Regulating During Crisis: A Qualitative Comparative Case Study of Nursing Regulatory Responses to the COVID-19 Pandemic

Kathleen Leslie; Sophia Myles; Sarah Stahlke; Catharine J Schiller; Jacob J Shelley; Karen Cook; Jennifer Stephens; Sioban Nelson

doi:10.1016/S2155-8256(23)00066-2

Regulating During Crisis: A Qualitative Comparative Case Study of Nursing Regulatory Responses to the COVID-19 Pandemic

J Nurs Regul. 2023 Apr;14(1):30-41. doi: 10.1016/S2155-8256(23)00066-2. Epub 2023 Apr 5.

Authors

Kathleen Leslie¹, Sophia Myles², Sarah Stahlke³, Catharine J Schiller⁴, Jacob J Shelley⁵, Karen Cook⁶, Jennifer Stephens⁷, Sioban Nelson⁸

Affiliations

¹ An Assistant Professor, Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada, and the Governance and Regulation theme lead for the Canadian Health Workforce Network.
² A postdoctoral fellow, Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Canada, and a research assistant at Athabasca University.
³ An Adjunct Professor, Department of Sociology, University of Alberta, and an instructor and research associate at Athabasca University.
⁴ An Assistant Professor and Coordinator of Undergraduate Nursing Programs, School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada.
⁵ An Associate Professor, Faculty of Law and School of Health Studies, Faculty of Health Sciences, Western University, and the Director of the Health Ethics, Law & Policy (HELP) Lab.
⁶ An Associate Professor, Faculty of Health Disciplines, Athabasca University.
⁷ An Assistant Professor and Associate Dean of Undergraduate Programs in the Faculty of Health Disciplines, Athabasca University.
⁸ A Professor in the Faculty of Nursing, University of Toronto.

Abstract

Background: The COVID-19 pandemic placed intense pressure on nursing regulatory bodies to ensure an adequate healthcare workforce while maintaining public safety.

Purpose: Our objectives were to analyze regulatory bodies' responses during the pandemic, examine how nursing regulators conceptualize the public interest during a public health crisis, and explore the influence of a public health crisis on the balancing of regulatory principles. We aimed to develop a clearer understanding of regulating during a crisis by identifying themes within regulatory responses.

Methods: We conducted a qualitative comparative case study examining the pandemic responses of eight nursing regulators in three Canadian provinces and three U.S. states. Data were collected from semi-structured interviews with 19 representatives of nursing regulatory bodies and 206 publicly available documents and analyzed thematically.

Results: Five themes were constructed from the data: (1) risk-based responses to reduce regulatory burden; (2) agility and flexibility in regulatory pandemic responses; (3) working with stakeholders for a systems-based approach; (4) valuing consistency in regulatory approaches across jurisdictions; and (5) the pandemic as a catalyst for innovation. Specifically, we identified that the meaning of "public interest" in the context of high workforce demand was a key consideration for regulators.

Conclusion: Our results demonstrate the intensity of effort involved in nursing regulatory responses and the significant contribution of nursing regulation to the healthcare system's pandemic response. Our results also indicate a shift in thinking around broader public interest issues, beyond the conduct and competence of individual nurses, to include pressing societal issues. Regulators are beginning to grapple with these longer-term issues and policy tensions.

Keywords: Regulation, nursing, COVID-19 pandemic, licensure, qualitative case study, legislation.