About this course:
This course explores the concept of professional identity in nursing, highlighting essential elements and strategies to foster the development of professional identity for nurses across all practice areas.
This course explores the concept of professional identity in nursing, highlighting essential elements and strategies to foster the development of professional identity for nurses across all practice areas.
Upon completion of this module, learners should be able to:
- discuss factors that contribute to nursing burnout, moral distress, and job dissatisfaction
- explore the statistics related to nursing turnover
- define professional identity in nursing
- discuss the role of the International Society for Professional Identity in Nursing in developing the domains of professional identity
- explore strategies to foster the development of professional identity in nursing
Nurses and other healthcare professionals (HCPs) work in fast-paced, stressful environments. Caring for patients from birth to death and during times of wellness and illness can be one of the most rewarding jobs. Nurses often describe choosing to enter healthcare as a calling to serve others. However, the multiple demands on each nurse's time throughout the workday can leave them frustrated, overwhelmed, and overextended. A nurse's inability to meet all competing demands adequately can result in burnout. When nurses experience burnout, negative consequences result for the nurse, their healthcare organization, and their patients. Nurses can experience physical and emotional manifestations of burnout (e.g., anxiety, depression, headaches) that impact their work and home lives. In addition, high rates of nurse and HCP burnout can lead to staffing concerns and turnover. When healthcare organizations are affected by HCP burnout, there can be a decrease in the quality of care provided and an increase in adverse safety events (Clark, 2021; Owens & Godfrey, 2022).
HCP burnout has been a recognized problem for decades. However, the COVID-19 pandemic has brought HCP burnout to the forefront of global and national priorities. Throughout the pandemic, nurses and other healthcare professionals experienced poor working conditions that resulted in burnout, moral distress, poor physical and mental health, job dissatisfaction, and high turnover (Owens & Godfrey, 2022). Raso and colleagues (2021) conducted a descriptive, cross-sectional survey of 5,000 nurses across the US to explore the relationship between perceptions of the impact of the COVID-19 pandemic and nurses' intention to leave their current position and the profession. These researchers found that 11.1% of nurses (in direct patient care or management) during the pandemic reported an intention to leave their current position, with an additional 19.6% undecided. In addition, the researchers found that 1.8% of the nurses intended to leave the profession altogether, with an additional 7.6% undecided. In January of 2022, the Nursing Solutions Inc (NSI) National Healthcare Retention and RN Staffing Report for 2021 was released, demonstrating the significant impact of the pandemic on the nursing workforce. According to the NSI report, the pandemic amplified the mismatch between the supply and demand of nurses. The resulting "great resignation" demonstrates the impact of hospital turnover rates in 2021 exceeding every previous NSI survey. More specifically, in 2021, nurses left bedside care roles at alarming rates, exceeding hospital turnover rates for all healthcare professionals. The turnover rate for staff RNs increased by 8.4% and currently stands at 27.1%, with step-down, telemetry, and emergency services experiencing the highest rates (NSI, 2022).
In 2007, the Institute for Healthcare Improvement (IHI) presented the Triple Aim framework to optimize healthcare system performance. The three dimensions of the Triple Aim consist of the following:
- improving the patient care experience
- improving the health of populations
- reducing the per capita cost of healthcare
Healthcare organizations and national leaders have recently highlighted that HCPs’ work environments are critical to achieving the Triple Aim. Therefore, many organizations have advocated expanding the Triple Aim to include a fourth dimension of attaining joy in work. The resulting Quadruple Aim addresses the importance of healthy work-life for HCPs as a foundation for achieving the Triple Aim. Addressing burnout and promoting joy in the workplace can improve patient outcomes and safety (Feeley, 2017; Fitzpatrick et al., 2019).
