Translating Power into Practice: Using TMT and the Capability Framework to
Understand Nurse Involvement in ICU Governance
[name]
[student number]
07 – 11 – 2025
1422 words
Introduction
, Nurses are a very important part of patient(-centered) care. They coordinate treatments, keep an eye
on patients, and make sure care is safe and effective. However, their voices are often missing from
important decisions. The COVID-19 pandemic showed why this matters, especially in intensive care
(IC) units. In the Netherlands, increasing IC capacity during the crisis was not just a logistical
challenge, but it was also a very political one. A 2021 survey by the Dutch professional association
V&VN found that 70% of nurses had no say in planning or organizing IC capacity, even though
national policy said they should have a “strong say” in these decisions (Van de Poel, 2020). Being left
out of these discussions therefore caused a lot of frustration, communication problems, and made it
harder to scale the IC safely.
This case therefore raises an important question: how does involving nurses in political negotiations
affect the quality and safety of IC capacity? To explore this, this paper looks at two related learning
goals:
(1) How is power constructed in healthcare decision-making?
(2) What is needed to give nurses the ability to implement their ideas?
Together, these questions look at both the structural and relational aspects of healthcare governance,
and have as a goal to understand how nurses’ expertise can be better integrated into political and
organizational decision-making. The issue is very relevant, as COVID-19 showed us that healthcare
system resilience and patient safety depend not just on technical resources (such as beds or
ventilators) but also on healthcare professionals’ ability to coordinate and adapt under pressure (like a
pandemic). Nurses, through their daily patient care and organizational work, have important
knowledge about staffing, workflow, and safety risks. However, despite this expertise, they remain
underrepresented in high-level decisions, and understanding this gap is therefore very important in
order to build more inclusive and effective governance models.
Conceptual Framework
To understand how power works in organizing ICU capacity, and how involving nurses (or leaving
them out) affects quality and safety, this paper uses two complementary theoretical lenses: Davina
Allen’s (2018) Translational Mobilisation Theory (TMT) and Patrick Lavoie’s (2025) Capability
Framework. Together, these perspectives help explain both how power is constructed in healthcare
and what conditions enable nurses to exercise it effectively.
TMT describes healthcare work as taking place in “strategic action fields”, which are social spaces
created by rules, hierarchies, and competing priorities, such as clinical, managerial, and political goals
(Allen, 2018). Nurses act as important connectors in these fields, helping to align fragmented
practices and ensure continuity of care. Allen calls them “obligatory passage points,” meaning that
Understand Nurse Involvement in ICU Governance
[name]
[student number]
07 – 11 – 2025
1422 words
Introduction
, Nurses are a very important part of patient(-centered) care. They coordinate treatments, keep an eye
on patients, and make sure care is safe and effective. However, their voices are often missing from
important decisions. The COVID-19 pandemic showed why this matters, especially in intensive care
(IC) units. In the Netherlands, increasing IC capacity during the crisis was not just a logistical
challenge, but it was also a very political one. A 2021 survey by the Dutch professional association
V&VN found that 70% of nurses had no say in planning or organizing IC capacity, even though
national policy said they should have a “strong say” in these decisions (Van de Poel, 2020). Being left
out of these discussions therefore caused a lot of frustration, communication problems, and made it
harder to scale the IC safely.
This case therefore raises an important question: how does involving nurses in political negotiations
affect the quality and safety of IC capacity? To explore this, this paper looks at two related learning
goals:
(1) How is power constructed in healthcare decision-making?
(2) What is needed to give nurses the ability to implement their ideas?
Together, these questions look at both the structural and relational aspects of healthcare governance,
and have as a goal to understand how nurses’ expertise can be better integrated into political and
organizational decision-making. The issue is very relevant, as COVID-19 showed us that healthcare
system resilience and patient safety depend not just on technical resources (such as beds or
ventilators) but also on healthcare professionals’ ability to coordinate and adapt under pressure (like a
pandemic). Nurses, through their daily patient care and organizational work, have important
knowledge about staffing, workflow, and safety risks. However, despite this expertise, they remain
underrepresented in high-level decisions, and understanding this gap is therefore very important in
order to build more inclusive and effective governance models.
Conceptual Framework
To understand how power works in organizing ICU capacity, and how involving nurses (or leaving
them out) affects quality and safety, this paper uses two complementary theoretical lenses: Davina
Allen’s (2018) Translational Mobilisation Theory (TMT) and Patrick Lavoie’s (2025) Capability
Framework. Together, these perspectives help explain both how power is constructed in healthcare
and what conditions enable nurses to exercise it effectively.
TMT describes healthcare work as taking place in “strategic action fields”, which are social spaces
created by rules, hierarchies, and competing priorities, such as clinical, managerial, and political goals
(Allen, 2018). Nurses act as important connectors in these fields, helping to align fragmented
practices and ensure continuity of care. Allen calls them “obligatory passage points,” meaning that
