Professional or student identity and commitment? Comparing the experiences of nursing students with literature on student success

Improving the rates of continuation and completion of nursing students is a priority to ensure there are sufficient qualified staff to deliver national healthcare services. In the literature, which is predominantly informed by research undertaken in traditional HE institutions with students studying conventional academic programmes, the development of a student identity and course commitment are identified as key components of persistence and success. This linear model assumes that student identity formation takes place during the transition into HE - and professional identities develop as graduates progress into the workplace. Qualitative research in the UK and Norway with nursing and midwifery students found that a strong desire to become a healthcare professional is often the starting point for enrolling in HE, rather than the culmination of the course. A strong future-facing professional identity and commitment sustain many students through the process of accessing and ‘enduring’ their nursing degree programmes that qualify them for practice. But these programmes do little to nurture professional commitment and identity, which could be harnessed to help these students to successfully complete their nursing studies. Recognising the differences between these professionally-oriented, future-facing students, and those studying traditional degree programmes, should inform approaches to improve the continuation and success of nurses. Their learning experience needs to be affirming and nurturing of this emerging professional identity to allow students to overcome academic and professional challenges they experience as they strive to become nurses, and allow them to fully embrace their professional identity.﻿


Introduction
This paper draws on qualitative research with nursing and midwifery students in higher education (HE) in Norway and the UK. It examines their experiences of studying and persisting in HE; it identifies strong future-facing professional commitment and identity, and weaker commitment to a student identity. Research on improving retention tends to focus on developing a student identity to improve commitment and completion, but this seems inappropriate for nursing students; alternative future-facing strategies could be employed to improve the retention and success of nursing students.
The HE sector is expanding worldwide by incorporating other disciplines and education institutions into the academy (Huisman et al., 2015), including many short-professional education programmes qualifying graduates for welfare-state professions (Brante, 2013). Originally these professions educated trainees in separate institutions, and incorporated practice-based learning; nursing students for example, worked as apprentices for much of their training. In Norway, nursing joined the HE sector in the early 1980s, while in the UK nursing was integrated into the university sector at the start of the twenty-first century. In both countries nursing programmes still require 50% of students' time to be spent on practical training (2005/36/EC).
Retaining students is a national and institutional priority across Europe (Vossensteyn et al., 2015), and retaining nursing students is especially important due high demand and a shortage of nurses (Nursing Times 2021). The problem of a lack of supply of nurses is compounded by the high withdrawal rate from nursing programmes, around a quarter of nursing students do not complete in both Norway and England (Jones-Berry, 2020).
As HE expands and offers a more diverse range of disciplines, including professional degrees such as nursing, in traditional academic institutions, this raises questions as to whether HE evidence-informed policies and practices designed to support 'traditional students' to persist are appropriate for students studying on professional programmes. This article focuses on the relationship between professional commitment and identity, student identity, and student persistence. It finds that many nursing students have a strong commitment to developing a professional identity on entering HE, which is both crucial to engaging and persisting in their studies, and is at times challenged by the course. This suggests that models of persistence need to be updated, and that institutional strategies need to recognise and nurture professional rather than student identity.

