mosby items and derived items © 2011, 2008 by mosby inc., an imprint of elsevier inc. chapter 4...
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Mosby items and derived items © 2011, 2008 by Mosby Inc., an imprint of Elsevier Inc.
Chapter 4 Nursing Licensure
and Certification
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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
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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
The History of Nursing Licensure (Cont’d)
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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
The History of Nursing Licensure (Cont’d)
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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
The History of Nursing Licensure (Cont’d)
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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
The History of Nursing Licensure (Cont’d)
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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
The History of Nursing Licensure (Cont’d)
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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
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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
Components of Nurse Practice Acts (Cont’d)
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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
Components of Nurse Practice Acts (Cont’d)
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Continued Competency
Mandatory continuing education Designated clinical practice hours Portfolios
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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
Components of Nurse Practice Acts
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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
Components of Nurse Practice Acts (Cont’d)
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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
Components of Nurse Practice Acts (Cont’d)
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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
Components of Nurse Practice Acts (Cont’d)
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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
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• 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
Certification (Cont’d)
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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
Certification (Cont’d)
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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
Certification (Cont’d)
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Current Issues in certification Legal issues of scope of practice for advanced
practice nurses Reimbursement for nursing services
Certification (Cont’d)
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Delegation of Authority to Others
Nurse practice acts establish legal definitions of delegation
Guidelines for delegation developed by nursing organizations
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Mutual Recognition ModelMutual Recognition Model
Nurse licensure compact (NLC): formed by Nurse licensure compact (NLC): formed by individual states to allow nurses to practice in individual states to allow nurses to practice in more than one state without applying for more than one state without applying for multiple licensesmultiple licenses
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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