Canadian Nurses Research Articles

Let's talk about it: the impact of nurses' implicit voice theories on individual agility and quality of care

PurposeThe complexity and uncertainty of healthcare operations increasingly require agility to safeguard a high quality of care. Using a microfoundations of dynamic capabilities perspective, this study investigates the effects of nurses' implicit voice theories (IVTs) on the behaviors that influence their individual agility.Design/methodology/approachThis research uses quantitative survey data collected from 2,552 Canadian nurses during the fourth wave of the Covid-19 pandemic in the fall of 2021. Structural equation modeling is used to test a conceptual model that hypothesizes the effects of three different IVTs on nurses' creativity, spontaneity, agility and the quality of care they deliver to patients.FindingsThe results reveal that voice-inhibiting cognitions (like “suggestions are criticisms for higher-ups”, “I first need a solution or solid data”, and “speaking up has negative repercussions”) negatively impact nurses' creativity and spontaneity in crafting solutions to problems they face daily. In turn, this affects nurses' individual agility as they attempt to adapt to changing circumstances and, ultimately, the quality of care they provide to their patients.Practical implicationsEven if organizations have little control over employees' pre-held beliefs regarding voice, they can still reverse them by developing and nurturing a voice-welcoming culture to boost their workers' agility.Originality/valueThis study combines two theoretical frameworks, voice theory and dynamic capabilities theory, to study how individual-level factors (cognitions and behaviors) contribute to nurses' individual agility and the quality of care they provide to their patients. It answers the recent calls of scholars to study the mechanisms through which healthcare operations can develop and sustain dynamic capabilities, such as agility, and better face the “new normal”.

How Do We Keep our Heads above Water? An Embedded Mixed-Methods Study Exploring Implementation of a Workplace Reintegration Program for Nurses Affected by Operational Stress Injury.

Nurses are exposed to potentially psychologically traumatic events which can lead to operational stress injuries (OSI). Workplace reintegration after an OSI can be challenging, especially with repeated exposure to potentially traumatic scenarios and workplace demands. A workplace reintegration program (RP) originally developed for police officers may be of benefit for nurses returning to work after an OSI. The purpose of this study is to investigate the perceived need for an RP for nurses, and its potential contextualization and implementation in the nursing context using an implementation science approach. This mixed-methods study collected data via questionnaires and focus groups from acute care nurses in Canada (N = 19). Data analysis was conducted using descriptive statistics, thematic analysis, and an organizational readiness assessment. Study participants indicated that formalized processes were rarely used to support nurses returning to work after time off due to mental health challenges. Themes included (1) "The Perfect Storm": the current state of return-to-work, (2) Integral Needs, and (3) A Break in the Clouds: hope for health. Exploration of innovative programs such as the RP may provide additional support to nurses affected by OSIs. Further research is needed regarding workplace reintegration for nurses, and contextualization and evaluation of the RP.

Organizational and Institutional Initiatives for the Recruitment, Retention, and Advancement of Black Nurses in the Canadian Healthcare System: A Rapid Review Protocol

Introduction: In response to protests for racial justice, several organizations and institutions have made public declarations denouncing anti-Black racism. One prominent sector emphasizing their commitment to addressing anti-Black racism is health care—more specifically, nursing. To address anti-Black racism, many Canadian organizations and institutions have announced initiatives to recruit, retain, and support the advancement of Black nurses. Our team is interested in charting these initiatives to inform future policy and program decisions related to the recruitment, retention, and advancement of Black nurses. Objective: The objective of this review is to identify and chart evidence of organizational and institutional initiatives related to the recruitment, retention, and advancement of Black nurses in Canada. Inclusion criteria: This rapid review will include sources focused on Black nurses in Canada. Further, this review is focused on the organizational or institutional initiatives that support or facilitate aspects of recruitment, retention, or advancement of Black nurses in the workforce in Canada. Methods: A comprehensive search, developed in collaboration with a library scientist, will be used to locate peer-reviewed and grey literature from select databases and repositories. Databases will be searched from time of inception, and language will be restricted to English and French sources. Title and abstract screening as well as full-text review will each be completed by two independent reviewers. Sources will be included if they meet the inclusion criteria for the population, concept, and context. Data will be extracted by two reviewers using an extraction tool. Data will be reviewed and consolidated before being presented narratively and visually.Protocol Registration: The protocol has been registered with Open Science Framework (OSF) on March 1st, 2023.

