐年增长，进入临床护理岗位的博士研究生学历护士也有所增加[5]，但其在临床岗位就业的数量占比仍然较低，属于稀缺人才资源[5-6]。选择临床岗位就业的护理学博士研究生在从以科研训练为主的研究生身份向以临床实践为核心的护士角色转变的过程中，面临着身份转换冲突与职业路径模糊等多重困境。然而，目前相关研究较多关注对护理学博士研究生人才队伍现状的描述和培养模式的探讨，针对其在临床岗位工作体验的相关证据不足，难以全面深入理解其困境背后的体验与需求[7-11]。与此同时，研究显示，博士研究生学历护士职业发展的核心期望并未获得充分重视，医疗机构和管理层面亦由于缺乏足够的实证依据，难以构建针对性的职业发展路径与支持系统[12]。
深入理解博士研究生学历护士的真实临床工作体验及其职业期望，对于改善其工作环境、制定科学用人策略和推动护理学科创新发展具有重要意义。因此，本研究采用描述性质性研究的方法，通过半结构式访谈，旨在深入了解当前博士研究生学历护士的临床工作体验以及期望，以期为优化其临床工作环境、完善职业发展路径提供依据，进而实现人才资源的优化配置与高效利用，促进其专业价值的充分发挥。
1　对象与方法
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1.1　研究对象
于2025年10月12日，采用目的抽样法，选取全职就职于我国医院的博士研究生学历护士作为研究对象。纳入标准：1）全日制护理学博士研究生；2）在临床一线工作时间≥1年；3）知情同意，且自愿参与本研究。排除标准：1）近1年内连续休假≥3个月；2）目前在外进修、访学等未在岗。遵循最大差异化原则进行抽样，选取年龄、性别、培养类型、毕业院校类型、职称、职务、所在医院级别、所在科室、工作年限、婚姻状况方面差异最大的护士作为研究对象。样本量以访谈内容不再出现新的主题、信息饱和为原则。本研究共访谈14名博士研究生学历护士。本研究已通过上海交通大学医学院附属第六人民医院伦理委员会审查[审批编号：2025-KY-404(K）]。
1.2　研究方法
1.2.1　制订访谈提纲
在文献回顾的基础上，研究者拟订访谈提纲初稿，进一步经过专家咨询以及预访谈，综合考量与修订后，形成了正式访谈提纲。访谈提纲：1）您目前从事的工作主要内容包括哪些？2）您在临床工作中的真实体会和感受有哪些？3）您在临床工作中有负向体会和感受时，是如何应对的？4）您对自己的临床工作方面的期望有哪些？5）您选择和能够坚持在临床工作的原因和考虑有哪些？6）您对医院的相关管理者和同事有哪些期望？7）您认为医院相关部门可以采取哪些措施提升博士研究生学历护士的临床工作体验和期待？8）可以谈谈您从事临床工作经历中印象深刻的事情吗？
1.2.2　资料收集方法
通过线上视频会议、电话的方式对14名受访者实施半结构化访谈收集相关资料。访谈前，研究者通过问卷星向研究对象介绍研究目的和研究内容，获得其知情同意和一般资料。在访谈过程中，研究者严格依照提纲进行访谈，同时依据受访者的回应灵活调整问题的次序及提问策略。访谈期间，研究者耐心聆听，鼓励受访者畅所欲言，同时避免使用带有偏见或引导性的语言。若受访者表述不清或内容可深化，则通过复述或进一步提问的方式，明晰其真实想法，同时注意观察并记录受访者的面部表情、肢体动作等非言语信息。每次访谈持续30~60 min，无新的内容出现则访谈结束。
1.3　资料整理与分析方法
