From “Outsider” to “Anchor”: A Qualitative Descriptive Study of Male Nursing Students’ Professional Identity Construction During Clinical Internships in China

From “Outsider” to “Anchor”: A Qualitative Descriptive Study of Male Nursing Students’ Professional Identity Construction During Clinical Internships in China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article From “Outsider” to “Anchor”: A Qualitative Descriptive Study of Male Nursing Students’ Professional Identity Construction During Clinical Internships in China Kaiyun Liu, Chengye Su, Guangpeng Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8295520/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background: Despite the global increase in men entering nursing, they remain a minority in a female-dominated profession. The clinical internship is a pivotal period for professional socialization, yet the nuanced process of how male students negotiate their identity within the specific cultural context of China remains under-explored. Objective: To explore the adaptation process, challenges, and professional identity construction of male nursing students during their clinical internships in China. Design : A qualitative descriptive study underpinned by a constructivist paradigm. Methods: Semi-structured interviews were conducted between November 2024 and March 2025. Data were analyzed using Reflexive Thematic Analysis. The study is reported in accordance with the Reflexive Thematic Analysis Reporting Guidelines (RTARG). Results: Three themes were constructed: 1) The Crucible of Practice, describing the profound shock of navigating the theory-practice gap and complex emotional labor; 2) The Double-Edged Sword of Gender, highlighting how students navigated gender stereotypes that simultaneously restricted their learning opportunities yet offered advantages in employability and physical resilience; and 3) From Adversity to Pragmatism, revealing a shift from idealistic expectations to a grounded, strategic career outlook. Conclusion : Clinical internship serves as a transformative crucible where male nursing students actively renegotiate their professional identity. Rather than being passive victims of gender bias, they strategically leverage their gendered status to find a "niche" in the profession. Educators and managers should provide targeted support to help them navigate gendered barriers while reinforcing their unique professional value. Male nurses Clinical internship Professional identity Reflexive thematic analysis Qualitative descriptive study Gender Figures Figure 1 Introduction Nursing has historically been socially constructed as a female-dominated profession, a gender stereotype that persists globally[ 1 , 2 ]. However, as healthcare needs grow increasingly complex, the value of gender diversity in the nursing workforce is gaining recognition. Evidence suggests that increasing male participation not only alleviates workforce shortages but also optimizes team dynamics and enhances patient care quality[ 3 ]. In China, aligning with these global trends, the enrollment of male students in nursing programs has risen significantly in recent years. Yet, despite this quantitative increase, men remain a distinct minority, navigating a professional landscape that is structurally and culturally feminized[ 4 ]. The transition from student to professional nurse is pivotal, and the clinical internship serves as the critical "liminal space" for this transformation [ 5 , 6 ]. This period is not merely about the acquisition of technical skills; it is a profound process of professional socialization where students internalize the values, norms, and identity of the profession [ 7 ]. For nursing students, the internship is often characterized by the "reality shock" of bridging the theory-practice gap and managing high-stakes interpersonal dynamics[ 8 , 9 ]. For male nursing students, this socialization process is fraught with additional complexity. They must negotiate their professional identity at the intersection of two conflicting scripts: the professional mandate of "caring" (often coded as feminine) and societal expectations of "hegemonic masculinity" (typically associated with stoicism, dominance, and technical mastery)[ 10 ]. This tension is particularly acute in the Chinese context, where traditional patriarchal norms and Confucian values deeply influence gender roles. Male students often face a "double bind": they are expected to succeed in a female-dominated hierarchy while simultaneously grappling with external societal stigma that questions their masculinity and career choice [ 11 , 12 ]. They may be stereotyped as "muscle labor" or experience barriers in accessing certain clinical experiences, such as obstetrics, which can hinder their holistic development. Existing literature has extensively documented the barriers facing men in nursing. Quantitative studies have identified factors such as lack of role models, gender-based discrimination, and isolation as primary stressors[ 1 ]. Qualitative inquiries have provided descriptive accounts of these challenges, highlighting experiences of being mistaken for doctors or feeling excluded from the "sisterhood" of nursing teams [ 4 ]. However, much of this research tends to present a static "inventory of barriers," portraying male students primarily as passive victims of a biased system. What remains under-explored is the dynamic agency of these students. How do they actively negotiate, resist, or reframe these gendered challenges during the intense pressure of clinical internships? How do they leverage their specific gendered traits to construct a viable professional identity amidst cultural adversity? Understanding this nuanced process of "becoming" is crucial, as the internship experience is often the deciding factor in their long-term retention in the profession[ 12 ]. Therefore, this study adopts a qualitative descriptive approach to move beyond identifying "what the problems are" to exploring "how students navigate them." By centering the authentic voices of male nursing students in China, we aim to systematically analyze their adaptation strategies and the dynamic trajectory of their professional identity construction. This inquiry seeks to provide educators and clinical managers with actionable insights to support male students in transforming from marginalized "outsiders" to resilient "anchors" of the nursing workforce. Methods Study design This study employed a qualitative descriptive design[13, 14], situated within a constructivist paradigm. Qualitative description is the methodology of choice when the goal is to provide a comprehensive, low-inference summary of events in the everyday terms of those events, staying close to the data while allowing for interpretative depth[15]. This approach aligns with our objective to capture the straightforward yet nuanced lived experiences of male nursing students without imposing a restrictive theoretical framework. Reflexive Thematic Analysis (RTA)[16] was utilized as the method for data analysis. The reporting of this study adheres to the Reflexive Thematic Analysis Reporting Guidelines (RTARG)[17]. Participants and Sampling Participants were recruited between November 2024 and March 2025 using purposive sampling to identify "information-rich" cases. We targeted male nursing students from multiple clinical teaching hospitals affiliated with a major university in China. Inclusion criteria were: (1) male gender; (2) currently enrolled undergraduate nursing student; (3) completion of at least six months of clinical internship (to ensure sufficient depth of experience); and (4) willingness to articulate their experiences. Thirteen students (N=13) participated. Sample size was determined not by "saturation"—a concept problematic in reflexive analysis—but by information power [18], ensuring sufficient breadth and depth to construct meaningful themes. Data Generation Semi-structured, face-to-face individual interviews were conducted by the first author, who has training in qualitative inquiry. The