See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/340458105

Professional identity: A concept analysis

Article in Nursing Forum · April 2020

DOI: 10.1111/nuf.12450

CITATIONS READS

104 22,408

1 author:

Anita Fitzgerald
California State University
9 PUBLICATIONS 322 CITATIONS

SEE PROFILE

All content following this page was uploaded by Anita Fitzgerald on 21 September 2020.

The user has requested enhancement of the downloaded file.

DOI: 10.1111/nuf.12450

CONCEPT ANALYSIS

Professional identity: A concept analysis

Anita Fitzgerald PhD, RN, AGNP, CNE

School of Nursing, California State University,

Long Beach, California
Correspondence
Anita Fitzgerald, PhD, RN, AGNP, CNE, School
of Nursing, California State University, Long
Beach, CA 90802.
Email: anita.fitzgerald@csulb.edu
Abstract
The purpose of this study is to give clarity to the concept of professional
identity, drawing from health‐related fields to help provide a common language
and understanding for research and practice. Professional identity,
professionalism, professional socialization, and other related terms are often
used without a clear definition or with conflicting definitions. This can lead to
misunderstandings and assumptions that complicate research and confuse
educators and professionals in guiding novice members. Concept analysis.
Initially, 737 articles were identified by searching CINAHL, PubMed Central,
Google Scholar, Academic Search Complete, PsyINFO, and SocINDEX for the
period 2000 to 2019. Finally, 68 studies met the inclusion criteria, 60 of which
are discussed in this concept analysis. This concept analysis uses the method
described by Walker and Avant. This concept analysis clarifies the definition of
professional identity, using literature from health and related professions, as
containing the attributes: skills and functions; knowledge values and ethics;
personal identity; group identity; and the influence of the context of care. A
more clear definition of professional identity will help researchers to have more
precision in their analyses and provide mentors and educators with a clear goal.

KEYWORDS

concept analysis, health professions, nursing, occupational therapy, pharmacy, physicians,

professional identity, professional socialization, professionalism, social work

1 | INTRODUCTION 1.1 | Background

The term professional identity is often used in the literature without
a clear definition or with conflicting definitions. This can lead to
misunderstandings and assumptions that complicate research and
confuse educators and professionals in guiding novice members.
Researchers and scholars even use different terms to have the
same meaning, including professionalism (National League for
Nurses [NLN])1; professional self‐concept2; and professional
socialization,3,4 which defines the process rather than the concept
itself. A common understanding of this concept will aid in
recognizing the presence or lack of professional identity and
support its continued development. The purpose of this concept
analysis is to provide a conceptual definition of professional identity
using the Walker and Avant method.
Defining what it means to be a professional has never been easy, nor
has it ever been standardized.5‐8 Several prominent researchers in
the early 2000s offered definitions of professionalism in general.
Gardner and Shulman9 discussed the mutuality between professions
and society, asserting that professions gain autonomy and prestige
from societal recognition, and in exchange, perform services to
society through their professional actions. They described six char-
acteristics of a profession as a commitment to clients and society; a
specialized body of knowledge; a specialized and unique set of skills;
the ability to make judgments with integrity in environments of un-
certainty; growing new bodies of knowledge through experience; and
a community of professionals who perform oversight and monitoring
of professional practice. Similarly, van Oeffelt et al10 offered six

Nursing Forum. 2020;1–26. wileyonlinelibrary.com/journal/nuf © 2020 Wiley Periodicals, Inc. | 1

2 |
elements of being a professional, some of which overlap with Gard-
ner and Shulman.9 These include providing best practice for clients
and society; acting with integrity in any environment; keeping cur-
rent with the theory of practice; critical reflection on one's own
practice; contributing to the profession and other professionals; and
interacting with other professionals. These definitions are important
as they help to describe professional identity from the perspective of
the group and as an individual within that group.
Literature defining a nursing professional used some of the same
categories and terminology. In particular, many sources described the
interplay between being defined as a nursing professional and a re-
sponsibility to society. Landmark research by Benner et al,11 Edu-
cating Nurses: A Call for Radical Transformation, used various terms to
describe the concept of professional identity including formation,
reformation, socialization, and acquisition of professional values.
They employed the term formation as a description of the develop-
ment of nursing skills and abilities, and “a way of being and acting in
practice and in the world” (Benner et al11 p166). Willits and Clarke12
asserted that modern nursing meets all the criteria of a profession,
because it has a body of knowledge, professional recognition, com-
munity recognition, a code of ethics, and a community of profes-
sionals providing oversight and monitoring the conduct of its
members.
13
Styles, a well‐known leader in nursing education, credentialing,
and international nursing, preferred to use the term profession‐
building to describe nursing's attempts to be considered a profession.
She described six attributes to be recognized as a true profession:
higher education; a distinct practice; research‐based knowledge;
autonomy and accountability; a code of ethics; and an organized
association. She denoted the ways in which regulation both reflects
and serves the attributes of a profession. She posited that the
process of self‐regulation and self‐identification is central to the
independent practice of a profession.
Manojlovich and Ketefian14 described a nursing professional
as an autonomous practitioner with a specific body of knowledge
and a code of conduct, who values her work and derives a sense of
accomplishment from it. More recently, an Australian discussion
paper describing the development of a framework for clarifying
nursing professional identity found similar attributes.12 They de-
scribed nursing professional identity as including a body of
knowledge, community recognition, group belongingness, a code of
ethics, and community oversight of conduct. As shown in these
examples, definitions of professional identity have parallels from
which a common definition can be found. Attributes that are
common to several authors are described below. These include
actions and behaviors, knowledge and skills, values, beliefs and
ethics, context and socialization, and group and personal identity.
2 | P UR PO S E
The purpose of this concept analysis of professional identity was to
clarify a term that is often used without an explicit definition, or at
FITZGERALD
other times used with conflicting description. This inconsistent use of
the concept makes it unclear and at times unserviceable. Adding
clarity to this sometimes‐vague concept promotes mutual under-
standing and adds precision to the concept.
3 | METHO DS
The Walker and Avant Method15 was employed to understand the
concept of professional identity. This method involves the following
eight steps: (a) select a concept; (b) determine the aims or purposes
of analysis; (c) identify all uses of the concept as possible; (d) de-
termine the defining attributes; (e) identify a model case; (f) identify
borderline, related, contrary, invented, and illegitimate cases;
(g) identify antecedents and consequences; and (h) define empirical
referents (p170).
3.1 | Data collection
3.1.1 | Search methods
A literature search was performed in EBSCOhost using the data-
bases CINAHL, Academic Search Complete, PsyINFO, and So-
cINDEX. These databases were chosen for their focus on medical
and social science professions. In addition, PubMed and Google
Scholar searches were completed separately. The search terms
used were professional identity OR nursing professional identity OR
nursing professionalism OR professional identity in nursing, using the
Boolean logic and truncation to create the terms nurs* and pro-
fessional*. Emphasis was given to nursing terminology to ensure all
potential nursing‐related sources were found. Limiters included
research published between 2000 and 2019, English language
only, journals, academic journals, and books. Editorials and com-
mentary, dissertations, and textbooks were excluded from con-
sideration. The reference lists of salient articles were also
screened for the inclusion of publications not found in the original
search.
The EBSCOhost search provided the most literature used in this
concept analysis, specifically literature on nursing professional iden-
tity. After the initial broad search as described above, further
searches were conducted using more limited phrases and truncated
terms, for example, profession*, and nurs*, and the term definition.
This helped us to find articles that included a definition of the term
but were not identified initially. In PubMed, each term was searched
separately, again using truncation. This search revealed articles al-
ready found in EBSCOhost, but also provided more articles related
to medical and interprofessional practice. Lastly, a Google Scholar
search was conducted using the original four search terms listed in
the preceding paragraph. This database provided the fewest unique
articles. Noncommercial sources, or gray literature, were not in-
cluded in the search (see Table 1 for article search and exclusion
process).
FITZGERALD
T A B L E 1 Article search and exclusion process
Arcles idenfied in the consulted databases (N = 737)
1st exclusion (by tle):
duplicates; arcles not focused on definion;
excluded law, teaching, counseling (N = 339)
2nd exclusion (by abstract):
arcles that did not provide definion (N = 203)
3rd exclusion (by reading):
arcles that did not provide clear definion; limited professions to nursing, medicine, social
work, occupaonal therapy, pharmacy, allied health, and professionalism. Also included
arcles found in references. (N = 68)
3.1.2 | Search outcome
The first search resulted in 737 citations, including research from all
professions. After screening by title, all duplicates were removed, as
were articles that did not focus on the definition or the work of the
entitled profession. In addition, articles focusing on law, teaching, and
counseling were removed to create a focus on health‐related fields. This
left 339 articles for further assessment. These 339 sources were
screened by abstract, again eliminating articles that did not provide a
definition of professional identity or a related concept. This left 203 ar-
ticles that were read or scanned for content. Based on this reading,
articles were eliminated that did not provide a definition of professional
identity, and the professions were further limited to nursing, medicine,
social work, occupational therapy, pharmacy, allied health, and pro-
fessionalism in general, leaving 68 sources that included a clear defini-
tion of the concept of professional identity. Other sources regarding
professional identity exist, looking at professional formation, activities for
its development, and other related topics, but were not included here,
as this concept analysis focuses on clarifying a definition of professional
identity. The research works included in this analysis were conducted in
the United States (15); Australia (13); the United Kingdom (10); Iran (7);
Canada (5); Israel (3); Norway (3); The Netherlands (3); Brazil (2); and
one each from China, India, Japan, New Zealand, Spain, Switzerland, and
Turkey. Of the 68 publications, 42 discussed nursing, 14 involved
physicians/medicine, 5 were about social workers, 2 about occupational
therapy, 1 about pharmacists, and 3 about health professions in general.
The remaining three discussed professions and professional identity in
general (this number adds up to 70 because two articles discussed
nursing and medicine). Of the 68 sources, 60 are discussed in this
concept analysis (see Table 2 for details on the included research).
| 3
4 | DEFINITIONS
According to the Merriam‐Webster's online dictionary (https://www.
merriam‐webster.com/dictionary/professional?utm_campaign=sd&
utm_medium=serp&utm_source=jsonld),18 the word “professional”
has four meanings in current usage: (a) “participating for gain or
livelihood in an activity or field of endeavor often engaged in by
amateurs”; (b) “of, relating to, or characteristic of a profession”; (c)
“following a line of conduct as though it were a profession”; and (d)
“one that is professional, especially one that engages in pursuit or
activity professionally.” It is these last three definitions that relate to
what research describes as the concept of professional identity.
In the literature, these definitions give meaning to the concept of
professional identity by clearly describing what a professional is.
Having the characteristic of a profession is a broad definition,
encompassing both the actions of a profession and the way in which
it is done. As such, most every definition in this analysis falls under
this definition. One who has conduct is as if in a profession again
refers to what one does and how one comports. The final definition
describes one who is or acts as a professional, which forms the basis
for individual and group identification as a professional.
5 | ATTRIBUTE S
5.1 | Actions and behaviors
Many studies defined professional identity based on what profes-
sionals do; the behaviors and activities of the profession. The
stronger the identification with the behaviors and activities,

