International Journal of Nursing Practice 2014; 20: 164–169


Constructing nurses’ professional identity through social identity theory Georgina Willetts RN RM MEd (Melb) Senior Lecturer, School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia

David Clarke PhD Director, International Centre for Classroom Research, Melbourne Graduate School of Education, University of Melbourne, Melbourne, Victoria, Australia

Accepted for publication December 2012 Willetts G, Clarke D. International Journal of Nursing Practice 2014; 20: 164–169 Constructing nurses’ professional identity through social identity theory The profession of nursing continues to struggle with defining and clarifying its professional identity. The definitive recognition of nursing as a profession was the moving of training from the hospital apprentice model to the tertiary sector. However, this is only part of the story of professional identity in nursing. Once training finishes and enculturation into the workplace commences, professional identity becomes a complicated social activity. This paper proposes social identity theory as a valuable research framework to assist with clarifying and describing the professional identity of nurses. The paper outlines the key elements of a profession and then goes on to describe the main concepts of social identity theory. Lastly, a connection is made between the usefulness of using social identity theory in researching professional identity in nursing, recognizing the contextual nature of the social activity of the profession within its workplace environment. Key words: nursing, professional identity, social identity theory

INTRODUCTION The notion of profession in nursing has had a troubled history. These troubles appear to continue today despite the modern profession of nursing meeting all recognized criteria of a profession. These recognized criteria are inclusive of the following: a systematic body of theory, professional authority, the sanction of the community and a regulative code of ethics, and the existence of

Correspondence: Georgina Willetts, School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Building 13C, Room C172, Wellington Road, PO Box 527, Clayton, Vic. 3800, Australia. Email: [email protected] © 2013 Wiley Publishing Asia Pty Ltd

professional bodies/associations that control and monitor conduct and performance within the profession.1,2 In Australia, nursing was not awarded the full status of a profession until the 1980s, despite being awarded this recognition much earlier in most other Western countries.3–6 Thirty years on from being awarded professional recognition, nurses continue to have trouble describing their work in parallel to other professions. This is not helped by the lack of research by nurses that aims to describe and clarify their identity within a professional context. This paper demonstrates the potential of social identity theory (SIT) to help in informing a research framework that would be applicable to the nursing context. Although this is not an exhaustive account of SIT, some of the main doi:10.1111/ijn.12108

Professional Identity and Social Identity

principles of this theory, including the concepts of social identities, group performance and self-categorization, are central to any consideration of professional identity. A brief description of professionalism is outlined initially, situating nursing within the professional context. The relevant concepts of SIT are provided, and the paper explores the contribution that SIT might make to research on the professional identity of nurses.

DISCUSSION Professionalism, professional identity and nursing Much has been written and much research done on nursing as a profession,4–7 but little research has been conducted into the development of the professional identity of nurses through the social context of their nursing work. Before reviewing the available literature on nursing identity, it is important to first clarify the significance of the construct of ‘profession’ to nursing and its importance in the development of the current nursing establishment. Historically, nursing has had a troubled relationship with the notion of profession. Even today, there remains a lack of consensus as to whether nursing is truly a profession. Initially, the campaign to move nursing towards professionalization began with the transfer of training from the apprentice-style model within the hospital setting into higher-educational institutions.3 In Australia this move occurred some time after it occurred in the rest of the Western world. From the 1960s to the 1980s, there was a deliberate move across the UK, North America, and Australia and New Zealand to establish nursing independently as a professional occupation. However, Australia was slower to do so than other Western countries, and nursing as a profession within Australia did not emerge legitimately until the mid-80s, when nursing gained entry into ‘the tertiary education sector’.3 There continued to be much opposition from the medical profession,3 and it took a further decade before all nursing education within Australia had finally been moved into tertiary educational institutions. This change in educational preparation is seen as the defining event in the recognition of the professional status of nursing alongside the traditionally recognized professions of medicine and law.3,8 The continued focus on educational preparation as the sole characteristic defining nursing as a profession compromises recognition of the other attributes that contribute to our conceptions of profession and professional identity.


