Nursing at the intersection of power and practice: a grounded theory analysis of the profession's social position

Graells-Sans, Ariadna ; Galbany-Estragués, Paola ; Rodríguez-Martín, Dolors ; Gasch-Gallén, Àngel (Universidad de Zaragoza)

Resumen: Aim
To explore nursing professionals' perceptions of the intersectional positioning of their profession within healthcare and society, examining how axes of oppression shape healthcare responses and resource management.

Design
A qualitative study framed in critical theory paradigm employing constructivist grounded theory, as outlined by Charmaz.

Methods
The study was conducted in Catalonia, Spain, between 2022 and 2023. A total of 26 nursing professionals participated, representing a range of professional roles and settings. Theoretical sampling guided participant recruitment and was saturated after 17 in-depth interviews and 2 thematic focus groups. Interviews and focus groups were transcribed verbatim. Thematic analysis, informed by Charmaz's approach, was applied to identify key dimensions and themes. Intersectionality theory was used as a critical analysis framework.

Results
A predominant theme emerged from data identified as ‘intersectional disempowerment of nursing profession’. Four categories shape this positioning: (1) symbolic and historical undervaluation of care, rooted in nursing's feminization and patriarchal norms; (2) patriarchal influence on professional leadership, manifested by men disproportionately occupy leadership roles, reinforcing vertical segregation; (3) intra-professional hierarchies and technocratic influence, forcing prestige disparities within nursing and promoting horizontal segregation; and (4) internalised barriers among nurses regarding professional prestige, authority and recognition which combined undermine nursing's visibility, legitimacy and influence within healthcare.

Conclusions
Nursing cannot be understood as a neutral profession. Its societal positioning is deeply shaped by structural inequities, gendered assumptions and entrenched hierarchies, which collectively undermine its potential for autonomy and recognition.

Impact
This study highlights the need to challenge intersectional hierarchies in nursing, promoting equitable recognition, policy reforms and leadership opportunities to enhance nurses' authority, visibility and professional empowerment within healthcare systems. Addressing these challenges requires systemic policy reforms and a critical re-evaluation of societal perceptions. What problem did the study address? Nursing's social image is strongly shaped by biomedical, technocratic and social views. The gap between nursing's public image and identity limits professional growth and recognition. Analysing how power relations intersect in nursing's social position is essential. What were the main findings? Nursing's role is shaped by the intersection of gender, prestige, socioeconomic status and social recognition. Nurses' empowerment must be tied to transforming unjust institutions and systemic structures. Where and on whom will the research have an impact? This study provides a critical analysis of the intersectional positioning of the nursing profession. The findings have implications at multiple levels: micro, by offering nurses a critical perspective on their professional positionality; meso, by providing healthcare managers with insights into the underlying factors contributing to nursing's undervaluation; and macro, by fostering reflection within the broader healthcare community on the power dynamics shaping interprofessional relationships.

Idioma: Inglés

DOI: 10.1111/jan.70126

Año: 2025

Publicado en: Journal of Advanced Nursing (2025), [13 pp.]
ISSN: 0309-2402

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Área Enfermería (Dpto. Fisiatría y Enfermería)