Longitudinal study on professional identity and future self-continuity of undergraduate nursing students

Abstract

Aim

To investigate the longitudinal developmental trajectories and bidirectional predictive relationships between professional identity and future self-continuity in undergraduate nursing students, providing a theoretical basis for targeted interventions to enhance future development of the nursing profession.

Design

A longitudinal cohort study among undergraduate nursing students in China.

Methods

A longitudinal study involved 260 nursing undergraduates from Zhejiang Province, China, selected through non-probability sampling. Data were collected at five time points: T1 (2021, enrollment), T2 (2022, end of the first year), T3 (2023, end of the sophomore year), T4 (2024, end of the junior year), and T5 (2025, end of the internship). Measures included the Professional Identity Questionnaire for Nurse Students (PIQNS) and Future Self-Continuity Questionnaire (FSCQ). Statistical analyses included Spearman correlation, box-and-violin plots, and cross-lagged panel modeling using SPSS 27.0 and Mplus 8.11.

Results

Professional identity scores demonstrated an inverted “U”-shaped distribution, peaking at T3 and declining at T5, while future self-continuity scores followed a “U”-shaped curve, highest at T1 and lowest at T3. Significant positive correlations between professional identity and future self-continuity were found at all time points. Cross-lagged analysis revealed unidirectional prediction of FSC by PI during T2→T3 and T3→T4, while FSC significantly predicted PI during T4→T5. Both constructs demonstrated temporal stability.

Conclusions

Professional identity and future self-continuity follow distinct developmental patterns, with clinical internships reshaping their relationship. These findings underscore the need for stage-specific interventions to improve nursing talent retention.

Introduction

Nursing is a pivotal component of the global healthcare system. As the largest professional group within the healthcare system, nurses play an irreplaceable role in maintaining and promoting public health, preventing public health emergencies, and responding to national and global health crises [1]. However, a persistent shortage of nursing professionals remains a severe challenge for healthcare systems worldwide [2]. For instance, in China, the number of registered nurses per thousand population is only about 4 by the end of 2023 [3], significantly lower than that of Japan (12.85%) [4], Europe (7.93%), the Americas (8.34%) [5], and Australia (14.07%) [6]. This disparity underscores the urgent need for effective strategies to develop and retain a sufficient nursing workforce, particularly among nursing students. In this context, undergraduate nursing students, as the future human resources for the nursing industry, have career choices that directly affect the industry’s high-quality development. However, studies show that as many as 31.4% of undergraduate nursing interns express an unwillingness to enter the nursing profession [7]. If this trend continues, it will not only exacerbate the talent shortage in the nursing industry, hindering its stable development, but also have profound adverse effects on public health, medical safety, and social welfare [8].

Nursing students’ professional identity (PI) refers to their cognitive evaluation and emotional attachment to the nursing profession, serving as a stable psychological trait that can predict their career behavior tendencies [9]. From the perspective of Social Identity Theory (SIT), the formation of professional identity (PI) is essentially an individual’s process of identity development during occupational socialization. This occurs by internalizing the values and role characteristics of the nursing profession into one’s self-concept. It represents the process by which students categorize themselves as belonging to the “nursing professional group” and internalize that group’s values, norms, and roles. The formation of this identity is a dynamic developmental process that begins during professional education and continues throughout one’s career, directly impacting students’ career choices and their long-term commitment to the profession [10]. Psychologically, PI encompasses an individual’s clear understanding and acceptance of their career goals, professional competencies, personal interests, and occupational values [9]. For nursing undergraduates, this identity involves transitioning from “student” to “prospective nurse” and gradually establishing a future nursing role. However, multiple studies have shown that nursing students’ levels of PI are generally low, with this phenomenon particularly pronounced among undergraduate students [11]. Low levels of PI are associated with adverse outcomes, such as major changes during studies, high turnover rates after entering the profession, and negative career attitudes [12], all of which hinder the development of nursing talent and compromise patient care quality.

In recent years, Future Self-Continuity (FSC) has garnered academic attention as a key predictor of career choices [13]. From the perspective of Possible Selves Theory (PST), FSC not only refers to an individual’s subjective perception of maintaining consistency and continuity between their present and future selves across the temporal dimension, but also reflects the psychological closeness and connection strength to one’s future “possible selves“ [14]. Although FSC overlaps conceptually with Perceived Capability or Career Aspirations, its core distinction lies in emphasizing cross-temporal identity consistency rather than mere capability assessment or goal setting [13, 15]. For undergraduate nursing students, robust FSC plays a crucial integrative and regulatory role in their professional development. It enables students to systematically incorporate setbacks encountered in coursework, skills training, and clinical practice into a future-oriented trajectory of professional role development, thereby fostering deep identification with the core values of the nursing profession [16].

