Professional Identity in Nursing: A Narrative Review of the ISPIN Definition and Domains Usage

Abstract

Introduction

Established in 2020, the International Society for Professional Identity in Nursing (ISPIN) developed a definition of professional identity in nursing (PIN). This definition encompasses four domains: values and ethics, knowledge, nurse as leader, and professional comportment.

Objective

This narrative review aimed to summarize and synthesize identified published evidence, the extent of discussion of PIN domains, and literature gaps for the ISPIN definition of PIN.

Methods

Sources included peer-reviewed literature published between 2018 to 2025 from CINAHL and PubMed. Gray literature through Google Scholar and ISPIN archived publications were also searched. These were identified by two researchers and a PRISMA flow diagram was developed. No registered protocol was utilized. Search and MeSH terms included “professional identity,” “nurs*,” and “ISPIN.”

Findings

Thirty-seven articles met inclusion criteria and were extracted from 16,295 initially identified articles, with the majority with authors from the United States. There were very few research papers and a noticeable dearth using quantitative methodologies. Twenty-eight of the retrieved articles were considered expert accounts, conceptual discussion or opinions, common for a relatively new concept.

Discussion

Nurse as leader was discussed in 34 of 37 articles. Professional comportment was discussed in 31 articles. Both knowledge and value and ethics were discussed in 28 articles.

Conclusion

This narrative review highlights the nature and prevalence of the ISPIN definitions and its four domains in current literature and can be visualized through diagramming. Minimal quantitative studies and a higher volume of discussion articles present limitations to its strength and applicability. Results suggests the need for further research in all domains, particularly in knowledge and values and ethics, and its implications in strengthening nursing practice and education.

Introduction

Professional identity is uniquely defined by its associated profession. Various health professions such as medicine, pharmacy, physical therapy, and others have a well-established focus on profession identity and its formation (Cruess et al., 2019). The International Society for Professional Identity in Nursing (ISPIN) (International Society for Professional Identity in Nursing [ISPIN], 2025) was developed in 2020 to foster the development and raise awareness of nursing's professional identity. This international endeavor started in 2018 with a think tank composed of nurses from academia, practice, members of regulatory bodies, and leaders within the profession to fully explore and develop this concept. An outcome of the 2018 Think Tank was a definition of professional identity in nursing (PIN), as “a sense of oneself, and in relationship with others, that is influenced by characteristics, norms, and values of the nursing discipline, resulting in an individual thinking, acting, and feeling like a nurse” (ISPIN, 2025). Four domains—knowledge, values and ethics, nurse as leader, and professional comportment were then established as part of a nurse's professional identity. While not yet widely adopted outside of the United States, this definition is now accepted and incorporated into United States academic standards to prepare future nurses (American Association of Colleges of Nursing, 2021; National League for Nursing Commission for Nursing Education Accreditation, 2021).

A strong PIN has a positive influence on patient quality indicators as well as nurses’ intention to stay in the profession (Phillips & Priddy, 2023). According to the Interprofessional Education Collaborative (IPEC) Core Competencies, roles and responsibilities for collaborative practice is one of their four competency domains (IPEC, 2023). This domain includes a solid understanding of the roles and scope of practice of each member of the care team to provide optimal care for their patients. During a time when burnout is increasingly common among nurses in a post-COVID era (Buchan & Catton, 2023; Galanis et al., 2021; Martin et al., 2023) and many healthcare organizations face nursing shortages (Buchan & Catton, 2023; Martin et al., 2023), it is important to further explore professional identity in the largest healthcare profession—nursing.

Failure to develop a strong PIN can impact both individual nurses and the profession. Individual nursing students without a strong PIN may struggle more as they transition from academe to practice, and experience increased burnout and attrition from the profession (Liebig & Weybrew, 2022). Nurses practicing without a strong PIN are more likely to focus on tasks and are less able to articulate their vital role in caring for individuals and communities. Their decreased contributions to patient outcomes or interprofessional care within a healthcare system are detrimental to the individuals in their care, and growth of the profession as a whole. (Fitzgerald, 2020).

Each individual brings a sense of themselves to the profession, and this sense of self serves as the foundation for educational institutions to build upon as they form the professional identity of future nurses. ‘Professional identity is initially formed during nursing education through engagement and reflection on multiple experiences' (Goodolf & Godfrey, 2021, p. 496). Partnership between academe and healthcare organizations provides a strong foundation of one's PIN, provided both sectors share the same definition of nursing's professional identity.

Different definitions of PIN are present in the literature, representing many different countries (Rasmussen et al., 2018). The practice of nursing may vary due to culture, healthcare systems, and reimbursement models, and yet there is a universality of nursing (Leininger, 1994). The ISPIN definition is intended to transcend borders, with individuals from various countries and cultures involved in the development of the definition, as well as research and implementation of this standard definition. This narrative review explores the published and gray literature to summarize and synthesize the emerging evidence using the ISPIN definition of professional identity in nursing, the extent of literature focus on individual PIN domains, and to identify future research needs on this important topic for the global nursing community.

Methods

The methodology of this narrative review involved a single-screening process and review by two authors. To ensure a rigorous process, this narrative review made use of the guidelines and checklist of the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) as outlined in Figure 1 (PRISMA, 2020). No registered protocol was utilized.

Figure 1.

PRISMA Flow Diagram (PRISMA, 2020).

Current literature and articles were sought for retrieval by hand searching from two major databases, CINAHL and PubMed, and gray literature was sought from Google Scholar and the online ISPIN publication archives. The data charting process involved an Excel spreadsheet available to all members of the team.

Papers were deemed eligible through inclusion and exclusion criteria. The initial search utilized the MeSH terms “professional identity” and “nurs*.” Inclusion criteria used were peer-review articles containing themes of PIN, including key terms Professional Identity in Nursing, values and ethics, knowledge, nurse as leader, and professional comportment. Additional inclusion criteria included articles published between 2018 and 2025, peer-reviewed, written in English language, and full text. Exclusion criteria included Pre-CINAHL articles, preprints, duplicate articles, non-peer review literature, incomplete or inaccessible papers, and book chapters.

The initial search produced an overwhelming variety and quantity of definitions and portrayals of PIN. For this reason, a second search was implemented to include the MeSH term, “ISPIN,” to explicitly reference ISPIN and provide baseline consistency with the goals of this search. A second adjustment to the inclusion criteria was made. This included narrowing the publication date range to January 2020 through 2025 to account for the time of the ISPIN PIN definition origination and relevancy to the current year. All levels of evidence were included in the search and retrieval process. To reduce the risk of bias, articles were reviewed by a minimum of two of the three authors, for meeting inclusion criteria. Table 1 captures the results of articles included in review.

