📄 medicine

The Mediating Effect of Positive Spiritual Coping on Professional Identity and Retention Intention Among Nursing Interns

This cross-sectional study of nursing interns reveals that while professional identity positively influences retention intention, positive spiritual coping acts as a partial suppressor in this relationship, accounting for nearly 42% of the total effect through a complex mediating mechanism.

Original authors: ruqiao luo, jie he, you xia, zhiwei zhou

Published 2026-07-31

📖 6 min read🧠 Deep dive

CC BY 4.0

Original authors: ruqiao luo, jie he, you xia, zhiwei zhou

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine the world of nursing as a massive, bustling ship sailing through stormy seas. The crew members are the nurses, and the "ship" is the healthcare system. For this ship to stay afloat, it needs a steady crew who want to stay on board for the long haul. But here's the tricky part: getting new crew members (nursing interns) to sign up for the whole voyage isn't just about teaching them how to tie knots or steer the wheel. It's about whether they feel like they belong on this ship.

Scientists have long known that if a sailor feels proud of their role and understands their purpose (called Professional Identity), they are more likely to stay on the ship. They also know that when things get rough, sailors who can find meaning and hope in their struggle (called Positive Spiritual Coping) tend to keep going. But there's a mystery: does feeling proud of being a nurse directly make you want to stay, or does it work by making you better at finding hope in the storm? And could it be that finding that hope actually makes you think twice about staying? This paper dives into that puzzle, looking at how these three things—pride in the job, finding hope in the hard times, and the desire to stay—dance together among nursing students finishing their training.

The Story of the Nursing Interns

In this study, researchers from The First Hospital of Changsha decided to take a snapshot of 328 nursing interns who had just finished their clinical training during the 2025–2026 academic year. Think of these interns as the fresh recruits who have spent months learning the ropes, dealing with real patients, and seeing the messy, beautiful reality of nursing. The team wanted to see how these recruits felt about their future and what was happening inside their heads.

They measured three main things:

Professional Identity: How much do they feel like "real nurses"? (The score was a moderately high 103.20 ± 20.10 out of a possible 150).
Positive Spiritual Coping: How well do they use their inner beliefs and support systems to handle stress and find meaning? (The score was a moderately high 62.05 ± 9.69 out of 85).
Retention Intention: Do they plan to stick with nursing after graduation? (The score was moderate at 18.54 ± 2.76 out of 24).

The Big Surprise: The "Suppression" Twist

Here is where the story gets interesting. Usually, you'd expect that if you love your job (high Professional Identity) and you are good at finding hope (high Positive Spiritual Coping), you would definitely want to stay. And, in a way, that is true. The study found that Professional Identity does directly push interns toward staying (a direct effect of 0.379).

However, the researchers discovered a sneaky, counter-intuitive twist. They found that Positive Spiritual Coping actually acted as a suppressor.

Imagine you are a detective. You have a strong hunch about a suspect (Professional Identity), and you want to catch them. But then, you find a piece of evidence (Positive Spiritual Coping) that makes you pause and think, "Wait, maybe this isn't the right path after all."

In this study, the more the interns felt a strong sense of professional identity, the better they became at using spiritual coping to find meaning. But here's the catch: this deep, spiritual processing actually lowered their intention to stay, slightly. It acted like a brake pedal. The data showed a negative mediation effect of -0.112.

Why would finding hope and meaning make someone want to leave? The authors suggest that when interns with a strong sense of identity use their spiritual coping skills, they start looking deeper. They begin to ask hard questions: "Does this job really fit my soul?" "Is the reality of the hospital (long shifts, heavy workloads) matching the beautiful ideal I have in my head?"

Because they are so good at coping and finding meaning, they become more sensitive to the gap between their high ideals and the sometimes harsh reality of the job. This deep reflection creates a "discrepancy" that makes them hesitate. So, while their pride in being a nurse pushes them to stay, their deep, spiritual processing pulls them back, making them question if they really belong.

The Final Scorecard

Even with this "brake pedal" effect, the overall result was still positive. The total effect of Professional Identity on Retention Intention was 0.267, which is still a significant push toward staying. The "suppressor" effect (the spiritual coping part) accounted for 41.95% of the total story, meaning it played a huge role in the mix, but it didn't cancel out the desire to stay completely.

The researchers found that:

Professional Identity and Positive Spiritual Coping were strongly linked (r = 0.676).
Professional Identity and Retention Intention were linked (r = 0.408).
But the path through Spiritual Coping was a bit of a detour that slowed things down.

What This Means for the Future

The paper suggests that we can't just tell nursing students, "Be proud, and you'll stay." It's more complicated. Because having a strong sense of identity and the ability to find meaning can actually make students more aware of the gaps between their dreams and reality, schools and hospitals need to be careful.

The authors suggest that to keep these interns on board, we need to do more than just boost their pride. We need to build supportive environments where they can talk about these hard questions. We need to help them bridge the gap between their high spiritual ideals and the daily grind of the hospital. If we can help them align their deep, spiritual understanding of nursing with the actual reality of the job, maybe that "brake pedal" won't be so strong, and more of them will choose to stay on the ship for the long voyage.

The study concludes that while the relationship is complex, understanding this "suppression" effect gives us a new tool to help nursing interns find their place in the profession. It's not just about making them feel good; it's about making sure their deep, spiritual connection to the job matches the world they are stepping into.