Occupational Socialization Theory (OST) provides a systematic analytical framework for revealing the profound interaction between PI and FSC in the professional development of undergraduate nursing students. This theory posits that individuals must progress through a series of formal and informal socialization stages to gradually internalize the norms and roles of the professional group, thereby completing the identity transition from “outsider” to “insider“ [17]. Within this process, FSC emerges as a critical psychological resource. It enhances individuals’ sense of belonging and identification with the nursing profession by reinforcing positive rehearsal of their future professional selves [18]. Xu [19]found a significant positive correlation between FSC and PI among undergraduate nursing students, demonstrating that higher levels of FSC cognition are associated with stronger professional identity. Wu’s 2022 study [20] further confirmed that college students’ FSC significantly and positively predicts professional identity, indicating that enhancing students’ awareness of their future selves can be an effective strategy for strengthening professional identity. Since individual behavior and psychological processes are influenced by perceptions of the continuity and stability of their self-concept across time [21], enhancing FSC can serve as an effective means to reinforce professional identity and stabilize the career mindset of nursing undergraduates. By strengthening the psychological connection between students’ present selves and their future professional selves, educators can ignite students’ enthusiasm for learning, thereby enhancing their professional competence and career identity.

Although existing research has confirmed the correlation between FSC and PI [22], most studies employ cross-sectional designs. No research has yet examined their predictive relationship at critical junctures of nursing professionalization, and the dynamic linkage mechanism between the two remains poorly understood [16]. Therefore, this study employs the Dynamics of Role Acquisition (DOFA) proposed by social professionalization theory, utilizing a five-wave longitudinal tracking design (T1-T5) to systematically analyze this dynamic process. This model posits that the formation of an individual’s professional role is a linear, progressive dynamic process(H1): progressing from the role anticipation phase to the formal role phase, then through the informal role phase, ultimately achieving role internalization [23]. Critically, each DOFA stage is characterized by a distinct psychological mechanism that is expected to produce qualitatively different predictive relationships between PI and FSC. In this model, the anticipatory stage refers to the period during which an individual forms preliminary expectations of a role through observation and information gathering before formally assuming that role; this corresponds to the early stages of nursing students’ enrolment (T1-T2). The formal stage involves systematic training and learning regarding the norms and requirements of the role; this corresponds to the period during which nursing students undertake their professional coursework (T2-T4). In the anticipatory and formal stages (T1-T4), students have not yet entered authentic clinical environments. During this period, professional identity is primarily constructed through classroom instruction, skills simulation, and peer socialization, a process theorized by Anticipatory Socialization Theory (AST) as “role rehearsal“ [24]. As PI becomes increasingly consolidated through repeated academic exposure, it functions as a cognitive scaffold that motivates students to project a coherent and idealized future professional self [25]. Accordingly, a stronger PI is expected to drive higher FSC, as students draw on their internalized professional values to envision and sustain a continuous future nursing self(H2:PI→FSC). The informal stage, meanwhile, emphasises interaction with ‘internal members’ within authentic practical settings; through continuous observation, imitation and feedback, students continually adapt and refine their understanding of the role, and in the process deeply integrate role norms into their self-concept. Ultimately, during the personalisation stage, they gradually develop a distinctive personal style of role performance. These two stages are integrated into the nursing students’ clinical placement period and the subsequent professional adaptation phase following the placement (T4-T5).In the informal and internalization stages (T4-T5), however, the psychological dynamic is theorized to reverse. Upon entering clinical practicum, students encounter the realities of professional practice, including high-intensity workloads, complex clinical relationships, and direct patient care, which may destabilize the idealized identity formed in the classroom [25]. Under these conditions, it is the student’s existing sense of future self-continuity (FSC), the degree to which they perceive their present self as connected to their envisioned future nursing self, that serves as a stabilizing resource, sustaining engagement and guiding behavioral adaptation in the face of role ambiguity [21]. In other words, FSC shifts from being an outcome of PI to functioning as an antecedent that reinforces and consolidates professional identity during role transition (H3: FSC→PI). Gaining a deep understanding of these developmental trajectories and their interactions will provide crucial guidance for nursing educators and administrators in designing targeted educational programs, thereby fostering a solid professional identity and specialized competencies among future nursing professionals.

Based on the theoretical framework and practical context outlined above, this study proposes the following hypotheses and conceptual model (see Fig. 1):

Fig. 1.

Conceptual model

• H1: Within the five-year cycle of undergraduate nursing education, both PI and FSC exhibit significant temporal stability, consistent with their trait-like nature and cumulative developmental trajectory across DOFA stages.

• H2: During the anticipatory and formal socialization stages (T1-T4), as PI is progressively consolidated through role rehearsal and professional coursework, PI significantly and positively predicts subsequent FSC levels.

• H3: During the informal-to-internalization stage of clinical practicum (T4-T5), when authentic role demands challenge classroom-based identity, FSC serves as a stabilizing psychological anchor and exerts a stronger driving influence on PI, such that future self-perception during practicum determines the ultimate consolidation of professional identity.

Method

Participants

This study employed a longitudinal design, recruiting participants through a multi-center, multi-stage non-probability convenience sampling method. Specifically, between September and November 2021, the research team established collaborations with multiple nursing colleges in Huzhou, Wenzhou, Hangzhou, and Jiaxing cities within China’s Zhejiang Province. Following formal approval from the academic administration departments of each partner institution, researchers conducted standardized recruitment presentations during the centralized orientation sessions for new nursing students at each school. Presentations were scheduled during designated class periods to comprehensively explain the study objectives, the five-year longitudinal design, the principle of voluntary participation, confidentiality measures, and participants’ right to withdraw from the study at any time without penalty. Students were given ample time to consider their decision and could ask questions before signing the informed consent form. Interested participants completed the baseline questionnaire after signing the written informed consent form, explicitly acknowledging that their decision to participate or withdraw would not affect their academic performance.