Table 1.

Narrative Review Findings and Implications.

Author(s) (year)	Level of evidence	Framework	Study design	Reliability	Purpose	Findings	Relevance and implications
Allen (2021)	Expert account (VII)	N/A	Discussion	Content expert, ISPIN Advisory Council Member	To discuss ways to create a safe learning environment and pedagogical approaches in effective PI formation in Gen Z nursing students.	All four PIN domains overlap and impact each other. Characteristics of Gen Z impact PIN formation, challenging one's values and ethics, diminishing the value of scientific discovery, challenging one's ability to engage in professional communication and collaboration, and limiting ability to gain and sustain leadership opportunities.	Given the specific Gen Z challenges, nursing educators must understand and show empathy towards students' unique needs in tailoring curriculum elements and PIN formation. Importance of using a holistic approach, focusing on gratitude, embracing failure, progress over perfection, worth and grit development.
Brewington et al. (2023)	Expert account (VII)	N/A	Discussion	Content experts, ISPIN Advisory Council Members	To discuss the nexus of Professional Identity in Nursing (PIN) and Diversity, Equity, and Inclusion, reflecting on the four domains of PIN.	DEI, PIN, and its 4 domains are interconnected. Importance of nurse leaders' knowledge to integrate DEI.	Integrating PIN at the systems level allows health care personnel understand the importance and value it brings to the nursing profession and all interacting disciplines. Understanding PIN formation through a DEI lens can improve health care, positive patient outcomes, positive organizational culture, the nursing profession, and society at large. The principles may have universal value, but DEI is perceived differently across organizations and nations.
Brewington and Godfrey (2020)	Expert account (VII)	N/A	Discussion	Content experts, ISPIN Advisory Council Members	To discuss PIN, its attributes and domains, and initiate an engagement process.	The 5 attributes of PIN are doing, being, acting ethically, flourishing, and changing identities. Each of the 4 domains of PIN have associated competencies.	Nurses must assume the leadership role to provide safe, quality care for patients and families. Important for nurses to be clear about the meaning and value of PIN which is the framework from which nurses practice. A global element would be appreciated in next steps.
Clark et al. (2024)	Expert Account (VII)	N/A	Discussion	Content experts, ISPIN Advisory Council Members	To introduce a conceptual model of PIN based on Bronfenbrenner's theory, PIN domains, and DEIB concepts and examine reciprocal relationships between DEIB and individual and collective formation of PIN.	DEIB is vital in shaping a nurse's professional identity. Bronfenbrenner's ecological systems theory illustrates the interconnectedness among PIN and DEIB.	Nurse leaders and educators are positioned to guide PIN development, considering DEIB concepts, social injustices, structural racism, and policies leading to health inequities. Nurses at the policy, practice, education, and public level are encouraged to integrate DEIB and PIN in their line of work. Further research of conceptual model is needed through the lens of a more global community of nurses.
Douglass et al. (2024)	Expert Account (VII)	N/A	Discussion	None disclosed.	To illustrate how faculty educate graduate nursing students in the development of professional identity using a conceptual framework to achieve competencies outlined in The Essentials.	Integration of the Conceptual Model of Professional Identity allows graduate educators to cultivate students ability to think, act, and feel like advanced professional nurses. The four PIN domains are intertwined within most domains of The Essentials; they serve as a benchmark for advanced-level nurses to foster their new role in their professional career.	Resources and time are required for graduate faculty to transform curriculum, teaching, and learning modalities, evaluate processes, and materials to support the direct patient care and preceptor expectation for the formation of PIN. Developing a strong professional identity is imperative for the success and sustainability amidst the evolving healthcare environment.
Embree and Liebig (2023)	Expert account (VII)	N/A	Discussion	Content experts, ISPIN Advisory Council Members	To explore the Nurse as Leader and provide a framework and recommendations for the professional development specialist (PDS) to facilitate learning of the this domain, modeling this transformation.	Importance for nurse leaders to self-nurture in order to advocate and promote well-being at work, at home, and in the community. The PDS aids in preparing students and nurses in their organization to enhance their talent of Nurse as Leader.	Improving leadership skills and traits will ultimately enhance patient care safety. Practicing nurses must have continued learning opportunities to develop leadership qualities given varied academic backgrounds.
Godfrey (2020)	Expert account (VII)	N/A	Discussion	Content expert, ISPIN Advisory Council Member	To discuss PIN and the evolution of the 4 domains through Think Tanks of 2018 and 2019; the ISPIN WHY statement; implications for building new knowledge of PIN.	Recommend shifting from emphasizing socialization and role-taking to formation. 4 domains of PIN discussed and a WHY statement was created following a Think Tank. Next steps were created in developing new knowledge of PIN.	Important that there is a “clear understanding of nurses' professional identity so that their unique contributions to improve health are recognized”. To foster PI, deans, directors, and faculty can join work groups, visit the ISPIN website, volunteer for efforts in practice, regulation, and education.
Godfrey (2022b)	Expert account (VII)	N/A	Discussion	Content expert, ISPIN Advisory Council Member	To discuss a nurse manager's quest to seek guidance from an ethics advisory board regarding appropriate and ethical language used in the workplace.	Nurses must maintain professional, respectful, and caring relationships with all members of the healthcare team. Duty to act to prevent harm is central to the standard of ethical conduct for nurses and other healthcare professionals	Understanding the depth and breadth of one's professional identity, nurses may have a greater appreciation for self-reflection while pondering duties and obligations as a professional nurse.
Godfrey (2022a)	Expert account (VII)	N/A	Discussion	Content expert, ISPIN Advisory Council Member	To discuss PIN and its 4 domains; to integrate the 4 domains as signposts through nurses' careers.	Diversity, equity, and inclusion are core to one's professional identity of nursing. All 4 PIN domains discussed.	The 4 domains of PIN may be used on an individual level in assessing one's own professional contributes and areas for growth and strength in nursing. PIN can foster an understanding to the professional life of nursing and help nurses become an even more vital part of nursing's changing profession, making space for nurses to voice their wisdom and value.
Godfrey and Joseph (2023)	Expert account (VII)	N/A	Discussion	Content experts, ISPIN Advisory Council Members	To explore the new language of PIN and translate its definition into the nursing discipline and society.	Professional identity has not been a priority like it has in other disciplines. The nursing shortage and pandemic are ideal times to help nurses reflect on PIN. Adversity can lead to opportunity. Links to mental health of nurses and nursing students.	Use the 4 domains in conversations, evaluations, and affirmations toward nurses. Contemporary language can lead to new knowledge development and help nurses find the language they need for professional development. Function more interprofessionally and collaboratively Support and advocate for other professions within the health care team Recognize that PIN is a global issue
Godfrey et al. (2023)	Qualitative Study (VI)	None disclosed	Inductive method of concept analysis via semi-structured interviews	Content experts, ISPIN Advisory Council Members	To explore transitions in PI when changing from providing direct patient care to leadership roles.	4 themes emerged: One's sense of professional identity is foundational; Professional Identity and Functional Role Work in Tandem; Leading expands one's view; We must build bridges	Authentic leadership is important to grow leadership and impact the nursing discipline in effective ways. Need to better describe and define professional identity and to build bridges ‘to advance the discipline in all practice, regulatory, and education environments' (p. 149) Importance of PIN to those in leadership roles in healthcare; ability to communicate the dichotomous relationship between the static or foundational nature of professional identity, and equally, dynamic expressions of it in any setting
Godsey and Hayes (2023)	Expert account (VII)	N/A	Discussion	Content experts, ISPIN Advisory Council Members	To discuss the nursing profession's lack of consistent brand message.	Nurses identify as leaders, empowered decision-makers, and autonomous health care providers. Maintaining consistency in the domain nurse as leader creates trust.	The brand image of ‘All Nurses are Leaders' can be achieved.
Goodolf and Godfrey (2021)	Expert account (VII)	Conceptual framework	Think tank methodology	Content experts, ISPIN Advisory Council Members	To explain PI science and discuss a think tank methodology.	PIN is formed during nursing education; facilitates emotional intelligence, ethical comportment, moral courage, and expands knowledge and expertise, leadership roles, and personal growth. Perceived faculty support encourages students to think like a nurse.	Conceptualizing and defining PIN as well as the values of patients and health professionals affect the therapeutic relationship and the delivery of quality patient care. A think tank methodology may bring clarity and understanding to build new knowledge and language within nursing. Limited international influence during Think Tank.