The National Academies of Sciences, Engineering, and Medicine (NASEM) and colleagues (2021) published the Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. This report explores how nurses can reduce health disparities while minimizing costs, utilizing technology, and maintaining a patient and family-centered focus. One of the critical areas discussed in this report is nurses' health and well-being. Well-being has been defined by Chari and colleagues (2018) as
an integrative concept that characterizes quality of life with respect to an individual's health and work-related environmental, organizational, and psychosocial factors. Well-being is the experience of positive perceptions and the presence of constructive conditions at work and beyond that enable workers to thrive and achieve their full potential. (p. 590)
Nurse well-being affects individual nurses' physical and mental health, job satisfaction, and joy or meaning in their work. In addition, nurse well-being affects patients and their perceptions of their care. The Future of Nursing 2020-2030 recommends that nursing education programs, employers, nursing leaders, nursing organizations, and licensing boards should implement structures and evidence-based interventions to promote nurses' health and wellness. One evidence-based intervention includes fostering professional identity within regulatory settings, clinical practice, and nursing education. Fostering professional identity can transform workplace environments to prevent burnout, moral distress, and mental and physical stress and promote job satisfaction and nurse retention (NASEM et al., 2021; Owens & Godfrey, 2022).
Professional Identity in Nursing
The concept of professional identity is new to nursing but has been used by other professions—such as veterinary medicine, pharmacy, and occupational therapy—for over 20 years. In these disciplines, the term professional identity has replaced the term professionalism. The development of this term in relation to nursing began in 2018. In response, the University of Kansas School of Nursing faculty invited nurse leaders in different practice areas to participate in a think tank to define professional identity, key elements, competencies, and exemplars in the nursing field. In 2020, the National League of Nursing (NLN) and the American Association of Colleges of Nursing (AACN) engaged with other nursing organizations to create the International Society for Professional Identity in Nursing (ISPIN), seeking to develop and raise awareness of professional identity formation for nurses. The ISPIN works closely with nursing educational organizations to incorporate professional identity formation into nursing school curricula. The ISPIN is also collaborating with Sigma Theta Tau International to create a data repository, including podcasts and webinars for professional identity in nursing. Since 2018, this effort has launched 28 publications and presentations and the creation of numerous active committees (e.g., the role of the leader, healthy work environment, propelling the science, disseminating widely, instrument development, entry-level integrations, advanced level nursing, and student focus; Brewington & Godfrey, 2020; Godfrey, 2022; University of Kansas Medical Center, n.d.-a, n.d.-b).
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The ISPIN and the American Nurses Association (ANA) have adopted Godfrey and Young's definition of professional identity as "a sense of oneself, and in relationship with others, that is influenced by characteristics, norms, and values of the nursing discipline, resulting in an individual thinking, acting, and feeling like a nurse" (Owens & Godfrey, 2022, para. 6). ANA has outlined the scope of practice guidelines for nurses, including the services they are deemed competent to perform based on their professional licensure. The ANA guidelines—most recently updated in 2021—describe the who, what, when, where, why, and how of nursing practice. Nurses have personal and professional identities that converge to form the values used in nursing practice. The ANA guidelines state that professional identity is more than just being or acting professionally; it is a transformational process in becoming a professional nurse that should begin in nursing school (ANA, 2021).
The importance of establishing a professional identity in nursing is also highlighted in the 2021 AACN baccalaureate essentials. The AACN essentials outline 10 domains (areas of competence) that constitute a framework for nursing practice. Domain 9 of the essentials focuses on professionalism, which has been defined as the "formation and cultivation of a sustainable professional nursing identity, accountability, perspective, collaborative disposition, and comportment that reflects nursing's characteristics and values" (AACN, 2021, p. 11).
Attributes and Domains
The discussion of professional identity in nursing began with two invitational Think Tanks, with leaders from education, practice, regulation, and healthcare. During the first Think Tank, participants created four domains of professional identity, including definitions and competencies for each domain. During the second Think Tank in 2019, the name ISPIN emerged. The group also created a why statement: "To operationalize a clear understanding of nurses' professional identity so that their unique contributions to improve healthcare are recognized" (Brewington & Godfrey, 2021, p. 201). ISPIN is currently establishing a steering planning committee and directing the workgroups discussed above (Brewington & Godfrey, 2021; Godfrey, 2020).
During both Think Tanks, members worked to create the domains of professional identity. They started by identifying the five attributes that describe professional identity in nursing (Owens & Godfrey, 2022):
- Doing: Nurses embrace society's rules and expectations and the professional standards and codes that outline their scope of practice; they function within the boundaries of their prescribed role.
