Abstract
Purpose:
To investigate the changing tendency and influencing factors of the professional identity of male nursing students in 3-year colleges and junior male nurses in China.
Background:
In China, the majority of nurses are 3-year nursing college graduates, among which male nurses are underrepresented. Many male nurses leave the profession 3 or 4 years after graduation. Little is known about the professional identity of Chinese male nursing students in 3-year colleges and junior male nurses.
Methods:
This study included 237 male nursing students from a 3-year college and 33 junior male nurses with less than 3 years of experience in China. By using the data collected with the Professional Identity Questionnaire of Nursing Students and through in-depth semistructured interviews from November 2019 to April 2020, t-test, and ANOVA analysis in SPSS22.0 were conducted and thematic analysis was applied to interviews.
Results:
Compared with undergraduate nursing students, Chinese male nursing students in 3-year colleges had a better professional identity, displaying a declining tendency with grades. Junior male nurses reported the lowest professional identity. Demographic factors such as family residence and presence of relatives in medical service were positively related to professional identity. Low professional identity was related to heavy workload as well as gender stereotypes. Two unique contextual factors influenced the professional identity: (a) curriculum setting and (b) nurse exams.
Conclusion:
College education and initial working experience were critical to professional identity formation for male nurses. Appropriate measures need to be taken to improve professional identity and promote gender diversity.
Keywords: nurse shortage, professional identity, junior male nurses, male nursing students in 3-year colleges, China
Nurse shortage is a problem being experienced around the world. This shortage can be attributed to both fewer individuals seeing nursing as an ideal profession and an increasing number of nurses leaving the profession every year (Yang et al., 2017), among which the newly graduates constitute a high proportion (Jin et al., 2013).
The nursing profession continues to be a female-dominated profession and the percentage of men remains underrepresented. Regardless of the actual figure in individual countries, men in nursing are clearly in a minority (Margaret, 2015). This gender imbalance presents a problem since it ignores diversity which, as O’Lynn (2013) argues, is crucial in the nursing workforce. There has been a steady demand for male nurses (Aynaci & Gulmez, 2019; Younas et al., 2019; Zheng et al., 2018). Some studies indicated significant advantages for men in nursing, including the potential to achieve higher technical skills in intensive care units and operating theatre, rapid decisions, and physical strength compared with female nurses (Gedzyk et al., 2019; Saleh et al., 2019).
By the year 2019, 4.09 million people registered as nurses in China, among those, male nurses only accounted for 2.3% (National Health Commission of China, 2020). Research on male nursing graduates indicated that only 28% males chose to work as a nurse (Wang et al., 2011), and the majority of male nurses leave the profession only 3 to 4 years after graduation (Enberg et al., 2007; MacIntosh, 2003; Li & Wang, 2008).
Prior research argues that low professional identity is contributing to nurses leaving the profession (Öhlén & Segesten, 1998). Professional identity is the professional self or self-concept of nursing that represents how nurses or nursing students perceive the nursing profession (Benner et al., 2010). It is theorized to be a key factor in nurses’ ability to provide high-quality care to improve patient outcomes (Cronenwett et al., 2007; Hensel & Laux, 2014; Jahanbin et al., 2012) and is thought to improve clinical performance (Cowin & Hengstberger-Sims, 2006) and job retention (Cowin et al., 2008; Deppoliti, 2008).
Comparatively, the professional identity level of nurses is significantly lower than those of other jobs and the identity crisis of male nursing students is particularly apparent (Megginson, 2008). Nursing college and internship are critical periods when professional identity is formed (Cheng et al., 2016; Chu, 2014; Henry & Paul, 1993). Nursing college is where men are likely to experience professional nursing for the first time (Ellis et al., 2006). The learning experience of male nursing students, both in the classroom and in the clinical placement, influences their perceptions toward the nursing profession and their decision to stay in or leave nursing (Yang et al., 2017). An investigation on 100 male nurses demonstrated that the more the years of working experience, the higher the professional identity level (Tao et al., 2016). The professional identity of junior nurses with less than 4 years of working experience is more susceptible to changes (MacIntosh, 2003).
