Opinion Leadership among Nurses in Public Debate: Moral Conviction, Credibility, and Collective Support.

Nurses' involvement in public and policy debates is increasingly recognised as essential for shaping health care systems, yet their voices remain largely invisible. When nurses do engage publicly, they may act as public opinion leaders, using their professional expertise and credibility to influence policy discussions. Little is known, however, about how public opinion leadership (POL) manifests in practice and what motivates nurses to take on such a role. A proposed health care reform in the Netherlands, known as the BIG2 proposal, triggered an unexpected wave of nurses speaking up in national media and on social platforms. This study explores how POL manifested during this reform and what motivated nurses to raise their voices. A qualitative design was used, combining a thematic and abductive approach. Twelve semi-structured interviews were conducted with Dutch nurses who publicly responded to the reform through newspapers or social media. The findings show that nurses who engaged in POL acted from moral conviction and professional credibility, rather than formal authority. Their motivation stemmed from feeling misunderstood or undervalued, which evoked emotions such as frustration and anger. Responsibility, encouragement, and solidarity sustained their engagement. Nurses used social and traditional media to connect with peers, journalists, and politicians, making their leadership visible and collective. POL appeared as a collective process grounded in moral conviction, professional expertise, and mutual support. These findings highlight how nurses can extend their influence beyond clinical settings and contribute to shaping health policy debates.