T A B L E 2 Details on identified research
Author Title
Adams, Hean, Sturgis, & Investigating the factors
Clark influencing PI of first‐year
health and social care
students
Akhtar‐Danesh, Perceptions of professionalism
Baumann, Kolotylo, among nursing faculty and
Lawlor, Tompkins, nursing students.
& Lee
Benner, Sutphen, Educating nurses: A call for
Leonard, & Day radical transformation
Best & Williams PI in interprofessional teams:
Findings from a scoping
review
Year Discipline Country Methodology
2006 Allied Health UK Qualitative Study: Questionnaire
of students beginning a
variety of health professions
using 4 tools. Sample size
–1254 (88% of total students)
Analysis: Ordinary Least
Squares (OLS) regression
model.
2013 Nursing Canada Qualitative Study: Q‐methodology
to identify common
viewpoints about
professionalism. 24 nursing
faculty and 30 nursing
students. Analysis: Q‐sort
analyzed using the PQ Method
2.11 test‐retest reliability.
Content validity assessed by a
team of domain experts.
2010 Nursing US Book: One in a series of studies
known as the Preparation for
the Professions Program for
the Advancement of Teaching,
funded by the Carnegie
Foundation National Nursing
Education Study. Based on
direct observation of
classroom and clinical
teaching at nine entry‐level
nursing programs, interviews,
observations, and national
surveys of faculty and
students.
2019 Nursing Australia Scoping review: 16 papers
analyzed (culled from 482
Main Findings
‐‐Differences in the strength of PI
across professions. ‐‐ Significant
variables: gender; profession;
previous work experience in
health; understanding of team
working; knowledge of
profession; and cognitive
flexibility.
‐‐ Four viewpoints:
1. Humanists
2. Portrayers
3. Facilitators
4. Regulators‐‐ Seven consensus
statements ‐‐ Major themes
included communication,
personal appearance,
professional codes, ongoing
education, interdisciplinary
collaboration, ability to adapt,
leadership, accountability,
caring, and professional
values.
‐‐ Nurses are undereducated for the
demands of practice; practice‐
education gap. ‐‐U.S. nursing
programs are very effective in
forming PI and ethical
comportment. ‐‐Clinical practice
assignments provide powerful
learning experiences, especially
in when integrated with
classroom teaching. ‐‐U.S.
nursing programs are not
effective in teaching nursing
science, natural sciences, social
sciences, technology, and the
humanities.
‐‐ Creating a PI is a social activity. ‐‐
Challenges included conflict
from a lack of recognition,
4
|
Definition of Professional
Identity (PI)
“Attitudes, values, knowledge,
beliefs and skills that are
shared with others within a
professional group” (p56).
No consensus about the
meaning or definition of
professionalism; Generally
recognized descriptors or
characteristics, including
knowledge, specialization,
intellectual and individual
responsibility, and well‐
developed group
consciousness.
The term formation as a
description of the
development of nursing
skills and abilities, and “a
way of being and acting in
practice and in the
world” (p166).
One's professional self‐
perception.
FITZGERALD
TABLE 2 (Continued)
Author Title
Binyamin Growing from dilemmas:
Developing a PI through
collaborative reflections on
relational dilemmas.
Bochatay Individual and collective
strategies in nurses’ struggle
for PI
Browne, Wall, Batt, & Understanding perceptions of
Bennett nursing PI in students
entering an Australian
undergraduate nursing
degree
Burford, Morrow, Professionalism education
Rothwell, Carter, & should reflect reality:
Illing Findings from three health
professions
Year Discipline Country Methodology
papers). PI and leadership and
management.
2018 Occupational Israel Qualitative Study: Collaborative
Therapy reflection (reflective writing,
sharing, and discussion). Data
collected from 12 groups, over
6 years. 392 cases and 196
personal reflections as part of
undergraduate classwork.
Analysis: Based on narrative
inquiry, using thematic
analysis.
2018 Nursing Switzer‐ Ethnographic study:
land Constructivist grounded
theory approach. Two nursing
teams in Swiss teaching
hospital. Field observations
with field notes and
semistructured interviews.
Analysis: Refined the
identified themes in an
iterative fashion. Used Atlas.ti
1.6 for coding.
2018 Nursing Australia Qualitative Study: Used drawing
and mind mapping exercises.
Analysis: Thematic analysis
and grouping. Used a modified
version of Rose's critical visual
methodology framework
(2001) as proposed by
Guillemin (2004).
2014 Medicine UK Qualitative Research: Twenty
focus groups with 112
students and educators from
paramedics, occupational
therapy, and podiatry.
Main Findings
diversity, or fault lines. ‐‐ Strong
leadership is important and
there is a need to actively
manage the integration of
different professionals.
Found six overarching relational
dilemmas for novice OTs:
Setting boundaries for patients;
coping with patient resistance;
handling physical aversion;
definition of the therapist's role;
whether or not to include the
family; collaboration or
differentiation with other health
therapists.
‐‐ Found an adaptation of PI from an
individual to a collective
viewpoint: individually, nurses
formed their PI through
recognition from other nurses. ‐‐
Collectively, nurses stressed
their specificity and their work,
which set them apart from other
healthcare professionals.
Four key themes were identified: to
be a nurse, I have to look the
part; to be a nurse, I have to
perform in a variety of roles; to
be a nurse, I have to connect
with others; and to be a nurse, I
have to care for myself.
‐‐ Interpersonally, professional
behavior not defined by what is
done, but by the ability to select
what to do. ‐‐Socially,
professional models give
Definition of Professional
FITZGERALD
Identity (PI)
Uses Ibarra's (1999) definition:
the constellation of
attributes, beliefs, values,
motives, and experiences
through which people
define themselves in a
professional role.
Individuals’ efforts to make
their work meaningful to
themselves, the
professional values that
differentiate them from
other groups.
A person's perception of
themselves within a
profession or the collective
identity of the profession.
Three elements of PI:‐‐
Individual: beliefs or
fundamental values formed
early. ‐‐Interpersonal:
dependent on contextual
|
(Continues)
5

TABLE 2 (Continued)
Author Title
Burford, & Rosenthal‐ Stereotyping and the
Stott development of clinicians’
professional identities
Clarkson & Thompson ‘Sometimes I don't feel like an
osteopath at all’‐ a
qualitative study of final
year osteopathy students'
professional identities
Cook, Gilmer, & Bess Beginning students’ definitions
of nursing: An inductive
framework of PI
Year Discipline Country Methodology
Analysis: Framework analysis.
Then, all transcripts were
coded using NVivo version 9.
2017 Medicine UK Book chapter: Looks at: 1, PI as
social identity. 2, The role of
stereotypes in PI
development. 3, Intergroup
relations and conflict. 4, How
these three points affect
medical education.
2017 Medicine UK Qualitative research:
Constructivist grounded
theory. Semistructured
interviews with eight final‐
year osteopathy students.
Analysis: Concurrent data
collection and analysis.
Focused coding to define five
categories.
2003 Nursing US Qualitative Study: Beginning
nursing students’ definitions
of nursing. 109 participants.
Analysis: Qualitative
descriptive approach.
Nonnumerical; Unstructured
Data; Indexing, Searching, &
Theorizing (NUD*IST N4
Classic) (1997) computer
Main Findings
definition to what is a
professional even before the
person joins the group‐‐ PI
development is shaped by
education, experience and
professional development, and is
reliant on context.
‐‐ PI is an individual's self‐concept in
terms of membership in a
professional group. ‐‐
Stereotypes can affect behavior
so that individuals behave in line
with stereotypes. ‐‐Intergroup
relations and conflict affect PI
development through bias,
status, and identification of self
and others as superior or
subordinate. ‐‐Social identity and
stereotyping are means of
transmitting and establishing
group norms.
Five main categories to describe PI:
approach to pt. care; view of
osteopathy; learning experience;
view of practical skills; PI
development continuum.
Three major themes of personal
definitions:‐‐ Nursing as a: verb ‐‐
caring, nurturing, teaching,
implementing, assessing/
analyzing, advocating, and
managing; ‐‐ Nursing as a noun –
profession, holistic system,
connecting, system, delivery
system, and discipline;‐‐ Nursing
as a transaction ‐‐ promotion of
6
|
Definition of Professional
Identity (PI)
factors. ‐‐Societal/
Institutional: r/t
community expectations,
to organizational cultures
(including management
support), and to local work‐
group norms.
A type of social identity; an
individual's self‐concept
defined in terms of his or
her membership of a
professional group.
The construction of a person's
experience, qualities,
beliefs, and values that
define their
professional role.
Personal identity as a
framework for PI. PI in
nursing is the development
within nurses of an internal
representation of people‐
environment interactions
in the exploration of
human responses to actual
or potential health
problems.
FITZGERALD
TABLE 2 (Continued)

Definition of Professional
FITZGERALD

Author Title Year Discipline Country Methodology Main Findings Identity (PI)

program. Lincoln & Guba health, treatment of illness,

(1985) method. prevention of illness, and
promotion of self‐care.

Costa Fernandes, Sales Identity of primary health care 2018 Nursing Brazil Qualitative Research: ‐‐ Nurses associate their PI with the PI is associated with the
da Silva, Rocineide nurses: Perception of “doing Semistructured interviews meaning of the word context in which one
Ferreira da Silva, everything.” with 48 primary healthcare “everything” (they have to do performs specific activities,
Martins Torres, de nurses from Brazil. Analysis: everything; in doing everything to whom these actions are
Araujo Dias, & Discourse analysis they do not have a distinct directed, and what results
Magalhâes Moreira (Orlandi, 2013). identification). from these activities.

Crigger & Godfrey From the inside out: A new
approach to teaching PI
formation and professional
ethics
2014 Nursing US Discussion Paper: To introduce
the Framework for Nurse
Professionals (FrNP) and the
Stair‐Step Model of
Professional Transformation.
‐‐ The FrNP combines the three
main ethical traditions:
principled ethics (rules),
utilitarian ethics (outcomes) and
virtue ethics (situated). ‐‐ The
Stair‐Step Model of Professional
Transformation describes a
process of PI development and
how FrNP practice decisions are
nested within these varying
levels of PI formation.
Being a member of a
profession with
responsibilities to society,
patients, other professions,
and oneself. Two
paradigms: Social ‐‐the
influence of social
expectations expressed as
nursing regulations,
standards, and
interventions; Psychological
‐‐ internalizing virtues of
the profession, such as
courage, integrity, and
compassion.

Cruess, Cruess, Reframing medical education to 2014 Medicine Canada Discussion Paper: Authors Ways to focus on PI formation A process in which a
Boudreau, Snell, & support PI formation propose that a principle goal (making it intentionally taught, developing physician
Steinert of medical education be the not left to chance) internalizes the
development of a PI. characteristics, values, and
norms of the profession,
and as a result begins to
think, feel, and act as a
physician.

Cruess, Cruess, & Stein Supporting the development of
PI: General principles
2016 Medicine Canada Discussion Paper: Describes Select Curricular methods: ‐‐
pedagogical methods to teach Establish PI as an educational
PI formation. objective.‐‐ Communities of
practice‐‐ Faculty development‐‐
Engage students‐‐ Share
responsibility‐‐ Create a
welcoming community‐‐
A process in which a
developing physician
internalizes the
characteristics, values, and
norms of the profession,
and as a result begins to
|

(Continues)
7
 8

TABLE 2 (Continued)
|

Definition of Professional
Author Title Year Discipline Country Methodology Main Findings Identity (PI)

Explicitly address known factors think, feel, and act as a

for the development of PI physician.

Dahl & Clancy Meanings of knowledge and
identity in public health
nursing in a time of
transition: Interpretations of
public health nurses’
narratives.
2015 Nursing Norway Qualitative Research: Interviews Three themes emerged: ‐‐ Being a When experiences in nurses’
with 23 Norwegian public generalist: “knowing a little work overlap with the
health nurses to define public about a lot”; and using clinical experiences of others, a
health nursing knowledge and judgment.‐‐ Being one who common PI is formed. PI is
PI. Analysis: empowers: focusing on related to the
Phenomenological resources and coping strategies; characteristics of a
hermeneutics. and ‐‐ Being occupied with professional group that
individual problem solving. distinguishes it from others
regardless of context.

