Nurses’ Engagement in Healthcare Policy‐Making: A Pragmatic Utility–Based Scoping Review

ABSTRACT

Aim

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.

Background

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.

Methods

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.

Sources of Evidence

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.

Discussion and Conclusion

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.

Implications for Nursing Practice

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

Implications for Health Policy

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.

1. Introduction

Policy‐making refers to the processes by which decisions are made, and actions are taken by individuals, organisations, or governments to achieve their specific goals and objectives (Birkland 2019; Cairney 2019). It occurs across levels, from local to national and international institutions, and can involve a wide range of stakeholders (Cairney 2019; OECD 2021).

In the context of health, the World Health Organization (WHO) defined policy‐making as the series of steps involved in the development, implementation, and evaluation of decisions and actions related to health organisations, to achieve specific healthcare goals within society and systems (WHO 2023). As healthcare systems continue to evolve in response to demographic change, workforce pressures, and emerging threats, the involvement of healthcare professionals in policy processes becomes increasingly relevant to ensure that policies are feasible, responsive, and ethically grounded (Annesley 2019; Birkland 2019; Cairney 2019).

With a global workforce of approximately 27 million (World Health Organization 2024), nurses play a critical role in healthcare systems, and their insights can help ensure that policies accurately reflect patient needs and healthcare delivery realities, while also shaping workplace conditions and professional practice (Arabi et al. 2014). By participating in healthcare policy‐making, nurses can embed clinical practice considerations within policy reforms, strengthening their voice on public health issues and enabling them to act as advocates and leaders (Annesley 2019; Arabi et al. 2014; Sundean et al. 2021).

Nurses’ engagement in policy‐making is understood as the active involvement of nurses in shaping health policies and influencing decisions across the policy cycle – from agenda setting and formulation to implementation and evaluation – at organisational/local, regional, and national levels (Wichaikhum et al. 2020). Such engagement may include formal participation (e.g., professional bodies, leadership and governance roles) as well as shaping decisions through advocacy, collaboration, and the generation or use of evidence to inform decision‐making. Moreover, engagement in policy‐making can strengthen nurses’ roles in advocacy and leadership, elevating nursing perspectives on public health priorities and health equity (Annesley 2019). Despite this potential, nurses have historically had limited participation in shaping health policies and are often more involved in implementation than in earlier stages of policy development (Sundean et al. 2021). International initiatives have also sought to strengthen nursing leadership and policy readiness, such as the Nursing Now Campaign promoted by the International Council of Nurses in collaboration with WHO (Mendes et al. 2020; Salvage and White 2019). Although nursing education and professional development have expanded in recent decades – placing greater emphasis on advanced competencies, leadership, and research – nurses’ participation in policy‐making remains uneven and limited across many contexts (Arabi et al. 2014; Hajizadeh et al. 2021; Rasheed et al. 2020; Wilson et al. 2020). The COVID‐19 pandemic further underscored the strategic value of nursing leadership and, in some settings, opened windows for nurses to inform policy responses when frontline expertise was essential to crisis decision‐making (Anders 2021). In parallel, several strategies have been proposed to strengthen nurses’ policy engagement, including training and mentoring to support evidence generation and evidence‐informed decisions, leadership development and education focused on policy processes and advocacy, and initiatives designed to ensure equitable opportunities for participation across gender, race/ethnicity, and socio‐economic backgrounds (Waddell et al. 2017).

Explanations for limited nurses’ policy engagement are commonly discussed in the literature in terms of intrinsic and extrinsic factors (Wilson et al. 2020; Rasheed et al. 2020; Hajizadeh et al. 2021; Sundean et al. 2021). Intrinsic factors include individual and professional characteristics that can hinder nurses’ engagement, such as limited awareness of policy processes, gaps in policy‐related knowledge and skills, low confidence, and insufficient exposure to policy work or leadership development (Wilson et al. 2020; Hajizadeh et al. 2021; Rasheed et al. 2020). Extrinsic factors operate at organisational and system levels and constrain nurses’ access to decision‐making spaces and recognition of expertise, including scarce or informal participation routes, time and workload pressures, hierarchical cultures, and unequal opportunities for leadership progression (Wilson et al. 2020; Sundean et al. 2021; Hajizadeh et al. 2021; Rasheed et al. 2020). Together, these organisational and system‐level constraints can reinforce the undervaluation of nursing expertise in policy arenas, limiting both their entry into such spaces and the legitimacy accorded to their contributions, even when policy issues are closely tied to care delivery (Rasheed et al. 2020; Hajizadeh et al. 2021; Sundean et al. 2021). Importantly, limited engagement should not be interpreted solely as a nursing‐specific deficit but also as a consequence of how governance structures recognise, include, and legitimise nursing perspectives (Rasheed et al. 2020; Hajizadeh et al. 2021). In this regard, compared with other professional groups that may have more institutionalised routes into governance and advisory structures, nurses may have fewer formal mechanisms for representation, which can constrain their influence on agenda setting and policy formulation (Rasheed et al. 2020; Sundean et al. 2021; Hajizadeh et al. 2021). In many policy settings, decision‐making bodies and advisory committees are often dominated by professions with long‐standing policy roles and institutional authority (e.g., physicians), which can increase their visibility, perceived legitimacy, and access to upstream policy processes (Dalglish et al. 2023). Consequently, nursing input may be sought mainly at later stages, often to support implementation, rather than as a central contribution to early problem framing, priority setting, and policy design (Rasheed et al. 2020; Sundean et al. 2021; Hajizadeh et al. 2021).

Considering nurses’ engagement alongside the involvement of other professional groups helps to situate nursing within interprofessional policy arenas and to clarify how unequal institutional access and professional authority shape which perspectives ultimately steer policy direction (Arabi et al. 2014; Hajizadeh et al. 2021; Rasheed et al. 2020; Wilson et al. 2020).

Nevertheless, nurses remain scarcely involved or engaged in policy‐making across many settings (Inayat et al. 2023; Juma et al. 2014; Kunaviktikul et al. 2010).

Existing knowledge syntheses have mainly examined factors influencing nurses’ and nurse leaders’ participation (Hajizadeh et al. 2021; Rasheed et al. 2020; Sundean et al. 2021), challenges that hinder involvement (Anders 2021), and educational strategies to promote earlier participation (Lee and Choi 2022). Clarifying what constitutes nurses’ policy engagement and how it differs from, or overlaps with, involvement in implementation remains essential to strengthening nursing contributions to policy development and addressing persistent gaps in representation.

However, a comprehensive conceptual understanding of nurses’ engagement in policy‐making remains limited (Rasheed et al. 2020). In particular, there is a need to identify and describe the key concepts that underpin nurses’ engagement in health policy‐making, so as to enable clearer measurement, more targeted interventions, and more coherent policy and educational strategies (Arabi et al. 2014; Anders 2021; Rasheed et al. 2020). To address this gap, we conducted a scoping review, informed by a pragmatic utility (PU) concept analysis, to identify the key concepts influencing nurses’ engagement in health policy‐making.

2. Methods

We conducted a scoping review following the Joanna Briggs Institute methodology and reported it in accordance with the PRISMA Extension for Scoping Reviews (PRISMA‐ScR) (Tricco et al. 2018) (Supplementary File S1). The protocol was registered in the Open Science Framework (OSF; registration DOI: https://doi.org/10.17605/OSF.IO/75P98).

To support conceptual clarification alongside evidence mapping, we integrated a PU concept analysis as an analytic layer within the scoping review (Chen et al. 2019; Morse 2016). This choice followed directly from the conceptual ambiguity identified in the Introduction: rather than imposing a predetermined framework, the PU analysis was used to derive the components of nurses’ policy engagement inductively from the literature, addressing the lack of a coherent conceptual structure noted in the background. The scoping review component was used to identify, select, and chart the relevant literature. Using the same set of included studies as the analytic dataset, the PU component examined how nurses’ policy engagement was described and operationalised across publications and organised the resulting concepts into structured components (Chen et al. 2019; Morse 2016; Weaver and Morse 2006).

Overall, the integrated process comprised: (1) clarifying the study purpose and research questions; (2) literature search and selection; (3) familiarisation with the literature; (4) inductive generation of analytical questions; (5) recording responses on a data collection sheet; and (6) conceptual synthesis.

2.1. Clarifying the Study Purpose and Research Questions

The review addressed the following research questions: (i) What evidence exists on nurses’ engagement in healthcare policy‐making? (ii) What are the foundational concepts that shape this engagement?

Accordingly, the objectives were to (i) systematically map the literature on nurses’ engagement in healthcare policy‐making and (ii) identify and define the foundational concepts that shape this engagement.

2.2. Literature Search and Selection

The search process was conducted by a team of researchers, who supervised the development of the search strategy and coordinated the database searches, under the supervision of a health librarian with experience in literature searching and scoping reviews.

To create an exhaustive and broad search strategy and identify the most appropriate keywords, an initial search of CINAHL (EBSCO) and EMBASE databases was undertaken in April 2025 to identify articles related to the topic. The words in the titles, abstracts, index terms, and keywords of relevant articles were analysed to develop a comprehensive search strategy. The searches used both thesaurus and free terms and included keywords related to the engagement of nurses in policy‐making. The search strategies were adapted for each database (Supplementary File S2).

2.3. Studies Were Considered Eligible If They Met the Following Criteria

2.3.1. Types of Participants

Studies included nurses working as registered nurses (RNs), nurse practitioners (NPs), advanced practice nurses (APNs), nursing experts, nurses’ leaders, or managers at all – micro, meso, and macro – levels of management or policy. Articles were excluded when they did not specify the population or when they included nurse students.

2.3.2. Concept

Studies that explored, described, or evaluated the engagement of nurses in policy‐making were included. Consistent with the definition adopted in the Introduction, engagement was understood as nurses’ active involvement in shaping health policies and influencing decisions across the policy cycle, from agenda setting and formulation to implementation and evaluation (American Nurses Association 2015, 2025). Because terminology is used inconsistently across the literature, nursing involvement was treated as a synonym of engagement.

2.3.3. Context

Studies referred to healthcare, social, and community policy‐making and reported information about nurses’ engagement were included. Studies were excluded when they referred to specific clinical areas or settings (e.g., oncology and public health).

