Author Affiliations
Abstract
Background: Developing professional identity can be challenging for faculty teaching in advanced practice nursing programs, particularly as students transition from learner to autonomous clinician. Reflective writing offers a pedagogical strategy for helping learners examine clinical experiences and emotions and integrate emerging professional values during this transition.
Methodology: This educational innovation used a descriptive qualitative approach to examine structured reflective writing assignments completed by nurse-midwifery students (N=12) during their final semester of education. Three guided reflections were designed to support professional role development by prompting students to explore their clinical experiences, patient interactions, and influential role-modeling encounters in a meaningful way. Reflections were de-identified and analyzed using an iterative thematic approach to identify patterns related to professional identity formation.
Results: Analysis revealed four recurring themes: (1) emerging vulnerability and self-awareness, (2) development of empathy and patient-centered perspective, (3) influence of role modeling on professional identity formation, and (4) recognition of clinical uncertainty and ongoing growth. Although the depth of reflection varied, most students demonstrated meaningful engagement and described important moments that shaped their evolving professional identities.
Conclusion: Structured reflective writing can provide a practical and scalable educational strategy for supporting professional identity development in midwifery and advanced practice registered nurse (APRN) education. Guided reflection helped students connect their clinical experiences with developing professional values, identifying the importance of empathy, and articulating intentions for future practice and growth.
Keywords
Midwifery education, Advanced practice registered nurse education, Reflective writing, Professional identity, Professional role development.
Introduction
For nursing students transitioning into advanced practice roles (APRNs), graduate education is a critical period of professional identity formation. In addition to acquiring clinical knowledge and procedural competence, APRN students must develop a clear sense of professional identity and understand how their values, behaviors, and decision-making shape patient care. In nurse-midwifery education, this developmental process includes learning the role of a professional midwife and internalizing standards of practice that emphasize evidence-informed, client-centered, and accountable care.[1]
Students’ future professional identities are shaped not only by coursework and clinical experiences but also by faculty and preceptors who serve as role models in classroom and clinical settings. The transition from registered nurse to advanced practice clinician requires time, mentorship, and opportunities for intentional reflection.[2] Without structured opportunities to examine how experiences influence beliefs, emotions, and practice patterns, students may struggle to articulate how they are growing into their professional roles.[3]
Reflective writing is one pedagogical strategy that can support this transition. Across health professions education, reflective writing has been used to foster self-awareness, critical thinking, communication, and meaning-making in response to clinical experiences.[4] In midwifery education, reflective writing may be particularly valuable because students routinely encounter emotionally complex, ethically nuanced, and clinically unpredictable situations.[3,5-7] Guided reflection can help students process these experiences, connect theory to practice, and recognize how small moments in care influence their development as clinicians.
At the core of reflective writing is the development of self-awareness, which in turn may support professional identity formation.[7] Prior scholarship has linked professional identity development in APRN and midwifery education to growing competence, ethical grounding, accountability, and a sense of belonging within the profession.[3,8,7] Reflective practice may help students identify these elements in action as they encounter vulnerable patients, demanding clinical environments, and formative relationships with faculty and preceptors.[9,10,11] Reflection may also support empathy, resilience, emotional intelligence, and lifelong learning.[12,13]
This manuscript describes an educational innovation using structured reflective writing assignments and presents a descriptive qualitative analysis of student reflections to explore professional identity development in midwifery education.
Methodology
This project represents an educational innovation using a descriptive qualitative approach to explore how structured reflective writing assignments supported professional identity development in midwifery students.
The intervention was implemented in a nurse-midwifery program during the final semester of the students’ education, commonly referred to as role integration. All students enrolled in the course completed the reflective writing assignments as part of required coursework. Participants were graduate-level midwifery students preparing to transition into independent professional practice.
Three reflective writing assignments were developed to cue students to identify and examine milestones in their professional development. We intentionally used assignments rather than discussion posts to create a more private space for vulnerability, honesty, and self-examination. One assignment was patient-focused, whereas the other two invited students to reflect on an event, colleague, preceptor, patient, or family interaction that influenced their emerging identity as a midwife (Table 1).
