JCDR - Register at Journal of Clinical and Diagnostic Research
Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X
Education Section DOI : 10.7860/JCDR/2018/27804.11649
Year : 2018 | Month : Jun | Volume : 12 | Issue : 6 Full Version Page : JC10 - JC13

Professional Attitude in Iranian Nursing Students

Masoumeh Shohani1, Leili Abedi2, Mahboobeh Rasouli3

1 Assistant Professor, Department of Nursing, Faculty of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran.
2 Ph.D Student, Department of Epidemiology, Kerman University of Medical Sciences, Kerman, Iran.
3 Assistant Professor, Department of Biostatics, Public Health School, Iran University of Medical Sciences, Tehran, Iran.

NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Mahboobeh Rasouli, Assistant Professor, Department of Biostatics, Public Health School, Iran University of Medical Sciences, Tehran, Iran.
E-mail: rasouli2007@yahoo.com


The first and most critical stage in nursing profession is when an individual enters the educational or apprenticeship environment as a nursing student. Therefore, the students’ professional attitudes and behaviours are very important during the courses.


To determine the professional attitude in Iranian Nursing Students.

Materials and Methods

This descriptive cross-divtional study was conducted from October 2015 to October 2016 at Ilam University of Medical Sciences. One hundred fourteen nursing students who studied in fourth to eighth semesters were randomly selected through proportionate stratified random sampling. Data collection tools consisted of a demographic information form and the Inventory to Measure Professional Attitudes in Student Nurses. Data analysis was performed using descriptive and inferential statistics through SPSS 18, while p<0.05 was considered significant.


A total of 75 (65.8%) of the student were interested in the nursing profession. A 60.52% and 15.8% of students considered educators and nurses to be effective in their professionalism, respectively. A 13.2% of the subjects were members of the Iranian Nursing Organization. The mean and standard deviation for the total score of the professional attitude was 91.01±15.7, which was above average. Scores in different factors of professionalism were contribution to the increase in scientific information load (15.97±3.35), collaboration (15.97±3.35), community service (10.93±2.74), ethical codes and theory (10.73±2.55), competence and continuous education (9.76±2.51), participation in professional organisations and professional development (9.61±2.17), autonomy (9.51±2.00) and working in committees (6.85±1.82).


Iranian nursing students are at moderate level of professionalism. Therefore, it seems necessary to identify the existing weaknesses in different aspects and try to fix them, while improving their strengths during student life.



Professionalism is one of the fundamental concepts in nursing [1]. It is one of the important topics in nursing communities, and was much considered by nurses in the last half-century [1,2]. Professionalism includes a set of attitudes that demonstrate levels of authentication, identification and commitment to a specific job. More professional and occupational experience can be gained through the adoption and approval of the attitudes and behaviours of a professional role model [3].

Students’ professional attitudes and behaviours during the courses is important in nursing education and must be taken into consideration during their training [1,4,5]. It is evident that the first and most critical stage in professionalism is when an individual enters the educational or apprenticeship environment as a nursing student [6].

Various factors affect professionalism in nursing and the role of nurse educators is particularly important [7]. The results of a study by Elahi N et al., indicated that the weakness of nurse educators in academic and clinical education is one of the factors that hinders a nursing student’s ability to acquire the competencies and higher levels of professionalism [8]. Nikbakht Nasrabadi A et al., also showed that unpreparedness of nurses to enter clinical environments is the main reason for the delay in the process of professionalism [7]. In fact, in all educational fields, influential variables such as behaviours, beliefs, emotions, feelings, interests, experiences, motivation and development of positive attitudes play significant roles in achieving educational goals [9]. Therefore, nursing education in all educational institutes must be planned and applied in a way that would lead to the creation of a positive professional attitude in nurses and nursing students [10].