Dikmen, Karataş, Arslan, The level of professionalism of
& Ak nurses working in a hospital
in Turkey
2016 Nursing Turkey Descriptive Exploratory Study:
89 nurses in public hospitals in
Turkey. Behavioral Inventory
Form for Professionalism in
Nursing (BIPN). Analysis: The
Mann‐Whitney U and the
Kruskal‐Wallis tests, as
nonparametric tests, using
SPSS version 17.
‐‐ Found low levels of
professionalism in these
nurses.‐‐ Highest levels of
professional behaviors were
competence and continuing
education.‐‐ Lowest were
autonomy, publication, and
research. ‐‐ Statistically
significant difference in BIPN
scores for ADN‐ and BSN‐
prepared nurses.
The manner of the work and
the behaviors of nurses in
providing quality care and
patient safety; defined
through their particular
body of knowledge, their
formal education, and
certification.

Ferrell, Christian, & Registered nurse experiences of
Rachel nursing PI: a qualitative
systematic review protocol
2017 Nursing US Proposal for a Literature
Review– qualitative studies
that investigate the
experiences of nursing PI in
registered nurses in nursing
care settings.
No results available: proposal only.
Uses NLN's definition: PI
“involves the
internalization of core
values and perspectives
recognized as integral to
the art and science of
nursing. The core values
become self‐evident as the
nurse learns, gains
experience, and grows in
the profession.”

Forenza & Eckert Social worker identity: A
profession in context
2016 Social Work US Qualitative Research: Individual
interviews with 16 practicing
social workers. Analysis:
Content analysis, using NVivo
10 and by hand.
Findings from interviews reveal 6
primary themes and 21
subthemes‐‐ Defining the
profession‐‐ Shared
perspectives‐‐ Pursuit of social
work‐‐ Practice areas‐‐ Macro
A form of social identity that
relates to an individual's
embodiment of group‐
based values and norms.
When one embodies the
group‐based values and
FITZGERALD
TABLE 2 (Continued)

Definition of Professional
FITZGERALD

Author Title Year Discipline Country Methodology Main Findings Identity (PI)

forces‐‐ Building professional norms of a professional

capacity community, he or she is
assumed to possess unique
skills and abilities.

Forouzadeh, Kiani, & Professionalism and its role in 2018 Medicine Iran Literature Review: Databases, The formation of PI is a process with Permanently showing
Bazmi the formation of medical PI. such as PubMed, Elsevier, the following domains: ‐‐ attitudes, values, and
Google Scholar, Ovid, SID, and Professionalism, ‐‐ Development conducts expected of a
IranMedex, 30 were assessed of a personal (psychosocial) and person for thinking, acting,
and selected for review. cultural identity. ‐‐ Reciprocal and feeling like a doctor.
relationship between the An integration of personal
formation of a desirable PI and and professional values.
development and strengthening Cited the Carnegie
of professionalism. Foundation study on
educating physicians in
saying that PI is the same
as the development of
professional values

Gardner & Shulman The professions in America
today: Crucial but fragile.
2005 PI US Introduction to a journal ‐‐ Generically, professions consist of
dedicated to the professions. individuals who are given a
certain amount of prestige and
autonomy in return for
performing for society a set of
services in a disinterested way.‐‐
Most would consider nurses,
social workers, and teachers as
members of critically important,
albeit less prestigious,
professions. This is generally
attributed to the status of those
whom they serve, and to the fact
that their ranks have long been
populated primarily by women.
Six characteristics of a
profession: ‐‐ a
commitment to clients and
society, ‐‐ a specialized
body of knowledge, ‐‐ a
specialized and unique set
of skills,‐‐ the ability to
make judgments with
integrity in environments
of uncertainty, ‐‐ growing
new bodies of knowledge
through experience; ‐‐ a
community of
professionals who perform
oversight and monitoring
of professional practice.

Goddard, de Vries, Prison nurses’ PI 2019 Nursing UK Literature Review: Prison Broad themes:‐‐ Image, role, culture, Uses Neary's (2014) definition:
McIntosh, & nursing. Analysis: No analysis and education have a direct “PI is the concept which
Theodosius procedure discussed. impact on the development of describes how we perceive
PI.‐‐ Resilience and burnout are ourselves within our
impacted by a strong PI or its occupational context and
lack. ‐‐ The PI of prison nursing is how we communicate this
poorly defined with no clear to others” (p14).
|

(Continues)
9

TABLE 2 (Continued)
Author Title
Goldie The formation of PI in medical
students: Considerations for
educators
Gregory, & Austin Pharmacists’ lack of profession‐
hood: PI formation and its
implications for practice
Haghighat, Borhani, Evaluating the formation of PI
Ranjbar, & Naseri in Iranian nursing students
after the implementation of
a new curriculum
Year Discipline Country Methodology
2012 Medicine UK Discussion Paper: The processes
underlying the formation and
maintenance of medical
students’ PI drawing on
concepts from social
psychology.
2019 Pharmacy Canada Qualitative Research: 17
community pharmacists from
Ontario. Semistructured
interviews. Analysis: Used
content analysis methods
described by Chi, used by
Mahamed.
2019 Nursing Iran Descriptive Cross‐Sectional
Study: 221 students in the last
three semesters of nursing
and midwifery school.
Analysis: Independent t test,
one‐way ANOVA, Pearson's
correlation, and linear
regression.
Main Findings
expression of the role within the
nursing profession or to other
disciplines.
‐‐ Identity formation is mainly social
and relational in nature. ‐‐
Educators, and the wider
medical society, need to
maximize opportunities in
relational settings. ‐‐ Helping
students form, and successfully
integrate their professional
selves is a fundamental of
medical education.‐‐ Students’ PI
formation is influenced more by
the informal and hidden
curricula than formal teaching
experiences.‐‐ Recommended:‐
interaction with appropriate role
models,‐ opportunities to
experiment ‐ feedback on
transitional identities.
‐‐ Participants reported little
reliance on PI‐‐Personal identity
was more important than PI‐‐
Lack of self‐confidence around
potential value of self‐disclosure
as a pharmacist‐‐ Reliance on
ingratiation and personal
identity as tactics rather than
professional knowledge and skill.
‐‐ The nursing education program in
Iran failed to advantageously
shape the PI of nursing
students.‐‐ Need to increase the
educational content related to
PI.‐‐ Improving the social status
of nurses can help to enhance
the PI of students.
10
|
Definition of Professional
Identity (PI)
PI is a social process in nature.
It develops in interactional
relationships and in
professional contexts in
established communities
such as universities,
hospitals, and community‐
based care organizations.
Part of how medical
students define their PI is
by how it compares with
and differentiates from
other groups; medical
students are in a process of
defining not only who they
are but who they are not.
The psychological and
internalized sense of
professionhood. Involves
the establishment of core
values, moral principles,
self‐awareness, and self‐
regulation.
Professional self‐perception
based on attitudes, beliefs,
feelings, values,
motivations, and
experiences that are
related to a specific
profession.
FITZGERALD
TABLE 2 (Continued)
Author Title
Hatem & Halpin Becoming doctors: Examining
student narratives to
understand the process of PI
formation within a learning
community
Heldal, Kongsvik, & Advancing the status of nursing:
Håland Reconstructing professional
nursing identity through
patient safety work
Hercelinskyj, Perceptions from the front line:
Cruickshank, Brown, PI in mental health nursing
& Phillips
ten Hoeve, Jansen, & The nursing profession: Public
Roodbol image, self‐concept and PI. A
discussion paper
Year Discipline Country Methodology
2019 Medicine US Qualitative Study: Analysis of 86
student reflections written
during the final session of
“Becoming a Physician”
curriculum. Analysis: Constant
comparative method, arriving
at consensus on themes
through discussion.
2019 Nursing Norway Qualitative study: Two group
interviews, four individual
interviews, and 5 h of
observation involving 10
nurses and three people from
hospital management.
Analysis: Ad‐hoc meaning
generation and what Kvale
calls meaning condensation.
2014 Nursing Australia Qualitative study: Naturalistic
study; Individual
semistructured interviews
with 11 mental health nurses
(MHN) in Australia. Analysis:
Thematic analysis by all
authors. Lincoln & Guba
method (1985)
2014 Nursing Nether‐ Discussion Paper (with Literature
lands Review). Databases used:
Searched MEDLINE, CINAHL,
and PsycINFO 1997 to 2010.
1216 relevant studies, with 18
meeting the inclusion criteria.
Main Findings
Narrative theme categories:‐‐
Performing physician tasks can
make one feel like a doctor‐‐
Demonstrating caring is a
fundamental task of doctors,‐‐
Integrating personal ideals with
professional values promotes PI
formation‐‐ Never feeling like a
doctor.
The following analytical categories
were developed:‐‐
Reconstructing trust, ‐‐
Reconstructing work, ‐‐
Reconstructing values,‐‐
Reconstructing professional
status.
The PI of MHN remains poorly
defined, regardless of the
context of practice.
‐‐ Nurses derive self‐concept and PI
from their public image, work
environment, work values,
education, and traditional social
and cultural values.‐‐ To improve
their public image and to obtain
a stronger position in health care
organizations, nurses need to
increase their visibility.
Definition of Professional
FITZGERALD
Identity (PI)
Uses Carnegie Foundation
study of medical education
(2010) definition: “A
representation of self,
achieved in stages over
time during which the
characteristics, values, and
norms of the medical
profession are internalized,
resulting in individual
thinking, acting, and feeling
like a physician.”
Uses Dadich & Doloswala
(2018) definition:
anawareness of the role
and functions that one
performs or is expected to
perform in a social context
as a member of a particular
profession.
The integration of personal
values, understanding and
motivations (of the MHNs),
and the internalization of
the knowledge, skills, and
attitudes which develop as
part of the nurses’
professional socialization.
Uses the definition of
(Fagermoen 1997): the
values and beliefs held by
nurses that guide her/his
thinking, actions, and
interactions with the
patient.
(Continues)
|
11
 12

TABLE 2 (Continued)
|

Definition of Professional
Author Title Year Discipline Country Methodology Main Findings Identity (PI)

Holden, Buck, Luk, PI formation: Creatinga 2015 Medicine US Discussion Paper: On the Assessments within the framework Uses definition by Wilson
Ambriz, Boisaubin, longitudinal framework development of the TIME for: ‐‐ providing feedback to et al16: The integration of
Clark, Mihalic, through TIME program. Defining PIF and learners;‐‐ evaluating curricular personal values, morals,
Sadler, Sapire, Spike, (Transformation in Medical developing framework. and extracurricular strategies to and attributes with the
Vince, & Dalrymple Education) promote PI;‐‐ advancing norms of the profession.
theoretical development.

Johnson, Cowin, Wilson, PI and nursing:contemporary
& Young theoretical developments
andfuture research
challenges
2012 Nursing Australia Discussion Paper/Literature
Review: Theoretical
discussion on the construct of
PI and factors that influence
PI throughout a career in
nursing.
‐‐ Education is a key period to A sense of self that is derived
nursing professional and perceived from the
development‐‐ Students gain the role nurses take on in the
knowledge and skills that work that they do.
separate nurses as professional
health care workers from lay
people.