Technical Summary: The Mediating Effect of Positive Spiritual Coping on Professional Identity and Retention Intention Among Nursing Interns

Problem Statement
Nursing interns represent a critical reserve force for the clinical workforce, yet their retention intention is increasingly threatened by post-pandemic economic pressures, rising educational requirements, and the cognitive dissonance caused by exposure to diverse employment realities via digital platforms. While professional identity is established as a determinant of retention, the specific mechanisms through which it influences retention intention remain under-explored. Specifically, the role of "positive spiritual coping"—defined as a stress response strategy involving the mobilization of internal beliefs and external resources to find meaning and value—has not been sufficiently investigated as a mediator in this relationship. Current literature largely focuses on bivariate correlations, leaving a gap in understanding the interactive dynamics among professional identity, spiritual coping, and retention intention.

Methodology
This study employed a cross-sectional survey design conducted at The First Hospital of Changsha during the 2025–2026 academic year.

Participants: The sample consisted of 328 valid responses from nursing interns who completed their clinical internships, representing a 95.07% valid response rate from 345 distributed questionnaires. Demographic data indicated a predominantly female (89.3%), rural-origin (67.4%), and junior college-educated (73.2%) cohort, with most having 1–6 months of clinical placement experience.
Instruments: Data were collected using:
1. A demographic questionnaire.
2. The Professional Identity Scale for Nurses (30 items, 5 dimensions; Cronbach's α = 0.877).
3. The Positive Spiritual Coping Subscale of the Spiritual Coping Questionnaire (17 items, 4 dimensions: personal, social, environmental, transcendental; Cronbach's α = 0.916).
4. The Chinese Version of the Nurse Retention Intention Scale (6 items; Cronbach's α = 0.826).
Statistical Analysis: Analyses were performed using SPSS 26.0 and Mplus 8.3. Pearson correlation analysis examined variable relationships. Structural Equation Modeling (SEM) with bootstrap resampling (5,000 iterations) was utilized to test the mediating role of positive spiritual coping, calculating 95% confidence intervals (CIs) for mediation effects.

Key Results

Descriptive Statistics: Nursing interns demonstrated moderately high levels of professional identity ($M=103.20, SD=20.10$) and positive spiritual coping ($M=62.05, SD=9.69$), alongside a moderate level of retention intention ($M=18.54, SD=2.76$).
Correlations: Professional identity showed significant positive correlations with both positive spiritual coping ( $r=0.676, P<0.01$ ) and retention intention ( $r=0.408, P<0.01$ ). Positive spiritual coping was positively correlated with retention intention ( $r=0.154, P<0.01$ ), though this correlation was weaker than that of professional identity.
Mediation Analysis: The study identified a partial suppressing mediation effect.
- Direct Effect: Professional identity positively predicted retention intention ( $\beta=0.379, P<0.001$ ).
- Indirect Effect: Professional identity positively predicted positive spiritual coping ( $\beta=0.676$ ), which in turn positively predicted retention intention ( $\beta=0.155$ ). However, the calculated mediation effect was negative ( $\beta=-0.112, 95\% CI [-0.272, -0.002]$ ).
- Total Effect: The total effect of professional identity on retention intention remained positive and significant ( $\beta=0.267$ ), but was reduced by the negative mediation path. The mediating effect accounted for 41.95% of the total effect.

Key Contributions
The primary contribution of this study is the empirical identification of a suppressing mediation pattern where positive spiritual coping partially offsets the positive direct effect of professional identity on retention intention.

Novel Mechanism: The study elucidates that while high professional identity generally fosters retention, it simultaneously enhances positive spiritual coping abilities. This heightened coping capacity may lead interns to engage in deeper professional self-reflection and re-evaluation.
The Paradox of Awareness: The authors posit that interns with strong professional identity and high spiritual coping may become more sensitive to the discrepancies between their idealized professional expectations (e.g., supportive environments, meaningful work) and the harsh realities of clinical practice (e.g., high workloads, nurse-patient conflicts). This "environment-expectation discrepancy," facilitated by their coping mechanisms, can paradoxically reduce retention intention, acting as a suppressor.

Significance and Claims
The paper claims to provide a novel theoretical foundation for developing interventions aimed at enhancing retention intention among nursing interns. By confirming that positive spiritual coping acts as a suppressing mediator, the study suggests that interventions cannot rely solely on boosting professional identity or spiritual coping in isolation. Instead, the authors argue for a multifaceted approach:

Educational and Clinical Collaboration: Institutions should create supportive clinical learning environments and humanistic mentorship systems to mitigate the "expectation-reality" gap.
Resource Access: Encouraging participation in group collaborations and professional exchanges can provide social support resources.
Systemic Optimization: Reducing career uncertainty through comprehensive exposure to career development and optimizing workforce allocation and compensation are necessary to stabilize the nursing workforce.

The authors conclude that while professional identity and positive spiritual coping are generally beneficial, their complex interaction requires nuanced management to prevent the suppression of retention intention caused by heightened awareness of professional challenges. The study acknowledges limitations regarding its single-center design and the lack of examination of moderating variables (e.g., gender, educational level), calling for future multi-center research to validate these findings.

The Story of the Nursing Interns

The Big Surprise: The "Suppression" Twist

The Final Scorecard

What This Means for the Future

Technical Summary: The Mediating Effect of Positive Spiritual Coping on Professional Identity and Retention Intention Among Nursing Interns

More like this