Current event #1: The impact of digital technology use on nurses' professional identity and relations of power
Abstract
Aim: Review how digital technologies in clinical nursing affect nurses' professional identity and power relations in clinical settings.
Design: Literature review.
Data sources: PubMed and CINAHL databases searched in April 2023.
Methods: Screened studies in English and German; studies were included in the final synthesis (reflecting discourse from 1992 to 2023).
Results: Digital technologies influence nurses' professional identity and power relations. Few studies address identity outcomes (e.g., moral agency, autonomy). Most studies report negative impacts on identity, such as barriers between nurses and patients reducing empathetic interaction. In power relations, tech-savvy nurses can wield power over colleagues and patients, depending on the technology. Investigations of these effects are underrepresented.
Conclusion: The review highlights the relationship between technology and nurses' professional identity and power dynamics. Future studies require dedicated, critical empirical work on how digitization shapes professional identity in nursing.
Implications for the profession: Digitization can alter nurses’ professional identity. Nurses aware of potential digitization effects can reflect on technology’s role in nursing.
Impact: Digital technology might reduce nurses’ moral agency and their ability to shape patient-centered care. Technologies can confer power over patients and colleagues, while also acting as a control mechanism. The authors advocate for nurses to actively shape digital care.
Reporting method: Follows the JBI Manual for Evidence Synthesis where applicable. EQUATOR guidelines were not applicable for this review.
Patient/public contribution: None.
Open access: Creative Commons Attribution-NonCommercial license; proper citation required for use.
Citation: Knop, M., Mueller, M., Kaiser, S., & Rester, C. (2024). The impact of digital technology use on nurses' professional identity and relations of power: a literature review. Journal of Advanced Nursing, 80, 4346-4360.
Introduction and aims
Context: ICT (information + communication tech) and digital technologies are increasingly integrated to improve care quality, streamline workflows, and support treatment. There is a push to transform nursing into a digitally enabled practice (Booth et al., 2021).
Rationale: Digital transformation promises benefits but also poses challenges to nursing's core values—especially the caring, interpersonal dimensions of nursing.
Professional identity (widely defined in this review): actions/behaviours, knowledge/skills, values/beliefs/ethics, context/socialization, and group/personal identity (Fitzgerald, 2020).
Objectives: twofold
(a) Illuminate nursing literature on the role of professional identity and its theoretical connection to digitization in the workplace.
(b) Pave the way for empirical studies examining how technology use and professional identity influence each other and related outcomes.
Focus questions (RQ):
RQ1: How do digital technologies in clinical nursing affect professional identity and care delivery in a way that reflects identity?
RQ2: How do digital technologies affect power relations between nurses and other healthcare actors?
Theoretical framing: Digital transformation interacts with identification processes and power relations in nursing; care is increasingly mediated by technology, potentially altering the nurse-patient relationship.
Structure of the paper: theory, methods, results, discussion, implications, limitations, conclusions.
Digital transformation and its impact on nurses' professional identity
Digital technologies can complement nursing by aiding data gathering, interpretation, reducing clinical complexity, and supporting decision-making (Hack-Polay et al., 2023; Stone, 2019).
Communication improvements with other professionals and patients via digital tools (Razavi et al., 2022; Van et al., 2004).
Challenges: technology can be perceived as an intrusion into traditional hands-on, interpersonal nursing roles, threatening core values of caring and direct patient contact (Booth et al., 2021).
Potential identity threats include frictions between digitized work patterns and traditional nursing values, reducing adoption and impacting moral agency (O'Keefe-McCarthy, 2009).
Relationship between identity and job satisfaction: higher identification with nursing correlates with higher job satisfaction, which in turn relates to turnover intentions (Niskala et al., 2020; Masum et al., 2016).
Digitization rate in nursing has historically been relatively low due to leadership and investment gaps; nursing lags behind other sectors in embedding digital identities (Fairman & D'Antonio, 2008).
Implication: digitization may either drive co-creation/diffusion or threaten professional identity—depending on design, implementation, and context.
Key concept: professional identity is adaptive, shaped by actions, knowledge, values, socialization, and identity work within a digital context (Philippa et al., 2021).
Power relations in nursing and technology use
Historical context: power in nursing has long been shaped by relations with medicine and institutional hierarchies; digitization introduces new dimensions of power via technology governance and data control.
Two main drivers of power in the digital era:
Technology’s role in achieving economic/clinical goals (e.g., efficiency, reduced staffing pressures) can create dependency on technology and shape organizational power structures.