- Being: Nurses make decisions based on their core values. This inherent quality prompts individuals to behave appropriately in diverse situations.
- Acting ethically: Nurses make fair and just decisions personally and professionally without allowing biases to impact their decision. They should be aware that biases exist but not allow them to influence their decision.
- Flourishing: Nurses will undergo a personal and professional transformation to a higher level of maturity and well-being. This transformation occurs on a continuum of growth.
- Changing identities: Nurses will understand the transition of identities as they move through stages of life. They must understand how their identities may change and that new behaviors may accompany these changes.
After establishing the definition and attributes of professional identity, the group worked to create the four domains of professional identity, including the definition and competencies for each. These are explained in Table 1 (Owens & Godfrey, 2022).
Domains of Professional Identity
Values and ethics
Core values and principles that guide a nurse's conduct
Analysis and application of information derived from either nursing or other disciplines
Nurses as leaders
Inspiring self and others to transform a vision into reality
A nurse's professional behavior is based on their words, actions, and presence
(Godfrey, 2020, 2022; University of Kansas Medical Center, n.d.-b)
Nursing students and nurses at all levels of practice should know and understand the four domains of professional identity. By embracing these domains, nurses can foster their professional identity in educational and workplace settings. Not only can professional identity promote nurses' well-being, but it can also improve their work environment, leading to improved nurse retention and safer, higher-quality patient care (Owens & Godfrey, 2022).
Values and Ethics
Provision 6 of the ANA Code of Ethics for Nurses establishes that nurses should take responsibility for establishing, maintaining, and improving an ethical work environment. Nurses across all healthcare settings will encounter ethical dilemmas. Nurses must evaluate these situations and work collaboratively to ensure safe, quality healthcare delivery. In addition to the core values identified above, nurses must be honest, respectful, truthful, and equitable. Nurses should promote patient autonomy by discussing care plans with patients and allowing them to make informed decisions. Nurses should respect a patient's decision even if it conflicts with their personal morals and values. Maintaining patient confidentiality and privacy is another aspect of ethical care. Given the accessibility of healthcare information, nurses should discuss a patient's care plan only with the interprofessional team members directly involved in the care (Owens & Godfrey, 2022).
As part of developing professional identity, nurses must read, understand, and apply the ANA Code of Ethics in all workplace environments. Sometimes, translating and applying the Code of Ethics can be challenging and require additional discussion and support. Many healthcare facilities have ethics committees to help navigate complex ethical dilemmas. Nurses are encouraged to participate actively in ethics committees, ethical rounds, or other opportunities for ethical discussions. The COVID-19 pandemic brought numerous ethical issues, including visitor restrictions, a lack of access to medical services and equipment, and supply and staffing shortages. These challenges often prevented nurses from caring for patients based on their values and morals. When nurses struggle with these ethical dilemmas, the risk of burnout and moral distress rises significantly. Burnout and moral distress can lead to nurse turnover and potentially harmful physical and psychological effects. Establishing and maintaining a professional identity can help nurses navigate ethical issues and provide nurses with the tools to advocate for supportive and healthy work environments (Owens & Godfrey, 2022).
In Provision 5 of the scope of practice standards, the ANA establishes that nurses are responsible for their ongoing professional development, competence, and lifelong learning. Nursing knowledge can be obtained through clinical experience, evidence-based practice, and scientific discovery. This component of professional identity is established in nursing school when students gain knowledge and develop skills. Practicing nurses should respect the need for lifelong learning and seek opportunities for professional development (i.e., conferences, in-services, journal clubs, certifications, and continuing education requirements). The AACN baccalaureate essentials state that nurses must understand and utilize evidence-based practice. Specifically, nurses should understand how to ask a well-designed clinical question, search academic databases for the best evidence, and critically appraise various research methodologies. Once nurses have identified and appraised the evidence, they must be able to apply that evidence in practice, considering various patient preferences and values. Nursing leaders and healthcare organizations also should support nurses in their ongoing knowledge acquisition and lifelong learning (AACN, 2021; ANA, 2021; Owens & Godfrey, 2022).
