Role Expectations for Nurses and Neuroscientific and Neurotechnological Advancements: A Qualitative Study on the Perceptions of Nurses on Their Roles and Lifelong Learning

Abstract

Nurses can understand and evaluate the impact of neuroscientific and neurotechnological advancements (NNA) from multiple standpoints given their roles as patient liaisons, advocates for their profession and their clients, leaders, and educators as well as their interactions with NNA such including deep brain stimulation and neuroimaging. We conducted semi-structured interviews with Canadian nurses to understand their perspectives on their roles in and outside the workplace, their familiarity with NNA and their ethical, legal, and social implications, their participation in NNA governance discussions and how lifelong learning can be applied to empower their participations in NNA governance discussions. Participants felt that nurses had the potential to meaningfully involve themselves in NNA governance discussions if given a greater opportunity. Participants were not offered lifelong learning surrounding the ethical, legal, and social implications of NNA. It would be fruitful to facilitate and empower nurses as contributors to NNA governance and ethics discussions.

Keywords

neurotechnology neuroethics neurogovernance nurses nursing lifelong learning

Background

With over 300,000 active professionals, registered nurses (RNs) are Canada’s largest group of healthcare providers (Canadian Institutes of Health Research, 2020). Nurses are exposed to and interact with many scientific and technological advancements that include neuroscientific and neurotechnological advancements (NNA), technological advancements that interact with the human nervous system (Barbe et al., 2014; Ong et al., 2017; Vidal et al., 2013). Neuroethics and neurogovernance are two discourses that emerged to engage with the associated ethical, legal, and social implications and governance of NNA (Garden et al., 2016; Garden & Winickoff, 2018; Northoff, 2009). In their occupations, nurses are expected to uphold multiple formal and informal roles including being leaders, political activists, advocates patient liaisons and educators (Downey et al., 2011; Gregor, 2001; Tourigny & Pulich, 2005). Outside of their occupation, nurses are also members of society and therefore can also have a role as active citizens. Lifelong learning opportunities are a means to enhance and develop the roles that nurses hold as professional and active citizens (Garden & Winickoff, 2018; Racine, 2015). Stakeholder engagement is one main focus of the neuroethics and neurogovernance discourses (Garden et al., 2016). Given the roles expected to be fulfilled by nurses and their exposure to NNA, nurses should have a stake in how NNA are discussed in neuroethics and neurogovernance discourses. However, nurses are still invisible in neuroethics and neurogovernance discourses, (Deloria & Wolbring, 2019). The objective of our study is to explore the familiarity of nurses with NNA and their implications; examine the perspectives of nurses on their roles within their occupation and in relation to NNA, neuroethics, and neurogovernance discourses and furthermore, understand the current lifelong learning processes in place for nursing professionals and the potential of lifelong learning to entice and empower nurses to contribute in a meaningful way to NNA, neuroethics, and neurogovernance discussions.

Nursing Role

Canadian nursing standards and leadership outline that nurses encompass a variety of roles in their occupation that include employee/worker, advocate, authority, educator, active citizen, and leader (Canadian Nurses Association, 2009, 2015, 2017). Nursing practice constantly changes and has expanded outside of hospital settings to also impact faith communities, schools, professional organizations, government agencies, and outreach whereby nurses are expected to adapt and deploy a variety of skills to fit each setting (Canadian Nurses Association, 2015). Specialty practices and certifications provide nurses with expertise related to certain populations or health concerns that include age (e.g., geriatrics) and type of care (e.g., palliative care, public health, psychiatry etc.) (Canadian Nurses Association, 2015).

Nursing and Active Citizenship

“Nursing is a practice discipline and it is also a political act” (Canadian Nurses Association, 2009).

The nursing practice immerse nurses in a variety of roles and skills that are not limited to medicine. Political activism and nursing are familiar intersections throughout history. Historical nursing figures such as Florence Nightingale (1859) exercised their political advocacy and activism to shape the climate of nursing as it stands today. Florence Nightingale (1859) understood that societal changes were necessary to navigate and implement appropriate healthcare standards and sanitation for clients in the clinical setting and the greater public. Today, it is standard practice for nurses to exercise advocacy in their roles for their clients, for themselves and for their staff (Abbasinia et al., 2019; Tomaschewski-Barlem et al., 2018). Nursing advocacy can be broadly defined as the promotion of the nursing profession towards the greater public or the nurse acting on behalf of their clients their families, and greater society (Hanks, 2008). It is noted that nurses are best suited for patient advocacy due to their close proximity to patients (Des Jardin, 2001; Mahlin, 2010). Although nurses promote advocacy in their clinical settings, social advocacy, and political activism does not end in their professional roles. Active citizenship can be promoted through advocacy. Active citizenship takes individual values and promotes them through democratic, non-violent means in the individual participation in political life, civil society, and their surrounding communities (Hoskins et al., 2006). Active citizenship is guided through the collective and authoritative action of the public to push forth their interests and further enhanced by learning opportunities. Nurses are expected to act as active citizens to utilize the collective and authoritative action as members of the public to push forth their interests outside of their profession (Bauer et al., 2012; Canadian Nurses Association, 2009; Stivers, 1990). It has also been recognized that lifelong learning is a tool that can be used to build up nursing role competencies that include political activism and advocacy (Ellenbecker et al., 2017; Williams et al., 2018).

Lifelong Learning

The Canadian Nurses Association (2004, 2007, 2009) acknowledges the importance of lifelong learning initiatives towards the quality and competencies of nurses across Canada.

Lifelong learning and professional development are regarded as integral to the practice of nursing. It is recognized that nursing does not end at the undergraduate and pre-occupational levels (Kapborg & Fischbein, 1998). Lifelong learning initiatives allow nurses to feel competent and well-prepared in their roles, maintain overall job satisfaction and be up to date in a constantly changing healthcare environment (Baker, 2010; Danielson & Berntsson, 2007; Gould et al., 2001, 2007; Shermont et al., 2009). As well, lifelong learning opportunities provide the needed knowledge for nurses to take an active and political role in and out of their occupation (Faulk & Ternus, 2004; Gehrke, 2008; Staebler et al., 2017). Lifelong learning initiatives are reflected in the quality of nursing profession through updated patient care, awareness of new innovations and technologies, development and acquiring skillsets, and obtaining the relevant knowledge needed for change and advocacy (Canadian Nurses Association, 2004, 2007, 2009; Gopee, 2005).