Goodyear (2021)	Expert account (VII)	N/A	Discussion	None disclosed	To share opportunities a nurse manager may use to foster professional identity development in nurses.	Establishing PIN relates to self-confidence collaboration to improve workplace and patient outcomes; it may start with motivation and purpose.	Knowing our PIN is an important aspect of a nurse leader Understanding your “why” provides a foundation for role modeling of PIN Development of PIN is meant to evolve, requiring mentorship and guidance.
Joseph et al. (2023a)	Concept Analysis/ Qualitative Study (VI)	King's theory of goal attainment	Model development process with observations and focus groups Fawcett method for conceptual model analysis and evaluation	Content experts, ISPIN Advisory Council Members	To illustrate how the conceptual model for professional identity in nursing is an active and transformative new mode of thinking for persons in practice, academia, research, regulation, and policy-making.	The model demonstrates interconnectivity, collaboration, accountability, and sustainability; promotes diversity, equity, inclusion, and role transparency. PIN is dynamic, influenced by four types of knowing; involves an active and transformative mindset.	In order to build on nursing knowledge and the science and practice of nursing, there needs to be a systematic empirical process. A conceptual framework for PIN will offer clear communication, relevant and consistent to understanding PIN and its influence on the public image of nursing. Practice and academia are interconnected and dynamic which will accelerate PIN formation; Research - test and refine the model's concepts, operational definitions, variables, and the relationships among them; explore the 4 domains; Regulation - functions as a method in understanding and advancing nursing as a profession internationally, is is intricately linked to concept of professional identity; Policy - develop confidence and communicate nursing brand image to nurses, legislators, and society to affirm PIN; maximize health in direct/indirect nursing roles
Joseph et al. (2023b)	Concept Analysis (Level VI)	None disclosed	Conceptual Design: Consensus Development Workgroup (CDW)	Content experts, ISPIN Advisory Council Members	To provide a framework to transform the professional identity and brand image of nursing from a caring discipline to one of leaders.	Promoting PI and the brand image of All Nurses as Leaders encourages nurses to exercise leadership when needed. The nursing profession encompasses advocacy, care, compassion, and critical thinking. Public perceptions influence PI.	Strategies to achieve the PI and brand image of All Nurses as Leaders: - Avoid minimizing our role as nurses - Influence and advocate for patients - Increase equity and improve the practice setting - Assume a reflective practice, foundational thinking, career development, personal and professional accountability - Utilize professional assertation and advocacy - Recognize the importance of nursing's contributions as leaders in practice and policy issues - Be consistent, positive, relevant, and distinctive advocacy for the nursing profession - Coach nurses to notice, interpret, respond, and reflect
Joseph and Godfrey (2023)	Expert account (VII)	N/A	Discussion	Content experts, ISPIN Advisory Council Members	To discuss a systems-based framework of PI to reframe nursing challenges and role expectations.	AACN Essentials and the National Academies of Science, Engineering, and Medicine [NASEM] are interrelated with the 4 domains of PIN. PIN is non-linear and evolves through professional experiences, leadership development, and through role changes. Leadership is an integral part of the nursing preparation; it is necessary for nurses to embrace the notion that all nurses are leaders.	Need for nurses to educate the public on nurses' role expectations and PIN domains, use all 4 domains for the formation of nursing education at all levels; provide practicing nurses support to provide leadership for the nursing profession advancement.
Joseph et al. (2021)	Expert account (VII)	N/A	Discussion	Content experts, ISPIN Advisory Council Members	To discuss the influence of leadership on nurses' professional identity, provide supportive evidence from 3 think tanks, and discuss implications of this new knowledge for nursing leadership and the formation and sustainability for PIN	Of all the 4 domains discussed, nurse as leader was highlighted. Nurse leaders are responsible for promoting and encouraging a healthy work environment, nurturing themselves, embracing their influence, assisting in identifying educational needs, promoting effective communication and constructive thought patterns, and incorporating conflict resolution skills.	"Visible, consistent, and effective nursing leadership will be vital to convert the enhanced attention and positive discourses about nursing into action.” Nurse leaders are encouraged to engage in self-leadership, creating and maintaining a constructive thought pattern How nurses lead, model, improve practice environments, foster lifelong learning, and test new interventions from ISPIN will impact the brand image and next generations, forming a stronger PIN.
Landis (2023)	Expert account (VII)	N/A	Discussion	Content expert, Advisory Council Member	To discuss the applicability of the Professional Identity in Nursing Scale [PINS] to assessing practice strengths and weaknesses of an individual and workplace.	ISPIN formed and defined PIN and developed 4 domains. Nurses with a strong sense of PIN provide higher level of patient care Nurses can use the PINS to evaluate areas of strengths and growth; reflect on how professional practice changes can increase PI.	The scale is meant to reflect on how changes to their professional practice can increase PIN. Quantifying PIN will reveal opportunities for growth and will only strengthen the future of nursing.
Landis et al. (2024)	Quantitative, Descrip-tive study (V)	None disclosed	Exploratory factor analysis (EFA); confirmatory factor analysis (CFA); 5-point Dreyfus Model survey	Update of a trustworthy scale. Content experts, ISPIN Advisory Council Members	To evaluate the psychometric properties of the PINS 2.0	PINS 2.0 shows adequate psychometric properties in measuring the concept of PIN, supported by the EFA and CFA	The PINS 2.0 scale is meant to strengthen a nurse's sense of PIN To interpret and use the tool for professional identity in nursing growth for individuals and groups Future research can include a longitudinal, interventional study to assess the ability to strengthen PIN over time
Landis et al. (2022)	Quantitative, Descriptive study (V)	DeVellis Scale	A Likert-type scale, PINS scale, construct and subcon-struct development and measure-ment	Trustworthy methods in scale development. Content experts, ISPIN Advisory Council Members	To measure nursing faculty and administrators' perceived level of importance regarding key components of PIN using the Professional Identity in Nursing Survey (PINS)	Diversity and inclusivity are essential to include in the PINS. Subconstructs of the 4 domains were endorsed as moderately to very important.	Next steps: To refine the scale items, test the scale with new participants, and ensure the scale is psychometrically sound. Recommendations for Nurse Educators: -Foster ways for students to develop their own PIN and reinforce ongoing lifelong learning.
Liebig and Embree (2023)	Expert account (VII)	Professional Identity Framework	Discussion	Content experts, ISPIN Advisory Council Members	To explore the domain of professional comportment and provide a framework for the professional development specialist (PDS) to teach on the concept and to model the domain to others.	Professional comportment is essential for building a durable foundation, allowing for nurses to connect, communicate, and collaborate with others. PDS faculty are needed to guide staff and students on this underdeveloped domain. 9 steps are interconnected to teach professional comportment.	Need for further discussion on professional comportment and recommendation for an assessment tool to measure professional comportment. Recommend that educators and PDS faculty to reflect on professional comportment as a component of PI.
Liebig and Godfrey (2022)	Expert account (VII)	N/A	Discussion	Content experts, ISPIN Advisory Council Members	To discuss the PIN language, its four domains, and its influence on practice; to encourage collaboration between academia and practice; to remind nursing that PIN is dependent on each nurse.	Five attributes of PIN include doing, being, acting ethically, flourishing, and changing identities. The four Domains included in discussion in addition to their constructs. An additional component is building better collaboration between academia and practice.	Important to understand and model PI and is dependent on everyone in the profession.
Liebig and Weybrew (2022)	Expert account (VII)	N/A	Discussion	Content experts, ISPIN Advisory Council Members	To explore the importance of PIN and its 4 domains - as a foundation on the journey of transition to practice	Identity formation assists nurses in helping establish the value and principles. Faculty can offer guidance for nurses transitioning to practice through discussions, mentorship, and advocacy.	Professional identity is foundational in the transition from academia to the practice environment
