Perceived social support and professional identity in nursing students during the COVID-19 pandemic era: The mediating effects of self-efficacy and the moderating role of anxiety

Background: Health professionals, including nurses, experienced heavy workloads and significant physical and mental health challenges during the coronavirus disease (COVID) 19 pandemic, which may affect career choices for those considering nursing and for nursing students. The COVID-19 pandemic is not only a period of risk, but also an occasion to redeploy the PI of nursing students. However, the relationship between PSS, SE, PI and anxiety remains unclear. This study aims to explore whether perceived social support (PSS) has an indirect effect on professional identity (PI) through mediation of self-efficacy (SE) and whether the anxiety can moderate the relationship between perceived social support and self-efficacy in nursing students during their internship period. Methods An observational, national cross-sectional study was conducted following the STROBE guidelines. An online questionnaire was completed by 2,457 nursing students from 24 provinces in China during their internship during September to October 2021. Measures included Chinese translations of the Professional Identity Questionnaire for Nursing Students, the Perceived Social Support Scale, the General Self-Efficacy Scale, the 7-item Generalized Anxiety disorder scale. Results Both PSS ( r  = 0.46, p < 0.001) and SE ( r  = 0.51, p < 0.001) were positively correlated with PI. The indirect effect of PSS on PI through SE was positive ( β  = 0.348, p  < 0.001), with an effect of 72.7%. The results of the moderating effect analysis showed that anxiety attenuated the effect of PSS on SE. Moderation models indicated that anxiety has a weak negative moderating effect on the effect of PSS on SE ( β  = − 0.0308, p  < 0.05). Conclusions A better PSS and higher scores in SE were associated with PI in nursing students, and a better PSS had an indirect effect on the PI of nursing students through SE. Anxiety played a negative moderating role in the relationship between PSS and SE.