Investigation and Analysis of the Employment Intentions of Undergraduate Nursing Interns after Graduation ()
1. Introduction
China faces a persistent shortage of nursing human resources. Although studies indicate that the equity of nurse allocation based on population distribution has been gradually improving over recent years, disparities in resource distribution across regions remain a critical concern [1]. Clinical internships are an essential component of medical education, serving as a vital bridge between theoretical knowledge acquired in academic settings and practical application in clinical environments. This phase plays a pivotal role in developing professional competencies, strengthening professional identity, and building confidence for future nursing practice. As nursing students transition into clinical settings, they gain deeper insights into hospital operations, organizational structures, and job responsibilities, all of which significantly influence their preparedness and overall internship experience.
Research indicates that nursing students often encounter considerable psychological stress during clinical training, which may lead to reduced satisfaction with their internships [2]. Furthermore, reports highlight a growing trend of “delayed employment” among nursing graduates, coupled with limited willingness to work at the grassroots level [3]. Professional identity among nursing students has been found to be relatively low and tends to decline following clinical exposure [4]. Specifically, only 23.98% of undergraduate nursing students express willingness to pursue careers in community nursing, primarily due to insufficient understanding of community-based roles, preferences for large hospitals, perceived low salaries, and limited career advancement opportunities [5]. Similarly, a survey revealed that merely 30.8% of vocational nursing students intend to return to their hometowns for employment, while 69.2% prefer working in more developed regions, reflecting a pronounced geographic imbalance in workforce distribution [6].
Clinical experiences can profoundly affect students’ mental health and professional perceptions. Studies have shown that nursing interns are susceptible to anxiety and depression following clinical practice, driven by workplace pressures, gaps in theoretical and practical competence, and adverse clinical incidents such as needlestick injuries or patient complaints [7]. These events not only trigger negative emotional responses—including fear and frustration—but also negatively impact students’ professional self-concept. Factors such as professional self-efficacy, perception of the hospital’s care environment, and intrinsic motivation toward nursing have been identified as key determinants influencing the professional identity of nursing interns [8].
While research on nursing education and employment intentions is increasingly reported in other parts of China, there remains a paucity of data regarding nursing students in underdeveloped regions of Guangxi. To address this gap, this study conducted a single-center cross-sectional survey at a hospital located in an underdeveloped area of Guangxi, China. Using a self-developed instrument—the “Questionnaire on Employment Intention of Undergraduate Nursing Interns After Graduation”—this research investigated the employment intentions of undergraduate nursing interns. The findings aim to provide evidence-based guidance for educational institutions and clinical supervisors in enhancing career counseling and clinical teaching strategies.
2. Objects and Methods
2.1. Research Object
This study was conducted in accordance with the principles of the Declaration of Helsinki. A cross-sectional study design was employed. A convenience sampling method was used to recruit 60 undergraduate nursing interns who met the predefined inclusion criteria from a tertiary hospital in Guangxi, China, between May 2025 and October 2025. Inclusion criteria were as follows: 1) enrollment in a full-time undergraduate nursing program; 2) currently undergoing clinical internship and capable of regular participation; 3) provision of informed consent and voluntary willingness to participate in the study. Exclusion criteria included: 1) prolonged leave of absence; 2) withdrawal from the academic program; 3) inability to complete clinical internship duties due to any medical or personal reasons.
2.2. Sample Size Estimation
This study aimed to explore the post-graduation employment intentions of undergraduate nursing students in Guangxi, China, specifically with regard to pursuing clinical nursing careers. To ensure statistical reliability, a cross-sectional design was employed, and sample size estimation was conducted in accordance with standard methods in medical statistics. Simple random sampling was applied, and the required sample size was determined using the following formula:
In this study, the significance level was set at α = 0.05 and the margin of error at δ = 0.1. Based on preliminary survey data, the estimated proportion was determined as p = 0.8. According to official statistics released by the Education Department of the Guangxi Zhuang Autonomous Region, China, on May 21, 2025, the total number of undergraduate nursing graduates in Guangxi in 2025 is projected to be approximately 10,000. Thus, the population size N was set to 10,000. Substituting these values into the sample size formula yielded a calculated sample size of n = 59. To ensure sufficient representation, the final sample size was rounded up to 60 cases.