Kalet, Buckvar‐Keltz, Measuring PI formation early in 2017 Medicine US Mixed Methods Research: 132 These PIF scores distributed A representation of self,
Harnik, Monson, medical school entering med students. similarly to novice students in achieved in stages over
Hubbard, Crowe, R., Professional Identity Essay other professions. Students time during which the
… Yingling (PIE); the Defining Issues Test reflected on these measures in characteristics, values, and
(DIT2); reflection. Analysis: meaningful ways suggesting norms of the medical
Spearman's and Pearson's utility of measuring PIF scores in profession are internalized.
correlation coefficient one‐ medical education.
way (ANOVA).

Lawson, Knudson‐ Student healthcare clinicians’ 2017 Nursing US Qualitative Study: Grounded Four common challenges students The result of the
Martin, Hernandez, illness narratives: PI Medicine theory interviewed 10 nursing faced navigating personal developmental process
Lough, Benesh, & development and relational students, 10 medical students, experiences of illness and that culminates in an
Douglas practice and 10 MedFT students. connecting to patients: ‐‐ understanding of self
Analysis: Line‐by‐line coding, discrepancies between ideal and within a chosen field.
focused coding, analytic lived experiences. ‐‐ challenges
memos, and theoretical coding of health care work and
to construct grounded theory. culture.‐‐ navigating power and
hierarchy.‐‐ developing a shell of
privacy.

Levy, Shlomo, & Itzhaky The ‘building blocks’ of PI
among social work
graduates
2014 Social Work Israel Quantitative Study: 160 social
work students who were
about to graduate, completed
six surveys. Analysis: Path
analysis (AMOS 5 program) to
analyze the research model.
‐‐ Satisfaction with supervision
positively and directly related to
PI. ‐‐ Personal values and
empathic concern indirectly
related to PI.‐‐ Personal stress
negatively associated with PI.
A complex factor, which
involves internalization of
the group's values and
norms as part of the
individual's own behavior
and self‐concept.

Lyneham, & Levett‐ Insights into registered nurses' 2016 Nursing Australia Qualitative Study: Four main professional values Professional values: Standards
Jones professional values through Semistructured interviews identified: ‐‐ Being person‐ that define professional
FITZGERALD
TABLE 2 (Continued)
Author Title
the eyes of graduating
students
MacIntosh Reworking professional nursing
identity
Manojlovich, & Ketefian The effects of organizational
culture on nursing
professionalism:
Implications for health
resource planning
Mariet Professional socialization
models in nursing
Matthews, PI measures for student health
Bialocerkowski, & professionals‐A systematic
Molineux
Year Discipline Country Methodology
with 14 students. Analysis:
Data read repeatedly and
word by word, then
categorized into four key
professional value groups.
2003 Nursing Canada Grounded Theory Study:
Experienced RNs who
graduated from diploma
programs and enrolled in bacc
nursing program. Analysis:
Used substantive and
theoretical coding (Beck,
1999), and constant
comparative analysis
(Glaser, 1978).
2002 Nursing US Secondary Data Analysis (from
Nursing Role Professionalism
Project). Analysis: Multiple
regression analysis. Bivariate
multiple linear regression.
2016 Nursing India Literature Review of conceptual
models on professional
socialization.
2019 Australia Systematic Review of eight PI
measures identified in two
Main Findings
centered. ‐‐ Kindness and
caring.‐‐ Being in control.‐‐
Commitment to learning.
Three‐stage process of reworking
PI:‐‐ Assuming adequacy.‐‐
Realizing practice. ‐‐ Developing
a reputation. 3 contextual
factors influence the process: ‐‐
Expectations.‐‐ Perception of
nursing status by others.‐‐
Acceptance, assistance, and
advocacy from others in the
workplace.
‐‐ Nursing professionalism and
strong organizational culture are
two resources for better patient
outcomes‐‐ Personal sense of
accomplishment not found to be
meaningful to nursing
professionalism.‐‐
Organizational culture predicted
16% of the variance.
Models appropriate for beginning
nursing students:‐‐ Hinshaw
(1976) Davis Model of Basic
Student Socialization.‐‐ Bandura
(1977) modeling. ‐‐ Benner
(1984) “novice to expert.”‐‐
Throwe & Fought (1987)
Developmental Model of
Professional Socialization of RN
students.• Edens (1987)
Explanatory model of
profsocialization in nursing
‐‐ The revised Nurses’ Professional
Values Scale and Macleod Clark
PI Scale had the greatest
Definition of Professional
FITZGERALD
Identity (PI)
behavior, and principles
and ideals that influence
moral judgment and give
meaning and direction to
clinical practice.
Professional socialization:
Process whereby
individuals acquire and
integrate the expected
knowledge, behaviors,
skills, attitudes, values,
roles, and norms deemed
appropriate and acceptable
to their chosen profession.
An autonomous practitioner,
armed with a unique body
of knowledge, who
practices within a specified
code of conduct and
derives a sense of
accomplishment from his
or her work.
Professional Socialization: The
process of internalization
and development or
modification of
occupational identity.
Absorbing the culture of
nursing (the rites, rituals,
and valued behaviors of
the profession).
Uses definition from Adams
et al17: “Attitudes, values,
knowledge, beliefs and
|
(Continues)
13
 14

TABLE 2 (Continued)
|

Definition of Professional
Author Title Year Discipline Country Methodology Main Findings Identity (PI)

review of psychometric phases. Analysis: COSMIN psychometric evidence. ‐‐ No skills that are shared with
properties checklist. measure fulfilled all criteria in others within a
the COSMIN checklist. professional group” (p56).

McLean From being a nurse to becoming
a ‘different’ doctor
2017 Nursing Australia Interpretative Phenomenological
Medicine Analysis (IPA): Interviews
with three experience
registered nurses enrolled in
an undergraduate medical
program. Analysis: The IPA
process suggested by Smith &
Osborn (2008)
‐‐ Highlighted the role of personal
and contextual factors in
becoming a doctor. ‐‐
Recommend the need for
interprofessional learning in
medical curriculum to cultivate a
health care culture of
collaboration rather than
competition.
A representation of self,
achieved in stages over
time during which the
characteristics, values, and
norms of the medical
profession are internalized,
resulting in individual
thinking, acting, and feeling
like a physician.

Miró‐Bonet, Bover‐ Genealogy as a critical toolbox: 2013 Nursing Spain Mixed Methods Study: Sources: ‐‐ The genealogical framework can Establishment of a body of
Bover, Moreno‐ Deconstructing the PI of five professional conduct be used to critique nurses’ PI.‐‐ knowledge, with its own
Mulet, Miró‐Bonet, nurses manuals for nurses’ training The PI of nurses not based on scientific basis, which
& Zaforteza‐ published during the Franco supposed universal values, but allows nurses to
Lallemand dictatorship in Spain; and six linked to local, historical differentiate their
interviews with nursing processes of normalization and contribution to the health
instructors or students at the resistance.‐‐ The PI of nursing is system from that of
time. Analysis: Foucauldian constituted not only from a physicians ‐‐ A process of
concept of genealogy as a globally informed perspective socialization that will lead
framework. but also through daily, locally nurses to internalize and
situated practice. acquire rules, knowledge,
skills, roles, values, and
culture characteristic of,
and unique to, their
profession.

Molleman & Rink The antecedents and
consequences of a strong PI
among medical specialists
2015 Medicine Nether‐ Literature Review: Introduces a
lands conceptual framework for
understanding the
antecedents of a strong PI
among medical specialists and
its consequences for the
quality of healthcare.
‐‐ Medical specialists with a strong
PI are likely to function
differently within and outside
their own domain.‐‐ Professional
identities of different specialties
already start to diverge in the
formation process, early in the
careers of medical specialists.
PI in medical specialists: Seeing
self as belonging to a
particular specialty. Shared
frame of reference,
endorse similar work
norms and same interests
in mind. Value and
emphasize key features of
specialty, such as certain
expertise, values, norms,
beliefs, attitudes, and
behaviors.
FITZGERALD
TABLE 2 (Continued)
Author Title
Neishabouri, Ahmadi, & Iranian nursing students’
Kazemnejad perspectives on transition to
PI: A qualitative study
National League for Practical/Vocational Nursing
Nursing Program Outcome:
Professional Identity
Porter & Wilton PI of allied health staff
Rasmussen, Henderson, Factors influencing registered
Andrew, & Conroy nurses’ perceptions of their
PI: An integrative literature
review
Year Discipline Country Methodology
2017 Nursing Iran Qualitative Content Analysis: In‐
depth unstructured interviews
with 35 Iranian BSN students.
Analysis: Content analysis
approach by Graneheim
&Lundman (2004). The
MAXQDAv.10 software
(VERBI GmbH, Berlin,
Germany) used for data
management.
2010 Nursing US Found in the document regarding
Practical/Vocational Nursing
Program Outcome.
2019 Allied Health Australia Cross‐Sectional Study: Online
questionnaire of PI: 226
responses. Analysis:
Descriptive statistics using
Microsoft Excel version 2010,
SPSS Statistics version 23.
Responses: Kruskal‐Wallis
test. Post hoc analyses using a
series of Mann‐Whitney U
tests.
2018 Nursing Australia Integrative Literature Review:
Investigating factors
influencing RNs’ perceptions
of their PI. Used PubMed,
CINAHL, EMBASE, and
Scopus. Articles published
between 2012 & 2017.
Main Findings
Four themes (15 categories): ‐‐
Satisfaction with professional
practice, ‐‐ Personal
development.‐‐ Professional
development.‐‐ Attaining
professional commitment.PI is a
significant factor influencing the
development of nursing
education and practice.
Describes the end‐of‐program, role‐
specific competencies
‐‐ Identified high PI among allied
health staff across each
workforce structure.‐‐
Statistically significant
differences between bed‐based
allied health staff and
ambulatory and community
allied health staff, but not
mental health allied health staff
Three categories influencing
perceptions of PI: ‐‐ the self (the
nurse who enacts the role in
practice), ‐‐ the role (what the
nurse does), ‐‐ the context (the
practice setting). Poor alignment
of these categories leads to
stress, tension, and uncertainty
affecting workforce retention.
Definition of Professional
FITZGERALD
Identity (PI)
Based on the individual's
attitudes, beliefs, values,
experiences, and
motivations. A form of
social identity and a
component of personal
identity. PI has a
relationship with the
individual's social status,
interpersonal interactions,
and interpretation of one's
own experiences.
PI “involves the internalization
of core values &
perspectives recognized as
integral to the art &
science of nursing. The
core values become self‐
evident as the nurse learns,
gains experience, & grows
in the profession.”
Uses the definition by Slay &
Smith (2011): “One's
professional self‐concept
based on attributes, beliefs,
values, motives, and
experiences” (p85).
One's perception of what it
means to be, and to act, as
a nurse. Takes place
through experience and
socialization and continues
through various
professional experiences.
|
(Continues)
15

