Professional Identity in Nursing CE Course

Course preview

Professional Identity

Disclosure Statement

This course examines the concept of professional identity in nursing, highlighting essential elements and strategies to promote the development of professional identity among nurses across all practice settings.

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 health care 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 their decision to enter the health care field as a calling to serve others. However, the multiple demands on nurses 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 arise for both the nurse and the health care organization, as well as for 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 increased turnover. When health care organizations are affected by HCP burnout, the quality of care provided can decrease, and adverse safety events can increase (American Nurses Association [ANA], 2024; Hudgeons, 2023; Owens & Godfrey, 2022).

HCP burnout has been a recognized problem for decades. However, the COVID-19 pandemic brought HCP burnout to the forefront of global and national priorities. Throughout the pandemic, nurses and other HCPs faced poor working conditions, which led to burnout, moral distress, compromised physical and mental health, job dissatisfaction, and high turnover rates (Owens & Godfrey, 2022). The National Council of State Boards of Nursing (NCSBN, 2023) examined the impact of the COVID-19 pandemic on burnout and stress among nurses in the United States. This study, conducted by the NCSBN, is considered the most comprehensive research examining the pandemic’s implications for the health care system. They found that approximately 100,000 registered nurses (RNs) left the workforce during the pandemic due to stress, burnout, and retirements and that another 610,388 RNs reported an intent to leave the workforce by 2027. Approximately 50% of nurses reported feeling emotionally drained, fatigued, and burned out a few times a week or every day. These issues were most pronounced in nurses with less than 10 years of experience. In January 2022, Nursing Solutions Incorporated (NSI) released its National Healthcare Retention and RN Staffing Report for 2021, 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” reflects the significant impact of hospital turnover rates in 2021, which exceeded those in every previous NSI survey. More specifically, in 2021, nurses left bedside care roles at an alarming rate, surpassing the hospital turnover rates for all HCPs. The turnover rate for staff RNs increased by 8.4%, peaking at 27.1%, with step-down, telemetry, and emergency services experiencing the highest rates (NSI, 2022). Nurse turnover rates began declining after 2021, reaching a low of 16.4% in 2024. Although there has been a steady decline in turnover rates since 2021, they still exceed those of prepandemic times (NSI, 2025).

In 2007, the Institute for Healthcare Improvement (IHI) presented the Triple Aim framework to optimize health care 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 health care

Health care organizations and national leaders have recently emphasized that HCPs’ work environments are critical to achieving the Triple Aim. Therefore, many organizations have advocated for expanding the Triple Aim to include a fourth dimension: attaining joy in work. The resulting Quadruple Aim emphasizes the importance of a healthy work–life balance for HCPs as a foundation for achieving the Triple Aim. Addressing burnout and promoting joy in the workplace can lead to improved patient outcomes and safety (Feeley, 2017; Fitzpatrick et al., 2019; Jordan et al., 2025).

The National Academies of Sciences, Engineering, and Medicine (NASEM) and its colleagues (2021) published “Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity.” This report examines how nurses can reduce health disparities while minimizing costs, leveraging technology, and maintaining a patient- and family-centered focus. One of the critical areas discussed in this report is the health and well-being of nurses. 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 enables workers to thrive and achieve their full potential (p. 590).

Nurse well-being has a significant impact on the physical and mental health, job satisfaction, and sense of joy or meaning in the work of individual nurses. Additionally, nurses’ well-being has a significant impact on patients and their perceptions of care. The Future of Nursing 2020–2030 recommends that nursing education programs, employers, nursing leaders, nursing organizations, and licensing boards 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 a professional identity can transform workplace environments, preventing burnout, moral distress, and mental and physical stress, while promoting job satisfaction and nurse retention (NASEM et al., 2021; Owens & Godfrey, 2022).

Professional Identity in Nursing

Early Evolution

n;">The concept of professional identity is relatively new to nursing, but it has been utilized 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 from various practice areas to participate in a think tank to define the professional identity, key elements, competencies, and exemplars in the nursing field. In 2020, the National League for Nursing (NLN) and the American Association of Colleges of Nursing (AACN) collaborated with other nursing organizations to establish the International Society for Professional Identity in Nursing (ISPIN), aiming to develop and promote awareness of professional identity formation among nurses. The ISPIN works closely with nursing educational organizations to incorporate professional identity formation into nursing school curricula. The ISPIN also collaborated with Sigma Theta Tau International to create a data repository, which includes podcasts and webinars focused on professional identity in nursing. Since 2018, this effort has launched over 51 publications and 112 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; ISPIN, n.d.-a, n.d.-b; University of Kansas Medical Center, 2019).