interview guide (see Supplementary File 1) was designed to elicit detailed narratives regarding the internship journey, focusing on moments of conflict, adaptation, and identity formation. Questions included: "Can you describe a moment during your internship where you felt your gender played a significant role?" and "How has this internship changed your view of nursing as a career?" Interviews lasted 45–60 minutes, were audio-recorded with consent, and transcribed verbatim. Field notes were taken to capture contextual nuances. Data analysis Data were analyzed following the six phases of Reflexive Thematic Analysis[16, 19]: (1) Familiarization: Immersion in the data through repeated reading of transcripts；(2) Coding: Systematic, inductive coding of the entire dataset, focusing on both semantic (explicit) and latent (conceptual) meanings regarding professional identity and gender; (3) Constructing Themes: Collating codes to identify patterns of shared meaning, moving beyond topic summaries to conceptual stories (e.g., "The Double-Edged Sword"); (4) Reviewing Themes: Checking candidate themes against the dataset for coherence and distinctiveness; (5) Defining and Naming Themes: Refining the essence of each theme; (6) Producing the Report: Weaving data extracts with analytic narrative. NVivo 14 software facilitated data management, but the interpretative work was driven by the researchers. Quality and Trustworthiness We adhered to quality criteria appropriate for "Big Q" qualitative research[20]. (1) Reflexivity: The research team engaged in continuous reflexive dialogue to reflect on how our own gender and professional positions might influence the interview dynamic and data interpretation. (2) Methodological Coherence: We ensured alignment between our constructivist stance, the qualitative descriptive design, and the analytical procedures. (3) Thick Description: We provided detailed accounts of the context and participants to facilitate transferability. (4) Audit Trail: A record of analytical decisions was maintained to demonstrate rigor. Ethics The study was approved by the Ethics Committee of Shandong First Medical University (Approval No. R202410160298). Written informed consent was obtained from all participants. Confidentiality was ensured by anonymizing transcripts and using pseudonyms in all reports. Results Participant characteristics Thirteen male nursing students participated in the study. All were undergraduate students from a medical university in China, aged 22 to 23 years. To maintain anonymity, participants are identified by codes P1 through P13 based on the interview sequence. Detailed demographic information is provided in Table 1. Table 1. Demographic Characteristics of Participants ID Age Group Education Level Hometown P1 18-20 Undergraduate Tianjin P2 21-23 Undergraduate Tai'an P3 21-23 Undergraduate Binzhou P4 21-23 Undergraduate Weifang P5 21-23 Undergraduate Tianjin P6 21-23 Undergraduate Tai'an P7 21-23 Undergraduate Binzhou P8 21-23 Undergraduate Binzhou P9 21-23 Associate Jinan P10 18-20 Associate Jinan P11 21-23 Associate Tai'an P12 21-23 Associate Jinan P13 21-23 Associate Jinan Thematic overview Through reflexive thematic analysis, we constructed three overarching themes that capture the trajectory of male nursing students' professional identity formation: (1) The Crucible of Practice, (2) The Double-Edged Sword of Gender, and (3) From Adversity to Pragmatism. These themes do not represent a linear progression but rather intersecting dimensions of their lived experience, illustrating how they navigate the complex terrain of clinical reality. A visual representation of the thematic structure is presented in Figure 1. Theme 1: The Crucible of Practice: Navigating the Theory-Practice Chasm and Clinical Reality This theme encapsulates the profound cognitive and emotional restructuring students undergo upon entering the clinical environment. The internship acts as a "crucible" where idealized textbook knowledge clashes with the chaotic reality of hospital work, forcing a rapid adaptation to high-stakes responsibility. The Idealism of Theory vs. the Complexity of Practice Participants described a jarring disconnect between the linear, standardized procedures taught in classrooms and the dynamic, multitasking nature of clinical practice. The transition required them to shift from a "single-threaded" learning mode to simultaneously managing documentation, technical procedures, and patient interaction. This gap was often experienced as a sense of unpreparedness. "I feel that a lot of theoretical knowledge just stays on paper or in books. [In reality], it's completely different." [P1] "After entering clinical work, I discovered that the job of a male nurse isn't just about giving injections or dispensing medicine; it actually requires a more complete and systematic set of skills." [P12] Navigating Trust Deficits in Interpersonal Communication As male interns, participants faced a "trust deficit" from patients and families. Unlike the idealized "humanistic care" models, real-world communication often involved managing skepticism, non-cooperation, or even hostility. Students described the emotional labor required to proactively "earn" trust, moving beyond their technical competence to prove their reliability. "You'll still encounter some patients who look down on us interns, won't let us do anything, or won't give us a pleasant look." [P3] "One parent got annoyed... he was yelling at my colleague. My colleague felt very wronged, and I also thought that parent was being quite unreasonable." [P11] Emotional and Ethical Shocks: Confronting Fragility The internship exposed students to the raw vulnerability of human life. Participants recounted vivid memories of trauma, death, and occupational hazards (e.g., needlestick injuries). These experiences triggered intense ethical reflection and emotional turmoil, ranging from helplessness to panic, which became pivotal moments in their maturation. "I saw a man lying on the hospital bed, covered in blood. At that moment, I just froze. I didn't know what to do." [P4] "That was the first time I saw a patient and felt so helpless... watching a life slowly fade away right in front of me. It really had a huge impact on me." [P12] "[After the needlestick injury]... your mood is very low... especially when you don't know the results, it's very unsettling." [P12] Theme 2: The Double-Edged Sword of Gender: Negotiating Role and Identity This theme highlights the paradoxical nature of being a male in a female-dominated profession. Gender acted as both a barrier and a resource—restricting learning opportunities in some contexts while providing distinct advantages in others. Restricted Access and the "Careless" Stereotype Gender bias manifested as operational restrictions, particularly in obstetrics and gynecology, where male students were often excluded from procedures to protect female patient privacy. Additionally, participants felt they had to work harder to overcome the stereotype that men are inherently "careless" or less suited for delicate nursing tasks. "During the month I interned in obstetrics, I basically couldn't perform any procedures; it was mostly our female classmates who did them for the mothers." [P9] "Especially when we rotated to a department like gynecology... there were many procedures we couldn't do, and you feel very awkward yourself." [P5] Instrumentalized Masculinity: The "Muscle" of the Ward Participants noted that their physical strength was often "instrumentalized" by the clinical team. While they accepted this role, they recognized that it sometimes reinforced a gendered division of labor where they were valued more for their "muscle" (e.g., lifting patients, moving equipment) than for their clinical acumen. "Male nursing students also took on some jobs with higher physical demands... the advantage [for the department] is quite significant." [P2] "So, compared to the female interns, the boys did a bit more physical work." [P4] The "Anchor" Effect: Resilience and Employability