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Enfermería Global

On-line version ISSN 1695-6141

Enferm. glob. vol.18 n.54 Murcia Apr. 2019  Epub Oct 14, 2019 


Professional identity of nurses: a literature review

Thais Araújo da Silva1  , Genival Fernandes de Freitas1  , Magali Hiromi Takashi1  , Tatiana de Araújo Albuquerque1 

1Nurse. PhD in Nursing. School of Nursing, University of São Paulo. São Paulo (SP), Brazil.

2Nurse. Professor. PhD in Nursing. School of Nursing, University of São Paulo. São Paulo (SP), Brazil.

3Student listener of the research group Training of Teachers of the Department of Teaching and Comparative Education Methodology. Faculty of Education, University of São Paulo. São Paulo (SP), Brazil.



To identify, in the scientific literature, the identity nuances of Nursing in several contexts, especially in the fields of management and teaching, to contribute and unfold new notes on the proposed subject.


Integrative review, aiming to solve the following question: What are the identity settings of Nursing as a profession in both managing and teaching context? Data was collected in June 2017, without time or language delimitation, in full, from Cinahl database, from BVS and Dedalus portal, and from Scielo magazine directory. At the end of the data analysis, seven studies had been selected.


It was noticed that studies that are inherent to the professional identity of the nurse manager at IDA Program are still little explored. However, it was possible to discuss the subject matter by immersing itself in publications that reflect on the professional identity of the teaching and management nurse.

Final considerations:

The literature mentioned in this study allowed us to glimpse the variants that affect the construction of an identity archetype, thus allowing new developments to arise because of the need to explore this eminently specific and peculiar subject, since it is an exciting subject, abundant in possibilities and transformations

Key words: Nurse's Role; Education; Integration; Nursing Administration; Professional Identity; Nurses


Since the 1930s, the professional phenomenon has been studied and analyzed in the sociology of the professions, since the temporal contexts have undergone mutations, especially in what concerns the studies of the professions1.

Iin a sociological analysis, the term profession has three meanings: the first refers to job, the second sense is defined as an occupation and the third sense, relates to the idea of ​​trade, defined in French as métier2.

Formerly the above-mentioned words were added to the institutions of interconnected trades, mainly in the family communities, since such abilities were interwoven with the art, whose monopoly prevailed in these competences. In this way, organized groups pleaded for rights to maintain their privileges2.

With the foundation of universities, competences linked to the liberal arts and mechanics, skills that comprised the artisans and intellectual workers, were disintegrating. The liberal arts began to have a purpose related to the activities of the spirit of the human being, which were characterized asoccupationsand mechanical arts were identified astrades2.

Reviewing the historical trajectory of Nursing is worthy to mention that the initial frame of recognition of Nursing as a occupations, came from Florence Nightingale, the precursor of Modern Nursing, focusing its efforts on the development of technical and scientific knowledge of this profession3.

The professionalization of nursing in Brazil occurred with the foundation of the Professional School of Nurses, in the Psychiatric Asylum, in 1890, which is, currently, named as Nursing School Alfredo Pinto of the Federal University of Rio de Janeiro (Unirio) 4.

The movement for the development of Modern Nursing or, also, known as Professional in Brazil, was propelled when nurses understood the urgent need for the foundation of Associations at regional and nationwide levels5.

In view of the paths gone by the aforementioned profession, we can see that the visibility, image and professional identity of nurse has been a focus of studies for the past decades.

In identity terms, it is in family and school socialization that the role models of identity are shaped and this occurs when the individual makes his/her professional choice, when he/she joins University and, especially, when he/she is inserted in the job market2.

Regarding Nursing, the identity settings traced back in the symbology of one´s vocation. The nurse's training was often, turned to moral conduct, sometimes, even to the detriment of knowledge5.

