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Historically nursing is seen as a vocation-oriented profession directed toward the physical, spiritual, and psychosocial needs of a patient (Dawson, 2006). Modern nursing appears to be at a critical crossroad as nursing makes up the largest part of the workforce in modern health care thus, health care resource needs to be used effectively and efficiently (Scott et al., 2014). Nursing covers a wide variety of daily activities within one scope of practice hence it is difficult to classify a nurse’s role in any single capacity. However, nursing at regional, national, and international levels appear to have similarities in their functional roles within society (Browne et al., 2018). Like Nightingale whose legacy has created and shaped our relevant twenty-first-century nursing and practice, we need to study the cultural, social, and economic concerns, with emphasis on their impact on health and nursing (Beck, 2010a). She evoked empowerment for nurses to grow and enhance their practices, and to think outside the permitted domains, therefore paving the path for and recognizing the importance of professional identity. Beck (2010a) writes that Nightingale adapted herself in response to her time but was ahead of her time through her innovation and commitment to developing a personal identity for herself and a professional one for nursing.
Professional identity has been described as how a person views themselves within their own professional roles, influenced by their values, characteristics, traits, beliefs, and experiences (Browne et al., 2018). Andrew (2012) further claims that not alone is it the person’s individual attributes but also the perception of their colleagues, public image, and environment that influences one’s individual perception of professional identity. Phillippa et al, (2018) categorized these traits as the self, the role: what do I do, and the concept: where do I do it. They note that these traits are interlinked as neither one alone can define personal professional identity, as the individual’s unique characteristics gained and learned through life experience, education, and work environment all aid in pursuing a professional identity. However, Hollip (2013) illustrates that it is a continuous developmental process as, with time, confidence grows thus further scope of practice develops. For instance, a student’s nursing professional identity begins with the start of the nursing program, evolving throughout one’s career influenced by education, practices, self-reflection, colleagues, and the work environment (Browne et al., 2018). These influences have aided in the establishment of continuous education, standards, and practices thus helping to unite and ground nurse theory and practices to develop nurse’s professional identity (Tinler et al., 2017). Browne et al. (2018) suggest that nurses and student nurses who have developed a firm professional identity are more flexible when faced with change and challenges in the workplace.
As Phillippa et al. (2018) suggest the role refers to boundaries one faces in one’s practice which can enhance, empower or inhibit professional identity. These boundaries can be caused by one’s self or environment. Health systems and the public image of nursing vary thus impacting the role of the nurse within modern society nursing (Ten Hoeve et al., 2013). Health and educational systems are said to be failing modern nurses causing a loss of their professional identity by impossible idealized
expectations about their duty in nursing, due to staff shortages, increased workload, and with no clear definition of what the nurse’s role in 21st century is (Austin, 2011). As public opinion of a nurse’s role and job varies dramatically from that of what the organization’s expectation of their employee is, this, in turn, causes nurses to struggle to develop a professional identity as they are torn between the public perception and the organizational constraints (Tinler et al., 2017). This has resulted in nurses becoming passive contributors to the care they provide thus resulting in poor job satisfaction and a lack of public and personal identity (Sellman, 2011). However, he notes if the self strives to achieve respect and professional identity this can lead to the nurse developing a sense of worth and meaning. For example, Dawson (2006) suggest that nurses working in specialized areas such as intensive care, become more autonomous, expanding on their basic nursing role resulting in changes in one’s self-image, and embracing change to develop their personal and professional identity, within their field and the wider medical profession. The contemporary nurse’s role needs to continuously adapt to the changing population needs (Timmins, 2002).
The concept refers to the organization’s role that impacts upon a nurse’s professional identity through policies, protocols, framework, and the concept of caring (Browne et al., 2018). The concept is entwined with the outward image of the nurse influenced by stereotypes and the public’s perception. The stereotypical image of the nurse maintained by the public has been sculpted by the media portraying nursing in the traditional image of one that is caring, empathetic and compassionate (Ten Hoeve et al., 2013). This image remains despite nursing progressing into the 21st century as a professional role obtained through education and further advanced post-education (Hollip, 2013). In comparison to many years ago, nurses were seen to be subordinate to the doctor with basic knowledge and skills thus, the influence of Nightingale, establishing the first nursing school in the 1860’s has developed nursing as a separate professional identity (Beck, 2010b). This paved the way forward in establishing the new scope of practices, and new roles which are governed by organization, to provide and enhance the standard level of care. However, organizational influence can impact the role of the nurse, for these policies, procedures, and targets all influence the professional identity of the nurse (Browne et al., 2018). Austin et al. (2009) discuss how the organization influences nurses and states that nurses suffer ‘compassion fatigue’ due to set targets established by the organization. Austin (2011) further suggests that the organization looks at nursing as a customer service model. Although this may be seen to enhance the efficiency of the health service i.e. decreasing waiting times, meeting metric targets, and ensuring practices are standardized, it does impact the nurse’s role by taking the focus away from that of a person-centered approach, to one of the tasks orientated and routinized like that of the customer service model. Austin (2011) further develops this customer service model by suggesting that while nurses deliver very good care, they are disoriented for this model doesn’t allow the nurse to respond to suffering with true compassion as they are trying to meet the targets. This in turn has a bearing on the self-identity as professional identity is interlinked, so one needs to be aware of one’s self, role, and concept to have an impact on developing a professional identity (Melody, 2014).
To conclude professional identity is strongly influenced by how we see ourselves, how others perceive us, and how we are viewed in society (Browne et al., 2018). Nurses need to develop their own sense of professional identity by taking pride in their contribution to modern health care (Sellman, 2011). Professional identity plays a key role in evolving nursing practices in the 21st century as there is a positive correlation between the image of nursing and the decision of students to choose a nursing career (Scott et al., 2014). As nurses are currently working in an increasingly multicultural healthcare setting with both patients and healthcare professionals coming from diverse backgrounds, professional identity is more than ever essential to the survival and evolution of nursing in the 21st century.
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