Fluent Essays

Q1: Select two initiatives or landmark report that moved the nursing profession from one focused on training to one focused on competency based profession.  Explain why each was important. Discuss how the impact to nursing practice or nursing education was measured. What was the impact of each on nursing program accreditation and nursing program quality. Shaping nursing profession regulation through history – a systematic review A. Stievano1 RN, MSN, PhD, R. Caruso2 RN, MSN, PhD , F. Pittella3 RN, MSN, F.A. Shaffer4 EdD, RN, FAAN, G. Rocco5 RN, MSN, PhD & J. Fairman6,7 RN, FAAN, PhD 1 Researcher, Centre of Excellence for Nursing Scholarship - Ipasvi Rome - Italy, 5 Director, Centre of Excellence for Nursing Scholarship, Ipasvi Rome, Italy, 2 Chief, 3 Director of Education, Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy, 4 President and Chief Executive Officer, CGFNS International, USA, 6 Chair, Department of Bio-behavioral Health Sciences, School of Nursing, University of Pennsylvania, USA, 7 Director Emeritus, Barbara Bates Center for the Study of the History of Nursing, Philadelphia, PA, USA STIEVANO A., CARUSO R., PITTELLA F., SHAFFER F.A., ROCCO G. & FAIRMAN J. (2019) Shaping nursing profession regulation through history – a systematic review. International Nursing Review 66, 17–29 Aim: The aim of this systematic review was to provide a critical synthesis of the factors that historically shaped the advancements of nursing regulators worldwide. Background: An in-depth examination of the different factors that moulded regulatory changes over time is pivotal to comprehend current issues in nursing. Introduction: In the light of global health scenarios, the researchers explored the factors that historically influenced the socio-contextual circumstances upon which governments made regulatory changes. Methods: A systematic search was performed on the following databases: PubMed, CINAHL, Scopus, OpenGrey and ScienceDirect. The review included papers from January 2000 to October 2016 published in English. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and an inductive thematic approach for synthesis. Results: Two main themes were identified: factors underpinning current challenges and historical and contextual triggers of regulation. The first theme was composed of three aspects: education, migration and internationalization, and policy and regulation; the second theme consisted of four attributes: demographics, economics, history of registration and wars, and historical changes in nursing practice. Discussion: Factors that shaped nursing regulation were linked to changing demographics and economics, education, history of nursing registration, shifting patterns of migration and internationalization, nursing practice, policy and regulation and significant societal turns often prompted by wars. Conclusion: A deeper understanding of the developments of the nursing regulatory institutions provides the foundation for portable standards that can be applied across an array of jurisdictions to guarantee a better public safety. Correspondence address: Alessandro Stievano, Centre of Excellence for Nursing Scholarship, Viale Giulio Cesare 78 - 00192 - Rome - Italy; Tel: +39-0645437035; Fax: +39- 0645437034; E-mail: [email protected] Funding The study was supported by a grant from the Centre of Excellence for Nursing Scholarship – Ipasvi Rome – Italy (Research Grant number 1.17.06). Conflict of interest No conflict of interest has been declared by the authors. 