Reflective writing assignments
| Assignment | Focus | Purpose |
| Reflection 1 | Meaningful clinical experience | Identify impactful learning and early professional self-awareness |
| Reflection 2 | Patient perspective in labor | Develop empathy and patient-centered understanding |
| Reflection 3 | Formative person, event, or encounter | Connect experience to professional identity and future practice |
Table 1: Focus and purpose of each of the reflection prompts/assignments
Each assignment included guided prompts. The first prompt asked students to describe an event or experience that affected them and their practice. The second asked students to interview a laboring patient by asking what they were most excited about and what caused the greatest anxiety, fear, or concern. The third asked students to reflect on a person, encounter, or event that had a lasting impact on their present or future practice as a midwife. Assignments were limited to 250 words and accompanied by guidance encouraging students to focus on a small moment, use concrete detail, write with honesty, and connect experience to future clinical practice (Table 2 for details regarding guidance for the reflection assignments).
| This should be an individually prepared reflective essay about your key takeaway(s) from a particular experience and how you plan to use it to inform your clinical practice. Here are some guidelines for writing this essay. |
|
Table 2: Writing around the small moment: personal reflective essay guidelines[7]
This project was conducted as an educational activity within an academic program. Student reflections were de-identified before analysis to protect confidentiality. Institutional review processes were followed as required by the authors’ institution for dissemination of educational work. Student reflections were reviewed after de-identification. An iterative thematic analysis was used to identify recurring patterns related to professional identity development. Reflections were read multiple times by the authors, who discussed emerging concepts and reached consensus on major themes represented across the assignments.
Results
Analysis of student reflective writing revealed four recurring themes related to professional identity development: emerging vulnerability and self-awareness, development of empathy and patient-centered perspective, influence of role modeling on professional identity formation, and recognition of clinical uncertainty and ongoing growth (Table 3).
| Theme | Description | Representative focus |
| Emerging vulnerability and self-awareness | Students recognized emotional responses, insecurities, and evolving confidence in clinical practice | Students’ first deliveries, self-doubt, growth in confidence |
| Development of empathy and patient-centered perspective | Increased awareness of patient experiences, fears, and individuality of care | Patient interviews, emotional support, birth experience |
| Role modeling and professional identity formation | Influence of preceptors and providers on students’ understanding of professional roles | Advocacy, communication style, provider behaviors |
| Recognition of clinical uncertainty and ongoing growth | Awareness of unpredictability in practice and commitment to continued learning | Unexpected events, vigilance, future practice intentions |
Table 3: Themes identified
Emerging professional vulnerability and self-awareness: Many students demonstrated increasing awareness of the emotional complexity of becoming a midwife. Some reflections remained largely descriptive and task-oriented.
During my clinical rotation, I had the opportunity to deliver two babies. It was then I realized that delivering babies takes a certain amount of force I didn’t realize I needed. The countless practice sessions during lab week still didn’t prepare me for the amount of traction needed to guide babies out.
Many others revealed vulnerability, uncertainty, and deepening self-awareness. Students wrote about first deliveries, feelings of guilt or inadequacy during challenging births, and personal insecurities that gradually became sources of strength in patient care.
It was supposed to be my first official delivery as a midwife student…I was going over emergency procedures with her as she was pushing. The protocols were playing in my head, steadily, and in the repeat picture, an old tape was turning in the cassette player. Maybe it was this illusion of preparedness. That caused the universe to…laugh at me. The head began to deliver; the turtle sign was clear even to my naïve, first-timer eyes. My preceptor jumped in and completed the birth…but with Apgars of 3,6, and 9, I felt nothing but guilt over this first delivery.
As soon as my preceptor would finish speaking with patients, they would look at me and ask, Hablas Español? I am Hispanic, and I look Hispanic. Spanish is my first language, but I lost most of it growing up, as my parents spoke more English trying to help us assimilate. Up until this point, I had been avoiding speaking Spanish to patients because of how embarrassed I was at not being able to speak fluently. Many shifts in, I’ve realized I greatly underestimated my fluency, and I don’t need to be perfect. It’s crazy to me that the thing that I have been so insecure about for most of my life has become one of the most rewarding parts of this rotation.