Despite recognition of the factors that affect professionalism and the modifications, changes and efforts made to develop the professional status of nursing, there is still a poor social image of the nursing profession in Iran [7]. The lack of professionalism has led to the criticism of nurses’ skills and abilities in providing nursing care [11] and they have often been considered impaired or incompetent in fulfilling their clinical tasks [12]. In addition, nurses have usually felt that they have not become fully professional yet and see numerous complex challenges in front of them on the way to professionalism [7,13]. Nevertheless, now-a-days the society needs nurses who can accept their profession, develop attitudes and characteristics related to professional roles in themselves and succeed in playing those roles in different conditions [14].

One of the important reasons to study the nurses’ attitudes before employment is to gain information about the attitudes and behaviours that exist among nursing students before employment. These attitudes can be identified before the nursing student start their professional life so that they would be able to recognise potential challenges and try to overcome those challenges through more positive attitudes. Therefore, the present study was aimed to investigate the professional attitude in Iranian Nursing Students.

Materials and Methods

Design and Sample of the Study

The present descriptive cross-sectional study was conducted from October 2015 to October 2016 at Ilam University of Medical Sciences. The population of the study comprised all undergraduate nursing students (280 students) in the fourth to eighth semesters. Sample size was determined to be 117 students based on a pilot study and a 95% confidence interval, while 114 questionnaires were filled completely and three questionnaires were omitted due to incomplete information. The sample size is given in details according to the following formula:

d=10%      δ=.58      α=.05      z1-α/2=1.96      N=117

The subjects were randomly selected through proportionate stratified random sampling. The inclusion criteria were being a nursing undergraduate, consent to participate in the study and the exclusion criteria were being guest and transfer students. The participants were selected randomly and after being informed about the research goals and being ensured about the anonymity of the questionnaires, they gave their consent to take part in the study. Thus, they were asked to fill out the questionnaires on the same day. Fourth to sixth semester students with clinical education experience completed the questionnaire on the university campus after the end of one of their classes and seventh and eighth semester students were invited to the faculty office to fill out the questionnaire, since they attended different courses.

Research Instruments

One of the data collection tools was a demographic information form to be filled out by nursing undergraduates. The form comprised the variables of age, gender, semester and items related of interest in the profession, membership in the Iranian Nursing Organization and the individuals who would affect the professionalism of nurses.

Another tool used to gather data was the Inventory to Measure Professional Attitudes in Student Nurses (IPASN). This scale measured nursing undergraduates’ attitudes towards professionalism and its levels. It is the only tool that is available to measure nursing undergraduates’ attitudes towards professionalism and was first devised by Hisar F et al., [4] and developed by Çelik B et al., [10]. This scale consists of 28 items grouped according to eight different factors based on the five-point Likert scale. Eight different factors of professional attitude included in this inventory are contribution to the increase in scientific information load (6 items), autonomy (3 items), collaboration (5 items), competence and continuous education (3 items), participation in professional organisations and professional development (3 items), working in committees (2 items), community service (3 items), and ethical codes and theory (3 items). The questions were answered based on a five-point Likert scale (1=completely disagree, 2=disagree, 3=no idea, 4=agree, 5=completely agree). The scale was translated into Persian after getting permission from the authors. Then, its validity was tested with the participation of 10 nursing lecturers. After some revisions, the internal consistency of the inventory was measured to be 0.96 using Cronbach’s Alpha. The reliability was calculated using test-retest with an interval of ten days and the Pearson’s coefficient of correlation was 0.81.

Data Analysis

Data analysis was carried out using descriptive and inferential statistics through SPSS 18, while p<0.05 was considered significant.

Research Ethics

The present study was conducted after getting permission from the Committee of Research at Ilam University of Medical Sciences in accordance with the ir.medilam.rec.1394.85 ethical code. The affiliated departments in the faculty of nursing and midwifery also agreed with the performance of the project.


The nursing students were within the age range of 19-45 with the mean and standard deviation of 22.71±3.13. The majority of the participants (60.5%) were female, 88.6% were single, 65.8% said they were interested in the nursing profession, the majority of them (69.3%) lived in the dormitory, 60.52% said that the nursing educators had been effective in their Professionalism and 15.8% considered the nursing personnel as the most influential factor in their professionalism. Only 13.16% of the subjects were members of the Iranian Nursing Organization [Table/Fig-1].