17© 2018 International Council of Nurses Literature Review http://orcid.org/0000-0002-7736-6209 http://orcid.org/0000-0002-7736-6209 http://orcid.org/0000-0002-7736-6209 http://crossmark.crossref.org/dialog/?doi=10.1111%2Finr.12449&domain=pdf&date_stamp=2018-03-23 Implication for nursing and health policy: Understanding factors that socially, legislatively and politically have influenced the development of regulatory bodies over time helps to mould local, national and international policies that have a stronger impact on health worldwide. To achieve this, there must be effective cooperation among systems of nursing regulations globally. Keywords: Credentialing, Economics, Globalisation, History, Immigration, Nursing Legislation, Nursing Pol- icy, Nursing Regulation, Registration, Systematic Reviews Introduction Historian Catherine Choi notes ‘Without a doubt, healthcare workers are on the move. In the new millennium, they are moving across national borders in significant numbers, and policy analysts and academics are taking note of the phe- nomenon’ (Choy 2010, p. 13). So the professions, their regu- latory bodies, and nations taking notice of nurses’ movement. As scholars have noted, since the Second World War, the migration of nurses across borders is tied to global eco- nomics, particularly the integration of markets and the cross- border movement of goods and services (Nelson 2013). The migration of nurses affects the health of both the country they leave and the nation they adopt, as the health of a coun- try is a critical indicator of the nation’s stability. The aim of this systematic review was to provide a critical synthesis of existing manuscripts about the factors that histor- ically shaped the advancements of nursing regulatory bodies worldwide and to delineate future dynamics in the ever-chan- ging agendas for regulatory authorities. Background Nurse migration across national borders, for whatever reason, has shaped global health by providing economic opportunities to nurses and their families (e.g. through remittances back home and influencing the price of nursing services). It has also served to have an impact on health care, gender hierar- chies, (e.g. the regulation of nurses has an impact on the sta- tus of women in both host and native countries) and income distribution as nurses move from culture to culture, from war zones to more peaceful areas and from high distribution areas to lower areas (Choy 2010, p. 14). As nurses move across the globe, and into areas such as the Gulf Countries and Europe (in addition to the traditional destinations of Australia, Canada, Great Britain and the Uni- ted States), many policymakers have raised questions about the portability of the nursing credentials and skills across national boundaries. How can one nation judge the quality and safety of a nurse from another State when nurses are so variably educated, regulated and disciplined without a com- mon set of international standards? As Nelson has noted, ‘What is typically involved [in regulation] is the oversight of curricula and accreditation of schools, the maintenance of the register (ensuring members are in good standing however so defined, but typically with continued education and recency of practice, along with relevant re-certification requirements and other auditable dimensions to competency assessment) and the management of misconduct’ (Nelson 2013, p. 86). Very often discussions surrounding regulations occur without context and understanding of how a nation’s regulations shape the nursing profession’s education and practice, as well as the health of particular nations. Regulatory priorities encompass the belief that the public should have access to providers who practise safely as defined by education standards and competencies backed by interna- tional or national boards and accrediting agencies. Given the international interest in the area of regulation of health professions and in the light of worldwide challenges brought on by the complexities of the fluctuating nursing and global health issues such as rising rates of chronic dis- eases, and the (re)emergence of new epidemics (Benton & Shaffer 2016), we believe it is time to examine how nursing regulations developed and have been propagated to serve the public and the profession. Nursing regulatory bodies and the regulations they develop and apply should play a paramount role in dealing with these challenges as their policies affect workforce movement (Gwatkin 2017; Speakman et al. 2017), sustainability of welfare in developing and developed coun- tries (McKee et al. 2013), decision-making in national and international health policies (Oliver et al. 2014) and