Mastery of technology can confer autonomy and authority to nurses, potentially elevating status relative to peers and patients when used effectively.
Technology as a three-fold power dynamic (as synthesized in the review):
1) Economic/clinical effectiveness creates a dependency of nurses on technology.
2) Dependency is exploited by organizational structures to enforce goals, roles, and behaviors, reinforcing hierarchy.
3) Nurses can use technology to exert power over patients and colleagues, leveraging objective data or standardized processes.Technology can create “structures of power” that may control care delivery (e.g., fixed documentation templates, policy-driven workflows) and even detach nurses from traditional care relationships when technology takes precedence over subjective judgments.
Examples from included studies show technology enables power via skills (e.g., more competent users gain status) and through the institutional capitalization of data (clinical truths constructed by tech).
Implications for practice: power dynamics are not solely interpersonal but are embedded in technology-enabled workflows and data governance.
Methods of the review
Design: Systematic literature review following the JBI Manual for Evidence Synthesis (Aromataris & Munn, 2020); EQUATOR guidelines not applicable for this type.
Data sources: PubMed and CINAHL; search conducted in April 2023.
Search strategy: (technolog* OR digitization OR digital) AND (nurs*) AND (power OR identity OR self-conception OR self-image OR self-perception OR congruence OR coherence).
Language: English and German; no year restriction to capture a broad historical view.
Exclusions: grey literature; studies not related to effects of technology on nurses’ professional identity, caring behavior, and power relations; non-clinical care focus; artefact-based definitions of technology.
Study selection: From an initial 874 records, after duplicates and screening, 38 full-text articles were assessed; 23 were excluded; 15 articles were included in the synthesis (Figure 1 PRISMA flowchart).
Quality appraisal: No formal structured quality appraisal; only peer-reviewed journal articles were included to ensure a minimum standard of quality.
Data abstraction: Extracted title, authors, journal, year, DOI/PMID, study type, technology type, outcomes, and conclusions; categorized results by impact on identity and on power relations.
Synthesis approach: Qualitative synthesis with categorization into two sub-types (identity impact and power impact); cross-study connections and thematic synthesis across outcomes.
Results: General findings
Publication span: 1992 (oldest) to 2020 (newest); 15 articles in total. Range is 1992–2020; mean publication age ~15 years, with SD ≈ 8.45 years.
Study design distribution:
Qualitative studies: 7 (≈46.5%)
Theoretical/discourse papers: 7 (≈46.5%)
One quantitative study: 1 (≈7%)
Topics of the included studies fall into two broad categories:
General/abstract discussions of digital environments and nursing identity
Specific technologies/environments (e.g., ICU tech, EHRs, telehealth, sensor/telemetric monitoring)
Observed outcomes: broad care-related outcomes (quality of care, practice of care) and more specific identity-related outcomes (moral agency, autonomy, self-concept, self-esteem).
Notable gaps: relatively few empirical studies addressing concrete identity outcomes; the majority are theoretical or descriptive in nature.
Results: Impact of technology on nurses' professional identity and care delivery
Ten of the 15 studies address identity and care delivery; overall trend: negative impacts of technology on professional identity and care delivery quality.
Key themes across studies:
Technology acts as an interlayer or barrier between nurse and patient, reducing direct interpersonal engagement and hands-on care.
Objectification of patient data may cause nurses to focus on measurements and technical indicators over patient subjective experience.
Potential dehumanization of care when subjective, psychosocial aspects are de-emphasized in favor of objective data or device-based measurements.
Some studies note technology can increase nurses’ perceived professionality when skills are demonstrated (self-concept, self-esteem) but may also shift focus away from emotional/psychosocial care.
In some contexts, technology use can widen responsibilities (e.g., telehealth expanding nurse roles) and broaden professional identity, even as it challenges traditional caring modalities.
Specific findings by study type:
Theoretical perspectives (e.g., O'Keefe-McCarthy 2009) suggest tech-mediated care may reduce moral agency by diminishing attention to patient preferences and subjective experiences.
Empirical studies (e.g., Erlen 1994; Wilkinson 1992; Bennett 2011) describe dehumanization through objectified patient characteristics or the substitution of human contact with machine-driven data.
Autonomy and self-esteem among nursing students and practicing nurses can be affected by technology use and expertise (Randle 2001; Dos Santos & Grativol Aguiar Dias de Oliveira 2016; Haghenbeck 2005; Arthur et al. 1999).
