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

초록

Purpose: The global significance of the nursing workforce is widely recognized; however, in physiciandominated healthcare systems, interprofessional boundary conflicts can limit nursing autonomy andhinder efforts to expand its scope of practice. This study examines discourse network dynamics aroundnursing legislation in South Korea over two decades, focusing on policy-actor interactions and issuediversification during periods of legislative deadlock and eventual breakthrough. Methods: We conducted a longitudinal discourse network analysis of 2,876 parliamentary speechesfrom 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 typeswere constructed: actor networks based on coparticipation in meetings and issue networks based ontopic similarity. Network-level metrics (density and centralization) and node-level centrality measureswere calculated. Results: Actor network density increased from 0.545 (deadlock) to 0.663 (breakthrough), whilecentralization decreased from 0.050 to 0.012 (transition), indicating a shift from concentrated control todistributed connectivity. Betweenness centrality shifted from concentration among experts (deadlock:0.545) to distribution among legislators (breakthrough: 0.024 for both progressive and conservativeparties), indicating structural changes in brokerage patterns. Issue network density remained stable atapproximately 0.500 across all periods, suggesting consistent discourse content despite substantialchanges in interaction patterns. Conclusion: Policy breakthrough coincided with structural changes in the actor network, characterizedby higher density, lower centralization, and distributed brokerage across ideological divides. Thesefindings advance methodology through discourse network analysis of nursing legislation, offer theoretical insights into network restructuring during policy change, and provide practical guidance forhealthcare workforce advocacy in contexts of professional boundary conflicts.

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