Another important issue concerning the identity of nurse in Brazil, occurred in the 1920s, one carried out one’s training in Nursing at the School of Nurses at the National Department of Public Health. A booklet titled "The modern nurse: Appeal to Brazilian Ladies", was disclosed for recruitment of professionals to perform in the assistance, stating identity characteristics based on gender, by saying that this profession was eminently a woman´s activity and a profession imbricated to devotion, since such a brochure affirmed that the nurse would have the "opportunity to practice the kindest of all the arts of life, finding the opportunity to reveal her own gifts and to forget herself"6.

Currently, studies point out that there is no "clarity regarding the attributions practiced by the nurse, both concerning to his/her performance in the nursing team as well as a member of an interdisciplinary team” 7, however, it is fundamental to enlighten to the nurse's identity, mainly in the context of its formation.

This invisibility and disorientation regarding a nurse´s professional identity may have cause in the incomprehension of Nursing as a profession, since the occupational class is formed by professional and non-professional workers, which means, with or without training, even if, according to the legislation, they all have legal support to perform their activities within that profession9.

In this meaning, it is noticed that, within the nurse category, there is a range of attributions and activities of this professional, whether it is management, education or tasks related to any duties of this class.

Both care, management and teaching, in the field of Nursing, are closely related, so it is not possible, in fact, to tear them apart. Although caring has an identity of its own, both managing and teaching do not fail to have their identity as well.

It is of vital importance to look at studies that explain professional identities, to clarify the peculiarities of the profession, in this case, Nursing, in order to highlight the obstacles and achievements that professionals of this class face. In this sense, the following question emerges: What are the Nursing identities settings as a trade in the managerial and teaching context?

Thus, this study aimed to indicate, in the scientific literature, the identity nuances of Nursing in various contexts, especially in the fields of management and teaching, to contribute and unfold new notes on the presented subject


The present study, in order to answer the guiding question, selected as a research method the integrative revision, which makes it possible to rectify and ascertain changes in the context through different realities, to raise new inquiries and to raise new investigations, allowing a review to the study objective, since it "brings together findings from studies developed through different methodologies, allowing reviewers to synthesize results without harming the epistemological affiliation of included empirical studies"10.

Thus, in this study, six steps were performed, namely: elaboration and definition of the question; insertion of the criteria for inclusion and exclusion of studies; definition of the information to be extracted from the selected studies; evaluation of the studies selected; interpretation and presentation of the data found11.

It should be pointed out that the collection was carried out in 2017 for the doctoral research of one of the authors of the present study who is a PhD student in the Nursing Management Program (PPGEn), at the University of São Paulo Nursing school, which has as its object the professional identity of the managing nurse inserted in the Assistance Teaching Integration Program (IDA), as a reference established between the University of São Paulo Nursing school (EEUSP) and the University Hospital of the University of São Paulo (HU-USP), from 1978 to 2015. The deadline for the defense of this doctoral thesis ranges 2020.

It is pointed out that this IDA program was raised by a proposal in which it aims at reconciling efforts of articulation between health and education institutions, focusing on the population´s real needs12.

In this way, the data collection was carried out through queries in Cinahl database, portal of the Virtual Health Library (VHL) and the Dedalus, and in the revision directory of the Scientific Electronic Library Online (Scielo), in June 2017.

The searches were redone in the following month of the current year to certify the results, since it was evidenced that there were few studies inherent to the subject, including those that were focused on the nuances of the nurse manager's professional identity in the context of the IDA program. However, some publications were elected, since they dealt with the topic relevantly, although some focused neither on the administrative field, nor on the teaching scenario, more specifically, the IDA program.

For the selection of the studies, the Descriptors in the Sciences of Health (DeCS) were used, in which it was possible to carry out an advanced search using the Boolean operator (AND). In this way, the search occurred as follows:

- Cinahl: The word "professional identity" was cross-referenced with the descriptors Nursing and Administration. 17 results were found;

- VHL: The descriptors Nurse's Role and Teaching were inserted, together with the key words Integration and Nursing Administration. 13 articles found. However, after reading all the articles of the search in full, none was found that corresponded to the object of the present research. In order to do so, the search strategy was redesigned, using the descriptors Identity Crisis and Nursing, and the keyword Administration; and 10 studies were found;

- Dedalus: Used the key words Professional Identity and Nursing Administration. Five articles were found;

- In Scielo: Using the descriptors Nurse's Role, Nurses and the keyword Administration. An article was found.

