The Ongoing "Doctor-Nurse Game": Power, Knowledge, and Advocacy Through the Lens of Nursing Standpoint Theory

Abstract

There is ongoing tension in healthcare where certain types of knowledge are privileged above others to the detriment of patient outcomes. This hierarchy marginalizes nursing knowledge and patient perspectives, reinforcing systemic inequities in care delivery. Revisiting Stein's (1967) "doctor-nurse game," in which nurses were expected to influence care indirectly while preserving physician authority, this paper examines how hierarchical patterns of communication and knowledge recognition continue to shape practice. Nursing standpoint theory serves as a framework for critically examining power dynamics within the healthcare setting, providing a means to critically examine how power operates within healthcare structures and interprofessional relationships. Applying nursing standpoint theory reveals how systemic power imbalances shape provider interactions and affect the ability of nurses to advocate for patients. The analysis demonstrates that nurses' embeddedness in patient care positions them uniquely to recognize and respond to gaps in care. Understanding the ways nurses and physicians are situated in relation to power helps explain persistent tensions and offers a path toward more equitable care delivery. Rather than treating advocacy as an individual reactive task, centering the nursing standpoint reframes it as a relational and structural practice that depends on reciprocal recognition of professional knowledge. Empowering nurses to navigate and reshape power relations is therefore essential to improving outcomes. This theoretical reorientation benefits patients, teams, and health systems by shifting the "game" from deference to deliberation in support of patient-centered care.

Keywords: advocacy; critical theory; healthcare systems; nurse–patient relationship; nursing standpoint theory; patient‐centered care; power dynamics.