ArticleInternational nursing review2026
Historical Roots of Hospital Nursing Centrism in China (1835-Present): A Path Dependence Analysis.
Article in International nursing review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Social Determinants of Digital Health Intervention Use in China: National Cross-Sectional Study.Journal of medical Internet research · 2026Article
- Beyond Horizontal Expansion: Structural, Educational, and Leadership Pathways to Nursing Professional Empowerment.Nursing inquiry · 2026Article
- Evaluating departmental performance and reimbursement-cost pricing distortions under DRG-based payment: evidence from a tertiary hospital in China.BMC health services research · 2026Article
- Historical roots of hospital-centred operational governance in China: a path dependence analysis and its implications for global health system reform.BMJ global health · 2026Article
- Nexus Between Operational Efficiency and New Quality Productivity in Hospitals: Does Dean Overconfidence Matter?Inquiry : a journal of medical care organization, provision and financingArticle
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Authors and funding
5 authors.
Funding
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Abstract
aimTo trace the historical evolution of hospital nursing centrism in China (1835-present) and examine how institutional path dependence has shaped the subordinate status of nursing within a doctor-dominated healthcare system. BACKGROUND/
introductionDespite major expansions in nursing education and policy advocacy, China's nursing profession remains structurally marginalized. Understanding the roots of this subordination requires a historical and institutional lens.
methodsDrawing on path dependence theory, this study analyzes five critical phases in the development of nursing in China from 1835 to the present. A four-dimensional analytical framework that encompasses professional, organizational, fiscal, and governance institutions was applied to archival records, policy documents, academic studies, and interview data. RESULTS OR
findingsFindings reveal that nursing has been persistently embedded in a "doctor-led, nurse-subordinate" governance structure. Although educational and legislative reforms expanded nursing's professional scope, entrenched institutional arrangements across the four dimensions have locked nursing into a structurally dependent position. DISCUSSION: The historical institutionalization of nursing as an auxiliary role has limited its professional identity, participation in governance, and access to resources. The analysis highlights the limitations of reforms focused solely on education and policy without restructuring governance mechanisms.
conclusionThe professional development of nursing in China has been constrained by enduring path-dependent forces. To achieve true professionalization, reforms must address deep-seated institutional logics. IMPLICATIONS FOR NURSING AND NURSING POLICY: Professional empowerment requires the redesign of nursing roles, decision-making power, and career pathways within hospital governance. Policy reforms should dismantle hierarchical governance structures and institutionalize nurses' participation in leadership, ensuring equitable distribution of authority and resources.
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