Narrative nursing: A primary ethical practice

Narrative medicine has emerged as an influential framework in contemporary healthcare, arguing that attending to patients' stories improves the quality of clinical practice and ethical reasoning. Yet the conversation surrounding narrative practice has developed largely within medicine, leaving nursing positioned as a secondary site of application rather than a primary source. This paper challenges that positioning. The paper argues that narrative nursing is not an extension of narrative medicine but a primary ethical practice in its own right, grounded in nursing's unique structural capacity for sustained, embodied presence at the site where illness stories unfold. The argument develops across three interlocking dimensions. The first establishes the conceptual foundations of narrative practice in healthcare, tracing a genealogy that extends beyond the most cited frameworks to include the contributions of Kleinman, Frank, and Benner. This genealogy suggests that nursing's relationship to narrative practice is not derivative but constitutive. The second examines nursing's structural position. Continuity, embodied presence, and relational depth are not features that nursing needs to acquire; they are its defining characteristics, and they are precisely the conditions under which illness stories can be told and heard. The third develops the ethical argument. Hearing a patient's story is an act of epistemic justice, moral witnessing, and relational care. Nursing's structural position makes it the discipline positioned to perform that act, drawing on the traditions of care ethics and the relational foundations already embedded in nursing practice. The paper concludes by arguing that narrative nursing has the potential to make a distinctive contribution to clinical ethics, one grounded in sustained, relational presence rather than in episodic encounter. The implications for nursing education, clinical practice, and professional identity are considered.