Impact of Career Readiness Levels on Professional Identity in Nursing

TL;DR

This study shows that higher career readiness in nursing students is linked to stronger professional identity, especially in their sense of social contribution.

Contribution

The study identifies specific correlations between career readiness subscales and professional identity factors in nursing students.

Findings

High career readiness students showed significantly higher professional identity scores across all measured factors.

Career readiness levels were positively correlated with all professional identity factors (p < 0.01).

Life Career Planning was specifically linked to the formation of a professional self-concept.

Abstract

Introduction: In nursing education, career readiness and professional identity are regarded as key factors influencing students’ career development. Previous studies have suggested that their interaction contributes to effective career formation. Therefore, this study examined differences in professional identity between nursing students with high and low levels of career readiness.

Methods: This analytical cross-sectional questionnaire survey was conducted among 329 first- to fourth-year male and female nursing students enrolled in a four-year program at Hirosaki University in Hirosaki, Japan. The Career Readiness Scale-Short Version (CRS-S) and the Professional Identity Scale for Medical University Students were used. A total of 157 valid responses were analyzed (valid response rate: 47.7%). Participants were divided into high- and low-score groups for each subscale of the Career Readiness Scale, and differences in the four professional identity factors were compared between groups using Mann-Whitney U tests, and associations were examined using Spearman’s rank correlation coefficient.

Results: For Occupational Career Concern (OCC), students in the high career readiness group showed significantly higher median scores than those in the low group across all professional identity items, including confidence in choosing a healthcare profession (p < 0.001), establishment of a professional self-concept (p < 0.001), pride in being needed as a healthcare professional (p < 0.01), and orientation toward social contribution (p < 0.01). Overall, career readiness levels were positively correlated with all professional identity factors (p < 0.01). In the low Occupational Career Autonomy (OCA) group, positive correlations were observed for the establishment of a professional self-concept (rs = 0.733, p < 0.01) and confidence in choosing a healthcare profession (rs = 0.543, p < 0.05). Additionally, Life Career Planning (LCP) was positively correlated with the establishment of a professional self-concept (rs = 0.530, p < 0.01).

Conclusions: Nursing students with higher career readiness tended to exhibit a professional identity, particularly in terms of their sense of social contribution as future healthcare professionals. Among students with lower career readiness, associations with professional identity were limited. OCA was linked to pride in choosing the healthcare profession and to the formation of personal views on healthcare, whereas LCP was related only to the formation of personal views on healthcare. These findings suggest that differences in the level of career readiness promote the development of professional identity in nursing education.

Tables

Table 1. Basic attributes of the study group (n=157)*SD: standard deviation

Item		Number of students	Percentage (%; or SD)
Academic year	First-year students	56	35.7
	Second-year students	26	16.6
	Third-year students	26	16.6
	Fourth-year students	49	31.2
Sex	Male	19	12.1
	Female	138	87.9
Mean age (years)	All	19.5	±1.3*
	Male	19.6	±1.5*
	Female	19.5	±1.5*

Table 2. Relationship between occupational Career Readiness Scales-Short Version and professional identity among medical university students (n=157)Values are presented as medians and interquartile ranges. p-values were calculated using the Mann–Whitney U test.n: number of students; F1: Confidence in choosing a healthcare profession; F2: Establishment of one’s own professional view of healthcare work; F3: Pride in being needed as a healthcare professional; F4: Orientation toward social contribution

Subscale items		High-score group (Occupational Career Readiness)			Low-score group (Occupational Career Readiness)			p
		n	Median	25th–75th percentiles	n	Median	25th–75th percentiles
Occupational Career Concern	F1	139	26.0	20.0-30.0	18	18.5	14.0-22.3	p<0.001
	F2		25.0	21.0-30.0		13.0	8.3-20.3	p<0.001
	F3		25.0	20.0-31.0		18.0	9.8-23.5	p<0.01
	F4		32.0	28.0-35.0		27.0	20.5-31.0	p<0.01
Occupational Career Autonomy	F1	142	25.0	20.0-30.0	15	24.0	20.0-29.0	p<0.001
	F2		25.0	18.0-30.0		25.0	22.0-31.0	p<0.001
	F3		24.0	20.0-31.0		25.0	20.0-29.0	0.134
	F4		31.5	27.0-35.0		30.0	25.0-35.0	p<0.05
Occupational Career Planning	F1	106	25.0	19.8-30.0	51	25.0	20.0-30.0	p<0.001
	F2		25.0	18.9-30.0		25.0	19.0-29.0	p<0.001
	F3		25.0	20.0-32.3		23.0	20.0-27.0	p<0.01
	F4		31.5	28.0-35.0		31.0	25.0-35.0	p<0.01