The ISPIN and the 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 both personal and professional identities that converge to form the values guiding nursing practice. The ANA guidelines state that professional identity is more than just being or acting professionally; it is a transformational process that begins in nursing school and leads to becoming a professional nurse (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 health care. 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, 2020, p. 201). ISPIN is currently establishing a steering planning committee and directing the workgroups discussed previously (Brewington & Godfrey, 2020; 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, both personally and professionally, without allowing personal biases to influence their professional judgments. 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 their definitions and corresponding competencies. These are explained in Table 1 (Owens & Godfrey, 2022).

Table 1

Domains of Professional Identity 

(Geoghan Marold et al., 2025; Godfrey, 2020, 2022; ISPIN, n.d.-a)

Nursing students and nurses at all levels of practice should be familiar with and understand the four domains of professional identity. By embracing these domains, nurses can foster their professional identity in educational and workplace settings. Professional identity can not only promote nurses’ well-being but also improve their work environment, leading to improved nurse retention and safer, higher-quality patient care (Geoghan Marold et al., 2025; ISPIN, n.d.-a; Owens & Godfrey, 2022).

Values and Ethics

Provision 6 of the ANA Code of Ethics for Nurses stipulates that nurses should be responsible for establishing, maintaining, and continually improving an ethical work environment. Nurses across all health care settings will encounter ethical dilemmas. Nurses must evaluate these situations and work collaboratively to ensure the delivery of safe and quality health care. In addition to the core values identified previously, nurses must be honest, respectful, truthful, and equitable in their interactions with patients and colleagues. Nurses should promote patient autonomy by discussing care plans with patients and allowing them to make informed decisions about their care. 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 health care information, nurses should discuss a patient’s care plan only with the interprofessional team members directly involved in the care (Liebig et al., 2024; 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 health care 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 raised numerous ethical issues, including visitor restrictions, limited access to medical services and equipment, and shortages of supplies and staff. These challenges often prevented nurses from caring for patients in accordance with 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 successfully navigate ethical issues and provide them with the tools to advocate for supportive and healthy work environments (Liebig et al., 2024; Owens & Godfrey, 2022).

Knowledge

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 formulate a well-designed clinical question, search academic databases for the most relevant 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 health care organizations should also support nurses in their ongoing knowledge acquisition and lifelong learning (AACN, 2021; ANA, 2021; Embree & Liebig, 2024; 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. With proper leadership training, nurses can effectively 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 health care organizations must provide leadership training and skill development to foster nurses’ professional identity (ANA, n.d., 2021; Embree & Liebig, 2023; Owens & Godfrey, 2022).

Professional Comportment

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. This domain is essential for building a durable foundation because it affects the nurse’s ability to connect, communicate, and collaborate with others. Even in challenging workplace conditions, nurses must maintain professional behavior through their words, presence, and actions in all interactions within the workplace. Health care organizations must promote safe and healthy work environments by enforcing zero-tolerance policies against harassment, bullying, and incivility. By promoting a healthy work environment, health care organizations can support nurse well-being and foster the development of a professional identity (ANA, n.d.; Liebig & Embree, 2023; Owens & Godfrey, 2022).

Fostering Professional Identity Among Nurses

Phillips and Priddy conducted a mixed-methods study exploring the role of professional identity in nursing practice and its impact on nursing practice. The researchers found a strong link between professional identity in nursing, the four domains of professional identity, and nurse job satisfaction and retention. Additionally, Phillips and Priddy found that working in environments that support a professional nursing identity has a positive impact on nurse well-being and patient safety (Phillips & Priddy, 2023). 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 their professional identity was related to their work, nursing role, patient care, health care 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 emphasized the importance of identity formation, which begins with students in nursing school. Traditionally, nursing education has focused on knowledge acquisition and skill building. However, knowledge alone is insufficient 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 employed to foster professional identity, including didactic instruction, case studies, and experiential learning opportunities that facilitate 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 what it means to be a professional nurse. As nursing students approach graduation, most have developed sufficient knowledge to begin 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 address professional identity more explicitly in preparation for clinical practice.
• Nurses should engage in lifelong learning and professional development to enhance their professional identity and professional growth.
• Interprofessional education should foster a shared understanding of roles and responsibilities to address professional identity.

Health care organizations also play a crucial role in shaping the professional identity of nurses. Nurses need to feel supported in their profession, and health care leaders can work to create a healthy work environment that fosters this support. In addition, health care 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).

References

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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

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Liebig, D., Embree, J. L., & Lough, C. (2024). Values and ethics domain for professional identity in nursing. The Journal of Continuing Education in Nursing, 55(6), 279–281. https://doi.org/10.3928/00220124-20240516-04

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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

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