Evolution of Nursing Licensure: From Florence Nightingale to Today

1. The Evolution of Licensure, Certification, and Nursing Organizations Joseph T. Catalano Chapter 3

2. History of Nursing Licensure • In the early days of nursing, when health care was relatively primitive and society’s expectations of nurses were low, there was little demand for regulations and controls over and within the profession.

3. History of Nursing Licensure • as technology and health care have advanced and become more complex, there has been a corresponding increase in societal expectations for nurses

4. History of Nursing Licensure Through their professional nursing organizations, nurses can help shape health- care regulations that establish the most freedom to provide effective care while maintaining the goal of protecting the public

5. History of Nursing Licensure • Throughout the last half of the 19th century and the first half of the 20th century, rapid growth in health-care technology led to the increasing use of hospitals as the primary source of health care. Individuals who were qualified to provide this care however, were in short supply

6. History of Nursing Licensure Nursing leaders who had always advocated some type of credentialing for nurses to ensure competency found that their attempts to initiate registration or licensure met with strong opposition from physician groups, hospital administrators, and practicing nurses themselves

7. History of Nursing Licensure • Florence Nightingale was the first to establish a formal list, or register, for graduates of her nursing school. • The first organized attempt to establish • a credentialing system was initiated in 1896 by the Nurses Associated Alumnae of the United States and Canada (later to become the American Nurses Association).

8. History of Nursing Licensure • the International Council of Nurses passed a resolution that required each state to establish a licensure and examination procedure for nurses. It took 3 years before the state of New York, through the New York Nurses Association, developed a licensure bill that passed the legislature

9. The Importance of Licensure Examinations Is necessary to prove that the individual is qualified to practice nursing safety; otherwise the public is not protected from unqualified practitioners

10. The Importance of Licensure Examinations • By 1923, all states had some form of licensure examination , however, the format and length of the examinations varied widely. Some states required both written and practical examinations to demonstrate safety of practice; others added an oral examination

11. The Importance of Licensure Examinations • the major nursing organizations in the United States eventually realized that,to achieve consistency of quality across the country, all nurses needed to pass a uniform examination.

12. The American Nurses Association (ANA) Council of State Boards of Nursing was organized in 1945 to oversee development of a uniform examination for nurses that could be used by all state boards of nursing

13. The NCLEX-RN • he National League for Nursing Testing Division developed a test that was implemented in 1950. Originally the test was simply called the State Board • Examination,).

14. The NCLEX-RN • but it was renamed the National Council Licensure Examination (NCLEX) in 1987. • In 1994, the computerized version of the examination was implemented—the National Council Licensure Examination Computerized Adaptive Testing, for Registered Nurses (NCLEX-RN

15. REGISTRATION VERSUS LICENSURE • Registration is the listing, or registering, of names on an official roster after certain pre-established criteria have been met. • whether an applicant had met the standards for the position

16. REGISTRATION VERSUS LICENSURE • Licensure is an activity conducted by the state through the enforcement powers of its regulatory boards to protect the public’s health, safety, and welfare by establishing professional standards

17. Role of Licensure • Licensure is a legal act by the state to recognize that licensed person is safe to practice • Primary function is to protect public safety Establishes only minimal levels of competency

18. REGISTRATION VERSUS LICENSURE • Licensure for nurses, as for other professionals who deal with the public, is necessary to ensure that everyone who claims to be a nurse can function at a minimal level of competency and safety. There are several different types of licensure

19. Types of Licensure • Permissive licensure: allowed people to practice as RNs as long as they did not use the title • Basically, permissive licensure only protects the “registered nurse” title but not the practice of nursing itself

20. permissive licensure • anyone could carry out the functions of an RN, regardless of their level of education, without having to pass an examination indicating competency. • Health-care administrators seem to support this type of licensure because it allows them to employ less-educated and lower-paid employees rather than the more highly educated and paid RNs.

21. Mandatory Licensure • Mandatory licensure requires anyone who wishes to practice nursing to pass a licensure examination and become registered by the SBN. • Because different levels of nursing practice exist, different levels of licensure are necessary.

22. Institutional licensure: • Institutional licensure allows individual health-care institutions to determine which individuals are qualified to practice nursing within general guidelines established by an outside board

23. Institutional licensure: Institutions benefit—cuts down on personnel costs Institutions try to bring the practice in by the back door—for example, by setting policy to allow foreign nurses to practice without taking the NCLEX

24. National Licensure • Mutual recognition is the recognition of nursing licensure that allows nurses licensed in one state to practice in other states without the necessity of seeking additional licensure

25. Registration (Registered Nurse): individual is in possession of certain minimal qualifications, such as having passed an approved nursing program • Certification: granting of credentials to indicate that an individual has achieved a level of ability higher than the minimal level of competency indicated by licensure • May or may not have legal status

26. CERTIFICATION • it may appear that there is not much difference between certification and licensure. • certification is a granting of credentials to indicate that an individual has achieved a level of ability higher than the minimal level of competency indicated by licensure.

27. CERTIFICATION • As technology increases and the health-care environment becomes more complex and demanding, nurses are finding a need to increase their knowledge and skill levels beyond the essentials taught in their basic nursing courses.

28. CERTIFICATION • Certification acknowledges the attainment of increased knowledge and skills and provides nurses with a means to validate their own self-worth and competence.

29. Individual Certification • The most common type of certification is called individual certification. • When a nurse has demonstrated that he or she has attained a certain level of ability above and beyond the basic level required for licensure in a defined area of practice, that nurse can become certified. • Usually some type of written and practical examination is required to demonstrate this advanced level of skill

30. Organizational Certification • Organizational certification is the certification of a group or health-care institution by some external agency. • It is usually referred to as accreditation and indicates that the institution has met standards established either by the government or by a nongovernmental agency.

31. Advanced Practice • Some state governments may either award or recognize certification granted to nurses in areas of advanced practice. In these cases, the certification becomes a legal requirement for practice at the APN level

32. Advanced Practice • Nurse Practitioners Lower Health-Care Costs • While Improving Quality of Care • A number of studies have been conducted over the past few years on how • advanced practice nurses (APN) fit into the health-care system and their overall • effect on the quality of care.

33. Advanced Practice • Initially, many physicians were opposed to APNs because they felt their level of training was inadequate to provide high-quality care and because they would be “cutting into” their practice and source of income