An integrative literature review and critical reflection on nurses' agency

Abstract

The idea of agency has long been used in the nursing literature in the study of nurses' roles regarding the patients they take care of, but it has not often been used to study its relationship with nurses themselves and their status in the healthcare system. The purpose of this article is to analyze how the idea of agency is used in nursing research to better understand how we might advance our thinking around nurses' agency to shape nursing and healthcare with an emancipatory intent. Based on the results of a literature review focused on the study of conceptions, treatments, and applications of the concept of agency in nursing, we present a critical discussion to reflect on the need to consistently define the idea of nurses' agency, to guide research concerned with this topic in theoretical frameworks with emancipatory and social change tenets, and to make a call to develop the idea of agency as a central one to rework nurses' relationship with themselves. The idea of agency provides a valuable analytical framework for the study of a wide range of issues around nurses' status in healthcare organizations and in the healthcare system while offering a means for nurses' emancipation.

Board talk: How members of executive hospital boards influence the positioning of nursing in crisis through talk

“…Moreover, our focus group discussions revealed a consensus among nurses that they excel in preparatory tasks rather than strategic roles during crises. And, therefore, as Lopez‐Deflory et al (2023a) state dominant approaches toward nursing agency deny the interdependency with and responsibility of other agents, for the positioning of nurses. Thus, board members and nurses need each other to reach a more effective interdependent collaboration based on expertise instead of hierarchy or “parentalism.”…”

“…Highlighting this as part of the influence on the positioning of nurses in crisis management unintendedly fuels a limiting narrative of a disadvantaged nurse and/or a detached board member. These limiting narratives are not helping in bettering the positioning of nursing (see, e.g., D'Antonio, 2006; Lopez‐Deflory et al, 2023a). However, from a relational leadership approach, the discursive practices (Barge, 2012) are complex and social interactions (Greenhalgh et al, 2023; Hosking, 1988; Hosking & Haslam, 1997).…”

“…Nevertheless, we cannot deny the asymmetric power relations (Aspinall et al, 2022; Kee et al, 2021) and the gendered images (Essex et al, 2023; Langley et al, 2019) that exist of and between board members and nurses in crises. As Lopez‐Deflory et al (2023a) recently stated; “Nurses play an active role not, only in the reproduction of the institutional status quo which maintains their subordination, but also in the challenge of the complex network of power that constitutes its subordination (…). Nurses should not be considered as the only ones responsible for this” (2023a, p. 6).…”

“…Highlighting this as part of the influence on the positioning of nurses in crisis management unintendedly fuels a limiting narrative of a disadvantaged nurse and/or a detached board member. These limiting narratives are not helping in bettering the positioning of nursing (see, e.g., D 'Antonio, 2006;Lopez-Deflory et al, 2023a).…”

“…Positioning of nursing in hospitals has historically been complicated (D'Antonio, 2006) because of the one‐sided historical frame of nursing as a relatively powerless profession (D'Antonio et al, 2010; Lopez‐Deflory et al, 2023a). This frame aligns with the frame of nurses as “heroes at the bedside,” resurfacing during the pandemic (Boulton et al, 2022).…”