Eligibility for participation was based on: (1) Enrollment in a full-time nursing program; (2) pursuit of a four-year bachelor’s degree; and (3) Willingness to participate. Exclusion criteria were: (1) had a diagnosed mental or psychological condition; (2) were reassigned to the nursing major against their will. Reasons for withdrawal from the study included: (1) leaving school or taking a break; (2) changing to another major; and (3) declining to continue participation for a range of other reasons. Ultimately, 204 individuals continued in the study, resulting in a withdrawal rate of 14.28%.

Research tools

General information questionnaire

The questionnaire was crafted by the research team and encompasses various aspects of the students’ profiles, such as their age, gender, hometown, family income, whether they are an only child, the educational background of their parents, the atmosphere at home, their lifestyle regularity, and the reason behind their choice of nursing as their major.

Professional identity questionnaire for nurse students (PIQNS)

It was compiled by Hao Yufang [26] in 2011. The scale consists of five dimensions and 17 items in total: professional self-concept; benefits and risks of staying in the job; social comparison and self-reflection; autonomy in career choice; and social persuasion. The Likert 5-level scoring method [27] is adopted, with scores ranging from 1 to 5 points from “very inconsistent” to “very consistent”, and one item is reverse-scored. The total score ranges from 17 to 85 points. A higher score indicates stronger PI. The Cronbach’s Alpha Coefficient of this scale is 0.827.

Future self-continuity questionnaire (FSCQ)

Originally developed by Sokol and Serpe [28], this scale was translated and adapted into Chinese by Shen [29]. It includes three dimensions: similarity, vividness, and positivity, with a total of 10 items. The Likert 6-point scoring method [30] is adopted, with scores ranging from 1 to 6, from “completely inconsistent with oneself” to “completely consistent with oneself”, and a total score of 60. The higher the total score, the higher the level of FSC. The Cronbach’s α coefficient of this scale is 0.78.

Data collection procedures

Data collection was conducted over five waves using the Questionnaire Star platform, guided by the Four-Stage Framework, Occupational Socialization Theory, and expert input. T1(Anticipatory Stage): The initial survey was conducted 3–4 months after the freshmen completed military training (completed on September 28, 2021), when students had become more familiar with the campus and their major. T2-T4 (Formal Stage): The second survey (T2) was conducted after the first academic year’s courses ended, between July and September 2022. The third survey (T3) was scheduled after the second academic year’s courses concluded, between July and September 2023. The fourth survey (T4) was arranged after the third academic year’s courses ended and before hospital internships, between June and July 2024. T5(Informal-internalization Stage): The fifth survey was conducted after the internships ended, between April and June 2025. A total of 238 general information and FSC questionnaires were initially distributed to first-year nursing students at universities in Huzhou City. Before data collection, researchers received standardized training, and uniform instructions were provided to address participants’ online questions. Materials and contact information were organized to ensure smooth follow-up data collection and facilitate participant engagement throughout the study.

Statistical analysis

Statistical analyses were conducted using SPSS 27.0 and Mplus 8.11. Quantitative data that conformed to a normal distribution were represented as mean ± standard deviation, while non-normally distributed data were denoted as M(P₂₅, P₇₅). Pearson correlation analysis was employed to investigate the correlations between PI and FSC at each time point. Confirmatory factor analysis (CFA) was conducted using MPLUS 8.11 to verify the factorial structure of the PIQNS and FSCQ at each measurement wave. To validate the longitudinal comparisons, measurement invariance testing was conducted to ensure that the observed changes in PI and FSC reflected true latent construct differences rather than measurement artifacts across the five time points. Repeated measures analysis of variance (ANOVA) was used to analyze the differences in FSC and PI among nursing undergraduates at various time points, and partial eta-squared () was calculated to assess the effect size. Post-hoc tests (Tukey HSD) were performed for pairwise comparisons. Box plots combined with violin plots were used to display the distribution characteristics of the main variables at each time point. The cross-lagged panel model was used to analyze the longitudinal association between PI and FSC. The model fit indices [31] were as follows: Comparative Fit Index (CFI) greater than 0.9, Tucker-Lewis Index (TLI) greater than 0.9, Standardized Root Mean Square Residual (SRMR) less than 0.08, Root Mean Square Error of Approximation (RMSEA) less than 0.05, and the significance level was set at 0.05.

Results

Baseline characteristics of participants

A total of 238 participants were enrolled at baseline; 204 completed the study, and 34 withdrew prematurely. No statistically significant differences were observed between the two groups for any baseline demographic variables. Table 1 presents the baseline characteristics of these participants. These results indicate that baseline data were homogeneous across both groups, ensuring comparability for subsequent analyses. Among participants, 32(15.69%) were male and 172 (84.31%) were female, with a mean age of 18.94 ± 0.49 years. Most participants were from rural areas, were not children, reported harmonious family environments, but had relatively low levels of parental education.