Studies on the professional identity of male nurses and male nursing students in China are far from enough. Less than 20 papers have been retrieved from the Chinese Core Collection and Chinese Social Sciences Citation Index. Extant research in China has carried out studies either on male nurses in large cities or male nursing undergraduate students in 4-year universities, and indicated that professional identity was influenced by personal factors and social factors. Parents’ educational background (Li, 2016; Wang et al., 2019 ;Yun, 2017), family residence (Meng, 2018; Wang et al., 2019; Zhang et al., 2019), number of siblings (Wang et al., 2019; Yao et al., 2016; Yun, 2017; Zhou, 2015), and presence of relatives in medical service (Meng, 2018; Wang et al., 2019; Yun, 2017; Zhang et al., 2019) were major demographic factors positively correlated with professional identity. Gender stereotypes (Li, 2016; Meng, 2018; Wang et. al, 2019; Yun, 2017; Zhang et al., 2019) and heavy workload (Li, 2016; Meng, 2018; Wang et al., 2019; Zhang et al., 2019) were reported to be common negative influencing factors.
According to China Health Statistics (2019), 85.4% of nurses were 3-year nursing college graduates. However, research on male nursing students from 3-year colleges was scant. Prior studies demonstrated the significance of nursing college and internship for professional identity formation, and instability of professional identity of junior male nurses, but little research has been done specifically on these groups of male nursing students and male nurses. This study, by a mixed quantitative and qualitative method, focused on all the male nursing students in a 3-year nursing college in a medium-sized city in China, among which grade 3 students are under internship, and male nurses with less than 3 years of experience in a major hospital in the same city who graduated from the above-mentioned college. This study aims to investigate the changing tendency of the professional identity of male nursing students in 3-year colleges and junior male nurses in hospitals whose professional identity formation is at critical periods, and explore the influencing factors of the professional identity of these particular groups, thereby serving as a reference for relevant authorities to roll out measures to provide individualized training and guidance, in order to maintain the stability of male nursing staff. Studying the professional identity of male nursing students and male nurses in China may also provide valuable insights into the training and retention of male nurses in other countries.
Methods
Design and Participants
A nonexperimental, quantitative, and qualitative design was used for this study. A convenience sample of the male nursing students and male nurses within the same nursing college and health system was utilized. Participant recruitment began via QQ, a social media platform in China, with a brief description of the study, all necessary study disclosures, and a direct link to Professional Identity Questionnaire of Nursing Students (PIQNS) in Wenjuanxing, an online survey application, after receiving approval from both the college and the health system’s review boards. We also conducted semistructured interviews.
The study was performed among all the 240 male nursing students from grades 1 to 3 in Anhui Medical College in Hefei, China, among which the third-year students are under internship. This college was chosen because it is the only 3-year college with a nursing major in the city. In addition, 33 male nursing graduates from Anhui Medical College with less than 3 years of experience were also included in the study, who worked in the Hospital Affiliated to University of Science and Technology of China, a top-three hospital in the city. The hospital was selected because of the presence of a larger number of male nurses who have graduated from Anhui Medical College. Approval for this study was obtained from Anhui Medical College (Decision no: 2019. 21.10) and Hospital Affiliated to University of Science and Technology of China (Decision no: 2019. 23.10), respectively. Written informed consents were obtained from all the participants.
Instruments
Professional Identity Questionnaire of Nursing Students (PIQNS), a well-received measurement tool that has been used in prior studies in China, was used in this study. It was developed by Doctor Yufang Hao in 2011 with satisfactory credibility. Reliability coefficient of the total scale is 0.926, and the reliability coefficients of all the subscales are larger than 0.7 (Hao, 2011). Previous studies indicated that the PIQNS test was recommended to evaluate the professional identity level of nursing students in China (Cheng et al., 2016; Chu, 2014; Gu and Tang, 2017; Liu, 2014; Zhang et al., 2019).
PIQNS includes two sections: (a) basic information, covering which grade (or at work), single child or not, family residence, parents’ educational background, reasons for choosing nursing major, the overall impression of the nursing profession, etc.; and (b) 16 items for professional identity, falling into career choice motive, career perception, emotion identity, career benefit and satisfaction, and career planning. The 16 items are ranked on a five-point Likert scale of which 1 is negatively stated (with 1 = strongly disagree to 5 = strongly agree). The higher the score, the more positive the professional identity.