TABLE 2 (Continued)
Author Title
Schmidt, & McArthur Professional nursing values: A
concept analysis
Shlomo, Levy, & Itzhaky Development of PI among social
work students: Contributing
factors
Seo, & Kim PI of Korean nurse practitioners
in the United States.
Shohani & Zamanzadeh Nurses' attitude towards
professionalization and
factors influencing it
Year Discipline Country Methodology
2018 Nursing US Concept Analysis: To clarify the
meaning of professional
nursing values. Analysis:
Walker and Avant's (2011)
method.
2012 Social Work Israel Quantitative Study: 160 social
work students about to
complete BSW degrees. Six
Questionnaires. Analysis: Path
analysis (The AMOS 5
program) was used to analyze
the research model.
2017 Nursing US Qualitative Study of seven
Korean NPs in the United
States. Analysis: Used the life
history research method.
2017 Nursing Iran Descriptive Study: 185 nurses
working in hospitals in Iran.
Analysis: SPSS software,
descriptive, and inferential
statistics.
Main Findings
Strong alignment leads to
satisfaction with the nursing
role, increased staff retention,
and improved quality of care and
patient outcomes.
‐‐ Professional nursing values
(human dignity, integrity,
altruism, and justice) serve as
the framework for standards,
professional practice, and
evaluation.‐‐ Personal and
professional values are modified
when students form a
professional nursing identity.
‐‐ The higher the satisfaction with
supervision, the less significant
social values were to PI. ‐‐ The
higher the satisfaction with
supervision, the lower their
levels of self‐differentiation.
Five themes regarding their PI as
NPs:‐‐ Patient‐centered
thinking‐‐ Responsibility for
patient care‐‐ Dedicated life‐‐
Diligence, ‐‐ Feelings of
achievement. *Of these, patient‐
centered thinking overriding
theme.
‐‐ Nurses’ attitudes on
professionalism at average level.
‐‐ Significant statistical
relationship between:‐ length of
service and attitude towards
professionalization‐
participation in self‐
empowerment training courses
and attitude toward
professionalization.
16
|
Definition of Professional
Identity (PI)
Professional Nursing Values:
Important professional
nursing principles of
human dignity, integrity,
altruism, and justice that
serve as a framework for
standards, professional
practice, and evaluation.
A complex factor, which
involves internalization of
the group's values and
norms as part of the
individual's own behavior
and self‐concept.
The characteristics that
delineate the role and
function of a given
profession
Professionalization includes
the application of
knowledge and skills,
carrying out standard
activities, leadership, self‐
discipline, professional
commitment, and social
values.
FITZGERALD
TABLE 2 (Continued)
Author Title
Snelgrove Nursing work in NHS Direct:
Constructing a nursing
identity in the call‐center
environment
Styles Regulation and profession‐
building: A personal
perspective
Sun, Gao, Yang, Zang, The impact of professional
& Wang identity on role stress in
nursing students: A cross‐
sectional study
Takashima & Saeki Practical actions shaped by the
internal structures of
occupational therapists’
professional identities
Thompson, Cook, & “I'm not sure I'm a nurse”: A
Duschinsky hermeneutic
phenomenological study of
nursing home nurses’ work
identity
Year Discipline Country Methodology
2009 Nursing UK Mixed Methods Research:
Secondary data analysis and
focus groups. Analysis: Based
on Harre & Van Langenhove
(1999) Inductive thematic
analysis
2005 Nursing US Guest editorial
2016 Nursing China Quantitative Study: Used three
questionnaires and
demographic questions, with
474 students from 3 schools.
Analysis: Cronbach's α,
EpiData Entry v3.1, SPSS,
Pearson correlation, point‐
biserial correlation, multiple
linear regression analysis, and
relative frequency.
2019 Occupational Japan Qualitative study: Grounded
Therapy theory semistructured,
interviews with 30 practicing
OTs. Analysis: Relationships
between participants’ types of
internal structures and their
practices.
2018 Nursing UK Hermeneutic Phenomenological
Study: Interviews with 13
nursing home nurses in North
East England. Analysis:
Content analysis by all
authors.
Main Findings
Four main themes identified: ‐‐
Claiming a nursing identity and
the importance of previous
experience‐‐ Holistic nursing‐‐
Insecurity and uncertainty‐‐
Claiming new skills
‐‐ Identifies elements of a
profession‐‐ Supports regulation
as a way to strengthen
professions. Self‐regulation and
self‐identification is central to
the independent practice of a
profession.
‐‐ A higher level of professional
identity was related to a lower
level of role stress. ‐‐ Age, being
the only child or not, education
level and having experience in
community organizations had
significant correlations with the
role stress scores.
‐‐ Three types of professional
identities with six properties.‐‐
Of the three types of PI, the
therapies of those whose
typology was consistent with
flexibility are the most beneficial
for clients.
‐‐ Nurses’ work activities and
professional group identity
influence their work identity. ‐‐
When work activities and
professional group identity do
not align with role expectations
Definition of Professional
FITZGERALD
Identity (PI)
An individual's conception of
what it means to be and act
as a professional, that is,
related to the ideology of a
profession; What
constitutes a profession
or not.
Described six attributes to be
recognized as a true
higher education;
1. profession:
2. a distinct practice;
3. research‐based
knowledge;
4. autonomy and
accountability;
5. a code of ethics;
6. an organized association
A form of social identity: PI
concerns group
interactions in the
workplace and relates to
how people compare and
differentiate themselves
from members of other
professional groups.
The acquisition of “the
character, dispositions,
beliefs, values, ways of
knowing, and ways of
seeing” that characterize a
profession”
(Hooper,2008, p228).
Defined in terms of the
meaning attached to the
tasks and activities of the
work: when identification
with the group is strong,
|
self‐identification as a
17
(Continues)
 18

TABLE 2 (Continued)
|

Definition of Professional
Author Title Year Discipline Country Methodology Main Findings Identity (PI)

work identity may be professional is

compromised. strengthened.

Vaismoradi, Salsali, & Perspectives of Iranian male
Ahmadi nursing students regarding
the role of nursing
education in developing a PI:
A content analysis study
2011 Nursing Iran Qualitative Study: Semi‐
structured interviews with 14
Iranian male nurses. Analysis:
Content analysis (Granheim &
Lundman, approach ‐ 2004)
Three main themes: ‐‐ Self‐identification with a
“reality–expectation profession.
incompatibility.”‐‐ “being
supported by the educational
system.” ‐‐ “nursing image
rectification.”

van Oeffelt, Ruijters, PI, a neglected core concept of 2018
van Hees, & Simons professional development
PI Nether‐ Book Chapter/Mixed Method
lands Study Online survey of three
groups: HRD professionals
(27), professionals (90), and
managers (26). In stage 2, in‐
depth interviews with HRD
professionals.
Defined 3 Selves:‐‐ The material self
is about responsibility and
ownership; ‐‐ The spiritual self is
about what makes one tick
(passions);‐‐ The social self is
about how one is a member of
communities/a give and take.
Identification with a group gives
input into who one is as a
professional.
Six elements of a professional:
‐‐ providing best practice
for clients and society, ‐‐
acting with integrity in any
environment, ‐‐ keeping
current with theory of
practice, ‐‐ critical
reflection on one's
practice,‐‐ contributing to
the profession and other
professionals,‐‐ interacting
with other professionals.

Wackerhausen Collaboration, PI and reflection 2009 PI Norway Revised and expanded version of ‐‐ Discusses three themes:‐ The
across boundaries Conference keynote anatomy of PI‐ Forms of identity
presentation Summarizes possession‐ Ways of acquiring
parts of research over 10 to PI‐‐ Interprofessional
15 years. collaboration is both necessary
and desirable. Intraprofessional
barriers and obstacles to
interprofessional collaboration.‐‐
Discussed microlevel (the level
of the practitioner) and
macrolevel (the public face of a
profession) of PI.
On the microlevel: taking on the
behavior of others in the
profession; doing, talking,
and performing as others in
group. On the macrolevel: a
combination of the
profession's official
recognition, the public
perception of the
profession, related
professions’ view of the
profession in question, and
the self‐image leaders and
ideologists explicitly
promote.

Wen 'Caring’‐an understanding of PI 2016 Nursing New Qualitative Study: ‐‐ PI centered strongly on caring The individual's perception of
by first‐year nursing Zeala- Semistructured interviews rather than recognizing the fitting into a professional
students nd with 3 first‐year adult nursing academic requirements for group, such as nursing. An
students. Analysis: Thematic nurses to be capable and individual's perceptions,
FITZGERALD
TABLE 2 (Continued)
Author Title
Wiles ‘Not easily put into a box’:
Constructing PI
Wiles & Vicary Picturing social work, puzzles
and passion: Exploring and
developing transnational
professional identities
Willetts & Clarke Constructing nurses’ PI through
social identity theory
Wilson, Cowin, Johnson, PI in medical students:
& Young Pedagogical challenges to
medical education
Year Discipline Country Methodology
analysis. (Holstein &
Gubrium, 2011).
2013 Social Work UK Qualitative Study:
Semistructured interviews,
seven students. Analysis:
Discourse analysis (Edley,
2001; Potter & Wetherell,
1987). Foucauldian theory and
conversation analysis.
2018 Social Work UK Findings from a workshop of
social workers from different
countries. 15 participants with
a range of social work roles.
2014 Nursing Australia Discussion Paper: Proposed social
identity theory (SIT) as a
valuable research framework
to assist with clarifying and
describing the PI of nurses.
2013 Medicine Australia Literature Review: Sources:
CINAHL Plus with Fulltext and
MEDLINE. Key words: medical
students, doctors /physicians, PI
Main Findings
competent in contemporary
practice.‐‐ All participants
identified a sense of “caring” as
the basis of their understanding
of PI.
Common usages of PI:‐‐ In relation
to desired traits,‐‐ Through
developing a sense of shared
identity with other social
workers, ‐‐ Alternatively, as a
process of individual
development.
Collective identity shared across
national boundaries Themes:‐‐
An imperfect fit.‐‐ Over the
horizon.‐‐ Tensions within the
social work role.‐‐ Tensions
between personal and PI.
‐‐ Group belongingness as a
consequence of
interpersonal–intergroup
continuum.‐‐ Group identity
salience.‐‐ Complexities of
individuals and their multiple
social identities. ‐‐ Situational
relevance and subjectivity of
these identities.
‐‐ Explored socialization,
communities of practice, clinical
settings, and patient and other
health care professional
interactions. ‐‐ Medical
education needs to be
responsive to changes in PI from
Definition of Professional
FITZGERALD
Identity (PI)
beliefs, values, knowledge,
and attitudes toward the
nursing profession.
A process in which each
individual comes to have a
sense of themselves as a
social worker.
Three meanings:‐‐ Desired
standards and
competences; ‐‐ A
collective sense of what it
means to be a social
worker;‐‐ Subjective
meaning for each
practitioner
Modern nursing meets the
recognized criteria of
profession: ‐body of
knowledge;‐professional
recognition;‐community
recognition; ‐a code of
ethics; ‐a community of
professionals providing
oversight and monitoring
the conduct of its
members.
The integration of personal
values, morals, and
attributes with the norms
of the profession.
|
(Continues)
19
 20

TABLE 2 (Continued)
|

Definition of Professional
Author Title Year Discipline Country Methodology Main Findings Identity (PI)

factors within medical student

or society.

Woods, Cashin, & Communities of practice and
Stockhausen the construction of the
professional identities of
nurse educators: A review of
the literature
2016 Nursing Australia Literature Review Sources:
CINAHL, MEDLINE,
COCHRANE, EBSCO,
Emerald, Proquest, and
Google Scholar. 293 peer‐
reviewed journal papers,
culled to 63.
‐‐ A community of practice can help
people collaborate toward
common goals and purpose. ‐‐
Nurse educators can benefit
from professional literature that
highlights collective and active
processes of individual and
shared identity formation.
Based on the values and
ethical standards that
define the profession and
the need for socialization
to identified benchmarks;
arises from personal
knowledge through
negotiated experiences
within a particular
community.

Worthington, Predictive validity of the 2013 Nursing Australia Quantitative Research using the ‐‐ Statistically significant higher PI Knowledge, beliefs, and skills
Salamonson, Macleod Clark PI Scale for Macleod Clark PI Scale scores for: females; previous common to a professional
Weaver, & Cleary undergraduate nursing (MCPIS‐9), compared with nursing‐related vocational group.
students student drop‐out rates 12 training; reported nursing as
months later.Analysis: SPSS their first choice; or engaged in
version 17.01 Cattell's scree nursing‐related paid work.‐‐ PI
test, Cronbach's α, Logistic has a direct relationship with
regression. student retention in the nursing
program.