Conversely, participants perceived their gender as a distinct asset in high-pressure environments like the Emergency Department. They described themselves as being viewed as the "anchor" or backbone of the team—offering emotional stability, stress resilience, and rapid execution. This perception directly boosted their confidence in the job market, where they felt "sought after." "In the team, they can act as the physical backbone or a pillar of support, like the 'anchor' of the team." [P9] "Especially when a critically ill patient arrives for rescue, I feel that the male teachers... in terms of execution or reaction speed... are indeed a bit better." [P12] "Many hospitals are more willing to hire us boys." [P6] Theme 3: From Adversity to Pragmatism: Coping and Career Trajectories The final theme illustrates the dynamic evolution of the students' professional identity. It describes a shift from passive anxiety to proactive adaptation, culminating in a pragmatic, calculated approach to their future careers. Shifting from Passive to Proactive Agency Over time, participants developed strategies to overcome initial barriers. They shifted from being passive observers to active agents who sought out learning opportunities, asked questions, and demonstrated their competence to win over skeptical mentors and patients. "[Before] I didn't communicate with the teacher... Now, when I go to a new department... I proactively ask questions and how I can help." [P5] "I often tell the teacher, 'Teacher, if there's anything... let me do it.''" [P12] Identity in Flux: Between Idealism and Economic Reality Professional identity was not static but fluctuated between moments of profound pride and disillusionment. While successful patient interactions reinforced their sense of mission, low salary expectations and high workloads often reduced nursing to merely "a means of making a living." This duality reflects a pragmatic reconciliation with the profession's reality. "Through this internship experience, I have gained a deeper understanding... it's not just a job, but more of a responsibility." [P6] "Right now, I see being a nurse more as a means to make a living... as long as it makes money, that's enough." [P10] Calculated Career Planning The internship experience crystallized vague career aspirations into specific, pragmatic plans. Decisions were driven largely by the desire for stability in a volatile economic climate. Students strategically targeted departments or hospitals where they felt their gendered advantages would be maximized and their weaknesses minimized. "I try to avoid general wards... because I feel I still have some problems with patient communication." [P7] "In this broad economic climate, I think it's pretty good to be able to find a hospital job and enter society smoothly." [P12] Discussion This study utilized a qualitative descriptive approach to illuminate the clinical internship experiences of male nursing students in China. The findings construct a narrative of transformation: from the initial shock of the "crucible" to a strategic negotiation of gender roles, culminating in a pragmatic commitment to the profession. These results challenge the simplistic view of male nurses as mere victims of bias, revealing instead their dynamic agency in navigating a feminized professional landscape. The Internship as a Liminal Space: Cognitive and Emotional Socialization Our first theme, "The Crucible of Practice," underscores that the internship is not merely a venue for skill acquisition but a profound "liminal space" for professional socialization[ 5 ]. While the "theory-practice gap" is a universal phenomenon in nursing education[ 21 ], our analysis reveals that for male students, this gap is compounded by a specific "trust deficit." Unlike their female counterparts who are often culturally assumed to be "natural caregivers," male students must perform extra emotional labor to legitimate their presence and "earn" patient trust [ 22 ]. This aligns with Benner’s[ 23 ] framework but adds a gendered dimension: male novices must not only learn how to nurse but also learn how to be accepted as a nurse. The emotional shocks reported—trauma, helplessness, and ethical dilemmas—further catalyze this maturation, serving as critical incidents that force a shift from idealized student thinking to the resilience required of a practitioner. Negotiating Hegemonic Masculinity: The "Double-Edged Sword" The "Double-Edged Sword" theme offers a nuanced understanding of how gender operates in nursing. Participants faced structural barriers (e.g., exclusion from obstetrics) consistent with the concept of "role strain" in cross-gender professions[ 1 ]. However, crucially, they did not reject their masculinity to fit in; rather, they instrumentalized it. By accepting roles as the "muscle" or the "anchor", they engaged in what Butler[ 24 ] might describe as a "performative" negotiation of gender. They strategically aligned their professional identity with traditional masculine traits—strength, emotional stability, and technical competence (especially in ER/ICU settings)—to carve out a legitimate niche within the feminized hierarchy. This strategy allows them to resolve the "double bind" of their identity: remaining "men" while becoming "nurses"[ 24 , 25 ]. Pragmatic Realism: Agency Amidst Structural Constraints The final theme, "From Adversity to Pragmatism," reveals a distinct form of professional commitment. Unlike the vocational "calling" often associated with nursing history, these male students exhibited what we term "calculated pragmatism." Their decision to stay in nursing was often driven less by intrinsic passion than by extrinsic stability and employability in a volatile economic climate[ 26 ]. This finding offers a critical counter-narrative to studies linking low professional identity solely to turnover[ 27 ]. Our participants demonstrated that one can have a "wavering" identity yet a "stable" career plan. This pragmatic stance serves as a protective mechanism, allowing them to detach from the emotional exhaustion of the job while valuing its socioeconomic benefits. It suggests that retention strategies for men should perhaps focus less on "inspiring passion" and more on clear career pathways and stability[ 3 ]. Limitations and Implications for Future Research Consistent with the qualitative descriptive tradition, these findings offer a rich, context-specific account of a particular cohort in China and do not claim statistical generalizability. The sample was drawn from a single university system, potentially limiting the transferability to other regions with different cultural norms. Additionally, as a cross-sectional study, it captures a "snapshot" of identity formation. Future research should employ longitudinal designs to track how this "pragmatic" identity evolves as these men transition from students to registered nurses. To support this "anchor" of the future workforce, nursing educators should acknowledge the specific "trust deficit" male students face and provide communication training tailored to overcoming gender bias. Clinical managers should be wary of "instrumentalizing" male students solely for physical labor, ensuring instead that they receive equitable opportunities for holistic skill development. Finally, recognizing their pragmatic career motivations, retention policies should emphasize clear career progression pathways and the stability of the profession. Conclusion This study concludes that for male nursing students in China, the clinical internship is a transformative crucible that demands the active renegotiation of both professional and gender identities. Far from being passive recipients of socialization, these students exercise significant agency. They navigate the "double-edged sword" of their gender by strategically leveraging masculine stereotypes (e.g., physical strength, emotional stability) to secure a valued position within the healthcare team. Their ultimate commitment to nursing is characterized by a "calculated pragmatism"—a rational choice prioritizing stability and employability over idealized vocationalism. Abbreviations RTA Reflexive Thematic Analysis Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of Shandong First Medical University (Approval No. R202410160298). All methods were carried out in accordance with relevant guidelines and regulations, including the Declaration of Helsinki. Informed consent was obtained from all participants. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available due to participant privacy protection, but are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Supported by the Shandong First Medical University Teaching Reform Project (grant number: JXGGYJ-22243242) Authors' contributions ** L: Writing – original draft, Visualization, Investigation, Formal analysis, Data curation, Conceptualization. ** S: Formal analysis, Conceptualization. ** W: Writing – review & editing, Validation, Supervision. Acknowledgments The authors would like to thank all the participants who participated in the study. 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Supplementary Files SupplementaryFile1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 01 Feb, 2026 Reviewers agreed at journal 18 Jan, 2026 Reviewers agreed at journal 13 Jan, 2026 Reviewers invited by journal 07 Jan, 2026 Editor assigned by journal 05 Jan, 2026 Editor invited by journal 18 Dec, 2025 Submission checks completed at journal 18 Dec, 2025 First submitted to journal 18 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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08:47:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1062236,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8295520/v1/6c5391db-0520-4337-9849-a12fcf8479fa.pdf"},{"id":99879771,"identity":"81bc8093-e199-4346-8b94-dfb55fc61618","added_by":"auto","created_at":"2026-01-09 11:05:32","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":15048,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8295520/v1/ba4970c275f4472d628c80a0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eFrom “Outsider” to “Anchor”: A Qualitative Descriptive Study of Male Nursing Students’ Professional Identity Construction During Clinical Internships in China\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNursing has historically been socially constructed as a female-dominated profession, a gender stereotype that persists globally[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, as healthcare needs grow increasingly complex, the value of gender diversity in the nursing workforce is gaining recognition. Evidence suggests that increasing male participation not only alleviates workforce shortages but also optimizes team dynamics and enhances patient care quality[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In China, aligning with these global trends, the enrollment of male students in nursing programs has risen significantly in recent years. Yet, despite this quantitative increase, men remain a distinct minority, navigating a professional landscape that is structurally and culturally feminized[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe transition from student to professional nurse is pivotal, and the clinical internship serves as the critical \"liminal space\" for this transformation [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This period is not merely about the acquisition of technical skills; it is a profound process of professional socialization where students internalize the values, norms, and identity of the profession [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. For nursing students, the internship is often characterized by the \"reality shock\" of bridging the theory-practice gap and managing high-stakes interpersonal dynamics[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor male nursing students, this socialization process is fraught with additional complexity. They must negotiate their professional identity at the intersection of two conflicting scripts: the professional mandate of \"caring\" (often coded as feminine) and societal expectations of \"hegemonic masculinity\" (typically associated with stoicism, dominance, and technical mastery)[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This tension is particularly acute in the Chinese context, where traditional patriarchal norms and Confucian values deeply influence gender roles. Male students often face a \"double bind\": they are expected to succeed in a female-dominated hierarchy while simultaneously grappling with external societal stigma that questions their masculinity and career choice [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. They may be stereotyped as \"muscle labor\" or experience barriers in accessing certain clinical experiences, such as obstetrics, which can hinder their holistic development.\u003c/p\u003e \u003cp\u003eExisting literature has extensively documented the barriers facing men in nursing. Quantitative studies have identified factors such as lack of role models, gender-based discrimination, and isolation as primary stressors[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Qualitative inquiries have provided descriptive accounts of these challenges, highlighting experiences of being mistaken for doctors or feeling excluded from the \"sisterhood\" of nursing teams [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, much of this research tends to present a static \"inventory of barriers,\" portraying male students primarily as passive victims of a biased system.\u003c/p\u003e \u003cp\u003eWhat remains under-explored is the dynamic agency of these students. How do they actively negotiate, resist, or reframe these gendered challenges during the intense pressure of clinical internships? How do they leverage their specific gendered traits to construct a viable professional identity amidst cultural adversity? Understanding this nuanced process of \"becoming\" is crucial, as the internship experience is often the deciding factor in their long-term retention in the profession[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, this study adopts a qualitative descriptive approach to move beyond identifying \"what the problems are\" to exploring \"how students navigate them.\" By centering the authentic voices of male nursing students in China, we aim to systematically analyze their adaptation strategies and the dynamic trajectory of their professional identity construction. This inquiry seeks to provide educators and clinical managers with actionable insights to support male students in transforming from marginalized \"outsiders\" to resilient \"anchors\" of the nursing workforce.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a qualitative descriptive design[13, 14], situated within a constructivist paradigm. Qualitative description is the methodology of choice when the goal is to provide a comprehensive, low-inference summary of events in the everyday terms of those events, staying close to the data while allowing for interpretative depth[15]. This approach aligns with our objective to capture the straightforward yet nuanced lived experiences of male nursing students without imposing a restrictive theoretical framework. Reflexive Thematic Analysis (RTA)[16] was utilized as the method for data analysis. The reporting of this study adheres to the Reflexive Thematic Analysis Reporting Guidelines (RTARG)[17].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and Sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were recruited between November 2024 and March 2025 using purposive sampling to identify \u0026quot;information-rich\u0026quot; cases. We targeted male nursing students from multiple clinical teaching hospitals affiliated with a major university in China. Inclusion criteria were: (1) male gender; (2) currently enrolled undergraduate nursing student; (3) completion of at least six months of clinical internship (to ensure sufficient depth of experience); and (4) willingness to articulate their experiences.