2.3.4. Types of Studies

Primary quantitative studies, including but not limited to descriptive, cohort, case–control, experimental, or quasi‐experimental studies, and qualitative studies, including but not limited to descriptive, phenomenological, and action research studies, were included. Mixed‐methods studies were also included if relevant. Secondary studies such as systematic, narrative, or scoping reviews, discussion papers, or theoretical papers were excluded, but their reference lists were screened to identify any potentially relevant papers. Only articles in English were included.

A full search was conducted on five peer‐reviewed databases: CINAHL, EMBASE, PubMed, SCOPUS, and Web of Science. Reference lists of the included studies were also screened to find additional studies through a manual search. Where full texts were not available, the first or corresponding authors were contacted by email; studies were excluded if the full text could not be retrieved. The results were screened by reading titles and abstracts. After completing the search, the identified records were uploaded to EndNote version 20, and duplicates were removed. The web app Rayyan (Ouzzani et al. 2016) was used to support the screening and selection process. During the screening and selection process, an additional researcher verified the relevance and eligibility of the studies selected for inclusion. Any disagreements were resolved through discussion between the research group.

2.4. Familiarisation With the Literature Reading of the Literature

Following study selection, three researchers undertook an initial familiarisation (“entering” the literature) phase through in‐depth reading of all included full texts. The purpose of this phase was to develop a shared understanding of how nurses’ policy engagement/involvement was used across the literature – specifically, the contexts in which it was described and the meanings and implications attributed to it. Researchers worked independently to annotate the texts and generate preliminary interpretive notes capturing concept‐relevant content (e.g., explicit and implicit descriptions of the phenomenon, the language used to characterise it, and references to related or overlapping constructs). To ensure transparent and consistent documentation, observations were recorded in a tracking system table (Morse 2016). This structured charting tool supported systematic capture of concept‐related information from each source (e.g., descriptions/definitions, contextual features and conditions, illustrative examples, and candidate components), enabling early mapping of how the concept was represented across studies and facilitating the management of a large evidence base. The independently completed tracking tables were subsequently compared and merged by a fourth researcher to produce a single consolidated dataset for subsequent analytic phases.

2.5. Inductive Generation of Analytical Questions

Building on the preceding step, three researchers undertook a further interpretive reading of all included articles to identify not only explicit descriptions but also implicit information revealing the ‘anatomy’ of the concept. During this stage, concept‐relevant text units and interpretive insights were sorted and added to the tracking system table, strengthening the preliminary conceptual map with nuanced meanings, contextual conditions, and relational cues embedded in the literature. In parallel, the same researchers critically reviewed the literature to inductively generate analytical questions, particularly when the evidence showed inconsistencies, ambiguities, or recurring components related to nurses’ policy engagement (e.g., what precedes the concept, its core features, consequences, boundaries, and allied constructs). A dedicated team meeting was then held to discuss, debate, and agree on the final set of analytical questions requiring further exploration. A summary of analytical questions was subsequently used as the analytic framework guiding focused extraction and synthesis in the data matrix (Supplementary File 3).

2.6. Recording Responses on Data Collection Sheet

Drawing on the analytical questions agreed by the team, a second, more focused round of data extraction from the included full texts was conducted. Building on the existing data in the tracking system table, three researchers conducted a further targeted extraction of any additional text needed to answer each analytical question, aiming to capture – consistently and comprehensively – the specific evidence required for the subsequent analytic step.

To organise this process, a data collection matrix was developed: each analytical question was listed as an item and paired with a structured field for charting (i) supporting evidence from each study and (ii) the corresponding responses from the literature. For each question, all relevant content across the included studies was identified, extracted, and compared; the resulting answer was then synthesised into a concise summary and entered into the matrix. For example, for the analytical question (e.g. What factors are demanded for or could directly influence [the concept]?), all data units capable of addressing the question were extracted and aggregated to generate a summary response, which was recorded in the responses column.

Extracted information and summary responses were charted under the key domain components identified during analytic framework development (antecedents, attributes, and outcomes), ensuring traceability to the original sources through the underlying extraction records. An extract of the completed data collection sheet is provided in Supplementary File S3.

2.7. Conceptual Synthesis

A group meeting was conducted to analyse each set of responses from literature in the data collection matrix to identify commonalities, divergences, and patterns across studies, capturing both explicit and implicit conceptual content. This involved a systematic process of comparison, contrast, and synthesis of the extracted text units and the corresponding responses, with iterative discussion to refine interpretations and resolve discrepancies.

As part of the conceptual synthesis, the aggregated responses were clustered into higher‐order conceptual components. Specifically, identified components were categorised into antecedents, attributes, and outcomes. Where relevant, additional components were examined to clarify boundaries of use and allied/overlapping constructs, supporting a more precise and usable conceptualisation.

Studies were also charted to provide a structured descriptive overview of the evidence, extracting: (i) author(s), year, and country; (ii) study design, context, and aim(s); (iii) participants, data sources/collection, and analytic approach; and (iv) key findings and underpinning lay concepts. These data were summarised in tables and graphical formats. A narrative descriptive synthesis accompanied the tabulated/charted results, linking the mapped study characteristics and the conceptual components derived from the PU analysis to the review aims.

2.8. Transparency and Rigour

Rigour was ensured throughout the PU approach through an independent, collaborative workflow, consensus‐based resolution of discrepancies, an audit trail, and traceability between analytic questions, supporting evidence, and the final synthesis. The strategies applied at each analytic stage are detailed in Supplementary Table SX.

All analytic stages were undertaken by three researchers and confirmed by a fourth researcher; final confirmation was provided by the full research team.

3. Results

3.1. Search Results

A total of 17,973 records were retrieved from the electronic and manual searches. After removing duplicates (n = 8,464), 9,509 articles were screened, and 74 were assessed for eligibility. Ultimately, 43 articles were included in the review (Supplementary File S4).

3.2. Study Characteristics

Published between 1999 and 2023, the included studies were qualitative (n = 22), quantitative (n = 21), or mixed‐methods (n = 2) and were conducted predominantly in North America, followed by Africa, Asia, the Middle East, Europe, and Oceania (Tables 1 and 2). The data collection in qualitative studies involved semi‐structured or in‐depth interviews (n = 17), focus groups (n = 3), or both (n = 1) and participant observation (n = 1). Data were analysed primarily through content analysis (n = 8) and thematic analysis (n = 7) (Table 1). Most of the quantitative studies used cross‐sectional designs (n = 10). All quantitative data were collected through surveys, and some were validated (e.g., registered nurses in health policies or the civic voluntarism model) or newly developed questionnaires (Table 2).

TABLE 1.

Characteristics of the qualitative primary studies included in the review (N = 22).

