Career comparison and professional identity reconsideration among undergraduate nursing students who formally applied to transfer out of nursing: a qualitative study

Formal applications to transfer out of nursing represent a distinct educational decision that extends beyond general dissatisfaction or intention to leave. However, little is known about how nursing students who take this formal step evaluate nursing, alternative pathways, and their anticipated professional roles. This descriptive qualitative study was conducted at a single medical university in China and was informed by the Theoretical Domains Framework (TDF). Criterion-based purposive sampling recruited 14 undergraduate nursing students who had completed their first academic year and formally applied to transfer out of nursing. Semi-structured interviews were analysed using a two-stage TDF-informed qualitative content analysis that combined inductive initial coding with deductive mapping to the TDF. Participants’ accounts covered all 14 TDF domains, although the domains were not equally prominent across interviews. Students differed in how well they understood nursing, their intended transfer majors, and the transfer process. They also differed in how they viewed their fit with the academic, interpersonal, and clinical demands of nursing and in what they expected from their future careers. Some participants valued nursing as a profession but did not see the nurse role as the one they wanted to pursue. When considering transfer, students compared aspects of nursing with those of alternative programmes, including job stability, workload, personal interest, professional responsibilities, and the practical demands of changing majors. These comparisons were not always based on complete information and were influenced to varying degrees by family and peers, emotional uncertainty, and institutional requirements. Formal transfer applications involved varied considerations about future careers and professional roles, and students differed considerably in how they reached their decisions. Their choices were shaped not only by personal interests and career expectations, but also by the information available to them, social influences, emotional responses, and the practical conditions of transfer. In universities with similar transfer arrangements, providing balanced information and individualised academic and career guidance may help students make better-informed decisions about whether to remain in nursing or pursue another programme.