Nurses' Engagement in Healthcare Policy-Making: A Pragmatic Utility-Based Scoping Review

This review aimed to map the available evidence on nurses' engagement in healthcare policy-making and to identify the foundational concepts that shape this engagement.

Nurses represent the largest professional group in healthcare systems and hold a central position in responding to population health needs. However, they remain underrepresented in policy-making arenas. Their engagement is increasingly recognised as essential for building equitable, responsive and patient-centred healthcare systems, yet it is limited by insufficient policy education, restricted access to decision-making spaces, and the absence of a guiding conceptual framework.

This scoping review was conducted using established methodological guidance for evidence mapping. A Pragmatic utility approach informed the conceptual analysis, allowing the available literature to be examined in relation to the usefulness, clarity, and applicability of concepts describing nurses' policy engagement.

A systematic search of peer-reviewed databases was complemented by manual searches of reference lists. Eligible sources examined nurses' engagement, participation or influence in healthcare policy-making across clinical, organisational, professional, or governmental contexts.

Nurses' engagement in policy-making was described through interrelated antecedents, attributes, and outcomes. Individual factors and professionalism were important antecedents, but engagement was strongly shaped by contextual conditions, including organisational support, opportunities for collaboration, and access to policy spaces. The findings suggest that policy participation is relational and depends on the ability to translate nursing expertise into policy-relevant messages. Engagement was associated with enhanced advocacy, exposure to positive role models, and education and information seeking, which may reinforce further participation.

Nursing organisations, educators, and leaders should strengthen policy and advocacy education, mentorship, leadership development, and opportunities for nurses to participate in policy-related activities.

Health systems should create organisational mechanisms that provide protected time, formal recognition, and access to policy forums, enabling nurses to contribute more effectively to policy decisions.