These reflections suggest that guided writing created space for students to acknowledge the emotional dimensions of professional growth.
Development of empathy and a patient-centered perspective: Reflections that centered on patient interviews highlighted growing empathy and a stronger patient-centered perspective. Students described how asking patients about their hopes and fears shifted attention from clinical tasks to the lived experience of childbirth.
What are you most excited about? “To not be pregnant anymore and to see my husband’s face when he holds his son for the first time. She was worried about another long labor…and we were able to discuss her plans for pain management. I enjoyed being able to spend some time with this patient and ask about her hopes and her fears. I think it’s easy to get caught up in the number of births, the hours I have to get, and how I’m supposed to manage so many patients at once. It’s easy to forget the uniqueness of this experience for each patient, each time.
Even when outcomes did not align with patient expectations, students recognized the value of presence, reassurance, and compassionate communication.
My patient’s greatest fear was having a cesarean delivery, but an exam revealed a breech presentation necessitating a cesarean. I found a moment before her bed rolled to the operating room. “I know this isn’t what you want…but I promise you we’re going to get through this together.” After she is back in her room…she touches my hand. “Thank you,” she says, then repeats it intently, “thank you.” As midwives, we can’t always prevent our patients’ worst fears from coming to pass. But midwifery care is essential to…patients with complications. Listening to her fears and offering our presence, even if it did not materially change the outcome of this patient’s birth, changed her experience for the better.
These responses suggested that students begin to understand midwifery care not only as clinical management but also as relational support during vulnerable moments.
Role modeling and professional identity formation: Preceptors and clinical faculty emerged as important influences on professional identity formation. Students described how role models shaped their understanding of advocacy, humility, trust, and holistic care.
My preceptor, Dr. C…she is the only Obstetrics and Gynecology (OB/GYN) in two counties. She takes her role as a community leader very seriously and with grace; she taught me how to be a real advocate for my patients…and treat them holistically. If someone missed their appointment, she would show up at their work to make sure they were okay. I want my patients to trust me the way her patients do…We as midwives have a special privilege in that we see women at their most vulnerable. I plan to utilize that privilege to be a positive influence on my community.
In many reflections, seemingly small actions by clinicians, such as physically positioning themselves at the patient’s level or extending care beyond the expected task, had an outsized influence on how students envisioned their own future practice.
On my very first day in clinic as a student, I saw my preceptor get down on the floor to show a pregnant woman how to do a set of stretches; physically getting on the floor… [this action] immediately diluted the power dynamic in the room. This is the kind of intervention that does not directly show up in metrics or billing but has an enormous impact on the patient’s experience of care.
These accounts illustrate the importance of role modeling in helping learners translate professional values into practice.
Recognition of clinical uncertainty and ongoing professional growth: Students also described a growing recognition of uncertainty, unpredictability, and the need for continued vigilance in clinical settings. Humbling or unexpected events often prompted reflection on what it means to remain attentive, adaptable, and grounded in the birth space.
I chose to share this humbling moment, as it was one of the most simple and fundamental lessons of midwifery I needed to learn. We were called to the room of a lovely epiduralized patient reporting constant pressure with her second baby. With shoe covers in hand, I sat down on a stool three feet away as the nurses began to break down the bed. Unseen by me, the patient turned her head to the side to quietly throw up. My preceptor, in a single, graceful motion, grabbed the drape, supporting the baby’s head as it passed the edge of the labor bed. My heart stopped. Since then, I practice with a renewed sense of vigilance about what is happening and where I am in the birth space. I gained deep respect for the true unpredictability of birth.
Across assignments, students frequently connected these lessons to their future practice, demonstrating that reflection supported not only retrospective processing but also forward-looking professional commitments.
