How Teachers’ Skills Could Steer Nursing Students Toward Careers in Elderly Care

As the world’s population ages at an unprecedented pace, the demand for nurses who specialize in the care of older adults is rising sharply. Yet nursing schools are struggling to fill the pipeline. In China, only about 38 percent of nursing students say they are willing to work with older people after graduation, a figure that alarms health planners facing a looming shortage of qualified geriatric caregivers. A new cross-sectional study published in Nursing Open offers a fresh clue about why so many students hesitate, and what educators might do about it. The research, led by Ting Liao and colleagues at Sichuan Vocational College of Health and Rehabilitation, examined how professional identity and perceptions of teacher competence shape vocational college nursing students’ willingness to enter geriatric nursing, and uncovered a hidden pathway that connects the two.

The study rests on a well-established psychological framework: social cognitive theory. According to this theory, a person’s career choices are driven not only by their own sense of identity and self-efficacy but also by the social environment surrounding them. In the context of nursing education, professional identity, the degree to which students see themselves as nurses and internalize the profession’s values, acts as an internal engine of career commitment. Educator competence perception, meaning students’ subjective evaluation of their teachers’ professional knowledge, teaching skills, practical guidance and ethics, functions as a form of social support that can either amplify or dampen that internal drive. The researchers hypothesized that professional identity would directly boost willingness to work in geriatric care, but also that it would do so indirectly, by making students view their gerontological nurse teachers more favorably, which in turn would strengthen their career intentions.

To test this, the team surveyed 842 nursing students at a vocational college in Sichuan province between April and September 2024. Participants were recruited through an online platform, with survey links distributed by class monitors via WeChat groups to avoid any pressure from instructors. All students had completed a geriatric nursing course, and participation was voluntary and anonymous, with results having no bearing on academic performance. The sample was overwhelmingly female, 89.43 percent, with an average age of just over 19 years, and included 555 second-year and 287 third-year students. After excluding refusals and incomplete questionnaires, the final dataset comfortably exceeded the minimum sample size of 690 that the researchers had calculated in advance as necessary for building a robust structural equation model.

The measurement instruments were carefully chosen and validated. Professional identity was assessed with the 17-item Professional Identity Questionnaire for Nursing Students, covering dimensions such as professional self-image, the benefits of staying in the profession versus the risks of leaving, social comparison and self-reflection, independence of career choice, and social modelling. Perceptions of educator competence were measured with the Chinese version of the Gerontological Nurse Teacher Scale, a 30-item instrument spanning theoretical knowledge, care for students, professional enthusiasm, practical training and social ethics. Willingness to engage in geriatric nursing was captured by the 21-item Willingness Engaging in Aged Nursing Scale, which draws on the theory of planned behavior and includes behavioral attitudes, subjective norms, perceived behavioral control and behavioral intentions. All three scales showed excellent internal consistency in this sample, with Cronbach’s alpha values of 0.891, 0.960 and 0.941 respectively.

The descriptive results painted a nuanced picture. Professional identity scores were moderate to high, with social modelling, students’ tendency to emulate professional role models, scoring highest, while social comparison and self-reflection scored lowest. Educator competence perception was similarly positive overall, with social ethics rated most favorably and practical training rated least. Willingness to engage in geriatric nursing landed at a moderate level, with the control dimension, students’ sense that they could actually pursue such a career, strongest, and the posture dimension, their overall stance toward the field, weakest. These patterns suggest that while students generally respect their teachers and feel reasonably confident, their enthusiasm for geriatric work remains lukewarm, echoing the broader recruitment crisis in elderly care.

Correlation analysis revealed that all three variables moved together. Professional identity correlated positively with educator competence perception at r = 0.444, with willingness to engage in geriatric nursing at r = 0.413, and educator competence perception correlated with willingness at r = 0.379, all statistically significant. Before testing the structural model, the researchers ran a confirmatory factor analysis to verify that the three instruments measured distinct constructs. Convergent validity was confirmed, with average variance extracted values of 0.72 for professional identity, 0.84 for educator competence perception and 0.61 for willingness, all above the conventional 0.50 threshold, and composite reliability exceeding 0.85 for every construct. Discriminant validity held up under both the Fornell-Larcker criterion and the heterotrait-monotrait ratio test, with all HTMT values below 0.85.

The structural equation model then delivered the study’s central insight. After adjustment for age, gender and academic year, professional identity showed a strong positive association with educator competence perception, with a standardized path coefficient of 0.70, and educator competence perception in turn predicted willingness to engage in geriatric nursing with a coefficient of 0.33. Professional identity retained a direct effect on willingness of 0.47, but a significant indirect pathway ran through teacher perceptions, contributing an additional standardized effect of 0.23. Bootstrapping with 5,000 resamples confirmed that every path was significant, with 95 percent confidence intervals that excluded zero. In plain terms, roughly a third of the total effect of professional identity on students’ willingness to pursue geriatric nursing flows through how positively they judge their educators’ competence. The final model fit the data well, with a chi-square to degrees of freedom ratio of 2.954, a comparative fit index of 0.983 and a root mean square error of approximation of 0.048.

Why would students with a stronger professional identity rate their teachers more highly? The authors suggest that students who clearly understand their professional roles and career values pay closer attention to the professional qualities their instructors display, and therefore evaluate them more favorably. Conversely, positive perceptions of educator competence may give students richer learning experiences and help them grasp the true significance of geriatric care, translating abstract professional values into concrete career intentions. Prior research supports both directions: teachers shape professional identity through role modeling, and students who admire their teachers’ expertise are more receptive to geriatric nursing knowledge. The partial rather than full mediation observed here also signals that other mechanisms, not yet measured, likely link identity to career choice, leaving room for future exploration.

The practical implications are considerable. Because educator competence perception appears to be a modifiable link in the chain, nursing schools could strengthen geriatric recruitment not only by cultivating students’ professional identity but also by investing in the professional competence of gerontological nurse teachers, particularly in practical training, which scored lowest among the teacher dimensions. Better-prepared, visibly competent educators could convert students’ existing professional commitment into genuine willingness to care for older adults. The authors caution, however, that the study has limits: the sample was drawn from a single Chinese vocational college, was predominantly female, relied on self-report measures, and the cross-sectional design cannot establish causality. Longitudinal and interventional studies will be needed to confirm whether improving educator competence truly shifts career choices. Still, in a world where aging populations are outpacing the geriatric workforce, this study points to a deceptively simple lever: the teachers standing at the front of the classroom may hold one of the keys to who ends up caring for the elderly.

Subject of Research: The relationship between professional identity, perceived educator competence and willingness to engage in geriatric nursing among vocational college nursing students in China

Article Title: Professional Identity, Educator Competence Perception and Willingness to Engage in Geriatric Nursing Among Nursing Students: A Cross‐Sectional Study

Article References: Liao, T., Zou, J., Wang, M., Song, Y., Cai, L., Yin, J., Chen, Y., & Wang, Y. (2026). Professional Identity, Educator Competence Perception and Willingness to Engage in Geriatric Nursing Among Nursing Students: A Cross‐Sectional Study. Nursing Open, 13(9), Article e70804. https://doi.org/10.1002/nop2.70804

Image Credits: AI Generated

DOI: 10.1002/nop2.70804

Keywords: geriatric nursing, nursing students, professional identity, educator competence, structural equation modelling, cross-sectional study, social cognitive theory, vocational education, aging population, nursing workforce, China, career willingness