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State COVID‐19 Policy Configurations and Registered Nurse Employment Recovery: A Mixed‐Set Qualitative Comparative Analysis of U.S. States and the District of Columbia (2021–2022)

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  • Maggie Foley
  • John Shaw
  • Caitlin Sockbeson
  • Karen Chin
  • Guohua Ma

Abstract

RN employment rebounded unevenly across the states of the U.S. after the acute phase of COVID‐19. We examine how 2021 state COVID‐19 policy mixes across six domains were associated with registered nurse (RN) employment recovery in 2022: telehealth expansion, early prescription refill flexibility, cost relief (cost‐sharing + vaccine cost relief), paid sick leave, mask mandates, and vaccine mandates. Using 51 jurisdictions (50 states plus the District of Columbia), we apply Qualitative Comparative Analysis (QCA) in a mixed‐set design, coding policy domains as crisp‐set membership indicators (0/1) based on documented adoption in 2021 and calibrating the outcome as a set‐membership score from the percent change in RN employment from 2021 to 2022 (p25/median/p75 anchors). At a consistency cutoff of 0.70, we identify multiple configurations sufficient for high recovery (solution consistency = 0.809; total coverage = 0.444), consistent with equifinality. Access‐oriented tools (telehealth expansion and refill flexibility) recur across several high‐recovery configurations, while mandates and paid sick leave vary across pathways. The empirical results are robust to stricter specifications, including a higher consistency cutoff (0.75), a higher frequency threshold (Freq ≥ 2), and alternative calibration anchors (20/50/80). In contrast, low recovery (1‐Y) is characterized by different sufficient configurations (solution consistency = 0.965; total coverage = 0.416), underscoring causal asymmetry. We interpret these results as configuration‐level associations rather than causal estimates and highlight how feasible access policies interact with mandates and workforce protections within broader state policy mixes linked to RN employment recovery.

Suggested Citation

  • Maggie Foley & John Shaw & Caitlin Sockbeson & Karen Chin & Guohua Ma, 2026. "State COVID‐19 Policy Configurations and Registered Nurse Employment Recovery: A Mixed‐Set Qualitative Comparative Analysis of U.S. States and the District of Columbia (2021–2022)," American Journal of Economics and Sociology, Wiley Blackwell, vol. 85(3), pages 389-403, May.
  • Handle: RePEc:bla:ajecsc:v:85:y:2026:i:3:p:389-403
    DOI: 10.1111/ajes.70043
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    References listed on IDEAS

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    1. Ashvin Gandhi & Ian Larkin & Brian McGarry & Katherine Wen & Huizi Yu & Sarah Berry & Vincent Mor & Maggie Syme & Elizabeth White, 2024. "The Health and Employment Effects of Employer Vaccination Mandates," NBER Working Papers 33072, National Bureau of Economic Research, Inc.
    2. Goolsbee, Austan & Syverson, Chad, 2021. "Fear, lockdown, and diversion: Comparing drivers of pandemic economic decline 2020," Journal of Public Economics, Elsevier, vol. 193(C).
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