Yazdannik, Yekta, & Nursing PI: An infant or one 2012 Nursing Iran Qualitative Research: 23
Soltani with Alzheimer semistructured interviews and
4 focus groups with 20 nurses
and 2 physicians in Iran.
Analysis: Discourse analysis, a
poststructuralism hybrid
method of Laclau and Mouffe,
and Fairclaughapproach.
‐‐ Nursing PI formed based on
cultural social structure, values,
and beliefs of the governing
health system. ‐‐ Nurses do not
show self‐concept that indicates
distinctive and developing
identity.
A concept of nursing and
functioning as a nurse,
including knowledge and
skills, self‐concept,
experiences, and the social
image of the profession.
Also, PI as a form of social
identity, in which the group
creates professional ideals
and values that are shared
among the professionals in
that group.

Zarshenas, Sharif, Professional socialization in 2014 Nursing Iran Qualitative Research: In nursing, sense of belonging and PI The way in which an individual
Molazem, Khayyer, nursing: A qualitative Semistructured interviews and contributes to professional views him/herself as a
Zare, & Ebadi content analysis focus groups with 43 nurses. socialization; it is suggested that nurse, who can perform
Analysis: Inductive content these factors, which improve nursing functions skillfully
analysis, and unanimous socialization in nurses, be taken and responsibly.
agreement of the researchers. into account by authorities.
FITZGERALD
FITZGERALD
the greater the professional identity, and in many cases the stronger
the job satisfaction. Rasmussen et al19 discussed how the activities of
a nurse, such as the provision of patient‐centered care, problem‐
solving, multitasking, and clear communication give the nurse a
feeling of empowerment and bolster professional identity. Thompson
et al18 defined professional identity in terms of the meaning attached
to the tasks and activities of the work. They studied nursing home
nurses and found that many had uncertainty about their identity
since the tasks they performed were different from the expected
characteristics of being a nurse. Participants described a feeling of
isolation and exclusion from the profession, which in turn affected
their job satisfaction and identification as a nurse. Heldal et al20
described how the functions and performance of a role give defini-
tion to professional identity. They stated that the professional
identity is context‐dependent, therefore, as work practices and
knowledge change, so does one's identity. This is illustrated by their
finding that some nurses in this study found increased professional
status after initiating a patient safety program.
Dahl and Clancy21 defined professional identity in the public
health nurses they studied as how those nurses experience and de-
scribe their practice. When experiences in their work overlap with
the experiences of others, a common professional identity is formed.
Wackerhausen22 described professional identity on both a macro and
a microlevel. On the microlevel, the level of the practitioner, a pro-
fessional was defined by taking on the behavior of others in the
profession; doing, talking, and performing as others in the group.
Wackerhausen22 found that while education and theoretical knowl-
edge were important, it is through shared behavior that one is fully
acknowledged as a member of a profession. Dikmenet al23 described
nursing professionalism as the manner of the work and the behaviors
of nurses in providing quality care and patient safety. Zarshenas
et al4 described professional identity as deriving in part from viewing
oneself as able to perform nursing functions skillfully and re-
sponsibly. One participant in their research described this as feeling
useful to the profession, which increased her sense of belonging.
5.2 | Knowledge and skills
Researchers also defined professional identity by what professionals
know, their knowledge and skills. When discussing professions in
general, van Oeffelt et al10 developed a model of professional iden-
tification that integrates expertise, a theory of knowledge, and pro-
fessional learning as key components in the professional self. Van
10
Oeffelt et al posited that these form the basis of professionalism,
which then supports the values of the profession and the social
context. Dikmen et al23 defined professions through their particular
body of knowledge, their formal education, and certification. These
authors asserted that it is the extent of knowledge, more than simply
experience, that ensures nurses are able to maintain a level of pro-
fessionalism in a rapidly advancing health care environment.
Yazdannik et al24 included knowledge and skills among other traits
when they defined nursing professional identity as a concept of
| 21
nursing and functioning as a nurse. This definition included the
self‐concept, experiences, and social image of the profession.
Benner et al11 described the development of professional iden-
tity, or formation in their words, as occurring when students acquire
and use knowledge to act with skilled know‐how. When this occurs,
Benner et al11 stated that students have a stronger association with
the social contract nurses have to care for vulnerable people. Wor-
thington et al25 defined professional identity in terms of the knowl-
edge, beliefs, and skills common to a professional group. They used
the nine‐item Macleod Clark Professional Identity Scale (MCPIS‐9) to
measure professional identity in nursing students in Australia. The
MCPIS‐9 was developed in 2006 to measure professional identity in
healthcare professionals and includes elements such as cognitive
flexibility and self‐reported knowledge.1,26 Worthington et al25 found
that the higher the levels on the MCPIS‐9, the higher the professional
identity, which translated into increased retention rates for partici-
pants in their study.
5.3 | Values, beliefs, and ethics
The characteristics most often cited as defining a profession are
values, beliefs, and ethics. Forty‐two of the sixty‐eight articles iden-
tified for this concept analysis cited such definitions. The NLN1
outlined this clearly in their outcomes and competencies document,
describing how knowledge alone is insufficient; professionalism in-
cludes internalizing the core values and beliefs of the profession as
well as understanding the context of the practice. Schmidt and
McArthur26 asserted that nurses must internalize values to develop
and sustain a professional identity. In discussing professional identity
for nurses, Woods et al8 focused on the values and ethical standards
that define the nursing profession and the need for socialization to
these benchmarks. MacIntosh27 described the elements of nursing
professionalism in experienced nurses as including social values, a
code of ethics, a mechanism for self‐regulation, and members
who are motivated by altruism and committed to the profession.
MacIntosh27 reflected on the stages of development of such attri-
butes, noting that values and ethics come only after confidence in
one's skills and know‐how.
In reference to physicians, Forouzadeh et al28 described pro-
fessional identity as integration of personal and professional values.
They cited the Carnegie Foundation study on educating physicians in
saying that professional identity is the same as the development of
professional values. Kalet et al29 described various sources, including
the Carnegie study, that define professional identity in terms of the
values, norms, and beliefs of the profession that must be committed
to and internalized. They measured professional formation in novice
medical students and found that strength in moral reasoning and a
commitment to professional values make students less vulnerable to
situational factors that challenge their professionalism.
Values, beliefs, and ethics were discussed in every discipline in-
cluded in this concept analysis. In social work, Forenza and Eckert30
found that the majority of their student participants identified
22 | FITZGERALD
value‐based concepts, such as social justice and empathy, as defining
the profession. In discussing the development of a self‐identity as an
31
occupational therapist, Binyamin described how students must
identify with the goals, values, and beliefs to make a professional
31
commitment. Binyamin asserted that alignment with these goals,
values, and beliefs helps students learn to navigate the various
relational dilemmas they encounter in their work. Gregory and
Austin32 defined professional identity formation in pharmacists as an
establishment of core values, moral principles, self‐awareness, and
self‐regulation. They described these attributes of professional
identity as important in pharmacy, as it is in medicine and other
professions, because the work is “messy,” and there are often no
clear‐cut answers.
5.4 | Context and socialization
Given that professional identity includes entry into a community of
practice, many researchers asserted that professional identity
cannot be separated from social identity. Thompson et al
discussed how the work role has a social identity rather than an
individual identity, therefore, when identification with the group is
strong, self‐identification as a professional is strengthened. Many
definitions of professional identity described a compact between
society and the professional.9,34‐36 Similarly, Crigger
Godfrey37 described professional identity, in part, as being a
member of a profession with responsibilities to society, patients,
other professions, and oneself. Other studies discussed the need
8,9,13,14
for self‐regulation and self‐identification. Heldal et al
stated that autonomy, which includes self‐regulation and taking
responsibility, is important to professional identity. Their study
also linked autonomy to the daily routines in a given workplace,
giving nurses both professional and clinical autonomy.
Similar to the research on social identity, studies described the
influence of the context in which professional identity is formed.
38
Goldie stated how professional identity develops in interactional
relationships and in professional contexts. For medical students,
38
Goldie found that this occurs in established communities such as
universities, hospitals, and community‐based care organizations.
Authors from Spain discussed nursing during the time of the Franco
dictatorship and the influence this had on nursing professional
identity.39 They described how professional identities are not stable
but are fundamentally affected by the political, cultural, and historical
realities that surround them. Crigger and Godfrey37 defined two
paradigms of professional identity—the social and the psychological.
They asserted that the social paradigm comes from the influence of
social expectations, expressed as nursing regulations, standards, and
interventions.
A related theme was to define professional identity by how it
38
compares with and differentiates from other groups. Goldie
scribed how medical students are in a process of defining not only
who they are but who they are not. Dahl and Clancy21 defined the
characteristics of a professional group that distinguishes it from
others regardless of context. They posited that this differentiation
from other groups gives the profession a distinct identity and the
professionals within that group a means to professional identity. In
interviews with nurses about their professional identity, Bochatay40
found that many discovered meaning in their work through the
professional values that differentiate them from other groups.
5.5 | Group and personal identity
Group identity was found to be a defining characteristic in many
sources. This refers to the profession being recognized by society,
and by the association each member can develop a professional
identity within that group. Adams et al,17 an oft‐cited reference for
subsequent research on professional identity, stated that the inter-
disciplinary nature of healthcare work makes social identity theory a
useful framework for the development of professional identity. Their
study asserted that those within each discipline are influenced by and
differentiate themselves from others that collaborate in patient care.
33
Yazdannik et al24 also wrote about professional identity as a form of
social identity, describing how the group creates professional ideals
and values that are shared among the professionals in that group.
Molleman and Rink39 researched medical specialists and found most
had a strong connection to their particular specialty. From this, they
and derived a secure professional identity as a member of that specialty.
A corollary found in the literature is self‐identification by the
individual as being part of a profession and therefore having
professional identity. Van Oeffelt et al10 began their model of
20
professional identity with the individual, how one identifies with