NNA, their Governance, and Nursing

NNA are products and processes that stimulate, enhance, or connect with the nervous system (Garden et al., 2016; Müller & Rotter, 2017). Many nurses are exposed at work to NNA that include, deep brain stimulation (Lanier & Buffum, 2011), transcranial magnetic stimulation (Bernard et al., 2009; Fitzsimons et al., 2009), neuromodulation (Mendez et al., 2012), neuroimaging (Holohan et al., 2013), and virtual reality (Choi, 2017; Elliman et al., 2016). In recent years, neuroethics and neurogovernance discourses emerged to investigate the ethical, legal, and social implications and the governance of NNA (Garden & Winickoff, 2018; Northoff, 2009; Roskies, 2002). The societal discussions of science and technology advancements should be a constant endeavor (Cheung & Wolbring, 2017; Einsiedel, 2004). Neurogovernance and neuroethics fields note that it is important to integrate the issues associated with NNA into education platforms so that the public and professionals can anticipate change and impact (Garden & Winickoff, 2018; OECD, 2002; OECD’s Centre for Educational Research and Innovation [CERI], 2005).

Given the potential exposure to various NNA in their occupation and role expectations such as leaders, educators, and advocates for their clients and their profession, it can be suggested that nurses also have a role as relevant influencers in neuroethics and neurogovernance discourses. Furthermore, as NNA also impact society outside of the clinical setting, nurses also have a role to play in NNA public debates as active citizens. Lifelong learning and professional development procedures used by nurses to stay up to date for their work can be used to entice and empower nurses to be influencers of neuroethics and neurogovernance discourses. In recent years, various studies have looked at the linkage between healthcare professionals and the ethical, legal, and social implications of NNA (Bell et al., 2009, 2016; Bell & Racine, 2013; Deloria & Wolbring, 2019; Villamil & Wolbring, 2019). The objective of our study was to add to the literature engaging with health professionals and NNA whereby we investigate the perspectives of nurses to understand their perspective on their roles as professionals and active citizens in neuroethics and neurogovernance discussions and the utility of lifelong learning to empower their involvement in neuroethics and neurogovernance discussions.

Methods

Design

The qualitative method for this study followed role theory to analyze how the nurse identity was shaped by the roles they associate with and the language used to frame their identity in relation to their occupations, lifelong learning, active citizenship, and NNA (Biddle, 1986). We employed semi-structured qualitative interviews to investigate how nurses perceive NNA, their roles as nurses and how these may apply to NNA and the neurogovernance and how these concepts interact in their occupation and their personal lives.

Data Collection

Purposive sampling was employed, and participants were recruited through email and word of mouth (Palinkas et al., 2015). Inclusion criteria required participants to identify as a nurse licensed to practice in Canada. Given that this study aimed to recruit a relatively homogenous population, the saturation of data was estimated to appear around 10 interviews (Boddy, 2016; Sandelowski, 1995). This number was reflective of gathering a sufficient size for appropriate thematic qualitative data analysis to capture the aspects of the group. To offer room for flexibility, a total of 12 Canadian nurses were recruited for the study and included nurses in Alberta and Manitoba. All participants had the option to conduct the interview through phone or in-person. Of the 12 participants, the 11 participants in Alberta opted for a face-to-face format and the 1 participant in Manitoba requested a phone interview.

Interview

Data were drawn from one interview with each participant conducted at settings chosen by participants for convenience and comfortability that included homes, libraries, and cafes as well as a phone interview, no follow up interviews were conducted. All 12 interviews ranging between 45 and 60 minutes were conducted between May 2019 and July 2019, and each interview was subsequently audio-recorded and transcribed verbatim (Yoosefi Lebni et al., 2020). A semi-structured interview format was employed to guide the flow of conversation and clarify meanings. A 41 question research protocol was developed by the researchers making use of prior research and knowledge of the researchers identifying gaps in the literature; focusing on nurse’s views on emerging NNA, and their ethical, legal, and social aspects, the understood role of the nurse in general and in relation to neuroethical and neurogovernance discussions and their views on lifelong learning within the nursing profession and its utility for enhancing the abilities of nurses to take part in neuroethical and neurogovernance discussion.

Ethics

This study received ethics approval from the University of Calgary Research Ethics Board (REB17-0785). All ethical concerns including privacy and confidentiality were outlined in the informed consent form provided to participants prior to the start of the interview. Participation in the study was completely voluntary, and participants were able to withdraw from the research process at any point until the completion of the interview. Prior to completing this interview, participants were asked to confirm their responses, or make any changes as needed. Throughout the interview process, all participants were assigned pseudonyms to uphold confidentiality and privacy, and no questions were linked to an identifiable person or associated with any response.

Data Analysis

The audio files from the semi-structured interviews were orthographically transcribed by the author using the Express Scribe playback software and Microsoft Word and then saved into a PDF format (Davidson, 2009). Raw data from the transcribed interviews were organized, analyzed, and coded using the ATLAS.Ti 8™ qualitative analysis software. Themes and concepts were then derived through the thematic content analysis of decontextualization and recontextualization of the raw interview data. Both authors first read through the interviews to familiarize themselves with the content. The first author conducted a content analysis of the transcribed interviews using the ATLAS.Ti 8™ software to organize ideas and concepts coded throughout each interview. Themes were grouped according to relevance, meaning, the research questions, and frequency.

Trustworthiness Measures: Peer Debriefing

The trustworthiness measures outlined by Guba and Lincoln (1994), were employed for qualitative analysis. Confirmability, as noted by Lincoln and Guba is achieved once transferability, dependability, and credibility measures are ensured during the research process (Lincoln, 1985). Confirmability is achieved when researchers’ interpretations are clearly derived from the data (Tobin & Begley, 2004). A latent coding process was performed on the 12 interview transcriptions to identify themes and ideas. To enhance credibility, the two authors working on this project engaged in peer debriefing. The authors engaged in a peer debriefing process to develop new themes and codes as well as settle differences in understanding and interpretation of the interviews. Themes generated by each author were regularly discussed to create a cohesive and encompassing interpretation of the data. Reflexivity and confirmability was practiced by the authors through the recognition of positionality throughout the project and the research process (Bourke, 2014). Both authors do not identify as nurses, and the study is approached by both authors as learners to recognize the expertise that lies in the participants experiences. As qualitative interviews were conducted, the interpretations of each author were considered to confirm meaning and definitions as indicated by interviewees and remain as accurate as possible to the stories expressed by participants. Reflexivity throughout the data analysis process was practiced through the consistent recording of thoughts, feelings, and interpretations. Each author created an audit trail through notes and codes in ATLAS.Ti 8™ to ensure that they were communicating ideas and thoughts throughout their own coding process for dependability measures (Koch, 1994). This study was not intended to be generalizable due to the specifics and nature of the sample; however, the data provided allows for transferability of relevant information needed for the public to decide whether to utilize a similar investigative process.