Table 1.

Baseline characteristics of participants

Variables		Participants（x±s）/ N(%)	Dropouts（x±s）/N(%)	x2/t	P
Gender	Male	32(15.69)	5 (14.71)	0.021	0.886
	Female	172(84.31)	29 (85.29)
Age		18.94±0.49	18.86±0.51	0.865	0.388
Origin of students	Rural	153(75)	26 (76.47)	0.035	0.852
	City	51(25)	8 (23.53)
Per capita monthly income of the family	<5000RMB	95(46.57)	13(38.24)	1.156	0.561
	5000-10000RMB	94(46.08)	19 (55.88)
	>10000RMB	15(7.35)	2 (5.88)
Whether one is an only child	Yes	42(20.59)	9 (26.47)	0.609	0.435
	No	162(79.41)	25 (73.53)
Father's educational level	Illiterate	3(1.47)	0 (0.00)	0.618	0.961
	Primary school	23(11.27)	5 (14.70)
	Middle school	120(58.82)	19 (55.88)
	High school	45(22.06)	8 (23.53)
	University and above	13(6.37)	2 (5.88)
Mother's educational level	Illiterate	2(0.98)	0 (0.00)	0.449	0.978
	Primary school	29(14.22)	5 (14.71)
	Middle school	143(70.1)	24 (70.59)
	High school	19(9.31)	3 (8.82)
	University and above	11(5.39)	2 (5.88)
Family atmosphere	Harmonious	146(71.57)	23 (67.65)	0.224	0.894
	Average	42(20.59)	8 (23.53)
	Unharmonious	16(7.84)	3 (8.82)
Regularity of life	Regular	73(35.78)	12 (35.29)	0.038	0.981
	Occasionally disrupted	115(56.37)	19 (55.88)
	Irregular	16(7.84)	3 (8.82)
Why did you choose nursing as your major?	Recommended by parents or relatives	83(40.69)	14 (41.18)	0.003	0.957
	Personal choice	121(59.31)	20 (58.82)

Pearson correlations analysis

The correlation analysis revealed a significant positive association between nursing students’ PI and FSC at each time point (T1-T5). All correlation coefficients were statistically significant (P < 0.05). For details, see the Fig. 2.

Fig. 2.

Correlation visualization heatmap

Reliability and validity analysis

Confirmatory factor analysis (CFA) and internal consistency reliability analysis were conducted for both the PIQNS and FSCQ scales at each of the five measurement waves (T1-T5). Both scales demonstrated acceptable to good model fit across all measurement phases. Both scales demonstrated acceptable to good model fit across all measurement phases, with CFI ranging from 0.932 to 0.954 and RMSEA ranging from 0.042 to 0.052. Internal consistency reliability was good for both scales, with Cronbach’s α coefficients ranging from 0.800 to 0.851 for PIQNS and 0.770 to 0.812 for FSCQ across the five time points. Detailed fit indices and reliability coefficients for each measurement wave are presented in Table 2.

Table 2.

Internal consistency and confirmatory factor analysis of the PIQNS and FSCQ at each measurement wave

Time Point	Scale	x2/df	CFI	TLI	RMSEA(95%CI)	SRMR	Average Factor Loading	AVE	Cronbach’s α
T1	PIQNS	1.448	0.937	0.925	0.047(0.035~0.059)	0.042	0.68	0.52	0.813
	FSCQ	1.528	0.951	0.938	0.051(0.039~0.063)	0.038	0.71	0.55	0.782
T2	PIQNS	1.411	0.940	0.930	0.045(0.033~0.057)	0.041	0.70	0.53	0.833
	FSCQ	1.508	0.948	0.934	0.050(0.038~0.062)	0.044	0.72	0.56	0.794
T3	PIQNS	1.375	0.933	0.921	0.043(0.031~0.055)	0.039	0.72	0.54	0.851
	FSCQ	1.549	0.943	0.929	0.052(0.040~0.064)	0.043	0.69	0.53	0.778
T4	PIQNS	1.487	0.932	0.920	0.049(0.037~0.061)	0.046	0.67	0.51	0.800
	FSCQ	1.468	0.954	0.943	0.048(0.036~0.060)	0.036	0.73	0.57	0.812
T5	PIQNS	1.393	0.939	0.928	0.044(0.032~0.056)	0.042	0.71	0.54	0.822
	FSCQ	1.508	0.946	0.932	0.050(0.039~0.063)	0.039	0.70	0.54	0.770

Differential analysis

The results of the box plot combined with the violin plot analysis revealed that the occupational identity scores of nursing university students at five time points (T1: enrollment, T2: end of freshman year, T3: end of sophomore year, T4: end of junior year before internship, T5: end of internship) exhibited an inverted “U” shape distribution with differences across various time points (F = 75.67, P<0.001=0.79). The mean occupational identity score was highest at T3, indicating that nursing students’ occupational identity was strongest at the end of sophomore year. No significant differences were found among T1, T2, and T4, suggesting relatively stable levels of occupational identity during these periods. The lowest mean score occurred at T5, suggesting a decline in occupational identity following the internship.