Student persistence in higher education
There is limited research specifically about the retention of nursing students (Heaslip et al., 2017), and articles mainly report on small-scale, single-institution research projects (Kaehne et al., 2014). Studies predominantly identify weak academic and writing skills, and the need for student support. A few studies identify the commitment and resilience of 'non-traditional' groups in HE, and how their strong desire and motivation to be healthcare professionals assists them to overcome challenges (e.g. McKendry et al., 2014).
The wider literature about student retention and success has been informed by US research, especially Tinto's Institutional Departure Model (Tinto, 1975(Tinto, , 1993, which is dominant (Tight, 2020). Tinto's model identifies a number of factors that contribute to students' decisions about whether to remain in or leave HE: pre-entry attributes (family background, skills and abilities and prior schooling); student commitment (including goal and institutional commitment and external commitments) and students' interaction with the institution, particularly integration into the academic and social systems. This paper focuses on commitment, while Sweetman et al. (in this special issue) focus on integration and Hovdhaugen et al. (in this special issue) critique and revise Tinto's model.
To improve student retention, the focus has been on the first-year experience; student commitment and integration have been nurtured through 'transition' (e.g. Moore et al., 2013), and the formation of a positive HE student identity (Moore et al., 2013): "…fostering a HE learning identity is essential for positive transitions" (MacFarlane, 2018(MacFarlane, , p. 1203. Student identity incorporates academic and social dimensions, and is collectively formed through the cohort or community of learners (Eccleston, 2009). Student identity is viewed as temporary, dynamic and socially constructed (Hussey & Smith, 2010), it provides a sense of 'studenthood' which allows learners to fit in and study successfully (Field & Morgan-Klein, 2010, p. 4).
Transition is a term widely used in the education sector to refer to students moving from one level or phase to another, but it is poorly defined (Gale & Parker, 2014) and under theorised (Eccleston, Biesta and Hughes 2010, Gale & Parker 2014). Gale & Parker (2014) differentiate three conceptualisations of transition: induction, development and becoming. Transition as induction, provides new students with introductory information and contacts to help them know more about how HE operates and to know more people within HE. Here the emphasis is on institutions providing an induction experience, but 'the terms of the transition are set by others' (Quinn, 2010: 119) and students are passive recipients of information.
Transition as development places greater emphasis on student adjustment to the new context, a 'shift from one identity to another' (Ecclestone et al., 2010: 6), and the development of a HE student identity (MacFarlane, 2018). The emphasis is on individuals changing, especially in terms of developing motivation, commitment, engagement and responsibility to participate in learning and co-curricular activities (e.g. Kift et al, 2010) A developmental understanding of transition embraces the notion of developing and fitting into and belonging in the new social milieu and gives students greater agency than transition as induction.
Transition is frequently operationalised as both inducting students into the new learning environment, and helping them to adjust and develop a student identity. Transition however is conceptualised as linear and time-bounded, lasting between a few days to the whole of the first year. Subsequently it is envisaged that students will make a transition to employment and a professional identity (Ecclestone 2009). Being an HE student is preparation for 'becoming somebody' (Ecclestone, 2009: 12;Ecclestone et al., 2010: 7) and developing a professional identity.
Arguably this linear model -creating a student identity and then a professional identity -may not reflect the experiences of the majority of students (Cohen & Ainley, 2000), but it certainly differs to the experiences of nursing students in our studies. Many came into HE already identifying with the nursing profession, and hence they do not first create a student identity and then a professional identity. Participation in an HE programme is seen as a means to end, rather than an end in itself, and something that has to be done in order to achieve the goal of entering their chosen profession in the future. Gale & Parker (2014) contrast transition as induction and development with transition as 'becoming'. They define this as 'a perpetual series of fragmented movements involving whole-of-life fluctuations in lived reality or subjective experience, from birth to death'. Gale & Parker (2014:16) define transition as the capacity to navigate change; this embraces more than a time-bounded process of change, and suggests greater dynamism and student agency. This comes closer to the experiences our nursing students describe, although they have a clearer end point in sight -becoming a nurse -than is incorporated into Gale and Parker's presentation of transition as becoming. This aligns with Worth's (2009) use of the idea of 'futurity', to understand youth transitions as becoming (drawing on Allport 1995 andGrosz 1999). Grosz offers a critique of time as neutral, rather than chronological, so past, present and future time can be all be aligned. Allport draws on the concepts of self-image, propriate striving and self-extension to argue that people have awareness of their own ability and place in society, coupled with motivation and a focus on the future, which leads them to extend themselves into a risky futurity. Worth (2009) stresses the idea of 'multiple becomings' (p1058), which enables multiple identities to co-exist. 'Futurity' is used here to embrace a less linear idea of time, which acknowledges that student nurses may simultaneously be drawing on previous experiences, engaging in current academic study and practice placements, and imagining themselves as future nurses. This has similarities with the concept of formation (Benner et al., 2010), through which students learn new ways of thinking, acting and being, which enable student nurses to move from being 'novices' to being 'experts' (Benner, 2000. Acknowledgement of these multiple transitions and identities, and the importance of formation and futurity is not widely built into contemporary HE transition theory or practices, but will be discussed below in relation to the findings from our empirical research.

