Historical Roots of Hospital Nursing Centrism in China (1835-Present): A Path Dependence Analysis.
Jackie Zhanbiao Li, Duo Wang, Huohuo Dai and 2 others
PMID 41729120WHAT IT FOUND
China's nursing profession remains structurally subordinate to physicians due to institutional choices made since 1835.
Despite educational expansion, governance reforms have failed to grant nurses autonomy or decision-making power. Breaking this 'path lock-in' requires changing hospital governance and resource allocation, not just training.
Key findings
01Nursing in China is defined by 'hospital nursing centrism,' where nurses are institutionally embedded in auxiliary roles that constrain professional autonomy.
02Historical analysis shows that despite the expansion of nursing education from 1978 to the present, nursing has not achieved a 'vertical breakthrough' in institutional status due to persistent doctor-led governance structures.
03Four structural constraints persist: professional dependency, organizational marginality, fiscal limitation, and governance exclusion, which prevent nurses from participating in core hospital decision-making.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Archival materials from key periods (1912–1927 and 1931–1945) were lost or incomplete. The study focuses on national-level institutions and may not reflect regional, urban-rural, or local governance heterogeneity. The analysis is confined to China, limiting direct generalizability to other national contexts. Methodological transparency and reproducibility are limited by the use of non-public archives and a lack of systematic coding procedures.
Declared interests
The authors declare no competing interests. No funding was reported.
The easy way to misread this
Do not interpret this paper as evidence that nursing education expansion has failed to improve patient care quality or clinical competence. The paper argues that education has advanced, but institutional *governance* power has not shifted to nurses. It is a critique of hospital power structures, not a measure of clinical outcomes.