Nursing Autonomy and Covid-19: A Temporal Theory of How Challengers Make Gains In Unsettled Times

Abstract

The onset of the COVID-19 pandemic unquestionably challenged healthcare systems worldwide, and forced healthcare and political leaders to make quick decisions in the face of many unknowns. In this paper, we highlight how the pandemic provided an opening in US Nurse Practitioners’ broader pursuit of expanded autonomy. The pandemic created an external jolt that could not have been replicated or completely foreseen by their profession. We argue that this pandemic is indicative of a broader phenomenon analogous to a punctuated equilibrium, which fosters a challenging profession’s entry into a new phase of their professionalization life cycle. Building on Freidson and Abbott’s theories of the profession, we offer additional theorization of how a challenging profession moves their cause forward; highlighting the role of temporality, we argue that challengers consolidate gains attained during long periods of small wins, and usher their professionalization into new phases through punctuations. We also provide empirical support for our theory by offering a survival analysis of US state policy changes made by state governors in response to rising COVID-19 cases in their states during the first month of the pandemic. We further discuss the implications for professions theory and healthcare management.