Details of the research studies
The empirical evidence this paper draws upon is derived from two projects, one in Norway and one in England. The English study was commissioned by Health Education England to explore the experiences of healthcare students with diversity characteristics in accessing and succeeding in NHS-funded HE programmes. This was a large mixed-methods project; it included 70 one-to-one qualitative interviews with undergraduate students studying healthcare programmes across ten HE institutions. The interviews were undertaken by trained student-peer-researchers. In this paper we draw on the 50 interviews with nursing and midwifery students, recruited through an email to students registered on relevant courses, and who self-identified as having at least one 'diversity characteristic'. The interviews were conducted during the 2015-16 academic year, before tuition fees were introduced for healthcare students in England, largely with students in their final year.
In Norway a similar interview guide was used with nursing students studying at three institutions, in the period May 2019 to June 2020. In total 30 students were interviewed; most individually and some in pairs. Students were mainly recruited at a lecture, which means that diversity was not necessarily a factor in the recruitment, but some interviewees had 'diversity characteristics', such as being of minority gender (male), mature age or a first-generation student. Some interviewees were in their third year, while others were in the second year, and year is therefore indicated in the quotes for Norwegian students.
The interviews were mostly conducted face-to-face, all were recorded and transcribed, and both projects had ethical research approval. The initial analyses were conducted by the country research teams, who each coded a selection of transcripts and identified emerging themes, themes were discussed and agreed, and applied by a single researcher to all transcripts. Comparative analyses were conducted by the authors through discussion and identification of similarities and differences.

Findings about professional and student identity and commitment
This section of the paper examines the findings from nursing students in Norway and the UK in relation to the idea of 'becoming', and in particular becoming a student and/or becoming a nurse. It discusses four themes: i. Strong commitment to the professional identity and becoming a nurse. ii. Weak student identity: Lack of interest in developing a student identity, and lack of opportunity. iii. The role of professional commitment in overcoming retention challenges. iv. The role of the course (academic and placement) in developing student and professional identity and commitment.

Strong commitment to the professional identity and becoming a nurse
The interviews explored participants' reasons for applying to study a nursing degree, and in both the UK and Norway students describe a strong passion, commitment and determination to become a nurse, which motivated them to enter HE. For example: Understanding this commitment further, nursing students typically reveal some common features. They have a desire to help people, they feel that nursing is a good fit for them, and that nursing offers a worthwhile career with good career prospects. Much of this desire is centred around the view that nursing has a strong social value because it is about caring for those who need it. In summary, the students engaging in nursing studies had a strong motivation to become a nurse, as they wanted to be of benefit to society, they felt the role was a good fit, and it offered good career prospects with almost guaranteed employment and plenty of choices and variety. Nursing is a role with meaning for them: they wish to care for others, connect with people, work closely with others, and do something of value, and many relate to it as a vocation. Many interviewees talked about their decision to enter a nursing programme as a long-term goal, or career arc, which they planned carefully to achieve, organizing entry to HE around considerations such as household income and house purchases, family formation and other responsibilities, to increase their chances of being successful. Indeed, one of the attractions of nursing for some students was a sense that it could be combined with having a family and periods of working part-time, without losing their professional career pathway. This level of planning seems unusual amongst students, and can be contrasted with young working-class students who drifted into local HE provision, and for many the first decision they made was to leave HE (Quinn et al. 2005). These students are undertaking longer-term planning, but it is not about becoming a student, but becoming a nurse; participating in HE is somewhat incidental.

Weak student identity: lack of interest and opportunity to develop a student identity
Interviewees did not choose to be students, they wanted to be nurses, and they did not feel like 'normal' undergraduates. Comments about in-depth studying/love of the subject, socialising with peers, self-discovery, hobbies, and living away from home for the first time, are largely absent from the way student nurses talk of their degree years. It is a fairly singletrack, focused and intensive experience, without new freedoms, or time for socialising, or exploration of interests. Few relish, or enjoy the academic or the social student experience, and there is a striking lack of attachment to or pride in being a 'student nurse'; the degree is instead something to 'get through'. Students also feel separated from the rest of the university in terms of campus space/location, and socially. Many of them say they have few friends or rarely see other students who study different subjects. The interviewees did not feel aggrieved, but they felt keenly they are having a very different university experience, which is not about the 'student experience', but a bridge to a professional life. The experience of becoming a nurse is not, for most, a stage or experience which is particularly enjoyable or satisfying in itself, but it is necessary to achieve a professional identity they are committed to reach. Quite a number of interviewees commented on the challenges of socialising with and integrating into the wider student population, partly due to shifts, but also other commitments, and frequently due to a separate site, located away from the rest of the university, including social, sport and leisure activities. Students were however willing to sacrifice the wider student experience to achieve their goal of becoming a nurse, although this lack of social engagement may contribute to the early withdrawal of some nursing students.

The role of professional commitment in creating motivation and overcoming retention challenges
Student nurses talked about how their professional commitment motivated them to participate in a nursing degree, and also how it keeps them going. It is clear that one of the key factors that pulls them through periods of uncertainty, stress, or failure, is their determination to work as a nurse.

