Background: Despite the widespread adoption of Nursing Information Systems (NIS), nurses often remain positioned as passive users, which limits the potential for system-driven care transformation. Objectives: This narrative review synthesizes evidence on nurses' innovative use behaviors in NIS to identify actionable pathways for empowering nurses as co-designers of digital health solutions. Methods: A synthesis of peer-reviewed literature was conducted using PubMed, Web of Science, CNKI, Wanfang, and VIP. Studies were selected based on relevance to nurses' roles in NIS innovation following the SANRA principles. Results: Nurses are key drivers in NIS innovation, shifting from passive users to proactive contributors to digital health. Evidence shows nurse-led initiatives improve patient safety, documentation, and care efficiency. Theories explain how nurses adapt NIS to clinical needs, especially in resource-limited settings. However, barriers remain, including inconsistent policies, inadequate digital training, and unequal system access. Discussion: Advancing NIS innovation may require a policy shift from basic functional training toward structural empowerment. Policymakers and healthcare leaders should consider positioning nurses as system co-designers, providing protected resources and formal incentive mechanisms to foster a sustainable digital nursing ecosystem.
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Guo et al. (2026) studied this question.
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