\u003c/p\u003e\n\u003cp\u003eThirteen students (N=13)\u0026nbsp;participated. Sample size was determined not by \u0026quot;saturation\u0026quot;\u0026mdash;a concept problematic in reflexive analysis\u0026mdash;but by information power [18], ensuring sufficient breadth and depth to construct meaningful themes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Generation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSemi-structured, face-to-face individual interviews were conducted by the first author, who has training in qualitative inquiry. The interview guide (see Supplementary File 1) was designed to elicit detailed narratives regarding the internship journey, focusing on moments of conflict, adaptation, and identity formation. Questions included: \u0026quot;Can you describe a moment during your internship where you felt your gender played a significant role?\u0026quot; and \u0026quot;How has this internship changed your view of nursing as a career?\u0026quot; Interviews lasted 45\u0026ndash;60 minutes, were audio-recorded with consent, and transcribed verbatim. Field notes were taken to capture contextual nuances.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed following the six phases of Reflexive Thematic Analysis[16, 19]:\u003c/p\u003e\n\u003cp\u003e(1) Familiarization: Immersion in the data through repeated reading of transcripts；(2) Coding: Systematic, inductive coding of the entire dataset, focusing on both semantic (explicit) and latent (conceptual) meanings regarding professional identity and gender; (3) Constructing Themes: Collating codes to identify patterns of shared meaning, moving beyond topic summaries to conceptual stories (e.g., \u0026quot;The Double-Edged Sword\u0026quot;); (4) Reviewing Themes: Checking candidate themes against the dataset for coherence and distinctiveness; (5) Defining and Naming Themes: Refining the essence of each theme; (6) Producing the Report: Weaving data extracts with analytic narrative.\u003c/p\u003e\n\u003cp\u003eNVivo 14 software facilitated data management, but the interpretative work was driven by the researchers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuality and Trustworthiness\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe adhered to quality criteria appropriate for \u0026quot;Big Q\u0026quot; qualitative research[20].\u003c/p\u003e\n\u003cp\u003e(1) Reflexivity: The research team engaged in continuous reflexive dialogue to reflect on how our own gender and professional positions might influence the interview dynamic and data interpretation.\u003c/p\u003e\n\u003cp\u003e(2) Methodological Coherence: We ensured alignment between our constructivist stance, the qualitative descriptive design, and the analytical procedures.\u003c/p\u003e\n\u003cp\u003e(3) Thick Description: We provided detailed accounts of the context and participants to facilitate transferability.\u003c/p\u003e\n\u003cp\u003e(4) Audit Trail: A record of analytical decisions was maintained to demonstrate rigor.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of Shandong First Medical University (Approval No. R202410160298). Written informed consent was obtained from all participants. Confidentiality was ensured by anonymizing transcripts and using pseudonyms in all reports.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipant characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThirteen male nursing students participated in the study. All were undergraduate students from a medical university in China, aged 22 to 23 years. To maintain anonymity, participants are identified by codes P1 through P13 based on the interview sequence. Detailed demographic information is provided in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1. Demographic Characteristics of Participants\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18.9911%;\"\u003e\n \u003cp\u003eID\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.365%;\"\u003e\n \u003cp\u003eAge Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32.3442%;\"\u003e\n \u003cp\u003eEducation Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.2997%;\"\u003e\n \u003cp\u003eHometown\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.9911%;\"\u003e\n \u003cp\u003eP1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.365%;\"\u003e\n \u003cp\u003e18-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3442%;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2997%;\"\u003e\n \u003cp\u003eTianjin\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.9911%;\"\u003e\n \u003cp\u003eP2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.365%;\"\u003e\n \u003cp\u003e21-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3442%;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2997%;\"\u003e\n \u003cp\u003eTai\u0026apos;an\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.9911%;\"\u003e\n \u003cp\u003eP3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.365%;\"\u003e\n \u003cp\u003e21-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3442%;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2997%;\"\u003e\n \u003cp\u003eBinzhou\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.9911%;\"\u003e\n \u003cp\u003eP4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.365%;\"\u003e\n \u003cp\u003e21-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3442%;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2997%;\"\u003e\n \u003cp\u003eWeifang\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.9911%;\"\u003e\n \u003cp\u003eP5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.365%;\"\u003e\n \u003cp\u003e21-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3442%;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2997%;\"\u003e\n \u003cp\u003eTianjin\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.9911%;\"\u003e\n \u003cp\u003eP6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.365%;\"\u003e\n \u003cp\u003e21-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3442%;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2997%;\"\u003e\n \u003cp\u003eTai\u0026apos;an\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.9911%;\"\u003e\n \u003cp\u003eP7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.365%;\"\u003e\n \u003cp\u003e21-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3442%;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2997%;\"\u003e\n \u003cp\u003eBinzhou\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.9911%;\"\u003e\n \u003cp\u003eP8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.365%;\"\u003e\n \u003cp\u003e21-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3442%;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2997%;\"\u003e\n \u003cp\u003eBinzhou\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.9911%;\"\u003e\n \u003cp\u003eP9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.365%;\"\u003e\n \u003cp\u003e21-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3442%;\"\u003e\n \u003cp\u003eAssociate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2997%;\"\u003e\n \u003cp\u003eJinan\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.9911%;\"\u003e\n \u003cp\u003eP10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.365%;\"\u003e\n \u003cp\u003e18-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3442%;\"\u003e\n \u003cp\u003eAssociate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2997%;\"\u003e\n \u003cp\u003eJinan\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.9911%;\"\u003e\n \u003cp\u003eP11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.365%;\"\u003e\n \u003cp\u003e21-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3442%;\"\u003e\n \u003cp\u003eAssociate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2997%;\"\u003e\n \u003cp\u003eTai\u0026apos;an\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.9911%;\"\u003e\n \u003cp\u003eP12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.365%;\"\u003e\n \u003cp\u003e21-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3442%;\"\u003e\n \u003cp\u003eAssociate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2997%;\"\u003e\n \u003cp\u003eJinan\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.9911%;\"\u003e\n \u003cp\u003eP13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.365%;\"\u003e\n \u003cp\u003e21-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.3442%;\"\u003e\n \u003cp\u003eAssociate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.2997%;\"\u003e\n \u003cp\u003eJinan\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eThematic overview\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThrough reflexive thematic analysis, we constructed three overarching themes that capture the trajectory of male nursing students\u0026apos; professional identity formation: (1) The Crucible of Practice, (2) The Double-Edged Sword of Gender, and (3) From Adversity to Pragmatism. These themes do not represent a linear progression but rather intersecting dimensions of their lived experience, illustrating how they navigate the complex terrain of clinical reality. A visual representation of the thematic structure is presented in Figure 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1: The Crucible of Practice: Navigating the Theory-Practice Chasm and Clinical Reality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme encapsulates the profound cognitive and emotional restructuring students undergo upon entering the clinical environment. The internship acts as a \u0026quot;crucible\u0026quot; where idealized textbook knowledge clashes with the chaotic reality of hospital work, forcing a rapid adaptation to high-stakes responsibility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Idealism of Theory vs. the Complexity of Practice\u003cbr\u003e\u003c/strong\u003eParticipants described a jarring disconnect between the linear, standardized procedures taught in classrooms and the dynamic, multitasking nature of clinical practice. The transition required them to shift from a \u0026quot;single-threaded\u0026quot; learning mode to simultaneously managing documentation, technical procedures, and patient interaction. This gap was often experienced as a sense of unpreparedness.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I feel that a lot of theoretical knowledge just stays on paper or in books. [In reality], it\u0026apos;s completely different.\u0026quot; [P1]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;After entering clinical work, I discovered that the job of a male nurse isn\u0026apos;t just about giving injections or dispensing medicine; it actually requires a more complete and systematic set of skills.\u0026quot; [P12]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNavigating Trust Deficits in Interpersonal Communication\u003cbr\u003e\u003c/strong\u003eAs male interns, participants faced a \u0026quot;trust deficit\u0026quot; from patients and families. Unlike the idealized \u0026quot;humanistic care\u0026quot; models, real-world communication often involved managing skepticism, non-cooperation, or even hostility. Students described the emotional labor required to proactively \u0026quot;earn\u0026quot; trust, moving beyond their technical competence to prove their reliability.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;You\u0026apos;ll still encounter some patients who look down on us interns, won\u0026apos;t let us do anything, or won\u0026apos;t give us a pleasant look.\u0026quot; [P3]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;One parent got annoyed... he was yelling at my colleague. My colleague felt very wronged, and I also thought that parent was being quite unreasonable.\u0026quot; [P11]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEmotional and Ethical Shocks: Confronting Fragility\u003cbr\u003e\u003c/strong\u003eThe internship exposed students to the raw vulnerability of human life. Participants recounted vivid memories of trauma, death, and occupational hazards (e.g., needlestick injuries). These experiences triggered intense ethical reflection and emotional turmoil, ranging from helplessness to panic, which became pivotal moments in their maturation.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I saw a man lying on the hospital bed, covered in blood. At that moment, I just froze. I didn\u0026apos;t know what to do.\u0026quot; [P4]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;That was the first time I saw a patient and felt so helpless... watching a life slowly fade away right in front of me. It really had a huge impact on me.\u0026quot; [P12]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;[After the needlestick injury]... your mood is very low... especially when you don\u0026apos;t know the results, it\u0026apos;s very unsettling.\u0026quot; [P12]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2: The Double-Edged Sword of Gender: Negotiating Role and Identity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme highlights the paradoxical nature of being a male in a female-dominated profession. Gender acted as both a barrier and a resource\u0026mdash;restricting learning opportunities in some contexts while providing distinct advantages in others.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRestricted Access and the \u0026quot;Careless\u0026quot; Stereotype\u003cbr\u003e\u003c/strong\u003eGender bias manifested as operational restrictions, particularly in obstetrics and gynecology, where male students were often excluded from procedures to protect female patient privacy. Additionally, participants felt they had to work harder to overcome the stereotype that men are inherently \u0026quot;careless\u0026quot; or less suited for delicate nursing tasks.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;During the month I interned in obstetrics, I basically couldn\u0026apos;t perform any procedures; it was mostly our female classmates who did them for the mothers.\u0026quot; [P9]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Especially when we rotated to a department like gynecology... there were many procedures we couldn\u0026apos;t do, and you feel very awkward yourself.\u0026quot; [P5]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstrumentalized Masculinity: The \u0026quot;Muscle\u0026quot; of the Ward\u003cbr\u003e\u003c/strong\u003eParticipants noted that their physical strength was often \u0026quot;instrumentalized\u0026quot; by the clinical team. While they accepted this role, they recognized that it sometimes reinforced a gendered division of labor where they were valued more for their \u0026quot;muscle\u0026quot; (e.g., lifting patients, moving equipment) than for their clinical acumen.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Male nursing students also took on some jobs with higher physical demands... the advantage [for the department] is quite significant.\u0026quot; [P2]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;So, compared to the female interns, the boys did a bit more physical work.\u0026quot; [P4]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe \u0026quot;Anchor\u0026quot; Effect: Resilience and Employability\u003cbr\u003e\u003c/strong\u003eConversely, participants perceived their gender as a distinct asset in high-pressure environments like the Emergency Department. They described themselves as being viewed as the \u0026quot;anchor\u0026quot; or backbone of the team\u0026mdash;offering emotional stability, stress resilience, and rapid execution. This perception directly boosted their confidence in the job market, where they felt \u0026quot;sought after.\u0026quot;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;In the team, they can act as the physical backbone or a pillar of support, like the \u0026apos;anchor\u0026apos; of the team.\u0026quot; [P9]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Especially when a critically ill patient arrives for rescue, I feel that the male teachers... in terms of execution or reaction speed... are indeed a bit better.\u0026quot; [P12]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Many hospitals are more willing to hire us boys.