There continues to be debate around whether nursing can justly be said to possess the attributes required of a profession, due in part to the lack of clarity over ‘identity, purpose and worth of nurses’.5 These attributes, as identified by Greenwood and Giddens,1,2 include: A systematic body of theory Professional authority The sanction of the community A regulative code of ethics The existence of professional bodies/associations that control and monitor conduct and performance within their profession It can be considered that this debate could be developed through further understanding the identities of nurses’ by nurses from the social perspective of their working contexts. The construct of identity becomes even more relevant when it is put in the context of professionalism as shaping personal identity, ‘binding an individual’s voluntary efforts into a common life and purpose’.9 In the attempt to identify with the concept of profession, nursing research has tended to focus on professional identity in relation to academic preparations and the early graduate year programs.10 This is only part of the story of profession and professional identity. To develop an understanding of and clarify professional identities in nursing, there is a need for research that has the potential for rich descriptions engaging all recognized attributes of the profession and not just academic preparation.11–13 A significant consideration that is currently absent in this discussion is a recognition of the importance of conducting nursing research focusing specifically on the social performance of nursing. Understanding of the construction of professional identities can be advanced through further exploration of social performance as a professional activity and of the daily activities of nurses within their social working groups. This is where social psychology, and particularly SIT, could advance understanding of professional identities in nursing.

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Social identity theory The importance of social identities is well researched within social psychology, and the SIT contribution to the understanding of social groups has particular significance in the nursing context. Since it was first described, SIT has developed a well-established research framework, with empirical data from a wide variety of settings to support its theoretical underpinnings.14–18 A brief description of SIT and its key concepts follows. © 2013 Wiley Publishing Asia Pty Ltd


G Willetts and D Clarke

Social identity theory defined SIT is an explanatory framework focusing on the psychological underpinnings of intergroup relations.15,19,20 There are some key hypotheses and concepts that afford this theory some distinctiveness in comparison with other social psychology theories. The key premise to SIT is that it foregrounds the importance of group belongingness as a consequence of the interpersonal–intergroup continuum as identified by Tajfel,15 with the focus being in-group behaviour and self-categorization within the group, unlike the more traditional lens that looks at individual behaviour analysis. Social identity theory could help to extend the findings of Levett-Jones and colleagues,21 who identified the importance of belongingness for student nurses during their clinical placements.21 It can be hypothesized that belongingness continues to be an important attribute in the social and professional identity of nurses well after they finish their student training. From the SIT perspective, social identity is displayed in group membership, ‘supported and sustained by group membership’.22 Further, social identity makes group behaviour possible.15 There has been much research around the application of SIT to organizational contexts.15,17,23 These research designs could be applied to nursing and its professional working contexts. In order to do this, an overall understanding of the main concepts around SIT is required, these being social identities, group performance and self-categorization.

Social identities The concept of social identities, one of the core underpinnings of SIT theory, can be further broken down into the concepts of social identity salience, nested identities and cross-cutting identities. Social identity salience. The idea of identity salience is a key concept in SIT. It was developed in identity theory and when applied to the social identity framework focuses on the salience of social identities rather than individual identities. The salience of a particular social identity is dependent on the group context. Individuals perform the social identity most relevant to their perception of the social setting. For example, someone functioning as leader of a clinical unit could in another setting function as mother, sister or daughter, with associated choices in social behaviour and therefore in social identity salience. Social identity salience is seen as significant in influencing identification and performance within the social or group © 2013 Wiley Publishing Asia Pty Ltd

context.23 In keeping with the idea of identity salience, there is an identity hierarchy, and this is explained as the probability of a given identity being invoked and includes the ranking of multiple identities in order of salience but dependent on the group context.17 Therefore, an individual’s salient social identity in one group might not be the same in a different group. Social identity salience can therefore be flexible depending on a given social situation.24 The significance of social identity salience is in the mobilization of group performance to achieve certain goals.23 Nested identities. Nested identities are those that are ‘attached to formal social categories’ as in organizational structures, formal roles and jobs, and formalized workgroups.17 Nested identities can be classified into higherorder identities and lower-order identities.17 Higherorder identities relate to ‘big-picture’ groups such as the Australian Health Practitioner Regulation Agency; lowerorder identities would relate to the nursing staff in a given clinical unit. Both higher- and lower-order identities have significant impact on social identities and are particularly important in relation to understanding identity within organizational social categories. Nested identities are seen to have three dimensions17: Inclusive/exclusive Abstract/concrete Proximal/distal Proximal/distal refers to the impact the identities have on an individual. Higher-order nested identities tend to have an indirect or delayed impact on an individual (distal impact). Lower-order nested identities tend to have a proximal impact, affecting an individual directly and immediately.17 The concept of nested identities helps in the conceptualization of the social identity framework, which helps the researcher to describe and identify the in-group characteristics of any given social group, particularly in relation to work. It can be assumed that identity salience is relatively stable in nested identities.

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Cross-cutting identities. Cross-cutting identities is a concept usually applied in organizational contexts, but the concept is equally relevant to professional contexts. Crosscutting identities are ‘attached to social categories and can be either formal or informal’.17 Social categories can be defined as ‘prototypical characteristics abstracted from the members’.25 An example of a formal cross-cutting identity might include membership of a committee;

Professional Identity and Social Identity

informal cross-cutting identity refers to friendship groups or cliques. Cross-cutting identities are usually lower-order identities and therefore tend to be concrete, exclusive and proximal.17 The salience of these groups will depend on the level of situational relevance and subjective importance,17 and therefore, the individual’s identity salience can fluctuate.