relation- ships between different global jurisdictions and countries (Benton et al. 2015a). Nursing regulatory bodies traditionally change in response to many factors such as societal turns, national health priori- ties and global economics. In increasingly forceful scenarios of global movement, an updated and more nimble approach is necessary to achieve goals expressed by the Global Strategy on Human Resources for Health: Workforce 2030 vision (WHO 2016). These goals are set to influence the policymak- ers of World Health Organization member States accelerating processes ‘Towards universal health coverage and the UN Sus- tainable Development Goals by ensuring equitable access to health workers within strengthened health systems’ (World © 2018 International Council of Nurses 18 A. Stievano et al. Health Organization 2016, p. 4). As the report and researchers have stressed, modern regulatory bodies’ approach should optimize access to contemporary quality services to all citizens worldwide (Benton & Shaffer 2016). A better historical under- standing of the factors that moulded the current nursing reg- ulatory bodies over time could be useful to assess education variations, market imbalances, cultural influences, and above all, ways to fairly and equitably support an increasingly mobile nursing workforce (Shaffer & To Dutka 2013). A his- torical perspective can also help to acknowledge the need for a modern role for nursing regulations to create portable stan- dards and shared competencies that will apply across an array of jurisdictions (Benton et al. 2015a). As Gilman & Fairman (2014, p. 206) have written: ‘Regula- tory development often exhibits a certain path dependency, and existing rules may reflect the historical context of their origins as much as contemporary assessments of patient care. Neither history nor habit is much of a rationale, however, much less an adequately substantiated rationale [for their characteristics]’. Most of the literature on nurse regulation has paid little attention to the factors that have historically shaped the regu- latory bodies due to procedural issues (i.e. complex bodies of evidence, impossibility to set clear inclusion criteria for pri- mary studies). Much of the research that exists is very recent and underexplored (Benton et al. 2015a,b). But nursing regu- lation has generated recent interest from policy reports such as the Human Resources for Health: Workforce 2030 that rec- ommends a guarantee of recognition of the nursing compe- tencies across nursing jurisdictions to strengthen citizens’ protection and foster nursing transnational flows, ensuring better public safety. Methods Design A systematic review was performed according to the recom- mendations of the Centre for Reviews and Dissemination (CRD 2008) and to the ‘Preferred Reporting Items for Sys- tematic Reviews and Meta-Analyses’ (PRISMA) statement and flow chart. Then, the authors adopted a three-stage approach: the free line-by-line coding of the findings of primary studies; the grouping of these meaning units into connected areas to create descriptive themes and the development of interpretive themes (Greenhalgh et al. 2005). This approach considers the main and common results of each included study and synthe- sizes it according to the following three phases: (a) the recog- nition of all the meaning units of the phenomena that have been studied, (b) the connection of these meaning units in descriptive themes and, (c) the rethinking of these descriptive themes through a process of interpretive abduction (Green- halgh et al. 2005). All those phases had to be iteratively handled to ensure a robust analysis. Search, selection and appraised outcomes A systematic search was performed to identify the literature related to factors which historically shaped the nursing regu- latory bodies worldwide. Accordingly, the authors used the PRISMA statement and flow chart to select studies for inclu- sion and to provide a systematic search (Liberati et al. 2009). The following computerized databases were searched: PubMed, CINAHL, Scopus, OpenGrey and