Table 3. Relationship between life Career Readiness Scales-Short Version and professional identity among medical university students (n=157)Values are presented as medians and interquartile ranges. p-values were calculated using the Mann–Whitney U test.n: number of students; F1: Confidence in choosing a healthcare profession; F2: Establishment of one’s own professional view of healthcare work; F3: Pride in being needed as a healthcare professional; F4: Orientation toward social contribution Establishment of one’s own professional view of healthcare work

Subscale items		High-score group (Life Career Readiness)			Low-score group (Life Career Readiness)			p
		n	Median	25th–75th percentiles	n	Median	25th–75th percentiles
Life Career Concern	F1	144	25.0	20.0-30.0	13	23.0	19.5-30.0	p<0.01
	F2		25.0	19.0-30.0		25.0	21.5-32.5	p<0.001
	F3		24.0	20.0-30.5		25.0	18.5-29.0	p<0.05
	F4		31.0	27.0-35.0		30.0	25.0-35.0	p<0.01
Life Career Autonomy	F1	145	25.0	20.0-30.0	12	22.0	19.3-30.5	p<0.001
	F2		25.0	18.5-30.0		26.5	21.8-33.3	p<0.001
	F3		24.0	20.0-30.5		25.0	17.8-30.5	0.130
	F4		32.0	27.0-35.0		30.0	25.0-34.8	p<0.05
Life Career Planning	F1	116	25.0	20.0-30.0	41	25.0	20.0-29.5	p<0.001
	F2		25.0	20.0-30.0		25.0	17.5-30.0	p<0.001
	F3		25.0	20.0-32.0		23.0	18.0-26.5	p<0.01
	F4		32.0	28.0-35.0		31.0	25.0-35.0	p<0.01

Table 4. Correlations between levels of career readiness and professional identity** Correlation coefficients are significant at the 1% level (two-tailed); * Correlation coefficients are significant at the 5% level (two-tailed); Correlation coefficients were calculated using Spearman’s rank correlation.

			Occupational Career Concern	Occupational Career Autonomy	Occupational Career Planning	Life Career Concern	Life Career Autonomy	Life Career Planning
			High-score group n=139	High-score group n=142	High-score group n=106	High-score group n=144	High-score group n=145	High-score group n=116
			Low-score group n=18	Low-score group n=15	Low-score group n=51	Low-score group n=13	Low-score group n=12	Low-score group n=41
			Correlation coefficients	Correlation coefficients	Correlation coefficients	Correlation coefficients	Correlation coefficients	Correlation coefficients
Professional Identity Scale for medical university students	F1: Confidence in choosing a healthcare profession	High-score group	0.327**	0.336**	0.499**	0.456**	0.459**	0.495**
	F2: Establishment of one’s own professional view of healthcare work		0.369**	0.458**	0.545**	0.481**	0.511**	0.451**
	F3: Pride in being needed as a healthcare professional		0.229**	0.234**	0.287**	0.385**	0.309**	0.326**
	F4: Orientation towards social contribution		0.350**	0.396**	0.405**	0.440**	0.470**	0.369**
	F1: Confidence in choosing a healthcare profession	Low-score group	0.214	0.543*	0.159	0.236	0.227	0.239
	F2: Establishment of one’s own professional view of healthcare work		-0.108	0.733**	0.298**	0.218	0.33	0.530**
	F3: Pride in being needed as a healthcare professional		0.109	0.431	0.227	-0.054	-0.047	0.126
	F4: Orientation towards social contribution		0.144	0.234	0.127	0.193	0.172	0.119