I think it was just a desire to be a nurse and get on in life. That's what kept me motivated and kept me going. Sometimes it is so much easier to think, 'What on Earth am I doing? You know, it's just so hard.' (Female, nursing student, England)
The focus for many of those who have had a hard time during the degree, with difficult placements, is to just get through the degree, get the qualification and become a nurse: While for other students, where the placements are challenging to their self-esteem and professional identity, they can come away with their identity and motivation to complete severely undermined. For example, one male student described how challenging and off putting his first placement was, and how badly this shook his confidence and sense of having chosen the right degree programme: I had not worked in any health setting before. It was the first time I came into contact with it, the nursing home [placement] in the first year. And it was, unfortunately, an absolutely horrible placement. We were told… not to take our study days off, because they were low on people, and they needed staff... It was exploitation, it was a bad working environment. There was so much that was negative, it was eight hard weeks.

(Male student, year 3, Norway)
In several descriptions of placements that were challenging, the role and influence of their supervisor was determinant: either helping to frame and support their learning and developing their professional sense of self, or undermining their belief in their capability and career choice. One positive example shows that this does not need to be particularly in-depth, or time-consuming supervision, but was about simply normalizing the stage of 'becoming' and as one of uncertainty and being in practice to develop the skills needed: We had one supervisor… She also said "you will not feel completely confident until you have been at work for a whole year" or something like that. And that's one of the best things I've ever heard. Because it helped me a lot. (Female student, year 2, Norway) A number of students described realising what kind of professional niche or area they wished to work in during their degree, and this became a powerful source of motivation, even if they had struggled with other parts of the programme. Students who struggled with placements focused on palliative or care home settings, enjoyed the mental health nursing or maternity and midwifery roles. A positive placement has the ability to develop commitment and motivation, and to pull students through difficult periods, and students have relied upon this commitment to help 'pull themselves through' tough times. Many of the students are strongly motivated to become a nurse, and this pulls them through the challenging experiences of the course. Placements operate as both as source of inspiration, and a site of struggle, questioning or confirming their professional choice, commitment and identity.

The role of the course in developing student and professional identity and commitment
One striking issue in the interviews is how much the sense of professional passion and commitment described is something students feel they 'arrived' at HE with. For example: This professional commitment is vital, but there is little evidence about how courses nurture, support and develop it. Rather, professional commitment can appear to be a resource that is 'used up' during the degree. It can be positioned as a personal or even an 'innate' quality, and development appears accidental, rather than planned. The interviews suggest that courses spend little time talking about career planning, the process of entering the workplace, and explicitly developing professional identities. Students talked about the difficulties of both being on placement and managing academic deadlines, this challenges students' confidence, and threatens both academic and professional identities.
It's incredibly challenging to balance studying and working. I don't think people give nursing students enough credit really. I honestly think this is one of the hardest courses in the university, if not the hardest course, because you've got to balance that, and a lot of people don't make it through. (Female, nursing student, England) The degree has been a little more demanding than I thought, especially in terms of time. We have a pretty hectic time, and do not have much room for fun. (Female student year 2, Norway) The placements themselves pose identity challenges; during this time trainees have neither a student nor a full professional identity, and the way they are treated can challenge students' views of themselves: The culture of the place, I found really difficult. The way I was getting treated by the mentors and the service users. (Male, nursing student, England) These challenges to their professional identity can cause students to question their suitability and commitment to complete the course:

I thrive as a nurse in many ways, but at the same time there have been a number of events during my studies that have made me question if I should become a nurse after they happened. (Female student, year 3, Norway)
Students did not feel that that their courses supported them to develop and engage with the various nursing identities: I do not think we had enough of that (deliberate motivation from the course). I would like to have more positive views about it from the school's side then. They could be more motivating and positive in the way they present the study. Because the reputation about being a nursing student in general is that it is demanding and difficult and all those things. I think that you should promote it by saying that practice is fun in a way, it is not just a struggle and toil all the time then. (Female student,year 2,Norway) In Norway the early placements are largely in care homes -working with older people and delivering personal care, and this is combined with a focus on elder-care in the academic course in the first year. For some students this provides a challenge to their professional commitment: I think there should have been a lot more variety in the first year, because it was just geriatrics. It's very flat and I think that for those who really do not want to work with the elderly, but maybe want to become a midwife, they feel that they have come to the wrong place. They feel that "no, this does not suit me, I cannot become a nurse because I do not like working with the elderly", for example. (Female student, year 2, Norway) Nursing students are actively thinking about their future identities and working towards them, but courses do not seem to recognize this. Nursing students in the UK felt that they received little guidance with respect to their future careers: If I'm honest, I don't think they helped a lot. They take you to one careers' fair where there are people from all over the UK. We did a unit on your CV and personal statement, which was good, but it's not enough. Then they leave you to get on with it. (Female, nursing student, England) Norwegian students similarly talked about wanting more information about future career possibilities, to help sustain their commitment and feed their professional identity development: We believe the lack of active and explicit development of professional identity is strange considering how central it is to persistence and completion amongst the students we inter-viewed across the two countries. Courses seem to be oblivious to the need to help 'sure up' professional commitment when it might be running low, and to explicitly support professional identity negotiation and formation.

