The United States has more nurses than any other country in the world, numbering greater than three million workers.1 Despite this sizeable workforce, debates surrounding nursing shortages in the US have persisted for decades. The large number of licensed nurse personnel also distinguishes the vocation as the second largest group of licensed professionals in the United States.2,3 In fact, nurse professionals are regulated through various methods, including licensure, educational standards, and background checks.
Regulations (i.e. licensure and educational requirements) may conceivably contribute to the nursing shortage while failing to control quality by restricting entry into the profession. Milton Friedman (1962) made the cogent argument against licensing physicians in Capitalism and Freedom:
I am persuaded that licensure has reduced both the quantity and quality of medical practice...It has reduced the opportunities for people to become physicians, it has forced the public to pay more for less satisfactory service, and it has retarded technological development...I conclude that licensure should be eliminated as a requirement for the practice of medicine. 4
Friedman is not alone among economists, policy analysts, politicians, and other researchers with regards to his views on licensure.5 Licensure has been accused of causing a host of health services issues, including restricting access, stifling innovation, raising costs, and reducing quality. While some or all of the reasoning against licensure may be valid, unique politics involved with the nursing industry obliges the profession to maintain – even augment – its regulations. Expressly, the nursing industry contends with the established organizations of other professions in health services, which can – through their own licensure or attempts against the licensure of nurses – devalue the work of nurses. Nurses, on the other hand, have been in factions historically. Stronger nursing regulations might aid the profession in gaining parity with other (more united) health...