Navigating Power Dynamics in Acute Care: Enhancing Nursing Autonomy and Implementing Evidence-Based Practice Through Interprofessional Collaboration

Aim : This study explores the impact of power dynamics between nurses and physicians in acute care settings, focusing on how these dynamics influence nursing autonomy and the implementation of Evidence-Based Practices (EBPs). It aims to identify strategies that promote interprofessional collaboration, enhance nurse leadership, and support shared decision-making to improve patient outcomes. Design : An exploratory qualitative methodological approach grounded in the philosophy of social constructivism was utilised in this study. Methods : Data were collected through non-participant observations, semi-structured interviews, and document analysis across two large NHS acute care hospitals in the Midlands. Thematic analysis, following Braun and Clarke’s framework, was used to identify key themes related to hierarchical barriers, nursing autonomy, and interprofessional collaboration. The participants included 37 staff nurses, ward managers, nurse managers, and physicians. Findings : The study revealed that hierarchical power imbalances, particularly medical dominance, significantly limit nursing autonomy and hinder EBP implementation. Nurses reported limited decision-making authority and were often excluded from critical care discussions. However, interprofessional collaboration, leadership development, and shared governance models were identified as effective strategies to reduce these power imbalances. Nurses who engaged in leadership training and participated in nurse-led initiatives experienced increased autonomy and reported improved patient care outcomes. Conclusion : Power imbalances hinder the implementation of EBPs by nurses in acute care settings. Enhancing nursing leadership, promoting interprofessional collaboration, and adopting shared governance models can empower nurses, improve autonomy, and enhance patient outcomes. Impact : The findings highlight the importance for healthcare organisations to invest in nursing leadership development, implement collaborative governance models, and foster interprofessional teamwork to support EBP implementation and improve patient care quality. Reporting Method : The study adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Patient/Public Contributions : Patients and the public were not directly involved in this study. However, the study’s focus on nurse-led initiatives has significant implications for improving patient care quality.