The FSC of nursing students across five distinct time points (T1-T5) exhibited a “U”-shaped distribution with differences across various time points (F = 112.11, P<0.001,=0.302). At T1, the initial enrollment phase, the mean FSC score was highest, indicating the most positive perception of FSC among nursing students. Conversely, at T3, marking the end of the sophomore year, the mean score was at its nadir, significantly lower than at other time points, suggesting a diminished perception of FSC at this stage. No significant differences were observed between T2, the end of the freshman year, and T4, before the end of the junior year, indicating a consistent level of perceived FSC between these two periods. At T5, following the internship, the mean score rebounded to a level comparable to T1, albeit significantly higher than at T2, T3, and T4, indicating a substantial improvement in the perception of FSC post-internship, nearly aligning with the levels observed at enrollment. For detailed information, refer to Table 3 and Fig. 3.

Table 3.

Scores of various variables at different time points (N=204)

Variables	T1	T2	T3	T4	T5	F	P	np2
FSC	41.86±5.81a	35.86±4.19c	30.12±3.65d	35.35±4.43c	38.99±4.78b	975.67	＜0.001	0.79
PI	53.11±8.53b	54.75±7.54b	58.41±7.67a	54.32±6.86b	50.95±6.63c	112.11	＜0.001	0.302

PI Professional identity, FSC Future Self-Continuity

Same letters indicate nonsignificant differences between time points; letters are arranged in descending order according to mean values

Fig. 3.

Box Plot of PI and FSC. Notes: Same letters indicate nonsignificant differences between time points; letters are arranged in descending order according to mean values

Cross-lagged panel model analysis

Analyze the longitudinal relationship between career identity and FSC of nursing college students using a cross-lagged model. After controlling for confounding factors such as age, gender, place of origin, psychological resilience, and whether they are only children, the model fits well, with fit indices of χ²=158.42, df = 85, CFI = 0.927, TLI = 0.931, SRMR = 0.051, and RMSEA = 0.039 (95% CI: 0.028 ~ 0.049). Fig. 4 is the cross-lagged model diagram.

Fig. 4.

Cross-lagged panel model. Notes: Solid paths are significant (P<0.05); dashed are not. Coefficients are standardized

The cross-lag model path showed that in the T1→T2 stages, the PI had no significant predictive effect on FSC (β = 0.056, P = 0.438), and the prediction of PI by FSC was also not significant (β = 0.120, P = 0.110), indicating that the new nursing students were still in the initial exploration of PI and FSC at the time of enrollment, which was still unstable and difficult to form a predictive relationship. In T2→T3 stages, PI significantly positively predicted FSC (β = 0.212, P < 0.001), but FSC did not predict PI significantly (β = 0.062, P = 0.223), indicating that the career identity of nursing college students was deepened through the course study of the first year of college, and a high degree of PI would promote the continuity of students’ active construction of future careers. In T3→T4 stages, PI had a significant positive prediction for FSC (β = 0.224, P = 0.002), while FSC had no significant prediction of PI (β = 0.068, P = 0.157), indicating that from the end of the second year of college to the time before the internship, students’ PI was further deepened, and identifying with the nursing profession further strengthened students’ continuity of future careers, but the prediction of FSC on PI was still limited(H2 was supported). In T4→T5, FSC could significantly and positively predict PI (β = 0.167, P < 0.001), while PI did not predict FSC significantly (β = 0.131, P = 0.082), indicating that the self-continuity of students as nurses in the future could be strengthened through an internship, and their sense of identity with the nursing profession could be enhanced. However, after the internship, the student’s PI did not significantly predict FSC (H3 was supported). In the autoregressive path, the autoregressive coefficients for PI and FSC were significant at each time point (P < 0.001), indicating that occupational identity and FSC were temporally stable and that the early level could predict later changes (H1 was supported).

Discussion

This study investigates the longitudinal relationship between PI and FSC among nursing students through a novel theoretical lens. The empirical results of this study provided full support for all three proposed hypotheses (H1, H2, and H3). This study presents the results of a repeated-measures ANOVA, using box plots and violin plots, from which we observed changes in the two variables. By employing a cross-lagged panel model, we elucidated their bidirectional temporal relationships, thereby advancing the theoretical understanding of their dynamic interplay. Our findings not only delineate the unique developmental characteristics of PI and FSC among nursing students but also identify their predictive pathways. These results provide empirically-based recommendations for strengthening the formation of PI and future career positioning among nursing students.

