1. Introduction
ursing as a career was started with the work of the British nurse Florence Nightingale. In the past decades, the trend of professionalism has been accelerating in nursing (Cant et al., 2011). The term professionalism refers to the behavior, quality, and goals that characterize the concept of nursing (Christman 1986; Khachian et al., 2016). In another definition, it is stated that professionalism is often associated with attitudes, knowledge, and behaviors that underlie successful clinical practice (Cornett 2006). The American Association of Colleges of Nursing also addresses civility as a component of the professionalism and expected behaviors of nursing professionals (Lasiter et al., 2012). 
Nursing education has always aimed at inculcating students with free and intellectual thinking, teaching ethics, and professional values. This is because professionalism in nurses leads to better care and patients’ greater satisfaction (Vanlaere & Gastmans 2007). Nursing professionalism is hidden in the nursing curriculum (Karimi et al., 2014). Besides, nursing education always emphasizes professionalism and respects values and commitment to community service delivery (Kim-Godwin et al., 2010). The formation of nursing professionalism begins at the onset of nursing education and continues after graduation; accordingly, the highest level of professionalism is achieved 3-5 years after graduation (Paik & Cho 2004). 
It is very difficult to define a person’s professionalism. This is because it is affected by personal and professional behavior; however, in the 1980s, Miller offered a model for determining and evaluating professional behavior (Miller et al., 1993). Eight attributes that demonstrate the degree of professionalism in nursing include the following: competence and continuing education; research development; assessment and evaluation; self-regulation and autonomy; participation in professional organizations; publication and communication, as well as adherence to the American Nursing Association (ANA) codes of ethics, and community service (Miller et al., 1993; Adams et al., 1996; Adams & Miller 2001). 
A study on pharmaceutical students indicated that personality traits can affect behavior and professionalism (Jensen et al., 2014). Personality is referred to as a set of traits, characteristics, and qualities of sustainability that distinguish an individual from the others (Mangal 2013). As a result, personality traits might be shared by different individuals concerning their thoughts, feelings, and actions; it may not always be easy to understand, due to biosocial pressures and circumstances (Francis et al., 2004). Personality traits are divided into 5 groups, including neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness (Goldberg 1993). 
A neurotic individual is frequently upset, experiences a negative temper, and is prone to depression. An extrovert individual is characterized by group desire, decisiveness, activity, excitement, and presenting openness towards new experiences. An agreeable person is ready to make sacrifices and remains warm, sympathetic, and benevolent. Conscientious individuals are efficient, regular, and responsible, and their actions are orderly, accurate, and sensible (Digman 1990). Furthermore, nurses frequently share common personality traits (Cupit & Sukal 2015). A study found that nurses with neuroticism and introverted traits are more exposed to burnout in the intensive care unit (Ntantana et al., 2017).
Nursing professionalism is essential in clinical care. Besides, personality traits impact professional behavior. Thus, this study aimed to investigate the relationship between the Big Five personality traits and nursing professionalism.
2. Materials and Methods
This cross-sectional correlational study was conducted in all teaching hospitals in Khorramabad City, Iran. The research sample consisted of 205 nurses working in teaching hospitals, i.e. selected by stratified sampling method based on Kim’s study (Kim & Kim 2016). The study inclusion criterion was having a bachelor’s degree in nursing.
The NEO Personality Inventory is a personality test introduced by Costa and McCrae in 1985 (Costa & McCrae 1988). The questionnaire consists of a long-form which contains 240 questions and a short form of 60 items. Costa and McCrae stated that the correlation of the short form to long-form was 0.77 to 0.92 per domain (Costa & McCrae 1986). In the present study, the short form of the questionnaire was used. The validity and reliability of its short-form have been investigated in various studies, and the relevant Cronbach’s alpha coefficient has been reported as 0.85 (Wachi et al., 2016; Fornés-Vives et al., 2016). The responses are scored on a five-point Likert-type scale, ranging from “1: Strongly disagree” to “5: Strongly agree”. 
In this inventory, 28 questions are scored reversely and each Big trait (neuroticism, extraversion, openness to experience, agreeableness, & conscientiousness) is examined by 12 questions. Scores for each attribute are divided into 3 levels; low, medium, and high. Accordingly, for each trait, a score between 12 and 24 indicates a minimum incidence of the symptoms or opposing signs of that trait; a score of 25 to 48 reflects moderate and stable, and a score of 49 to 60 indicates significant symptoms of that Big trait. To better understand the magnitude of any personality type, the score obtained in each area was classified into three groups of high, moderate, and low severity. The validity coefficients of the Persian version of this questionnaire has been determined as 0.53 to 0.64, i.e. at the significant level of P≤0.01; its reliability has been supported by the test-retest approach in the 5 domains of neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness as 0.81, 0.73, 0.75, 0.79, and 0.83, respectively (Zare’ & Mohammadzadeh 2012). In this study, the Cronbach’s alpha coefficient of the NEO Personality Inventory (NEO-PI) was calculated as 0.519.
The Goze professional behavior questionnaire was applied to assess nursing professional behavior. This questionnaire consists of 27 questions answered on a 5-point Likert-type scale, with “never” assigned to the score of 1 and “always” to the score of 4. Additionally, in this questionnaire, one question asks nurses to express their interest in the nursing profession, i.e. rated from zero to 10. The minimum and maximum obtainable scores on this questionnaire are 27 to 135; a higher score indicates better nursing professionalism. The reliability and validity of this questionnaire have been demonstrated and its Cronbach’s alpha coefficient was measured as 0.95 (Goz & Geckil 2010; Khachian et al., 2016). In the present study, the reliability of this questionnaire was calculated as 0.899 by Cronbach’s alpha coefficient. A demographic form was also used to collect the research subjects’ characteristics.
The achieved data were analyzed by descriptive and inferential tests using SPSS. Kolmogorov–Smirnov test findings determined that the data have a normal distribution. Therefore, the Pearson correlation coefficient was used to determine the correlations with a significance level of 0.05.
3. Results 
Most of the study participants were female (77.6%) and married (66%). The Mean±SD age of the research subjects was 30.82±6.98 years and their Mean±SD work experience was 84.16±83.149 months.
The Mean±SD score of professionalism was 113.08±13.04. Furthermore, and the Mean±SD rate of the nurses’ interest in the nursing profession equaled 7.13±2.74. Table 1 presents the relationship between the main variables and the demographic information of study participants. 