Full text

Introduction

In recent years, Japan has been experiencing rapid population aging and declining birth rates [1,2]. By 2030, it is estimated that more than 30% of the population will be aged 65 years or older, while nearly 20% will be aged 75 years or older; consequently, one in every three people in Japan will be a senior citizen [1]. In addition, the total fertility rate has remained well below the replacement level, and the number of live births has continued to decline over recent decades [2]. Although the number of employed nursing professionals has been steadily increasing [3], the demand for nurses remains high, and concerns over a nursing shortage persist. Nursing student enrollment has declined since fiscal year 2019 due to the effects of the declining birth rate [4]. Previous studies revealed that nursing students were more likely than students in other fields to have made early career decisions [5,6]. Many begin imagining themselves as nurses during elementary or junior high school and eventually enroll in nursing programs as initially hoped [6]. Furthermore, a relationship has been reported between nursing students’ intrinsic motivation, such as a desire to contribute to others or society, and a concern for academics, and subsequent career maturity [7]. In addition, as students advance through their academic years and gain practical training experience, their career image of the nursing profession becomes more concrete. At the same time, they also encounter the challenges and demands of the nursing field [8,9].

Career maturity is defined as “an individual’s readiness and attitude towards making career choices, decisions, and subsequent adaptation,” and within this concept, career readiness affects future outlooks [8]. In other words, nurturing a firm commitment to becoming a nurse and maintaining the motivation to continue one’s studies despite challenges [10] are considered important perspectives in supporting career development and maturity. On the other hand, professional identity is defined as “a sense of unity between the self and one’s profession” [11], and its establishment during the student years is considered to be strongly associated with career development and maturity [9].

In nursing education, career readiness and professional identity are regarded as important factors influencing students’ career development [10-18]. The Model Core Curriculum emphasizes the development of professional qualities and competencies necessary for future practice [10]. Previous studies related to the curriculum have reported efforts to strengthen professional identity among academically underperforming students [13], the importance of program continuity for better curricular integration and student support [14], and the recognition of professional competence as a key predictor of the hidden curriculum in nursing education [15]. Notably, the level of professional identity among nursing students has been shown to be closely associated with career planning [16]. In addition, studies have focused on prioritizing individuals with low confidence in clinical nursing practice among clinical instructors and administrators [9], assessing low levels of career maturity in nursing students [17], and examining the formation of professional identity among male nurses [18]. Collectively, these studies highlight a strong research interest in professional identity and levels of career maturity. Educational approaches that effectively integrate career readiness and professional identity may therefore contribute to a more meaningful undergraduate nursing program and influence subsequent career development.

Although previous studies reported on the relationship between career maturity and motivation for career choice among nursing university students [7], and another study addressed the relationship between career readiness and vocational career maturity in nursing students [19], the relationship between professional identity and career readiness across different levels of career readiness among nursing students has yet to be investigated.

Therefore, the aim of this study was to examine differences in professional identity between nursing students with high and low levels of career readiness, as well as the associations between career readiness and professional identity. Clarifying the association between career maturity and professional identity may help nursing students better understand the meaning of career development and enhance their preparedness through enriched career education. At the same time, such findings may assist educators in creating more supportive academic environments. This study, therefore, aims to provide foundational evidence for the development of effective career education in nursing programs.

Materials and methods

Subjects and study period

This study was an analytical observational study. Participants were recruited using convenience sampling based on a non-probability (purposive) sampling method.

Subjects were 329 male and female nursing students from the first to fourth years of the four-year nursing program at Hirosaki University in Hirosaki, Japan. The survey was conducted between April 5 and April 30, 2024. Only students who expressed willingness to participate and provided informed consent were allowed to complete the questionnaire. Assuming a response rate of 45% and a margin of error of 5.7%, a required sample size of 300 participants was calculated. To account for potential absentees on the survey day and missing data, questionnaires were distributed to a total of 329 students.

Inclusion criteria were (1) enrollment as a first- to fourth-year student in the nursing program at Hirosaki University, (2) consent to participate in the study, and (3) completion of the questionnaire. Exclusion criteria were (1) non-consent to participation and (2) incomplete responses. All respondents completed every questionnaire item; therefore, no participants were excluded due to missing data.