Some evidence suggests technology use can increase perceived quality of care when accompanied by skilled use, but may create dependency on technologies that shape clinical behavior (Dillard-Wright 2019; McIntyre et al. 2020).
Representative synthesis points:
Technology can both reflect and reinforce professional identity (tech skills linked to identity and status), while simultaneously altering the care relationship through mediation and data-driven norms.
The shift from body-centered, patient-facing care to technology-mediated care can affect the moral, psychosocial, and empathetic dimensions of nursing.
Table 1 (summary of included studies): key studies and outcomes include (authors, year, study type, technology type, primary identity-related outcomes, power-related outcomes). See notes below for a concise mapping:
Arthur et al. (1999) – Descriptive study – International sample – Caring attributes, professional self-concept; technology influences identity; perceived reflectiveness of care.
Bennett (2011) – Ethnographic – Satellite dialysis nursing – Tech environment; technology skills linked to hierarchy/power among nurses; identity tied to tech competence.
Dillard-Wright (2019) – Theoretical – ICU tech – EHR as panopticon; impact on professional autonomy and discipline in nursing practice.
Dos Santos & Grativol Aguiar Dias de Oliveira (2016) – Qualitative interviews – General tech env. – Autonomy not explicitly discussed; tech environment linked to autonomy concerns.
Erlen (1994) – Theoretical – General healthcare tech – Meaning of care and quality; tech’s seductive power and potential to alter perception of care.
Haghenbeck (2005) – Qualitative – Critical care tech – Practice of care; potential tech malfunctions affecting confidence; impact on identity.
Hibbert et al. (2004) – Ethnographic – Home telehealth (COPD) – Tech may broaden or reshape nursing identity, but can also extend responsibilities; power relations varied.
Jensen (2008) – Theoretical – Clinical ICT – Impact on identity not explicitly discussed.
McIntyre, Burton & Holmes (2020) – Theoretical – Sensor/telemetric tech – Tech use shapes professional behavior/identity.
Nagington, Walshe & Luker (2016) – Qualitative – General healthcare tech – Quality of care; ethics of technology in palliative home care; identity implications.
Nasington et al. (2016) – (see above; content aligns with palliative/home care tech)
O'Keefe-McCarthy (2009) – Theoretical – ICU tech – Moral agency; ambulatory care impact; deprofessionalization concerns.
Petersen & Bertelsen (2012) – Qualitative case – General healthcare tech – Care practice; power dependent on tech adoption; autonomy/power relationships tied to tech exposure.
Randle (2001) – Qualitative – General tech env. – Self-esteem; influence on professional identity; tech skills influence recognition and status.
Monteiro & Curado (2016) – Theoretical – General tech env. – psychosocial/humane aspects of care; identity implications.
Wilkinson (1992) – Theoretical – ICU tech – Impact on care practice; patient/nurse relationships; identity implications.
Results: Impact of technology on power relations
Ten of 15 studies address power relations.
Core findings:
Technological skills confer power: better tech skills correlate with higher perceived hierarchy/status among nurses (Bennett, 2011).
Autonomy and authority: skill level and autonomy determine the ability to shape technology implementation (Dos Santos & Grativol Aguiar Dias de Oliveira, 2016).
Technology as a means to express power over patients: technology can objectify patient illness experiences, enabling nurses to exert control (Nagington et al., 2016; O'Keefe-McCarthy, 2009).
Inherited power structures: power embedded in technology itself, with rules and workflows that can exclude some nurses from certain technologies or ways of delivering care (Erlen, 1994; Petersen & Bertelsen, 2012).
Technology-enabled management control: digital systems can be used by management to exert control over staff and processes, reinforcing hierarchical relations.
Interplay with patient care: technology can empower nurses to exert influence over patient care decisions but may also constrain practice by fixed processes and data-driven imperatives.
Overall takeaway: technology introduces new vectors of power that can both elevate and constrain nursing practice, depending on governance, access, and skill distribution.
Summary of included studies (Table 1) – key takeaways
The studies collectively show a spectrum of identity effects from technology use, ranging from enhanced self-concept with high technological competence to dehumanization and deprofessionalization when technology dominates care processes.
The literature is heterogeneous in design (qualitative, theoretical, occasional quantitative) and in the specificity of technology contexts (general ICT to ICU tech, EHRs, telehealth, sensor tech).
A consistent thread is the tension between efficiency/economics and preserving person-centered care and psychosocial aspects of nursing.
