When Care Does Not Count: Epistemic Injustice and the Organisational Recognition of Nursing Knowledge

Abstract

This discussion paper examines how care-based nursing judgement becomes recognised, narrowed or excluded as professional knowledge within healthcare organisations. Nursing care is often described as relational, ethical, practical or compassionate, yet these descriptions may obscure its epistemic content: trained perception, contextual interpretation, anticipatory reasoning, moral judgement, continuity work and practical synthesis under uncertainty. Drawing on epistemic injustice, nursing knowledge development, care ethics and organisational governance, the paper argues that injustice in nursing knowledge is not only interpersonal but organisational. It identifies three mechanisms through which care-based nursing knowledge may be downgraded: credibility distortion, interpretive narrowing and restricted epistemic uptake. The paper further develops the idea of reductive recognition: care may become visible in organisational systems only after being translated into categories that diminish its nursing rationality. Five organisational conditions are proposed for recognising care as knowledge: credible reception, hermeneutic infrastructure, shared knowledge governance, educational preparation and balanced standardisation. The central contribution is to shift the question from whether nurses possess knowledge to how healthcare organisations decide which forms of nursing knowledge are allowed to count.