COVID-19 and nurse practitioner autonomy: a quantitative analysis and analytic narrative of nurse practitioner professionalisation amid physician dominance

One understudied aspect of the COVID-19 pandemic is the opportunity it provided for nurse practitioners (NPs) to practice autonomously and therefore professionalise. We undertake a quantitative analysis to understand how the pandemic impacted scope of practice laws governing NPs in the United States. We find that NPs were newly granted at least temporary autonomy in 22 US states, and that those policy changes were associated with increasing COVID-19 caseloads. We construct an analytic narrative that situates the COVID-19 pandemic in the larger context of NP professionalisation under physician dominance. We argue that NPs professionalised by achieving small wins of establishing presence, building legitimacy, forming coalitions, and gaining ubiquity between legislation and a pandemic. We use the case of NP professionalisation to build the concept of a professionalisation opportunity structure, which we define as a framework of conditions available for an occupational group to gain autonomy and which consists of periods of small wins punctuated by field-level changes. A professionalisation opportunity structure provides an explanation of professionalisation that transcends intra-occupational dynamics and could be applied to other healthcare occupations seeking to professionalise under physician dominance.