Longitudinal trajectories and developmental characteristics

The PI of nursing college students was distributed in an inverted “U” shape and showed differences across various time points. This result is consistent with the dynamic development of PI [32]. In the T1 to T3 stages, PI showed an upward trend, with the highest average PI score at T3. This may be because, from T1 to T3, students’ learning transitioned from medical to nursing basic courses, helping them build a preliminary understanding of the nursing profession. As their studies deepened, their mastery of professional knowledge gradually improved, and students felt their growth in the professional field [25]. They were better able to align their personal ideals with the development of the nursing profession, actively exploring the intrinsic value of nursing [33], thereby continuously increasing their professional identity, which peaked at the T3 time point. Furthermore, according to James Marcia’s identity status theory, the establishment of identity depends on two core dimensions: exploration and commitment [34]. Identity formation is a dynamic, cyclical process that involves “deferral-achievement-re-deferral-re-achievement” known as the MAMA cycle. At the T3 time point, nursing students are transitioning from “exploration” to “commitment,” moving from the “deferral phase” into the “achievement phase” of identity development. Through specialized coursework, students develop a clear psychological investment after examining professional values. This self-awareness, driven by endogenous motivation, propels PI to a peak in phases. From T3 to T5, PI tends to decline, and the average PI score is the lowest at T5, which may be related to academic and internship pressure. From the perspective of identity status theory, this stage represents an individual’s regression from an initial “achievement " back into a “deferral,” or even triggering an “identity crisis.” During the T3 to T4 period, students begin to be exposed to the core curriculum of the nursing profession and need to master complex clinical operation skills, which significantly increases the difficulty of learning, and the high intensity of learning pressure leads to students’ fatigue and anxiety, thus weakening the positive feelings towards the nursing profession [35, 36]. At the same time, during the third year of college, students begin to face employment pressure. They may still feel confused about the specific direction of their future careers, worrying about whether they will be able to find a job after graduation. This ambiguity in career goals and uncertainty about the future will further reduce career identity [37]. From T4 to T5, students enter clinical placement, facing a high workload, complex doctor-patient relationships, and a gap between career aspirations and reality, which weakens their sense of identity with the nursing profession. This “Reality Shock” triggered the second “delay phase” in the career identity “MAMA cycle”. This is confirmed by Wu’s research [38], which shows that stressors such as fear of error, interpersonal conflict, and the gap between theory and practice can undermine nursing students’ professional identity. As seen in our research, the stress from academic curricula and clinical practice can weaken students’ professional identity, which emphasizes the need to optimize course settings, strengthen career guidance and psychological support systems for students during their junior year, improve internship guidance and feedback mechanisms, and focus on students’ mental health to help them better cope with stress and enhance their professional identity.

FSC was distributed in a U-shape, with significant differences across time points. There was a downward trend from T1 to T3, with the highest at T1 and the lowest at T3. The reason for this may be that the new students are in the idealistic stage of their careers at the beginning of their enrollment [21], and they have a clear goal orientation for the future, leading them to feel a high level of future self-continuity [39]. However, in first- and second-year (T1→T3) college courses, students begin to face pressure to perform academically and uncertainty about their future career development. At this stage, students not only have to cope with the study of professional courses but also consider future internships, employment, and other opportunities. This multifaceted pressure can leave students feeling lost about their future career development, which can affect their self-perception and perception of continuity [40]. This suggests that we should pay attention to students’ professional psychological development from enrollment through the end of the second year of university, and provide timely career guidance and psychological support to help them better adapt to professional learning and career planning, thereby enhancing their future self-continuity. It is worth noting that T3, as the tipping point of this downward trend, marks a turning point in the future development of self-continuity. After stress adaptation and cognitive adjustment in the first two years of college, the environment and self-esteem of students’ professional learning and career exploration have changed significantly when they enter the third year, laying the basic conditions for the subsequent recovery of FSC. From T3 to T5, FSC is on the rise, which may be related to students having completed most of the core courses in their majors during their third year of college and having accumulated more solid nursing knowledge and skills [41]. This accumulation of professional knowledge gives them a clearer understanding of their professional abilities, strengthens their confidence in their future career development, and thus enhances their future self-continuity [42]. At the same time, during clinical placement, students participate in Patient care and Medical Care teamwork, which enhances their professional competence and instills a sense of professional value, thereby increasing the continuity of students’ future nursing work [43]. This reflects the different impacts of theoretical learning and staged changes in clinical practice on PI and FSC, and provides a time-node basis for the phased implementation of PI and FSC interventions.

The dynamic bidirectional relationship

From T1 to T2, the PI and FSC of nursing students cannot predict each other. Analyzing the reason, it may be that at the time of admission, understanding of the nursing profession remains only in an ideal state, students have not been exposed to clinical practice, and their sense of identity with the nursing profession is not sufficient to support the continuity of future career development. This is also supported by a study on nursing education in Norway [44], which highlights the critical role of clinical nursing experience in shaping professional identity. The study found that 93.7% of Advanced Practice Nurse (APN) students and APN practitioners agree that clinical nursing experience is essential for developing nursing competencies and advancing professional identity. Secondly, during the T1 to T2 stages, students come from various places and must address various problems independently, gradually accepting the different personality traits and living habits of their classmates, resulting in role maladaptation for most first-year students [45]. In addition, individuals in late adolescence are still developing their ability to plan for future careers and may focus more on immediate goals than on career development after graduation [46]. This stage may see itself more as a student than as a future nursing professional. This ambiguity of identity may leave them lacking sufficient motivation and a sense of direction when facing career-related problems, which, in turn, affects the formation and development of future self-continuity [47]. Therefore, across the T1 to T2 stages, the PI and FSC of nursing students do not predict each other, reflecting the uncertainty and dynamics of students’ perceptions of the nursing profession and career planning in the early stage of college.

