"Unequal Powers": A Foucauldian-Bourdieusian Analysis of Nursing Hierarchies

Abstract

This study explores the complex power dynamics among nurses and between nurses and patients within a district hospital in Ghana, drawing on Michel Foucault's theory of power/knowledge and Pierre Bourdieu's theory of capital. While previous studies have primarily focused on nurse-patient relationships, this research expands the analytical lens to include intra-professional hierarchies, emphasising how power is enacted, contested, and negotiated within the nursing profession itself. Using focused ethnography, data were collected through interviews, focus group discussions, participant observation, and informal dialogues with 32 nurses. The findings reveal that nurses derive power not only from clinical knowledge or institutional rank (cultural capital) but also from material wealth (economic capital) and influential networks of authority (social capital). These sources of power affect interpersonal relations, contribute to workplace tensions, and ultimately shape patient care. The study further highlights how patients, especially those aware of their rights, sometimes resist traditional hierarchies, asserting power through knowledge. By integrating Foucault and Bourdieu, the paper presents a nuanced framework for understanding institutional power in healthcare settings, highlighting the relational and multidimensional nature of authority in nursing practice.