Demographic variables for the nursing students participating in the study.

Age (years)Minimum: 19Mean: 22.71Standard deviation: 3.13
Maximum: 45
Marital statusMarried1311.4
SemesterFourth to sixth7868.4
seventh and eighth3631.6
Interest in the nursing professionYes7565.8
Place of residenceDormitory7969.3
With the family3026.32
Friend’s home32.63
Membership in the Iranian Nursing OrganizationYes1513.16
Individuals and factors that affect professionalismNursing educators6960.52
Nursing personnel1815.80
Hospital clinical environment2723.68

Mean and standard deviation for the total professional attitude score was 91.01±15.7. Mean scores on different factors are given in [Table/Fig-2].

Mean scores for different factors of the professional attitude among the nursing students.

Professional attitudeRangeMean±Standard deviation
Total professional attitude28-14091.01±15.7
Contribution to the increase of scientific information load6-3015.97±3.35
Competence and continuous education3-159.76±2.51
Participation in professional organizations and professional development3-159.61±2.17
Working in committees2-106.85±1.82
Community service3-1510.93±2.74
ethical codes and theory3-1510.73±2.55

There is a significant relationship between the total professional attitude score and the semester (p<0.01) and gender (p<0.003). However, there is no statistically significant relationship between the variables of interest in the nursing profession and age and the total professional attitude score (p>0.05) [Table/Fig-3].

The relationship between Professional Attitude Score and demographic characteristics.

VariablesProfessional Attitude Score Mean (SD)p-value
GenderMale96.4 (16.3)0.003
Female87.5 (14.4)
Age (years)-22.7 (3.2)0.31
Semester≤493.3 (15.6)0.01
5-692.1 (14.7)
≤780.1 (19.7)
Interest in the nursing professionYes92.4 (14.8)0.4
No89 (20.5)


This study was conducted to determine the professional attitude in Iranian Nursing Students. The results of the study showed the 39.5% and 60.5% of students were male and female, respectively. The results also showed that 65.8% of the students were interested in the nursing profession.

Nursing students stated that nursing educators and the nursing personnel had the highest effects on their professionalism, respectively. The role of nursing educators seems to be particularly important in this regard [7], and it can be said that any kind of shortcoming or negligence on the part of the educators might have detrimental effects on the process of professionalism. Elahi N et al., consider scientific and practical weaknesses of nursing educators as obstacles in front of the nursing students to gain competency and become professional [8].

In addition to educators, nurses with clinical experiences also play an important role in the professionalism of the nursing students. Undoubtedly, a nurse’s positive or negative attitude can also affect the attitudes of nursing students. The results of the previous studies [2,15] show that the years of working experience acquired as a nurse are significantly related to professionalism. Altiok HO et al., carried out a qualitative study about the meaning of professionalism for the nursing students and concluded that the awareness of educators, nurses and other team members regarding the importance of their roles, their relationships with the nursing students, the status of the role model and the clinical environment were the factors related to the development of a professional identity in nursing students [16].

Professionalism has some particular aspects. One of the important aspects of professional attitude in nursing students is the academic load of the students. This aspect got the mean score of 15.97±3.35 in this study. When the students are encouraged in the process of learning and participate in this process actively, they can develop a professional identity in a much more efficient manner [17]. A factor that can contribute the academic load of the students is giving them feedback on their performance. In this regard, Anderson EE et al., stated that educators and trainers’ provision of feedback can lead to an increase in the nursing students’ self-confidence, autonomy and professionalism [18].

Another important aspect of professionalism in nursing is professional autonomy. The evidence indicates that the level of autonomy among nurses and nursing students is low. A study conducted about professional autonomy among students of medical sciences who were in their fourth year of education showed that the students of midwifery, medicine and nursing got the highest scores regarding professional autonomy, respectively [19].