Study methods

Data were collected through a web-based questionnaire created using Microsoft Forms (Microsoft Corp., Redmond, WA, USA). The questionnaire in Japanese with its English translation is provided in Appendix A. The purpose of the study and the request for participation were explained orally to second- to fourth-year students following a guidance session held at the beginning of the 2024 academic year. The explanation of the study was provided orally to first-year students after the first lecture of the general education course “Introduction to Data Science,” with the cooperation of the faculty member in charge of the course (from the Department of Nursing). Participants were informed in advance that the survey would take approximately five minutes to complete.

Study contents

The questionnaire consisted of the following contents: (1) subject characteristics, including academic year, sex, and age; (2) Career Readiness Scale-Short Version (CRS-S); and (3) the Professional Identity Scale.

Career Readiness Scale-Short Version

The CRS-S, developed by Sakayanagi [8], was used in this study. The CRS-S consists of two domains: Occupational Career Readiness (OCR) and Life Career Readiness (LCR), each of which is further divided into three subdomains. OCR includes Occupational Career Concern (OCC), Occupational Career Autonomy (OCA), and Occupational Career Planning (OCP), whereas LCR includes Life Career Concern (LCC), Life Career Autonomy (LCA), and Life Career Planning (LCP).

Participants responded to items assessing each subdomain. For OCC, they indicated the extent to which they were interested in their future occupation and work style, sought information to enrich their working life, and considered their future work to be an important issue. For OCA, they rated the degree to which they intended to shape their working life through their own efforts, planned how to spend their working life independently, and actively challenged themselves to enhance their occupational experience. For OCP, participants evaluated whether they had concrete plans to achieve their desired working style, held personal goals regarding the type of professional they wanted to become, and engaged in planned actions to lead a fulfilling working life.

Similarly, for the LCR subdomains, participants rated their interest in their future life and lifestyle, their efforts to access information to enrich life, and the seriousness with which they considered how to live in the future for LCC. For LCA, they indicated the extent to which they intended to shape their life through their own efforts, independently considered how to live, and actively challenged themselves to lead a fulfilling life. For LCP, participants reported whether they had concrete plans to achieve their desired lifestyle, held personal goals regarding the kind of person they wanted to become, and engaged in planned actions to lead a fulfilling life.

Each domain of the CRS-S consists of three subdomains-career concern, career autonomy, and career planning-with three items per subdomain, yielding a total of 18 items across the scale. Responses were rated using a five-point Likert scale: “5 = Strongly applicable,” “4 = Somewhat applicable,” “3 = Neutral,” “2 = Slightly inapplicable,” and “1 = Not applicable at all”. Each subdomain score ranged from 3 to 15, with higher scores indicating greater career readiness (i.e., a higher level of career maturity) in the respective domain. In the analysis, subdomain scores of ≤9 were categorized as the low-score group, whereas scores of ≥10 were categorized as the high-score group.

Internal consistency reliability of the CRS-S in the present study was acceptable to good, with Cronbach’s alpha coefficients of 0.79 for OCC, 0.73 for OCA, 0.76 for OCP, 0.83 for LCC, 0.83 for LCA, and 0.85 for LCP.

Professional Identity Scale for medical university students

The Professional Identity Scale for medical university students, developed by Fujii et al. [20], was used in this study. Factor analysis of the original 34 items yielded four factors, from which the five items with the highest factor loadings for each factor were selected, resulting in a total of 20 items.

Based on this, Ochiai et al. [6] further shortened the scale by selecting the top five items for each of the four factors (F1, F2, F3, and F4), resulting in a 20-item version with five items per factor, which was used as a reference in the present study. The scale consists of the following four factors [6, 20].

The Four Factors

The four factors are as follows: F1: Confidence in choosing a healthcare profession, F2: Establishment of one’s own professional view of healthcare work, F3: Pride in being needed as a healthcare professional, and F4: Orientation towards social contribution.

For F1: participants responded to items such as whether they thought choosing nursing was a good decision, whether they could not imagine working in any other occupation, whether they intended to continue nursing throughout their lives, whether they felt that becoming a nurse was an authentic way of life for them, and whether they could proudly state to others that they were nursing students.

For F2: tems assessed whether participants had a clear idea of the kind of nursing they wanted to practice, whether they felt capable of providing nursing care that reflected their individuality, whether they had a clear vision of the kind of nurse they wanted to become, whether they believed they would be able to practice nursing in their own way in the future, and whether they felt they had their own ideas regarding the nature of nursing.