Mazyck (2023)	Expert account (VII)	N/A	Narrative Essay	Content expert, ISPIN Advisory Council Member	To provide a personal account of school nursing experience and formation of PIN.	Nurse as leader looks like school nurses advocating for safe and quality care for students. Nurse leaders influence awareness and cultivation of PIN and can extend the influence nurses have in health care.	Developing PIN influences the next generations of school nurses.
Mbalinda et al. (2024)	Descriptive Quali-tative (Level VI)	Lincoln and Guba (1986) Four Trustworthy criteria	Focused group discussions (FGDs); Coding and transcription of interviews	Peer review, meticulous data collection	To explore the understanding and barriers to professional identity among nursing and midwifery students and recent graduates in Uganda.	There is a strong understanding of PIN and its defining characteristics Barriers to PIN formation include lack of clinical work, mentoring, collaboration, clear scope of practice, policy implementation, and the high workload, low self-esteem, and negative media portrayals of nursing and midwifery	Need to communicate clear scope of practice, improve clinical mentorship, and engage nursing leadership in the development of PIN in students
Meyer and Faan (2022)	Expert account (VII)	N/A	Reflection	Content experts, ISPIN Advisory Council Members	To reflect on the development of PIN, creating a sound language, quantification, and applicability to nursing curriculum.	All 4 PIN domains were defined. A 34 item, psychometrically sound instrument tested the definition, domains, and key elements of PIN. Effective communication, integrity, trustworthiness, and respect are the most important to PIN.	Nurse leaders have the responsibility to use language that most effectively conveys what it is to think, act, and feel like a nurse. It is important that PIN is interwoven throughout nursing curriculum.
Owens (2021)	Qualitative phenomenological (Level VI)	Conceptual Model	Phenomenological approach, Semi-structured interview guide provided	Content expert, ISPIN Advisory Council Member Trustworthiness was ensured using 5 different criteria.	Explore the perceptions and experiences of rural NPs while they transitioned from being registered nurses to family NPs (FNPs). To examine if and how new FNPs experience their professional identity formation in their first year of rural primary care practice.	Four themes emerged including learning new knowledge, interaction with others, incentives to learn and practice in rural health care, and professional identity formation. Participants valued the importance of life-long learning and professional development. Professional comportment is an important component of NPs' professional identity formation.	The Process of PI Formation for Rural Family Nurse Practitioner Model emerged and adds to the literature gaps. This model may help guide leaders in developing curriculum and programs to support rural FNP professional development. Future research can incorporate more diverse group of NP graduates from other parts of the US. Leaders can collaborate with federal and state policy makers to implement programs that provide tuition reimbursement for NPs who agree to practice at rural health care facilities. Encompassing professional comportment into NPs' successful professional identity formation could be critical and needs to be further explored.
Owens and Denny (2024)	Qualitative (VI)	Not disclosed	Descriptive; Braun and Clarke data analysis	Content experts, ISPIN Advisory Council Members; Trust-worthy data analysis.	To explore the perceptions of prelicensure undergraduate nursing students regarding their learning experiences pertaining to PIN.	All participants wrote the importance of learning ethics and values, knowledge, and professional comportment in developing PIN. Most participants (93%) shared that all nurses should be leaders.	Adds to the literature on effective pedagogical methods to facilitate PIN formation in prelicensure undergraduate nursing students. Further research is needed to explore this phenomenon in other nursing programs and a longitudinal study.
Owens and Godfrey (2022)	Expert account (VII)	N/A	Discussion	Content experts, ISPIN Advisory Council Members	To discuss the fostering of PIN in education, practice, and regulation; Review the 4 domains of PIN and ways to apply to the profession.	PIN focuses on the transformational nature rather than the transactional aspects of professionalism. There is a strong relationship among PIN, the four domains, and job satisfaction and retention. Working in environments that support PIN impacts the health and well-being of nurses leading to safe and quality patient care.	Developing a strong PIN has the potential to improve the healthcare workplace environment, promote wellbeing, impact the delivery of safe patient care, and enhance nurse workforce retention.
Owens et al. (2024)	Expert account (VII)	None disclosed.	Discussion	Content expert, ISPIN Advisory Council Members	To distinguish between “professionalism” and “professional identity” and their connection to one another.	The Amended Miller's Pyramid: Nursing can guide nursing students through professional identity formation. Consistent language is necessary in describing professionalism and professional identity when learning to be a professional.	Research opportunities exist in studying professionalism and professional identity across the career continuum and helping nurses become more aware of professional behaviors and practices within their professional identity.
Phillips and Priddy (2023)	Descriptive, Mixed methods (V)	None disclosed	Mixed-methods, convergent design	Content experts, ISPIN Advisory Council Member R&V not addressed	Search for linkages between PI formation and nursing; understand what working nurses knew about professional identity, its formation, and how it impacts nursing practice	PI is critical to functioning in a nursing role. There is a strong connection between PIN and the wellbeing of patients and nurses. PIN supports healthy work relationships, work environment, job satisfaction, and retention and requires an alignment among self, role, and context.	Leaders must reflect on their own professional identities, values, work meaning, and support needed from their leaders. Address behaviors and policies interfering with PIN. Nurse leaders can support PIN by recognizing and supporting professional growth, shared decision making, participating in American Nurses Credentialing Center (ANCC) Magnet/Pathway to Excellence programs, and clearly communicating the organization's mission, vision, and values.
Ramos-Sandoval (2022)	Expert account (VII)	N/A	Discussion	None disclosed	To discuss the importance of having a foundation of PIN so to encourage the expansion of knowledge, skills, and values.	All 4 domains discussed in relation to their value in crisis.	PI is the foundation on how we provide high quality care to our patients and the tool to bring light to our patients.
Thompson (2023)	Expert Account (VII)	N/A	Discussion	Content expert, ISPIN Advisory Council Member	To communicate the importance of PIN in driving positive patient outcomes and its influence on a sense of wellbeing. To discuss the integration of the 4 domains of PIN with Watson's Theory of Human Caring.	There is a relationship between knowledge and its influence on PIN, leading to a sense of wellbeing. The 4 domains of PIN act as guideposts and PI replaces the doing of nursing to the ‘being’ of a nurse toward a sense of wellbeing and flourishing. Nurse as leader is not as readily identifiable by the public or profession.	Nursing leadership can use the conceptual framework as a basis for professional practice models to support their staff as they progress towards flourishing The framework can be used individually to facilitate a discussion with nursing staff, assist leaders and staff in identifying guideposts to inform their PI of ‘being’ a nurse, and address challenges and opportunities to grow in their practice. Having a solid yet flexible PI is at the core of nursing care quality, student recruitment, and staff retention.
Ulrich (2023)	Expert account (VII)	N/A	Discussion	None disclosed.	To encourage reflection of one's own PIN and integrate nurse as leader into the role of a professional nurse.	Before nurses can lead, they must see and embrace themselves as leaders. All four domains of PIN must be understood.	A leader is not dependent on having an official title, but rather, is a critical component of the professional identity of a professional nurse.
Weybrew et al. (2024)	Expert account (VII)	N/A	Discussion	Content expert, ISPIN Advisory Council Member	To review PIN and its domains and to discuss results of a mixed methods online survey.	Practicing nurses see a strong connection between PIN and safe, high-quality patient care, nursing job satisfaction, and retention. When PIN is lacking, there is unclarity in roles, lack of unified value system, ineffective decision-making, increased conflict, and impaired teamwork.	Changes are needed in the nursing profession and work environment. Nurses must understand what professional identity is and determine ways to form and foster their own professional identity.
Wolf et al. (2025)	Expert account (VII)	Framework provided by AACN and NLN	Discussion at ATI Summit	Content expert, ISPIN Advisory Council Member	To describe the use of ISPIN domains, definitions, and conceptual model as a framework to create a student handbook to be used as a template by nursing schools and colleges.	ISPIN framed student handbook has been used at two different nursing schools with positive feedback.	To utilize the framework to create intentional and pin-pointed work and activities in the nursing curriculum. Further research is needed to explore the effectiveness of this PIN framework in more nursing colleges and universities.