由2名具有质性研究分析经验的研究者在访谈结束24 h内，将访谈录音转录为文字，导入Nvivo 14软件，并采用内容分析法分析结果。对访谈内容进行反复阅读后标记重要部分的观点作为最小编码单位，对文本进行开放编码，之后通过对编码进行归类形成亚主题，再根据亚主题之间的相似性提炼形成主题[13]。若在此过程中出现分歧，则由研究小组集体讨论并作出最终决定。在分析资料时，研究者通过撰写反思日志、与同行交流等方式提升研究的严谨性，最大限度地减少个人偏见及预设观念对研究结果的潜在影响。
2　结果
收起
累计实施访谈589 min，转录文字约16万字。通过对14名博士研究生学历临床护士（编号D1~D14）的访谈资料进行反复整理、分析、归纳、提炼，共形成3个主题和9个亚主题。受访者一般资料见表1。
2.1　角色冲突下的困境与职业认同
博士研究生学历护士在临床实践中普遍面临角色多元性带来的冲突、科研与临床深度整合的现实壁垒以及职业认同的阶段性变化过程。
2.1.1　多元角色下的工作冲突
博士研究生学历护士往往承担着科研探索者、临床实践者与岗位管理者三重角色，这种多元角色冲突的核心源于时间、资源等多维的差异化需求。在时间维度上，科研工作所需的“沉浸式思考环境”需求与临床工作的“不可预测性”带来冲突。D1指出：“科研工作有的时候可能就是需要比较能沉浸的这样的一个空间或者说时间进行思考，但在临床琐碎事情很多，一旦被打断，很难再进入思考和科研的状态”；D7也提及：“平常监控临床质量、协调科室人力排班等管理事务已经占据很多精力，科研只能‘见缝插针’推进，周末还要组织科研会诊，常因疲劳导致效率下降”。在资源维度上，科研与管理的推进均需行政授权，但多数受访者面临“有需求无权限”的困境。D2提到：“申请多中心研究时需6个病区护士协助数据收集，因无正式行政职务，只能逐一向各科室护士长请求帮忙，部分科室直接拒绝，导致课题数据收集进度延迟”；D13也指出：“跨科室科研协作时，无护理部明确授权就无法调派护士，导致项目停滞”。
2.1.2　学科特色下的科研困境
尽管受访者均认为护理科研应“源于临床、反哺临床”，但由于护理科研方向较为宽泛、临床护理情景复杂以及临床护士学历普遍较低的学科特色下，难以实现科研与临床的深度整合。受访者表示，一部分体现在科研方向的转变，即博士期间的研究方向与实际的临床工作岗位不匹配，需根据新的工作岗位与需求调整研究方向。D1指出：“工作后，领导出于学科发展的考虑，将我安排到医院的优势学科，但是这也面临着我要重新开辟一个新的研究方向，重新积累新的研究基础”。D5也指出：“博士阶段我主攻慢性病管理，现在我定了眼科门诊后，需重新学习专科知识，此前积累的科研基础几乎无法复用，只能从一些小问题切入，科研深度明显不足，也无法延续和整合前期博士期间的研究基础和成果”。另外还体现在成果转化层面，由于临床护理情景的复杂性，受访者表示科研的产出、落地、推广存在难度。D8提到：“我曾经针对耐药菌感染防控设计的流程进行优化，发表文章后想要进一步在临床推广，但因未与科室绩效挂钩，临床执行不久便恢复原状”。在团队协作层面，受访者也提出科研项目的开展需要团队的协作，但是临床护士普遍学历水平低，缺乏科研思维，难以在科研项目开展过程中给予有效的支持和帮助。D9表示：“科室仅2名全日制硕士研究生，多数护士无科研基础，他们也只想着干好自己的临床工作就行，没有想过要去搞科研”；D6也表示，“我尝试让临床护士撰写个案报告，但多数人仅能完成数据记录，无法提炼科研问题，联动效果有限”。
2.1.3　动态演变下的职业认同