For F3: With the introductory statement “As a nurse…,” participants were asked whether they believed they were an indispensable presence in the healthcare field, whether they had been and would continue to be needed by many people, whether they would increasingly be required as members of healthcare teams, and whether they believed nursing was grounded in its own academic discipline.

For F4: Participants responded to items regarding whether they wished to contribute to patients, to meet patients’ needs, to contribute to society, to advance medical care, and to further the development of nursing as a discipline.

Responses were rated on a seven-point Likert scale, from “7 = Strongly applicable” to “1 = Not applicable at all,” and the average total score was calculated. For each factor, the minimum possible score was 5, and the maximum possible score was 35. Higher scores indicated a higher level of professional identity. Scores ranged from 1 to 7, with higher scores indicating a stronger level of professional identity. Internal consistency reliability was high, with Cronbach’s alpha coefficients of 0.91 for Factor 1 (F1), 0.87 for Factor 2 (F2), 0.95 for Factor 3 (F3), and 0.96 for Factor 4 (F4).

Data analysis

Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize participant characteristics. The scores from the CRS-S and the Professional Identity Scale for Medical University Students were analyzed using the Mann-Whitney U test, as the data did not meet the assumptions of normal distribution. Furthermore, the relationship between career readiness and professional identity was examined using Spearman's rank correlation coefficient. All statistical analyses were conducted using IBM SPSS Statistics, version 25 (IBM Corp., Armonk, NY, USA). A p-value of less than 0.05 was considered statistically significant.

Ethical considerations

Subjects were informed of the purpose of the study, that participation was voluntary, and that their privacy would be protected with no personally identifiable information collected. The same information was also provided in written form via the web-based questionnaire and in the e-mail used to distribute it. At the beginning of the questionnaire in Microsoft Forms, participants were asked to indicate their consent by selecting “Agree” or “Disagree”. Consent was considered to be obtained when “Agree” was selected. The survey was anonymized by disabling name recording in the form settings. After collecting responses, the data were exported to Microsoft Excel (Microsoft Corp.), and the distribution history (Office 365 Forms, Microsoft Corp.) was deleted. The form settings allowed only one response per subject.

This study was conducted with the approval of the Graduation Research Ethics Review Committee of the School of Health Sciences, Faculty of Medicine, Hirosaki University (approval no.: HS2023-080).

Results

Subject characteristics

Among 329 nursing students, 157 responses were valid (valid response rate: 47.7%). First-year students accounted for the largest group with 56 students (35.7%), followed by fourth-year students with 49 students (31.2%). There were 19 male students (12.1%) and 138 female students (87.9%). The overall mean age was 19.5 ± 1.3 years (mean ± standard deviation) (Table 1).

Relationship between OCR and professional identity among medical university students (group comparison)

For the CRS-S, subdomain scores ranged from 3 to 15. Based on predefined criteria, participants with scores of ≤9 were categorized into the low-score group, whereas those with scores of ≥10 were categorized into the high-score group. These groupings were applied consistently across analyses to examine differences in professional identity factors.

Regarding OCC, the median scores of the high-score group were significantly higher than those of the low-score group for all four professional identity factors: F1 (p<0.001), F2 (p<0.001), F3 (p<0.01), and F4 (p<0.01). Concerning OCA, the high-score group scored significantly higher than the low-score group on F1 (p<0.001) and F4 (p<0.05), whereas no significant difference was observed for F3. For F2, although the median scores were identical between the two groups, the interquartile range (IQR) was significantly higher in the low-score group (IQR: 22.0-31.0).

With regards to OCP, the high-score group scored significantly higher than the low-score group on F3 (p<0.01) and F4 (p<0.01). In contrast, the median scores for F1 and F2 were identical between the two groups. However, for F1, the IQR was significantly higher in the low-score group (IQR: 20.0-30.0), whereas for F2, the IQR was significantly higher in the high-score group (IQR: 18.9-30.0) (Table 2).

Relationship between LCR and professional identity among medical university students (group comparison)

Regarding LCC, the high-score group had significantly higher median scores than the low-score group for F1 (p<0.01) and F4 (p<0.01). For F2, although the median scores were identical between the two groups, the IQR was significantly higher in the low-score group (IQR: 21.5-32.5; p < 0.001). In addition, the low-score group scored significantly higher than the high-score group on F3 (p < 0.05).