Nurses as Leaders
The ANA establishes in Provision 3 of the Code of Ethics that nurses must demonstrate leadership by promoting, advocating, and protecting the rights and safety of patients. Leadership in nursing can be formal (i.e., nurse manager) or informal (i.e., staff nurse serving as a mentor to other nurses); the 2020-2030 Future of Nursing report calls for all nurses to serve as leaders in their workplace. In addition, the ANA scope of practice guidelines outline the leadership responsibilities of nurses, including delegating care appropriately, mentoring colleagues, resolving conflicts, participating in professional organizations, and communicating and leading change efforts. Given the proper leadership training, nurses can lead interprofessional teams, promote community health initiatives, advocate for policy changes, direct system change efforts, and engage in best practices to promote health equity. Nursing schools and healthcare organizations must provide leadership training and skill development to foster nurses' professional identity (ANA, n.d., 2021; Owens & Godfrey, 2022).
The ANA establishes in Provision 1 of the Code of Ethics that nurses must promote a culture of kindness and civility in the workplace. Professional comportment includes the professional behaviors that nurses exhibit, such as treating colleagues, employees, students, and others with dignity and respect. Even in challenging workplace conditions, nurses must maintain professional behavior through their words, presence, and actions in all workplace interactions. Healthcare organizations must promote safe, healthy work environments by enforcing zero-tolerance policies for harassment, bullying, and incivility. By promoting a healthy work environment, healthcare organizations can support nurse well-being and foster professional identity development (ANA, n.d.; Owens & Godfrey, 2022).
Fostering Professional Identity among Nurses
Phillips and Priddy presented the results of a mixed-methods study exploring the role of professional identity in nursing practice in a webinar for the Academy of Medical-Surgical Nurses. The researchers found a strong link between professional identity in nursing, the four domains of professional identity, and nurse job satisfaction and retention. In addition, Phillips and Priddy found that working in environments that support professional nursing identity positively impacted nurse well-being (Phillips & Priddy, 2021). Similarly, Rasmussen and colleagues (2021) conducted a mixed-methods study to explore the understanding of professional identity in nursing. The researchers found that personal and professional factors influenced nurses' understanding of their professional identity. The participants reported that professional identity was related to each nurse's work, nursing role, patient care, healthcare team, work environment, and perception of others. In addition, participants reported that their professional identity changed over time due to maturity, increased knowledge and skills, empowerment through education, and a broadening scope of practice (Rasmussen et al., 2021).
Nursing faculty play a critical role in the development of professional nursing identity. Owens and Godfrey (2022) have highlighted the importance of identity formation beginning with students in nursing school. Traditionally, nursing education has focused on knowledge acquisition and skill building. However, knowledge is not sufficient to develop a professional nursing identity. Thus, these researchers advise nursing program leaders to learn about professional identity and integrate content into undergraduate and graduate curricula, including professional identity language, definitions, domains, and exemplars. Various educational modalities should be used to foster professional identity, including didactic, case studies, and experiential learning opportunities that allow socialization within the nursing role. Fitzgerald and Clukey (2021) conducted a qualitative study to understand the meaning of professional identity among graduating nursing students. The graduate students shared many characteristics of a nursing professional, including knowledge, caring, teamwork, and integrity. In addition, the students identified communication, competence, confidence, advocacy, critical thinking, and leadership as descriptors of a professional nurse. Fitzgerald and Clukey (2021) reported that the participants discussed the importance of nursing defining itself as a profession.
Nurse educators can support a strong foundation for nursing professional identity by developing and promoting a shared understanding of being a professional nurse. As nursing students get closer to graduation, most have developed sufficient knowledge to start their nursing careers. Therefore, nurse educators should focus on enhancing exposure to role models and providing experiential learning opportunities to foster critical thinking and clinical judgment (Fitzgerald & Clukey, 2021). Additional recommendations for nursing education and practice include the following (Rasmussen et al., 2021):
- Undergraduate nursing education should more explicitly address professional identity in preparation for clinical practice.
- Nurses should engage in lifelong learning and professional development to enhance their professional identity.
