Background: Evidence-based nursing career development programs can support workforce planning, retention, and recruitment by harmonizing career guidance, capability development, and progression. Despite their recognized value, utilization varies across countries, organizations, and specialties, with limited evaluation of their development, implementation, or effectiveness. This scoping review explores key themes to inform nursing career development for Aotearoa New Zealand and identifies areas for further research. Aim: To provide a comprehensive overview of what is known about the evaluation of nursing career development programs. Method: A scoping review was conducted using Levac's six-step model. Rayyan software supported extraction and synthesis. CINAHL, ProQuest Central, PubMed, Scopus, and Policy Commons were searched for peer-reviewed and gray literature published between 2005 and 2025. Results: Eight studies met the inclusion criteria, reflecting the scarcity of research in this area. Three key themes emerged: (a) differing program structures, (b) varied outcome measures and implementation approaches, and (c) individual and organizational barriers and facilitators. Evidence suggests career development programs positively impact professional development and nurse retention, but challenges include administrative burden and difficulties in measuring effectiveness. Conclusions: This review highlights a significant gap in evaluating nursing career development programs globally. Evidence supports these programs as valuable tools for workforce development, while knowledge gaps remain regarding patient outcomes and cost-effectiveness. Protocol Registration: Open Science Framework (doi.org/10.17605/OSF.IO/QK5MG).
Background The nursing workforce is a key determinant of health system resilience, quality, and sustainability. In Italy, nurses receive significantly lower salaries compared to the OECD average, and the country has one of the lowest nurse-to-population ratios in Europe. This study examines the Italian nursing pay gap as a systemic vulnerability in health policy, with implications for the National Health Service's (NHS) capacity to deliver safe and continuous care. Methods This study follows a descriptive policy analysis approach integrated with comparative data analysis. Salary and workforce data were obtained from Organisation for Economic Co-operation and Development (OECD) datasets (2015–2024) and complemented with national and international institutional sources. The analysis was guided by Walt and Gilson's Policy Triangle and the Nursing Theory of Complex Adaptive Systems (NTCAS). Results Italy reports an average nursing salary of approximately USD 48,000 (PPP), about 21% lower than the OECD average, and a density of 6.2 nurses per 1,000 inhabitants compared with 9.4 internationally. In the selected country comparison, higher salary levels co-occurred with higher nurse density, while the policy analysis identified persistent constraints in remuneration, career development, workforce planning, and retention. Theoretical interpretation frames the pay gap as a systemic variable with potential consequences for quality, safety, and equity. Discussion The Italian pay gap reflects structural weaknesses in workforce governance rather than an isolated issue. Limited career pathways, migration, and workforce shortages further increase system vulnerability. Conclusion Addressing the nursing pay gap is a strategic priority to strengthen retention, reduce inequalities, and ensure the long-term sustainability of the NHS.
IntroductionActive involvement of nurse leaders in policy advancement is considered crucial, particularly in Africa, where nurses constitute most of the health workforce. This review was conducted to determine factors that influence African nurse leaders' participation in policy development.MethodThe databases CINAHL and MEDLINE were searched to answer the review question. The search parameters were adjusted to include studies in English and between 2012 and 2025. The review partially followed the JBI methodology for evidence synthesis. Two reviewers conducted data extraction and independently assessed all included studies. The PRISMA guideline guided study selection reporting. Results were thematically analysed.ResultsSeven studies were identified. The review reveals a spectrum of challenges and opportunities impacting nurse leaders' involvement in policy development. The main theme that emerged from the included studies was enablers and constraints in health policy development, with four subthemes. Namely: enablers of nurse leaders' engagement, perceived value, knowledge and gendered influences, limited and peripheral participation, structural, organisational and individual barriers.ConclusionPersonal, structural and institutional factors were enablers and bottlenecks that limit involvement of African nurse leaders in health policy. Implementing strategies such as leadership support, education, professional recognition, organisational empowerment, and governmental support could elevate the role of nurse leaders in policy development, contributing to a more robust and inclusive healthcare policymaking landscape in Africa. Additional case studies and longitudinal research are needed to examine the factors influencing nurse leaders' involvement in policy development across different African contexts.
Forty-one states in the United States that adopted Medicaid expansion through the Affordable Care Act reached historically low rates of uninsured that have endured through 2025. The One Big Beautiful Bill Act (OBBBA) signed into law on 4 July 2025 contains numerous provisions that place Medicaid expansion coverage at risk. Resulting changes to Medicaid expansion include work requirements, a decrease in federal match funds for expansion programs, cost-sharing fees for recipients, stricter eligibility requirements, more frequent re-enrollment periods, and limitations on family planning services provided by organizations that also provide abortion services. Because each state with Medicaid expansion has implemented this program differently, states will be impacted differently and with various timelines. The impact of OBBBA on Medicaid expansion in the state of New Hampshire is discussed in detail and examined from the perspective of a community mental health center. Nursing implications are discussed within the framework of Fawcett and Russell's conceptual model of nursing and health policy. Recommendations for advocacy and the nurse's role as an important stakeholder are discussed.
Background: U.S. state licensing restrictions requiring written practice agreements for certified nurse-midwives (CNMs) lack evidence of improved patient safety and instead contribute to maternity care workforce shortages. The objective of this study was to examine restrictive state licensing and practice policies for CNMs to identify the problem they were intended to solve. Methods: This was a qualitative content analysis of state policies that require CNMs to obtain written practice agreements, collected in January 2022, using the "What's the Problem Represented to be" framework. Analysis was completed by two midwife researchers with interpretation assistance from a panel of expert midwives. Results: Variation in written practice agreement requirements across states demonstrated that the regulations echoed historical physician complaints about the "midwife problem" first articulated in 1912. Effects of this problemization are inaccurate workforce data and persistent maternity care shortages. The problemization is maintained by the physician organization's advocacy against midwifery autonomy. The COVID-19 pandemic policy modifications demonstrated that states could eliminate restrictions when prioritizing access without compromising safety. Conclusions: Restrictive CNM licensing regulations perpetuate professional gatekeeping rather than ensuring public safety, directly contributing to maternity care shortages. State legislatures should eliminate written practice agreement requirements for CNMs and adopt evidence-based criteria focused on practitioner qualifications rather than supervisory relationships. National nursing organizations should advocate for regulatory reform, prioritizing healthcare access. Removing these barriers can expand the maternity care workforce and improve access to reproductive healthcare, particularly in underserved communities.