For F2, the median score was also significantly higher in the high-score group (p < 0.05), whereas for F3, the low-score group showed a significantly higher median score than the high-score group (p < 0.001). Concerning LCA, the high-score group had significantly higher scores for F1 (p<0.001) and F4 (p<0.05). In contrast, for F2, the median score was significantly higher in the low-score group (p < 0.001), and no significant difference was observed for F3. Regarding LCP, the high-score group had significantly higher median scores than the low-score group for F3 (p < 0.01) and F4 (p < 0.01). Although the median scores for F1 and F2 were identical between the two groups, the IQRs were significantly higher in the high-score group for F1 (IQR: 20.0-30.0) and F2 (IQR: 20.0-30.0) (Table 3).

Relationship between levels of career readiness and professional identity (correlation analysis)

In all high career readiness groups, overall weak to moderate positive correlations were observed between each dimension of career readiness and professional identity across all factors (p < 0.01). In the low OCA group, a strong positive correlation was found between professional identity F2, representing the establishment of personal views on the healthcare profession, and OCA (Spearman’s rs = 0.733, p < 0.01). In addition, the low OCA group showed a positive correlation between professional identity F1, reflecting confidence in career choice, and OCA (rs = 0.543, p < 0.05). Furthermore, in the low LCC group, a positive correlation was observed between professional identity F2 (establishment of personal views on the healthcare profession) and LCC (rs = 0.530, p < 0.01) (Table 4).

Discussion

This study examined the relationship between OCR and LCR with professional identity. In Japan, various governmental policies have been implemented to promote work-life balance and the creation of a gender-equal society, aiming to enrich the quality of social life for its citizens. Within this context, students are engaged in the formation of their professional identity as nurses [20]. In this study, significant correlations were observed between career readiness and all dimensions of professional identity in the high career readiness group. This finding is consistent with the notion that professional identity develops through recognition of oneself as a member of a specific group [21], suggesting that students majoring in nursing may internalize such awareness through their daily academic and clinical experiences. In contrast, in the LCR group, professional identity F2, which represents the establishment of independent personal views on the healthcare profession, showed a higher median score and a strong positive correlation. This suggests that these students may consciously choose to major in nursing while recognizing this aspect of professional identity as a minimum requirement for psychological growth, integrity, and well-being [22].

OCC consists of keywords such as interest, information, and commitment [8]. In the present study, students in the high-score group showed higher median scores than those in the low-score group across all four factors of the Professional Identity Scale: F1 “Confidence in choosing a healthcare profession,” F2 “Establishing one’s role as a healthcare professional,” F3 “Pride in being needed as a healthcare professional” and F4 “Orientation toward social contribution.” In particular, with regard to F1, students appear to have clear goals from the time of admission, such as obtaining professional qualifications and developing specialized expertise [23], which may contribute to a sense of integration between the self and the profession as part of their professional identity. The participants were already interested in the nursing profession, and the results indicated that they held a strong awareness of their professional identity.

Previous reports have noted that attitudes, values, and beliefs function as readiness for behavior [24]. Similarly, in this study, a higher level of OCC was associated with a stronger professional identity. Given that professional identity has also been reported to influence profession-specific behaviors such as caring [25], the findings suggest that, within nursing education, students with higher OCC are more motivated to engage in their studies with a strong sense of professional identity. In contrast, LCC did not show such a pronounced tendency in relation to professional identity as OCC did, even among students in the high-score group. Previous studies have suggested that the formation of professional identity requires practical training experiences and the meaning attributed to those experiences [21], which may explain why students are able to conceptualize nursing primarily as a “profession.” However, with regard to exercising one’s abilities (competence), feeling connected to others (relatedness), and making self-directed and coherent choices (autonomy) [22], it can be inferred that students may not yet have reached a stage at which these elements are fully integrated into their broader life course and personal growth.