ScienceDirect. The key terms used for search were as follows: ‘regulatory body’ OR ‘regulatory bodies’ OR ‘registration’ AND ‘nurse’ OR ‘nurs*’ ‘history’ OR ‘change’ OR ‘growth’ OR ‘progression’ OR ‘pro- gression*’ OR ‘transformation’ OR ‘transformation*’. Searches for misspellings and MeSH terms were automatically added in PubMed searches. Indeed, the authors followed up references in papers or books, consulting experts in the field and hand- searched two journals (i.e. International Nursing Review and Journal of Nursing Regulation). The searches’ objectives were aimed to explore the factors that historically shaped the advancements of nursing regulatory bodies worldwide and to delineate future dynamics in the ever-changing agendas for these authorities. The inclusion criteria acknowledged papers with different methodologies to better cover large bodies of evi- dence, and they encompassed records: (a) published between January 2000 and October 2016 to highlight the most recent interest in the literature regarding the topic under scrutiny, (b) written in English, (c) with abstract and (d), with full texts focused on changes in nursing regulatory bodies worldwide. No exclusion criteria were identified considering the study method, but the authors applied the records quality appraisal as an exclusion criteria in the eligibility phase (i.e. PRISMA flow chart phase 3). The quality appraisal of eligible papers was per- formed to ensure the quality of the included manuscripts, using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). JBI-QARI is a useful instrument to evaluate papers which have diverse methodologies. Two authors (AS, RC) independently conducted the pro- cess of including records. Consensus discussions solved potential disagreements for each phase, which are shown in Fig. 1. In the first phase (i.e. identification), the search queries – which was developed for computerized databases – identified 222 records and other 101 records were identified by following up the references and by hand-searching. In the second phase (i.e. screening), the duplicates were removed (n = 135) and 30 papers were excluded using time filters, and © 2018 International Council of Nurses Regulatory changes through history 19 then, other 115 papers were excluded reading titles and abstracts because their focus did not meet the research aim. In the third phase (i.e. eligibility), the 43 full texts were retrieved, read and assessed using JBI-QARI by the indepen- dent work of all authors. In this phase, the overall JBI-QARI decision (i.e. include or exclude) was discussed within a con- sensus meeting. The authors’ agreement concerned both the inclusion and exclusion decisions. Twenty-nine manuscripts were excluded because their overall foci were far from the description of factors which shaped the nursing regulatory bodies. Then, the Fleiss’ Kappa index was used to objectively assess the degree of agreement among authors’ decision of inclusion/exclusion for the last 14 papers. The consensus meeting was considered concluded when the authors reached a consensus with Fleiss’ Kappa index ≥0.70. Therefore, in the fourth phase (i.e. inclusion) were included all the 14 papers. The whole flow diagram of the search and selection process is shown in Fig. 1. Data synthesis Data from each included paper were synthesized using a stan- dard format: authors, type of study, country, publication year, purpose of the study, main findings (Table 1). The papers included in the study were inductively content analysed through a line-by-line coding to search for concepts (Vaismoradi et al. 2013) to identify all the key codes of the phenomena researched by two authors (RC, FP), and then, the research team gave a narrative account and discussed con- flicting results within and between studies. During this pro- cess, the main codes were clustered in descriptive themes and ultimately in two main interpretive themes (Table 2). In fact, during 2 days of research retreats (with all authors) and through Skype meetings, clusters were discussed, clarified and reconceptualized into interpretive themes