Nursing Licensure and Certification

Chapter 4


Nursing Licensure and Certification


Susan R. Jacob, PhD, MSN, RN




Key Terms



Accreditation


Voluntary process by which schools of nursing are approved to conduct nursing education programs.


Advanced practice nurse (APN)


Legal title for nurses prepared by education and competence to perform independent practice.


American Nurses Association (ANA)


Professional organization that represents all registered nurses.


American Nurses Credentialing Center (ANCC)


An independent agency of the American Nurses Association that conducts certification examinations and certifies advanced practice nurses.


Certification


Process by which nurses are recognized for advanced education and competence.


Commission on Collegiate Nursing Education (CCNE)


A subsidiary of the American Association of Colleges of Nursing (AACN) with responsibility for accrediting baccalaureate and higher-degree nursing programs.


Compact state


A term of law. In the context of the Nurse Licensure Compact, a state that has established an agreement with other states allowing nurses to practice within the state without an additional license. The interstate compacts are enacted by the state legislatures.


Continued competency program


A variety of initiatives to ensure nurses’ knowledge, skills, and expertise beyond initial licensure.


Grandfathered


Statutory process by which previously licensed persons are included without further action in revisions or additions in nurse practice acts.


International Council of Nursing (ICN)


Professional organization that represents nurses in countries around the world.


Licensure by endorsement


The original program whereby nurses licensed in one state seek licensure in another state without repeat examinations. The requirements are included in state nurse practice acts or accompanying rules and regulations.


Mandatory continuing education


Educational requirements imposed by individual states for renewal of a license.


Mutual recognition of nursing


Program developed by the National Council of State Boards of Nursing (2012). The Nurse Licensure Compact program establishes interstate compacts so that nurses licensed in one jurisdiction may practice in other compact states without duplicate licensure.


National Council of State Boards of Nursing (NCSBN)


Organization whose membership consists of the board of nursing of each state or territory.


National League for Nursing (NLN)


Professional organization whose members represent multiple disciplines. The National League for Nursing conducts many types of programs, including accrediting nursing education programs.


Nurse practice act


Statute in each state and territory that regulates the practice of nursing.


State board of nursing


Appointed board within each state charged with responsibility to administer the nurse practice act of that state.


Sunset legislation


Statutes that provide for revocation of laws if not reviewed and renewed within a specified time period.



We thank Janet C. Scherubel, PhD, RN, for her contribution to this chapter in the fourth edition.




image


Additional resources are available online at:


http://evolve.elsevier.com/Cherry/


VIGNETTE


Three nurses are discussing their nursing practice licenses. Joe Branch, a senior nursing student, is preparing for initial licensure. Mary Stone’s license is due for renewal. Carmella Larkin has just moved into the state. As the three are talking about these changes in their practice, Giorgio Gonzales, a nurse practitioner, joins the group. Giorgio recently completed a certification examination and is interested in becoming certified for advanced practice. All the nurses have a general knowledge of the requirements for licensure and certification but lack the specific information needed to legally practice within the state.


Mary suggests contacting the state board of nursing. The nurses agree that this is a sensible idea, and Mary leaves to phone the board of nursing. On returning, Mary informs the group that the answers to all of their questions can be found in the state’s nurse practice act and accompanying rules and regulations, which can be accessed online on their website. She tells them that the state board of nursing office will also send free copies of both documents to individuals who request them.


The situation described here is not uncommon. Nurses need specific, current information on licensure and renewal of licensure. The most comprehensive sources for this information are the state nurse practice act and the state board of nursing. These resources provide accurate descriptions of the law governing nursing practice within each state and the U.S. territories. Every nurse and nursing student will benefit from obtaining a copy of their state’s nurse practice act and becoming familiar with its contents.




Chapter Overview


To practice nursing as a registered nurse (RN)! That is the goal of every student nurse. A goal achieved through study, clinical practice, and successful completion of the National Council Licensure Examination–Registered Nurse (NCLEX-RN®). This chapter discusses how and why nursing licensure developed, steps necessary to becoming licensed, licensure regulations, and the responsibilities of an RN.


After licensure as an RN, nurses must still maintain and increase their knowledge and skills. Many nurses may wish to specialize in a particular area of nursing and expand their practice. Nurses with these goals may seek certification in a specialty field. This chapter describes certification, the means to achieve certification, and the organizations that administer certifying examinations. Whether it is licensure or certification, the nursing profession is continually progressing. Legal requirements to practice are continually being revised to ensure the protection of the public. Throughout history and in the current health care environment, nurses face complex issues and new challenges as they seek to increase their competence and ensure the delivery of excellent nursing services to patients. This chapter explores issues related to licensure and certification as well as some of the challenges nurses and students will face.



The History of Nursing Licensure


Recognition: Pins and Registries


The aim of caregivers throughout history has been to be recognized and acknowledged for one’s skills and achievements. Early caregivers, particularly in the monasteries and convents of the medieval period, were identified by the habits they wore. Frequently, special insignias designated health personnel. During the Crusades, a large Maltese cross adorned the habits of the Knights Hospitalers of St. John of Jerusalem on the battlefield (Kalisch and Kalisch, 2003). These forms of identification allowed others to recognize their particular skills in caregiving and healing. More recently, nurses around the world wore a readily identifiable symbol of their school of nursing—the nursing cap.


Today, as in the past, the school of nursing pin identifies graduates from a particular school of nursing. Early in each school’s history, the students and faculty crafted the pin. The pin’s emblems and text symbolize the philosophy, beliefs, and aspirations of the nursing program. Students receive their own pin at graduation in a special pinning ceremony. Nurses wear their pins proudly as evidence of their achievement, learning, and skill. It is one way in which nurses distinguish themselves as distinct health care providers with a specialized body of knowledge and clinical skills.


