ORIGINAL RESEARCH article
Front. Med.
Sec. Healthcare Professions Education
Key enablers and barriers to ICU nurses' professional identity: A qualitative study
Provisionally accepted
- 1West China Hospital of Sichuan University, Chengdu, China
- 2Guilin University of Electronic Technology, Guilin, China
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Objectives: To explore the key enablers and barriers influencing the professional identity among Intensive Care Unit (ICU) nurses. Methods: This is a qualitative study that employed a purposive sampling approach and was conducted in the intensive care units (excluding pediatric ICUs) of two tertiary hospitals in Chengdu, China. One-on-one, semi-structured in-depth qualitative interviews were conducted with 37 ICU nurses. The Ecological Systems Theory (EST) provided the theoretical framework for this study. Thematic analysis approach was used to analyze the data. Results: We developed four themes to explain the qualitative data: Individual Motivation and Achievement System (IMAS), Team Collaboration and Support System (TCSS), Technology and Societal Support System (TSSS), Sociocultural and Values System (SVS). IMAS highlighted intrinsic motivation, professional competence, and patient satisfaction as key enablers, while lack of research and innovation capabilities, excessive workload, frequent night shifts, and misunderstanding from patients' families constitute major challenges. TCSS reflected the importance of effective teamwork and multilevel support, with improper collaboration identified as a barrier. TSSS emphasizes the dual role of advanced technology and public health emergencies, representing both opportunities and challenges. SVS reflects the beneficial effect of positive social perceptions and cultural values, contrasted with social cognitive biases as obstacles. Conclusion: This study underscores enablers and barriers influencing ICU nurses' professional identity within the EST framework. Professional competence and a sense of irreplaceability enhance intrinsic motivation, whereas excessive workload and promotion pressure undermine stability. Interprofessional collaboration and multilevel support reduce burnout, while technological advances both improve efficiency and increase skill-related anxiety. Interventions such as optimizing workload and work environment, providing professional development, improving performance evaluation, and implementing hospital policies and broader healthcare reforms in China may strengthen professional identity, improve job satisfaction, and support the sustainable development of ICU nursing practice.
Keywords: Intensive care unit (ICU), ICU nurses, Ecological Systems Theory, professional identity, multidimensional framework, qualitative research
Received: 30 Aug 2025; Accepted: 04 Nov 2025.
Copyright: © 2025 Tang, Yang, Wang, Zou and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yixiu Liu, 753537003@qq.com
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