Results

The results of this study will outline participant backgrounds, and then further outline key themes and subthemes that were identified during the interviews (Table 1).

Table 1.

Overview of the Themes and Subthemes Outlined by the Views of Canadian Nurses.

Themes	Sub themes	Sub-subthemes
1. Role and skill expectations	1.1. Nurse role
	1.2. Personal nursing role	1.2.1. Advocate
		1.2.2. Authority
		1.2.3. Decision maker
		1.2.4. Evidence based practitioner
		1.2.5. Expert
		1.2.6. Knowledge producer
		1.2.7. Leader
		1.2.8. Nurse educator
		1.2.9. Patient liaison
		1.2.10. Stakeholder
2. Advocacy, Active Citizenship, and Governance	2.1. Barriers and motivators
2. Advocacy, Active Citizenship, and Governance	2.2. Nursing voice: hierarchy
3. ELSI
4. Lifelong learning and professional development	4.1. Types and topics
4. Lifelong learning and professional development	4.2 Barriers and motivators
5. NNA	5.1. Role
	5.2. ELSI considerations
	5.3 Advocacy and active citizenship
	5.4. Lifelong learning

The majority of participants (n = 11 out of 12 participants) in our study were female and undergraduate degree holders (Table 1). The participants ranged from their early twenties to their late fifties and held multiple occupational backgrounds throughout their nursing career that included palliative care, public health, post-secondary education, and neuro (Table 1). Formal workplace roles identified by participants included bedside nurse, researcher, and unit manager (Table 2).

Table 2.

Participant Characteristics.

Variables	N	%
Gender (n = 12)
Female	11	91.67
Male	1	8.33
Age (n = 12)
20–30	2	16.67
31–40	2	16.67
41–50	3	25.00
51–60	5	41.67
Degree (n = 12)
IEN/BCN	1	8.33
BN	5	41.67
BsN	1	8.33
BN and BSc	1	8.33
MN	3	25.00
PhD	1	8.33
Current formal workplace role (n = 12)
Recent graduate	1	8.33
Nurse educator/nurse consultant	2	16.67
Bedside nurse	2	16.67
Vaccine coordinator	1	8.33
Professor/instructor	2	16.67
Unit manager	1	8.33
Post doctorate fellow	1	8.33
Unit quality coordinator	1	8.33
Living donor coordinator	1	8.33
Units/specialty experience (n = 15)
Long term care	1	6.67
Psychiatry	2	13.33
Occupational health	1	6.67
Nephrology and transplant	1	6.67
Public health	2	13.33
Private sector	1	6.67
Post secondary education	2	13.33
Acute geriatrics	1	6.67
Neuro	1	6.67
NICU	1	6.67
Pediatric ICU	1	6.67
Research	1	6.67

Note. IEN = internationally educated nurse; BCN = bridge to canadian nursing program.

Role and Skill Expectations

Participants determined the role expectations that they held for nurses in general and the expectations that they held for themselves in their current profession. In some cases, participants held onto the notion of ideal roles for themselves and their colleagues, but relented that due to their scope of practice, the formal role that they had as well as the fear of burn out discouraged them from practicing certain skills or roles they wanted.

Nurse Role

Participants were asked what critical skills and roles they determined nurses should uphold. Participants identified that clinical skills such as dressing changes, and patient assessment were critical for nurses to practice (n = 11 out of 12), however they also identified that professionalism (n = 2 out of 12), accountability (n = 3 out of 12), communication skills (n = 8 out of 12), research experience (n = 2 out of 12), task orientation (n = 1 out of 12), empathy (n = 3 out of 12), and holistic knowledge (n = 6 out of 12) were also important skills for a nurse. The participants were further asked of their opinions on nursing leadership and framework of practice for Canadian nurses (Canadian Nurses Association, 2015; Huston, 2008).

All nurses responded positively to the roles and skills outlined and indicated that this was the ideal role that nurses should uphold in practice. However, some nurses (n = 7 out of 12) indicated that although this sentiment was ideal, it was not necessarily achievable.

P11: Yeah, for sure! I mean, this is beautiful.. this is beautiful! [haha] Is it achievable? Hmm.. this is the ideal! [yeah] . . .when this filters down to the front line [yeah], is this actually what our RN’s are doing? They are desperately hanging on by their fingernails to give, safe, quality patient care [yeah]. And I am not convinced that one thing about this can be applied. So, this is beautiful [yeah], yeah and this is what I think ideally should happen.. but.. in practice. . .”

All participants identified strongly with being a nurse and they emphasized the importance of their roles as nurses. However, potential for burnout and lack of passion for nursing was identified to be a threat. Participants (n = 10 out of 12) identified that the environment that they are placed in has a large role in shaping the motivation and drive for their occupation.

P10: “. . .we get stuck in rote work in terms of the clinical [yeah, yeah] technical skills [yeah], and I don’t believe that is where the magic of nursing lies [of course]. You know, we can train a monkey to give an injection [haha], and probably do it perfectly, but, but there is so much more to that act”

P11: “I think that frontline nurses are desperately trying to do a good job in an environment that is so incredibly complex you know.. and so, um. . . and constrained. [yeah], and um. . . resource limited.. and I, I think that sometimes it is really challenging you know.”

Personal Nursing Role

Participants identified skills and expertise that were unique to their unit specialty and their formal occupational roles. These expectations became more specific depending on the role that a nurse was in. The participants identified that for certain roles, additional certification and learning was required. Although basic knowledge and training is consistent, the expectations for a psychiatric unit nurse, for example, differed from a vaccine coordinator. The nurses were asked if they identified with a list of roles that they were provided with and were asked to justify their responses (Table 3).

Table 3.

Nursing Roles Participants Identified With.

Role	Familiarity	Frequency (n = 12)
Active citizen	Yes	11
Active citizen	No	1
Advocate	Yes	12
Advocate	No	0
Authority	Yes	7
Authority	No	5
Decision-maker	Yes	10
Decision-maker	No	2
Evidence based practitioner	Yes	12
Evidence based practitioner	No	0
Expert	Yes	12
Expert	No	0
Knowledge producer	Yes	10
Knowledge producer	No	2
Leader	Yes	12
Leader	No	0
Nurse educator	Yes (formal)	8
	Yes (informal)	4
	No	0
Patient liaison	Yes	12
Patient liaison	No	0
Stakeholder	Yes	10
Stakeholder	No	2

The majority of participants saw themselves actively using these roles inside and outside of their occupation.

