Professional competence development in the context of clinical uncertainty: a qualitative exploration of infection prevention and control nurses at a tertiary hospital in China

Background Infection prevention and control nurses (IPCNs) are critical to preventing and controlling of healthcare-associated infections (HAIs), supporting patient safety, and responding to public health disasters. Although the significance of such a role is increasingly recognized, China lacks a unified training program or credentialing for IPCNs. We are now in a highly contrived and uncertain clinical setting that urges us to acquire a deep-seated comprehension of how we may enable IPCNs to develop their professional competence without institutionalized support. It is also necessary to identify the contextual and structural challenges they encounter. Objectives To explore the professional dilemmas facing IPCNs in a Chinese tertiary hospital setting, characterized by a lack of standardized training systems and institutional support, and how they navigate these dilemmas in dynamic and complex clinical scenarios. The study also aimed to examine how these experiences shape the development of professional competence and its relationship with professional role identity. Methods This study was conducted between 01/10/2025 and 30/11/2025 at a Grade A tertiary hospital in Jiangsu Province, China, where IPCNs with diverse professional backgrounds and levels of experience were recruited. Data were collected through online semi-structured interviews, with 16 participants. The interview guide focused on the professional dilemmas IPCNs experience in clinical practice, how they address these dilemmas, and how they develop their professional competency. All interviews were audio-recorded with the participants’ consent, and the recordings were transcribed verbatim. A thematic analysis of the transcripts was performed to identify and synthesize recurring and meaningful themes. Results Based on the findings, four core themes and 14 subthemes were identified: (1) practice environments characterized by prominent uncertainty; (2) challenges and costs in achieving competent practice; (3) informal learning in the absence of institutional support; (4) mutual shaping of professional competence and role identity. Conclusion This study provided empirical evidence of the dynamic process of professional competency development among IPCNs at a tertiary hospital in China, and clarified how this process was interwoven with the construction of their professional role identity in uncertain clinical contexts lacking systematic training and institutional support. These findings offer transferable insights for developing contextually appropriate IPCN training systems, support mechanisms, and competency development pathways in similarly structured tertiary-hospital settings.