There is recognition of a global nursing shortage and maldistribution of nurses across and within jurisdictions as well as among sectors (public/private/voluntary) and geography within countries (World Health Organization [WHO], 2006). This shortage has contributed to increased migration of nurses from rural to urban, from sector to sector, and from one jurisdiction to another. Governments have become frustrated when their efforts to rectify these shortages have been impeded by what they see as regulatory barriers to mutual recognition, migration, and workforce mobility (WHO, 2006). Attaining the right balance between the speedy processing of applications and the need to make sure nurses are appropriately qualified and have no outstanding conduct allegations can generate significant work for the regulator.
In addition, shortages of nurses have stimulated governments to focus on workforce reform. In an attempt to find more efficient, effective solutions, governments have proposed new cadres of workers or changes to existing scopes of practice. At least initially, new cadres are often unregulated; as a result, questions of who does what and to what standard often emerge. Also, issues of who educates and supervises these new groups can often generate considerable debate (WHO, 2008).
The third dimension is the lack of functioning workforce planning systems. Carlton (2006) noted that nurse shortages were projected to grow and suggested this would drive rationalization of regulatory arrangements, but no detailed explanation of how this would happen or what the resulting system would look like was given. The Pew Health Professions Commission (1995b), however, noted that some regulators provide useful data. Accordingly, the inclusion of the core responsibility to provide regular, timely, and accurate data on the stocks, flows, and demographic profiles of the various categories of registrants may result in regulators being viewed as valuable contributors to the workforce planning process.