Table 1 Types of identity conflict defined as disharmony and dyssynchrony, and their modulating influences

Disharmony within Ring

Professional Expectations vs. Work Obligations

“I wish I had time to explore my patients emotional or psychosocial needs…but it's not always possible….” (N3)

Enhanced professional skills (N1, N2, N4) better prepared nurses for difficult patient encounters

Nurses received emotional support and practical advice through informal support from nursing and medical colleagues (N8) and through formal support programs (N6)

An open and supportive non-hierarchical work environment enhanced teamwork, self-care and working practice. (N4, N6, N8)

Heavy workloads and responsibilities (N7, N8)

Lack of protected out-of-hospital time for self-care (N7, N8)

Lack of opportunities to grieve (N6) and for support (N7) (e.g., mortality rounds)

Professional Role vs. Professional Hierarchy

“There is still hierarchy..without seniority, some people they don’t accept your instructions.” (N1)

Dyssynchrony across Rings

Innate vs. Societal

“A patient asked me to pray for her…not being in that religion, I won't be able to. And the patient can get a bit offended.” (N4)

Individual vs. Societal

“Patients who are similar in age and background [to me]…are challenging because it reflects [my] own mortality.” (N1)