Inclusion criteria were based on studies that answered the guiding question and met the following criteria: original research articles published in English, Portuguese or Spanish. The search had no restriction on limited publishing time because it was a strictly specific subject.

Exclusion criteria were based on repeated publications, reflective studies, letters to the editor, books, theses, dissertations, editorials, comments, abstracts, and studies that did not address relevantly the subject matter of the review objective.

The analysis of the material collected was carried out by two reviewers, who critically read the titles and summaries of the publications. In case of any hesitation or disagreement, the analysis of a third reviewer would be required.

Of the 46 articles, only 14 met the requirements of this subject. Of these, seven were excluded because they fit the exclusion criteria, which resulted in seven articles, which were read and re-read in full, critically and the data were systematized. After this analysis, the seven articles answered the guiding question and completed the final corpus of the study.


For the characterization of the selected studies, each article received a code denominated by the letter T followed by the number presented in the order of selection (Figure 1).

Figure 1. Coding of articles followed by the number presented in the order of selection. Brazil, 2018 

The synthesis of the classification of the study sample according to year, country and database, portal or directory of journals, are placed inFigure 2.

Figure 2. Characteristics of selected studies in the integrative review, according to code, year, region, country, study approach and study scenario. Brazil, 2018. 

Most of the articles selected come from Brazil; being observed that only one elect from Spain and one from the United States. Among these articles, two of them are in Cinahl, two in the VHL, two in Dedalus and one in Scielo.


Among the 17 studies found in Cinahl, one stands itself out because it addresses the professional identity of nurse working in primary care in Spain, where they have support for prescribing medicines to patients. The study reveals that, even if the users of the Spanish health services trust and respect both nurses and physicians, professional identity is still widely discussed among Nursing professionals, even if nurses are qualified to prescribe medications, they are still waiting for a formal legalization. Thus, they believe that such legalization would increase the professional autonomy and, consequently, this would positively affect the professional identity13.

The scenario described above is similar to Brazil, regarding the prescription of medicine by the nurse, whose activity is supported by Law n. 7.498/1986, article 11, item II, letter "c", which states that the prescription of medicines may be performed by nurses in public health programs under institutional protocols14.

It is important to emphasize that the "professional autonomy of nurses is linked to the core of professional identity, since it is constituted of inherent characteristics within this profession", and that this is closely connected with access to higher education and the progress of research in this area15.

Another relevant study, found in Cinahl's database, was to identify and analyze the discursive statements that characterized the Human Resources in Nursing in the 1940s by the Brazilian Red Cross. The research was based on Michel Foucault´s thought. A study of a historical-documentary approach, with sources related to Nursing published in the newspaper "A Gazeta", from 1940 to 1945, and of the Regulation of the Nursing School of the Brazilian Red Cross, State Branch of São Paulo (EECVB- FESP), 1940. Thus, the results were based on the discourse on the woman/nurse, in the sense that, to practice nursing at the time, was a way for women to serve the Motherland, emphasizing the characteristics in which the woman/nurse should being subservient, 'sweet' and possessing femininity; and these attributes were legitimized by the State and by the church. The results also pointed to a professional identity based on the military model, through which the EECVB was a prototype in the training of the nurse; bearing in mind that, at that moment, the world was going through World War II16.

It is pertinent to trace back Florence Nightingale's choice of Nursing for the Call of God in which she reports that her mission was to be a nurse by divine assignment. This Call of God was considered and then translated by her as a vocation. This ideology had been transferred to the English, American, and Canadian nurses and later brought to Latin America17. Thus, such characteristics mentioned in the above study may be in line with the ideological inculcation of Florence's time, especially with regard to being subservient.

In this reflection, it is necessary to add the gender issue, since it is known that, during the course of humanity, most of the historical scenarios point to women´s struggles for rights.

