The COVID-19 pandemic presented a window of opportunity for policy change, but was not exploited as such everywhere. Surprisingly, in Switzerland, usually characterized by a stable political landscape and incremental policy changes, an unexpected reform, the Nursing Initiative, was adopted. This paper examines the underlying mechanisms driving this adoption, employing a cross-fertilization of the multiple streams framework with the programmatic action framework and relying on expert interviews. The analysis shows that partial streams coupling began years before the pandemic, facilitated by the strengthening of nursing care professions’ identity into a programmatic group. Switzerland’s direct democracy enabled the opening of an agenda window, allowing the programmatic group to effectively couple their policy with political dynamics in the policy process. Finally, the COVID-19 crisis acted as a decision window, opening from the problem stream and providing momentum for policy action and decision-making.

This article draws on the Programmatic Action Framework (PAF) to tackle the question of how the dominance and decline of a specific policy programme in a policy sector can be explained. It starts from the observation that visionary policy programmes, defined as a set of policy goals and instruments that find their expression in subsequently adopted and interconnected policy reforms, may shape a sector’s policies over several decades. Linking policy programmes to programmatic groups that promote these programmes in search of boosting their careers and authority, the programme’s rising and declining dominance can be explained by the career trajectories of programmatic actors. By displaying empirical evidence for the argument from German health policy, the article shows that proponents of today’s change are opponents of tomorrow’s change since individual careers depend on the dominance of policy programmes.