Results

The methodology discussed above yielded a total of 37 articles that met the criteria and were included in the review. Table 1 outlines findings and implications based on the four domains and topics of the 37 articles. While databases containing international publications were searched, all the papers were from the United States.

A diagram was created to visualize the individual PIN domains explored and associated concepts (See Figure 2). Twenty-eight articles mention all four domains of ISPIN definition of PIN, addressing knowledge, values and ethics, professional comportment, and nurse as leader. Professional comportment is discussed in 31 articles, three of which discuss only this domain. While 34 articles of the 37 retrieved articles discussed nurse as leader, six focused exclusively on this domain. Both values and ethics and knowledge were not discussed independently but considered alongside others in twenty-eight articles.

Figure 2.

Diagram of the Four Domains of Professional Identity in Nursing.

Using Melnyk and Fineout-Overholt (2019) as a guide, twenty-eight of the 37 articles were evaluated as level VII evidence, encompassing expert accounts and opinions. Six out of the 37 articles are level VI evidence, being qualitative studies or concept analyses. Three articles are level V evidence, mixed qualitative and quantitative methodologies.

Discussion

The four domains of the ISPIN (2025) definition of PIN are used to organize the discussion of findings from the narrative review.

Professional Comportment

Forming part of the ISPIN definition, professional comportment is defined as “a nurse's professional behavior demonstrated through presence, words, and action” (Brewington & Godfrey, 2020, p. 70). Professional comportment replaced the prior domain of self-awareness after the second think tank, with self-awareness becoming a competency (Goodolf & Godfrey, 2021).

Professional comportment is essential for building an occupational foundation and allows nurses to connect, communicate, and collaborate with others as well as demonstrating self-awareness and relating effectively to others (Liebig & Embree, 2023). Ramos-Sandoval (2022) also saw collaboration as a key aspect of professional comportment, with actions based on respect and patient-centered objectives. This is achieved by recognizing a person's needs and concerns and including them in planning and care.

