Organizational Position and Structural Empowerment in Chinese Community Nursing: An Interpretive Case Study

Abstract

Nurse empowerment is widely recognized for advancing professional development and job satisfaction, yet its structural dimensions remain underexplored in China's community nursing sector. Guided by Kanter's structural empowerment theory, this interpretive case study examines how formal hierarchies and informal organizational dynamics converge to shape community nurses' access to power in nonward settings. Drawing on 24 semistructured remote interviews and unstructured observations in Shenzhen, four interrelated themes were identified: (1) dual-function caregiving roles, (2) entitlement to formal power, (3) variation in informal roles, and (4) inequities in informal power. Each theme explicitly connects to core components of structural empowerment, access to supply, information, support, and opportunities, illustrating how organizational structures and interpersonal relationships jointly shape nurses' empowerment experiences. Findings reveal tensions between formal structures intended to promote empowerment and informal dynamics that sustain power asymmetries. By unpacking these layered power relations, the study offers critical insight into structural empowerment in decentralized nursing contexts and calls for both policy and managerial reforms to foster inclusive, ethically grounded organizational cultures.

Keywords: community nursing; nurse empowerment; nursing management; organizational theory; professional relationships; workplace equity.

Figure 1

Power dynamics of community nurses within dual-role structures. Note: This figure synthesizes key findings by illustrating the formal and informal roles held by community nurses, the factors shaping these roles, and their implications for empowerment. Green lines denote “equal” formal access to organizational power; however, the dotted lines signify that such access is mediated by differences in informal roles shaped by interpersonal ties. These variations are depicted by orange lines, indicating uneven empowerment, nurses with stronger alliances gain greater access to power, while those with weaker networks face constraints. The figure also highlights how informal roles influence the degree of power nurses derive from formal positions. In community health service centers, characterized by flat hierarchies and limited staffing [4, 18], the interplay between formal and informal roles was less pronounced than in-hospital settings. Still, within Chinese organizational culture, formal and informal roles remain deeply interlinked: higher formal status often translates into stronger informal influence, and vice versa, through mechanisms of authority and social support.