However, in the two time periods T2-T3 and T3-T4, the PI predicts FSC in the same direction. From a theoretical perspective, the unidirectional prediction of PI on FSC before the internship can be explained by the Anticipatory Socialization Theory(AST). This theory posits that, before formally entering a professional group, individuals undergo psychological “role rehearsal” by internalizing the group’s values, behavioral norms, and role requirements [48]. The underlying reason may be that, after two years of specialized knowledge and skill training, students develop a clearer, more stable understanding of the complexity and necessity of nursing work. This internalized professional identity fosters a more positive outlook on their future career development in nursing, prompting them to proactively construct FSC based on this blueprint [49]. A meta-analysis also found that sophomores and juniors have a deep integration and match with the nursing profession [50], and through targeted professional knowledge learning and skill reserves, they can meet the needs of workplace adaptation and sustainability after entering the workforce. At the same time, at this stage, students gradually mature psychologically, can better cope with academic and career pressure, and improve their psychological adaptability, so that they have more positive expectations for future career development and enhance their future self-continuity [51]. Secondly, through the nursing skills training courses offered by the school, students can experience nursing work in simulated situations. They gradually master a variety of nursing skills, ranging from unfamiliar to proficient, which increases their sense of accomplishment and further enhances their confidence and recognition of the nursing profession [52, 53]. These hands-on experiences enable students to gain a clearer understanding of their roles and responsibilities as future nurses, contributing to the formation of the FSC. This suggests that schools should organize activities such as hospital visits and nurse career interviews at an early stage to help students establish PI as early as possible. At the same time, schools should optimize the design of training courses, enhance students’ adaptability to the curriculum, promote students’ positive self-awareness, and strengthen the construction of FSC.

From T4 to T5, FSC has a significant positive predictive effect on PI, whereas PI has no significant predictive effect on FSC. This finding contrasts sharply with the relationship between the two during the pre-internship period, suggesting that the internship experience may have reconstructed the dynamic relationship between the student’s PI and FSC. The reason for this may be that during the internship, students gain in-depth experience in clinical practice, receive positive feedback on nurse-patient care, nursing teamwork, and patient recovery and discharge, and experience the value of the nursing profession. strengthens the self-continuity of becoming a nurse in the future, which further enhances the PI [54]. Huang’s research [55] found that clinical reflection can foster personal insight, provide new perspectives on patient interactions, provide valuable insights into nursing work, reinforce professional values when integrated with clinical practice, and may contribute to the development of professional identity. This is consistent with the results of this study, which show that clinical practice experience during the internship enhances perceptions of professional value through positive feedback, which in turn improves PI. During the internship, students can be exposed to different areas of the nursing profession, and through internships in different departments and exchanges with teachers, students can have a clearer understanding of their interests and career directions, as well as the development path and promotion opportunities of the nursing profession, to clarify their future career goals and further improve their career planning, and improve their future self-continuity, which will help strengthen their professional identity [56, 57]. The predictive effect of student PI on FSC after internship was not significant. This may be due to fluctuations in PI among some students during the internship period, amid high-intensity nursing work and complex doctor-patient relationships, and it is difficult for the original PI based on the school period to continue to sustainably support theort the construction of FSC [32]. Moreover, the internship period is a transition period from student status to professional identity, which requires students to adapt psychologically, gradually adjust their professional mentality, and adapt to the new working environment and work requirements, and the challenge of this psychological adaptation may weaken the predictive effect of professional identity on future self-continuity [58]. This emphasizes that we should pay special attention to the psychological support of students during their internships, with regular professional psychological counseling, to help nursing students build a stable PI and provide motivation for the sustainable development of their nursing career in the future.

Implications for nursing education and management

This study reveals the dynamic trajectories of PI and FSC among undergraduate nursing students over time, along with their complex bidirectional predictive relationship. These findings not only deepen our understanding of the psychological evolution logic in the occupational socialization of undergraduate nursing students but also provide empirical evidence for constructing a precise, phased teaching intervention system. Based on the developmental logic of Occupational Socialization Theory, the intervention focus during the Anticipatory Stage (T1-T2) should center on role initiation and constructing realistic career expectations, as PI and FSC do not yet significantly predict each other. Educators can implement structured mentorship programs pairing new students with clinical experts or outstanding senior students to provide tangible role models [59] simultaneously organizing early clinical observation and experiential activities to help students develop objective career awareness before intensive skill training, thereby preventing the “reality shock” caused by the disconnect between idealized and actual expectations [60]. Secondly, during the Formal Stage (T2-T4), where PI significantly and positively predicts FSC, the priority should be maintaining professional identity and fostering continuity of the future self. Highly realistic simulation training allows students to gain practical experience in safe, authentic settings, enhancing professional efficacy [59]. Narrative learning activities can enrich students’ identity narratives as “future nurses,” strengthening the psychological reality of their professional selves [61]. Additionally, schools should offer personalized career planning services to help students deeply integrate personal interests with industry development paths, solidifying career identity [59]. Entering the Informal-Internalization Stage (T4-T5), the FSC becomes a critical resource for stabilizing the PI, necessitating a shift in intervention focus to systematically strengthen students’ connection to their future professional selves. Clinical preceptors should regularly organize structured reflection sessions to guide interns in constructively reconciling idealized expectations with professional realities. Concurrently, growth-oriented positive feedback mechanisms should be established, explicitly acknowledging interns’ contributions to reinforce perceptions of professional value [62]. Second, to address the significantly increased stress at this stage, hospitals and schools must provide accessible psychological support and resilience training. This buffers the erosion of professional identity by the real-world environment, ultimately enabling the successful internalization of professional identity [59, 63]. The profound significance of this phased, process-oriented intervention extends beyond optimizing educational outcomes within academic settings. It empowers individuals for long-term career development, thereby providing a core driving force for the stability and sustainable growth of the nursing workforce.