In their descriptive study, Landis et al. (2022) use a Likert-type scale to measure constructs and subconstructs of the four domains under PIN. While each domain contains at least three items endorsed as moderately to very important, the authors discovered professional comportment contained the greatest number of items endorsed as moderately to highly important by nurse educators (Landis et al., 2022). Endorsed items included words such as respectful, patient-centered, self-aware, collaborative, confident, engaged, motivated, and resilient (Landis et al., 2022).

The domain of professional comportment guides the important aspect of creating an ethical environment, remaining respectful, professional, and caring for patients, colleagues, visitors, families, and all members of the healthcare team (Godfrey, 2022a). According to Joseph and Godfrey (2023), professional comportment calls for a commitment among coworkers and leaders to treat one another respectfully. This also entails a commitment to guide communication, foster therapeutic learning environments, and teach the skills necessary to manage incivility from others (Liebig & Embree, 2023). Further, Owens and Godfrey (2022) characterize professional comportment as demonstrating professional behavior through words, actions, and presence in all workplace environments and is relevant in all aspects of a nurse's life. Professional comportment entails having no tolerance for harassment, bullying, or microaggressions (Owens & Godfrey, 2022).

The critical nature of professional comportment is understood to stem from two perspectives. Owens (2021) examines the importance of the nurse practitioner's professional identity formation and Allen (2021) identifies the noticeable challenges of developing professional identity among the youngest generation of nurses. In an important acknowledgement that the profession must recognize historical and cultural changes, Allen (2021) communicates the high levels of anxiety and low levels of confidence in those of the Generation Z, or Gen Z, which may limit their ability to communicate effectively with the interprofessional team and the need to develop strategies to support this skill. Variances in how the nursing role is enacted between cultures can also impact how professional comportment is displayed throughout the world. Professional autonomy and actions are in part based on regulatory statutes that vary between countries. Having a shared understanding of professional comportment can benefit nurses and healthcare organizations as nurses increasingly move between countries or emigrate to new cultures and healthcare systems in different countries (Konlan et al., 2023).

Summary

Professional comportment is a foundational domain. It requires self-awareness, confidence, and the ability to respectfully and effectively interact, collaborate, and communicate with and among healthcare team members. Abiding by this domain disallows harassment, bullying, and microaggressions within the workplace. Cultivating the qualities of professional comportment translates into patient-centered and quality patient care. A lack of these qualities inhibits nurses’ ability to integrate effectively within the health care team and provide safe, high-quality care. Attention must be given to every nurse, from the youngest and newest members of the profession to those with advanced practice degrees. This is a challenge for nurse educators, as well as those in practice.

Nurse as Leader

Nurse as leader is defined by ISPIN as ‘inspiring self and others to transform a shared vision into reality’ (Brewington & Godfrey, 2020, p. 70). While recognizing the ISPIN foundation of nurse as leader, other authors expanded on this definition.

Among the discussions of nurse as leader, there was a consistent theme in emphasizing that all nurses are leaders regardless of role. Joseph and Godfrey (2023) encourage the brand image of All Nurses as Leaders. Echoed by Owens and Denny (2024) in their descriptive qualitative study, most participants believed all nurses should be and see themselves as leaders. This encourages nurses to exercise leadership to enhance the safety and efficacy of patient care, nurse satisfaction, and excellence in education, research, and other practice spheres (Joseph et al., 2023b). Ulrich (2023) stresses the importance of nurses seeing themselves as leaders before they can lead, “inspiring self and others to transform a shared vision” (p. 377).

In their qualitative study, Godfrey et al. (2023) found most nurse leaders valued their professional identity. Advancing all aspects of the profession was important while maintaining authentic leadership. Godsey and Hayes (2023) describe nurses as leaders as “empowered decision-makers” and “autonomous healthcare providers” (p. 190). This helps build the brand and image of nursing.

Nurse as leader encompasses skills and knowledge such as communication, collaboration, innovation, vision, presence, emotional intelligence, commitment to excellence, and critical thinking (Embree & Liebig, 2023; Liebig & Godfrey, 2022). This domain entails certain characteristics: care, respect, moral and ethical courage, integrity, and compassion for others and for self (Embree & Liebig, 2023; Joseph et al., 2021; Liebig & Godfrey, 2022). Nurse as leader also involves aspects of career development, evidence-based practice, professional socialization, professional accountability, patient safety and quality, and application to nursing practice (Embree & Liebig 2023).

Owens and Godfrey (2022) build upon these characteristics, emphasizing that nurse as leader refers to leadership characteristics while promoting, advocating, and protecting the rights, health, and safety of patients and not a job title or position. Nurse leaders must also practice self-care to enable them to advocate and promote well-being at work, at home, and in the community (Embree & Liebig, 2023). In addition, nurses as leaders are responsible for promoting and encouraging a healthy work environment, embracing their influence to impact cross-functional and interdisciplinary teams, assisting in identifying educational needs, promoting effective communication, and incorporating conflict resolution skills (Joseph et al., 2021). Carrying out this domain to reduce clinician burnout and enhance clinician well-being would require that systems and processes allow nurses to practice to the fullest scope of their professional authorization or licensure (Joseph & Godfrey, 2023).

Establishing strength in the domain of nurse as leader has positive implications for quality and safety, as well as patient outcomes (Embree & Liebig, 2023; Phillips & Priddy, 2023). Embracing their role as leaders, nurses must advocate for high-quality patient care. Understanding and enacting nurses as leaders within a healthcare team has the potential to advance the quality of care provided as well as the profession, in all settings where nurses are active (Mazyck, 2023).

In their descriptive study, Landis et al. (2022) studied the subconstructs of each of the four domains utilizing the Professional Identity in Nursing Survey (PINS). Under leadership, the themes of advocate, committed to excellence, negotiate conflict, trustworthy, and effective communicator were endorsed at 98% or greater as moderately to very important (Landis et al., 2022). According to Ramos-Sandoval (2022), leadership skills are necessary for advocacy and communicating with patients and the healthcare team, as communication with patients and families is a priority. Mazyck (2023) offers an engaging narrative account of how PIN formation, and this domain in particular, is crucial for school nurses, having the responsibility to advocate for safe and high quality care for young people.

