Influence of Learning Engagement and Academic Self-Efficacy on Professional Identity of Vocational Nursing Students Following Extended Vocational Training Model

Introduction: China's rapidly aging population has intensified demands on the healthcare system, particularly for complex elderly and critical care, creating an urgent need for a highly skilled nursing workforce. The five-year consistent nursing program, which admits junior high school graduates and provides over 8 months of clinical practice before higher vocational enrollment, represents a crucial training pathway. However, the psychological foundations-specifically academic self-efficacy (ASE), learning engagement (LE), and professional identity (PI)-of first-year students in this program remain inadequately studied, despite their importance for developing clinical competence in geriatric care. Objectives: This study aimed to investigate the interrelationships and mediating mechanisms between ASE, LE, and PI among first-year students in China's five-year nursing program, with the goal of informing training optimization for elderly and critical care. Methods: This cross-sectional study enrolled 321 first-year nursing students who completed validated questionnaires measuring PI, LE, and ASE. Bias-corrected bootstrapping mediation analysis (5,000 samples, 95% CI) was performed to test the hypothesized model, with only-child status as a covariate. Results: Participants demonstrated moderate-to-high levels of all three constructs. Correlation analysis revealed ASE was strongly positively correlated with LE (r = 0.806, p < 0.001) and moderately with PI (r = 0.566, p < 0.001), while LE showed a significant positive correlation with PI (r = 0.654, p < 0.001). Mediation analysis confirmed LE fully mediated the ASE-PI relationship, with a significant indirect effect (β = 0.569, 95% CI [0.420, 0.749]) and a not significant direct effect (β = 0.089, p = 0.309). Conclusion: These findings identified learning engagement as a crucial mechanism through which academic self-efficacy enhances professional identity. Educational interventions should simultaneously strengthen students' academic confidence and actively promote learning engagement through tailored clinical training and simulated scenarios to develop nurses who are better prepared for China's aging-related healthcare challenges.