Conclusions, implications and recommendations
Nursing students have a qualitatively different student experience to traditional students, due to the volume of teaching and placements, being frequently located away from the main campus, and limited opportunities to engage socially and belong within a wider peer group. When we consider how central the notion of 'commitment' is to the student retention and non-completion literature, it is striking how different nurses are in both the nature of their commitment to their course, and the dynamic of this professional commitment in relation to their degree experiences and reflections on how they progress and overcome challenges. They generally have a strong commitment to becoming a nurse (in the future), and a weak commitment to being a student (in the present). They also generally describe entering the degree with a sense of commitment and destination, rather than this being something that develops during their degree -although it may be developed and strengthened, or undermined, by placements and other course experiences. This suggests that transition work should embrace the idea of 'transition as becoming', 'futurity' and formation rather than attempting to engage nursing students in developing a student identity.
Nursing students generally take a bold step of 'self-extension' into the world of nursing, moving from their comfort zone to a new world, embracing HE study and placement learning (Allport 1995). This is connected to their self-image, informed by a belief that they have the ability and characteristics to become a (good) nurse, and strong commitment to give something back to society; thus they are motivated to strive for a better future for themselves and for others. They draw on past experiences, and future expectations as they engage in their nursing degree in the present; the importance of the future seems to dominate their current experiences and identity formation. Some come in full of confidence that they have what it takes, and will be suited to nursing, while others hope they can become a 'good nurse'. The future is uncertain, but the students are committed to this future professional identity and need support getting there. Gale & Parker (2014) and Worth (2009) would reject the idea that students simply become nurses; rather they would see 'transition as becoming' as a perpetual state, but these perspectives place an emphasis on the future self. As with any future event, the sense of solidity and confidence of reaching this point is vulnerable to stress and being undermined by setbacks. The motivational power of student nurses' future, professional identity therefore should be seen as a valuable resource to degree programmes, but also as one that needs active engagement and effort to foster and develop throughout the degree. While many students are lucky enough to have positive, affirming and inspiring placements, there are many others who have extremely challenging placements or never get a chance to experience the areas or specialisms within healthcare that they think might suit them best.
We suggest that, at present, the significance and centrality of futurity, in motivation and identity -is largely ignored in the practices and support offered to student nurses, which instead is grounded in the present and in the immediate and next step or task to complete as a student. The past and the future are largely used to frame student nurses as being in deficit (weak academic track record, not yet proper nurses). They also find themselves with no clear 'place to stay' in terms of identity. The traditional student identity holds little appeal and feels 'other' to most student nurses. However, a 'fully fledged' nursing identity feels intimidating and as a responsibility too far for many during training, where they want recognition of their inexperience and uncertainty, and need for mentoring and support while they learn the skills they need. Thus, an interim identity which is founded on their role as nurses-in-training, or professionals of the future, is sorely needed to help connect their commitment and motivation into degree programme success. There should be more recognition of the bold steps students have already taken, the importance of future professional identity, and support to cope with the perceived risks to this identity. In short, the academic and placement learning experience needs to be more affirming, and supportive to allow people to draw on past and current experiences to become nurses within a supportive and enabling context. Benner et al., (2010) identify this as 'formation', which changes the self, and is achieved by combining academic knowledge, skilled know-how (or practice) and the values, goals and ideals of the profession, to develop nurses -and supports students to become nurses. A similar approach is proposed by Griffioen (2019), who argues that balanced professionalism is achieved by HE combining professional knowledge, professional action and professional identity. Our research reinforces the need for professional courses to integrate learning to be a 'professional', to both inculcate values, but also to help renew and grow professional commitment and identity in students, which are essential to both success in HE and in nursing careers.

Conflict of interest
The corresponding author states that there is no conflict of interest.
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