博士研究生学历护士的职业认同呈现出困惑迷茫期-自我重建期-稳定认同期3个阶段的动态演变。D13的受访者描述了自己在临床岗位工作的职业认同演变过程：“刚开始到医院工作，我其实是迷茫和困惑的，不知道博士在医院可以做什么，但是随着我慢慢学习专业技能、掌握实操技巧，主动融入我们科室以后，我适应了很多。到现在看到手里管的病人一个个康复出院以后就感觉越来越有成就感”。在困惑迷茫期，多数受访者因“高学历与低临床技能”的落差产生自我怀疑。如D4描述：“刚开始我和所有不同学历层次的护士一样，经历临床科室的轮转，有时候一些操作我还没有专科学历的同事做得好，就会觉得特别委屈，会怀疑自己辛苦获得博士研究生学历的意义”。在自我重建期，受访者通过自我学习与寻求外部支持逐步完成自我重建。D8提到：“因为从来没有接触过ECMO（体外膜肺氧合）的使用，我就经常向高年资护士请教，利用休息时间反复学习，后面真正掌握以后，同事对我刮目相看，我也很有成就感”。多数受访者在1~2年后逐渐形成清晰的职业认同，且临床工作的价值感也得到提升，即进入了稳定认同期。D14指出：“博士研究生学历护士在临床当中优势是比较突出的，能很好地和学科团队进行配合，看待问题也不局限于问题本身，会通过思考和反思如何用科研的方法提升和反哺临床护理工作，更好地整合科研与临床”。
2.2　压力负荷下的留职动因与应对
博士研究生学历护士尽管在临床工作中面临多重压力，仍选择留职临床工作岗位的核心动因在于临床岗位展现出的综合性优势，与此同时，受访者表示可以通过积极的应对策略缓解并适应压力。
2.2.1　多重压力下的工作挑战
博士研究生学历护士在临床工作中面临多重外部压力，表现为外界期望过高、情感劳动过载、学科地位偏见的相互交织。从外界期望来看，医院与同事对博士研究生学历护士存在“全能化”期待。D10提到：“领导总希望你一进来就拿大课题，第1年就催着我去申请国自然，并且期待一申就中”；D12也提到：“博士期间专注科研，临床操作生疏，首次给新生儿注射时手抖，被同事调侃‘只会做科研也不行啊，怎么连这么简单的操作都不会’”。这种高期待成为博士研究生学历护士职业初期的显著挑战和压力来源。与此同时，情感劳动的隐性过载进一步加剧其压力，D14提到：“之前遭遇过病人家属情绪崩溃后被她破口大骂，尽管理解家属焦虑和激动，也花了很多时间去调整心态但还是很低落，甚至影响次日工作状态”；D11也表示：“我们科室病人很多都是重症病人，家属因经济压力或病情反复而情绪激动，需要投入大量时间进行情绪疏导，长期下来会形成一定的心理负荷”。值得注意的是，由于护理学科在医学领域中仍处于弱势位置，业界对护理学科的地位普遍存在偏见，并体现在临床工作的各个方面。D1表示：“我们护理专业的博士也是受过正统的科研训练，其能力不比其他学科的差，但整体感觉医院的职能科室不认同护理学科的价值，在科研方面的支持是缺乏的”。D4提到：“与医生合作时，对方认为我们只会做问卷调查，不认可护理在多学科研究中的学术价值，仅让配合收集数据，不让参与课题设计与成果讨论”。这种学科层面的认知偏差使得博士研究生学历护士的学术付出难以获得对等的价值认可。D8也提到：“我跟家属在做宣教的时候给他提出了专业的糖尿病足护理建议，但是他不认可，非要医生跟他说他才听得进去，认为医生更加专业，我们护士只会打针、发药”。
2.2.2　综合优势下的留职动因
面对诸多挑战，博士研究生学历护士仍选择留在临床工作岗位的核心原因在于临床岗位能够提供相较于单纯科研岗位更立体化的职业发展路径与资源支持。首先，科研资源可及性显著提升。D6提到：“在临床会比较容易收集到一些数据，这一点还是比较好的”；此外，D12强调临床数据量的不可替代性：“门诊每年有约2 000例慢性伤口病人档案，这是在高校教学科研岗位无法获取的数据”；D9也提到：“在医院做的课题比较贴合临床实践，有利于真正解决护理学科需要解决的问题”。其次，职业发展通道更快捷。