2.3. Research Methods
2.3.1. Literature Review Method
A comprehensive literature review was conducted through multiple sources, including academic books from university libraries, online databases such as CNKI, Wanfang, PubMed, and VIP (Chinese Science and Technology Journal Database). The search focused on domestic and international studies concerning the post-graduation employment intentions of medical students. Based on a systematic analysis and synthesis of the collected literature, the research topic was finalized.
2.3.2. Research Instruments
1) General Information Questionnaire: A self-developed instrument comprising 5 items, including gender, place of residence, and whether the participant is an only child. The detailed content of the questionnaire is presented in Table 1.
2) The Employment Intention Survey Form for Undergraduate Nursing Interns After Graduation was developed based on a comprehensive review of relevant literature and expert consultation. Following an iterative process of revision and refinement, the instrument underwent a pilot test with 30 participants who met the inclusion criteria. The feasibility and practical applicability of the questionnaire were confirmed through this pre-test, leading to the establishment of the final version. The finalized survey comprises six items in total: Items 1, 4, and 6 are single-choice questions, whereas Items 2, 3, and 5 are multiple-choice questions. The questionnaire utilized in this study consists of unordered multiple-choice questions. As such, reliability analysis is typically not performed on non-scale data. The detailed content of the questionnaire is presented in Table 2.
2.3.3. Questionnaire Collection Methods
The participants completed the questionnaire online. Participants independently completed the survey online, with an average completion time of approximately five minutes. The system backend performed quality control checks on responses, screened for valid submissions, and facilitated data collection, statistical processing, and preliminary analysis to ensure both the authenticity of the collected information and the timeliness of data retrieval.
2.3.4. Statistical Analysis Methods
Data were collected through an online questionnaire administered via the Wenjuanxing platform. The collected data were then organized and analyzed using SPSS software. Descriptive statistics, including rates and percentages, were employed to summarize and interpret the survey results.
3. Results
3.1. General Information of the Survey Subjects
The results are presented in Table 1. A total of 60 questionnaires were distributed in this survey, and all 60 valid responses were successfully collected, yielding a 100% response rate. Among the participants, 95% identified as female and 5% as male. With regard to family residence, the distribution was as follows: urban areas (40%), townships (38.3%), and rural areas (21.7%). Furthermore, 83.3% of the nursing students reported that they are not only children. With respect to parental occupation, 90% of the caregivers indicated employment in fields unrelated to healthcare, while only 10% had at least one parent working in a medical profession. Household income levels were categorized as follows: medium (51.7%), upper-middle (23.3%), lower-middle (13.3%), and low-income (11.7%).
Table 1. General information of the respondents.
Variable |
Classification |
Frequency |
Percentage (%) |
Gender |
Male |
3 |
5 |
Female |
57 |
95 |
Family residence |
City |
24 |
40 |
Township |
23 |
38.3 |
Rural regions |
13 |
21.7 |
Whether the individual is an only child |
Is |
10 |
16.7 |
No |
50 |
83.3 |
Whether one of the parents is employed in a profession related to healthcare or nursing |
Is |
6 |
10 |
No |
54 |
90 |
Household income (CNY/month) |
Abundance (>20,000) |
0 |
0 |
Above-average performance level (15,000 - 20,000) |
14 |
23.3 |
Moderate level (10,000 - 14,999) |
31 |
51.7 |
Lower-middle level (5000 - 9999) |
8 |
13.3 |
Poverty (<5000) |
7 |
11.7 |
3.2. Survey Results on Employment Intentions of Undergraduate Nursing Interns after Graduation
The survey findings are presented in Table 2. Among the research participants, 60% indicated a willingness to engage in clinical nursing work upon graduation, 20% expressed unwillingness, and 20% reported being undecided at this time. The primary reasons for willingness to engage in clinical nursing, ranked in descending order, include job stability (83.33%), ample career development opportunities (55.56%), favorable welfare benefits (38.9%), challenging nature of the work (36.1%), improved social recognition (25%), a conducive working environment (16.7%), the meaningfulness of the profession (13.9%), and other factors (5.6%). Conversely, the main reasons for unwillingness to enter clinical nursing after internship, also listed in order of prevalence, are shift work with irregular schedules (91.6%), complicated nurse-patient relationships (83.3%), high levels of work-related stress (66.7%), heavy and demanding workloads (58.3%), occupational risks (50%), difficulties in professional advancement (25%), and other miscellaneous reasons (16.7%). Notably, half of the respondents indicated that they might still opt for clinical nursing out of necessity if no better alternatives were available. However, the remaining half firmly stated they would not. Regarding their initial motivation for choosing the nursing major, 75% cited ease of employment as the primary factor, 60% acknowledged it was due to not being admitted into clinical medicine programs and thus accepting nursing as an alternative, and 25% attributed their decision to parental or familial guidance. When asked, “If you could choose again, would you still study nursing?”, 80% responded affirmatively, 16.7% answered negatively, and 3.3% remained uncertain.