Article, country	Design	Context	Aim	Participants	Data collection and analysis	Findings	Underpinning lay concepts
Anderson et al. 2016, Australia	Participatory action research	Rural health service	To engage nursing staff in a rural health service in the development of a minimum nursing standards policy;	N = 13 RNs and nurse leaders	Focus group discussion Thematic analysis	Theme 1. Personal/staff features Theme 2. Organisational features	Professionalism Contextual resources or barriers Collaboration within and between
Asuquo 2019, Africa	Qualitative descriptive study	Organisational and healthcare policy	To assess the extent of nurse's leadership in research and policy formulation as well as social, political, and contextual factors that have influenced nurses’ leadership in research and policy development	N = 12 RNs and nurse leaders	Interviews Focus group discussions Qualitative descriptive	Theme 1. Research leadership gap Sub‐themes 1. Marginal participation in knowledge creation, l Sub‐theme 2. Leadership challenges and envisioned Sub‐theme 3. Solutions to knowledge creation Theme 2. Policy leadership dearth Sub‐themes 1, namely leadership imperviousness Sub‐theme 2. Going with the flow	Education and information seeking
Bartmess et al. 2022, USA	Qualitative descriptive study	Hospital	To increase understanding of staff nurses’ perceptions of factors that hinder or support nurse involvement in hospital nurse staffing policy‐making and to learn more about how nurses are, or would like to be, involved	N = 32 RNs	Open‐ended and semi‐structured responses	Theme 1. ‘We aren't asked’: structural barriers to staff nurse involvement. Theme 2. ‘No one cares’: workplace culture barriers to staff nurse involvement. Theme 3. ‘They’ versus ‘we’: lack of power sharing for staffing decision‐making.	Individual factors
Cheraghi et al. 2015, Iran	Qualitative descriptive study	Iranian Council of Nurses	To elucidate Iranian nurses’ status in policy‐making for nursing in health system	N = 22 Boards’ nurses	In‐depth interviews Content analysis	Theme 1. The policy‐making framework Theme 2. Perceived status of nurses in policy making Theme 3. The manner of nurses’ participation in policy making	Collaboration within and between
Ditlopo et al. 2014, Africa	Qualitative descriptive policy analyisis framework	National health workforce policies	To analyse and frame the dynamics, strengths, and weakness of nurses’ participation in health workforce policies;	N = 101 Frontline nurs’ leaders and RNs	In‐depth interviews Thematic content analysis based on Walt and Gilson policy analysis framework	Theme 1. The extent of nurses’ participation in nursing policies Theme 2. The nature of nurses’ participation Theme 3. Contestations and complexities of consultation and participation	Frame nursing policies
El‐Jardali et al. 2014, Lebanon	Case study	Key informants of parliament, ministers and school of nursing	(a) Generating in‐depth insights on the public policy‐making process; (b) Identifying the factors that influence policy‐making and assessing to what extent evidence is used in this process	N = 29 Nurse leaders and educators	Semi‐structured interviews Panel discussion Thematic analysis on Walt and Gilson's ‘Policy Triangle Framework’	Dimension 1. Content Dimension 2. Context Dimension 3. Actors Dimension 4. Process	Contextual barriers or resources
Gebbie et al. 2000, USA	Qualitative descriptive study	National, state, local and organisational health policy	(a) To describe ways nurses are and are not effective in the development of health policy; (b) To provide useful information for those interested in making nursing a more vital part of the policy arena;	N = 27 RNs	Semi‐structured interviews Ethnographic observation Thematic analysis	Theme 1. What do nurses bring to policy Theme 2. What are the career paths of nurses in policy positions Theme 3. What could improve the policy contributions of nurses	Individual factors Education and information seeking
Hajizadeh et al. 2021, Iran	Qualitative descriptive study	Hospital nurses’ managers	(a) To explore the barriers and facilitators concerning nurse managers’ participation in the health policy‐making process	N = 16 Nurse managers and key informants	Semi‐structured Interviews Thematic analysis	Main theme 1. Participation barriers Sub‐themes. Nurse managers’ characteristics; Organisational structure; External/environmental barriers Main theme 2. Participation facilitators Sub‐themes. Improvements in collaboration and communications; Governmental and non‐governmental organisational activities; Reforms in the health policy‐making process;	Education and information seeking
Han 2020, South Korea	Qualitative phenomenological study	Civic and community policy	To explore the healthcare policy reform activities of Korean nurses engaged in civic organisations	N = 7 RNs and nurse leaders	In‐depth interviews Colaizzi phenomenological analysis	Theme 1. Recognition of social responsibilities and limitations faced Theme 2. Becoming a healthcare professional Theme 3. Social solidarity beyond nursing Theme 4. Political influence outside the political arena Theme 5. Leading reform by entering the political arena	Experience positive role models
Hughes 2010, UK	Ethnography study	Boards of local health groups	To examine nurses’ experiences on Local Health Groups and, more broadly, the gendering of organisational culture and the specific challenges this presents for nurses and nursing	N = 15 Nurses’ board members	In‐depth Interviews and non‐participant observations Thematic analysis	Theme 1. Nursing identity Theme 2. The nursing contribution Theme 3. Medical power	Individual factors Professionalism
Inayat et al. 2023, Canada	Qualitative descriptive study	Hospital Nurses Leaders	To explore strategies to enhance nurses’ involvement in policy‐making from the perspective of nurse leaders	N = 11 Nurse leaders	In‐depth Semi‐structured Interviews Thematic analysis	Theme 1. Strategically revisit and implement educational approaches Theme 2. Becoming transformative leaders Theme 3. Improving social image of nurses Theme 4. Developing triadic partnerships Theme 5. Empowering nurses through reflective and supportive mechanisms	Professionalism Contextual barriers or resources Collaboration within and between
Juma et al. 2014, Africa	Qualitative descriptive study	National, provincial and district levels Kenyan decision‐makers of public health care system	(a) To analyse the extent of nurses’ involvement in the national policy development processes in the health sector; (b) To analyse the reasons for nurses’ inadequate involvement in the national policy development in the health sector; (c) To describe the mechanism through which nurses’ involvement in policy development processes can be improved	N = 32 Nursing and non‐nursing leaders and RNs	Open‐ended interview Content analysis	Category 1. Nurses’ involvement in national policy processes Category 2. Reasons for inadequate involvement of nurses Category 3. Enhancing nurse participation in policies	Individual factors Contextual barriers or resources Education and information seeking
Kerschner and Cohen 2002, USA	Qualitative descriptive study	Senate and house health and welfare committees	To examine and describe the lived experience of individual legislative decision‐making;	N = 4 Nursing legislators	In‐depth interviews Inductive phenomenological analysis	Theme 1. Understanding the issue Theme 2. Shaping a personal stand Theme 3. Weighing for action	Professionalism Contextual barriers or resources Education and information seeking
Kunaviktikul et al. 2010, Thailand	Mixed‐method qualitative descriptive part	Steering Committee of the Thailand Nursing Council and/or the Nurses’ Association of Thailand	To explain the levels of knowledge about and involvement in national health policy development by nurses in Thailand	N = 26 Nurse leaders	Semi‐structured in‐depth interviews Content analysis	Category 1. Policy formulation Category 2. Policy Implementation Category 3. Policy modification	Professionalism Education and information seeking
Lewinski and Simmons 2018, USA	Descriptive study	Nursing boards and directors	To understand practicing nurses’ knowledge and engagement in health policy advocacy with the goal of creating a continuing education programme on health policy advocacy specifically for nurses	N = 118 RNs	Open‐ended questions Content analysis	(1) Open‐ended responses indicated confusion between patient and political advocacy, suggesting that an easily accessible continuing education programme could provide education about different advocacy approaches to help nurses leverage their clinical expertise specifically to influence health policy advocacy	Education and information seeking
Macdonnell 2010, Canada	Qualitative descriptive policy study	Hospital management	(a) To understand nurses’ capacity and gender effect on social and health policy participation; (b) To understand how nurses influence policy through their everyday political work;	N = 10 Canadian female nurses	In‐depth interviews Narrative life history methodology	Theme 1. Diverse and hierarchical nature of policy processes Theme 2. Webs and ladders Theme 3. Contextual factors	Individual factors
O'Connor 2017, UK	Qualitative descriptive study	National Health Service nursing boards	To explore nurses’ views on future priorities for the profession and to examine social media as an engagement tool to aid policy discussion and development	N = 64 RNs, nurse leaders, legislators	Virtual focus group on Twitter Thematic analysis	Theme 1. Technology and Informatics Theme 2. Research Theme 3. Education Theme 4. Mental health Theme 5. Advanced practice The top ten hashtags used during the #CNOScot chat were nurses, research, and education	Education and information seeking
Sarnkwawkum and Oumtanee, 2019, Thailand	Hermeneutic phenomenological study	House of Representatives in Thailand	To explore the lived experiences of being a nurse politician	N = 7 Nurse politicians	In‐depth interviews Content analysis van Manen's method	Theme 1. Becoming a politician Theme 2. Applying nursing science to help people. Theme 3. Supporting the nursing profession	Collaboration within and between Experience positive role models
Tilley and Tilley 1999, UK	Case study	Small Postgraduate Unit	To identify major changes in the tasks and responsibilities of the nurse manager at a small postgraduate unit as major changes in policy and financial environment;	N = 1 Nurse leader	Participants observation Content analysis	Overarching theme. The changing position of the nurse manager before and after trust status Sub‐themes Operational responsibilities Relations with corporate management Relation with junior managers Financial control Human resource management (HRM) issues	Experience positive role models
Waddell et al. 2017, USA	Delphi study (qualitative part)	Nurse Members of an Action Coalition Leadership Team	To describe and quantify experiences of nurse leaders working to influence policy and to build consensus for priority skills and knowledge within nursing conceptual framework	N = 22 Nurse leaders	Focus group interview Content analysis	Theme 1. A passion for policy Theme 2. The importance of clear communication Theme 3. Understanding the who and when of policy work	Frame nursing policies
Warner 2003, USA	Phenomenological study	Health profession commission	To explore the set of skills called political competence of 6 politically expert nurse activists	N = 6 Expert nurse activists	In‐depth interviews Interpretative phenomenology	Theme 1. Nursing expertise as valued currency Theme 2. Opportunities created through networking Theme 3. Powerful persuasion Theme 4. Commitment to collective strength Theme 5. Strategic perspective: A view from stepping back Theme 6. Perseverance	Education and information seeking
Wichaikhum et al. 2020, Thailand	Delphi study	Nursing professional organisations	To develop a strategic model of participation in policy development for nurses in Thailand	N = 15 Organisational, educational, and researchers/scholars/experts	Three rounds of in‐depth interviews Open‐ended survey questions Content analysis as frequency count	(1) The strategic model contains 25 participation strategies for nurses wishing to engage with public health policy development; (2) Strategies were organised in five main domains related to nurses (i), nurse leaders (ii), nurse researchers/scholars (iii), nursing educational institutions (iv), and nursing professional institutions (v).	Frame nursing policies
Wilson 2002, Canada	Qualitative descriptive study	Organisational policy	(a) To test the theory of Cohen et al. (1996) of political development stages through describing and comparing a specific example of political action by nurses and non‐nurses.	N = 3	Semi‐structured interviews Discursive analysis	(1) The political action undertaken by both nurses substantiated the first 2 (self‐interest) of 4 (political action engagement) theorised political stages (2) Finding provides partial support for the third stage of Cohen et al.’s political sophistication	Contextual barriers or resources
Wilson et al. 2020, Canada	Grounded theory	Canadian Nursing Organization	To explain and understand the common reason of why and how nurses became politically active, and what they achieved	N = 10 Politically active nurses	In‐depth interviews Thematic analysis	Theme 1. Early life experiences and education are key for nurses’ political involvement Theme 2. Nursing values, education, and practice are paramount for nurses to engage in politics Theme 3. Becoming aware of policy decision‐making implications and being encouraged to get involved in politics or political action Theme 4. Being mentored and feeling supported to be politically active Theme 5. Winning battles and feeling recognised as a source of energy to keep politically active Theme 6. Bringing nursing education and practice background skills to politics Theme 7. Nurses’ political involvement achievements	Education and information seeking Collaboration within and between Individual factors Professionalism

RNs: registered nurses.

TABLE 2.

Characteristics of the quantitative primary studies included in the scoping review (N = 21).