D10提及：“在职称晋升速度方面优势还是很明显的，高校同学任讲师8年还没有评上副高，我在医院第5年就已经通过评审了”；D1也提到：“我来医院时间比较短就能有管理岗位，是很难得的，这也让我看到医院层面对我的重视，也是我坚定继续留在临床工作比较大的原因”。最后，经济激励差异显著。D2提到：“高校就职同学年薪较低，我的基本工资加科研奖励远超高校工资；D7也表示：“护理部设立科研成果转化分成制度，我的智能输液报警专利转化后获销售额分成”。D4也提到交叉学科优势：“在医院更容易接触到多学科的临床专家，比如与营养科合作开展研究，可以直接获取多维度临床指标”。
2.2.3　压力负荷下的应对策略
面对压力负荷，博士研究生学历护士发展出积极调整心态、寻求组织支持以及进行注意转移3类适应性策略应对。
2.2.3.1　积极调整心态
D3面对临床质疑时明确表态：“不跟他们一般计较，干吗跟他们一般计较呢？就自己心态很好啊”，将评价标准转向自我认同；D14也提到：“还能怎么办，let it go啊，不要想那么多，自己整理好情绪就行”。
2.2.3.2　寻求组织支持
D7在遭遇临床排斥后寻求行政干预：“向护士长反映学习需求，要求安排专人带教临床技术”；D1也提到：“先自我调节，然后让自己先接受这个事情，有机会的话，再寻求一些上层领导的帮助，和他们进行沟通协调”。
2.2.3.3　进行注意转移
D10提到：“带孩子能消除负面情绪……回家看到娃就可以忘却工作的烦恼，不会再想到那些有的没的”；D13也表示：“感觉压力很大的时候，我就会去看场电影、唱唱歌或者去运动，转移一下注意力，这样能够暂时放空自己”。
2.3　职业发展中的需求与期望
2.3.1　职业路径的清晰规划
博士研究生学历护士认为当前医院及护理部层面对其职业路径的规划仍不够清晰，期待医院建立适配的阶梯式职业路径规划，避免高学历护士的科研优势被分散消耗。D12指出：“科室对博士的职业培养没有明确方向，我入职后感觉眉毛胡子一把抓，找不到重点，特别希望有一个清晰规划，比如第1年轮转打基础，第2年定专科方向，第3年独立领题”。此外，受访者均表示就职单位对目前高学历护士的培养模式仍存在碎片化的问题，D9反映：“目前科室各自为政，有的博士纯搞科研，有的焊在临床，全看护士长偏好，没有统一、标准化的路径指引，对于博士研究生学历护士的培养应该有明确、标准化的规划和路径”。医院层面对于高学历护士的职业发展路径不清晰、培养模式碎片化是博士研究生学历护士阐述职业困扰和离职意愿的主要原因，D10提出双轨制发展方案：“应区分临床专家与科研骨干路径，前者考核专科门诊建设，后者关注课题转化率，让想走科研路的博士有机会专注课题，想走临床路的能聚焦专科技能，而非‘一刀切’培养”，不然长期的困惑下，会考虑是否要转去高校，他们对于护理博士研究生的培养路径是比较清晰和成熟的”。
2.3.2　科研资源的公平配置
博士研究生学历护士开展科研时由于医院制度、不同职能部门间的认知差距面临经费短缺、团队缺乏、评审不公的资源困境，建立与护理学科相适配的科研支持机制和保障资源的公平配置是受访者的普遍期待。
2.3.2.1　经费支持
D1提到：“护理学科的资助经费非常低，比如我做智能化干预，护理部课题的资助是远远不够的”；D9也提到：“医院提供给我的院级课题仅3万元经费，连多中心数据采集都不够，希望能够增加一些课题经费用于开展临床研究”；D10也指出：“我们是没有科研启动经费的，之前做课题的一些费用都是自掏腰包，我觉得可以设立像护理博士专项基金之类的，在课题研究过程中根据进展情况进行基金的分阶段发放，完成阶段性目标就追加经费，这样也可以激励大家持续推进研究”。
2.3.2.2　团队配置