Increasing the Visibility and Influence of Canadian Nurses within the United Nations System.

Founded in 1945, the United Nations (UN) system has become the place where countries come together to discuss complex and multifaceted issues that no one country can tackle alone. Civil society continues to be an integral part of the UN system, supporting the work of various entities and providing expertise on core pillars such as development, human rights and peace and security. Some global nursing leaders have made considerable progress in increasing nursing engagement and visibility across the system; however, representation remains small. Despite a strong appetite to be involved in global public policy, there is also a need to increase awareness and knowledge of how to engage with and navigate key global organizations. Numerous opportunities exist for civil society to participate in, learn from and influence the work of the UN. This article provides Canadian nursing leaders with examples of pathways to explore to become formally affiliated with entities within the UN system.

Differentiating Specialized and Advanced Nursing Roles: The Pathway to Role Optimization.

We aimed to differentiate the practice patterns of nurses in specialized and advanced roles in a cross-sectional study. Canadian nurses completed a self-report questionnaire (June 2017-September 2017). Demographic data and time spent in five domains of advanced practice were compared across three nurse groups. Regression analysis examined factors associated with domain involvement. Respondents (n = 1,107) represented all provinces/territories, including 396 specialized nurses (SNs), 211 clinical nurse specialists (CNSs) and 490 nurse practitioners (NPs). Nurses across all groups were the most involved in direct comprehensive care and the least involved in research. NPs were more involved in direct comprehensive care compared to CNSs (p < 0.001) and SNs (p < 0.001). CNSs were more involved than SNs and NPs in support of systems, education, research and professional leadership (p < 0.001). Role type, years as an advanced practice nurse and specialist certification were modest predictors of domain involvement. Distinguishing how specialized and advanced nursing roles contribute to healthcare can inform policies to support their optimal utilization in healthcare systems.

How We Manage Patients with Indolent B-Cell Malignancies on Bruton’s Tyrosine Kinase Inhibitors: Practical Considerations for Nurses and Pharmacists

The most common forms of B-cell malignancy, non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL), have seen a drastic shift in the treatment landscape over the last two decades with the introduction of targeted agents. Among them are Bruton's tyrosine kinase (BTK) inhibitors, which have demonstrated excellent efficacy in indolent B-cell NHLs and CLL. Although BTK inhibitors are generally thought to be more tolerable than chemoimmunotherapy, they are associated with a unique safety profile including varying rates of rash, diarrhea, musculoskeletal events, cardiovascular events, and bleeding. Ibrutinib was the first BTK inhibitor to gain a Health Canada indication, followed by second-generation BTK inhibitors acalabrutinib and zanubrutinib, which have better safety profiles compared to ibrutinib, likely due to their improved selectivity for BTK. As BTK inhibitors are oral agents given continuously until disease progression, long-term adverse event (AE) monitoring and management as well as polypharmacy considerations are important for maintaining patient quality of life. This paper intends to serve as a reference for Canadian nurses and pharmacists on dosing, co-administration, and AE management strategies when caring for patients with indolent B-cell NHL or CLL being treated with BTK inhibitors.

Decolonization the what, whyand how: A treatieson Indigenous nursing knowledge.

Decolonization the what, whyand how: A treatieson Indigenous nursing knowledge.

Canada's Aging Federal Prison Population: Health Disparity, Risk, and Compassionate Release for Persons Convicted of Sexual Offenses.

The Canadian federal prison population is increasingly aging within institutions that were never intended or designed to meet the complex medical and mental health needs of older incarcerated persons. Increasing numbers of incarcerated persons are "aging in place," and many are dying within federal correctional institutions. Persons convicted of sexual offenses comprise a large-and growing-proportion of this aging population. The Correctional Investigator Canada has recently called for an expansion of access to compassionate release for the aging federal prison population, yet little progress has been made. In this article, we explore the significant challenges faced by the aging population in federal institutions, including insufficient access to appropriate care, challenges in application for compassionate release, and how questions of risk may affect the potential for community transfer. Questions of risk overshadow decisions on early release of incarcerated persons, especially those convicted of sexual offenses. Nurses play a central role in the provision of care to aging incarcerated persons and in advocacy for better access to services when a patient's needs cannot be met within the institution. This article presents a call to action for forensic nurses in Canada (and beyond) to advocate for both improved services within federal correctional institutions and for expedited access to compassionate release of aging incarcerated persons, especially those nearing end of life. The significant disparity in access to health care for aging incarcerated persons compared with their nonincarcerated counterparts represents a significant concern.