In gaining professional autonomy, nurses face challenges such as a vague definition of autonomy, use of inappropriate tools to measure autonomy, lack of a theory related to nursing autonomy, improper education for the nursing students and emphasis on traditional training on the part of the educators, failure in cooperation and teamwork, lack of support on the part of the administrators and inappropriate management structure [20]. Doing autonomous professional activities is an important criterion that must be paid attention to by nurses and nursing students [21]. Howkins EJ et al., focused on the importance of political awareness and teamwork in the definition of professionalism [21].

Nursing students are also willing to perform autonomous activities. One of the these in the study of Altiok HO et al., was taking care of a patient by the nursing students only, particularly when they gave that care without an educator’s supervision [16]. This was exactly what gave them a sense of competence and professionalism. Anderson EE et al., also stated that when nursing students operate independently of their educators, they feel they are real nurses and have better relationship with their patients [18].

Collaboration has also been recognised as an aspect of professionalism. Collaboration and teamwork are essential elements in nursing [22] and increase in collaboration among nurses is a critical factor and a key strategy that helps maintain a safe and effective clinical environment [23]. However, there are several challenges in the area of collaboration among nurses and nursing students [24]. The results of this study showed a high mean score of 15.97±3.35 from the viewpoint of students, indicating that they are willing to collaborate and participate in teamwork. However, collaboration is something that must be taught to the nursing students [24]. Collaboration is in fact a two-way process, and all clinical teams should provide nursing students with their full support and assistance. The clinical staff should trust the nursing students and collaborate with them. From the view of nursing students and nursing educators, low collaboration on the part of the clinical staff is one of the internship problems [25].

Providing patients with knowledge-based care is an important and influential aspect of nursing students’ professionalism. Kapborg I et al., stated that when nursing students give clinical care with awareness, they create a sense of being useful [26]. Andersson EP also argued that power of knowledge is very valuable in nursing students’ understanding of professionalism [27]. In fact, assuming responsibility for their actions enables nursing students to feel competent and strong [28].

Yet another important aspect of professionalism is membership in professional organizations [29]. In this study, few students of nursing (13.16%) were members of the Iranian Nursing Organization. Considering the age of the Iranian Nursing Organization and the role it plays in the professionalism of nurses, a small number of nurses are members of this organization. In a study carried out by Wynd CA, few nurses were members of professional organizations such as ANA, but the same small number got higher scores in regard with professionalism [2].

One other significant aspect of professionalism is participation in teamwork. Team membership, participation in the processes of care-giving and working like a nurse are important concepts in the experience of professionalism among nursing students [16]. Team membership contributes to the increase in self-confidence and autonomy and improves relationships with others, i.e., develops abilities necessary to participate in teamwork. The results of a study by Bradbury-Jones C et al., also showed that students’ collaboration with nurses and their participation in teamwork help them feel empowered [28].

According to the definition of nursing, one major role of the nurses in a society is the provision of social value. Although the social value aspect of professionalism was only measured through three items in this study, the higher-than-average score on this aspect showed that the participants in the study were willing to provide social value. As a matter of fact, not only do nurses have a responsibility to take care of patients, but also they play an important role in the rehabilitation of the sick people and well-being of the healthy individuals.

An important and valuable aspect of professionalism is observance of the code of ethics; a topic taken into account by previous studies. Wade GH refers to defending the patients’ rights as one of the responsibilities of a professional nurse [30]. In fact, a very important dimension of professional nursing is the nurse’s awareness of ethical and legal responsibilities [26]. Nurse’s awareness of these rules is required and helps them give better and more appropriate care based on a set of principles. It also prevents them from having to get involved in the legal cases related to the patients’ rights or issues of forensic medicine.


A limitation of the study is that the sample was selected from only one university. Conducting research projects with larger sample size at a national level can lead to better results regarding the problems of professionalism.


In this study, nursing students were at an average level of professionalism. Professionalism requires more focused attention and taking firmer steps. Undoubtedly, the first stage of professionalism for nurses is their course of education as university undergraduates. Being aware of the nursing students’ attitudes and behaviours can contribute to the recognition of their potential problems in professionalism.


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