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Cited by 8Nursing Education, Practice, and LeadershipOccupational and Professional Licensing RegulationHealthcare Regulation

Regulating during crisis: a qualitative comparative case study of nursing regulatory responses to the COVID-19 pandemic

Open access
Leslie, Kathleen, Myles, Sophia, Stahlke, Sarah, Schiller, Catharine J., Shelley, Jacob J., Cook, Karen, Stephens, Jennifer, Nelson, Sioban·2023·Journal of Nursing Regulation
DOI 10.1016/s2155-8256(23)00066-2PMC PMC10074059
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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.

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  • Another recent and drastic shift in regulatory governance is the amalgamation of regulatory bodies within and across professions to increase efficiency which is represented in the literature within our review.

    “Another recent and drastic shift in regulatory governance is the amalgamation of regulatory bodies within and across professions to increase efficiency which is represented in the literature within our review [5,12,16,52,112,198,208,209].”

    From Nursing regulation in Canada: Insights from a scoping review (2025) · cites this paper as [16]

    Theme 2 and the Discussion’s Limitations section describe the amalgamation of British Columbia’s nursing and midwifery regulators, supporting an example of a merger across professions. The paper does not say that this amalgamation was undertaken to increase efficiency, nor does it describe an amalgamation within a profession; its Discussion mentions improving efficiency in regulatory processes more generally. Page numbers were not available in our copy. (LLM, conf=0.85)

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  • Since the COVID-19 pandemic, nursing regulators have faced additional pressure to modernize, harmonize, and rapidly adapt regulatory approaches to meet current health system needs.

    “Since the COVID-19 pandemic, nursing regulators have faced additional pressure to modernize, harmonize, and rapidly adapt regulatory approaches to meet current health system needs [16].”

    From Nursing regulation in Canada: Insights from a scoping review (2025) · cites this paper as [16]

  • Only 30 (37.5%) of the included empirical studies situated Canadian nursing regulation as the main area of inquiry.

    “Only 30 (37.5%) of the included empirical studies situated Canadian nursing regulation as the main area of inquiry [16,105,108,115,116,123,128,133,136–139,141–143,145,151–153,155,157,160,161,163–165,168,174–176].”

    From Nursing regulation in Canada: Insights from a scoping review (2025) · cites this paper as [16]

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Research works printed but not linked: 2

  1. Benton D.C. Alexander M. Fotsch R. Livanos N. Lessons learned and insights gained: A regulatory analysis of the impacts, challenges, and responses to COVID-19. OJIN: The Online Journal of Issues in Nursing 25 3 2020
  2. Professional Standards Authority for Health and Social Care. (2021, April 15). Learning from Covid-19: A case-study review. https://www.professionalstandards.org.uk/publications/detail/learning-from-covid-19-a-case-study-review

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Authors
Leslie, K., Myles, S., Stahlke, S., Schiller, C. J., Shelley, J. J., Cook, K., Stephens, J., & Nelson, S.
Affiliations
  • Athabasca University (CA)
  • University of Toronto (CA)
  • University of Alberta (CA)
  • University of Northern British Columbia (CA)
  • Western University (CA)
Corresponding author
Leslie, Kathleen
ORCID
Venue
Journal of Nursing Regulation
Publisher
Elsevier BV
Published
2023-04
Volume
14
Issue
1
Pages
30-41
ISSN
2155-8256 (ISSN-L)
DOI
10.1016/s2155-8256(23)00066-2
PMC
PMC10074059
OpenAlex
W4362640421
Cited by
8
References
21
Citations by year
2026: 3 · 2025: 3 · 2023: 1 · 2022: 1
FWCI
4.61
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Nursing Regulation (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Council of State Boards of Nursing
Topics
  • Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Education, Practice, and Leadership
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Occupational and Professional Licensing Regulation
  • Health Sciences › Health Professions › Health Information Management › Healthcare Regulation
Keywords
nursing regulation, COVID-19 pandemic, public interest, regulatory burden, risk-based regulation, regulatory agility, stakeholder engagement, healthcare workforce, pandemic response, regulatory innovation, Canada, United States

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