I never want to get to a place where I stop treating labor and birth as a profound magical life event for a person. I see labor and birth as a divine process. I owe it to myself and my patients to try my best to continue to be a midwife who views birth with awe and veneration.
Although the depth of reflection varied, most students engaged meaningfully with the prompts and articulated important dimensions of professional identity development.
Discussion
This educational innovation demonstrates that structured reflective writing can support professional identity development among midwifery students by promoting self-awareness, empathy, and integration of clinical experiences into evolving professional roles. The thematic findings suggest that guided reflection helps learners move beyond task-oriented descriptions of care toward deeper engagement with the relational, emotional, and ethical dimensions of practice.
The theme of emerging vulnerability and self-awareness underscores the importance of creating space for students to process the emotional complexity of becoming an advanced practice clinician. As learners transition into professional roles, they must reconcile expectations of competence with the realities of uncertainty, responsibility, and imperfect control. Reflection appeared to help students name these tensions and make meaning of them, supporting the development of self-awareness that is foundational to professional identity formation.
The theme of empathy and patient-centered perspective further highlights the value of prompts that direct attention to patients’ hopes, fears, and lived experiences. By asking students to listen closely to laboring patients, the assignments encouraged movement away from checklist thinking and toward a fuller appreciation of relational care. This is especially important in midwifery, where the quality of the patient’s experience is inseparable from the quality of care itself. Midwives recognize that birth, especially first birth, is a life-changing event, an event that years later women can recall in acute detail.[14]
The influence of role modeling on professional identity formation was also prominent. Students consistently described preceptors and faculty as shaping their understanding of advocacy, humility, trust, and presence. These reflections suggest that professional values are often learned not only through formal instruction but also through observing how experienced clinicians behave in small but meaningful moments. This finding reinforces the need for intentional role modeling in clinical education.
Finally, students’ reflections on uncertainty and ongoing growth point to the developmental value of reflective writing beyond a single assignment. Learners described moments of surprise, humility, and recalibration that informed them how they hoped to practice in the future. In this way, reflective writing supported both retrospective analysis and prospective professional formation.
This approach has practical value for midwifery and APRN education because it is feasible, low cost, and adaptable to a range of curricula. Structured prompts can be incorporated into clinical courses to support deeper learning without requiring major curricular restructuring. At the same time, variability in the depth of student engagement remains an important limitation. Not all learners reflected the same level of insight, and this work reflects the experience of a single educational setting. Future efforts might strengthen this approach through additional instruction on reflective depth, peer feedback, or longitudinal use across the curriculum.
Conclusion
Reflective writing served as a meaningful educational strategy for supporting professional identity development in midwifery students. Through structured assignments, students examined formative experiences, deepened empathy, and articulated how clinical encounters were shaping their future practice. These findings suggest that guided reflective writing can be a valuable addition to midwifery and APRN education, particularly during periods of role transition when learners are developing the values, awareness, and professional commitments that will guide their practice.
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Acknowledgments
Not reported
Funding
This manuscript received no external funding.
Author Information
Corresponding Author:
Wendy R. Gibbons
Department of Nursing,
Nell Hodgson Woodruff School of Nursing, Emory University
1520 Clifton Road, Atlanta, GA 30322
Email: [email protected]
Co-Authors:
Desiree M. Clement
Department of Nursing,
Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322
Lalita M. Kaligotla
Department of Nursing,
The Ohio State University College of Nursing,
Jane E. Heminger Hall 1577 Neil Avenue, Columbus, OH 43210
Authors Contributions
Conceptualization was led by Wendy R. Gibbons, Desiree M. Clement, and Lalita M. Kaligotla. The methodology was developed by Wendy R. Gibbons. Formal analysis was conducted by Wendy R. Gibbons, Desiree M. Clement, and Lalita M. Kaligotla. The original draft of the manuscript was prepared by Wendy R. Gibbons, Desiree M. Clement, and Lalita M. Kaligotla, and all three authors were also responsible for reviewing and editing the manuscript. Project administration was carried out by Wendy R. Gibbons.
Conflict of Interest Statement
The authors declare no conflicts of interest.
Guarantor
None