Group performance SIT has also informed significant research into group performance in relation to organisations.26 SIT takes the perspective that an organization depends on its employees to ‘engage in spontaneous acts of cooperation, helping and innovation’ and not simply enact a job description.23 SIT breaks down group performance into three significant categories for description: (i) motivation; (ii) group performance goals and norms; and (iii) efficacy. Motivation. SIT is concerned with what motivates the individual to work on behalf of the collective rather than simply focusing on what motivates the individual.23 Thus, motivation to perform is intertwined with identification with the group. However, this relationship between identification and performance is not a simple relationship. Social identity salience mediates between identification and performance. Group performance goals and norms, along with efficacy, play a similar mediating role.23 Group performance goals and norms. Group norms in SIT are not seen as external to the individual. Instead, SIT sees group norms as ‘standards that are internalized through identification and thus mainly affect group members’ attitudes and behaviours to the extent that individuals identify with the group’.23 This, therefore, indicates that high performance is only a goal if it is a group goal or group norm. In terms of an organization, the relevance of group goals and norms will be dependent on the salience of particular performance standards. Efficacy. Efficacy, as used in this paper, refers to the ‘identification-induced motivation to perform well’.23 This motivation is driven by the perception of the individual consciously controlling performance: ‘volitional control’.23 This supports the view that tasks are more likely to be undertaken if performance success is expected either by the group or the individual. One of the key attributes of a profession is autonomy within practice, so the concept of efficacy should be of interest in research


into the nursing profession. Historically, nurses have been viewed as an oppressed group, dominated, disciplined and shaped by external but powerful ideologies such as medicine and gender issues, significantly restricting nurse professional efficacy27.

Self-categorization Turner and Hogg described self-categorization in the 1980s,28 expanding on individuals’ understandings of self and the collective, which are regarded as cognitive constructs.29 The individual is viewed in terms of ‘idiosyncratic personal attributes’, whereas a group is viewed in terms of group attributes shared by those who are perceived to be within the group.15 The individual is afforded many categories at differing levels of abstraction. The higher the category level, the more inclusive the abstraction is, and the lower the category level, the more exclusive the abstraction becomes.15 Self-categorization is perceived to have three levels15: Superordinate or human level Intermediate or social level as an in-group member Subordinate or personal level SIT espouses that individuals’ sense of self-worth is reflected in their evaluation of the groups to which they belong. In addition to this, evaluation of the individual’s level of respect within the group, rather than evaluation of the group as a whole, has an effect on the individual’s self-esteem.22 Understanding self-categorization and professional identity in nursing could have implications for future research.

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Social identity theory and its relevance to professional identity in nursing Applications of SIT to nursing contexts and towards developing understandings of social identity, social performance and self-categorization are important to professional identity in nursing. There has been little focused research into the social identity that describes nurses and its correlation to their professional identity. There is potential for SIT to contribute to informing and describing contexts in which professional nurses undertake their work and to give voice to the diversity of identities within nursing. The identity of nursing work remains obscure and often difficult to explain, and there is a risk that this lack of clarity devalues nurses’ work. Nurses have worked hard to obtain the classification of a profession for nursing, but further work is required to justify and clarify nurses’ © 2013 Wiley Publishing Asia Pty Ltd


G Willetts and D Clarke

professional position within health care. SIT might provide a language through which recognition can be given to the situational and multifaceted nature of nurses’ professional activity.



CONCLUSION Professional identity in nursing is complicated, and nurses historically have struggled to define their work in parallel to the other professions. It is proposed that through applying SIT to the nursing profession, nurses will develop a fuller understanding of their own professional identity. As explained throughout this paper, SIT recognizes the contextual importance of organizational groups. Equally important are the contexts in which professional groups engage in the daily activities characteristic of their profession and their workplace. The emphasis in this paper has been on the capacity of this theory to facilitate examination of nursing as a profession through research. The relevant concepts include group belongingness as a consequence of the interpersonal–intergroup continuum, group identity salience, the complexities of individuals and their multiple social identities, and the situational relevance and subjectivity of these identities. An adequate understanding of nurse professional identity must incorporate recognition of the diversity of contexts in which nurses undertake their practice. It is essential that our understanding of nurse professional identity not be limited to the academic preparation of nurses and the transition of graduates into the workplace. Rather, comprehensive and clear description of professional identity in nursing requires specific attention to the workplace settings where and the social actions through which nurses meet the daily demands of their profession. By giving priority to the daily activities of nursing (rather than to issues of credentialing), research can better contribute to the recognition within nurse professional identity of the uniqueness of nursing knowledge and nursing practice.