D4指出“临床工作大家都很忙，要求专科护士全职配合搞科研几乎不可能，但是我觉得可以按课题需求配临时科研团队，比如在做这个课题的时候给1名专职研究助理，临床护士协助科研的可算绩效加分，这样对方参与积极性更高，也不用再求着别人帮忙”。
2.3.2.3　评审机制
D1提到：“医院层面一些科研项目的评选上会优先推选医疗的，对我们护理的重视程度就比较低，都不给我们与外面人比拼的机会。希望之后科教处可以设护理专项评审通道，比如邀请护理高校教授、三级甲等医院护理专家去评项目书，或者医院每年预留几个护理学科课题申报名额，直接推荐到市级或省级评审”。
2.3.3　行政管理的赋权期望
博士研究生学历护士在临床岗位的跨部门协作与决策中面临无权限、无话语权的赋权瓶颈，期待能够通过行政赋权突破工作中的协作壁垒。
2.3.3.1　权限协调
D2提出：“应授予博士一定的行政职务，便于协调多科室资源，我之前牵头多中心研究时，因没有行政头衔，对接6个病区收集数据时有几个病区直接拒绝，如果你是护士长的话肯定不会这么被动”。D14也指出：“博士头衔不等于指挥权，你说‘需要调2名护士协助随访’，护士长一句‘临床忙’就给怼回来，没有护理部的正式授权，根本协调不动资源”。
2.2.3.2　决策参与
D12表示：“我们在科室发展决策中缺乏话语权，比如之前科室在讨论专科建设重点时，我因为是普通护士，所以提的一些建议并没有被重视和采纳，如果有决策权的话，很多事情就更好开展，也能去实现自己的一些想法”；D4也补充到：“获得护理部授权后，我主导的跌倒预防项目能直接对接各科室护长，不仅将全院评估耗时缩短40%，还推动了专科协作，这让我更期待医院明确博士参与科室发展会议的权利，这样才能真正把学历优势转化为实际发展成效，而非仅停留在‘口头重视’”。
3　讨论
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3.1　角色整合与认同构建是博士研究生学历护士发挥临床学术桥梁作用的关键
本研究显示，博士研究生学历护士在临床实践中面临科研、临床与管理多重角色的冲突与整合困境，与现有护理人力研究中关于高学历护理人才“角色超载”的研究结果[14-15]一致。博士研究生学历护士在职业初期普遍经历自我怀疑与身份困惑，尤其在临床技能与科研能力未能同步发展时易产生学历-能力认知偏差和自我否定，从而产生较低的职业认同感[16]。这种角色适应困难不仅影响其个人职业满意度，也可能造成高层次护理人才资源的隐性流失。然而，多数受访者表述会通过主动学习、团队融入与临床反思逐步实现角色适应和自我重建，并建立起以护理科研反哺临床为核心的职业认同，体现了高学历护士所具备的反思性实践能力[17]。此外，博士研究生学历护士职业认同的动态演变过程提示护理管理者应重视博士研究生学历护士的职业过渡期，通过明确角色定位与临床导师制度、设立阶段性能力达标标准等方式，帮助其实现从“科研型博士生”向“学者型临床专家”的转型，从而充分发挥其在循证实践与护理质量改进中的桥梁作用。此外，医院层面相关职能部门也应当充分认识到博士研究生学历护士在整合理论研究与临床实践方面的独特优势，为其建立合适的岗位，如与专科护理、循证实践以及科研教学等需求匹配的岗位，充分发挥其作为“临床学术桥梁”的重要作用。
3.2　压力应对与留职动因彰显组织支持在人才保留中的核心价值