This panorama, in which the woman was treated as a being inferior to men, can be conferred through the posthumous work of Tito Lívio Castro. The author emphasizes that a man's brain weighed more than a woman's, and so this was the reason why her inferiority and insipidity. However, the author was concerned to study in greater depth such craniometry, since, in this way, he believed that it would help, favor and facilitate the insertion of women in education18.

In this sphere - gender - there is obsolete dichotomy inherent in the nurse´s image, as regards the characteristics of 'holiness' and 'promiscuity'. Although such idiosyncrasies are archaic, they persist to this day in the social imaginary. The idea of ​​the 'holy' nurse comes from the time when the care was carried out by the religious, deaconesses, and was based on chariTable and philanthropic actions. The idea of ​​the 'trivial' nurse comes from the story in which the women who performed the care in hospitals, were considered of moral doubt and that they took bribery19.

In this aspect, relations of power emerge, once this is situated as an interactionist phenomenon, that is, from relationships that allow the individual to experience the process of insertion and interaction with the environment in which one socializes20.

Starting from the VHL portal, a study had been found that highlighted the issue of the identity crisis of Nursing teachers, since there is a great demand of individuals who seek this profession. The study reflects the concern of the training bodies regarding teacher training for doing so in an effective way. The authors add that among the requirements that a Nursing professor needs to have, it stands out one´s capacity in articulating the theory and practice21.

Another study had as objective to correlate the stages of the elaboration of social and professional identity matrix with the phases of development and construction of the nurse manager´s knowledge. A qualitative study was carried out, which carried out a semistructured interview and a graphic projective test with nurses in management practice in the context of private hospitals in Belo Horizonte, Minas Gerais. The results presented three phases during the identity construction process. The first, known as identity crisis, pointed out that the nurse manager has a bureaucratic role and is far from practical. In the second phase - transition - is the moment in which the professional identity is being elaborated, being able to solve the question of who I am and who I want to be, however, in this phase, crises can still occur. One of the perceptions that one research participant pointed out was that her managerial activity was in "consonance with direct patient care, even though it was being provided by other members of the nursing team"22. The equilibration phase (third phase) demonstrates the apex of incorporation, acceptance and absence of crisis, thus establishing a sTable identity representing the nurse-manager as the centerpiece in the interrelationships, "reflecting the importance of the nurse in the viability of interpersonal relationships and in the management of the resources involved in the provision of patient care” 22.

In a sociological analysis, it is crucial to detect which dynamics shape the categories that are socially meaningful. Therefore, identity models can not be compared to existing groups at any given time, because they are threatened by obsolescence, especially in times of crisis2.

At the end of the century and millennium, it does not seem to me that any configuration of identity forms has acquired universal legitimacy, or even consensual knowledge. If this hypothesis is precise, the previous configurations may be considered "in crisis" insofar as their legitimacy gives no more than it does. If the plurality of forms and their combinations continue to be an insurmounTable constant, doesn´t it imply that any of them succeeded in imposing themselves historically? The question of human identity will remain, as Norbert Elias thought, still problematic2.

It ought to be noticed that, during the historical trajectory of Nursing, identity crises occurred, since the events and changes of reality, ruptures always occur, and these cooperate for the crisis scenario. Although advances in Nursing struggles and achievements have been evident, nurses' invisibility in society is still noticeable.

Going back to the search mechanism, now undertaken in Dedalus, a study aimed to define and analyze the nurse-instructor’s profile of the admission training of nurses at the Intensive Care Unit (ICU). Twenty-nine nurses from a tertiary care hospital from private institutions in São Paulo participated in this study. The methodological approach was based on the perspective of action research, with the support of the focal group technique and the interlocution by electronic means, for data collection. In the study, the word identity appears several times, when it says that the nurse-instructor of the ICU maintains its identity by the way of acting and caring, because they believe "that the education, the exchange of knowledge and their socialization occurred during the training are transformers of reality "23. Thus, it is a reference for the group that is in training, serves as a mirror for the same one and helps in the formation of the professional identity of the ICU nurse at that institution23.