\u0026quot; [P6]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3: From Adversity to Pragmatism: Coping and Career Trajectories\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe final theme illustrates the dynamic evolution of the students\u0026apos; professional identity. It describes a shift from passive anxiety to proactive adaptation, culminating in a pragmatic, calculated approach to their future careers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eShifting from Passive to Proactive Agency\u003cbr\u003e\u003c/strong\u003eOver time, participants developed strategies to overcome initial barriers. They shifted from being passive observers to active agents who sought out learning opportunities, asked questions, and demonstrated their competence to win over skeptical mentors and patients.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;[Before] I didn\u0026apos;t communicate with the teacher... Now, when I go to a new department... I proactively ask questions and how I can help.\u0026quot; [P5]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I often tell the teacher, \u0026apos;Teacher, if there\u0026apos;s anything... let me do it.\u0026apos;\u0026apos;\u0026quot; [P12]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIdentity in Flux: Between Idealism and Economic Reality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProfessional identity was not static but fluctuated between moments of profound pride and disillusionment. While successful patient interactions reinforced their sense of mission, low salary expectations and high workloads often reduced nursing to merely \u0026quot;a means of making a living.\u0026quot; This duality reflects a pragmatic reconciliation with the profession\u0026apos;s reality.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Through this internship experience, I have gained a deeper understanding... it\u0026apos;s not just a job, but more of a responsibility.\u0026quot; [P6]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Right now, I see being a nurse more as a means to make a living... as long as it makes money, that\u0026apos;s enough.\u0026quot; [P10]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCalculated Career Planning\u003cbr\u003e\u003c/strong\u003eThe internship experience crystallized vague career aspirations into specific, pragmatic plans. Decisions were driven largely by the desire for stability in a volatile economic climate. Students strategically targeted departments or hospitals where they felt their gendered advantages would be maximized and their weaknesses minimized.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I try to avoid general wards... because I feel I still have some problems with patient communication.\u0026quot; [P7]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;In this broad economic climate, I think it\u0026apos;s pretty good to be able to find a hospital job and enter society smoothly.\u0026quot; [P12]\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study utilized a qualitative descriptive approach to illuminate the clinical internship experiences of male nursing students in China. The findings construct a narrative of transformation: from the initial shock of the \"crucible\" to a strategic negotiation of gender roles, culminating in a pragmatic commitment to the profession. These results challenge the simplistic view of male nurses as mere victims of bias, revealing instead their dynamic agency in navigating a feminized professional landscape.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003eThe Internship as a Liminal Space: Cognitive and Emotional Socialization\u003c/h2\u003e \u003cp\u003eOur first theme, \"The Crucible of Practice,\" underscores that the internship is not merely a venue for skill acquisition but a profound \"liminal space\" for professional socialization[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. While the \"theory-practice gap\" is a universal phenomenon in nursing education[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], our analysis reveals that for male students, this gap is compounded by a specific \"trust deficit.\" Unlike their female counterparts who are often culturally assumed to be \"natural caregivers,\" male students must perform extra emotional labor to legitimate their presence and \"earn\" patient trust [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This aligns with Benner\u0026rsquo;s[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] framework but adds a gendered dimension: male novices must not only learn how to nurse but also learn how to be accepted as a nurse. The emotional shocks reported\u0026mdash;trauma, helplessness, and ethical dilemmas\u0026mdash;further catalyze this maturation, serving as critical incidents that force a shift from idealized student thinking to the resilience required of a practitioner.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eNegotiating Hegemonic Masculinity: The \"Double-Edged Sword\"\u003c/h2\u003e \u003cp\u003eThe \"Double-Edged Sword\" theme offers a nuanced understanding of how gender operates in nursing. Participants faced structural barriers (e.g., exclusion from obstetrics) consistent with the concept of \"role strain\" in cross-gender professions[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, crucially, they did not reject their masculinity to fit in; rather, they instrumentalized it. By accepting roles as the \"muscle\" or the \"anchor\", they engaged in what Butler[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] might describe as a \"performative\" negotiation of gender. They strategically aligned their professional identity with traditional masculine traits\u0026mdash;strength, emotional stability, and technical competence (especially in ER/ICU settings)\u0026mdash;to carve out a legitimate niche within the feminized hierarchy. This strategy allows them to resolve the \"double bind\" of their identity: remaining \"men\" while becoming \"nurses\"[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003ePragmatic Realism: Agency Amidst Structural Constraints\u003c/h2\u003e \u003cp\u003eThe final theme, \"From Adversity to Pragmatism,\" reveals a distinct form of professional commitment. Unlike the vocational \"calling\" often associated with nursing history, these male students exhibited what we term \"calculated pragmatism.\" Their decision to stay in nursing was often driven less by intrinsic passion than by extrinsic stability and employability in a volatile economic climate[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This finding offers a critical counter-narrative to studies linking low professional identity solely to turnover[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Our participants demonstrated that one can have a \"wavering\" identity yet a \"stable\" career plan. This pragmatic stance serves as a protective mechanism, allowing them to detach from the emotional exhaustion of the job while valuing its socioeconomic benefits. It suggests that retention strategies for men should perhaps focus less on \"inspiring passion\" and more on clear career pathways and stability[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Implications for Future Research\u003c/h2\u003e \u003cp\u003eConsistent with the qualitative descriptive tradition, these findings offer a rich, context-specific account of a particular cohort in China and do not claim statistical generalizability. The sample was drawn from a single university system, potentially limiting the transferability to other regions with different cultural norms. Additionally, as a cross-sectional study, it captures a \"snapshot\" of identity formation. Future research should employ longitudinal designs to track how this \"pragmatic\" identity evolves as these men transition from students to registered nurses.