Table 2. Survey results on post-graduation practice intentions of undergraduate nursing interns.
Issue |
Frequency |
Percentage % |
1. Would you like to pursue clinical nursing work after graduation? (Single-choice question. This question includes skip logic: selecting “Yes” will direct you to question 2 and bypass questions 3 and 4; selecting “No” will allow you to skip question 2; selecting “Uncertain” will allow you to skip questions 2 and 3) |
|
|
Is |
36 |
60 |
No |
12 |
20 |
Uncertain |
12 |
20 |
2. What factors contribute to your willingness to pursue clinical nursing practice after graduation? (Multiple-choice question) (n = 36) |
|
|
A stable position with long-term employment prospects |
30 |
83.3 |
There is significant potential for development |
20 |
55.6 |
Comprehensive welfare benefits package |
14 |
38.9 |
The task presents a significant level of challenge, requiring careful planning and dedicated effort to achieve successful outcomes |
13 |
36.1 |
Enhancement of social status |
9 |
25 |
Favorable working environment |
6 |
16.7 |
Work holds significant meaning and contributes to personal fulfillment and societal development |
5 |
13.9 |
Others |
2 |
5.6 |
3. What factors contribute to your reluctance to pursue clinical nursing roles after graduation? (Multiple-choice question) (n = 12) |
|
|
Operate on a three-shift rotation system with an irregular work schedule |
11 |
91.6 |
Complex nurse-patient relationships |
10 |
83.3 |
High levels of work pressure |
8 |
66.7 |
The workload is substantial and complex |
7 |
58.3 |
There are inherent risks associated with the job |
6 |
50 |
Challenges in Professional Title Advancement |
3 |
25 |
Others |
2 |
16.7 |
4. If no employment opportunity offers better cost-effectiveness and overall advantages compared to clinical nursing, would you choose to remain in the nursing profession for the sake of job stability and livelihood? (n = 12) |
|
|
Is |
6 |
50 |
No |
6 |
50 |
Uncertain |
0 |
0 |
5. What were the primary motivations for initially choosing to pursue a degree in nursing? (Multiple-choice question) (n = 60) |
|
|
It is relatively straightforward to secure employment |
45 |
75 |
I was unable to gain admission to the clinical medicine program, so I opted for my second-choice major |
36 |
60 |
Adhere to the guidance and arrangements provided by your parents or elders |
15 |
25 |
Others |
2 |
3.3 |
6. If you were given another opportunity to choose your academic major, would you still opt for nursing? (Single-choice question) (n = 60) |
|
|
Is |
48 |
80 |
No |
10 |
16.7 |
Uncertain |
2 |
3.3 |
4. Discussion
4.1. General Data Analysis of the Research Subjects (Table 1)
The study population was predominantly female (95%), with males accounting for only 5%, reflecting a significant gender imbalance. This finding suggests that women will continue to constitute the primary workforce in nursing and maintain a dominant presence in the profession, which aligns closely with the current gender distribution among clinical nurses in China. Existing research [9] indicates that male nurses experience higher levels of work-related stress and lower job satisfaction compared to their female counterparts. Therefore, nursing administrators should implement targeted strategies to address the key sources of occupational stress and factors influencing job satisfaction among male nurses. Such interventions are essential to enhance motivation, improve job satisfaction, and ensure the stability of the male nursing workforce. Furthermore, evidence from study [10] shows that overall nurse retention intentions are suboptimal, particularly among male nurses. Hospital management should recognize gender-specific differences and develop tailored intervention programs to strengthen retention rates across diverse nurse populations.