A semistructured interview was also conducted with willing participants for qualitative data collection. The following questions were included: (a) Why did you choose nursing profession?; (b) What do you think of nursing profession?; (c) What are the things that you dislike about being a male nurse?; and (d) What courses or measures help you change your perception of nursing profession?
Data Collection
The data were collected from November 2019 to April 2020. Prior to data collection, complete study information and informed consent were provided to all the participants. The interviewer reminded the participants of their right of withdrawal during data collection. The link of PIQNS was sent to all the participants via QQ, a social media platform in China. Of the 240 male nursing students invited to participate, 227 male students (102 grade 1 students, 69 grade 2 students, and 56 interns were at grade 3) responded to the survey. Questionnaire-reclaiming efficiency was 93.9%. All 33 male nurses responded to the survey.
On scale completion, participants were invited to participate in a 30-min semistructured interview. The final 20 volunteers (5 male nurses and 15 male nursing students) were interviewed through QQ. All the interviews were recorded upon these interviewees’ approval.
Data Analysis
Descriptive statistics, t-test, and analysis of variance (ANOVA) were used for the quantitative data analysis in SPSS 22.0. The total professional identity scores were calculated by recoding items under each scale and then summing the scores. The qualitative data of the semistructured interview were analyzed using thematic analysis: data transcription, initial coding, theme search, theme review, and theme defining (Braun & Clarke, 2006).
Results
Quantitative Findings
Approximately 60% of male nursing students and males nurses were from rural area. Only 27.6% chose nursing major out of personal interest. Most of the respondents had relatives in medical service, with 77.31% reckoning that males have strengths over female counterparts. However, 40.77% were reluctant to admit they were male nurses in front of new friends. Only 10.2% gave a definite answer to whether to remain in the nursing profession.
Professional identity of 237 male nursing students in 3-year colleges and 33 junior male nurses with less than 3 years of experience scored (83.22 ± 12.68). It revealed that male nurses’ professional identity was above average, and career perception and career choice motive ranked high, whereas career benefit and satisfaction ranked the lowest (Tables 1 and 2).
Table 1.
Total Professional Identity of Male Nursing Students and Male Nurses.
| Items | Total Mean Value | No. of Items | Item Mean Value |
|---|---|---|---|
| Career choice motive | 21.66 ± 3.36 | 3 | 3.61 ± 0.47 |
| Career perception | 15.48 ± 3.36 | 2 | 3.87 ± 0.76 |
| Emotion identity | 20.75 ± 3.25 | 4 | 4.15 ± 0.59 |
| Satisfaction | 14.12 ± 2.80 | 4 | 3.53 ± 0.67 |
| Career planning | 13.52 ± 2.80 | 3 | 3.38 ± 0.64 |
| Total | 83.22 ± 12.68 | 16 | 3.62 ± 0.49 |
Table 2.
Descriptive Analysis of Quantitative Findings.
| Factors and Items | Mean ± SD |
|---|---|
| F1 Career Choice Motive | |
| My understanding of the career is solely from friends, relatives, teachers, etc. | 3.272 ± 1.158 |
| I have tried to know about different professions in order to firm my belief | 3.426 ± 0.967 |
| External factors are to be considered when choosing a job | 3.296 ± 0.931 |
| F2 Profession Perception | |
| I desire to know stories about successful nursing professionals | 3.389 ± 1.03 |
| I hope to communicate with experienced nursing professionals | 3.721 ± 1.007 |
| F3 Career Emotion Identity | |
| I am willing to be a nurse | 3.564 ± 1.108 |
| I love my major and I am ready to work hard on it | 3.606 ± 0.993 |
| I will feel depressed if I leave the profession | 3.141 ± 1.097 |
| I will be proud of nursing job | 3.535 ± 1.055 |
| F4 Career Benefit and Satisfaction | |
| I can display my strength and ability in nursing | 3.452 ± 1.003 |
| I can use my creativity in nursing | 3.295 ± 0.986 |
| It makes me pleasurable to be a nurse | 3.487 ± 1.004 |
| I am sure I can be successful in nursing profession | 3.585 ± 1.006 |
| F5 Career Planning | |
| I have invested too much money/time in it, so I don’t want to change a job | 3.492 ± 1.083 |
| I will not change my profession | 3.425 ± 0.993 |
| I often plan my future | 3.714 ± 0.967 |
A significant difference was detected between grades (p = .01), and the scores of professional identity decreased. The professional identity of junior male nurses scored the lowest. There was a significant difference concerning emotion identity, professional benefit and satisfaction, and career planning, However, career perception was not statistically different according to grade (p = .198) (Table 3).