Advocate

Within their occupation, all participants outlined that they were advocates for their client’s safety and quality of care. Participant’s advocacy reflected their current occupations and the type of clients that they interact with. All participants indicated that they were not only advocating for the patients that they interact with, but also for the staff and fellow nurses.

Authority

Participants who identified as authorities were hesitant to fully accept the role as an authority (n = 7 out of 12).

P2: “Um.. I mean, the patient would perceive as an authority, yes, but do I feel that I am the authority- no.”

Participants reasoned that due to experience, knowledge, or formal occupational role, others would perceive them to be an authority. One participant outlined that their authority was relative and was present both within their occupation as a nurse and outside of their occupation as a mother.

Decision maker

Participants identified as decision-makers given their occupational roles and responsibilities (n = 11 out of 12).

P12: “Uh.. yes, I do see myself as a decision maker.. um, not only am I making decisions if I am at the bedside regarding my patient’s care and what needs to be communicated to other team members, that type of thing but also within my new role in terms of quality improvement, I am making decisions everyday about.. is this part of my role, is this something that somebody else should be doing? [yeah] is this beneficial to the unit [mhmm], is it going to impact.. how is it going to impact our staff and our patients [yeah]”

One participant relented that although they made nursing decisions, they were not in the position to be the ultimate decision-maker and acknowledged other roles and individuals to be responsible for the highest level of decision making.

Evidence-based practitioner

All participants indicated that they were evidence-based practitioners and indicated that this was necessary due to the changing nature of healthcare to continue to provide updated and quality care for their clients as well as understand their practice and the importance of their roles.

P8: “Absolutely, I believe in staying informed and staying current [yes] and yeah that is when we teach and we are doing the whys, understand why we are doing it, it makes sense and then you’re doing it the right way”

Expert

All participants acknowledged that they were experts in their areas due to their skills, knowledge, experience, and passion for their roles. One participant indicated that although they did not have much experience, expertise is determined through the ability to be open to change and development as a nurse.

P4: “I think that I am, even though I am a brand-new nurse, I think that I am very open minded, and I am very cognisant of what I am trying to do in regards to my scope of practice and in regards to ethical stuff, with regards to restraining of patients or knowing whether I should be verbally deescalating or using a chemical restraint. I am always open to criticism of whether or not I did good or bad things, because an expert does not necessarily mean that you know that you are doing, but also being open to be able to develop yourself in different ways.”

Knowledge producer

Participants who acknowledged themselves to be knowledge producers (n = 10 out of 12) indicated that they were conducting research formally or disseminating and developing knowledge from their experiences and expertise in the field.

P10: “Yes, yes and that’s um.. I think in part that comes from the research that I am required to conduct in my role at the University [uhuh], mmm, but also just in terms of lifelong learning and always looking for best practices and looking for new evidence and thinking about ‘how does that apply? How do we integrate this?’

Some participants identified knowledge production to be a formal process and moved away from the title knowledge producer (n = 2 out of 12).

Leader

All participants were more accepting of the term leader over authority. Participants indicated that they were leaders formally through their occupation role or informally through seniority communication and mentorship.

P4: “Um, I think I do, [mhmm] um, I always as I said earlier, being a leader does not necessarily mean, you are able to give everything around, but being able to know the comfort level of your coworkers and being able to ask them, ‘okay, is it okay if you do this?’ prior to delegating, and being able to make a plan with the team is very important prior to making an intervention and this is what I always try to do.”

Nurse educator

Participants identified as a formal nurse educator (n = 7 out of 12) or an informal nurse educator (n = 5 out of 12). Participants indicated that formally and informally they were educating clients on treatments, communicating with staff, and also mentoring students and junior staff.

P5: “Yes, yep definitely. And this happens in formal settings in workplace wellness programs and lunch and learns, but also in health surveillance, educating the workers about the need for health surveillance and protect their personal protective equipment?”

Patient liaison

All participants identified as a patient liaison in their occupations even though some participants did not work with patients directly in their formal roles. Participants identified themselves as interpreters for the patients and other staff members to ensure that patients understand and are acknowledged.

P8: “I’ll talk about resource, understanding resource and networking, connecting to the right thing and then connecting patients to the right things.”

Stakeholder

Participants identified that they were stakeholders in their occupation and that their voices were valuable and necessary as health professionals (n = 10 out of 12).

P6: “Yeah, I have a vested interest in making sure that my job is done well, my patients are treated properly, my employer is protected, that I am protected, and everything is about board yes, definitely a stakeholder.”

Some participants (n = 3 out of 12) identified that their stake is multifacted they carried their role as a stakeholder in different areas of their occupation and outside of their occupation as well. However, others expressed that due to their positions and limited expereience, they were not in the position to be relevant stakeholders (n = 2 out of 12).

Advocacy, Active Citizenship, and Governance

Most participants (n = 11 out of 12) viewed themselves as potential active citizens inside and outside of their workplace. Participants expressed that they had a multi-faceted role that allowed them to participate and advocate for separate topics in the workplace and in their personal lives. Inside the workplace, participants expressed that they were passionate about ethical practice, particularly patient and client safety as well as preventing burnout and fighting for staff rights. Some nurses acknowledged that active citizenship is a multi faceted role and outlined issues that they were active outside of the workplace.

P1: Yeah, of course, all the time, I talk to my family and friends when I find a topic that I’m like passionate about or like want to teach them about, like, yeah. . . depends on who I am talking to[okay] if its like my friends and family, its more of like an active citizen, but if its in my workplace its more of like the professional role

Participants outlined that they hold different priorities and roles inside and out of the workplace and these conversations differ on the environment that they are part of. Participants (n = 7 out of 12) indicated that their roles inside and outside of their occupation were balanced when trying to influence policy.

Barriers and motivators

Participants were currently active in issues related to their occupation (n = 11 out of 12) however, other participants however expressed that it was difficult to be active outside of their occupation, and this is not a huge priority at the time (n = 7 out of 12). Participants reasoned that there was limited time at the moment to further participate in their community given their circumstances as a parent and time spent at work, however hoped that this sentiment would change through time. Participants who were older expressed being more involved in the community against counterparts who had younger children.

P8: Well, actually you know how we talked about different people at points in life and doing things [mhmm], well I am in that point in my life where I want to give back [I see], like when you finish education and you do this and that. And also, to be a volunteer and to mentor students

One participant indicated that there were constraints within their role in their occupation that limited what they felt that they were able to speak out about in policy.