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1 Giddens A. Sociology, 6th edn. Cambridge: Polity, 2010. 2 Greenwood E. Attributes of a profession. Social Work 1957; 2: 45–55. 3 Duffield CM. Nursing in Australia comes of age! International Journal of Nursing Studies. 1986; 23: 281–284. 4 Prowse J, Prowse P. Role redesign in the National Health Service: The effects on midwives’ work and professional


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boundaries. Work, Employment and Society 2008; 22: 695– 712. Aranda K, Law K. Tales of sociology and the nursing curriculum: Revisiting the debates. Nurse Education Today 2007; 27: 561–567. Cooke H. Seagull management and the control of nursing work. Work, Employment & Society 2006; 20: 223–243. Ball E. A social purpose model for nursing. Nursing Forum 2011; 46: 152–156. Freidson E. Professionalism: The Third Logic. Chicago, IL, USA: University of Chicago Press, 2001. Sullivan WM. Work and Integrity: The Crisis and Promise of Professionalism in America. San Francisco, CA, USA: JosseyBass, 2005. Salvage J. Professionalization—or struggle for survival? A consideration of current proposals for the reform of nursing in the United Kingdom. Journal of Advanced Nursing 1988; 13: 515–519. Corbin J. Is caring a lost art in nursing? International Journal of Nursing Studies 2008; 45: 163–165. Flatley M, Bridges J. Promoting the art of caring for older people. International Journal of Nursing Studies 2008; 45: 333–334. Maben J. The art of caring: Invisible and subordinated? A response to Juliet Corbin: ‘Is caring a lost art in nursing?’. International Journal of Nursing Studies 2008; 45: 335– 338. Abrams D, Hogg MA. Group Processes & Intergroup Relations 10 years on: Development, impact and future directions. Group Processes & Intergroup Relations 2008; 11: 419–424. Haslam SA. Psychology in Organizations: The Social Identity Approach, 2nd edn. London and Thousand Oaks, CA, USA: Sage, 2004. Hogg MA, Abrams D, Marques J. The Social Psychology of Inclusion and Exclusion. Hove, UK: Psychology Press, 2005. Hogg MA, Terry DJ. Social Identity Processes in Organizational Contexts. Philadelphia, PA, USA and Hove, UK: Psychology Press, 2001. Hogg MA, Terry DJ. Social identity and self-categorization processes in organizational contexts. Academy of Management Review 2000; 25: 121–140. Giannakakis AE, Fritsche I. Social identities, group norms, and threat: On the malleability of ingroup bias. Personality and Social Psychology Bulletin 2011; 37: 82–93. Haslam SA, Jetten J, Postmes T, Haslam C. Social identity, health and well-being: An emerging agenda for applied psychology. Applied Psychology: An International Review 2009; 58: 1–23. Levett-Jones T, Lathlean J, Maguire J, McMillan M. Belongingness: A critique of the concept and implications for nursing education. Nurse Education Today 2007; 27: 210– 218.

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22 Hogg MA, Abrams D. Intergroup Relations: Essential Readings. Philadelphia, PA, USA and Hove, UK: Psychology Press, 2001. 23 Haslam SA. Social Identity at Work: Developing Theory for Organizational Practice. New York: Psychology Press, 2003. 24 Stryker S, Serpe RT. Commitment, identity salience and role behavior: Theory and research example. In: Ickes W, Knowles ES (eds). Personality, Roles and Social Behavior. New York: Springer, 1982; 199–218. 25 Ashforth BE, Mael F. Social identity theory and the organization. The Academy of Management Review 1989; 14: 20–39.


26 Burford B. Group processes in medical education: Learning from social identity theory. Medical Education 2012; 46: 143–152. 27 Delacour S. The construction of nursing: Ideology, discourse and representation. In: Gray G, Pratt R (eds). Towards A Discipline of Nursing. Melbourne: Churchill Livingstone, 1991; 413–433. 28 Turner JC, Hogg MA. Rediscovering the Social Group: A SelfCategorization Theory. Oxford and New York: Blackwell, 1987. 29 Turner JC, Oakes PJ, Haslam SA, McGarty C. Self and collective—Cognition and social context. Personality & Social Psychology Bulletin 1994; 20: 454–463.

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Constructing nurses' professional identity through social identity theory.

The profession of nursing continues to struggle with defining and clarifying its professional identity. The definitive recognition of nursing as a pro...
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