The central argument proposed here is that nursing leadership cannot be adequately understood as a technical or organizational competence and must be reclaimed as an ethical expression of professional identity, emerging from the internalization of professional values and deontological principles.
Abstract
Nursing leadership has become an almost unquestioned imperative in contemporary discourse on healthcare systems. It is invoked in policy documents, educational frameworks, and organizational strategies as a key competence for managing complexity, improving outcomes, and ensuring the sustainability of care systems. However, despite this broad legitimization, the concept of leadership in nursing is often treated in predominantly functional terms. It is frequently approached as a neutral and intrinsically positive construct, increasingly articulated in relation to skills, organizational influence, and professional functions. 1 When leadership is reduced to a set of competencies or managerial capacities, it risks losing its moral foundation. In this way, it becomes detached from the very foundations of nursing practice, which is intrinsically ethical, relational, and value-oriented. The central argument proposed here is that nursing leadership cannot be adequately understood as a technical or organizational competence. Rather, it must be reclaimed as an ethical expression of professional identity, emerging from the internalization of professional values and deontological principles. The dominant discourse on nursing leadership reflects a strong orientation toward functionality and performance. Transformational leadership, for example, is widely associated with improved organizational outcomes, greater staff satisfaction, and enhanced team performance, and is often presented as a desirable and teachable style. 2 Similarly, evidence-based leadership emphasizes the integration of the best available evidence into decision-making processes, aligning leadership with the goals of quality and patient safety. 3 Authentic leadership, in turn, introduces attention to the moral and relational dimensions, underscoring the importance of coherence between values and actions. 4 Although these models offer relevant contributions, they share a common limitation. When critically examined, these models risk reducing leadership to a set of developable and measurable competencies, neglecting the identity-related and ethical dimensions that sustain professional practice. In this way, they risk fragmenting the phenomenon,
Objective: To elaborate and present an integrated conceptual definition of clinical leadership in nurses, empowering, based on the results of a systematic literature review.
Methodology: This study used Walker and Avant’s approach, which consisted of eight systematic steps. The literature search was conducted using electronic data from PubMed, Scopus, Science Direct, Sage Journal, ClinicalKey Nursing, and Proquest published from 2021 until 2025.
Results: An integrated conceptual framework identified three key antecedents (structural empowerment, supportive leadership climate, clinical leadership capabilities) and four core attributes, including transformational influence, enabling empowerment, relational and collaborative competencies, and ethical and professional integrity. The consequences include nurse well-being and growth, clinical excellence and safety, innovation and service improvement.
Conclusion: This conceptual analysis resulted in an integrated clinical leadership framework, conceptualizing clinical leadership in nurse empowerment as a system-level construct with interdependent components. These findings provide a strong theoretical foundation for the development of valid measurement instruments and the design of targeted interventions in clinical settings.
Mazly Astuty, T. Hariyati, Tuti Nuraini et al.· Rawal Medical Journal· 0 citations
This paper argues that competence in nursing education is ethically incomplete without epistemic agency. Contemporary nursing programmes are increasingly shaped by competencies, assessment rubrics, curriculum mapping and audit-ready evidence. These mechanisms are legitimate and necessary for accountability, but they may become ethically insufficient when they make professional formation visible mainly as performance, compliance or documentation. Epistemic agency refers to the capacity to interpret experience, justify claims, question assumptions and participate as a legitimate knower in nursing practice. Although the term may be unfamiliar to some nurse educators, its absence is visible when students are trained to enact standards without being equally supported to reason about uncertainty, credibility, patient testimony and the knowledge claims embedded in care. Existing commitments to reflection, critical thinking, evidence-based practice, person-centred care and student voice provide important educational values, yet they often lack a sufficiently explicit account of the epistemic harms that occur when credibility, intelligibility and authority are unequally distributed. They do not fully explain how some knowers are believed while others are doubted, how some forms of knowledge become authoritative while others are treated as anecdotal and how nursing knowledge itself may be positioned as practical implementation rather than disciplinary contribution. Epistemic agency cannot be secured merely by asking students to think critically or nurses to listen more attentively. Such responses underestimate the social, institutional and curricular conditions through which knowledge is made credible, intelligible and actionable. Drawing on social epistemology, nursing ethics and nursing knowledge development, this discussion paper reframes epistemic agency as a condition of ethical professional formation beyond competence alone. No empirical data are reported. Practical reflexive prompts are offered for curriculum leaders, nurse educators, clinical supervisors and students.