Article, country	Design	Context	Aim	Participants	Data collection and instrument	Data analysis	Results	Underpinning lay concepts
AbuAlRub and Foudeh 2017, Jordan	Descriptive cross‐sectional study	Health policy	(a) To examine the level of involvement of Jordanian nurses in health policy development (b) To examine the perceived benefits, barriers, and impacts on health outcomes of involvement in the health policy process	N = 231 RNs	Survey Registered nurses’ involvement in health policies 79‐item questionnaire	Descriptive statistics	(1) The most frequent health policy activities indicated by participants were ‘voting for a candidate or a health policy proposal’ (37.7%), followed by ‘taking part in a protest or demonstration regarding a health policy issue’ (25.5%) and ‘providing information to consumers or other professionals’ (23.4%); (2) The three most frequent perceived benefits to involvement in health policy were ‘improving the health of the public’ (69.3%), followed by ‘opportunity to develop new skills’ (59.3%) and ‘making a difference in other lives’ (59.3%); (3) The participants perceived that ‘using mass media or public events to address a health policy issue’ and ‘providing health‐related information to consumers or other professionals’ had the highest perceived impact on health outcomes, followed by‘testifying or doing research for a health‐related legal action’	Individual factors Enhances advocacy
Ahoya et al. 2016, Africa	Descriptive correlational cross‐sectional Study	Organisational policy	To determine political efficacy, political participation, and the relationship between political efficacy and political participation among nurses at the tertiary‐level hospitals	N = 225 RNs	Survey 42‐item three‐structure questionnaire based on civic voluntarism model	Descriptive statistics	(1) The most frequently reported barriers to political participation were identified as having little free time (74%), lack of trust in politicians (72%), fear of conflict/confrontation (71.9%), and lack of educational preparation (65%) (2) The facilitators for nurses’ involvement in political participation: availability of free time and money, civic skills, personal interest in politics, self‐belief and confidence, and a strong party affiliation. Among these, availability of resources, such as time and money, appears to be the most important facilitator as evidenced by the strong positive correlation between that factor and political participation.	Contextual barriers or resources
Al Faouri et al. 2021, Jordan	Cross‐sectional Descriptive correlational study	Private, governmental, and university‐affiliated hospital	(a) To examine the level of Jordanian head nurses’ involvement in health policy development and their perceived benefits and barriers; (b) To identify the relationships between level of knowledge, competence, and interest in health policy and the level of involvement in health policy development; (c) To explore the relationship between the level of self‐efficacy (efficacy expectation and outcome expectation) and the level of involvement in health policy development;	N = 250 head and senior nurses	Survey 79‐item self‐administered questionnaire	Descriptive statistics and Pearson correlation coefficient	(1) There was a moderate level of involvement of head nurses in the policy development (mean = 3.26, SD = 0.83); (2) The most frequently cited political activity was ‘providing written reports, consultations, research’ (37.2%); ‘lack of time’ (61.6%) was the most perceived barrier, while ‘improving the health of the public’ (47.6%) was the most perceived benefit; (3) Workshops or sessions at conferences are the most indicated source of knowledge (54.7%); (3) Participants had an excellent level of skills with positive relationships between competence and both the levels of professional and personal involvement in health policy (mean = 29.204, SD = 8.3); (4) Participants reported a low level of confidence in performing political activities as well as the impact of such activities on health outcomes (56.8%); (5) A positive relationship was indicated between self‐efficacy and the levels of professional and personal involvement in political activities (r = 0.089; p = 0.196).	Contextual barriers or resources Education and information seeking
Alhassan et al. 2019, Africa	Descriptive cross‐sectional study	Hospital organisational policy	To determine the extent to which nurses in Ghana engage in political activities and to identify the demographic characteristics influencing nurses’ political participation	N = 272 RNs	Survey 40‐item Political Astuteness Inventory (PAI) questionnaire	Descriptive statistics	(1) Study findings suggested that nurses are generally very active in registering to vote, voting, and registering to be a member of a professional nursing organisation; however, they often do not participate in other forms of political activities; (2) Nurses’ level of political participation, practices usually result in forms of political activity.	Individual factors Professionalism Contextual barriers or resources Collaboration within and between Enhances advocacy Experience positive role models
Avolio 2014, Canada	Exploratory descriptive study	Organisational policy	To identify the characteristics regarding nurse's beliefs and practices on politics and advocacy and to acquire knowledge regarding a little‐known phenomenon	N = 201 RNs	Survey 55‐item questionnaire 1 developed survey and Social Justice Advocacy Scale	Descriptive statistics	(1) To answer the first research question regarding nurses’ beliefs about their role as a political advocate, 77.5 % (n = 155, M = 4.00, SD = 0.821) reported that they either agreed or strongly agreed that it is important for nurses to be politically active. Sixty‐six per cent (n = 132, M = 3.76, SD = 0.925) of nurses agreed or strongly agreed that it is the role of the nurse to address health and nursing issues in their community. Additionally, 94.5% of nurses either agreed or strongly agreed (n = 188, M = 4.33, SD = 0.612) that it is a nurse's role to address professional issues in their places of employment. (2) Nurses overall agreed (n = 200, M = 3.58, SD = 0.592) that they had an interest, confidence, and an understanding of their government systems; (3) The five most common activities that nurses reported to be involved in were: voting at the federal and provincial levels, discussing health and nursing‐related issues with work colleagues, voting at the municipal level, and agreeing with the statement ‘I always vote’.	Professionalism
Barzegar Safari et al. 2020, Iran	Cross‐sectional descriptive study	Iran University of Medical Sciences	To examine the factors related to the participation of nurses in the provision of health services and the perceived benefits and barriers to their participation in health policy‐making	N = 220 RNs	Survey 53‐items questionnaire	Descriptive and non‐parametric statistics	(1) Two hundred twenty nurses participated in this study, with 166 (76.1%) women and 52 (23.9%) men. Mean age and work experience were 33.54 ± 4.60 and 8.93 ± 3.53 years, respectively; (2) ‘Providing written reports of the problems or receiving consultation from a related official’ (M = 3.29, SD 1.16) and ‘Verifying or studying related legal affairs to health policies’ (M = 1.79, SD 0.92) were, respectively, the performance items most and least frequently cited by the participants; (3) Perceived barriers to participation in health policy‐making was ‘Disappointment with work Procedures’ (n = 111; 50.4%); (4) The perceived benefits of participation in health policy‐making were ‘Resolution of nursing challenges by nurses’ (n = 124; 56.6%).	Contextual barriers or resources Education and information seeking
Bar Yosef et al. 2020, Israel	Quantitative cross‐sectional study	Hospital organisational policy	(a) To expand knowledge on the extent of the on‐the‐job policy involvement of frontline hospital‐based RNs on various policy levels (the hospital department, its nursing service, the hospital management, other organisations, the local authority, and the government), and (b) To understand the role of motivational and organisational factors in predicting personal on‐the‐job policy activities by examining the following hypotheses	N = 200 RNs	Survey 83‐item questionnaire on job involvement in specific policy activities; Policy skills; political interest at local and national levels; political efficacy; political network involvement; professional network involvement; policy engagement education; tangible organisational support for on‐the‐job policy engagement	Descriptive statistics	(1) The overall engagement of nurses in on‐the‐job policy activities was limited and focused primarily on their immediate surroundings, their departments and their hospitals, and much less on local or national policies; (2) The most common policy activities were internal and indirect and included receiving feedback from patients to improve nursing care policy and calling colleagues’ attention to policy issues. Positive significant correlations emerged between motivational and organisational factors and personal policy activities, and these contributed 55% to the explained variance; (3) The findings enhance the relevance of integrating motivational and organisational factors in understanding the policy activity of nurses. As such, increasing personal involvement of hospital nurses in policy formulation processes requires professional training that seeks to improve nurses’ policy skills, to enhance their political interest and efficacy, and to encourage their involvement in political and professional networks.	Individual factors Professionalism Contextual barriers or resources Education and information seeking
Cramer 2002, USA	Cross‐sectional descriptive study	Organisational policy	To determine factors influencing nurses’ political participation	N = 118 nurses of ANA membership or non‐membership	Survey 27‐item Civic voluntarism model questionnaire 5‐point Likert scale	Descriptive statistics	(1) The conceptual framework is the civic voluntarism model (CVM), which posits that three factors influence organised participation: (a) having the engagement (motivation), (b) having the resources (wherewithal), and (c) having networks of recruitment (cues to action and requests); (2) The CVM and its influencing factors and dimensions were useful in predicting nurses’ organized participation; (3) Resources and engagement were found to be the most important influencing factors, whereas networks of recruitment were less important; (4) Rank ordering of each influencing factor's dimension was used to develop a parsimonious list of predictors specific to nurses. Free time and personal efficacy were found to be the two most significant dimension predictors of nurses’ organized participation.	Contextual barriers or resources Collaboration within and between education and information seeking
González‐García et al. 2021, Spain	Delphi study	Government representatives	To propose the model of competencies to be developed by the middle nurse manager in the Spanish healthcare system	N = 50 Expert nurse leaders	Survey 5‐point Likert scale on nurse competences	Descriptive statistics and principal component analysis	(1) The resulting dimensions of the middle nurse management competency model were: (a) management; (b) communication and technology; (c) leadership and teamwork; (d) knowledge of the health care system; (e) nursing knowledge; (f) personality; (2) A total of 51 competences were evaluated by experts and structured into six dimensions: management, communication and technology, leadership and teamwork, knowledge of the healthcare system, nursing knowledge, and personality with a consensus of 80%; (3) The PCA pointed out the structural validity of the proposed model through the saturation of the main components (Cronbach α > 0.631).	Frame nursing policies
Hajizadeh et al. 2021, Iran	Delphi study	Health policy	To develop a framework for nursing managers to participate in the health policy‐making process	N = 17 expert nurses, health policy, health services management, and nursing managers faculty	Survey 5‐point Likert scale on participation framework in health policy	Descriptive statistics	(1) A total of 28 items were entered into the Delphi study. Five sections: Barriers, facilitators, advantages, disadvantages, and factors affecting the participation of nursing managers in the health policy‐making process . Experts who met the inclusion criteria responded to rounds 1 (n = 20) and 2 (n = 16). Following the two rounds of the Delphi study, 27 items were selected and discussed by experts using a 12‐part checklist related to the framework.	Individual factors Professionalism Contextual barriers or resources Collaboration within and between