Nursing programs also maintain a record of all graduates. Florence Nightingale started this practice in 1860 when she created a list of graduates of the St. Thomas’s School of Nursing in England. This list became known as the “registry” of graduate nurses. The registry of nurses initiated by Nightingale provided institutions, as well as patients, with a system of identifying graduates of particular nursing programs. These lists proclaimed to all the skills and knowledge of graduates. These nurses could then be distinguished from lay practitioners and local citizens who provided care to the ill and infirm. Today nursing programs around the world continue the tradition started by Nightingale and maintain a registry or listing of all graduates of the nursing program. In addition, state and international agencies maintain lists of nurses practicing in their jurisdictions.




Early Licensure Activities


U.S. nursing programs developed in much the same manner as was the pattern in England. As early as 1867, Dr. Henry Wentworth Acland encouraged licensure of English nurses. However, it was not until 1896 that attempts were made to license nurses in the United States. Prior to the late 1800s, many hospitals established training programs to prepare nursing staff for their own institutions. The programs varied based on the needs of the hospital, the availability of physicians and nurses for training students, and resources devoted to the training. It became apparent to many nurses that consistent minimum standards to practice across settings were necessary. These standards would provide for safety of the public and improve the mobility of nurses among institutions. A key advocate for these standards was the Nurses Associated Alumnae of the United States and Canada. This organization later became the American Nurses Association (ANA). However, the group met with resistance from hospitals, physicians, and even nurses. The early attempts at nursing licensure failed for lack of broad-based support (Joel, 2006).


Nurses worldwide mounted an extensive educational campaign explaining the purposes and safeguards inherent in licensure. Success was achieved, for in 1901 the International Council of Nurses passed a resolution that each nation and state examine and license its nurses. Several U.S. states responded shortly thereafter. In 1903, North Carolina, New Jersey, New York, and Virginia were the first to institute permissive licensure. The licensure rules were voluntary. These permissive licenses permitted but did not require nurses to become registered.


Under permissive licensure, educational standards were set at a minimum of 2 years of training for nurses. State boards of nursing were established with rules for examinations as well as revocation of the license. Nurses not passing the examination could not use the title of RN. These early regulations served two purposes: first to protect the public from unskilled practitioners, and second to provide legal sanctions to protect the title of RN. The New York State Board of Regents began a registry of nurses successfully completing all requirements. In 20 years, by 1923, all states had instituted examinations for permissive licensure. Each state’s licensure examinations varied in content, length, and format and included written, oral, and practice components. The early work in examinations for licensure was the forerunner of today’s licensure and certification requirements (Kalisch and Kalisch, 2003).


The early state efforts in licensing nurses were commendable. Nonetheless, there was considerable variability among states in nursing education requirements, the licensure examinations, and the nurse practice acts themselves. The widespread variability in nurse practice acts prompted the ANA (and later the National Council of State Boards of Nursing [NCSBN]) to design model nurse practice acts. The model acts provided a template for states to follow. The first was published in 1915. These model practice acts are revised and updated as nursing practice advances. For example, the NCSBN approved the most recent revision of the model practice act and administrative rules in 2011 (NCSBN, 2012c).


The model nurse practice act is composed of many sections including a definition of nursing and the scope of practice for the RN, descriptions of advanced practice nursing, requirements for prescriptive authority of nurses, nursing education, compact guidelines, and processes for disciplinary actions against nurses who violate sections of the act. Separate sections of the model act provide guidelines for state boards of nursing and the necessary requirements for entry into practice. The most recent model practice act is available online at the NCSBN website (NCSBN, 2009c).


From these model acts, each state or jurisdiction developed a unique practice act. Although individual states and territories’ practice acts address the needs of that jurisdiction, each includes the sections described in the model act. Students and practicing nurses may obtain the nurse practice act for any jurisdiction by contacting that state or territorial board of nursing. Appendix B provides a listing of state boards of nursing addresses and Internet addresses, which also can be found on the Evolve website.



Mandatory Licensure


Once each state had established permissive licensure, the next movement was toward a requirement that all nurses must be licensed. This practice is termed mandatory licensure. New York was the first state to require mandatory licensure, although this requirement was not in place until 1947. At the same time, nursing groups moved to standardize nursing licensure testing procedures.


After World War II, the ANA formed the NCSBN. The council was composed of a representative of each state and jurisdiction in the United States. As part of its original activities, the council advocated a standardized examination for licensure. These varied activities culminated in the National League for Nursing administering the first State Board Test Pool Examination in 1950. The written examination included separate sections on medical-surgical nursing, maternity nursing, nursing of children, and psychiatric nursing. This format for examination continued for more than 30 years, and many of today’s nurses took these examinations.


The next major event in licensure efforts occurred in 1982 with the development of the first NCLEX-RN examination. The test was revised to include all nursing content within one section of the examination. In addition, the format was changed to present questions in a nursing process format. Just as with previous versions of licensing examinations, the NCLEX-RN examination has evolved over time. Paper-and-pencil testing was replaced with computerized adaptive testing in 1994. Extensive information on the NCLEX-RN examination may be found in Chapter 28 of this text.



Components of Nurse Practice Acts


Each state develops rules and regulations to govern the practice of nursing within that state. These rules are in the nurse practice acts or in its accompanying rules and regulations to administer the act. Many nurse practice acts are patterned after the ANA or the NCSBN model practice acts, and all contain comparable information.


Stay updated, free articles. Join our Telegram channel

Nov 6, 2016 | Posted by in NURSING | Comments Off on Nursing Licensure and Certification

Full access? Get Clinical Tree

Get Clinical Tree app for offline access