others and separates oneself from others. This study asserted that
identification with a group gives input into who one is as a pro-
fessional. When Crigger and Godfrey37 wrote about the psycho-
logical aspects of nursing, they were referring to the individual
internalizing the virtues of the profession, such as courage, in-
tegrity, and compassion. By this, the study found, participants
identified as being part of the profession of nursing. Rasmussen
et al19 conducted a literature review of nursing professional
identity encompassing articles published between 2012 and 2017.
They found that the studies supported the idea that nursing pro-
fessional identity takes place through experience and socialization
and continues through various professional experiences. Cruess
et al35 wrote about a similar process happening in the training of
physicians. Their definition of professional identity described a
process in which a developing physician internalizes the char-
acteristics, values, and norms of the profession, and as a result
begins to think, feel, and act as a physician.
6 | M O D EL CA S E
de-
A model case of a person with a well‐developed professional identity
has all the defining attributes of the concept. This hypothetical model
case involves Maria, a nurse with 7 years of experience. She is able to
FITZGERALD
perform all the functions of her job and is confident in the patient care
area. Maria graduated from an accredited nursing program and passed
the NCLEX licensing exam on her first try, proving she has the knowl-
edge to provide safe and effective care. Other nurses on her unit often
turn to Maria for her opinion and feedback about patient care. Maria is
seen as a person of high moral and ethical status. She has shown
commitment to her job and her patients. She has good relationships and
is respected by the other nurses and healthcare staff. She regularly gets
commendation by patients, stating she shows them respect, provides
good care, protects their privacy, and puts their interests first. She is
proud to be a nurse at her hospital and often recommends it to others
as a good place to work. Maria enjoys being recognized as a nurse both
at work and outside the hospital, and often volunteers to talk about her
work at the career day at her local high school.
7 | BORDERLINE CA SE
A borderline case of professional identity contains many of the
elements, but not all of them. This hypothetical case is about
Ethan. Ethan works with Maria, and they went to the same nursing
school. Ethan did not really want to be a nurse, but his parents
recommended it to him as a good career. He comes to work just in
time for shift change and never volunteers for overtime. He is seen
as a “good enough” nurse but has been known to talk about
patients he dislikes when in the hospital cafeteria. He agrees with
his parents that nursing is a good career and stays in his job for the
money and job security. He fixes and sells classic motorcycles on
the side and would 1 day like to make this his full‐time job.
8 | C O N T R A R Y C A SE
A contrary case of professional identity has none of the character-
istics of the concept. The term “nurse” is used very loosely by the
general public, referring to anyone who provides care to the ill or
aging. This contrary case is Jennifer, who works as a Certified Nur-
sing Assistant (CNA) at an assisted living center. When asked what
she does, Jennifer says that she is a “nurse” but is vague about where
she works. At her work, she helps residents with ambulation, bathing,
and other personal needs, but only when specifically requested. She
can often be seen asking residents and their families if they have the
need for a personal assistant. She would like to leave her current job
and work with an individual in their home. She feels this would be
easier than what she now does. She has let her CNA license lapse
because she has not completed her continuing education courses and
figures she will correct this when asked by her employer.
9 | A NT E C E D E NT S
Antecedents of professional identity must occur or be in place
before the concept occurs. There are requirements of a profession,
| 23
including an educational degree, certification, or both, denoting the
proper knowledge to perform the work of the profession.9‐11,41,42
To be determined as a profession, there must be shared ethics and
standards that define the work, the knowledge, and the values for
the profession.8,27‐29,31,32,35,37 For nursing, these are included in the
American Nurses Association Nursing Code of Ethics. Because
professional identity is so closely associated with social identity,
there must be a supportive community of practice.4,21,27,37,38,43
Persons with a strong professional identity would consider them-
selves as a member of this group and have been socialized and/or
mentored into the work.34 Rasmussen et al19 gave a comprehensive
description of antecedents to professional identity, including au-
tonomy, responsibility, confidence, clinical judgment, the ability to
collaborate with others, and the organizational structure and re-
sources. The research found that if any of these antecedents are
missing, it will be difficult, at times impossible, for a person to de-
velop a healthy professional identity.
Zarshenas et al4 studied nurses at all levels, including stu-
dents, and found that a sense of belonging to a profession led
students to try harder in school. Similarly, Crigger and Godfrey37
and Cruess et al35 both stated that intentional teaching of pro-
fessional identity strengthens success, promotes trust, and im-
proves outcomes in professional education. Role models and
clinical supervisors were found to have an impact (either positive
or negative) on a Student's developing professional identity.4,16,44
Shlomo et al44 found that satisfaction with one's educational su-
pervisor was the strongest influence on professional identity
formation.
10 | CO N SE Q UEN CE S
The consequences of professional identity are both explicitly
mentioned and alluded to in much of the literature. In some cases,
the authors stated the result of a strong professional identity, and in
others, they discussed the consequences of a lack of professional
identity. Van Oeffelt et al10 listed a variety of consequences found in
the literature, including higher immunity to stress, enhanced
self‐confidence, more successful careers, and a more positive attitude
that makes the professional less affected by a poor work environ-
ment. Rasmussen et al19 identified that the sense of belonging that
comes from professional identity can lead to job satisfaction and
feelings of achievement.
In the clinical setting, a strong professional identity was found to
be good for patient safety20; resulted in better practice and patient
outcomes14,19,39,45,46; increased satisfaction with practice19,34,43,47;
decreased stress48; and improved retention and recruitment of
practitioners.19,34,45,49,50 MacIntosh27 described how a supportive
workplace increased nurses' professional identity.
Sources described the lack of professional identity as risking a
superficial commitment to the profession leading to poor‐quality
nursing care,51 moral distress, and values dissonance.52 A weak
professional identity was found to increase stress20 and decrease
24 | FITZGERALD
self‐confidence and decision‐making ability.32 And when there are
low rates of professional identity, there is the risk of allowing others
to define the profession.49
11 | EMPIRICAL R EF ERE NTS
Empirical referents are things that allow us to see and measure
professional identity. They are tangible evidence of the existence of
the concept. There are a variety of screening tools that measure
professional identity, including the Clarity of Professional Identity
(CPI), the Macleod Clark Professional Identity Scale (MCPIS), the
Nurse Self‐Concept Questionnaire (NSCQ), the Nurses' Professional
Values Scale—Revised (NPVS‐R), the Professional Identity Five Fac-
tor Scale (PIFFS), the Professional Identity Scale for Nursing Students
(PISNS), the Professional Self Identity Questionnaire (PSIQ), and the
Values Survey (TVS). Using an extensive literature review, Matthews
et al53 analyzed the reliability and validity of the above‐mentioned
tools. The NPVS‐R, TVS, the PISNS, and the NSCQ were designed for
nursing students so their generalizability is limited. The authors
found that the MCPIS was the best tool for a range of health pro-
fessions and the NPVS‐R was the best measurement for nursing
professional identity.
12 | D I S C U SS I O N
Definitions of professional identity used in the literature vary greatly
when there is an explicit definition at all. This can lead us to confu-
sion and miscommunication and assumptions that researchers and
readers all share a collective understanding. The ability to designate
and support professional identity is important; therefore, a common
language is essential. Evaluation of the literature reveals common
themes and characteristics among those studies that give an explicit
definition of professional identity. These include the ability to
perform the functions of the profession; knowledge, as evidenced by
education and/or certification; identification with a community of
practice and with the values and ethics of the profession; and
personal identification as a professional within an identified
professional group. There is overlap in these themes; however, no
resource includes them all.
Many sources discussed the positive effect of the context or
social environment on the development of professional iden-
tity.4,17,24,49,54,55 Woods et al8 specifically cited the need for com-
munities of practice to help develop a professional identity. In
medical education, there is a developing philosophy that professional
identity must be intentionally taught, not left to chance.35 Goldie38
was an early proponent of training in professional identity in medical
56
schools, calling it fundamental to medical education. Burford et al
portrayed the potentially nurturing influence of the environment
in medical school by stating, “professionalism is grown, not
made” (p361).
Various sources described the ways in which interdisciplinary
training can either benefit or clash with professional identity.
McLean57 stated that interdisciplinary training helps professions
understand each other and can benefit the professional identity of
those in each group. Both Adams et al17 and Haghighat et al34 de-
scribed how it can help professionals to know themselves better and
therefore it supports self‐concept and self‐esteem. Molleman and
Rink39 found that interdisciplinary training decreased the threat to
professional identification when a person was criticized because it
helped professionals understand each other. Wackerhausen22 was
the only source to find that interprofessional training could be ne-
gative. He stated it can be a barrier to professional identity in that
the professional groups have no shared language, which could lead to
perceived competition. However, he contended that this deficit can
be overcome in part due to the benefits of interdisciplinary training
such as friendship and its positive effect on the immune system.
Multiple sources described professional identity as an evolving
process.5,7,17,34,35,37,58,59 While some said it begins before training in
medicine17,34 or in nursing7,59; others described it as beginning with
formal education in the profession.35 However, all cited the im-
portant interplay between the educational and training process and
professional identity. Research in education found that the devel-
opment of a professional identity leads to students trying harder,4
having more success,37 and to greater retention of students.25
Vaismoradi et al60 found an increase in professional identity in stu-
dents who felt support from the educational institution, particularly
by feeling trusted and being defended. Threats to professional
identity can come from discrepancies between ideals and rea-
lity,27,60,61 particularly when there are incongruities between the
didactic and clinical portions of education.
13 | CON CLUSIO N
Professional identity has been shown to be important to a variety
of health‐related professions; however, none has created an
agreed‐upon definition of the term. This risks inconsistent and
unsupported development of professional identity within the
professions. There are many common themes throughout the lit-
erature, which could make the task of formalizing this concept
easier. These include actions and behaviors, knowledge and skills,
values, beliefs and ethics, context and socialization, and group and
personal identity. This concept analysis strove to give some clarity
to the use of the concept of professional identity drawing from a
variety of health‐related fields. Having a common understanding