Kunaviktikul et al. 2010, Thailand	Mixed‐method quantitative descriptive part	Ministry of Public Health Ministry of Education Steering Committee of Thailand Nursing Council and/or the Nurses’ Association of Thailand	To explain the levels of knowledge and involvement in Thailand's national health policy development	N = 2121 RNs	Survey Instrument: 76‐item 2‐sections questionnaire based on Longest (2002) model (a) knowledge on national health policy development process, (b) level of involvement in the national health policy development process	Descriptive statistics	(1) 61.2% of the nurses had a high level of knowledge, and 17.7% had a very high level of knowledge on the health policy development process; (2) The 47.9% had a high level of knowledge about the policy formulation phase; the 92.5% had a very high level of knowledge of the policy implementation phase. Policy modification was of high level for the 25.0% and of a low level of knowledge and very low level of knowledge for the 20.5% and for the 19.4%, respectively; (3) 72.8% of RNs reported ‘no’ involvement in health policy. 78.9% of the participants had no involvement in the policy formulation phase, 62.3% had no involvement in the policy implementation phase, and 70.6% had no involvement in the policy modification phase.	Professionalism Education and information seeking
Kung and Rudner Lugo 2015, South Korea	Quantitative descriptive study	Florida Coalition of APNs’ membership organisation	To examine factors aligned with advocacy among advanced practice registered nurses	N = 884 APRNs	Secondary analysis of online Survey	Descriptive statistics	(1) Having a high educational level and involvement in a professional organisation are each individually statistically associated with perceiving practice barriers, engaging in political activism, and willingness to speak with media. Emerging nurse leaders need an understanding of policy issues, an appreciation of the potential of the profession, and enhanced advocacy skills; (2) Only 23% of respondents said they were involved in political activism to resolve barriers to practice; (3) Politically active APRNs were more likely to be older than 50 years old, have a doctorate, belong to a professional organisation, and have more years of nursing experience; (4) Gender, type of APRN, and years of APRN experience did not significantly correlate with political activism.	Enhances advocacy
Lazarus and Lee 2006, USA	Quantitative descriptive study	Nursing Board of Alabama	To identify which factors influence policy nursing competences;	N = 527 LN = 463 ED = 34 OL = 30	Survey Questionnaire on factors influencing nursing competences	Descriptive statistics	(1) Entry certification (LN = 96%; ED = 100%; OL = 100%), self‐evaluation (LN = 70%; ED = 59%; OL = 70%), and employer evaluation (LN = 83%; ED = 88%; OL = 70%) were the most frequently identified factors in ensuring nursing involvement in policy‐making.	Education and information seeking
Lazure et al. 2016, USA	Case study	Technical Review Committee and State Board of Health	(a) To understand what decision‐makers considered the most valuable information to promote their understanding of the need for a scope of practice change;	N = 22 RNs and nursing leaders	Survey 2‐item questionnaire Rated with a 5‐point Likert scale	Descriptive statistics	(1) The most useful informational formats for understanding issues surrounding scope of practice changes were (a) statistical data (90%), (b) formally requested testimony (90%), and (c) provider stories (85%); (2) ‘Research evidence based on peer review journals’ was considered as the most useful element to influencing decisions on scope of practice change (80%); (3) ‘Receiving clear and concise information’ was the most important element to prepare effective verbal and written testimony from respondents (75%);	Education and information seeking
Niedźwiedzka 2003, Poland	Quantitative descriptive study	Ministry of Health, regional public health centres and primary care unit managers	(a) To obtain data describing the needs, preferences and limitations of healthcare managers; (b) To identify significant environmental factors influencing their information behaviours;	N = 800 HDDs, SFDs, HNs, CEOs	Postal survey	Descriptive statistics	(1) The knowledge and skills necessary to develop and implement health programmes were needed most by HDDs (91.8%); (2) More frequent reasons why practice is not evidence‐based, according to respondents, were the lack of motivation to update knowledge (HNs 75%), the lack of finances to buy technologies (HDDs 74% and HHNs 71%); (3) Major barriers in accessing research publications were financial (HHNs 73%) and lack of time CEOs 70%); (4) 95% of HNs do not perceive a lack of knowledge in research methods or database searching (SFDs 88%) to gain more knowledge in policy‐making; (5) Synthesis of evidence for managers was perceived as the preferred format of publications from HHNs (68%).	Education and information seeking
Oden et al. 2000, USA	Quantitative descriptive study	American Academy of Nurse Practitioners	(a) To determine the level and type of public policy involvement, as well as perceptions regarding public policy involvement of nurse practitioners	N = 600 RNs	Survey 20‐item questionnaire	Descriptive statistics	(1) 59.6% of nurses were involved in three or fewer public policy activities. The most frequently indicated activities included voting (87%) and giving money to policy campaigns (57%); (2) Lack of time was the most frequently cited barrier, while improving the health of the public was cited most often as a benefit; (3) Overall, nurse practitioners felt they had limited knowledge on how to go about changing public policy, were somewhat interested in public policy issues, believed the actions of public policymakers were very important, and believed these actions influenced the public health; (4) 79% had received some information/education on public policy change which helped them to increase their active involvement on policy‐making.	Education and information seeking
O'Rourke et al. 2017, USA	Cross‐sectional Descriptive Study	American Academy of Nurse Practitioners	(a) To describe the political efficacy and political participation of U.S. NPs and gain insight into factors associated with political interest and engagement	N = 632 nurse practitioners	Survey 13‐item Efficacy Index 10‐item Trust in Government Index Questionnaires	Descriptive statistics	(1) Overall, NPs have low political efficacy. Older age (p ≤ 0.001), health policy mentoring (p ≤ 0.001), and specific education on health policy (p ≤ 0.001) were all positively associated with internal political efficacy and political participation; (2) External political efficacy was not significantly associated with any of the study variables; (3) Political activities of NPs are largely limited to voting and contacting legislators. Identifying factors that engage NPs in grassroots political activities and the broader political arena is warranted, particularly with current initiatives to make changes to state laws and regulations that limit their practice.	Contextual barriers or resources Education and information seeking
Salvador 2010, USA	Cross‐sectional Descriptive Study	Health policy	To identify nurses’ political perceptions and practices of their involvement in policy‐making	N = 302 RNs	National Survey 18‐item 5‐point Likert scale and multiple questions	Factor analysis Descriptive statistics	(1) Registered nurses’ political perceptions and practices related to involvement in health policy activities were examined within the context of the social cognitive theory and the health belief model of behaviour change; (2) In total, 73.5% of nurses were involved in two or fewer health policy activities, and 26.5% had no participation in health policy activities; (3) Factor analysis was used to identify predictors of involvement in health policy; a majority (68.8%) of nurses reported receiving no education in health policy; (4) Of those receiving health policy education as part of their initial nursing instruction, most (66.7%) rated their policy skills obtained as poor.	Individual factors
Scherb et al. 2011, USA	Descriptive Correlational study	Midwestern health care network	To explore staff nurse ratings of actual and preferred decisional involvement and determine differences in actual and preferred ratings between staff nurses and nurse managers	N = 320 RNs and nurse leaders	Survey Based on Decisional Involvement Scale 21‐item questionnaire with a 5‐point Likert scale	Descriptive statistics	(1) The staff nurse's mean rating of DIS was 2.10 (SD = 0.58), and the mean rating of DIS was 2.79 (SD = 0.52); (2) There was a statistically significant difference (p = 0.001) between the nurse managers’ actual rating of DIS (M = 2.22; SD = 0.36) and their preferred rating of involvement (M = 2.56; SD = 0.45); (3) There was no statistically significant difference between the staff nurses’ and nurse managers’ ratings of actual decisional involvement for the overall DIS (p = 0.164), but there were statistically significant differences in the subscales of unit governance and leadership (p = 0.011) and collaboration/liaison activities (p = 0.021).	Experience positive role models
Shariff 2014, Africa	Delphi study		To build consensus on factors that act as facilitators and barriers to nurse leaders’ participation in health policy development	N = 78 expert nurse leaders of policy and research	Delphi survey Questionnaire of 2‐sections	Descriptive statistics	(1) Factors that affect participation in health policy were ten: being involved; being knowledgeable and skilled; being supported; positive image of nursing; enabling structures; available resources; lack of involvement; lack of knowledge, skills, and support; negative image of nursing; lack of enabling structures; (2) The findings of the study indicate that both facilitators and barriers exist. The former include being involved in health policy development, having knowledge and skills, enhancing the image of nursing, and enabling structures and processes. The latter include lack of involvement, negative image of nursing, structures, and processes, which exclude them.	Professionalism Collaboration within and between Experience positive role models Education and information seeking
Shariff and Potgieter 2012, Africa	Delphi study	Ministry of Health Academic organization	To develop an empowerment model that could be used to enhance nurse leaders’ participation in health policy development	N = 78 expert nurse leaders of policy and research	Delphi survey Questionnaire of 2‐sections	Descriptive statistics	(1) The expert panellists indicated that they become involved in health policy development through nursing organisations, position(s) held, and on an individual basis; (2) The findings suggest that in the perception of the expert panellists, nurses’ involvement in the policy arena is limited; (3) Over half of the expert panellists participate in health policy development at the national level: 20 (54%). Their participation decreases at regional 16 (43%), global 11 (30%), and provincial 11 (30%) levels of health policy development. Over half, 20 (51%), of the expert panellists participate in health policy implementation.	Collaboration within and between
Vandenhouten et al. 2011, USA	Quantitative descriptive predictive study	Wisconsin Healthcare institutions and four educational institutions	To identify the level of political participation of RNs as well as the factors contributing to that participation	N = 468 RNs	79‐item questionnaire based on political participation survey PAI ISI Civic Literacy Test	Descriptive statistics	(1) Most participants (95%) reported being currently registered to vote, voting in all or most of the presidential elections (83%), and more than half voting in all or most state elections since they were old enough to vote (62%); (2) Common political activity reported included talking to others about why they should vote for or against a party or candidate (75%), using campaign buttons, T‐shirts, stickers, or yard signs (71%), and contacting an elected official in the past 5 years (41%); (3) The majority of the participants (88%) perceived they have little to no time for political activities both generally and within nursing organisations; (4) The dimension psychological engagement was most strongly correlated (r = 0.67), followed by resources (r = 0.60) and recruitment networks (r = 0.44); (5) There were statistically significant differences in mean political participation scores among the sample with different political views, stronger party affiliation, different age groups, number of years working as an RN, level of nursing education, and income levels.	Individual factors Professionalism Contextual barriers or resources Education and information seeking
Waddell et al. 2017, USA	Mixed‐method (quantitative part)	Nurse members of an action coalition leadership team	To describe and quantify experiences of nurse leaders working to influence policy and to build consensus for priority skills and knowledge useful in policy efforts within the context of a previously developed nursing conceptual framework	N = 9 nurse leaders	Survey on experts’ agreement to emerging themes from focus groups rated with a 10‐point Likert scale	Descriptive statistics	(1) Knowledge‐based competence: empirical knowledge was ranked next highest by study participants when considering their preparation to testify at a public hearing (60%); (2) Knowledge‐based competence: empirical knowledge was ranked next highest by study participants when considering their preparation to prepare for a legislative visit (mean = 9.22; IQR 7–10); (3) Participants identified how to deliver a message effectively as the most important aspect of policy participation to be targeted in baccalaureate nursing education (mean = 9.2; IQR 8–10). Knowledge of the policy process closely followed in order of importance for baccalaureate education (mean = 9.13; IQR 8–10).	Frame nursing policies

