Key enablers and barriers to ICU nurses' professional identity: a qualitative study

To explore the key enablers and barriers influencing the professional identity among Intensive Care Unit (ICU) nurses.

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.

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.

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.