Thompson (2023) argues that the domain of nurse as leader is not readily identifiable by the public or the profession. Nurses are not often seen as influencers or independent in the care of patients due in part to healthcare settings and systems. It is not known if nurses in more formal leadership roles would promote PIN over their managerial tasks. This domain must be viewed as an integral part of nursing preparation and embraced by each nurse (Joseph & Godfrey, 2023). Another recent barrier is the inner conflict experienced by the latest generation of nurses. Gen Z nurses may display less than established norms of professional behaviors (Allen, 2021). While this generation is interested in demonstrating leadership, their inner motivation and skills may require ongoing development (Allen, 2021). Cultural variances may also impact nurses seeing themselves as leaders. In countries and cultures where nurses are seen in a subservient role, leadership enactment as part of one's role may be limited and challenging at best and contribute to culture and role shock when faced with expectations of all nurses are leaders.

Summary

Nurse as leader is described thoroughly in the literature. The profession of nursing has the opportunity to articulate what it looks like to portray nurses as leaders. Despite emphasizing the theme that all nurses are leaders, there is a noticeable gap between the vision and the reality. Not all nurses regard themselves as leaders (Thompson, 2023). The portrayal of the nurse as leader is also not as readily identifiable by the public and nurses’ intrinsic motivation and self-identification may be barriers.

Also, the brand of nursing is not recognized or protected on a global level. While there is a shared appreciation in prioritizing this domain, the roles of nurse leaders are different across the globe. All nurses are leaders is a concept that needs further global exploration and clarification (Mbalinda et al., 2024). In fact, ‘nurse as follower’ is advocated in some international contexts (Freeman, 2021). The nursing profession must address how to best develop intrinsic beliefs of being a leader so that all nurses, regardless of role, generation, geography, or educational preparation, can enact this domain.

Values & Ethics

The ISPIN definition of values and ethics is “a set of core values and principles that guide conduct” (Brewington & Godfrey, 2020, p. 70). In their quantitative, descriptive study, Landis et al. (2022) studied the subconstructs of PIN and found that integrity, caring, and empathy are regarded as moderate to very important by almost all participants (greater or equal to 98%). Ramos-Sandoval (2022) highlighted integrity, empathy, and being caring as part of this domain. These are exemplified in Ramos-Sandoval (2022) by an ICU nurse taking time to talk with patients about their feelings to best support their needs, eventually leading to trust between the patient and nurse.

Liebig and Godfrey (2022) describe values and ethics as personal and professional standards that guide conduct, including concepts such as integrity, accountability, credibility, advocacy, compassion, and respect; each of which must be actioned. Owens and Godfrey (2022) discuss values and ethics as the ability to maintain and improve ethical work environments, ensuring conditions of employment are conducive to safe, quality healthcare that uphold shared values and ethics while working with interprofessional team members. For Joseph et al. (2023a), they are core values and principles that guide conduct.

Values and ethics exist in a reciprocal relationship with PIN. While values and ethics may influence a nurse's professional identity, conversely, Liebig and Weybrew (2022) comment that identity formation assists nurses in establishing their values and principles. These are an often assumed aspect of nursing, but demand vigilance and further research. With the advancement of health information technology and the integration and implications of artificial intelligence, value and ethics acquisition becomes a more pressing issue and not assumed to be an automatic assimilation (Allen, 2021). The International Code of Ethics for Nurses and national regulatory body codes stress the importance and key role values and ethics play in nursing practice. While there are cultural variations across the globe, the ICN Code embodies the primacy of values and ethics associated with the identity of the nurse. Given the changes in technology and the moral dilemmas faced by nurses on a daily basis, it is vital to further build on the scientific knowledge of this domain.

Summary

Common conceptualization of values and ethics in nursing is having integrity, empathy, and being caring. These have both a historical and cultural tradition. However, there are now multiple and competing influences on the youngest generation of nurses, and uncertainty about how commonly espoused nursing values and ethics will be internalized in the future (Allen, 2021). As undergraduate nursing students become part of the profession they must be supported to achieve a suitable alignment between their own personal/cultural values and those of the profession they seek to join. These values and ethics are part of the art of nursing that must be nurtured in the face of technological advances in order to maintain this vital professional identity domain.

As this review demonstrates, literature is sparse regarding the values and ethics domain of PIN. It is possible that values and ethics have been emphasized in the nursing profession to the extent that the need for discussion of transformation, application, or relevance to nursing's professional identity is now regarded as less urgent. According to recent polls, nursing is ranked as the most trusted profession, but in both the United States and Great Britain, percentage rankings have fluctuated in recent years (Brenan & Jones, 2024; Ipsos Veracity Index, 2023). Attention must be paid to this trend, and calls for the further development of research literature examining this domain within the nursing profession, especially in light of current technological innovations and influences.

Knowledge

The ISPIN definition of knowledge is the “analysis and application of information derived from experiences, critical reflection, and scientific evidence” (Brewington & Godfrey, 2020). Knowledge underpins ethical awareness, and is the basis for demonstrating clinical judgment, evaluating evidence and interventions, and recognizing cues and patterns (Landis et al., 2022; Ramos-Sandoval, 2022). Knowledge entails reflection, having innovation, and clinical judgment (Liebig & Godfrey, 2022). Joseph et al. (2023a) further explores the intricacies of knowledge as a state of personal knowing, or awareness of oneself, aesthetic knowing, ethical knowing, and empirical knowing; these ways of knowing greatly influence an individual's PIN.

Godfrey (2020) emphasizes the importance of building new knowledge related to professional identity. The attributes of the knowledge domain can now be measured through the PINS (Landis, 2023). Owens and Godfrey (2022) expand on the inquiry of new knowledge, stating that nurses are accountable for ongoing professional development, competence, and life-long learning: knowledge that extends beyond formal education (Liebig & Godfrey, 2022). This domain requires ongoing learning, with leadership supporting best practices and evidence to create a positive knowledge based work environment (Joseph & Godfrey, 2023).

One of the challenges to developing the knowledge domain are the rapid developments of the digital age. Allen (2021) states that there is a general sense of decreased attention spans given the high media consumption and polarized voices, distracting from the value of scientific discovery (Allen, 2021). Knowledge, as a domain, is more than passing a national licensing or certification exam, it requires attention to an attitude and action of lifelong learning. Licensure and specialty certification exams test knowledge at a given point in time, and do not represent the lifelong learning required as part of nursing's professional identity and the rapid expansion of knowledge in nursing and healthcare in general. Failure to maintain up-to-date knowledge can have a negative impact on patient outcomes, and contribute to an outdated identity of the profession. The knowledge domain crosses all spheres and roles of nursing, from bedside to boardroom, and must be fully explored and studied to help nurses grow in this aspect of their professional identity. Nursing education models vary throughout the world, with varying emphasis on types of nursing practiced (community/public health emphasis vs. acute or critical care emphasis) based on healthcare organizations within a country or region. The ISPIN knowledge domain definition can serve as a unifying agent for all nurses, regardless of location, setting, or level, of practice.