Abbreviations: HDDs: directors of self‐government health departments; SFDs: sickness fund directors; HNs: hospital head nurses; CEOs: hospital chief executives; LN: licence nurses; ED: educators; OD: organisational leaders; PCA: principal component analysis; APNRs: Advanced practice registered nurses.

3.3. Characteristics of Participants

A total of 9,738 nurses constituted the overall sample, with sample sizes ranging widely across quantitative (9–2,121) and qualitative (1–118) studies (Tables 1 and 2). Studies included primarily RNs and nurses of middle nursing management (n = 6761), APNs (n = 884), senior nurses’ managers or legislators (e.g., Ministry of Health) (n = 2064), and nurses’ educators or researchers/scholars’ experts (n = 29).

3.4. Common Concepts of Nursing Engagement in Policy‐Making

A total of eight key concepts on nurses’ engagement in policy‐making emerged from the analysis. Each of these concepts was further elaborated through specific sub‐concepts. A detailed summary of all concepts and related sub‐concepts is provided in Table 3 and in Figure 1.

TABLE 3.

Identified lay concepts and sub‐concepts from the studies (n = 43).

Antecedents	Lay concepts	Sub‐concepts
	Individual factors	Personal characteristics (e.g., gender) (Huges 2010; McDonnel 2010; Wilson et al. 2020) Self‐interest and motivation on policy‐making (AbuAlRub and Foudeh 2017; Alhassan et al. 2019; Bar Yosef et al. 2020; Bartmess et al. 2022; Gebbie et al. 2000; Hajizadeh, Zamanzadeh, and Khodayari‐Zarnaq 2021; Hughes 2010; Juma et al. 2014; Kerschner and Cohen 2002; Macdonnell 2010; Salvador 2010; Vandenhouten et al. 2011; Wilson et al. 2020)
	Professionalism	Job position and role (Alhassan et al. 2019; Avolio 2014) Nurses’ professional‐specific obstacles (Anderson et al. 2016; Hajizadeh, Zamanzadeh, and Khodayari‐Zarnaq 2021; Inayat et al. 2023; Kunaviktikul et al. 2010; Shariff 2014)
Attributes	Contextual resources or barriers	Barriers (Ahoya et al. 2016; Al Faouri et al. 2021; Alhassan et al. 2019; Anderson et al. 2016; Bar Yosef et al. 2020; Barzegar Safari et al. 2020; Cramer 2002; El‐Jardali et al. 2014; Hajizadeh, Zamanzadeh, and Khodayari‐Zarnaq 2021; Inayat et al. 2023; Juma et al. 2014; Kerschner and Cohen 2002; O'Rourke et al. 2017; Vandenhouten et al. 2011; Wilson 2002) Resources (Alhassan et al. 2019; El‐Jardali et al. 2014)
	Collaboration within and between	Inter‐ and intra‐professional collaboration (Alhassan et al. 2019; Anderson et al. 2016; Cramer 2002; Hajizadeh, Zamanzadeh, and Khodayari‐Zarnaq 2021; Inayat et al. 2023; Wilson et al. 2020) Membership and associationism (Cheraghi et al. 2015; Sarnkwawkum and Oumtanee 2019; Shariff and Potgieter 2012; Shariff 2014)
	Frame nursing policies	Model to understand and direct nurses in policy‐making (Ditlopo et al. 2014; Waddell et al. 2017) Competency model for policy‐making (González‐García et al. 2021; Wichaikhum et al. 2020)
Outcomes	Enhances advocacy	Making a difference in health outcomes (AbuAlRub and Foudeh 2017; Alhassan et al. 2019; Kung and Rudner Lugo 2015)
	Experience positive role models	Successful role models (Alhassan et al. 2019; Han 2020; Sarnkwawkum and Oumtanee 2019; Shariff 2014; Scherb et al. 2011; Tilley and Tilley 1999)
	Education and information seeking	Education/training in policy‐making (Al Faouri et al. 2021; Bar Yosef et al. 2020; Barzegar Safari et al. 2020; Gebbie et al. 2000; Oden et al. 2000; O'Rourke et al. 2017; Shariff 2014; Vandenhouten et al. 2011; Wilson et al. 2020) Uniform nursing curricula (Cramer 2002; El‐Jardali et al. 2014; Gebbie et al. 2000; Hajizadeh et al. 2021; Kunaviktikul et al. 2010; Juma et al. 2014; Kerschner and Cohen 2002; Shariff 2014; Lazarus and Lee 2006; Lewinski and Simmons 2018; Vandenhouten et al. 2011; Warner 2003) Evidence and technological solutions (Asuquo 2019; Lazure et al. 2016; Niedźwiedzka 2003; O'Connor 2017)

FIGURE 1.

Conceptual model of nurses’ engagement in healthcare policy‐making. The figure summarises the foundational concepts identified in the review, organised into antecedents, attributes, and outcomes.

3.4.1. Antecedents

Antecedents represent the foundational conditions that enable or encourage nurses to participate in policy processes. These include personal motivations and values (individual factors) and a strong sense of professional identity and responsibility (professionalism).

3.4.2. Individual Factors

A range of individual factors appear to influence nurses’ engagement in policy processes, suggesting that personal attributes and internal motivations play a critical role in shaping engagement. The personal characteristics of nurses, such as gender or work experience, influence their participation in policy‐making. The study of Macdonnel et al. (2010) highlighted that experienced nurses seem more ‘politically’ motivated than nurses with fewer years of experience, especially in developing unions and/or becoming managers (Wilson et al. 2020). Two studies discussed gender issues and their influence on the participation of nurses in policy‐making (Hughes 2010; Macdonnell 2010). In particular, the qualitative study of Macdonnell suggested that the participation of women at the medium policy‐making level compared to men is generally low. Likewise, Hughes et al. (2010) affirmed that women are less involved in policy‐making than men, at medium and high levels, despite the higher prevalence of women in the nursing profession than men (Hughes 2010). Self‐interest and motivation towards policy‐making emerged as an important precursor of nurses’ engagement in policy‐making in most studies (Alhassan et al. 2019; Bar Yosef et al. 2020; Bartmess et al. 2022; Gebbie et al. 2000; Hajizadeh, Zamanzadeh, and Khodayari‐Zarnaq 2021; Hughes 2010; Juma et al. 2014; Macdonnell 2010; Salvador 2010; Vandenhouten et al. 2011). In particular, AbuAlRub and Foudeh (2017: 6) affirmed that the strong motivation and interest of nurses towards policy‐making influenced their political processes and their ‘taking part in policies’. Alhassan et al. (2019) found that a strong motivation of nurses towards political stimuli positively increased the development of political cooperation and engagement in the political process.

Interest in public policy recognised nurses as political agents of change, especially when they have to participate in persuasive speeches to encourage patient groups (Bar Yosef et al. 2020; Hughes 2010; Kerschner and Cohen 2002; Wilson et al. 2020). On the contrary, a lack of interest in policy‐making seems to reduce the interest of nurses in taking part in policy‐making (Vandenhouten et al. 2011). Nurses, consequently, need to acquire self‐interest and enthusiasm for political involvement (Wilson et al. 2020) and look inwards at their values, beliefs, and identify their perceptions of politics (Bar Yosef et al. 2020; Hughes 2010; Kerschner and Cohen 2002; Wilson et al. 2020). Indeed, nurses’ values and prominence distinguished them as active members of political groups, enabling their participation in policy‐making, particularly through their leadership roles within organisations (Bar Yosef et al. 2020).

3.4.3. Professionalism

Job position and role seem to influence policy‐making activities, membership, and associationism that influence nurses’ political awareness and action. Alhassan et al. (2019) and Avolio (2014) found that nurses in leadership roles were more likely to participate in policy‐making activities due to their awareness of policy‐making. However, as emerged from Kunaviktikul et al. (2010), hospital nurses are generally not interested in getting involved in policies, despite possible opportunities, for example, invitations from leaders or managers. Nurses’ profession‐specific obstacles prevent them from being involved in policy‐making (Inayat et al. 2023). Nurses have low professional self‐esteem (Anderson et al. 2016) and therefore experience no political clout. They argue that this combination creates a political barrier and presents a challenge to nursing leaders to equip staff as advocates for themselves and others (Anderson et al. 2016; Hajizadeh et al. 2021; Shariff 2014). Feelings of inadequacy and powerlessness can negatively affect their involvement in policy‐making (Shariff 2014). Otherwise, a strong perception of autonomy or a positive professional image can promote the impact of nursing on policy‐making (Hajizadeh et al. 2021; Shariff 2014).

3.4.4. Attributes

Attributes describe how engagement in policy‐making is manifested. They encompass the availability or lack of structural and organisational support (contextual resources or barriers), the capacity to build collaborative relationships within nurses and across other professions (collaboration within and between), and the ability to contribute strategically to the development and shaping of policy content (framing nursing policies).

3.4.5. Contextual Barriers or Resources

Most studies identified organisational and contextual barriers that influence nurses’ engagement in policy‐making. Heavy workloads, limited time, and shortages of human and organisational resources make it difficult for nurses to participate effectively in complex political processes (Ahoya et al. 2016; Al Faouri et al. 2021; Alhassan et al. 2019; Anderson et al. 2016; Bar Yosef et al. 2020; Barzegar Safari et al. 2020; Cramer 2002; El‐Jardali et al. 2014; Hajizadeh, Zamanzadeh, and Khodayari‐Zarnaq 2021; Inayat et al. 2023; Juma et al. 2014; Kerschner and Cohen 2002; O'Rourke et al. 2017; Vandenhouten et al. 2011; Wilson 2002). Many nurses report difficulties balancing work and personal life, which further limits their participation and often confines engagement to more sporadic forms of policy activism (Al Faouri et al. 2021). Long working hours and inadequate staffing exacerbate these constraints (El‐Jardali et al. 2014). Fear of taking time away from family has been identified as a major deterrent to political involvement; consequently, nurses may be reluctant to ‘give up their own time’ to engage in policy‐making activities (Anderson et al. 2016; El‐Jardali et al. 2014). Financial constraints and staff shortages also reduce involvement in policy processes (El‐Jardali et al. 2014; Hajizadeh et al. 2021; Kerschner and Cohen 2002). Limited funding affects not only individual nurses but also their organisations, restricting opportunities to build policy competence, for example, by supporting attendance at education or training courses (El‐Jardali et al. 2014; Hajizadeh et al. 2021; Kerschner and Cohen 2002). Conversely, when resources such as protected time and financial support are proactively managed, they can facilitate nurses’ participation in policy‐making (El‐Jardali et al. 2014). Finally, the broader national policy and regulatory context shapes nurses’ opportunities to engage in policy‐making (Alhassan et al. 2019). In particular, supportive government regulation and clear institutional arrangements can strengthen nurses’ representation in policy‐related structures and enable them to compete for leadership roles in health policy (Alhassan et al. 2019).