Table 3.
Professional Identity of Male Nursing Students and Males Nurses at Different Periods.
| Factors | Grade 1 (N = 102) |
Grade 2 (N = 69) |
Grade 3 (n = 56) |
On the job (n = 33) | p |
|---|---|---|---|---|---|
| Career choice motive | 3.65 ± 0.59 | 3.51 ± 0.62 | 3.65 ± 0.67 | 3.2 ± 0.57 | .000 |
| Career perception | 3.74 ± 0.83 | 3.64 ± 0.96 | 3.54 ± 1.05 | 3.47 ± 0.96 | .198 |
| Emotion identity | 3.56 ± 0.76 | 3.41 ± 0.81 | 3.44 ± 1.01 | 3.27 ± 0.9 | .000 |
| Satisfaction | 3.59 ± 0.77 | 3.42 ± 0.87 | 3.33 ± 0.93 | 3.11 ± 0.8 | .003 |
| Career planning | 3.72 ± 0.74 | 3.58 ± 0.91 | 3.43 ± 0.76 | 3.41 ± 0.7 | .000 |
| Profession identity | 3.65 ± 0.62 | 3.49 ± 0.78 | 3.48 ± 0.75 | 3.28 ± 0.6 | .010 |
No statistically significant difference could be detected when the participants were evaluated according to whether they were the only child in the family. No association was detected for paternal or maternal education. Evaluation according to family residence revealed that male nursing students and male nurses whose families were located in the rural areas had a higher level of professional identity. Comparison according to whether there were any relatives engaging in medical service yielded a significant result. Those who had relatives in medical service tended to have a better professional identity (Table 4).
Table 4.
Comparison of Professional Identity Score of Male Nurses and Male Nursing Students With Different Demographic Features.
| Factors | Category | Number | Career Choice Motive | Career Perception | Emotion Identity | Satisfaction | Career Planning | Profession Identity |
|---|---|---|---|---|---|---|---|---|
| The only child | Yes | 61 | 3.59 ± 0.68 | 3.67 ± 0.95 | 3.39 ± 0.89 | 3.43 ± 0.91 | 3.63 ± 0.85 | 3.52 ± 0.74 |
| No | 199 | 3.53 ± 0.61 | 3.65 ± 0.94 | 3.49 ± 0.86 | 3.46 ± 0.84 | 3.62 ± 0.81 | 3.54 ± 0.7 | |
| t | 0.803 | 0.108 | −0.953 | −0.302 | 0.091 | −0.211 | ||
| p | .422 | .914 | .341 | .763 | .927 | .833 | ||
| Father’s education | Primary school | 96 | 3.54 ± 0.68 | 3.69 ± 0.91 | 3.48 ± 0.82 | 3.47 ± 0.81 | 3.59 ± 0.79 | 3.54 ± 0.65 |
| Middle school | 152 | 3.51 ± 0.63 | 3.66 ± 0.91 | 3.44 ± 0.87 | 3.43 ± 0.86 | 3.61 ± 0.83 | 3.51 ± 0.71 | |
| College or above | 23 | 3.7 ± 0.73 | 3.58 ± 1.17 | 3.53 ± 0.99 | 3.52 ± 0.97 | 3.77 ± 0.87 | 3.61 ± 0.82 | |
| t | 1.572 | 0.241 | 0.257 | 0.232 | 0.821 | 0.383 | ||
| p | .219 | .783 | .771 | .793 | .436 | .681 | ||
| Mother’s education | Primary school | 97 | 3.586 ± 0.63 | 3.63 ± 0.94 | 3.44 ± 0.83 | 3.43 ± 0.79 | 3.61 ± 0.81 | 3.51 ± 0.66 |