Furthermore, as shown in Table 3, for F2, the high-score group scored significantly lower in LCC. Table 2 also shows that the majority of subjects in this study were female. Previous studies reported that nursing students were often preoccupied with exams and job-hunting [7] and that women, in particular, generally bear significant responsibilities within the household [26]. These findings suggest that, in relation to F2 (OCC), students may be too focused on immediate tasks, such as exams and employment, to envision their future lives or to imagine themselves working as nurses in the long term. Particularly with regard to OCC, occupational identity showed a significant difference in the median scores between the high- and low-score groups, with the high group scoring higher. However, this trend was not observed for LCR. This may be due to factors such as having chosen nursing as a major unconsciously or having limited confidence in their ability to engage in clinical nursing practice [9]. Since narrowing the target group has been shown to help underserved adolescents realize their aspirations for higher education and future careers [27], it is necessary to provide pre-graduation guidance tailored to each individual.

No significant differences were observed in OCA or LCA in relation to F3. A previous study demonstrated that students who had not yet entered clinical practice often found it difficult to develop a sense of pride in being needed as healthcare professionals [6]. Although the present study targeted only nursing students, similar results were observed. This suggests that not only limited experiences, such as clinical training, but also broader real-world clinical experiences as working professionals are important in fostering this aspect.

Since only a small number of students participate in career guidance sessions and webinars [28], previous research has reported the need for intervention programs aimed at improving emotional management abilities and emotional application skills [9]. Furthermore, in university education programs, it is necessary to increase training opportunities, such as role-playing, to enhance students’ “sense of pride in being needed as healthcare professionals” [6]. In addition, similar to structured career development initiatives implemented during doctoral training [29], it is also essential to provide students with guidance that conveys the availability of postgraduate education opportunities.

In a study by Ochiai et al. [6] that compared the Professional Identity Scale for medical university students and the types of career decision-making processes, students showed a strong orientation towards social contribution. Similarly, the present results demonstrated that OCR and LCR were both associated with a high orientation towards social contribution (F4), supporting previous findings. These results suggest that students studying healthcare generally possess a strong desire to contribute to society. According to Table 3, the high-score group had significantly higher scores for F4 of professional identity than the low-score group. Additionally, Table 3 shows that many students cited reasons such as “being able to support patients and their families up close” and “wanting to be helpful to others” as their motivation for choosing a nursing major. These results are consistent with previous findings [6]. Therefore, students in the high career readiness group view nursing as a profession fundamentally rooted in contributing to people and society, and nursing students generally have a strong orientation towards people and social contribution. To promote subjective well-being and help students approach new challenges in social contexts, individual and group interventions should be proposed [30]. Doing so can serve as motivation for enhancing their sense of well-being.

This study has several limitations. First, it was conducted at a single university and included only nursing majors, which restricts the generalizability of the findings. Second, although participants were enrolled in different tracks-nursing, public health nursing, midwifery, and teaching-they were uniformly treated as “nursing professions” with respect to career readiness. Given the distinct career paths involved (e.g., hospital nurses, public health nurses working under Japan’s unique lifelong employment system, and other trajectories), evaluating them as a single group is inherently problematic. Therefore, future studies should divide participants into multiple groups and examine these differences separately. Third, imbalances in academic year and sex were present in the sample, and clinical training experience also varied by year. As students progress, they participate not only in clinical placements at various facilities but also in seminars and employment-support programs; therefore, both career readiness and professional identity may differ by academic year. Future studies should examine these aspects by grade level. Finally, because this was a cross-sectional study, research involving larger populations and longitudinal designs is warranted.

Conclusions

This study demonstrated that higher levels of career readiness among nursing students were associated with a stronger professional identity, particularly in terms of orientation toward social contribution. In particular, OCC showed a significant relationship with all factors of professional identity, indicating that interest, information-seeking, and commitment to one’s career play a central role in shaping the identity of future nurses. In contrast, LCC was less strongly related to professional identity, suggesting that students tend to prioritize immediate occupational aspects, such as exams and employment, over long-term life career perspectives.

These findings highlight the importance of fostering career readiness, especially OCC, within nursing education as a means of strengthening professional identity. To achieve this, structured educational interventions, such as role-playing, career guidance, and opportunities for reflection, should be integrated into the curriculum. Furthermore, tailored support for students to balance occupational and life career perspectives may help promote a more comprehensive and sustainable professional identity. Future longitudinal studies involving diverse nursing programs are warranted to clarify how career readiness contributes to identity formation throughout academic and professional development.