3.4.6. Collaboration Within and Between

Professional collaboration, both interprofessional and intraprofessional, can be beneficial in enhancing nurses’ engagement in policy‐making (Alhassan et al. 2019; Anderson et al. 2016; Cramer 2002; Hajizadeh et al. 2021; Inayat et al. 2023; Wilson et al. 2020). Perceived support by other healthcare professionals or institutions has been described as a beneficial factor in the political activity of nurses (Wilson et al. 2020). However, ‘sectarianism’ and medical dominance are perceived as barriers rather than as facilitators of nurses’ participation in healthcare policy‐making (Cramer 2002). These challenges date back over a century and have been shaped by the physician–nurse relationship and the influence of the biomedical model (Cramer 2002). In particular, as emerged by Inayat et al. (2023), nurses have been suspected of neglecting health policy issues compared to physicians and are therefore not involved in health policy debates. Lack of support from peers or other professionals and burnout were found to be significant issues affecting involvement (Alhassan et al. 2019; Anderson et al. 2016; Hajizadeh et al. 2021). For example, participants in the study by Hajizadhe et al. (2021) indicated that being recognised as ‘politically competent’ by other professionals and receiving credit for their work has been recognised as an important element in nurses’ participation in policy‐making.

Membership and associationism also emerged as influential factors in nurses’ political awareness and action. Cheraghi et al. (2015) found that nurses who were members of associations were more politically aware and engaged in policy‐making activities. Similarly, Sarnkwawkum and Oumtanee (2019) found that nurses who were members of professional organisations were generally more engaged in policy‐making activities. Likewise, Shariff and Potgieter (2012) identified that nurses affiliated with political organisations demonstrated strong political activism and actively encouraged their colleagues to participate in policy‐making processes. Indeed, political collaboration reinforces the commitment of nurses to a common goal (Shariff2014). However, nurses seem to lack the necessary influence to contribute to the political agenda (Cheraghi et al. 2015). Nurses are virtually never involved in concrete policy decision‐making processes and generally agree with prior formulations of others (Cheraghi et al. 2015).

3.4.7. Framing Nursing Policies

Two studies (Ditlopo et al. 2014; Waddell et al. 2017) applied conceptual frameworks to examine and guide nurses’ engagement in policy‐making. Ditlopo et al. (2014), using qualitative thematic analysis, developed a policy analysis framework informed by four national health workforce policies. They highlighted that nurses’ participation in policy‐making is complex and contested, with limited agreement about which nursing group legitimately represents nursing interests in the political arena. They also reported a disconnect between nursing leadership and frontline nurses in terms of policy awareness and engagement. Waddell et al. (2017) proposed a conceptual framework that described and quantified priority skills and knowledge to support nurse leaders’ involvement in policy‐making, identifying policy‐related knowledge and communication capacity as key priorities. Related competency and strategic models were subsequently examined by González‐García et al. (2021) and Wichaikhum et al. (2020). González‐García et al. (2021) identified 51 competencies nurses require to participate effectively in policy‐making. Wichaikhum et al. (2020) developed a strategic model to guide nurses in policy development and decision‐making, outlining 25 participation strategies tailored to clinical nurses, nurse leaders, researchers, educational institutions, and professional organisations.

3.4.8. Outcomes

Outcomes refer to the results of nurses’ engagement in policy‐making. Across studies, engagement was associated with stronger advocacy for patients and communities (enhanced advocacy) and with exposure to positive role models that encouraged further learning and information seeking (experiencing positive role models). Conversely, limited policy education and training constrained effective participation (education and information seeking).

3.4.9. Enhanced Advocacy

The advocacy perspective of nurses in policy‐making refers to the supportive role nurses play in advocating for policies that benefit the health and well‐being of patients and communities. Only one study was found to support this concept. Kung and Rudner Lugo (2015) reported that patient advocacy encouraged nurses to participate in policy‐making and, in turn, supported policy implementation. In their survey of Advanced Practice Registered Nurses, respondents indicated that nurses’ involvement in policy‐making strengthens advocacy skills and enables them to articulate and advance clear positions on policy issues in support of patients’ and communities’ health.

Nurses’ sense of ‘making a difference in health outcomes’ (Alhassan et al. 2019) emerged as a significant factor that influences participation in policy‐making. In that regard, AbuAlRub and Foudeh (2017) affirmed that patients and community health are one of the most important perceived benefits for nurses to be involved in policy‐making.

3.4.10. Experiencing Positive Role Models

A facilitator of political involvement is the awareness of strategies identified by successful nurses in leadership roles (Alhassan et al. 2019). Indeed, nursing historical leaders possessed many common traits, including vision, risk‐taking, contact and collaboration with people in power and positions of authority, and a drive to influence the government to achieve their goals (Sarnkwawkum and Oumtanee 2019; Shariff 2014; Tilley and Tilley 1999).

Learning from successful leaders also emerged as an influencing factor for nurses’ political awareness and action. Han (2020) found that nurses with mentors or role models who were successful in policy‐making were more likely to participate in policy‐making activities. Sarnkwawkum and Oumtanee (2019) and Scherb et al. (2011) similarly reported that nurses who experienced positive role models in policy‐making were more frequently involved in policy activities.

3.4.11. Education and Information Seeking

Nursing education is a fundamental aspect of providing quality healthcare services (Barzegar Safari et al. 2020; Oden et al. 2000; O'Rourke et al. 2017; Vandenhouten et al. 2011; Wilson et al. 2020). However, a lack of knowledge of policies is a limiting factor for the participation of nurses in policy‐making. Disparities in nursing education between different nursing schools have been a persistent problem for the future scarce involvement of nurses in policy‐making (Al Faouri et al. 2021; Gebbie et al. 2000; Shariff 2014). Furthermore, inadequate knowledge can limit nurses’ ability to advocate for their patients and influence health policies (Wilson et al. 2020). Improving nurses’ knowledge and policy experience is important to promote their active participation in health policy‐making (Bar Yosef et al. 2020). The lack of training and education in policy‐making is an issue in several studies (Barzegar Safari et al. 2020; Oden et al. 2000; O'Rourke et al. 2017; Vandenhouten et al. 2011; Wilson et al. 2020). One of the main barriers to nurses’ participation in public policy is the ‘lack of know‐how’ and competencies in policies (Vandenhouten et al. 2011). In that regard, nurses require education, scholarship, and research activities to support their efforts and develop in a policy‐making context (Wilson et al. 2020).

The lack of a coherent and structured curriculum could also represent a barrier to the participation of nurses in policy‐making (Gebbie et al. 2000; Hajizadeh et al. 2021; Lazarus and Lee 2006; Lewinski and Simmons 2018; Warner 2003). In particular, the reorganisation of nurses’ educational curricula can ensure that all nursing students receive a comprehensive and consistent education on policies (Cramer 2002; Juma et al. 2014; Kerschner and Cohen 2002; Shariff 2014). Furthermore, incorporating policy expertise and political education into the nursing curriculum may improve nurses’ ability to influence healthcare policy and advocate for their patients (Kunaviktikul et al. 2010; Vandenhouten et al. 2011; Warner 2003). In that regard, as emerged from the studies of El‐Jardali et al. (2014) and Gebbie et al. (2000), addressing disparities in education, incorporating political expertise and political education, in order to define and transferable skills in policy engagement, are important steps towards achieving these goals. In general, nurses refer to various evidence and technology resources to guide their participation in policy‐making (Asuquo 2019). Indeed, by relying on research‐based evidence, seeking and using relevant information, and leveraging technology or social media, nurses can play a fundamental role in shaping policies. Furthermore, using evidence and technology resources, nurses can have a positive impact, increasing patient care (Asuquo 2019). Research‐based evidence could influence nurses’ involvement in policy‐making, as it helps inform practice and ensure that policies are evidence‐based (Asuquo 2019). Several studies highlighted the importance of research‐based evidence in policy‐making (Asuquo 2019; Lazure et al. 2016; Niedźwiedzka 2003). Nurses can participate in information searches that support policy‐making (Lazure et al. 2016), which involves identifying relevant research studies, synthesising and interpreting research findings, and applying them to policy decisions (Asuquo 2019). This approach can ensure that policies are grounded in current research evidence and are more likely to be effective in addressing the issues they aim to tackle (Asuquo 2019; Lazure et al. 2016; Niedźwiedzka 2003). The use of social media and investment in technology can also help assess nurses’ participation in policy‐making. Social media can be used to communicate with other professionals and policymakers, share information and ideas, and support policy initiatives, as well as providing valuable data to improve healthcare outcomes (Lazure et al. 2016; O'Connor 2017).

4. Discussion

The findings are discussed below in relation to the two research questions, addressing first the extent and nature of the available evidence and then the foundational concepts that shape nurses’ engagement in healthcare policy‐making.

Addressing the first research question, the available evidence was geographically broad but unevenly distributed, with most studies conducted in Western countries, particularly the USA, and a substantial proportion originating from Asia and Africa. Nursing practice and healthcare systems vary considerably across countries and regions, and this cultural and organisational diversity may shape how nurses engage in policy‐making (Sundean et al. 2021). Despite these variations, nurses’ engagement in policy‐making appears to be a globally debated topic, spanning low‐, middle‐, and high‐income countries (Hajizadeh et al. 2021), and the period covered (1999–2021) underscores a sustained interest over time. Across this evidence base, however, nurses were consistently described as more involved in policy implementation than in upstream phases such as agenda setting and formulation, indicating a persistent gap between the recognised value of nursing contributions and their actual participation in shaping policy.

Methodologically, the qualitative evidence most commonly relied on content analysis and thematic analysis (Wilson et al. 2020). While well‐suited to identifying patterns and meanings, several authors argue that more innovative qualitative designs are needed to capture the dynamic and multifaceted nature of nurses’ engagement in policy‐making (Chiu et al. 2021; Hajizadeh et al. 2021). Approaches such as participatory action research and other collaborative methodologies may offer more interactive and inclusive ways to involve nurses as active contributors to the research process, potentially generating richer insight into how engagement develops, is negotiated, and is sustained (Cornish et al. 2023). In the quantitative literature, cross‐sectional survey designs predominated, reflecting a demand in policy settings for timely ‘snapshots’ of attitudes and practices that can inform decisions (Kaplan 2004; Hajizadeh et al. 2021). However, reliance on surveys may limit depth and fail to fully capture the relational and contextual complexity of policy engagement (Jackson 2026; Ramani‐Chander et al. 2024).