The Canadian Landscape of Genetics and Genomics in Nursing: A Policy Document Analysis.

Genetics and genomics (GG) are transforming approaches to healthcare in Canada and around the globe. Canadian nurses must be prepared to integrate GG in their practice, but modest research in this area suggests that Canadian nurses have limited GG competency. Countries that have integrated GG across nursing provided guidance to nurses about the practice implications of GG through regional nursing policy documents. These documents propelled action to integrate GG across nursing. Little is known about the GG content in the nursing policy document infrastructure in Canada. This study aimed to examine the guidance for GG-informed nursing practice as provided by Canadian nursing organizations in official professional documents. Qualitative document analysis was used. A hybrid inductive/deductive analysis approach was used to analyze findings within the diffusion of innovation theory framework. There is an overall lack of depth and breadth of Canadian nursing documents that include content related to GG. Of the (n = 37) documents analyzed, four themes were generated including (a) GG guidance in nursing education; (b) regulators' requirements for foundational GG knowledge, (c) Canadian Nurses Association (CNA) as an early catalyst to GG integration; and (d) early adopters in speciality practice. There are opportunities to enhance the guidance available to Canadian nurses for the application of GG, through documents of nursing professional associations, nursing education accreditation organizations, and regulatory bodies. Findings suggest oncology and perinatal nurses are the early adopters which is an important consideration in future strategies to implement GG into Canadian nursing.

Strategies Used in Canadian Nursing Programs to Prepare Students for NCLEX-RN® Licensure Exam

Nursing educators need strategies for preparing students to be successful in the National Council Licensure Examination (NCLEX-RN®). Understanding the educational practices used is an important step in informing curricular decisions and helping regulatory agencies evaluate nursing programs' efforts to prepare students for practice. This study described strategies used in Canadian nursing programs to prepare students for the NCLEX-RN®. A cross-sectional descriptive national survey was completed by the program's director, chair, dean, or another faculty member involved in the program's NCLEX-RN® preparatory strategies using the LimeSurvey platform. Most participating programs (n = 24; 85.7%) use one to three strategies to prepare students for the NCLEX-RN®. Strategies include the requirement to purchase a commercial product, the administration of computer-based exams, NCLEX-RN® preparation courses or workshops, and time dedicated to NCLEX-RN® preparation in one or more courses. There is variation among Canadian nursing programs in how students are prepared for the NCLEX-RN®. Some programs invest considerable effort in preparation activities, while others have limited ones.

Sustaining the Canadian Nursing Workforce: Targeted Evidence-Based Reactive Solutions in Response to the Ongoing Crisis.

Inadequate staffing, excessive workloads, endemic violence and unhealthy workplaces are some of the challenges facing Canadian nurses. Leaving these issues unaddressed has had pernicious impacts on the nursing workforce: thousands of nurses across Canada have been suffering from extreme stress, anxiety and burnout, leading many of them to leave their current jobs and, for some, the profession of nursing altogether. We conducted a comprehensive yet rapid review of evidence-based solutions from the peer-reviewed and policy literature, stakeholder dialogues and member surveys commissioned by the Canadian Federation of Nurses Unions that could be implemented and scaled across Canada. Our findings support coordinated series of collectively planned, carefully sequenced and evidence-based interventions to retain, return, integrate and recruit nurses targeted to support the nursing workforce from training to early-, mid- and late-career stages. The implementation of these reactive solution bundles will also enhance the quality of healthcare services and, more broadly, the healthcare system.

N05 Highlighting the critical contributions of Inflammatory Bowel Disease nurses in Canada: Perspectives from nurses, gastroenterologists, individuals living with IBD, and caregivers.