\u003c/p\u003e \u003cp\u003eTo support this \"anchor\" of the future workforce, nursing educators should acknowledge the specific \"trust deficit\" male students face and provide communication training tailored to overcoming gender bias. Clinical managers should be wary of \"instrumentalizing\" male students solely for physical labor, ensuring instead that they receive equitable opportunities for holistic skill development. Finally, recognizing their pragmatic career motivations, retention policies should emphasize clear career progression pathways and the stability of the profession.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study concludes that for male nursing students in China, the clinical internship is a transformative crucible that demands the active renegotiation of both professional and gender identities. Far from being passive recipients of socialization, these students exercise significant agency. They navigate the \"double-edged sword\" of their gender by strategically leveraging masculine stereotypes (e.g., physical strength, emotional stability) to secure a valued position within the healthcare team. Their ultimate commitment to nursing is characterized by a \"calculated pragmatism\"\u0026mdash;a rational choice prioritizing stability and employability over idealized vocationalism.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eRTA Reflexive Thematic Analysis\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of\u0026nbsp;Shandong First Medical University (Approval No. R202410160298). All methods were carried out in accordance with relevant guidelines and regulations, including the Declaration of Helsinki. Informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to participant privacy protection, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSupported by the Shandong First Medical University Teaching Reform Project (grant number: JXGGYJ-22243242)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e** L: Writing \u0026ndash; original draft, Visualization, Investigation, Formal analysis, Data curation, Conceptualization.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e** S: \u0026nbsp;Formal analysis, Conceptualization.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e** W:\u0026nbsp;Writing \u0026ndash; review \u0026amp; editing, Validation, Supervision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the participants who participated in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eO\u0026apos;Lynn, C.E., \u003cem\u003eGender-based barriers for male students in nursing education programs: prevalence and perceived importance.\u003c/em\u003e J Nurs Educ, 2004. \u003cstrong\u003e43\u003c/strong\u003e(5): p. 229-36.\u003c/li\u003e\n\u003cli\u003eYang, C.I., et al., \u003cem\u003eThere is nothing wrong with being a nurse: The experiences of male nursing students in Taiwan.\u003c/em\u003e Jpn J Nurs Sci, 2017. \u003cstrong\u003e14\u003c/strong\u003e(4): p. 332-340.\u003c/li\u003e\n\u003cli\u003ePowers, K., et al., \u003cem\u003eThe Lived Experience of Being a Male Nursing Student: Implications for Student Retention and Success.\u003c/em\u003e J Prof Nurs, 2018. \u003cstrong\u003e34\u003c/strong\u003e(6): p. 475-482.\u003c/li\u003e\n\u003cli\u003eZhou, Y., et al., \u003cem\u003eMale nursing students\u0026rsquo; experiences of their clinical internships: A qualitative study.\u003c/em\u003e Heliyon, 2024. \u003cstrong\u003e10\u003c/strong\u003e(10): p. e31075.\u003c/li\u003e\n\u003cli\u003eSpouse, J., \u003cem\u003eBridging theory and practice in the supervisory relationship: a sociocultural perspective.\u003c/em\u003e J Adv Nurs, 2001. \u003cstrong\u003e33\u003c/strong\u003e(4): p. 512-22.\u003c/li\u003e\n\u003cli\u003eShoghi, M., et al., \u003cem\u003eStrategies for bridging the theory-practice gap from the perspective of nursing experts.\u003c/em\u003e Heliyon, 2019. \u003cstrong\u003e5\u003c/strong\u003e(9): p. e02503.\u003c/li\u003e\n\u003cli\u003eDinmohammadi, M., H. 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Qualitative study.\u003c/em\u003e Int J Nurs Stud, 2014. \u003cstrong\u003e51\u003c/strong\u003e(5): p. 752-60.\u003c/li\u003e\n\u003cli\u003eProsen, M., \u003cem\u003eNursing students\u0026apos; perception of gender-defined roles in nursing: a qualitative descriptive study.\u003c/em\u003e BMC Nurs, 2022. \u003cstrong\u003e21\u003c/strong\u003e(1): p. 104.\u003c/li\u003e\n\u003cli\u003eNie, S., et al., \u003cem\u003eThe Professional Identity of Nursing Students and Their Intention to Leave the Nursing Profession During the Coronavirus Disease (COVID-19) Pandemic.\u003c/em\u003e J Nurs Res, 2021. \u003cstrong\u003e29\u003c/strong\u003e(2): p. e139.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Male nurses, Clinical internship, Professional identity, Reflexive thematic analysis, Qualitative descriptive study, Gender","lastPublishedDoi":"10.21203/rs.3.rs-8295520/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8295520/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Despite the global increase in men entering nursing, they remain a minority in a female-dominated profession. The clinical internship is a pivotal period for professional socialization, yet the nuanced process of how male students negotiate their identity within the specific cultural context of China remains under-explored.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To explore the adaptation process, challenges, and professional identity construction of male nursing students during their clinical internships in China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e: A qualitative descriptive study underpinned by a constructivist paradigm.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Semi-structured interviews were conducted between November 2024 and March 2025. Data were analyzed using Reflexive Thematic Analysis. The study is reported in accordance with the Reflexive Thematic Analysis Reporting Guidelines (RTARG).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThree themes were constructed: 1) The Crucible of Practice, describing the profound shock of navigating the theory-practice gap and complex emotional labor; 2) The Double-Edged Sword of Gender, highlighting how students navigated gender stereotypes that simultaneously restricted their learning opportunities yet offered advantages in employability and physical resilience; and 3) From Adversity to Pragmatism, revealing a shift from idealistic expectations to a grounded, strategic career outlook.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Clinical internship serves as a transformative crucible where male nursing students actively renegotiate their professional identity. Rather than being passive victims of gender bias, they strategically leverage their gendered status to find a \"niche\" in the profession. Educators and managers should provide targeted support to help them navigate gendered barriers while reinforcing their unique professional value.\u003c/p\u003e","manuscriptTitle":"From “Outsider” to “Anchor”: A Qualitative Descriptive Study of Male Nursing Students’ Professional Identity Construction During Clinical Internships in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-09 11:05:28","doi":"10.21203/rs.3.rs-8295520/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-02T03:54:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"134549474403963118779202479768946871103","date":"2026-01-18T09:48:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"324454411099173434829236495082195438907","date":"2026-01-13T21:20:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-07T10:19:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-05T10:15:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-18T12:51:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-18T12:25:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-12-18T12:11:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f7ed76b2-9072-40ea-b19f-a776e56df0c1","owner":[],"postedDate":"January 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-09T11:05:28+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-09 11:05:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8295520","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8295520","identity":"rs-8295520","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}