Limitations

This study has several limitations. Firstly, while the sample was recruited from multiple nursing schools across Zhejiang Province, the convenience sampling method and geographic limitation to a single province remain methodological constraints. This non-probability approach may limit the representativeness and generalizability of the findings to nursing student populations in other regions of China with different educational systems, healthcare contexts, or sociocultural environments. Future research should employ probability sampling methods across multiple provinces to enhance external validity. Secondly, concerning methodological constraints, the assessment relied solely on self-reported questionnaires, which may introduce recall or social desirability bias. Additionally, this study did not conduct rigorous cross-temporal measurement invariance testing. Although the measurement instruments demonstrated good internal reliability and construct validity at each time point, future research should employ measurement invariance analysis to more rigorously verify whether the PIQNS and FSCQ possess fully equivalent measurement meanings throughout nursing students’ four-year professional socialization process. Furthermore, while the attrition rate across the five-wave data collection was relatively low (14.28%), changes in unmeasured variables over the four years may have introduced confounding effects that could not be fully controlled. Finally, regarding research scope and variable interplay, the current cross-lagged model focused on bidirectional relationships without exploring complex mediating mechanisms or external influences, such as clinical mentorship quality. Crucially, this study was confined to the academic phase, thereby limiting the exploration of the long-term value of FSC in nursing career development. Future research should extend beyond graduation to verify whether this construct can effectively predict career retention, job satisfaction, and career adaptability.

Conclusions

This longitudinal study reveals that PI and FSC among undergraduate nursing students exhibit distinct developmental trajectories: PI follows an inverted “U” shape, peaking at the end of the sophomore year and declining post-internship, while FSC shows a “U” shape, bottoming out at the end of the sophomore year and rebounding post-internship. Their predictive relationship is stage-dependent: PI unidirectionally predicts FSC before the internship (T2→T3, T3→T4), whereas FSC significantly predicts PI post-internship (T4→T5). Both constructs demonstrate temporal stability. These findings highlight the need for stage-specific interventions, particularly in clinical internships, to enhance nursing students’ PI.

Abbreviations

PI

Professional Identity

FSC

Future Self-Continuity

PIQNS

Professional Identity Questionnaire for Nurse Students

FSCQ

Future Self-Continuity Questionnaire

SIT

Social Identity Theory

PST

Possible Selves Theory

OST

Occupational Socialization Theory

DOFA

Dynamics of Role Acquisition

AST

Anticipatory Socialization Theory

CFA

Confirmatory Factor Analysis

ANOVA

Analysis of Variance

CFI

Comparative Fit Index

TLI

Tucker-Lewis Index

SRMR

Standardized Root Mean Square Residual

RMSEA

Root Mean Square Error of Approximation

IRB

Institutional Review Board

APN

Advanced Practice Nurse

Authors’ contributions

Conceptualization: [Yu Zhang], [JiaLin Lv]. Data curation: [Xinyu Yang], [JiaLin Lv], [Jia Mao], [Jiawen Pan], [Shuxin Zhang].Formal analysis: [JiaLin Lv], [Yu Zhang].Investigation: [All]. Methodology: [JiaLin Lv], [Xinyu Yang], [Jia Mao], [Jiawen Pan], [Shuxin Zhang], [Wenqian Weng].Project administration: [LiXiu Zhang].Supervision: [Qing Zhou], [LiXiu Zhang]. Writing-original draft: [Yu Zhang], [JiaLin Lv]. Writing-review & editing: [All].

Funding

Not applicable.

Data availability

The datasets generated and analyzed during this study are not publicly available due to privacy and ethical restrictions, as they contain personally identifiable information of the student participants collected under confidentiality agreements. Data sharing is further constrained by the terms of the institutional ethics approval (Ethics Committee of Huzhou University, approval number: 202212-01). Interested researchers may submit a reasonable request for data access to the corresponding author, subject to institutional review and ethical approval.

Declarations

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Huzhou University (approval number: 202212-01) and conducted in accordance with the Declaration of Helsinki (https://www.wma.net/policies-post/wma-declaration-of-helsinki/). All participants provided written informed consent prior to enrollment, explicitly acknowledging that their decision to participate or withdraw would not affect their academic performance. This article does not contain any studies with animals performed by any of the authors. This study was not formally registered, and the analysis plan was not formally pre-registered.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.