Social fields, where interactions occur, are scenarios in which the individual develops his / her personal and professional skills, so it is not possible to understand individual identities without understanding and being part of a collective field24.

Another work raised in the strategy above (Dedalus), although it does not explicitly explore the question of a nurses’ professional identity, it brings in its objectives nuances of the knowledge and historical and contemporary powers of Nursing, which, in a way, assists in the composition of one’s professional identity. Thus, the objectives of this work were: to reconstruct the historical determinants implied in the institution of nursing management models; identify the current context of the managerial model, its meaning and future possibilities; to apprehend the coping strategies of this problematic in what refers to the knowledge and powers and to elaborate proposal and strategies for the reconstruction of Nursing within the institution. A qualitative case study was done in a large public hospital, located in Curitiba, Paraná, Brazil. The participants of the research were 12 Nursing workers being eight nurses, two technicians and two nursing assistants. Tthis study points out the struggles along the course of Nursing within the health institution. It shows that the nurses had little decision-making power within the hospital, that there was a need to change the managerial model of the hospital, and that there was a strong threat to extinguish the Nursing Director position. The study also shows that some nurses, when inserted in the management, did not consider themselves nurses any longer, but, managers of a unit; that there were identity crises of the nurses because of the disorganization of the organizational model, since this hospital was revising and implanting a new model of organization, mainly, in what referred to the abolition of the Nursing Board, since many nurses had the feeling of not belonging, the lack of recognition and identity25.

The feeling of belonging is a preponderant factor in the construction of a professional identity, since it focuses on the visibility of a profession in the articulation of competences and on the technical, scientific and relational evidences, in which they culminate in a social representation of the profession, enabling the profile of the profession’s autonomy, recognition and particular skills26.

In Scielo, a study relevant to the present study, conducted an essay in an attempt to discuss and reflect on the subjective issues that are at stake in the management of health services inherent to the nurse-manager. This study reflects that the positivist and cartesian ideologies influenced the split between the feminine and masculine world. Such conceptions may have affected the stereotyping of the professional collective identity of the nurse, especially with regard to submission. The study also questions that within the health services, the fact that health dimensions are focused on the treatment of the disease, it makes the nurse’s actions invisible in the context of their work, since it prioritizes the biological health model, and the nurse is a professional who seeks, in his/her training, to look at the patient holistically. However, this reductionist view is argued when it is questioned that such invisibility of the nurse’s work can be tied to the comparison of groups, especially those that work in the health area27.

Once again, it is alluded to the gender issue, in the sense that the majority of nursing professionals are female, corroborated by the research conducted by the Oswaldo Cruz Foundation (Fiocruz), sponsored by the Federal Nursing Council (Cofen), regarding the profile of Brazilian nursing professionals. It should be noted that this research was presented on August 13, 2015, at the São Paulo State Legislative Assembly, and points out that 84.6% of nursing professionals are female28.

In this set of studies that refer to the idea of ​​the professional identity of nurses, it is pointed out that nursing has experienced and goes through multiple processes in the construction of an identity capable of understanding its role in society.

Therefore, it is of elementary importance that new studies embrace new concepts, values, assumptions, and contribute to the understanding of this path to the present day, allowing a response to the concerns that emerge with the contemporary scenario on the causes, effects and trends of this profession


Based on this literature review of studies that invoke the current topic, it was sought to highlight the publications inherent to the object of this proposal that refers to the nurse manager’s and educator’s professional identity in different scenarios, to know and understand nursing professional trajectory.

It is reiterated that, although many studies bring up the issue of the professional identity of the nurse, studies that are inherent to the specific subject of the nurse manager’s professional identity in IDA Program are still little explored, so it is of essential importance that researchers in this field publish studies related to this subject, for example.

However, the literature mentioned in this study allowed us to glimpse the variants that influence the construction of an identity archetype, allowing with that, new developments arise due to the need to inquiry this eminently specific and peculiar subject, since it is a provocative topic, full of possibilities and transformations.


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Received: March 12, 2018; Accepted: June 02, 2018

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