Theoretical contributions emphasize implications for ethics, education, and governance, calling for mixed-methods research to capture both objective and subjective dimensions of digital nursing practice.
Discussion: Objectives and key results
Objective 1: Identify literature on the interrelation between digital technologies and nurses’ professional identity and power relations.
Objective 2: Reveal needs for theoretical and empirical work examining how digitization shapes nursing identity and outcomes.
Key results:
There is a paucity of studies focusing on concrete identity-related outcomes; existing work highlights moral agency, autonomy, self-concept, and self-esteem but in limited depth.
A predominance of negative portrayals of technology’s impact on professional identity and the nurse-patient relationship, especially via dehumanization or objectification.
Digital technology can both enhance status through demonstrated skills and undermine it through increased dependence and mechanical task orientation.
Current state of research:
Despite rapid digital transformation, research on its impact on nursing practice remains uneven and somewhat sparse, with many articles being conceptual rather than empirical.
The COVID-19 era has intensified digital health adoption, underscoring the need for empirical work on identity and power in digitized nursing practice.
Dehumanization of interaction and care:
Technology may reduce direct nurse-patient contact and shift care toward objective measurements, potentially compromising psychosocial aspects of care and salutogenic outcomes.
Design of technology (e.g., user interfaces, data presentation) critically influences whether technology augments or diminishes patient-centered care.
Recognition and power through technological skills:
Despite potential dehumanization, competency with digital tools can be a source of recognition and professional legitimacy for nurses and students.
The paradox exists where tech skills can confer status while simultaneously increasing dependence on systems and organizational structures.
Theoretical implications:
The logic of leveraging technology for economic efficiency may reshape the meaning of care and patient-centeredness, with potential negative implications for patient participation and trust.
Calls for normative and empirical work, including mixed-methods designs, to capture both the objective and subjective dimensions of digitized nursing practice.
Practical implications:
Tech design and governance should involve nurses from the outset to empower their status and ensure alignment with nursing identity.
Education should integrate ethics and normative discourses about digitized work environments, preparing nurses to navigate technology while maintaining core caring values.
Safe, experimental spaces for nurses to engage with digital tools can mitigate fear and competency gaps that hinder positive identity development.
Limitations discussed by authors:
Subjective interpretation bias due to the chosen method.
Limited databases (PubMed and CINAHL) and keyword choices may exclude relevant studies.
Exclusion of grey literature and potential biases in included studies.
Some older studies reflect historical understandings of technology that differ from contemporary AI-enabled systems.
Recommendations for future research:
Increase empirical, especially mixed-methods, research to examine normative, ethical, and psychosocial outcomes of digitization in nursing.
Focus on context-sensitive studies that consider social cues, work environment, and patient interactions when introducing digital tools.
Explore how nursing education and curricula can foster ethical competencies and normative discourse around digitization.
Practical implications and recommendations
Technology design and governance:
Involve nurses early in the design and governance of digital tools to align technology with nursing identity and patient-centered care.
Provide ongoing (self-)education to reduce technophobia and enable meaningful use of digital tools in practice.
Create safe, controlled environments that allow nurses to experiment with new technologies and build confidence without compromising patient care.
Nursing education and normative discourse:
Integrate ethics and normative theories into nursing curricula to help students form a robust professional self-conception in a digitized world.
Use EMRs and other digital platforms in education to prepare graduates for real practice while emphasizing person-centered care and empathy.
Encourage reflexive practice about how technology shapes care interactions and relationships with patients.
Research and policy implications:
Promote mixed-methods research to understand both the measurable and experiential effects of digital care on identity and patient outcomes.
Consider policy and organizational changes that balance efficiency with the psychosocial needs of patients and nurses.
Limitations of the review
Potential for bias due to subjective interpretation and limited data sources (PubMed, CINAHL only).
Exclusion of grey literature may omit relevant practical insights.
Heterogeneity of study designs and dates (1992–2020) may limit comparability and applicability to current AI-enabled technologies.
Geographic concentration in the countries covered by included studies may limit generalizability.
Conclusion
Digitization of nursing practice has profound implications for professional identity and power relations.
The literature suggests potential negative effects on moral agency, empathy, and psychosocial aspects of care, while also highlighting opportunities for empowerment through digital skills.
A critical, reflective, and empirical approach is needed to understand and manage technology’s impact on nursing identity and patient-centered care.
Nurses should be equipped to actively shape digital care, ensuring technology supports, rather than supplants, core nursing values.