| Middle school | 162 | 3.586 ± 0.63 | 3.7 ± 0.92 | 3.48 ± 0.86 | 3.46 ± 0.88 | 3.63 ± 0.82 | 3.55 ± 0.72 | |
| College or above | 12 | 3.47 ± 0.61 | 3.53 ± 1.1 | 3.45 ± 1.09 | 3.55 ± 1.06 | 3.61 ± 0.95 | 3.52 ± 0.89 | |
| t | 0.621 | 0.558 | 0.101 | 0.283 | 0.036 | 0.179 | ||
| p | .536 | .571 | .904 | .754 | .965 | .836 | ||
| Family residence | Rural | 191 | 3.54 ± 0.58 | 3.69 ± 0.85 | 3.53 ± 0.77 | 3.51 ± 0.78 | 3.61 ± 0.75 | 3.63 ± 0.74 |
| City | 69 | 3.42 ± 0.51 | 3.43 ± 0.91 | 3.28 ± 0.74 | 3.28 ± 0.71 | 3.43 ± 0.69 | 3.42 ± 0.65 | |
| t | 2.527 | 2.533 | 2.942 | 2.595 | 1.973 | 2.985 | ||
| p | .011 | .012 | .004 | .011 | .043 | .003 | ||
| Relatives in medical service | Yes | 191 | 3.55 ± 0.64 | 3.72 ± 0.91 | 3.51 ± 0.86 | 3.49 ± 0.84 | 3.64 ± 0.83 | 3.56 ± 0.71 |
| No | 69 | 3.33 ± 0.61 | 3.38 ± 1.02 | 3.29 ± 0.89 | 3.28 ± 0.93 | 3.56 ± 0.81 | 3.39 ± 0.71 | |
| t | 2.244 | 2.778 | 2.84 | 2.874 | 0.679 | 2.781 | ||
| p | .022 | .006 | .000 | .000 | .497 | .000 | ||
| Whether attend off-campus nursing-related activities during holidays | Yes | 190 | 3.55 ± 0.64 | 3.72 ± 0.91 | 3.51 ± 0.86 | 3.49 ± 0.84 | 3.64 ± 0.83 | 3.56 ± 0.71 |
| No | 70 | 3.33 ± 0.61 | 3.38 ± 1.02 | 3.29 ± 0.89 | 3.28 ± 0.93 | 3.56 ± 0.81 | 3.39 ± 0.71 | |
| t | 2.244 | 2.778 | 2.84 | 2.874 | 0.679 | 2.781 | ||
| p | .022 | .006 | .000 | .000 | .497 | .000 | ||
| Whether attend lectures or activities tailored for males at school or in hospital | Yes | 40 | 3.54 ± 0.58 | 3.69 ± 0.85 | 3.53 ± 0.77 | 3.51 ± 0.78 | 3.61 ± 0.75 | 3.63 ± 0.74 |
| No | 220 | 3.42 ± 0.51 | 3.43 ± 0.91 | 3.28 ± 0.74 | 3.28 ± 0.71 | 3.43 ± 0.69 | 3.42 ± 0.65 | |
| t | 2.527 | 2.533 | 2.942 | 2.595 | 1.973 | 2.985 | ||
| p | .011 | .012 | .004 | .011 | .043 | .003 | ||
| Whether attend any courses related to professional identity at school or in hospital | Yes | 202 | 3.49 ± 0.61 | 3.66 ± 0.94 | 3.46 ± 0.95 | 3.48 ± 0.92 | 3.62 ± 0.86 | 3.53 ± 0.76 |
| No | 58 | 3.42 ± 0.63 | 3.53 ± 0.91 | 3.28 ± 0.84 | 3.28 ± 0.83 | 3.44 ± 0.72 | 3.33 ± 0.61 | |
| t | 2.263 | 2.623 | 2.229 | 2.484 | 2.162 | 2.378 | ||
| p | .026 | .000 | .032 | .000 | .041 | .038 |
Statistical difference was identified when the participants were evaluated according to whether they have attended off-campus nursing-related activities during holidays. Association was also detected between professional identity and active involvement in the courses related. Similarly, those who attended lectures or activities tailored for males at schools or in hospitals had a better professional identity. However, there were few tailored lectures or activities for male nursing students or male nurses (Table 4).
