This study was conducted in accordance with the principles of the Declaration of Helsinki. A cross-sectional study design was employed. A convenience sampling method was used to recruit 60 undergraduate nursing interns who met the predefined inclusion criteria from a tertiary hospital in Guangxi, China, between May 2025 and October 2025. Inclusion criteria were as follows: 1) enrollment in a full-time undergraduate nursing program; 2) currently undergoing clinical internship and capable of regular participation; 3) provision of informed consent and voluntary willingness to participate in the study. Exclusion criteria included: 1) prolonged leave of absence; 2) withdrawal from the academic program; 3) inability to complete clinical internship duties due to any medical or personal reasons.

This study aimed to explore the post-graduation employment intentions of undergraduate nursing students in Guangxi, China, specifically with regard to pursuing clinical nursing careers. To ensure statistical reliability, a cross-sectional design was employed, and sample size estimation was conducted in accordance with standard methods in medical statistics. Simple random sampling was applied, and the required sample size was determined using the following formula:

In this study, the significance level was set at α = 0.05 and the margin of error at δ= 0.1. Based on preliminary survey data, the estimated proportion was determined as p = 0.8. According to official statistics released by the Education Department of the Guangxi Zhuang Autonomous Region, China, on May 21, 2025, the total number of undergraduate nursing graduates in Guangxi in 2025 is projected to be approximately 10,000. Thus, the population size N was set to 10,000. Substituting these values into the sample size formula yielded a calculated sample size of n = 59. To ensure sufficient representation, the final sample size was rounded up to 60 cases.

2.3.1. Literature Review Method

A comprehensive literature review was conducted through multiple sources, including academic books from university libraries, online databases such as CNKI, Wanfang, PubMed, and VIP (Chinese Science and Technology Journal Database). The search focused on domestic and international studies concerning the post-graduation employment intentions of medical students. Based on a systematic analysis and synthesis of the collected literature, the research topic was finalized.

2.3.2. Research Instruments

1) General Information Questionnaire: A self-developed instrument comprising 5 items, including gender, place of residence, and whether the participant is an only child. The detailed content of the questionnaire is presented in Table 1.

2) The Employment Intention Survey Form for Undergraduate Nursing Interns After Graduation was developed based on a comprehensive review of relevant literature and expert consultation. Following an iterative process of revision and refinement, the instrument underwent a pilot test with 30 participants who met the inclusion criteria. The feasibility and practical applicability of the questionnaire were confirmed through this pre-test, leading to the establishment of the final version. The finalized survey comprises six items in total: Items 1, 4, and 6 are single-choice questions, whereas Items 2, 3, and 5 are multiple-choice questions. The questionnaire utilized in this study consists of unordered multiple-choice questions. As such, reliability analysis is typically not performed on non-scale data. The detailed content of the questionnaire is presented in Table 2.

2.3.3. Questionnaire Collection Methods

The participants completed the questionnaire online. Participants independently completed the survey online, with an average completion time of approximately five minutes. The system backend performed quality control checks on responses, screened for valid submissions, and facilitated data collection, statistical processing, and preliminary analysis to ensure both the authenticity of the collected information and the timeliness of data retrieval.

2.3.4. Statistical Analysis Methods

Data were collected through an online questionnaire administered via the Wenjuanxing platform. The collected data were then organized and analyzed using SPSS software. Descriptive statistics, including rates and percentages, were employed to summarize and interpret the survey results.

The results are presented in Table 1. A total of 60 questionnaires were distributed in this survey, and all 60 valid responses were successfully collected, yielding a 100% response rate. Among the participants, 95% identified as female and 5% as male. With regard to family residence, the distribution was as follows: urban areas (40%), townships (38.3%), and rural areas (21.7%). Furthermore, 83.3% of the nursing students reported that they are not only children. With respect to parental occupation, 90% of the caregivers indicated employment in fields unrelated to healthcare, while only 10% had at least one parent working in a medical profession. Household income levels were categorized as follows: medium (51.7%), upper-middle (23.3%), lower-middle (13.3%), and low-income (11.7%).

Table 1. General information of the respondents.