María Antuña-Casal, Marta Rios· Nursing Ethics· 0 citations
Aim To clarify the concept of relational communication competence (RCC) within nursing leadership and management through concept analysis. Background No unified conceptual definition currently bridges leadership, communication competence, and person‐centered care in nursing, a gap that constrains both competency frameworks and workforce development. While the issue is illustrated through the context of older‐adult care, the analysis extends more broadly to nursing leadership and management across diverse clinical and organizational settings. Methods We conducted a concept analysis guided by Walker and Avant’s framework. A structured search across PubMed, Scopus, Web of Science, and APA PsycNet yielded 19 eligible studies. Two reviewers independently extracted conceptual definitions, communication behaviors, and theoretical constructs from each study into a structured concept matrix, then compared entries iteratively until recurring patterns consolidated into defining attributes, antecedents, consequences, and empirical referents, with no new attributes emerging from the final studies reviewed. Results The analysis identified three defining attributes: relational sensitivity, effective information exchange, and collaborative engagement. All three attributes must co‐occur: No single attribute alone constitutes RCC, and this combination has not been consistently specified in nursing leadership scholarship. Antecedents included communication knowledge, cultural awareness, structured dialog opportunities, and supportive organizational climates. Consequences included stronger therapeutic relationships, greater patient engagement, improved team collaboration, and reduced clinical uncertainty. Empirical referents included empathic listening, transparent clinical explanation, verified shared understanding, and facilitated dialog. Conclusion RCC is defined as the capacity for healthcare communication that is responsive to contextual and emotional cues, informationally clear, and participatory across patients, families, and professionals. The analysis offers an integrated framework for bringing relational leadership, communication competence, and person‐centered care into closer conceptual alignment in nursing practice. Implications for Nursing Management Nurse managers require programs that develop all three attributes together, embedding RCC as a unified leadership capability rather than treating awareness, information exchange, and participation as separate concerns.
J. Almazan, Darya Zvonareva, Eddieson Pasay-an et al.· Journal of Nursing Managemen...· 0 citations
This article examines nursing professionalization in the Republic of Korea in light of two Korean laws enacted in 2024: the Nursing Act and legislation on integrated community care. Drawing on nursing professionalism and sociology of professions literature, we distinguish professionalism-the identity, knowledge, values, clinical judgment, ethics, and accountability constituting nursing practice-from professionalization, the institutional process through which nursing work gains jurisdiction, authority, legal protection, reimbursement, and social legitimacy. The Korean case shows that legal recognition creates visibility but does not by itself produce professional authority. Nursing role development in Korea is shaped by population aging, chronic illness, community-care demand, physician-delegated medical support tasks, cost-containment pressures, uneven workforce distribution, and weak reimbursement for nursing services. We argue that professionalization requires more than role expansion: it requires scope and role standards, education-credentialing alignment, legal authority and accountability, reimbursement mechanisms, nurse-led community models, and academic-practice-policy governance. The Korean case offers a theoretically useful example of the gap between statutory recognition and institutionalized professional authority.
Hae Won Kim, H. Lee· ANS. Advances in nursing sci...· 0 citations
BACKGROUND
Professional values and moral resilience are recognized as essential attributes of nursing practice. In critical care settings, where nurses routinely face ethical complexity and high-stakes decisions, it is important to understand how these attributes shape professional competence.
AIM
To examine the relationship between professional values and professional competence among critical care nurses, and to determine whether moral resilience mediates this relationship.
STUDY DESIGN
This descriptive and correlational study was conducted among nurses working in the critical care units of six hospitals between August and October 2025. The reporting was conducted in accordance with the STROBE guidelines. Three validated instruments were used: a professional values scale (range 1-5, with higher scores indicating stronger professional values), a moral resilience scale (range 1-4, with higher scores indicating greater moral resilience) and a professional competence scale (range 1-5, with higher scores indicating greater professional competence).
RESULTS
In total, 201 nurses participated in the study. Mean scores were high for professional values (4.45 ± 0.61 out of 5), moral resilience (3.27 ± 0.43 out of 4) and professional competence (4.26 ± 0.36 out of 5). Professional values were significantly and positively correlated with professional competence (r = 0.329, p < 0.001), whereas moral resilience showed no significant association with either variable. The direct effect of professional values on professional competence was significant (β = 0.193, p < 0.001), whereas the indirect effect through moral resilience was non-significant (β = 0.003, 95% CI [-0.005, 0.014]).
CONCLUSION
Professional values appear to play an important role in promoting professional competence among critical care nurses, whereas moral resilience did not mediate this relationship. Strengthening ethics-based education and professional value development may enhance competence in critical care practice.
RELEVANCE TO CLINICAL PRACTICE
Nurse educators and managers should prioritize the integration of professional values into nursing curricula, continuing professional development and clinical practice to strengthen professional competence among critical care nurses. Because moral resilience was not associated with competence, resilience-supporting initiatives may be directed primarily at nurses' well-being and retention rather than competence.
Shaimaa Mohamed Amin, Heba Emad El Gazar, M. Zoromba et al.· Nursing Critical Care· 0 citations
Passive language patterns undermine nursing’s professional influence by obscuring clinical expertise and the inherent value of nursing. This article offers a practical approach for transforming nursing practice language across clinical, educational, organizational, and systems leadership. Using 4 core principles: using active leadership verbs, connecting actions to outcomes, emphasizing expertise and evidence-based practice, and demonstrating influence through change-oriented language. This approach provides specific language transformations that demonstrate nursing’s strategic value, strengthen financial acumen, and drive policy change. It is important to note that this transformation emphasizes nursing’s core values and ensures nursing is recognized and resourced appropriately.
Lynn D. Mohr, Cynthia Rothenberger, Lynn Marilyn Schallom et al.· Journal of Nursing Administr...· 0 citations
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