Among the research participants, 40% were from urban areas, 38.3% from towns and villages, and 21.7% from rural regions. The combined proportion of participants from towns, villages, and rural areas exceeds that from urban areas, suggesting a higher concentration of nursing students in non-urban settings. This distribution may be attributed to relatively lower household economic conditions in non-urban areas compared to urban centers, as well as the comparatively favorable employment prospects associated with the nursing discipline. Only 10% of the participants had parents employed in medical-related professions, indicating limited intergenerational occupational continuity within the healthcare field. Regarding household income, 51.7% reported a medium monthly income level, while a minority (23.3%) reported incomes above this level. These findings are largely consistent with the data on per capita disposable income of residents in Guangxi, released by the Development and Reform Commission of the Guangxi Zhuang Autonomous Region on April 3, 2025 [11].
4.2. Post-Graduation Employment Intentions of Undergraduate Nursing Interns (Table 2)
A low proportion of research participants expressed willingness to pursue clinical nursing roles after graduation. Among the respondents, 60% indicated an intention to work in clinical nursing upon graduation, 20% explicitly stated they would not, and another 20% remained undecided. These findings suggest that despite having completed training in nursing, a significant minority (20%) do not intend to enter clinical practice, while an additional fifth are uncertain about their future career paths. Consequently, only 60% of the student cohort are committed to pursuing careers aligned with their academic training. This trend raises concerns regarding potential shortages of clinical nursing personnel in the future. Administrators in educational institutions and supervisors at teaching hospitals should therefore prioritize enhancing students’ internship experiences by fostering supportive learning environments, improving job satisfaction during clinical placements, and ultimately strengthening post-graduation employment intentions among nursing interns.
4.2.1. Analysis of the Reasons Why Research Subjects Are Willing to Engage in Clinical Nursing Work
The primary factors influencing individuals’ willingness to engage in clinical nursing, ranked in descending order of importance, are job stability (83.33%), ample career development opportunities (55.56%), favorable welfare benefits (38.9%), work-related challenges (36.1%), enhanced social status (25%), a positive working environment (16.7%), the meaningfulness of the work (13.9%), and other reasons (5.6%). With the ongoing advancement of China’s aging society, the demand for geriatric care professionals is expected to rise significantly in the coming years, contributing to an increased prominence of home-based nursing services. Concurrently, the growing need for nurses specializing in personal care will create substantial career prospects for nursing students, further reinforcing their inclination toward clinical nursing careers. Salary levels and welfare packages serve as key indicators of human capital return on investment; occupations that offer relatively high returns with manageable entry costs are naturally more attractive, and nursing is increasingly perceived as such a profession. Furthermore, existing research [12] suggests that nursing education programs should adopt diversified teaching strategies, with an emphasis on fostering undergraduate students’ professional interest and continuously strengthening professional identity training, which plays a crucial role in promoting a positive and proactive development of nursing students’ professional self-concept.
4.2.2. Analysis of the Reasons Underlying Nursing Graduates’ Reluctance to Pursue Clinical Nursing Careers
The primary factors contributing to graduates’ reluctance to engage in clinical nursing following internship, ranked by prevalence, include shift work and irregular schedules (91.6%), complex nurse-patient relationships (83.3%), high work pressure (66.7%), heavy workload and cumbersome procedures (58.3%), occupational risks (50%), difficulties in professional title advancement (25%), and other miscellaneous reasons (16.7%). Nursing managers and departmental teaching supervisors should comprehensively understand interns’ intrinsic needs and practical experiences through multidimensional assessment. Efforts should be made to provide a supportive and positive working environment that strengthens nursing students’ professional commitment. It is recommended that during each one-month clinical rotation, one week be allocated for placement in specialized outpatient clinics without night shifts. Such an arrangement would allow students to manage their clinical and academic responsibilities more effectively, thereby enhancing their sense of professional identity and job satisfaction, which in turn may strengthen post-graduation employment intentions in clinical nursing. According to existing research [13], internship experiences in specialized outpatient settings positively influence undergraduate nursing students’ professional identity and subjective well-being. The structured involvement of specialized nurses in clinical teaching can facilitate students’ integration into clinical practice, promoting mental health and the development of professional competence.