The foundational concepts that emerged relating to nurses’ engagement in policy‐making were individual factors and professionalism (antecedents); contextual resources or barriers, collaboration within and between, and frame nursing policies (attributes); enhance advocacy, consciousness, and action in policies, and education and information seeking (outcomes).

Antecedents shaping nurses’ engagement in policy‐making are recognised as complex and multifaceted, reflecting the inherently dynamic nature of policy processes (Chiu et al. 2021; Hajizadeh et al. 2021). Within our synthesis, individual factors and professionalism captured the preconditions that influence whether nurses are able – and feel entitled – to enter policy arenas. Although the literature (Smith et al. 2025) does not fully explain why nurses often remain underrepresented in health policy‐making, our findings suggest broad agreement on key influences. Nurses’ engagement can contribute to better‐informed policies and improved patient and community outcomes by bringing practice‐based knowledge into decision‐making and strengthening advocacy for equity and social justice (Etowa et al. 2023). However, persistent barriers continue to limit engagement, including time constraints, insufficient resources, limited policy knowledge, and a perceived lack of influence within policy arenas (Scott and Scott 2021). Notably, lack of resources was the most frequently reported constraint and was also highlighted as a major barrier for nursing leaders’ participation in health policy‐making (Rehman et al. 2024).

Professional and organisational antecedents were also prominent. Organisational cultures that do not prioritise or support nurses to take action in policy‐making may inhibit engagement, particularly when policy work is not recognised as part of legitimate professional practice. In this regard, Hajizadeh et al. (2021) noted that gaining external support was a sub‐topic associated with developing a positive work environment (Hajizadeh et al. 2021). Conversely, limited support from key stakeholders – including the political sector, government officials, and professional organisations – has been associated with low levels of involvement in policy‐making (O'Brien‐Pallas and Hayes 2008). Taken together, these findings suggest that antecedents extend beyond individual motivation and include structural and cultural conditions that determine whether nurses have the opportunity, resources, and institutional permission to participate.

Three concepts – contextual resources or barriers, collaboration within and between, and the ability to frame nursing policies – describe how engagement is enacted. Contextual resources shape whether nurses can translate intention into action; access to time, networks, mentoring, organisational support, and opportunities to participate is often decisive. Collaboration reflects the collective and relational nature of policy engagement, including partnership with other nurses, professional associations, interdisciplinary colleagues, and policy actors (Smith et al. 2025; French et al. 2024). The ability to frame nursing policies highlights the importance of articulating nursing priorities, translating frontline experience into policy‐relevant language, and positioning nursing contributions credibly within policy debates (French et al. 2024).

A growing body of frameworks and models has been developed to describe nurses’ engagement in policy‐making, largely in response to two recurring problems in the literature: the complexity of policy processes and the lack of practical guidance for translating nursing expertise into policy influence. The civic voluntarism model highlights how community involvement and civic engagement shape participation, positioning policy engagement as an extension of wider social action (Ostrander et al. 2021). The Political Astuteness Inventory similarly frames engagement as dependent on political knowledge and awareness, reinforcing the need to navigate political environments strategically (Byrd et al. 2012). Together, these approaches suggest that effective policy engagement requires a versatile skill set, combining civic engagement, community awareness, and political acumen, rather than relying on professional credibility alone (Clarke et al. 2021). Complementing these perspectives, tools such as the Social Justice Advocacy Scale foreground the motivational and ethical dimension of policy participation, aligning engagement with equity‐oriented advocacy and action on disparities (Marszalek et al. 2017). More practice‐oriented models address the need to operationalise what policy engagement requires in day‐to‐day roles and professional development, as illustrated by González‐García et al. (2021) and Wichaikhum et al. (2020).

Outcomes referred to the results or consequences associated with nurses’ engagement in policy‐making. Across the included studies, engagement was linked to enhanced advocacy for patients and communities, including advocacy aligned with equity and social justice aims. Engagement was also associated with consciousness and action in policies, reflecting nurses’ understanding of the political landscape and willingness to act (Etowa et al. 2023). This includes recognising the roles of stakeholders (e.g., government officials, policymakers and advocacy groups) and engaging in practical activities such as writing to elected representatives, participating in advocacy initiatives, serving on committees, and voting to ensure that nursing perspectives are represented in policy processes (Çatıker 2022). A further outcome was education and information seeking, which also appears to function as a mechanism that strengthens engagement. Using research evidence to support policy arguments and to advocate for evidence‐informed decisions was emphasised across the literature. Technology may facilitate engagement by improving access to relevant information and enabling communication and mobilisation through digital tools, including social media. Educational and research infrastructures were also highlighted: within low–middle‐income countries, doctoral education and research training were described as facilitators of nurses’ engagement in policy‐making processes (Hajizadeh et al. 2021). Consistent with this, O'Connor (2017) argues that education and research are necessary to develop workforce participation and that preparing nursing students for health policy engagement is fundamental if nurses are to influence the planning, organisation, and financing of health care. Integrating policy expertise and political education within curricula may strengthen nurses’ ability to influence policy and advocate for patients, while also reinforcing professional identity and confidence in decision‐making. Mentoring and experiential opportunities – at undergraduate, graduate, and early‐career levels – were repeatedly highlighted as important for developing policy competence among novice nurses (Smith et al. 2025).

Building on our results, the review reinforces that meaningful nurse participation in policy‐making discussions and legislative initiatives can support the development of more equitable and effective health systems by ensuring that frontline expertise is translated into policy decisions. Nurses are well positioned to advocate for patient‐centred policies, cost‐conscious reforms, and approaches that advance social justice and reduce health disparities (Scott and Scott 2021). However, our findings also indicate the need for greater recognition, respect and access to policy forums. Professional associations and regulatory bodies have an important role in championing nurses’ inclusion and coordinating collective strategies to strengthen political involvement, while organisations should foster cultures that legitimise and support policy engagement. Within these supportive structures, nurse managers and leaders can translate intent into practice by involving unit‐level nurses in policy discussions, advocating for wider representation, and implementing initiatives that prepare aspiring managers and future leaders for sustained policy engagement (MacDonald et al. 2012).

4.1. Limitations

This study has some limitations that warrant consideration. First, our inclusion criteria were restricted to English‐language publications. While this ensured a consistent appraisal of the literature, it may have excluded culturally specific meanings and nuances reported in other languages, potentially limiting the conceptual breadth. Second, the search was conducted across a selected set of databases, and relevant evidence indexed elsewhere may have been missed, including studies that could have informed the earlier development and evolution of the concept.

5. Implications for Nursing and Health Policy

Despite progress in nurses’ skills and knowledge, this review indicates a persistent gap between the recognised importance of nursing voices in policy‐making and their active participation in policy forums. Addressing this gap will require coordinated action at multiple levels, including structural, educational, and cultural change: reducing workload and resource barriers, strengthening institutional support, and adopting leadership approaches that enable participation and develop future policy‐ready leaders. Integrating policy, advocacy, and political skills into nursing education may further build confidence and capability, while healthcare organisations should foster environments that legitimise and support nurses’ involvement. Nursing associations, leaders, and regulatory bodies are also well placed to advocate for meaningful inclusion and to mobilise collective strategies that strengthen nurses’ political influence. Overall, the foundational concepts identified here provide a structured basis for future research and intervention development, supporting efforts to amplify nurses’ collective voice and to ensure that nursing expertise and frontline realities inform equitable, patient‐centred policy outcomes and improve health systems globally.

6. Conclusions

This scoping review systematically maps and summarises lay concepts of nurses’ engagement in policy‐making. Overall, our results suggest that there is growing interest in exploring nurses’ engagement in policy‐making worldwide, and that research on this topic has used diverse methods and tools. The antecedents, attributes, and outcomes of nurses’ engagement in policy‐making provide a structured framework for understanding the multifaceted nature of policy‐making. These concepts emphasise the need to explore factors influencing nurses’ engagement and to develop strategies that facilitate and promote their active participation. The refined understanding of research capacity in nursing concentrates on consistent and effective use of the concept by policymakers, managers, nursing philosophers, and researchers in various documents, literature, and communications. Furthermore, the exploration of antecedents, attributes, and outcomes encourages a nuanced approach on multiple levels to enhance nursing research competence, motivation, infrastructure, and collaboration. However, the need for further research to evaluate the impact of nurse leaders and frontline nurses at various levels is emphasised. Considering these findings, it is evident that fostering nurses’ engagement in policy‐making and nurturing research capacity in nursing are pivotal steps towards building a more equitable, effective, and patient‐centred healthcare system globally.

Author Contributions

Conceptualization: Beatrice Albanesi, Riccardo Casciaro and Marco Clari. Methodology: Beatrice Albanesi, Riccardo Casciaro and Marco Clari. Investigation: Beatrice Albanesi, Riccardo Casciaro, Elena Casabona, Alessio Conti, Paula Alite‐Cerezuela, Samuel Cooke, Ros Kane, Nikoletta Karavani, Venetia‐Sofia Velonaki, Flores Vizcaya, Adelaida Zabalegui, Roberta Sammut and Marco Clari. Data curation: Beatrice Albanesi, Riccardo Casciaro and Marco Clari. Formal analysis: Beatrice Albanesi, Riccardo Casciaro and Marco Clari. Writing – original draft preparation: Beatrice Albanesi, Riccardo Casciaro and Marco Clari. Writing – review and editing: Beatrice Albanesi, Riccardo Casciaro, Elena Casabona, Alessio Conti, Paula Alite‐Cerezuela, Samuel Cooke, Ros Kane, Nikoletta Karavani, Venetia‐Sofia Velonaki, Flores Vizcaya, Adelaida Zabalegui, Roberta Sammut and Marco Clari. Supervision: Marco Clari. Project administration: Beatrice Albanesi and Marco Clari. All authors have read and agreed to the published version of the manuscript.

Funding

The research was funded by the European Academy of Nursing Science (EANS).

Conflicts of Interest

The authors have no conflict of interest to declare.

Supporting information

Supporting file 1: inr70208‐sup‐0001‐SuppMat.docx

Supporting file 2: inr70208‐sup‐0002‐SuppMat.docx

Supporting file 3: inr70208‐sup‐0003‐SuppMat.docx

Supporting file 4: inr70208‐sup‐0004‐SuppMat.docx

Supporting file 5: inr70208‐sup‐0005‐SuppMat.docx