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Beyond Horizontal Expansion: Structural, Educational, and Leadership Pathways to Nursing Professional Empowerment
Qian Yang1, Juanjin Wang1, Yuzhou Xu1
1Department of Rehabilitation Medicine, Suzhou Ninth People's Hospital, Suzhou, Jiangsu Province, China.
Nursing Inquiry
|July 23, 2026
Summary
Despite advances in nursing education, nurses lack professional autonomy due to persistent structural barriers. This paper outlines a synergistic strategy involving institutional, educational, and leadership reforms for sustainable nursing empowerment.
Area of Science:
- Healthcare Management
- Nursing Studies
- Organizational Theory
Background:
- Global nursing education has expanded horizontally but not vertically in professional autonomy.
- Nurses experience structural subordination in clinical governance, resource allocation, and decision-making.
Purpose of the Study:
- To analyze the persistent gap in nursing professional autonomy.
- To identify key mechanisms hindering nursing empowerment.
- To propose an integrated framework for achieving sustainable nursing empowerment.
Main Methods:
- Historical institutionalist lens to trace critical junctures in nursing's configuration.
- Examination of competency-based evaluation frameworks and entrustment-supervision scales.
- Analysis of leadership constructs and measurement threats in leadership interventions.
Main Results:
- Historically entrenched path dependence reinforces a doctor-led, nurse-subordinate structure.
- Deficits in competency evaluation and supervision scales limit genuine decision-making power.
- Conceptual overlap and measurement threats weaken leadership intervention evidence.
Conclusions:
- Institutional restructuring, educational enhancement, and leadership development must be synergistic.
- A coordinated pathway is proposed for sustainable nursing empowerment.
- Addressing these interconnected mechanisms is crucial for advancing nursing autonomy.
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