P7: I think nurses, like we have an association that governs us, and I think that people like ..they’re confined to this. Like, we have the union and the association, and people feel sort of like if they speak outside of things that they will get in trouble for it.

Nursing voice: Hierarchy

Participants all expressed that they had a voice and their opinions were relevant and important, however they expressed that their voice was not necessarily acknolwedged by others. Participants reasoned that this limited the magnitude of nursing voices in policy and discussions.

P7:. . .they don’t think they are heard. [ohh] Like for example, yesterday I was at this huge QI day, and the feedback that I received from the participants is that they didn’t feel like they had a voice [ohh] so they come there an they feel that every opportunity that they think they might have to share, they don’t. . . I think that they have more of a voice than they think they have and they don’t feel confident enough to exercise this.

P4: Um, I feel like, being an RN.. um.. often is perceived is being an assistant, but I think it is becoming a leader, because we are one of the few front line staff that are there 24/7 and being able to coordinate and collaborate with, with different um, members of allied health [mhmm] as well as physicians and all of that. Uh, I think we really take a lead in that because we have as much, more of the knowledge face to face than other professionals.

Two participants expressed the struggle for nursing involvement in boards and discussions. If nurses felt passionate about a topic, the limited room for involvement in higher discussions was a deterrent to get involved.

Participants expressed that they would relent issues to higher powers such as their boards to become the voice for them if the did not feel that they were heard. If participants were not confident in particular areas, they felt that they needed to defer to and learn more before they felt comfortable enough to be a relevant voice.

ELSI

Participants were asked about their understanding of ethical, legal, and social issues in their occupation and how these manifested. Participants were asked to provide scenarios on areas where there would be ELSI concerns and considerations and how important it was for them to consider them in their current roles or in nursing in general. All participants outlined how important ELSI was in their occupations and the impacts of their decisions in practice. Most participants (n = 8 out of 12) recognized that although the principles underlie their practice, ELSI is not always a main thought. It was acknowledged by these participants (n = 8 out of 12) that the daily workload for nurses leaves little room for them to critically think and consider the impacts of their work.

P11: CNA, the Canadian Nurses Association has ethics statement.. ethical practice statement [yeah]. Those kinds of things are important.. but how ethics statements get blurred at the front lines. . . [yeah, it is kind of difficult]. Who the heck is going to read all of those pages? Nobody haha.

P4: We tend to take things for granted, and the thing that I find in a lot of health care workers that could inhibit these discussions would be burn out because it is such a big factor on the way we think [mhmm] and sometimes people don’t realize that the fatigue could.. um, inhibit you from looking at these decisions.

Participants indicated that patient safety, respect, delivery of services, and informed consent were ethical factors that they considered. All participants indicated that they had a legal obligation as nurses to practice safely and ethically. In comparison to ethical implications, participants indicated that the legal aspects of care were not necessarily practiced or considered as often. Some participants (n = 7 out of 12) indicated that for example, informed consent, privacy, and appropriate documentation were legal considerations that they took in their occupation. The social, broader impacts of their occupation were not as heavily considered as the ethical impacts. Nurses indicated that interpersonal impacts and impacts in their occupation have the potential to affect a larger picture and affect the lives of individuals and the quality of care that they receive.

Lifelong Learning and Professional Development

Participants were asked about the lifelong learning and professional development opportunities in their occupation and if engagement with these opportunities enhanced their occupational roles. All the participants deemed lifelong learning as an important and necessary component of their practice. Participants indicated that due to the changing nature of medicine and society, it was imperative that they constantly engage in lifelong learning to remain competent and competitive in the workforce. Participants who were in formal leadership and education positions (n = 7 out of 12) indicated that they needed to constantly build on their knowledge in order for the information to trickle down appropriately.

Types and topics

The following Table 4 outlines the types of lifelong learning opportunities and the topics that participants were aware of and engaged with. Participants all agreed that there were lifelong learning opportunities always available in their occupation with a variety of topics offered.

Table 4.

Types and Topics of Lifelong Learning Opportunities Expressed by Participants.

Topics	Types
ELSI	Recertification and certification exams
Burnout prevention	Seminars
Client centered care	Sexual assault examiner course
Healthy public policy	Speakers
Infection control	Specialty associations
Injury prevention	Textbook
Instructional skills workshop	Town halls
Introduction to new technologies	Travel
Learning to teach	Webinars
Research methodology	Workshops
NVCI	Hands on learning
Pharmacology	Blended (online and classroom)
Policies and procedures	Booklets
Politics	Classroom
Quality improvement	Conference
Scope of practice and unit specific	Formal learning
Specialty topics (occupational nurse, neuro, coordinator, etc.)	Experiential learning
Stroke training	Communication
Systems thinking	Discussion forums
Clinical practice (CPR, glucometer)	Face to face
Technology	Masters and higher education
Sexual assault examination	Meetings
Wound and osotomy care	Online
Nursing consultant	Reading journal articles

Barriers and motivators

Participants in academia and in the private sector had a greater opportunity and benefits to accessing educational opportunities (n = 3 out of 12). One participant in academia indicated that alongside professional development days, they were provided with a professional development account with funds allocated to finance various conferences, seminars, or workshops that they wished to attend. Those who were employed under the public health services (n = 8 out of 12) were offered three lifelong learning days and had access to online learning platforms. Those in the private sectors (n = 1 out of 12) had access to lifelong learning on online databases and were offered professional development days. However, frontline nurses (n = 9 out of 12) indicated that staffing and external expenses associated with conferences and workshops were not always guaranteed and therefore limited the amount that they were able to access. Participants indicated that although these opportunities were available, pursuing lifelong learning was difficult for those on the frontline (n = 10 out of 12). Some participants revealed that although they were aware of opportunities, they have not pursued more education themselves due to factors such as limited funding, and lack of paid time off. Participants identified that factors such as time, financial constraints and interest in the opportunities deterred them from pursuing more lifelong learning opportunities (Table 5).

Table 5.

Barriers and Motivators to Lifelong Learning and Professional Development.

Barriers	Motivators
Cost of programs	Paid time
No paid time outside of work to learn	Self accountability
Time	Staff encouragement
Availability of programs	Testimonials
Family priorities and childcare	Role dissatisfaction and career advancement
Unable to cover shift	Free programs
Unable to take days off	Gifts and monetary grants
Lack of interest	Money reimbursement
Modularized learning	Workplace environment
Delivery of learning	Supporting employer
Limited access to journals	Variability in programs
Lack of emphasis by employer	Interest in topic
Work and life balance
Budget cuts
Lack of awareness

One participant identified that the environment on the unit is a large influence on pursing learning opportunies, and found that it was sometimes frowned upon to pursue further learning.