offering a new understanding of the main factors that historically shaped the advancements of nursing regulatory bodies worldwide (Tho- mas & Harden 2008). Fig. 1 Systematic review flow diagram. © 2018 International Council of Nurses 20 A. Stievano et al. T a b le 1 S u m m a ry o f th e st u d ie s in cl u d ed in th e re v ie w A u th o r( s) T yp e o f st u d y C o u n tr y P u b li ca ti o n ye a r P u rp o se o f th e st u d y M a in fi n d in gs B en to n D .C ., G o n z� a le z- Ju ra d o M .A ., B en ei t- M o n te si n o s J. V . (a ) D el p h i st u d y In te rn at io n al p er sp ec ti v e 2 0 1 3 T o g en er at e in te rn at io n al co n se n su s o n a co n te m p o ra ry d efi n it io n o f p ro fe ss io n al n u rs e re g u la ti o n A se t o f 4 7 k ey fe at u re s o f h ig h -p er fo rm in g re g u la to ry b o d ie s w as ag re ed . A lt h o u g h a p re fe re n ce fo r th e d el eg at ed se lf -r eg u la to ry m o d el an d si n g le -b o ar d ad m in is tr at iv e ap p ro ac h w as ex p re ss ed , th e u n d er ly in g ra ti o n al e fo r su ch a p re fe re n ce w as u n cl ea r B en to n D .C ., G o n z�a le z- Ju ra d o M .A ., B en ei t- M o n te si n o s J. V . (b ) S y st em at ic R ev ie w In te rn at io n al p er sp ec ti v e 2 0 1 3 T o ex am in e th e cu rr en t p o li cy li te ra tu re o n p ri n ci p le -b as ed re g u la ti o n an d co m p ar e th is w it h th e se t o f p ri n ci p le s ad v o ca te d b y th e IC N A m ap p in g o f te rm s b as ed o n a d et ai le d d es cr ip ti o n o f th e p ri n ci p le s u se d in th e v ar io u s re se ar ch an d p o li cy d o cu m en ts w as g en er at ed . T h is m ap p in g fo rm ed th e b as is o f a cr it iq u e o f th e cu rr en t IC N p ri n ci p le s. A p ro fe ss io n al se lf - re g u la ti o n ad v o ca te d b y th e IC N w as id en ti fi ed B en to n D .C ., G o n z�a le z- Ju ra d o M .A ., B en ei t- M o n te si n o s J. V . R ev ie w / D o cu m en ta ry an al y si s In te rn at io n al p er sp ec ti v e 2 0 1 4 T o id en ti fy o p p o rt u n it ie s to st re n g th en p u b li c p ro te ct io n an d re d u ce b ar ri er s to fr ee d o m o f m o v em en t P o te n ti al re la ti o n sh ip s w er e id en ti fi ed b et w ee n fa ct o rs su ch as g eo g ra p h ic re g io n , le g al tr ad it io n s, ad m in is tr at iv e ap p ro ac h , re g u la to ry m o d el an d ec o n o m ic st at u s an d th e n u m b er an d ap p ro ac h es u se d to sp ec if y d efi n it io n s. A m aj o r w ea k n es s in th e p re ci si o n o f d efi n it io n s w as d is co v er ed C u tc li ff e J. R ., B aj k ay R ., F o rs te r S ., S m al l R ., T ra v al e R . C as e st u d y In te rn at io n al p er sp ec ti v e 2 0 1 1 T o co n si d er th e is su e o f n u rs in g re g u la ti o n w it h in th e co n te x ts o f g lo b al iz at io n an d p sy ch ia tr ic /m en ta l h ea lt h n u rs in g . It d ra w s at te n ti o n to th e in cr ea si n g ly m o b il e an d co n n ec te d in te rn at io n al n u rs in g w o rk fo rc e an d th e ex is te n ce o f si g n ifi ca n t d is p ar it ie s b et w ee n co u n tr ie s an d ev en p ro v in ce s w it h in co u n tr ie s co n si d er in g th em es su ch as n u rs in g p o li ci es T h er e ar e si g n ifi ca n t d is p ar it ie s b et w ee n co u n tr ie s. It is n ee d ed an in te rn at io n al o v er si g h t b o d y to fa ce w it h in te rn at io n al iz at io n . T h is ap p ro ac h co u ld ad d re ss is su es su ch as in te rn at io n al sh o rt ag e o f n u rs es an d en fo rc e p ro fe ss io n al re g u la ti o n D u n ca n S ., T h o rn e S ., R o d n ey P . C ri ti ca l p o li cy an al y si s In te rn at io n al p er sp ec ti v e 2 0 1 5 T o d is cu ss th e im p ac t o f re ce n t re g u la to ry tr en d s o n w h at In te rn at io n al C o u n ci l o f N u rs es co n si d er s n u rs in g ’s th re e p il la rs (i .e . th e p ro fe ss io n o f n u rs in g , so ci o - ec o n o m ic w el fa re o f n u rs es an d n u rs e re g u la ti o n ) T h em es su rf ac in g fr o m th is an al y si s in cl u d ed re g u la to ry d is co n ti n u it y , a ti g h te n in g o f re g u la to ry co n tr o l an d an in cr ea si n g ly m an ag er ia l g o v er n an ce cu lt u re © 2018 International Council of Nurses Regulatory changes through history 21 T a b le 1 C o n ti n u ed A u th o r( s) T yp e o f st u d y C o u n tr y P u b li ca ti o n ye a r P u rp o se o f th e st u d y M a in fi n d in gs F ai rm an J. A ., R o w e J. W ., H as sm il le r S ., S h al al a D . T h eo re ti ca l/ d is cu ss io n U S A 2 0 1 1 T o d is cu ss th e cr it ic al fa ct o rs li m it in g n u rs e p ra ct it io n er s’ ca p ac it y to p ra ct ic e to th e fu ll ex te n t o f th ei r ed u ca ti o n , tr ai n in g an d co m p et en ce ar e st at e- b as ed re g u la to ry b ar ri er s T h is is a cr it ic al ti m e to su p p o rt an ex p an d ed , st an d ar d iz ed sc o p e o f p ra ct ic e fo r n u rs es . E co n o m ic fo rc es , d em o g ra p h ic s, th e g ap b et w ee n su p p ly an d d em an d , an d th e p ro m is ed ex p an si o n o f ca re n ec es si ta te ch an g es in p ri m ar y ca re d el iv er y . A g ro w in g sh o rt ag e o f p ri m ar y ca re p ro v id es se em s to en su re th at n u rs es w il l u lt im at el y b e re q u ir ed to p ra ct ic e to th ei r fu ll es t ca p ac it y F ea ly M .G ., et al . R ev ie w / D o cu m en ta ry an al y si s In te rn at io n al p er sp ec ti v e 2 0 0 9 T o p ro v id e a sy n th es is o f li te ra tu re o n in te rn at io n al p o li cy co n ce rn in g p ro fe ss io n al re g u la ti o n in n u rs in g an d m id w if er y , w it h re fe re n ce to ro u te s o f en tr y in to tr ai n in g an d p at h w ay s to li ce n su re M u lt ip le ro u te s o f en tr y in to in it ia l tr ai n in g an d m u lt ip le p at h w ay s to li ce n su re p o se ch al le n g es , in te rm s o f ac h ie v in g co m m o n ly ag re ed u n d er st an d in g s o f p ra ct ic e co m p et en ce . N u rs e le ad er s n ee d to co n si d er th e p o te n ti al fo r co n si d er ab le v ar ia ti o n in co m p et en cy re p er to ri es am o n g n u rs es tr ai n ed in g en er ic an d sp ec ia li st in it ia l m o d el s F re n ch P . H is to ri ca l N ew Z ea la n d 2 0 1 1 T o d is cu ss th e n u rs in g re g is tr at io n h is to ry in N ew Z ea la n d N u rs in g N ew Z ea la n d re g is tr at io n is th e o ld es t w o rl d w id e (1 9 0 1 ). It w as d et er m in ed b y a so ci al re q u es t es p ec ia ll y b y th e m ed ic al ar ea au sp ic es . O n ly re ce n tl y (2 0 0 0 s) n u rs in g is an in d ep en d en t d is ci p li n e an d p ro fe ss io n in N ew Z ea la n d Jo n es M .L . H is to ri ca l U K 2 0 1 2 T o co m m en t th e p at h th at le d to th e re g is tr at io n o f n u rs es in 1 9 1 9 R eg is tr at io n o f n u rs es is th e fi rs t st ep to sa fe g u ar d s th e h ea lt h an d w el l- b ei n g o f th e p u b li c, th ro u g h th e se tt in g o f st an d ar d s o f ed u ca ti o n , tr ai n in g , co n d u ct . H o w ev er , th e d eb at e re la te d to re g is tr at io n is al iv e S o in e A . H is to ri ca l In te rn at io n al p er sp ec ti v e 2 0 1 0 T o d is cu ss n u rs in g re fo rm s u n ti l W o rl d W ar I W it h th e F ir st W o rl d W ar I, m an y st at es re fo rm n u rs in g w h er e st at e re g is tr at io n an d re g u la ti o n re p re se n te d a m il es to n e to p o la ri ze n u rs in g id en ti ty w it h an in te rn at io n al p er sp ec ti v e S o la n o D ., R af fe rt y A .M . H is to ri ca l U K 2 0 0 6 T o lo o k at th e h is to ri ca l b ac k g ro u n d o f o v er se as n u rs e re cr u it m en t in th e B ri ti sh co n te x t T h e re ce n t im p le m en ta ti o n o f th e N u rs in g an d M id w if er y C o u n ci l’ s O v er se as N u rs e P ro g ra m to re g u la te th e re g is tr at io n ro u te fo r in te rn at io n al n u rs e re cr u it s to th e U K is sy m p to m at ic o f g ro w in g in te rn at io n al n u rs e re cr u it s to th e U K an d in te rn at io n al n u rs e m ig ra ti o n © 2018 International Council of Nurses 22 A. Stievano et al. Results Of the 14 included papers (Table 1), three were reviews, six were historical