The survey findings are presented in Table 2. Among the research participants, 60% indicated a willingness to engage in clinical nursing work upon graduation, 20% expressed unwillingness, and 20% reported being undecided at this time. The primary reasons for willingness to engage in clinical nursing, ranked in descending order, include job stability (83.33%), ample career development opportunities (55.56%), favorable welfare benefits (38.9%), challenging nature of the work (36.1%), improved social recognition (25%), a conducive working environment (16.7%), the meaningfulness of the profession (13.9%), and other factors (5.6%). Conversely, the main reasons for unwillingness to enter clinical nursing after internship, also listed in order of prevalence, are shift work with irregular schedules (91.6%), complicated nurse-patient relationships (83.3%), high levels of work-related stress (66.7%), heavy and demanding workloads (58.3%), occupational risks (50%), difficulties in professional advancement (25%), and other miscellaneous reasons (16.7%). Notably, half of the respondents indicated that they might still opt for clinical nursing out of necessity if no better alternatives were available. However, the remaining half firmly stated they would not. Regarding their initial motivation for choosing the nursing major, 75% cited ease of employment as the primary factor, 60% acknowledged it was due to not being admitted into clinical medicine programs and thus accepting nursing as an alternative, and 25% attributed their decision to parental or familial guidance. When asked, “If you could choose again, would you still study nursing?”, 80% responded affirmatively, 16.7% answered negatively, and 3.3% remained uncertain.

Table 2. Survey results on post-graduation practice intentions of undergraduate nursing interns.

The study population was predominantly female (95%), with males accounting for only 5%, reflecting a significant gender imbalance. This finding suggests that women will continue to constitute the primary workforce in nursing and maintain a dominant presence in the profession, which aligns closely with the current gender distribution among clinical nurses in China. Existing research [9] indicates that male nurses experience higher levels of work-related stress and lower job satisfaction compared to their female counterparts. Therefore, nursing administrators should implement targeted strategies to address the key sources of occupational stress and factors influencing job satisfaction among male nurses. Such interventions are essential to enhance motivation, improve job satisfaction, and ensure the stability of the male nursing workforce. Furthermore, evidence from study [10] shows that overall nurse retention intentions are suboptimal, particularly among male nurses. Hospital management should recognize gender-specific differences and develop tailored intervention programs to strengthen retention rates across diverse nurse populations.

Among the research participants, 40% were from urban areas, 38.3% from towns and villages, and 21.7% from rural regions. The combined proportion of participants from towns, villages, and rural areas exceeds that from urban areas, suggesting a higher concentration of nursing students in non-urban settings. This distribution may be attributed to relatively lower household economic conditions in non-urban areas compared to urban centers, as well as the comparatively favorable employment prospects associated with the nursing discipline. Only 10% of the participants had parents employed in medical-related professions, indicating limited intergenerational occupational continuity within the healthcare field. Regarding household income, 51.7% reported a medium monthly income level, while a minority (23.3%) reported incomes above this level. These findings are largely consistent with the data on per capita disposable income of residents in Guangxi, released by the Development and Reform Commission of the Guangxi Zhuang Autonomous Region on April 3, 2025 [11].

A low proportion of research participants expressed willingness to pursue clinical nursing roles after graduation. Among the respondents, 60% indicated an intention to work in clinical nursing upon graduation, 20% explicitly stated they would not, and another 20% remained undecided. These findings suggest that despite having completed training in nursing, a significant minority (20%) do not intend to enter clinical practice, while an additional fifth are uncertain about their future career paths. Consequently, only 60% of the student cohort are committed to pursuing careers aligned with their academic training. This trend raises concerns regarding potential shortages of clinical nursing personnel in the future. Administrators in educational institutions and supervisors at teaching hospitals should therefore prioritize enhancing students’ internship experiences by fostering supportive learning environments, improving job satisfaction during clinical placements, and ultimately strengthening post-graduation employment intentions among nursing interns.