Some nurses (n = 8 out of 12) outlined that because educational opportunities are often taken outside of work and into personal time, it causes potential for disinterest and burnout.

P7: I think that they are burnt out.. they’re burnt out. And they kind of like have been in this job, it is mundane for a lot of them and they just don’t care anymore, because they’re capped off in their salary, they don’t get bonuses, they dont get anymore money. So, they can go to work and do very little, or they can go to work and do a lot and everybody makes the same. I think it is lack of incentive for them, they just sort of get comfortable, they just sort of walk out the door and they are done.

Participants (n = 5 out of 12) indicated that aside from financial support, a positive learning environment and support for learning was an important motivator to pursue learning opportunities.

P6: If I have coworkers that I work with that value lifelong learning and that are going to, even if it is not for CARNA and they’re going to all of these programs because they are interested in it [mhmm], because it feeds their development as a person, as a professional as a whatever [mhmm], I find that contagious in a group. . . so I think those sorts of incentives and getting people even just to speak more about activities that they are doing for continuing learning and then to find out about different ways of doing it.. people get tired of doing the same online course.. so, it is variability in the presentation too [mhmm], those are better incentives that actual, tangible handouts.

NNA

Participants were given the NNA topic to gauge their awareness and understanding of various societal issues and how they applied their roles and lifelong learning to this issue. Many of the nurses (n = 9 out of 12) engaged positively with role expectations and lifelong learning initiatives in general but were hesitant to apply such areas if they did not currently witness NNA impacting their occupations. Participants were given a list and asked what types of NNA they were familiar with (Table 6).

Table 6.

Participant Familiarity with NNA.

NNA	Familiarity	Frequency (n = 12)
Virtual reality	Yes	12
Virtual reality	No	0
Cochlear implant	Yes	12
Cochlear implant	No	0
Neuroimaging	Yes	10
Neuroimaging	No	2
Brain imaging	Yes	10
Brain imaging	No	2
Brain simulation	Yes	8
Brain simulation	No	4
Deep brain stimulation	Yes	8
Deep brain stimulation	No	4
Cognitive enhancement	Yes	3
Cognitive enhancement	No	9
Transcranial magnetic stimulation	Yes	3
Transcranial magnetic stimulation	No	9
Neuromodulation	Yes	3
Neuromodulation	No	9
Brain/human computer interface	Yes	2
Brain/human computer interface	No	10

The participants were asked if they interacted with these technologies in their occupation. Many of the participants indicated that they were aware of the uses of NNA and were aware that some clients went off unit to receive therapies related to NNA, however most participants (n = 8 out of 12) themselves did not interact or administrate these therapies to clients aside from utilizing virtual reality as a teaching tool for upcoming nurses (n = 1 out of 12) or providing cognitive enhancement medication (Adderall, Vyvanse, etc.) for patients that required this treatment (n = 3 out of 12). One participant in psychiatry outlined another NNA not indicated on this list, electroconvulsive therapy, and its potential uses on clients on the unit. Although other nurses indicated that there were potential uses for virtual reality in their occupations, they did not interact with these technologies themselves.

Role in NNA

Participants were asked if they saw their current roles apply to NNA. Many of the nurses were unfamiliar with NNA and did not seem themselves exercising these roles in relation to this area (n = 7 out of 12). Those who identified as having roles in relation to NNA were those in leadership positions (n = 5 out of 12) where it would be necessary to take on a greater role and voice in regard to NNA impacts in their occupation. However, all participants indicated that in the future if NNA become more involved in their occupation, they would adapt and develop a more active role in relation to NNA.

P3: But, with me, because of the fact that I am a single mom, I have so much responsibility, that my. . . my time in focused with that. But, if I had more time, more leisure time [mhmm], well probably in the future. Well, because I am a persona that has a very strong, uh strong person, and if I know what is right I will fight for it. . . I see myself doing that in my community as well, if I can organize my finances and my life and everything else yes for sure.

ELSI considerations

Participants raised ELSI considerations involving NNA as it pertained to their occupation. Participants extended concerns towards job security (n = 5), playing god (n = 2), privacy (n = 8), replacing human interaction (n = 8), clinical side effects (n = 4), and whether the technology itself will benefit or harm the patient (n = 12).

P12: . . .Probably haven’t thought much about it [yeah]. Um, but can definitely see that there would be some ethical implications due to it. Um.. we always have the conversation around when it comes to treatment, that if it versus risk [yeah of course]. So, there’s that side of it as well as. . .how.. I mean using new technologies is always fun [yeah] and interesting and um there’s always lots of research for it. But.. is it beneficial to the patient just because it’s fun for the researcher? Or is it actually benefitting the patient at all?

Advocacy and active citizenship

All participants acknowledged that they would be advocates for their patients and clients if there were affected by NNA. Outside of the occupation, most nurses (n = 11 out of 12) did not see any role that NNA could take so they were less passionate or active in relation to NNA affecting greater society. In terms of NNA conversations, participants did not feel confident in leading discussions surrounding NNA, but they understood that they had a relevant voice and would make it heard if needed. All participants indicated that they needed more knowledge on the topic and would feel more comfortable allowing experts and researchers in NNA to make decisions surrounding the development and impacts of NNA.

Lifelong learning

All participants indicated that more education was necessary to form a solid opinion on the impacts of NNA on their occupations.

P12: I mean, if the professional development opportunities are surrounding those types of technologies were there, I think that nursing would have a great opportunity to spread that.. um. knowledge [right], um, outside of the healthcare system [mhmm].. but I just, I, I can’t think.. I just don’t know that those professional development opportunities are there yet.. so, its hard to envision how you can then.. bring that out [yeah, that’s fair]. Especially when it is so difficult to get access to the education we need now in terms of clinical enhancement, really thinking ahead again is something that I think is 2 steps ahead of what we need right now

However, participants (n = 10 out of 12) also indicated that it would be difficult to get nurses to engage in professional development opportunities for concepts and ideas that were not currently relevant or interesting especially when the topics that they were interested in were not available or accessible.

P5: I’m not sure, it is a very small population that it impacts [okay] and I know that the valuable time for curriculum and you kind of choose your priorities [okay], so I am not sure I think being open to advancements in technology and being plugged into a network of, of advancements would be a better way, and that would be something that I would appreciate, rather than having a course solely on it.