Qualitative Findings
Reasons Why Male Nurses Chose the Nursing Profession
As to the motives to choose the nursing profession, 77.8% of respondents indicated that better job opportunity and stability are the primary reasons. For example, one of the male nursing students said:
My first choice was clinical medicine. But I switched to nursing major because I had heard that it was much easier to land a job with a nursing diploma in today’s competitive job market.
Another student stated that:
My aunt is a nurse. She recommended me to work as nurse, because nursing job was stable. (Grade 2 male nursing student)
In addition, male nurses had physical advantages, mental toughness, and fewer family obligations, so they were reported to have more promotion opportunities (Wang & Yu, 2019). All the five male nurses said that they were given more attention and provided with more training opportunities.
Perception of Nursing Profession
Over half of the respondents held negative perceptions toward the nursing profession, pointing out nurses had lower social status and the job was laborious.
For example, one of the first-year students stated that:
I heard that nursing job mainly involved life care and basic nursing. It can be repetitive and boring. It seemed to me that males were not suitable for it. (Grade 2 male nursing student)
Another student said that:
Nurses can only obey doctors’ orders and do as instructed. Nursing job is not considered important on the part of patients, receives little respect and enjoys low social status. I did not want to tell others I am a male nurse. (Grade 3 male nursing student)
Reasons for Disliking the Nursing Major/Profession
Tight curriculum, intense pressure, and irregular working hours were the main reasons. In China, students in 3-year nursing colleges usually attend 40–50 hr of lessons a week and have to pass nationwide nurse exams in the third year to become a registered nurse. Nurses are in serious shortage in China and generally have heavy workloads. In most Chinese hospitals, nurses have to work 40 hr a week (Zhang et al., 2019). Over half of the respondents reported that they had too many courses in school, often worked night shifts, and had little time to spend with girlfriends or family. They experienced intense pressure from study, work, and life. One respondent working in the ICU shared his experiences as follows:
My girlfriend broke up with me last month. As I just started working for the first year, I was really stressful at work, which had negatively influenced my mental health. I lost my temper easily. In addition, due to irregular working hours, I couldn’t had dates as my girlfriend expected because our spare time just couldn’t match.
Furthermore, due to gender stereotypes, male nurses may experience discrimination from the patients, family members, and friends (Wang & Yu, 2019). Most respondents reported that they had been teased and discriminated, and were concerned that the stereotypical images may negatively impact their marriage prospects. One interviewee shared his story as follows:
I just had a girlfriend, but she never told her friends that I was a nurse in gynaecology department because she feared her friends may make fun of me.
Courses or Activities Shaping Professional Identity
Both the male nursing students and male nurses responded that Nursing Ethics, Nursing Etiquette, and Career Planning had effectively changed their perception of the nursing profession. Nursing specialty courses delivered by male teachers were reported to be helpful in shaping their professional identity. Their perception of the nursing profession has also changed through clinical observation, internship, and special activities organized for males, such as lectures, speech contests, or salons. A male nursing student said that:
Almost all our nursing teachers were females, but our college invited a male nurse to teach us surgical nursing this term. I really liked it when he shared his experience in hospital with us. It helped me to see the great potential of being a male nurse. And on May 12, our college organized a lecture on career development for male nursing students. It was also helpful.
One male nurse described:
In fact, only by working in the hospital can you had a better understanding of the job. Our hospital started a salon for male nurses in 2019. We could attend lectures, informal discussions or speech contests every two months. I thought it was a good way to improve male nurses’ job satisfaction and professional identity.
Discussion
This study sought to provide insight on the professional identity of male nursing students in 3-year colleges and junior male nurses with less than 3 years of experience in China. Our findings highlighted four themes.