The scores of the subjects in each of the Big Five personality traits are listed in Table 2. 



Table 3 presents the intercorrelations (Pearson’s r) among the Big Five personality traits and the professionalism score obtained by the research subjects. 



4. Discussion
Most of the research subjects were female with an average age of 30 years, i.e. in line with the study of Tanaka and Naami (Tanaka et al., 2014; Naami et al., 2014). Wynd reported a significant relationship between the level of work experience and professionalism (Wynd 2003). In the present study, however, there was no significant relationship between professionalism and staffing experience, i.e. in accordance with Tanaka’s study; they documented no significant relationship between professionalism and work experience of up to 10 years (Tanaka et al., 2014). A study examined ethics and professional values in nursing students; accordingly, it was observed that students in the last year of academic education had more respect for ethics and professional values (Bulut et al., 2015). However, this result was not supported in the present study. 
The current study data revealed that the highest mean score of the maximum number of subjects was in agreeableness and extraversion, which tallies well with the results of Pitt’s study; they reported that nurses obtained a higher score in empathy and narcissism, and were more communitarian in attitude (Pitt et al., 2014). We found no relationship between the main variables and workplace ward; however, Ong’s study revealed that extraversion and intellect/imagination were associated with the odds of choosing psychiatric nursing (Ong et al., 2017). 
The present study findings indicated that three Big personality traits –extroversion, agreeableness, and conscientiousness– were directly related to nursing professionalism; however, neuroticism presented an inversed relationship with nursing professionalism. A study demonstrated that professional ethics among medical staff was directly related to the four big traits of conscientiousness, agreeableness, openness to experience, and extraversion; however, it had a reverse relationship with neuroticism (Qasemi & Behroozi 2015). Except for openness to experience, the rest of their results were consistent with the present study. Jasemi et al. argued that personality characteristics have substantial relationships with obedience to professional standards in nursing students. They recommended that personality characteristics be considered as a key standard for the employment of new students in nursing (Jasemi et al., 2020). 
Moreover, the current present data supported the findings of other studies according to which personality traits impact professional performance and the provision of advanced services at the pharmacy (Rosenthal et al., 2016; Niculită 2013). Shafii et al. stated that hospital executives can advance their nurses’ performance by strengthening staff accountability and hiring accountable personnel (Shafii et al., 2018).
5. Conclusion
The personality traits and nursing professionalism are closely linked; nursing professionalism is directly related to extraversion, conscientiousness, and agreeableness. However, it presented an inversed relationship with neuroticism. Finally, the personality traits of nurses are important factors in predicting their professional behavior.
Ethical Considerations
Compliance with ethical guidelines
The names of the nurses and the information of the research participants remained confidential. Also, participation in this study was voluntary and informed consent forms were obtained from all individual participants in the study.
Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 
Authors' contributions
Conceptualization and supervision: Behnam Masmouei; Methodology: Mehdi Harorani; Data collection: Hossein Bazvand and Zahra karimi; Writing-original draft: Mohammad-Rafi Bazrafshan; Writing-review & editing: Mozhgan Jokar.
Conflict of interest
The authors declared no conflicts of interest.


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