Beyond competence: Epistemic agency, epistemic injustice and ethical professional formation in nursing education.

Abstract

This paper argues that competence in nursing education is ethically incomplete without epistemic agency. Contemporary nursing programmes are increasingly shaped by competencies, assessment rubrics, curriculum mapping and audit-ready evidence. These mechanisms are legitimate and necessary for accountability, but they may become ethically insufficient when they make professional formation visible mainly as performance, compliance or documentation. Epistemic agency refers to the capacity to interpret experience, justify claims, question assumptions and participate as a legitimate knower in nursing practice. Although the term may be unfamiliar to some nurse educators, its absence is visible when students are trained to enact standards without being equally supported to reason about uncertainty, credibility, patient testimony and the knowledge claims embedded in care. Existing commitments to reflection, critical thinking, evidence-based practice, person-centred care and student voice provide important educational values, yet they often lack a sufficiently explicit account of the epistemic harms that occur when credibility, intelligibility and authority are unequally distributed. They do not fully explain how some knowers are believed while others are doubted, how some forms of knowledge become authoritative while others are treated as anecdotal and how nursing knowledge itself may be positioned as practical implementation rather than disciplinary contribution. Epistemic agency cannot be secured merely by asking students to think critically or nurses to listen more attentively. Such responses underestimate the social, institutional and curricular conditions through which knowledge is made credible, intelligible and actionable. Drawing on social epistemology, nursing ethics and nursing knowledge development, this discussion paper reframes epistemic agency as a condition of ethical professional formation beyond competence alone. No empirical data are reported. Practical reflexive prompts are offered for curriculum leaders, nurse educators, clinical supervisors and students.