Professional Identity of Male Nursing Students in the 3-Year Colleges Is Above Average but Declining Along Grades
Professional identity score of male nursing students in 3-year colleges was lower than those of other professions, which was consistent with prior studies (Jin et al., 2013; Tao et al., 2016; Zheng, 2018). Previous research indicated that the higher the educational background, the lower the professional identity in the nursing profession (Cheng et al., 2016; Li & Wang 2008; Zhang et al., 2019). This study also revealed that the professional identity of male nursing students in 3-year colleges was higher than that of undergraduate male nursing students in universities in China. One of the primary reasons was that nurses with a degree aspired to study further and avoid heavy clinical nursing tasks (Zheng, 2018). In addition, nurses with diploma and degree perform the same duties and have similar salaries in most Chinese hospitals with approximately US$50 difference (Zheng, 2018), which may frustrate nursing students with degrees.
Furthermore, different from findings on male nursing students in 4-year universities (Liu et al., 2011; Xu et al., 2013), the professional identity of male nursing students in 3-year college was decreasing with grade. In 3-year nursing colleges in China, students learn theoretical courses at school for the first 2 years and go to hospitals for internship in the third year. Grade 1 students are provided with foundation courses such as anatomy and physiology. Nursing specialty courses are included in the curriculum for grade 2 students, and grade 3 students have internships in hospitals for the whole year. The first-year students had little contact with the nursing profession, and their perception of the nursing profession was somewhat idealistic (Sun et al., 2017; Zhang et al., 2019), so their professional identity tended to be the highest. While the third-year students faced the pressure of internship, job hunting, and nationwide nurse license exam (passing rate was around 40%), they often reported a lower professional identity than grade 1 and 2 students (Sun et al., 2017).
Professional Identity of Junior Male Nurses With Less Than 3 Years Working Experience is the Lowest
This study indicated that the professional identity of new male nurses who work for less than 3 years was much lower than male nursing students. Prior studies (Liu, 2014; Rudman, 2014; Tao et al., 2016) also revealed that the first 3 to 4 years were critical periods when the junior nurses displayed the highest level of pressure and burnout and had the lowest professional identity. In most hospitals in China, the nurses will change departments every 3 to 4 months for clinical rotation during the first year, which can be challenging and stressful (Liu, 2014; Tao et al., 2016). The new nurses are required to participate in nationwide exams (passing rate is around 80%) to acquire senior nurse certificates in the third year. Most respondents described their work as fully occupied and difficult: heavy workload, frequent night shifts, working overtime, discrimination from patients and the general public, and little personal time for socializing or dating.
Family Factors Are Less Important. Practical Concerns Over Job Opportunity and Security Are Primary Positive Factors. Intense Pressure and Gender Stereotypes Are the Key Negative Factors
This study indicated that family factors are less important. Different from previous findings (Gu and Tang, 2017; Wang et al., 2019; Zhou, 2015), the professional identity of male nursing students in 3-year colleges and junior male nurses was not positively correlated with whether they had any siblings or parents’ educational background. However, those who were from rural areas or have relatives in medical service reported higher professional identity.
With China’s increased enrollment of college students and a growing number of graduates flooding the job markets, such practical concerns as employment opportunity, job stability, and career development have become priority considerations when choosing majors. Nursing, ranked Top 10 in terms of employment rate for a successive 5 years in China (Zheng, 2018), therefore, has attracted many students. This is consistent with the findings by Zamanzadeh et al. (2013), Zhou (2015), and Wang and Yu (2019).
The very nature of nursing job and gender stereotypes, including heavy workload, irregular working hours, and bias from patients and the general public, are the primary factors negatively influencing male nurses’ professional identity, which was in line with prior studies (Wang & Yu, 2019; Zhang et al., 2019; Zheng, 2018; Zhou, 2015). Nurses were seriously lacking in China and generally had heavy workloads (Zhang and Tu, 2020). Junior nurses in this study reported that they worked more night shifts, and experienced great stress from work, study, and life. They had little time to socialize or date. In addition, nurses’ perceptions of public stereotyping not only influence the development of self-concept and self-esteem, but this can also subsequently influence job satisfaction and performance (Browne et al., 2018). Due to gender stereotypes, nearly half of respondents were reluctant to admit they were male nurses in front of new friends, and working as a male nurse, especially in departments such as gynecology and obstetrics, negatively influenced their marriage prospects. All these led to low career benefit and satisfaction as demonstrated in Table 1.