papers illustrating the development of regula- tory bodies in different countries, two were policy analysis about the future trends of regulatory systems, one was a paper illustrating a case study on nursing regulation, one was a Delphi study on a contemporary definition of professional nursing regulation and, one was a discussion paper. More- over, the investigated settings were mainly cross-national. The analysis of the included papers drove the identification of two main themes: • Factors underpinning current challenges; • Historical and contextual triggers of regulation. Theme 1: factors underpinning current challenges This theme was formed by three subthemes: ‘education’, ‘mi- gration & internationalization’ and ‘policy & regulation’ (Table 2). Education The identified papers highlighted how the history of licensure has always been connected to education and to the routes of entry into nursing (Fealy et al. 2009; Lloyd Jones 2012), often standardizing credentialing through systems of licensing, accreditation, certification (While 2014). Regulation and equivalency of nursing education was a major historical issue, and it still represents a current challenge. Education equiva- lency supports migration as well as serving to indirectly improve the nursing education standards of different nations. Regulatory authorities play a pivotal role in developing safer credentialing evaluation of professionals for the public safety, and for more culturally specific standards that are popula- tion-based. Country-specific standards in education were typi- cally introduced with regulation (Lloyd Jones 2012). Although many nations, such as those who were former British colonies developed similar systems of nursing education, those outside of the colonial orbit had different motivations and created different outcomes (Nelson 2013; Salami & Nelson 2014). Fealy et al. (2009) noted that in many countries, the nursing profession is at the point where international policies (rather than local or national policies) should guide regulations, or at the least, serve as benchmarks for growing consistency. The nursing workforce movement depends on this consistency (Fealy et al. 2009). Policy and regulation Common threads and needs between policy and regulation were highlighted throughout the included manuscripts, such as the need for professional regulation and policies to beSh af fe r F . A ., T o D u tk a J. C ri ti ca l p o li cy an al y si s U S A 2 0 1 3 T o lo o k at g lo b al la b o u r m o b il it y as a lo g ic al o u tg ro w th o f th e g lo b al iz at io n o f th e w o rl d ’s w o rk fo rc e C h al le n g es fo r In te rn at io n al E d u ca te d N u rs es b ri n g in to fo cu s th e re g u la to ry im p li ca ti o n s fo r ju ri sd ic ti o n al au th o ri ti es in te rm s o f cr ed en ti al s ev al u at io n W h il e A . H is to ri ca l U K 2 0 1 4 T o d is cu ss th e W o rl d W ar I fr o m th e p er sp ec ti v e o f th e d is tr ic t n u rs in g T h e N u rs es ’ R eg is tr at io n A ct en su re d th at fu tu re n u rs es h ad to m ee t a cr ed en ti al in g st an d ar d an d p ro te ct ed th e em er g in g p ri v il eg es to th o se h o ld in g th e ti tl e as so ci at ed w it h th e n ew p ro fe ss io n ; b ei n g a st at e re g is tr at io n n u rs e b ec am e a p re re q u is it e fo r d is tr ic t n u rs e tr ai n in g af te r th e A ct W o n g F .K .Y ., Z h ao Y . H is to ri ca l C h in a 2 0 1 2 T o d es cr ib e th e d ev el o p m en t o f n u rs in g ed u ca ti o n in th e p as t, p re se n t an d fu tu re in C h in a N u rs in g ed u ca ti o n in C h in a, b o th at th e p re re g is tr at io n an d p o st -r eg is tr at io n le v el , p la y s a k ey ro le in b u il d in g a st ro n g te am o f n u rs es to fu lfi l th e h ea lt h m is si o n o f th e co u n tr y . E d u ca ti o n fo ll o w ed a ra p id ch an g in g p at h in th e la st h u n d re d y ea rs , u n ti l th e re ce n t p at ie n t- ce n tr ed ca re ap p ro ac h © 2018 International Council of Nurses Regulatory changes through history 23 Table 2 Elements that influence nursing profession …