Discussion

Nurses retain multiple roles in their professions that allow them to engage in a number of opportunities. The nurses in our study reflect that as a multifaceted and diverse practice, the nursing profession can provide but also hinder opportunity for the nurse’s roles. On one hand there is an expectation that nurses retain critical roles and have an untapped potential that is unrecognized by other professionals and higher ups that should be acknowledged more. On the other hand, nurses are expected to maintain a multifaceted role that contributes to increased role ambiguity, burnout, and job dissatisfaction. It was found that the nursing profession has an untapped potential to critically engage with NNA, neuroethics, and neurogovernance discussions, however their work environments and roles posed barriers to their active participation in policy, lifelong learning and NNA, neuroethics, and neurogovernance discussions. Our findings are discussed through the role expectations of nurses, their roles as active citizens, and lifelong learning opportunities.

Role Expectations of Nurses

Role theory is based on the idea that individuals retain certain roles that are expected of them by society, and these expectations shape the roles that they expect from themselves (Biddle, 1986). Nursing role expectations have been noted to create role conflict, role ambiguity, and influence overall job satisfaction and burnout (Cunningham & Slevin, 2005; Tunc & Kutanis, 2009; White & Kudless, 2008).

Findings from this study indicate that a disjoint exists between the expectations that society and the profession holds for nurses and the expectations that they hold for themselves. On one end, participants felt that nurses are not considered to be a meaningful voice and are not often sought to be involved in various conversations and discussions. Through our conversations with nurses, there was recognition that they had the capacity to do more in a given role and to fill more roles, but the environment and positions constrained them from reaching their potential. Köppen et al. (2018) revealed that although nurses were highly motivated to pursue new roles, there was a mismatch between motivation and the availability of opportunities, and in addition to this, workforce shortages were noted to be a large barrier for nurses, as nurses take on core nursing tasks when shortages are presents. As Köppen et al. (2018) reveals, there is a need to retain sufficient staff levels to offset workplace load when introducing new roles. It has been noted in the academic literature that nurses are often not considered to be a meaningful voice and are not often sought to be involved in conversations and discussions surrounding leadership and policy (Köppen et al., 2018), as well as neuroethics and neurogovernance discussions (Deloria & Wolbring, 2019).

Our participants expressed similar frustration at the lack of recognition be higher powers, and their exclusion from boards and committees. Participants indicated that at times, they felt that nursing was considered to be an assistant role in comparison to other professions.

On the other end, nurses are expected to exercise a variety of roles in practice, keep ELSI considerations paramount and retain passion and drive for their occupation. However, through our conversations with nurses it became evident, that although these concepts are ideal, they get lost in translation at the frontline. The participants in this study placed a large emphasis on the impact of lifelong learning and professional development in their occupation, and their potential to meaningfully involve themselves in discussions at the political and governance levels, although this was not often acted upon. From the interviews with participants, it is seen that nursing as a profession encompasses many responsibilities and roles and nurses struggle to keep up with a constantly changing environment and meet the responsibilities that they should fulfill in the moment. By nature as a nurse, you are a leader, you are a stakeholder, however it is difficult to develop and home in on these roles in an occupation that leaves little room for change or development (Brown et al., 2000; Cunningham & Slevin, 2005).One study by White and Kudless (2008) expressed that the leaders of interdisciplinary teams were non-nurses, and participants were frustrated because, “. . .while nurses said they believed they were recognized for their overall contributions, they thought they were not recognized for their full scope of preparation and skills, mainly because these were not understood by others. ‘A nurse is a nurse is a nurse’ was echoed by many focus group participants”. This same line was reiterated by participants in our study when expressing their frustrations towards how they were acknowledged in their occupation.

Given the many problems linked to role expectations of nurses a lot of work has to be done to entice and empower nurses to partake in a meaningful way in neuroethics and neurogovernance discussions. For example, enabling frontline nurses to take part in neuroethic and neurogovernance discussions has to involve deconstructing a multilayer of factors such as burnout and role ambiguity (Mudallal et al., 2017; Tunc & Kutanis, 2009; Wang et al., 2015; Yao et al., 2018).

Nursing Advocacy and Active Citizenship: Political Involvement Inside and Outside of the Profession

Nurses can carry their skills used to advocate in their occupations, outside of their occupation towards the development of active citizenship and political involvement. All of the nurses in our study expressed. that they were advocates in their field for their patients, however less than half (5 out of 12) of the participants expressed that they carried this advocacy outside of their occupation as active citizens. Through increased participation in civil life, citizens are able to advocate and push forward their rights to further foster good governance and policy (Clarke & Missingham, 2009; Hoskins et al., 2006).

However, there are various barriers. A study by Vandenhouten et al. (2011) analyzed the level of political participation among Midwest RNs. The majority of respondents participated in smaller activites, that included voting, political discussions, and contacting their elected officials, however, they also indicated that barriers such as time, and money hindered thier involvement. Another study noted, “Political involvement is further weakened by role ambiguity, role issues, and role incongruity. The role of the nurse must be balanced with the needs and complexity of getting things done politically. The role of the nurse politician adds further uncertainty and incongruity to the practice of the nursing profession” (Boswell et al., 2005).

The nurses in our study also expressed that their multi-faceted roles also included increased responsibilities that may hinder active participation and civic engagement. Our participants expressed frustration at the lack of value and recognition from higher powers, and their exclusion from boards and committees. The study by Vandenhouten et al. (2011), also revealed that less than 50% of respondents felt that they had an impact on local policy, and even less participants felt that they could impact government decisions. Other studies found that instances where frontline nurses were involved in policy making, were limited to implementation, rather than the concptualization and policy creation (Barzegar Safari et al., 2020; Bell et al., 2016; Kunaviktikul et al., 2010; Shariff & Potgieter, 2012). Florell (2021) describes the antecedents towards nursing activism, noting that empowerment for nurses should be in place to act, and nurses must recognize their potential, and abilities to confront existing power structures. However, existing hierarchies and narratives around nursing hinder the idea of taking part in political advocacy and governance. A similar sentiment has been proposed in relation to governance education for nurses. Sundean et al. (2019) acknowledged that nurses retain the capacity to engage with governance, however as they were not formally educated about governance concepts, and do not see governance leadership as part of the nursing identity, they do not pursue governance opportunities.