Courses or Activities Improving Professional Identity of Male Nurses
As indicated in the investigation, courses, lectures, or activities tailored for males were positively correlated with their professional identity. The semistructured interview revealed that humanity courses closely related to nursing had effectively changed male nursing students’ perception of the nursing profession, including Nursing Ethics, Nursing Etiquette, and Career Planning. Further nursing specialty courses delivered by male nurses were reported to be helpful in shaping male nursing students’ professional identity, which is consistent with previous studies (Jin et al., 2013; Liu, 2014). Special activities organized for males, such as lectures, contests, or salons were also proven to be useful (Gu, 2017).
Conclusion
Through investigations on male nursing students in a 3-year nursing college and male nurses with less than 3-year working experience in hospitals in China, who are at a critical stage of professional identity formation, it has been revealed that family factors such as residence or presence of any relatives in medical service still exert influence on professional identity, but parental education and number of siblings do not impact the professional identity of male nursing students pursuing diploma and male nurses with less than 3 years of experience. Male nursing students in 3-year colleges had a declining professional identity, and junior male nurses with less than 3 years of experience reported the lowest professional identity. Whether the schools or hospitals have organize special activities, courses, and training for males has a positive influence on male nurses’ professional identity formation. Employment opportunity, job security, and career development are chief motives for career choice. Tight curriculum, pressure from nurse exams, irregular working hours, and discrimination from the general public are key factors negatively affecting professional identity.
Implications
In order to improve the professional identity of male nurses and retain more male nurses in the profession, regulatory bodies, hospitals, and nursing education providers are supposed to take joint measures. Regulatory bodies should advocate for the recruitment of more males in educational programs and practice (Younas & Sundus, 2018). It is crucial for hospitals to rationally allocate assignments and shifts. Faculty role models, supportive mentorship systems and continuous training programs are also important for the elevation of the professional identity of male nurses.
It is essential for educational institutions to design individualized curriculum and programs to support the ongoing development of professional identity in nursing students of different genders. Adequate attention should be given to the special needs and characteristics of male nursing students, recruiting more male teachers or inviting male nurses to deliver courses, organizing tailored activities for male students, and arranging earlier exposure to clinics.
Limitations and Future Research
To investigate the unique features and changing tendency of the professional identity of male students pursuing a diploma in nursing and junior male nurses, this study focused on male nursing students in a 3-year nursing college and male nurses who graduated from the college with less than 3 years of working experience. As the college investigated is the only 3-year college with a nursing major in the city, the sample is relatively small and limited. We expect that future research can fill in the gap by studying male nursing students in a more broad range of educational institutions and hospitals.
Based on the findings, it is recommended that more research should be done to nursing students in 3-year colleges and junior nurses who constitute the majority of the workforce and whose professional identity is prone to change. Additional studies among male nurses of these particular groups can be conducted with a larger population. Studies should be done to identify and evaluate strategies to recruit more male students and assist male students to become successful nurses. Male students indicated the need for more male mentors and tailored courses and lectures; therefore, institutions can develop curriculum and mentorship programs accordingly, which is an open area for further research.
Footnotes
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Anhui Ministry of Education [grant number 2020zdxsjg178];Anhui Medical College[grant number 2019ahyzjyxm011]; Anhui Ministry of Education[grant number gxyq2017168]
Ethical Approval Obtained: The study protocol was approved by the ethics review board of Anhui Medical College (Decision no: 2019. 21.10) and Hospital Affiliated to University of Science and Technology of China (Decision no: 2019. 23.10). All of the procedures were performed in accordance with the Declaration of Helsinki and relevant policies in China.
Informed Consent Obtained for Research: All participants provided written informed consent prior to enrolment in the study.
ORCID iD: Yan Chen 
https://orcid.org/0000-0002-4029-4627
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