Identifying Distinct Trajectories and Predictors of Professional Identity in Nursing Interns: A Prospective Cohort Study
Zhengju Chen, Peng Shao, Hongrang Chen, Biaoxin ZhangABSTRACT
Aim
Clinical internships represent a critical phase for shaping professional identity in undergraduate nursing students, which significantly influences their career intentions, workforce retention, and the stability of the nursing profession. However, limited research has examined the dynamic, heterogeneous developmental patterns of professional identity throughout the internship period. This study aimed to identify distinct trajectory classes of professional identity and their predictors, with the goal of informing targeted interventions to strengthen professional identity and reduce workforce attrition.
Design
Prospective cohort study.
Methods
This prospective cohort study enrolled undergraduate nursing interns from two tertiary hospitals in Anhui Province, China, from January to December 2024. Professional identity was measured using the Professional Identity Questionnaire for Nurse Students (PIQNS) at three time points: the end of the 3rd (early), 6th (middle), and 9th (late) months of internship. We used Latent Class Growth Modelling (LCGM) to identify distinct developmental trajectories. Univariate analyses and binary logistic regression were performed to examine factors associated with trajectory membership.
Results
Of the 251 interns who completed all assessments, LCGM identified two distinct trajectory classes: a low‐level group ( n = 128, 51%), characterized by low initial scores, a mild mid‐internship rise, and a subsequent moderate decline; and a high‐level group ( n = 123, 49%), characterized by consistently high scores, a slight mid‐internship increase, and only minor late‐stage fluctuation. The logistic regression results revealed that voluntarily choosing nursing as a university major (reference = no, OR = 0.195, p = 0.002), liking nursing (reference = dislike, OR = 0.260, p < 0.001), and having leadership experience (reference = no, OR = 0.446, p = 0.007) were all associated with lower odds of being classified into the low‐level group (all OR < 1).
Conclusion
The development of professional identity among nursing interns exhibits significant inter‐individual heterogeneity. Clinical educators and academic instructors should consider these distinct trajectory classes when designing personalized, stage‐specific interventions to enhance professional identity and mitigate workforce attrition in nursing.
Implications for the Profession
These findings provide actionable guidance for clinical preceptors and academic instructors to identify interns at risk of professional identity decline, especially those with non‐voluntary major choice, low professional interest, or no leadership experience. Educators should implement stage‐specific support: pre‐internship orientation to manage expectations, mid‐internship competency feedback and peer mentoring, and late‐internship career counselling and resilience training to reduce burnout and employment pressure. Such targeted interventions may enhance professional identity stability and improve nursing workforce retention.
Patient or Public Contribution
No patient or public contribution.