Abstract Background Multidisciplinary teams are essential in managing Inflammatory Bowel Disease (IBD). IBD nurses play a critical role in improving patient outcomes and providing cost-effective quality of care. In Canada, access to IBD nurses remain inconsistent. There are more than 270,000 people living with IBD in Canada and fewer than 90 IBD nurses to care for them. This study was conducted to capture the value of IBD nurses, to identify gaps in resources, and to generate strategies for building IBD nurse capacity and enhancing the contributions of IBD nurses in Canada. Methods A convergent mixed-methods design was utilized to gather input from 4 stakeholder groups: IBD nurses, gastroenterologists, individuals living with IBD, and caregivers. Data collection was done through completing a review of the literature, stakeholder surveys, and one-on-one online semi-structured interviews with all stakeholders. Descriptive statistics were used for the quantitative analysis. Semi-structured interviews were audio recorded and transcribed verbatim then thematically analyzed. Results The IBD nurse’s role in clinical care was recognized as a value-add across all stakeholder groups. Having access to a specialized IBD nurse was recognized as a service that elevates the quality and continuity of patient care. As the interface between patients and other healthcare providers, there was recognition amongst stakeholders that IBD nurses are ideally positioned to educate patients about IBD management, general health promotion in the context of chronic disease and may support other aspects of care such as psychosocial, nutrition, and other extraintestinal manifestations or to help guide patients toward appropriate care channels. Many IBD nurses view advocacy as a logical extension of their official responsibilities, helping IBD patients to make treatment decisions and assisting them with disease challenges that affect their quality of life. Conclusion IBD nurses represent an underused resource in Canadian IBD care. Canada currently falls short of the recommended 2.5 full-time IBD nurse equivalents per 250,000 population. Achieving this objective will require a commitment to train IBD nurses and additional funding for their education and employment. The government can work with nursing institutions to set benchmarks, establish training programs, and create opportunities for IBD nurses in Canada. Introducing more IBD nurses into the system and using them to their full capacity makes sense from both a clinical and economic standpoint. It lifts the burden on gastroenterologists and primary care physicians, reduces costs to health systems while improving the overall quality of care for IBD patients.

Development of a New Care Pathway for Depression and Anxiety in Adult-Onset Isolated Dystonia.

Recently, we identified barriers and facilitators to the screening and treatment of depressive and anxiety symptoms in adult-onset isolated dystonia (AOID). These symptoms are common, functionally impairing, and often underdetected and undertreated. To develop a care pathway for mood symptoms in AOID. We used a multistep modified Delphi approach to seek consensus among healthcare professionals with experience of AOID on the screening, diagnosis, and treatment of mood symptoms. A combination of face-to-face meetings and online surveys was performed from 2019 to 2020. We created the survey and then reviewed with stakeholders before 2 rounds of Delphi surveys, all of which was finally reviewed in a consensus meeting. A purposive sample of 41 expert stakeholders from 4 Canadian provinces, including neurologists, nurses, psychiatrists, psychologists, and family physicians, was identified by the research team. The Delphi process led to consensus on 12 statements that operationalized a pathway of care to screen for and manage depression and anxiety in people with AOID. Key actions of the pathway included yearly screening with self-rated instruments, multidisciplinary involvement in management involving local networks of providers coordinated by movement disorders neurologists, and access to educational resources. The Delphi panel indicated the 2 core steps as the documentation of the most recent screening outcome and the documentation of a management plan for patients who were positive at the last screening. This new care pathway represents a potentially useful intervention that can be used to build an integrated model of care for AOID.

Nursing during the COVID-19 pandemic: A reflective thematic analysis of how the hamster wheel shifted personal and professional control.

The aim of this national study was to examine the experience of nurses 9-12 months after the onset of the pandemic. This article reports the reflective thematic analysis of the qualitative portion of a mixed methods study of the experiences of 1319 Canadian nurses between February to May 2021. Data gathering occurred through open-text box questions in an online survey. Three overarching themes were found: (1) the hamster wheel, (2) the shifting sense of control, and (3) the inability to leave the pandemic at work. This research presents a national perspective of nurses which contributes to the wider global narrative. The experience of redeployment, nurses as decision-makers, communication and leadership challenges were all factors impacting mental health and intraprofessional collaboration. The findings revealed the immense pressure, mental health concerns, and professional implications for nurses in all domains. No public or patient contributions.

The Role of Character and Competence in Canadian Nursing Leadership: Show me how you Lead and I will tell you who you are

The role of character and competence in effective leadership is significant. Who the leader is as a person often manifests in how they lead. Leadership effectiveness could be obtained through the process of continuous, intentional, and purposeful commitment to acquiring empirical education, as well as a commitment to other ways of acquiring knowledge. Education, especially university education, could open the door for epistemic transformation as well as personal transformation. Leadership in Canadian nursing profession is evident in every area and context of nursing practice, including in the frontline nursing. Canadian nurses, therefore, need to make conscious commitment to acquiring continuous leadership education that could translate to both epistemic transformation and personal transformation, which could lead to the acquisition of skills and technical competencies for effective leadership.

