Evolving trends in nurse regulation: what are the policy impacts for nursing's social mandate?

Abstract

We recognize a paradox of power and promise in the context of legislative and organizational changes in nurse regulation which poses constraints on nursing's capacity to bring voice and influence to pressing matters of healthcare and public policy. The profession is at an important crossroads wherein leaders must be well informed in political, economic and legislative trends to harness the profession's power while also navigating forces that may put at risk its central mission to serve society. We present a critical policy analysis of the impact of recent regulatory trends on what the International Council of Nurses considers nursing's three 'pillars' - the profession of nursing, socioeconomic welfare of nurses and nurse regulation. Themes surfacing from this analysis include regulatory discontinuity, a tightening of regulatory control, and an increasingly managerial governance culture. These themes illuminate insights and strategies required to renew and revitalize the social mandate of our profession amidst a climate of urgency in the questioning of nurse scholars with respect to the future of the profession. At this historic juncture, nurses must clearly understand the implications of legislative and organizational regulatory changes to ensure the profession contributes to full capacity in achieving health and health equity globally.

Shaping nursing profession regulation through history – a systematic review

“…In this scenario, strategic strands of action coming from professional policies should be considered to invigorate nursing's social mandate (Duncan et al. ). This is a position that has been advocated for decades without effective movement towards these common standards, although the International Council of Nurses has, since 1986, adopted principles for professional self‐regulation.…”

“…Economic conditions have also shaped education and practice conditions, leading to an influence on the production and work output of nurses (Duncan et al. ). These conditions have also led to predatory recruitment practices and poor working conditions that could be improved through a better regulation (World Health Organization ).…”

“…the title of nurse or physician; Duncan et al. ). A regulated licensure entry system signifies standardized education aimed to prepare nurses to work in different environments in transnational contexts.…”

Nursing professionalization and welfare state policies: A critical review of structural factors influencing the development of nursing and the nursing workforce

“…A gap in the nursing literature on professionalization has been previously identified by researchers who argued that the impact of political and socioeconomic factors on nursing is strong; however, there is insufficient scholarship studying the influence of political structures on its development (Duncan et al., ; Jacobs, ; Van den Heede & Aiken, ). Similarly, a case study analyzing the professionalization of nursing in Mexico concluded that, although the state plays a significant role in the process, one that is larger than that played by nurses, who rely on the often limited economic and political resources available to them, the role is not well understood (Squires, ).…”

In search of our collective voice

“…While historically nursing might have combined all of what the International Council of Nursing considers “pillar” functions (i.e., regulation, professional practice and socio‐economic welfare) into a single organization, the pressures of the modern world have placed these functions in sufficient conflict that those organizations that traditionally performed multiple functions have had to split and consolidate functions. As regulatory bodies and bargaining units have formalized and expanded their strength and scope in this context, the need for a strong third organizational entity—the professional association voice—has become more difficult to defend within the profession (Duncan, Thorne, & Rodney, ). Thus, some of the structures within which nursing's collective public contributions have historically been shaped, developed, strengthened, and clarified are being dismantled and reconfigured into entities with quite different roles and functions, often less directly informed by nursing philosophy than by workplace realities and tensions.…”