Chapter 4 Nursing Licensure and Certification

1. Chapter 4 Nursing Licensure and Certification

2. The History of Nursing Licensure • Recognition: pins and registries • Nursing pins • Symbolize the school’s philosophy, beliefs, and aspirations • Evidence of achievement, learning, and skills • Registry • Nightingale started the tradition of maintaining a registry of all graduates in 1860 • Provided institutions and clients with the means to ascertain the skills and knowledge of graduates

3. The History of Nursing Licensure (Cont’d) • Purpose of licensure • As nursing programs proliferated, the need to demonstrate a certain level of nursing skill and knowledge evolved • Primary purpose was, and still is, the protection of the public

4. The History of Nursing Licensure (Cont’d) • Early licensure activities • 1896: first attempts to license nurses in the United States • Failed because of lack of support by hospitals, physicians, and nurses • 1901: International Council of Nurses passed a resolution that each state should examine and license nurses • States established boards of nursing to develop rules for examination and licensure of nurses and govern the practice of nursing

5. The History of Nursing Licensure (Cont’d) • 1903: four states instituted permissive licensure, and nurses were not required to comply • 1915: because of variability among states’ licensure requirements, ANA designed “model nurse practice acts” • 1923: all states had instituted examinations for permissive licensure

6. The History of Nursing Licensure (Cont’d) • Mandatory licensure • 1930s: New York first state to require mandatory licensure • 1950: NLN administered first State Board Test Pool Examination, a standardized exam for licensure • 1982: first NCLEX examination • 1994: paper-and-pencil test replaced by computerized adaptive testing

7. The History of Nursing Licensure (Cont’d) • Current licensing activities • Efforts to provide common definitions of nursing practice, standards of education, and testing for entry into practice for all states have been successful • “Mutual recognition model” of nursing practice • Resolution adopted in 1997 by the delegate assembly of the National Council of State Boards of Nursing • Provides for individual state boards to adopt an interstate compact, allowing nurses licensed in one state to practice in all other states and territories

8. Components of Nurse Practice Acts • Components • Statements that refer to protecting the health and safety of the populace • Statements to protect the title of registered nurse • Definition of professional nursing • Definition of advanced practice, which may be expressed in a single definition or may be separately defined • Description of requirements for licensure

9. Components of Nurse Practice Acts (Cont’d) • Description of requirements and procedures necessary for entry into practice • Description of requirements for renewal of licensure • Designation of a regulatory board to administer the nurse practice act • Guidelines for delegation

10. Components of Nurse Practice Acts (Cont’d) • Role of regulatory boards to ensure safe practice • Membership of the board of nursing usually appointed by the governor’s office • Duties of the board of nursing • Administering the state’s nurse practice act • Granting and renewing licenses and taking disciplinary action when provisions of the act are violated

11. Continued Competency • Mandatory continuing education • Designated clinical practice hours • Portfolios

12. Components of Nurse Practice Acts • Special cases of licensure • As a U.S. government employee, nurses have to be licensed in only one state to practice across the country • Military and government nurses • Foreign nurse graduates: Nurses who receive education in another country must take a special examination administered by the Commission on Graduates of Foreign Nursing Schools before applying for a license to practice in this country • International practice

13. Components of Nurse Practice Acts (Cont’d) • Revision of nurse practice acts • Nurse practice acts are written and passed by legislators • Governmental agencies, administrators, and special interest groups seek to influence the legislation and accompanying rules and regulations • Nurses and nursing associations • Physicians, pharmacists, and other health-related specialties • Representatives of hospitals, long-term care groups, and managed care groups

14. Components of Nurse Practice Acts (Cont’d) • Because of varied interests, it is essential for nurses to understand the nurse practice act and additional legislation that will alter the act and influence nursing practice • Sunset legislation • Laws found in many states to ensure legislation are current and reflect the needs of the public • Through sunset activities, nurse practice acts are updated and revised

15. Components of Nurse Practice Acts (Cont’d) • Delegation of authority to others: regulations for delegating to unlicensed personnel and LPN/LVNs are found in the nurse practice act and may vary from state to state • Current licensure activities • Mutual recognition model • Continued competency

16. Certification • History • Began as a voluntary effort controlled by nursing organizations • Nurse anesthetists became the first nursing specialty to certify practitioners in 1946 • American College of Nurse-Midwives began certifying practitioners in 1961 • Need for standardization in certification programs recognized in 1975 • American Nurses Credentialing Center (ANCC) was formed as a central organization for certification of nurses • American Board of Nursing Specialties was organized with eight members in 1991 with the mission to ensure high standards and quality in the education, evaluation, and practice of certified nurses

17. Certification (Cont’d) • History • ANA • Occupational Health Nurses Certifying Board • Neuroscience Nurses Certifying Board • Rehabilitation Nurses Certifying Board • Nurse Anesthetists • Nutritional Support Nurses Certifying Board • Nephrology Nurses Certifying Board • Orthopedic Nurses Certifying Board • Some states now require certification for advanced practice

18. Certification (Cont’d) • ANCC • Offers certification in 25 areas of specialty nursing • Certified more than 200,000 nurses as of 2009 • Purpose • Recognizes excellence in nursing practice • Nongovernmental agencies, usually professional nursing organizations, grant certification • Requirements and practice opportunities vary markedly

19. Certification (Cont’d) • Steps to certification • Become informed about specific requirements in the chosen specialty • Contact the ANCC or specialty nursing organization offering certification to determine the educational experience and examination requirements • Contact the state board of nursing for information about legal requirements for practice in a specific specialty area

20. Certification (Cont’d) • Current Issues in certification • Legal issues of scope of practice for advanced practice nurses • Reimbursement for nursing services

21. Delegation of Authority to Others Nurse practice acts establish legal definitions of delegation Guidelines for delegation developed by nursing organizations 21

22. Mutual Recognition Model Nurse licensure compact (NLC): formed by individual states to allow nurses to practice in more than one state without applying for multiple licenses 22

23. New Issue in Advanced Practice Nursing • Which organization will credential and regulate advanced practice nursing? • The NCSBN proposes that it is the best organization to credential as well as license advanced practice nursing • Nursing professional and specialty organizations are responding to this proposal