📖 ABSTRACT/OVERVIEW
Background: Hierarchical interprofessional dynamics in Nigerian hospitals systematically marginalise nursing authority, limiting nurses' contributions to collaborative patient management. Critical realist theory provides a generative framework for understanding structural, cultural, and agency-level mechanisms that reproduce this marginalisation. Aim: This study investigated the mechanisms shaping nurse authority in interprofessional teams at teaching hospitals in South East Nigeria. Methods: A critical realist multiple case study design used document analysis, participant observation across six wards, and 36 individual and group interviews with nurses, physicians, and managers at three teaching hospitals. Retroductive reasoning identified causal mechanisms. Results: Three generative mechanisms were identified: colonial medical hierarchy institutionalised through professional regulation; gendered professional socialisation normalising deference; and knowledge asymmetry produced through differential continuing education access. Contextual conditions including bed-to-nurse ratios and management philosophy modulated the expression of these mechanisms. Conclusion: Structural and cultural mechanisms systematically suppress nurse authority in Nigerian interprofessional teams. Professional regulatory reform, nursing authority legislation, and gender-transformative professional development are theorised as necessary interventions for equitable interprofessional practice. Keywords: nurse authority, interprofessional teams, critical realism, South East Nigeria, professional hierarchy.
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