Summary

The insufficient literature surrounding the domain of knowledge points to the need for more research in this area of PIN. Lifelong learning is vital; embracing the rapidly evolving evidence and digital world is a possible means to further development of this domain. The profession must also pay close attention to how the knowledge domain transcends geographical and cultural boundaries to express the universality of nursing. Continued professional and knowledge development could be a bridge that fuels nurses’ desire to stay in the profession; more research in this area is needed.

DEI, Culture, and Generational Trends

Literature on PIN and its domains expand across DEI, culture, and generations. Brewington et al. (2023) emphasize the complementary relationship between diversity, equity, and inclusion (DEI) and PIN. This relationship weaves into all four PIN domains (Brewington et al., 2023). While the terminology is not universally accepted, DEI components are universal and relevant to the development of PIN. Culture, perceptions, geography, and generational differences affect the evolution of PIN. The nursing profession has historically and globally centered around task completion (Godfrey & Joseph, 2023), a situation that is compounded by the growth of technology and electronic health records (Forde et al., 2023). Moving away from task-focused, and living into one's PIN will expand the nursing profession to be more holistic and inclusive of diverse people (Godfrey & Joseph, 2023).

The development of one's PIN is an ongoing process influenced by the trends and characteristics of generational trends and the prevailing culture (Allen, 2021; Goodyear, 2021; Mao et al., 2021). It is essential to integrate PIN in all aspects of nursing curriculum (Meyer and Faan, 2022). In their descriptive study, Owens and Denny (2024) found all participants believed in the importance of learning ethics and values, nursing knowledge, and professional comportment as critical in developing PIN.

Identifying Gaps

Among the 37 articles retrieved, the PIN domain of nurse as leader was discussed the most, having a presence in 34 of the articles. Following in frequency, professional comportment was mentioned in 31, while knowledge and values & ethics tied in frequency in 28 of the retrieved articles. There is a need for literature to focus on the two domains of knowledge and values & ethics individually. Descriptive and qualitative literature is appropriate at this stage of knowledge development and the subjective nature of PIN. Given the limited quantitative methodologies found in current research, further PIN tool development and research expansion are needed to strengthen the level of evidence (Landis et al., 2024; Liebig & Embree, 2023) and further establish the domain and domain attributes across nursing populations and settings. While the definition of PIN and its domains are intended to be universally applicable, there is a greater need for global involvement in the development and application of this definition. Invitations to global leaders must be considered in further exploring PIN domains.

Implications for Practice

While the ISPIN definition of PIN is relatively new, this body of knowledge is rapidly expanding and has multiple implications for practice. There is room for growth in the scientific knowledge base within all of the domains of PIN, but especially in the domains of knowledge, and values and ethics, the two domains with the least amount of published literature on PIN using the ISPIN definition. Both of these areas may seem intuitive to nursing practice. However, taking either of these domains for granted has the potential to have negative implications for the nursing profession.

Systems thinking using the PIN domains rather than the continued adoption of a task approach can aid in eliminating clinical burnout and improve the well-being of nurses (Joseph & Godfrey, 2023). Given the impact of a continued large turnover rate of practicing nurses on organizations (Bae, 2023) this should be a priority. A strong sense of professional identity can decrease role strain or confusion of nurses, as well as foster increased self care activities that decrease stress and burnout among nurses. Healthcare organizations will also see a positive financial impact due to cost savings related to lower turnover rates when a nurse leaves an organization, estimated, using US figures, at three times a nurse's annual salary (Bae, 2023). A strong professional identity may also encourage more nurses to remain in the profession (Joseph et al., 2023b) easing shortages experienced by multiple organizations throughout the globe.

The development of a strong sense of nurse as a leader impacts the individual nurse, patients, and the profession overall. A strong nurse leader will advocate for their clients’ needs, decreasing undesired outcomes and improving quality of care (Phillips & Priddy, 2023). Nurses are not universally accepted as leaders, often more focused on completing assigned tasks in different regions of the world. Developing a strong professional identity in the domain of nurse as leader has the potential to strengthen the world's understanding of the full scope of practice possible for nurses. With a global migration of nurses (Bakhshi et al., 2022) the broader enactment of nurse as leader provides a commonly accepted understanding of roles and scope of practice. While many elements of PIN are universal, we also need to understand the subtle differences that result from culture and education, to promote the integration of overseas educated nurses.

Strengthening the professional identity of nurses starts with their formation during nursing education and continues throughout the practice years. During nurses’ pre-registration or licensure years, professional identity domains can be part of clinical evaluation tools, reflective journal topics, or part of portfolio development that demonstrates their growth in this area during their educational formation. Further research is needed to explore professional identity development among new nurses through advanced practice nurses (Allen, 2021; Owens, 2021) of various generational and cultural backgrounds. Curricular and educational adaptations that embrace the ISPIN definition of PIN allows educators to meet learners of all cultures, backgrounds, and ages. Inherent in the ISPIN definition of PIN is the sense of oneself, which acknowledges the diversity of multiple perspectives while establishing a sense of belonging to a profession. The increased diversity of our clients calls for a strong personal and professional identity to give high-quality, equitable care to all.

Limitations

The literature search within this narrative review involved a single-screening process. Despite the literature reviewed by two reviewers, the choice in screening process may have excluded relevant literature. The literature search generated a large number of discussions and qualitative studies, with limited quantitative studies. This finding suggests a limited rigor of current literature. Twenty-three of the retrieved articles were considered expert accounts, conceptual discussion or opinions. Arguably, this is expected for a new phenomenon, but limits its strength and applicability.

Conclusion

This narrative review highlights the current body of literature on the four domains of PIN. While described the most in the literature, nurse as leader is not as readily identifiable or relatable to the nursing professional on an individual or global level. Therefore, further exploration of nurse as leader is necessary to embody this as reality and transcend national borders. Strong professional comportment translates into patient-centered and quality patient care and without this, inhibits nurses’ integration into the healthcare team. Along with knowledge, values and ethics are least prevalent in the literature. Given the automaticity in today's technologically-driven world and the values of the current generation of nurses, this domain must be re-evaluated to reinvigorate the relationship between value and ethics and the PIN. The fourth domain, knowledge, was also minimally discussed in the literature. Recognizing knowledge as lifelong learning may be the key to transcend geographical and cultural boundaries and to re-ignite nurses’ desire to stay in the profession.