Opening the locked doors: reimagining nursing leadership through a century of history, creativity and lived experience

Background: Despite a century of professional development, inequities persist in who is recognised, heard and legitimised as a nursing leader. Understanding these inequities requires attention to the historical, structural and epistemic conditions through which leadership has been constructed. Aims: To critically examine the development of nursing leadership in the United Kingdom since 1919 and reimagine leadership through an equity-focused framework integrating history, theory, lived experience and creative inquiry. Methods: An interpretive narrative literature review synthesised historical texts, policy documents, leadership theory, empirical nursing research, professional reports and selected published oral histories. Analysis was informed by critical pedagogy, feminist epistemology and social constructionism, with poetry and metaphor used as artful modes of inquiry. Results: The synthesis identified enduring gendered, racialised and professional hierarchies shaping leadership legitimacy, voice and progression. Integrating these insights generated a cyclical five-part framework comprising critical consciousness, knowing, trauma, internalised projections and growth, with artfulness operating across the framework as inquiry and praxis. Conclusions: Nursing leadership equity requires structural and epistemic transformation rather than individual adaptation or representation alone. The framework extends leadership theory by centring power, embodiment and alternative ways of knowing, and calls for policy and organisational accountability that redistributes authority, legitimises diverse knowledge and links voice to material change.