- Interprofessional education should address professional identity through a shared understanding of roles and responsibilities.
Healthcare organizations also play a critical role in developing professional identity in nursing. Nurses need to feel supported in their profession, and healthcare leaders can work to create a healthy work environment. In addition, healthcare organizations should develop a professional identity statement and align the definition and domain of nursing professional identity with their organization's mission, vision, values, and professional practice model (Owens & Godfrey, 2022).
American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf
American Nurses Association. (n.d.). Ethics and human rights. Retrieved October 6, 2022, from https://www.nursingworld.org/practice-policy/nursing-excellence/ethics
American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). https://www.nursingworld.org/practice-policy/scope-of-practice
Brewington, J., & Godfrey, N. (2020). The professional identity in nursing initiative. Nursing Education Perspectives, 41(3), 201. https://doi.org/10.1097/01.NEP.0000000000000667
Chari, R., Chang, C. C., Sauter, S. L., Petrun Sayers, E. L., Cerully, J. L., Schulte, P., Schill, A. L., & Uscher-Pines, L. (2018). Expanding the paradigm of occupational safety and health: A new framework for worker well-being. Journal of Occupational and Environmental Medicine, 60(7), 589-593. https://doi.org/10.1097/JOM.0000000000001330
Clark, E. (2021). Nurse burnout. NurseJournal. https://nursejournal.org/resources/nurse-burnout
Feeley, D. (2017). The Triple Aim or Quadruple Aim: Four points to help set your strategy. Institute for Healthcare Improvement. http://www.ihi.org/communities/blogs/the-triple-aim-or-the-quadruple-aim-four-points-to-help-set-your-strategy
Fitzpatrick, B., Bloore, K., & Blake, N. (2019). Joy in work and reducing nurse burnout: From triple aim to quadruple aim. Advance Critical Care, 30(2), 185-188. https://doi.org/10.4037/aacnacc2019833
Godfrey, N. (2020). How to think/act/feel like a nurse: Forming professional identity in nursing. Dean's Note, 41(4), 1-3. https://www.ajj.com/sites/default/deansnotes/2020/spring2020.pdf
Godfrey, N. (2022). New language for the journey: Embracing a professional identity of nursing. Journal of Radiology Nursing, 41(1), 15-17. https://doi.org/10.1016/j.jradnu.2021.12.001
National Academies of Sciences, Engineering, and Medicine, National Academy of Medicine, Committee on the Future of Nursing 2020-2030, Flaubert, J. L., Le Menestrel, S., Williams, D. R., & Wakefield, M. K. (2021). The Future of Nursing 2020-2030: Charting a path to achieve health equity. National Academies Press.
Nursing Solutions Inc. (2022). 2022 NSI national healthcare retention and RN staffing report. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf
Owens, R. A., & Godfrey, N. (2022). Fostering professional identity in nursing. American Nurse Journal: The Officials Journal of the American Nurses Association, 17(9). https://www.myamericannurse.com/fostering-professional-identity-in-nursing
Phillips, B. C., & Priddy, K. D. (2021). Safety and quality begins with a strong professional identity: Report from nurses in practice - A mixed method study. https://library.amsn.org/amsn/sessions/7697/view
Rasmussen, P., Henderson, A., McCallum, J., & Andrew, N. (2021). Professional identity in nursing: A mixed method research study. Nurse Education in Practice, 53, 103039. https://doi.org/10.1016/j.nepr.2021.103039
Raso, R., Fitzpatrick, J. J., & Masick, K. (2021). Nurses' intent to leave their position and the profession during the Covid-19 pandemic. The Journal of Nursing Administration, 51(10), 488-494. https://doi.org/10.1097/NNA.0000000000001052
University of Kansas Medical Center. (n.d.-a). Our impact. Retrieved October 6, 2022, from https://www.kumc.edu/school-of-nursing/outreach/consulting/professional-identity/about/our-impact.html
University of Kansas Medical Center. (n.d.-b). What is professional identity in nursing? Retrieved October 6, 2022, from https://www.kumc.edu/school-of-nursing/outreach/consulting/professional-identity/about/what-is-professional-identity-in-nursing.html