4.2.3. Employment Choices Following Graduation and Rationale for Initial Nursing Program Selection
Fifty percent of the research participants indicated that, in the absence of better alternatives, they would ultimately opt for clinical nursing positions as a means of livelihood. This finding may be attributed to the fact that the majority of participants come from lower-middle-income families, and out of familial obligations, they are inclined to accept employment in fields they do not prefer. The remaining 50% stated that they would not accept a job they dislike solely for financial reasons. When asked about their initial motivation for choosing the nursing major, 75% of the participants cited its relatively high employability. This outcome likely reflects the current labor market conditions in China, where college graduates face significant challenges in securing employment, and nursing is perceived as a stable career option.
Sixty percent of respondents indicated that they opted for nursing as their second choice due to unsuccessful attempts to gain admission into clinical medicine programs, while twenty-five percent reported that their decision was influenced by the recommendations or arrangements of their parents or elder family members. This trend may be attributed to traditional Chinese cultural values, which emphasize filial respect and the expectation that younger generations follow the guidance of their elders. When asked whether they would choose to pursue nursing again if given the opportunity, 80% of participants responded affirmatively, suggesting a high level of satisfaction and lack of regret regarding their initial career choice. In contrast, 16.7% answered negatively, and 3.3% remained uncertain, indicating that while the majority are content with their decision, a small proportion continue to experience reservations about having entered the nursing field.
Institutions of higher education should strengthen undergraduate nursing students’ professional identity and sense of belonging to the institution through comprehensive strategies, including refining curriculum design, delivering structured career planning guidance, fostering sustained engagement with healthcare industries and alumni networks, promoting clinical internships and hands-on training opportunities, ensuring adequate academic and emotional support systems, and establishing timely and effective feedback mechanisms. Such measures will facilitate a constructive synergy between students and the institution, thereby enhancing student motivation, engagement in learning, and overall academic achievement [14].
5. Conclusion
The proportion of undergraduate nursing students expressing willingness to pursue clinical nursing roles after graduation remains relatively low, indicating a need for enhanced motivation and support among nursing interns regarding career engagement in clinical settings. Key factors influencing students’ willingness to enter clinical nursing include job stability, ample professional development opportunities, favorable welfare benefits, and the intellectually challenging nature of the work. Conversely, major deterrents to pursuing clinical nursing careers include the rotating shift system, irregular working hours, complex nurse-patient dynamics, high levels of occupational stress, heavy and demanding workloads, and inherent job-related risks. Additionally, the primary reason most students initially choose the nursing major is the relative ease of securing employment; however, a small but notable number report regret over their decision to pursue nursing education.
6. The Authors Propose Several Recommendations to Enhance the Career Aspirations of Nursing Students
Post-Graduation
First, hospital administrators should rationally optimize the organizational structure of nursing personnel and take proactive measures to prevent nurse burnout. Nursing managers should ensure a reasonable distribution of workloads for both clinical nurses and interns. Second, the shift scheduling system should be optimized to reduce physical and mental fatigue among clinical nurses and interns, thereby improving job satisfaction and strengthening their intention to pursue careers in nursing. Third, educational institutions should provide comprehensive career guidance and planning sessions for graduating students, emphasize pre-employment training, and foster a strong sense of professional identity and pride. Fourth, in terms of clinical teaching management, hospitals should strengthen training programs for clinical instructors, enhance their teaching and mentoring competencies, demonstrate care and support for nursing students, serve as positive role models, and thereby bolster students’ confidence in clinical practice.
Funding
This paper is the undergraduate teaching reform project of Guangxi Higher Education, Guangxi Education Higher Education [2023] No. 24 (Project No. 2023JGZ153); 2023 University-Level Education and Teaching Reform Research project of Youjiang Medical College for Nationalities (Project No. JGZHL2023-27); A self-financed project initiated by the Health Commission of the Guangxi Zhuang Autonomous Region (Project No. Z-L20230883).
Authors’ Contributions
Yijuan Li, Chuntao Jin: proposed research ideas and designed research schemes; Yijuan Li, Liwei Huang: Conducting experiments and investigations; Chuntao Jin, Liwei Huang, Shuangqi Li, Meiyan Ou, Ting Meng, Yanzhen Lu: Data collection, data sorting, and statistical analysis; Yijuan Li, Chuntao Jin, Liwei Huang, Shuangqi: Paper writing. Liuxue Lu: Overall check and review papers.
Acknowledgements
We gratefully acknowledge all participants in this study for their valuable contributions.
NOTES
*Co-first author.
#Corresponding author.