Social Support and Career Adaptability Shape Nursing Interns’ Professional Identity
Professional identity during clinical training is not a soft measure of morale; it is a working determinant of whether future nurses see themselves as part of the profession they are preparing to enter. In this preprint, investigators examined how social support, perceived stress, psychological resilience, and career adaptability intersected with professional identity among nursing interns in a tertiary hospital setting. The cohort matters because internship is the point at which classroom commitment collides with ward pressure, role ambiguity, and daily patient care responsibilities.
The study included 407 nursing interns from a tertiary hospital in Quanzhou, enrolled through convenience sampling between May and July 2025. Participants completed a general information questionnaire along with validated scales for social support, perceived stress, psychological resilience, professional identity, career adaptability, and intention to remain employed as nurses. Statistical analysis relied on descriptive methods, group comparisons, correlation testing, multiple linear regression, and mediation analysis using PROCESS.
The overall professional identity score was 61.74 ± 11.08, and 73.5% of interns fell into the moderate range. In practical terms, most interns were not disengaged, but neither were they firmly anchored in a durable professional self-concept. The score distribution suggests a cohort sitting in a transitional zone: motivated enough to stay in training, yet vulnerable to erosion if the clinical environment repeatedly undermines confidence, belonging, or perceived competence.
Career Adaptability Emerged as the Strongest Psychological Link
The clearest signal in the dataset came from career adaptability. Professional identity was positively correlated with career adaptability at r = 0.609, a stronger association than the one observed for social support or psychological resilience. Social support also tracked positively with professional identity at r = 0.474, while psychological resilience showed a smaller but still meaningful correlation at r = 0.389. Perceived stress moved in the opposite direction, with a negative correlation of r = -0.378.
Those directions are clinically intuitive. Interns who can anticipate, adjust to, and actively manage changing work demands are more likely to internalize the role of nurse as a viable long-term identity. Adaptability likely functions as the bridge between external encouragement and internal commitment: when support from family, supervisors, and peers is converted into coping capacity, the profession feels less threatening and more inhabitable. Stress works against that process by narrowing attention, increasing emotional exhaustion, and making the role feel like a sequence of demands rather than a developing vocation.
A single variable can carry disproportionate weight in a transitional workforce.
Social Support Worked Directly and Indirectly on Identity
Multiple linear regression placed social support and career adaptability among the positive predictors of professional identity. Career adaptability carried a standardized coefficient of β = 0.309, while social support showed β = 0.383, both with p < 0.001. The model explained 49.2% of the variance in professional identity, a substantial share for a behavioral and educational dataset.
The mediation analysis sharpened the story. Career adaptability partially mediated the relationship between social support and professional identity, with an indirect effect value of 0.288 and a 95% confidence interval of 0.221 to 0.363. That indirect pathway accounted for 40.2% of the total effect. In other words, support does not merely reassure nursing interns; it appears to help build the adaptive skills that allow them to claim the professional role more confidently.
This finding has immediate institutional relevance. If support only arrives as encouragement without practical scaffolding, the effect may remain incomplete. Mentorship, structured feedback, and workplace belonging likely matter because they translate social affirmation into behavioral competence. The mechanism is straightforward: support reduces uncertainty, adaptability improves coping with uncertainty, and identity consolidates when repeated coping experiences reinforce the sense of “I can do this work.”
Family Attitudes and Career Intentions Mapped to Identity Scores
Several background factors separated interns with stronger and weaker professional identity. Parents’ attitude toward nursing, reasons for choosing the profession, personal attitude toward the major, and employment intention were all associated with significant differences in professional identity scores. These are not trivial demographic details. They reveal how identity formation begins well before clinical placement and continues to be shaped by family expectations, original motivations, and the future the student imagines for themselves.
The regression model also identified reasons for choosing the profession and employment intention as significant negative predictors, with β = -3.603 and β = -7.116, respectively. The direction of these coefficients should be interpreted within the study’s coding structure, which was not fully detailed in the abstract, but the broader message remains clear: the pathway into nursing and the intention to remain employed are entwined with how interns evaluate their role. When the choice of major is driven by factors that do not foster lasting identification, professional commitment may stay fragile.
What Nursing Schools and Hospitals Can Change Now
The most actionable implication is that professional identity is not fixed at entry and is not solely determined by academic aptitude. It is malleable during internship, when social support systems and adaptive skills can still be strengthened. Hospitals and training programs can focus on supervision that is consistent rather than punitive, peer environments that reduce isolation, and mentoring that helps interns interpret setbacks as part of skill acquisition rather than proof of inadequacy.
Psychological resilience still matters, but this preprint places it behind social support and career adaptability in the observed network of associations. That hierarchy is useful. It suggests institutions should not limit interventions to individual coping lectures or generic wellness messaging. Training environments need to actively shape the conditions in which resilience becomes usable and identity can mature.
Limits of a Cross-Sectional Preprint
The data come from a single tertiary hospital and rely on a cross-sectional design, which limits causal inference. The sample was drawn through convenience sampling, so the findings may not generalize to nursing interns in other regions, institutions, or educational systems. The study also depends on self-reported measures, which leaves room for response bias and shared-method inflation.
Even with those constraints, the signal is coherent: professional identity rises with social support and career adaptability, and it falls as perceived stress climbs. The unanswered practical question is how best to build those supports into clinical training at scale, and whether the same mediation pattern holds across different hospitals, cultures, and stages of internship.