Interestingly nurses have been emphasized as a critical voice in policy development, reform, and leadership (Barzegar Safari et al., 2020; Patton et al., 2018; Turale & Kunaviktikul, 2019). Nurses have made strides in health policy development and reform, have contributed valuable research, and pioneered policy change (Ellenbecker et al., 2017; Hanks, 2013; Kelo et al., 2013).

Active Citizenship: Facilitating Neuroethic and Neurogovernance Involvement

There has been interest towards greater public involvement in neuroethics, and neurogovernance discussions (Garden & Winickoff, 2018; Racine, 2012; Racine et al., 2005). Nurses are relevant stakeholders as professionals and active citizens that should have a voice in neuroethics and neurogovernance discussions given their roles as leaders, educators, and liaisons as well as the emphasis of political involvement and advocacy in their occupations (Canadian Nurses Association, 2009; Huston, 2008). However, as one scoping review noted, there is no academic literature in this regard that links the political, advocacy, and policy roles of nurses to neuroethics and neurogovernance discussions and how to enable nurses as professionals and as active citizens in this regard (Deloria & Wolbring, 2019). Our study suggests that Deloria and Wolbring (2019) were right in their assumptions that nurses can fulfill much more and have the capacity to do so if given the opportunity. Most participants in this study hesitated towards involving themselves in neuroethics and neurogovernance discussions given their experiences, knowledge on the topic and involvement with these technologies.

Given the motivation and interest, the nurses in our study demonstrated that they are able to think about, engage with, and further involve themselves in discussions surrounding NNA. We suggest that more must be done to facilitate the participation of these professionals in NNA, neuroethics, and neurogovernance discussions. Experts in NNA, neuroethics and neurogovernance discourses should encourage greater involvement from a diverse spectrum of participants, including frontline and nursing leaders. Such participation would enrich the NNA discourses, and benefit patients, health professionals, and the public.

Lifelong Learning

Learning about NNA, neuroethics, and neurogovernance is a prerequisite to partake in discussions surrounding NNA. As well, lifelong learning is a mechanism used by the nursing profession to keep nurses up to date. The participants in this study placed a large emphasis on the impact of lifelong learning and professional development in their occupation, and their potential to meaningfully involve themselves in discussions at the political and governance levels, although this was not often acted upon.

At the same time, participants expressed stress at finding and completing lifelong learning opportunities that they needed for their current occupations citing restrictions that were in place in their personal lives, lack of emphasis from employers and a lack of accountability from staff, and that there was little room to explore other options for areas that they did not deem directly applicable to their work or were not of interest to them. Nurses expressed that they needed to be picky with what opportunities they chose because of the limitations that their employment offers them to expand on their knowledge. The barriers outlined by our participants fits with existing studies acknowledging the barrier to effective lifelong learning such as costs, travel, available content, occupational and personal responsibilities, motivation, and time away from work (Bahn, 2007; Cleary et al., 2011; Cooper, 2009; Gould et al., 2007; Griscti & Jacono, 2006; Kubsch et al., 2003; Nalle et al., 2010; Schweitzer & Krassa, 2010).

In a study by Bell et al. (2016), it was indicated that,

“Trainees from diverse healthcare professions (eg, nursing, social work, physiotherapy) are not well prepared to handle many of the ethical issues associated with psychiatric DBS because, among other reasons, they may be unprepared to engage in ethical reflection, they have a limited understanding of issues associated with scientific uncertainty, and they may lack an interdisciplinary understanding about ethical issues”.

When prompted, nurses engaged with ethical and critical thinking considerations with NNA even when these advancements were not applied to their occupations. With more developed lifelong learning initiatives and opportunities for knowledge development, nurses can be a critical and important role and provide meaningful input as professionals and active citizens in neuroethics and neurogovernance discussions. However, there was a lack of internal motivation among nurses when considering lifelong learning in general, and in relation to NNA, neurogovernance, and neuroethics. NNA was not an interest or did not seem to have a large impact in their current roles and thus nurses were hesitant to pursue these opportunities for further learning and involvement given all the problems they already faced.

Aside from the fact that continued education was mandatory for their occupation the participants indicated that their nursing environment did not foster excitement for learning, whether it was lack of enthusiasm shown by staff or the mode of delivery of nursing content through online platforms. This sentiment is outlined in other studies that emphasize that nurses wanted stimulating environments through mentoring and support as well as engaging and interesting delivery and content of learning (Danielson & Berntsson, 2007).

Given that academic literature does not engage with the involvement of nurses as professionals and active citizens in neuroethics and neurogovernance discussions it seems reasonable to assume that there is no mentorship available in the workplace of our participants and others to encourage contribution to NNA, neuroethics, and neurogovernance discourses.

Limitations

All participants in this study were collected through purposive sampling and account for a small section of the nursing profession. The views of these participants do not encompass the opinions and roles of the entire profession; however, the opinions of these nurses provide information rich insight into their voices and perspectives surrounding their roles, lifelong learning, and the engagement with NNA discourses. Follow-up studies are encouraged to gain a broader understanding on nursing involvement in NNA discussions.

Conclusion

Although studies have been published on lifelong learning and role identity for nurses, the considerations on how these interact with NNA, neuroethics, and neurogovernance fields were yet to be understood. The findings of this study indicate that nurses are ideal candidates for participation in NNA, neuroethics, and neurogovernance discussions however the complexities and problems systemic in their frontline work deters them from taking interest and integrating the appropriate knowledge and tools to effectively take part in these discussions inside and out of their occupations. It is indicated that potentially these frontline factors need to be rectified before fruitful consideration and involvement for nurses in NNA, neuroethics, and neurogovernance discussions can take place. Institutional change is warranted to allow for frontline nurses to be able to take an active part in lifelong learning opportunities and political advocacy. Changes should include continuous engagement with frontline nurses to create suitable lifelong learning delivery and opportunity that would best suit their needs. As well, fostering the potential of nurses should include providing increased exposure to political involvement at the educational and practice level, this would include creating seats at ethics boards and leadership teams to include nurses at the frontline, as well as actively seeking out and respecting the nursing voice in higher, policy matters. Further recognition and research on the disjoint between nurse self perceived role and their expected roles are needed to reconcile these differences and foster an environment for nurses to thrive and encompass all the roles as expected of them.

Footnotes

Author Note

This study was approved by the Conjoint Health Research Ethics Board (CHREB) at the University of Calgary on February 23, 2018 (REB17-0785).

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Government of Canada, Canadian Institutes of Health Research, Institute of Neurosciences, Mental Health and Addiction ERN 155204 in cooperation with ERA-NET NEURON JTC 2017.

ORCID iD

Gregor Wolbring

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