4.2.1. Analysis of the Reasons Why Research Subjects Are Willing to Engage in Clinical Nursing Work

The primary factors influencing individuals’ willingness to engage in clinical nursing, ranked in descending order of importance, are job stability (83.33%), ample career development opportunities (55.56%), favorable welfare benefits (38.9%), work-related challenges (36.1%), enhanced social status (25%), a positive working environment (16.7%), the meaningfulness of the work (13.9%), and other reasons (5.6%). With the ongoing advancement of China’s aging society, the demand for geriatric care professionals is expected to rise significantly in the coming years, contributing to an increased prominence of home-based nursing services. Concurrently, the growing need for nurses specializing in personal care will create substantial career prospects for nursing students, further reinforcing their inclination toward clinical nursing careers. Salary levels and welfare packages serve as key indicators of human capital return on investment; occupations that offer relatively high returns with manageable entry costs are naturally more attractive, and nursing is increasingly perceived as such a profession. Furthermore, existing research [12] suggests that nursing education programs should adopt diversified teaching strategies, with an emphasis on fostering undergraduate students’ professional interest and continuously strengthening professional identity training, which plays a crucial role in promoting a positive and proactive development of nursing students’ professional self-concept.

4.2.2. Analysis of the Reasons Underlying Nursing Graduates’ Reluctance to Pursue Clinical Nursing Careers

The primary factors contributing to graduates’ reluctance to engage in clinical nursing following internship, ranked by prevalence, include shift work and irregular schedules (91.6%), complex nurse-patient relationships (83.3%), high work pressure (66.7%), heavy workload and cumbersome procedures (58.3%), occupational risks (50%), difficulties in professional title advancement (25%), and other miscellaneous reasons (16.7%). Nursing managers and departmental teaching supervisors should comprehensively understand interns’ intrinsic needs and practical experiences through multidimensional assessment. Efforts should be made to provide a supportive and positive working environment that strengthens nursing students’ professional commitment. It is recommended that during each one-month clinical rotation, one week be allocated for placement in specialized outpatient clinics without night shifts. Such an arrangement would allow students to manage their clinical and academic responsibilities more effectively, thereby enhancing their sense of professional identity and job satisfaction, which in turn may strengthen post-graduation employment intentions in clinical nursing. According to existing research [13], internship experiences in specialized outpatient settings positively influence undergraduate nursing students’ professional identity and subjective well-being. The structured involvement of specialized nurses in clinical teaching can facilitate students’ integration into clinical practice, promoting mental health and the development of professional competence.

4.2.3. Employment Choices Following Graduation and Rationale for Initial Nursing Program Selection

Fifty percent of the research participants indicated that, in the absence of better alternatives, they would ultimately opt for clinical nursing positions as a means of livelihood. This finding may be attributed to the fact that the majority of participants come from lower-middle-income families, and out of familial obligations, they are inclined to accept employment in fields they do not prefer. The remaining 50% stated that they would not accept a job they dislike solely for financial reasons. When asked about their initial motivation for choosing the nursing major, 75% of the participants cited its relatively high employability. This outcome likely reflects the current labor market conditions in China, where college graduates face significant challenges in securing employment, and nursing is perceived as a stable career option.

Sixty percent of respondents indicated that they opted for nursing as their second choice due to unsuccessful attempts to gain admission into clinical medicine programs, while twenty-five percent reported that their decision was influenced by the recommendations or arrangements of their parents or elder family members. This trend may be attributed to traditional Chinese cultural values, which emphasize filial respect and the expectation that younger generations follow the guidance of their elders. When asked whether they would choose to pursue nursing again if given the opportunity, 80% of participants responded affirmatively, suggesting a high level of satisfaction and lack of regret regarding their initial career choice. In contrast, 16.7% answered negatively, and 3.3% remained uncertain, indicating that while the majority are content with their decision, a small proportion continue to experience reservations about having entered the nursing field.

Institutions of higher education should strengthen undergraduate nursing students’ professional identity and sense of belonging to the institution through comprehensive strategies, including refining curriculum design, delivering structured career planning guidance, fostering sustained engagement with healthcare industries and alumni networks, promoting clinical internships and hands-on training opportunities, ensuring adequate academic and emotional support systems, and establishing timely and effective feedback mechanisms. Such measures will facilitate a constructive synergy between students and the institution, thereby enhancing student motivation, engagement in learning, and overall academic achievement [14].