The impact of regulatory perspectives and practices on professional innovation in nursing

Abstract

Since at least the 1970s in Canada, there have been calls for health system reforms based on innovative roles and expanded scopes of practice for nurses. Professional regulatory organizations, through legislation, define the standards and parameters of professional nursing practice. Nursing regulators emphasize public protection over the advancement of nursing; regulatory processes and decisions tend to be conservative and risk-averse. This study explored the impact that regulatory processes have on innovation in nursing roles. Nurses in a range of unique practice situations were interviewed, including nurses in non-traditional roles and/or settings, those with cross-jurisdictional career histories, and those working in interdisciplinary practices and educational settings. For these nurses, nursing practice was viewed through a traditional clinical lens, which did not fit for them. They experienced hassle, delay, and inconsistencies in regulatory practices. They felt mistreated and fearful of the regulator and lamented the ways in which ambitious, creative, capable nurses were stymied in attempting new applications for nursing knowledge. Nursing is constraining its own mandate to contribute to health care through stringent licensing processes. Healthcare reform provides an opportunity for nursing regulators to rethink their processes and provide the latitude for nurse-driven change. K E Y W O R D Shealthcare reform, innovation, nursing, professional regulation, regulatory conservatism | INTRODUCTIONFor decades, there have been calls for health system reform based on innovative roles for health professionals and maximized professional scopes of practice. Nursing has been regarded as central to a more sustainable system that focuses on primary, community-based care rather than acute care, and on health rather than illness. Although policy documents from health professionals and policy-makers continue to call for a redeployment of professional skill, the system continues to be physician-and hospital-focused and there has been little fundamental movement toward envisioned reforms. Professional regulatory organizations, through legislation, define the standards and parameters of professional practice. Nursing regulators tend to emphasize public protection over the advancement of nursing. Thus, professional regulatory processes tend to be quite conservative, with an emphasis on risk reduction. This conservative regulatory perspective may constrain innovation and the use of professional knowledge that has been envisioned over the years.There is almost no empirical evidence about the impact that professional regulatory practices have on innovation in health professional roles such as nursing. This article reports the findings of a qualitative study that aimed to explore the impact of nursing professional regulation (licensing) on nurses' abilities to expand their scopes of practice and develop innovative and advanced roles for nurses that respond to emerging health and system needs and ensure that nursing is able to att...

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