Structural Change of Policy Networks and Legislative Breakthrough: A 20-Year Discourse Network Analysis of Nursing Legislation in South Korea

PURPOSE: The global significance of the nursing workforce is widely recognized; however, in physician-dominated healthcare systems, interprofessional boundary conflicts can limit nursing autonomy and hinder efforts to expand its scope of practice. This study examines discourse network dynamics around nursing legislation in South Korea over two decades, focusing on policy-actor interactions and issue diversification during periods of legislative deadlock and eventual breakthrough. METHODS: We conducted a longitudinal discourse network analysis of 2,876 parliamentary speeches from the South Korean National Assembly across three periods: deadlock (2005-2006), transition (2019-2023), and breakthrough (2024). Latent Dirichlet allocation identified eight topics. Two network types were constructed: actor networks based on co-participation in meetings and issue networks based on topic similarity. Network-level metrics (density and centralization) and node-level centrality measures were calculated. RESULTS: Actor network density increased from .545 (deadlock) to .663 (breakthrough), while centralization decreased from .050 to .012 (transition), indicating a shift from concentrated control to distributed connectivity. Betweenness centrality shifted from concentration among experts (deadlock: .545) to distribution among legislators (breakthrough: .024 for both progressive and conservative parties), indicating structural changes in brokerage patterns. Issue network density remained stable at approximately .50 across all periods, suggesting consistent discourse content despite substantial changes in interaction patterns. CONCLUSIONS: Policy breakthrough coincided with structural changes in the actor network, characterized by higher density, lower centralization, and distributed brokerage across ideological divides. These findings advance methodology through discourse network analysis of nursing legislation, offer theoretical insights into network restructuring during policy change, and provide practical guidance for healthcare workforce advocacy in contexts of professional boundary conflicts.