The study identified three profiles of career decision difficulties in 562 undergraduate nursing students from three Chinese universities: multidimensional decision block (58.5%), knowledge-action disconnect (34.0%), and information-based advantage (7.5%). Latent profile analysis and multinomial logistic regression methods were used to evaluate data from verified measurements. Career decision-making difficulties are associated with negative outcomes such as reduced motivation to learn, weakened professional identity, burnout and higher turnover risk. Perceived social support, involvement in education, and classroom leadership status were significantly associated with these profiles. Students in the multidimensional decision block profile can benefit from structured career development courses. Strengthening the processing of career information is important for the disconnection of knowledge from activity profile. Improving engagement in learning, decision-making skills and support networks can reduce student insecurity.