and a common language will help in research and in education,
career training, and the continued development of professional
identity, which ultimately improves patient outcomes and in-
creases satisfaction with one's practice.
ORCI D
Anita Fitzgerald http://orcid.org/0000-0002-2057-6643
FITZGERALD
REFERENC ES
1. National League for Nursing. Outcomes and Competencies for Graduates of
Practical/Vocational, Diploma, Associate Degree, Baccalaureate, Master's,
Practice Doctorate, and Research Doctorate Programs in Nursing. New York,
NY: National League for Nursing; 2010.
2. Porter J, Wilton A. Professional identity of allied health staff. J Allied
Health. 2019;48(1):11‐17. https://doi.org/10.1080/10447310902864951
3. Mariet J. Professional socialization models in nursing. Int J Nurs Educ.
2016;8(3):143‐148. https://doi.org/10.5958/0974‐9357.2016.00107.0
4. Zarshenas L, Sharif F, Molazem Z, Khayyer M, Zare N, Ebadi A. Pro-
fessional socialization in nursing: a qualitative content analysis. Iran
J Nurs Midwifery Res. 2014;19(4):432‐438.
5. Browne C, Wall P, Batt S, Bennett R. Understanding perceptions of
nursing professional identity in students entering an Australian un-
dergraduate nursing degree. Nurse Educ Pract. 2018;32:90‐96. https://
doi.org/10.1016/j.nepr.2018.07.006
6. Costa Fernandes M, Sales da Silva LM, Rocineide Ferreira da Silva M,
Martins Torres RA, de Araujo Dias MS, Magalhâes Moreira TM.
Identity of primary health care nurses: perception of “doing
everything”. Rev Bras Enferm. 2018;71(1):142‐147. https://doi.org/10.
1590/0034‐7167‐2016‐0382
7. Johnson M, Cowin LS, Wilson I, Young H. Professional identity and
nursing: contemporary theoretical developments and future research
challenges. Int Nurs Rev. 2012;59(4):562‐569. https://doi.org/10.
1111/j.1466‐7657.2012.01013.x
8. Woods A, Cashin A, Stockhausen L. Communities of practice and the
construction of the professional identities of nurse educators: a re-
view of the literature. Nurse Educ Today. 2016;37:164‐169. https://
doi.org/10.1016/j.nedt.2015.12.004
9. Gardner H, Shulman LS. The professions in America today: crucial
but fragile. Daedalus. 2005;134(3):13‐18. https://doi.org/10.1162/
0011526054622132
10. van Oeffelt TPA, Ruijters MCP, van Hees AAJC, Simons PR‐J.
Professional identity, a neglected core concept of professional
development. In: Black K, Warhurst R, Corlett S, eds. Identity as a
Foundation for Human Resource Development, 2018:237‐251. https://
doi.org/10.4324/9781315671482‐16
11. Benner P, Sutphen M, Leonard V, Day L. Educating Nurses: A Call for
Radical Transformation. San Francisco, CA: Jossey Bass; 2010.
12. Willetts G, Clarke D. Constructing nurses' professional identity
through social identity theory. Int J Nurs Pract. 2014;20(2):164‐169.
https://doi.org/10.1111/ijn.12108
13. Styles M. Regulation and profession‐building: a personal perspective.
Int Nurs Rev. 2005;52(2):81‐82. https://doi.org/10.1111/j.1466‐7657.
2005.00436.x
14. Manojlovich M, Ketefian S. The effects of organizational culture on
nursing professionalism: implications for health resource planning.
Can J Nurs Res. 2002;33(4):15‐34.
15. Walker LO, Avant KC. Strategies for Theory Construction in Nursing.
New York, NY: Pearson Education, Inc; 2019.
16. Wilson I, Cowin LS, Johnson M, Young H. Professional identity in
medical students: pedagogical challenges to medical education. Teach
Learn Med. 2013;25(4):369‐373. https://doi.org/10.1080/10401334.
2013.827968
17. Adams K, Hean S, Sturgis P, Clark JM. Investigating the factors in-
fluencing professional identity of first‐year health and social care
students. Learn Health Soc Care. 2006;5(2):55‐68. https://doi.org/10.
1111/j.1473‐6861.2006.00119.x
18. Professional. (n.d.), Merriam‐Webster's Collegiate Dictionary. Retrieved
from https://www.merriam‐webster.com/dictionary/professional. Ac-
cessed March 6, 2020.
19. Rasmussen P, Henderson A, Andrew N, Conroy T. Factors influencing
registered nurses' perceptions of their professional identity: an in-
tegrative literature review. J Contin Educ Nurs. 2018;49(5):225‐232.
https://doi.org/10.3928/00220124‐20180417‐08
| 25
20. Heldal F, Kongsvik T, Håland E. Advancing the status of nursing: re-
constructing professional nursing identity through patient safety
work. BMC Health Serv Res. 2019;19(1):418. https://doi.org/10.1186/
s12913‐019‐4222‐y
21. Dahl BM, Clancy A. Meanings of knowledge and identity in public
health nursing in a time of transition: interpretations of public health
nurses' narratives. Scand J Caring Sci. 2015;29(4):679‐687. https://doi.
org/10.1111/scs.12196
22. Wackerhausen S. Collaboration, professional identity and reflection
across boundaries. J Interprof Care. 2009;23(5):455‐473. https://doi.
org/10.1080/13561820902921720
23. Dikmen Y, Karataş H, Arslan GG, Ak B. The level of professionalism of
nurses working in a hospital in Turkey. J Caring Sci. 2016;5(2):95‐102.
https://doi.org/10.15171/jcs.2016.010
24. Yazdannik A, Yekta ZP, Soltani A. Nursing professional identity: an
infant or one with Alzheimer. Iran J Nurs Midwifery Res. 2012;17:
S178‐S186.
25. Worthington M, Salamonson Y, Weaver R, Cleary M. Predictive va-
lidity of the Macleod Clark Professional Identity Scale for under-
graduate nursing students. Nurse Educ Today. 2013;33(3):187‐191.
https://doi.org/10.1016/j.nedt.2012.01.012
26. Schmidt BJ, McArthur EC. Professional nursing values: a concept
analysis. Nurs Forum. 2018;53(1):69‐75. https://doi.org/10.1111/nuf.
12211
27. MacIntosh J. Reworking professional nursing identity. West J Nurs Res.
2003;25(6):725‐741. https://doi.org/10.1177/0193945903252419
28. Forouzadeh M, Kiani M, Bazmi S. Professionalism and its role in the
formation of medical professional identity. Med J Islam Repub Iran.
2018;32:130. https://doi.org/10.14196/mjiri.32.130
29. Kalet A, Buckvar‐Keltz L, Harnik V, et al. Measuring professional
identity formation early in medical school. Med Teach. 2017;39(3):
255‐261. https://doi.org/10.1080/0142159X.2017.1270437
30. Forenza B, Eckert C. Social worker identity: a profession in context.
Soc Work. 2018;63(1):17‐26. https://doi.org/10.1093/SW/SWX052
31. Binyamin G. Growing from dilemmas: developing a professional
identity through collaborative reflections on relational dilemmas. Adv
Health Sci Educ. 2018;23(1):43‐60. https://doi.org/10.1007/s10459‐
017‐9773‐2
32. Gregory P, Austin Z. Pharmacists' lack of profession‐hood: profes-
sional identity formation and its implications for practice. Can Pharm J.
2019;152(4):251‐256. https://doi.org/10.1177/1715163519846534
33. Thompson J, Cook G, Duschinsky R. “I'm not sure I'm a nurse”: a
hermeneutic phenomenological study of nursing home nurses' work
identity. J Clin Nurs. 2018;27(5‐6):1049‐1062. https://doi.org/10.
1111/jocn.14111
34. Haghighat S, Borhani F, Ranjbar H, Naseri P. Evaluating the formation
of professional identity in Iranian nursing students after im-
plementation of a new curriculum. J Nurs Midwifery Sci. 2019;6(3):
138‐143. https://doi‐/10.4103/JNMS.JNMS_1_19
35. Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. Reframing medical
education to support professional identity formation. Acad Med. 2014;
89(11):1446‐1451. https://doi.org/10.1097/ACM.0000000000000427
36. Akhtar‐Danesh N, Baumann A, Kolotylo C, Lawlor Y, Tompkins C,
Lee R. Perceptions of professionalism among nursing faculty and
nursing students. West J Nurs Res. 2013;35(2):248‐271. https://doi.
org/10.1177/0193945911408623
37. Crigger N, Godfrey N. From the inside out: a new approach to teaching
professional identity formation and professional ethics. J Prof Nurs.
2014;30(5):376‐382. https://doi.org/10.1016/j.profnurs.2014.03.004
38. Goldie J. The formation of professional identity in medical students:
considerations for educators. Med Teach. 2012;34(9):e641‐e648.
https://doi.org/10.3109/0142159x.2012.687476
39. Molleman E, Rink F. The antecedents and consequences of a strong
professional identity among medical specialists. Soc Theory Health.
2015;13(1):46‐61. https://doi.org/10.1057/sth.2014.16
26 | FITZGERALD
40. Bochatay N. Individual and collective strategies in nurses' struggle for
professional identity. Health Sociol Rev. 2018;27(3):263‐278. https://
doi.org/10.1080/14461242.2018.1469096
41. Takashima R, Saeki K. Practical actions shaped by the internal structures
of occupational therapists' professional identities. Open J Occup Ther.
2019;7(3):1‐16. https://doi.org/10.15453/2168‐6408.1567
42. ten Hoeve Y, Jansen G, Roodbol P. The nursing profession: public
image, self‐concept and professional identity. A discussion paper.
J Adv Nurs. 2014;70(2):295‐309. https://doi.org/10.1111/jan.12177
43. Seo K, Kim M. Professional identity of Korean nurse practitioners in
the United States. J Am Assoc Nurse Pract. 2017;29(4):195‐202.
https://doi.org/10.1002/2327‐6924.12439
44. Shlomo SB, Levy D, Itzhaky H. Development of professional identity
among social work students: contributing factors. Clin Supervisor. 2012;
31(2):240‐255. https://doi.org/10.1080/07325223.2013.733305
45. Sun L, Gao Y, Yang J, Zang XY, Wang YG. The impact of professional
identity on role stress in nursing students: a cross‐sectional study. Int
J Nurs Stud. 2016;63:1‐8. https://doi.org/10.1016/j.ijnurstu.2016.08.010
46. Holden MD, Buck E, Luk J, et al. Professional identity formation:
creating a longitudinal framework through TIME (Transformation in
Medical Education). Acad Med. 2015;90(6):761‐767. https://doi.org/
10.1097/ACM.0000000000000719
47. Neishabouri M, Ahmadi F, Kazemnejad A. Iranian nursing students'
perspectives on transition to professional identity: a qualitative study.
Int Nurs Rev. 2017;64(3):428‐436. https://doi.org/10.1111/inr.12334
48. Wiles F. ‘Not easily put into a box’: constructing professional identity. Soc
Work Educ. 2013;32(7):854‐866. https://doi.org/10.1080/02615479.
2012.705273
49. Hercelinskyj G, Cruickshank M, Brown P, Phillips B. Perceptions from
the front line: professional identity in mental health nursing. Int J Ment
Health Nurs. 2014;23(1):24‐32. https://doi.org/10.1111/inm.12001
50. Goddard D, de Vries K, McIntosh T, Theodosius C. Prison nurses'
professional identity. J Forensic Nurs. 2019;15(3):163‐171. https://doi.
org/10.1097/JFN.0000000000000239
51. Miró‐Bonet M, Bover‐Bover A, Moreno‐Mulet C, Miró‐Bonet R,
Zaforteza‐Lallemand C. Genealogy as a critical toolbox: deconstructing
the professional identity of nurses. J Adv Nurs. 2013;70(4):768‐776.
https://doi.org/10.1111/jan.12236
52. Lyneham J, Levett‐Jones T. Insights into registered nurses'
professional values through the eyes of graduating students. Nurse
Educ Pract. 2016;17:86‐90. https://doi.org/10.1016/j.nepr.2015.
11.002
53. Matthews J, Bialocerkowski A, Molineux M. Professional identity
measures for student health professionals—a systematic review of
View publication stats
psychometric properties. BMC Med Educ. 2019;19(1):308. https://doi.
org/10.1186/s12909‐019‐1660‐5
54. Burford B, Rosenthal‐Stott HES. Stereotyping and the development of
clinicians' professional identities. In: Mavor KI, Platow MJ, Bizumic B,
eds. Self and Social Identity in Educational Contexts. London: Routledge;
2017:279‐296. https://doi.org/10.4324/9781315746913‐ch16
55. Levy D, Shlomo SB, Itzhaky H. The ‘building blocks’ of professional
identity among social work graduates. Soc Work Educ. 2014;33(6):
744‐759. https://doi.org/10.1080/02615479.2014.883600
56. Burford B, Morrow G, Rothwell C, Carter M, Illing J. Professionalism
education should reflect reality: findings from three health professions.
Med Educ. 2014;48(4):361‐374. https://doi.org/10.1111/medu.12368
57. McLean M. From being a nurse to becoming a ‘different’ doctor. Adv
Health Sci Educ. 2017;22(3):667‐689. https://doi.org/10.1007/
s10459‐016‐9700‐y
58. Cook TH, Gilmer MJ, Bess CJ. Beginning students' definitions of
nursing: an inductive framework of professional identity. J Nurs Educ.
2003;42(7):311‐317.
59. Wen JS. ‘Caring’‐an understanding of professional identity by first‐
year nursing students. Whitireia Nurs Health J. 2016;23:37‐44.
60. Vaismoradi M, Salsali M, Ahmadi F. Perspectives of Iranian male nur-
sing students regarding the role of nursing education in developing a
professional identity: a content analysis study. Jpn J Nurs Sci. 2011;8(2):
174‐183. https://doi.org/10.1111/j.1742‐7924.2010.00172.x
61. Lawson L, Knudson‐Martin C, Hernandez BC, Lough A, Benesh S,
Douglas A. Student healthcare clinicians' illness narratives: professional
identity development and relational practice. Am J Fam Ther. 2017;45(3):
149‐162. https://doi.org/10.1080/01926187.2017.1322926
AU TH OR B IO GRA P H Y
Anita Fitzgerald, PhD, RN, AGNP, CNE is an Assistant Professor
at California State University, Long Beach.
How to cite this article: Fitzgerald A. Professional identity:
A concept analysis. Nursing Forum. 2020;1–26.
https://doi.org/10.1111/nuf.12450