Perspectives of Pediatric Nephrologists, Intensivists and Nurses Regarding AKI Management and Expected Outcomes.

Acute kidney injury (AKI) in critically ill children is associated with increased risk for short- and long-term adverse outcomes. Currently, there is no systematic follow-up for children who develop AKI in intensive care unit (ICU). This study aimed to assess variation regarding management, perceived importance, and follow-up of AKI in the ICU setting within and between healthcare professional (HCP) groups. Anonymous, cross-sectional, web-based surveys were administered nationally to Canadian pediatric nephrologists, pediatric intensive care unit (PICU) physicians, and PICU nurses, via professional listservs. All Canadian pediatric nephrologists, PICU physicians, and nurses treating children in the ICU were eligible for the survey. N/A. Surveys included multiple choice and Likert scale questions on current practice related to AKI management and long-term follow-up, including institutional and personal practice approaches, and perceived importance of AKI severity with different outcomes. Descriptive statistics were performed. Categorical responses were compared using Chi-square or Fisher's exact tests; Likert scale results were compared using Mann-Whitney and Kruskal-Wallis tests. Surveys were completed by 34/64 (53%) pediatric nephrologists, 46/113 (41%) PICU physicians, and 82 PICU nurses (response rate unknown). Over 65% of providers reported hemodialysis to be prescribed by nephrology; a mix of nephrology, ICU, or a shared nephrology-ICU model was reported responsible for peritoneal dialysis and continuous renal replacement therapy (CRRT). Severe hyperkalemia was the most important renal replacement therapy (RRT) indication for both nephrologists and PICU physicians (Likert scale from 0 [not important] to 10 [most important]; median = 10, 10, respectively). Nephrologists reported a lower threshold of AKI for increased mortality risk; 38% believed stage 2 AKI was the minimum compared to 17% of PICU physicians and 14% of nurses. Nephrologists were more likely than PICU physicians and nurses to recommend long-term follow-up for patients who develop any AKI during ICU stay (Likert scale from 0 [none] to 10 [all patients]; mean=6.0, 3.8, 3.7, respectively) (P < .05). Responses from all eligible HCPs in the country could not obtained. There may be differences in opinions between HCPs that completed the survey compared to those that did not. Additionally, the cross-sectional design of our study may not adequately reflect changes in guidelines and knowledge since survey completion, although no specific guidelines have been released in Canada since survey dissemination. Canadian HCP groups have variable perspectives on pediatric AKI management and follow-up. Understanding practice patterns and perspectives will help optimize pediatric AKI follow-up guideline implementation.

Validation and prioritisation of health informatics competencies for Australian nursing and midwifery leaders: A modified Delphi study

BackgroundHealth informatics competency standards for nurses are required to ensure the use and management of health information technologies contributes to the delivery and management of safe, quality care delivery. Historically, these competencies have been identified for nurses as a general group and specifically for undergraduate nursing students but not to the same extent for nurse leaders. AimThe aim of this study was to validate and prioritise health informatics competencies for Australian nurse leaders. MethodThis study utilised a modified Delphi technique to validate and prioritise 26 health informatics competencies for the Australian setting. The competencies were previously developed for Canadian nurses through literature review and consulation with experts. This modified Delphi study included invitations to 20 Australian Chief Nursing Information Officers who were then asked to extend the invitation to nurse leaders in their corresponding organisations. ResultsEleven Chief Nursing Information Officers and seven Nurse Leaders completed the study including 3 rounds of informatics competencies consensus surveys. As a result, 22 revised competency statements were agreed to by the study participants. The top priority competency (Nursing and Midwifery leaders support clinicians to adopt and use information and communication technologies that support safe, quality care delivery) was also the highest ranked in the Canadian team’s initial work. This reflects a common objective of nurses’ need to ensure technology is fit for purpose, not only for nurses and midwives, but for patient safety and quality of care. ConclusionKnowledge is required in the digital health landscape in order for nursing leaders to increase their capability in decision-making in the current and future digital healthcare environments. Differences in the competencies validated and prioritised by Australian nurse leaders and previous work by Canadian nurse leaders support the need to examine context-specific factors for nurse leaders to utilise these competencies.