博士研究生学历护士在面临高压力负荷时，既依赖个体层面的积极调适策略，也需要组织层面提供的资源与支持。本研究中，受访者普遍提到医院在科研资源、职称晋升与经济激励方面的综合优势等结构性支持是其选择留职的关键动因，与王芹等[18]关于组织支持感对护理人员留职意愿的预测作用研究结果一致。罗忠琛等[7]通过对10名护理学在读博士研究生的深入访谈也发现，合适岗位和发展空间等资源优势也是这类群体从事临床护理工作的考虑之一，与本研究结果一致。医院相关职能部门及护理管理者应更加重视系统性支持环境的构建，从而增强其职业获得感，并将学术能力持续转化为护理服务质量提升与临床创新成果。同时值得注意的是，博士研究生学历护士在压力负荷下采用的积极调整心态、寻求组织支持等应对策略，反映出其具备较高的心理韧性与情绪智力，这一特质与姜小鹰等[19]提出的护理博士研究生的核心能力要求相吻合。这提示护理管理者在引进博士研究生学历护士后应重视博士研究生学历护士的复合型压力，主动关注其心理状态与职业适应水平，及时识别与疏导其高负荷状态，从而保障其身心健康，促进其学术能力稳步转化为临床实践创新。
3.3　制度创新与资源配置是博士研究生学历护士专业成长的重要保障
本研究中博士研究生学历护士普遍期待更加清晰的职业路径、专项科研资源与适度的行政管理赋权，这反映出当前护理人力资源管理体系在高层次人才使用与培养方面仍存在制度空白。当前医院人事架构大都仍沿袭“医教研”一体化模式，未考虑护理学科发展的特殊性，医院仍将高学历护士纳入传统护士晋升体系，导致其独特的价值被制度性忽视[12]。本研究结果表明，博士研究生学历护士在推动护理学科发展、优化临床流程与引领循证实践方面具有显著潜力。苏雅等[20]研究也指出，对于博士研究生学历护士而言，更应该关注的是其实践转化能力和领导力的培养，而这类人才作用的发挥亟需组织层面的制度保障与资源倾斜。建议医院层面制定差异化的临床专家与科研骨干等不同领域的培养路径，避免人才使用的“泛化”与“浪费”。在科研支持方面，可设立护理博士研究生专项基金、配备科研助理、构建院内高层次护理人才专项评审机制，从而提升其科研产出与转化效率。在管理赋权方面，应通过授予实质性行政职务或项目协调权限，有效破除跨部门行政壁垒，推动其角色从“高学历执行者”向“临床创新推动者”的有效转变。
4　小结
收起
本研究发现，博士研究生学历护士常面临临床、科研与管理的三重角色冲突，专业价值仍存在学科偏见，但通过自我调节和平台资源整合，逐渐形成稳定的职业认同。博士研究生学历护士普遍呼吁建立清晰的职业发展路径，优化评价体系，并给予科研资源与管理赋权的针对性支持。未来需从医疗机构层面重构人才定位，破除学科偏见，完善资源配置，以充分发挥博士研究生学历护士的专业价值，推动护理学科的高质量发展。

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doi: 10.12102/j.issn.1009-6493.2026.15.014
  • 接收时间：2025-10-19
  • 首发时间：2026-10-30
  • 出版时间：2026-08-10
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  • 收稿日期：2025-10-19
  • 修回日期：2026-05-08
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    1上海交通大学医学院附属第六人民医院，上海 200233
    2上海市质子重离子医院，复旦大学附属肿瘤医院， 上海市放射肿瘤学重点实验室，上海质子重离子放射治疗工程技术研究中心
    3中国医学科学院北京协和医院

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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