Typologies of professional identity among graduating baccalaureate-prepared nurses.

Key wordsNursing education, professional identity, patient safety, quality and safety education for nursesAbstractPurpose: The purpose of this study was to identify patterns of professional identity arising from the Quality and Safety Education for Nurses (QSEN) attitudes among students completing their prelicensure education.Design: This mixed-method study used a modified Q-methodology design with a purposeful sample of 36 baccalaureate students graduating from three campuses of a large Midwestern university. Data were collected near the end of the spring semester of 2013.Methods: Participants rank-ordered their agreement or disagreement with a set of subjective statements reflecting the 46 QSEN attitudes. Data were analyzed using a standard three-step approach that included generating a correlation matrix, completing factor analysis followed by varimax rotation, and calculating the factor scores.Findings: Twenty statements represented consensus among the participants, and there was strong agreement that patient safety was both an individual and a team effort. Three professional identity typologies emerged: champions, collaborators, and individualists.Conclusions: Evidence was found that these students internalized the QSEN attitudes to varying degrees, but more work may be needed to internalize all attitudes, especially those related to patient-centered care. Future research is needed to evaluate how students with different perspectives transition to practice and to explore other factors that comprise professional identity.Clinical Relevance: This study expands on what is known about patterns of professional identity among nurses and helps provide a beginning framework for understanding the values new graduates bring to practice.A nurse's professional identity is thought to create the foundation for promoting the ideals of the profession and thus serves as a key factor in providing quality care that improves patient outcomes (Benner, Sutphen, Leonard, & Day, 2010; National League for Nursing, 2010). Though few dispute the importance of such an identity, what constitutes this phenomenon and how it is constructed is poorly understood (Johnson, Cowin, Wilson, & Young, 2012).Literature Review and Theoretical BackgroundProfessional Identity and Quality and Safety Education for NursesEnsuring safe care is a fundamental value and ethical responsibility of the nursing profession (International Council of Nurses, 2000). Growing recognition that adverse events are a significant cause of morbidity and mortality has given rise to global efforts to improve patient safety (Donaldson & Fletcher 2006; Institute of Medicine [IOM], 1999; Richardson & Storr, 2010). Within the United States, the Quality and Safety Education for Nurses (QSEN) project represents a national effort to redesign nursing education around knowledge, skills, and attitudes increasingly necessary to protect patient safety and improve care (Cronenwett et al., 2007). Developed with funding from the Robert Wood Johnson Foundation and building on the IOM (2003) report that found clinical education had not kept up with changing healthcare systems and patient populations, QSEN created a new paradigm for nursing education. In order to practice safely and effectively, QSEN posits that the foundations of a nurse's professional identity should be grounded in six competency areas: (a) quality improvement (QI); (b) safety; (c) patient-centered care; (d) informatics; (e) evidence-based practice (EBP); and (f) teamwork and collaboration.Though experts suggest that QSEN should serve as the foundation of a nurse's professional identity and employers are beginning to look for the QSEN competencies in new hires (Falls & Hensel, 2012), very little is known about if or how the QSEN attitudes are collectively internalized to form this identity. Individual characteristics may play a role in how students integrate these attitudes. …