The impact of funding models on the integration of registered nurses in primary health care teams: protocol for a multi-phase mixed-methods study in Canada

BackgroundFamily practice registered nurses co-managing patient care as healthcare professionals in interdisciplinary primary care teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases while being cost-effective. Currently, however, it is unclear how different funding models support or hinder the integration of family practice nurses into existing primary health care systems and interdisciplinary practices. This has resulted in the underutilisation of family practice nurses in contributing to high-quality patient care.MethodsThis mixed-methods project is comprised of three studies: (1) a funding model analysis; (2) case studies; and (3) an online survey with family practice nurses. The funding model analysis will employ policy scans to identify, describe, and compare the various funding models used in Canada to integrate family practice nurses in primary care. Case studies involving qualitative interviews with clinic teams (family practice nurses, physicians, and administrators) and family practice nurse activity logs will explore the variation of nursing professional practice, training, skill set, and team functioning in British Columbia, Nova Scotia, Ontario, and Quebec. Interview transcripts will be analysed thematically and comparisons will be made across funding models. Activity log responses will be analysed to represent nurses’ time spent on independent, dependent, interdependent, or non-nursing work in each funding model. Finally, a cross-sectional online survey of family practice nurses in Canada will examine the relationships between funding models, nursing professional practice, training, skill set, team functioning, and patient care co-management in primary care. We will employ bivariate tests and multivariable regression to examine these relationships in the survey results.DiscussionThis project aims to address a gap in the literature on funding models for family practice nurses. In particular, findings will support provincial and territorial governments in structuring funding models that optimise the roles of family practice nurses while establishing evidence about the benefits of interdisciplinary team-based care. Overall, the findings may contribute to the integration and optimisation of family practice nursing within primary health care, to the benefit of patients, primary healthcare providers, and health care systems nationally.

Hindsight Is 2020: A Graduate Student Perspective.

The year 2020 was unpredictable and brought about unimaginable change for our world, disrupting operations within the nursing profession and healthcare systems at large. In this discussion paper, we revisit a report from the Canadian Nurses Association, Toward 2020: Visions for Nursing (Villeneuve and MacDonald 2006), from a graduate student perspective. In this 2006 report, the authors presented a series of predictions for the preferred future of nursing in Canada in 2020. Even without the pandemic, the pre-existing trends in healthcare and nursing did not favour success for the visions presented in this national nursing report. Now, two years after 2020, we examine the extent to which these predictions held true in the following areas: health systems, nursing practice, nursing workforce, nursing education and nursing regulation. We conclude that most of the preferred scenarios were unmet or partially met, and argue that it is critical to enact relevant preferred scenarios now. While the deleterious effects of the pandemic will be felt by the nursing profession for years, these experiences did not hinder our collective ability to lead change in Canada. We offer insights to provide recommendations for nursing actions toward a healthier future for Canadians. The best of nursing in Canada is within sight.

Using Narrative Inquiry to Understand Anti-Muslim Racism in Canadian Nursing.

Islamophobia or, anti-Muslim racism, and more specifically, gendered islamophobia targeting Muslim women who wear a hijab is rising globally and is aggravated by the COVID-19 pandemic. However, anti-Muslim racism is not well understood in Canadian nursing. This study utilized narrative inquiry to understand anti-Muslim racism through the experiences of nurses who wear a hijab with the goal of putting forward their counter-narrative that disrupts anti-Muslim racism in Canadian nursing. Narrative inquiry informed by Critical Race Feminism, care ethics, and intersectionality were used to analyze the factors shaping anti-Muslim racism and composite narratives were used to present the results. The three composite narratives are: 'This is Who I Am: A Muslim Nurse with a Hijab and an Accent'; 'I Know What is at Play: Unveiling Operating Power Structures and Power Relations'; and 'Rewriting the Narrative: Navigating Power Structures and Power Relations'. These composite narratives constituted the nurses' counter-narrative. They revealed intersections of gendered, racial divisions of labour and religious narratives that shape anti-Muslim racism, as operating power relations in nursing, and how Muslim nurses reclaimed control to resist their racialized stereotypes. Findings suggest that anti-Muslim racism in nursing operates through multiple intersecting power relations. Using stories can mobilize transformational change so that anti-racist practices, policies, and pedagogy can be embraced.