1. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 4 Nursing Licensure and Certification

2. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. The History of Nursing Licensure  Recognition — pins and registries  Nursing pins Symbolize the philosophy, beliefs, and aspirations of the school Symbolize the philosophy, beliefs, and aspirations of the school Evidence of achievement, learning, and skills Evidence of achievement, learning, and skills  Registry Nightingale started the tradition of maintaining a registry of all graduates in 1860. 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 Provided institutions and clients with the means to ascertain the skills and knowledge of graduates

3. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  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

4. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Early licensure activities  1896—first attempts to license nurses in the United States  First attempts 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 began to establish boards of nursing to develop rules for examination and licensure of nurses and to govern the practice of nursing. The History of Nursing Licensure

5. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  1903—Four states instituted permissive licensure, and nurses were not required to comply.  1915—Because of variability among states’ licensure requirements, ANA designed “model nursing practice acts.”  1923—All states had instituted examinations for permissive licensure. The History of Nursing Licensure

6. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Mandatory licensure  1930s—New York was the first state to require mandatory licensure.  1950—NLN administered the first State Board Test Pool Examination, a standardized examination for licensure.  1982—development of the first NCLEX examination  1994—Paper-and-pencil test was replaced by computerized adaptive testing. The History of Nursing Licensure

7. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  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 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 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

8. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Components of Nursing 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. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Description of requirements and procedures necessary for initial 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 Nursing Practice Acts

10. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  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 Responsible for administering the state’s Nurse Practice Act Responsible for administering the state’s Nurse Practice Act Responsible for granting and renewing licenses and taking disciplinary action when provisions of the Act are violated Responsible for granting and renewing licenses and taking disciplinary action when provisions of the Act are violated Components of Nursing Practice Acts

11. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Continued Competency  Mandatory continuing education  Designated clinical practice hours  Portfolios

12. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  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 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. 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 International practice Components of Nursing Practice Acts

13. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Revision of nursing practice acts  Nursing 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 Nurses and nursing associations Physicians, pharmacists, and other health-related specialties Physicians, pharmacists, and other health-related specialties Representatives of hospitals, long-term care groups, and managed care groups Representatives of hospitals, long-term care groups, and managed care groups Components of Nursing Practice Acts

14. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  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 reflects the needs of the public. Laws found in many states to ensure legislation are current and reflects the needs of the public. Through sunset activities, Nurse Practice Acts are updated and revised. Through sunset activities, Nurse Practice Acts are updated and revised. Components of Nursing Practice Acts

15. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  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 Nursing Practice Acts

16. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. 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 was recognized in 1975. American Nurses Credentialing Center (ANCC) was formed as a central organization for certification of nurses. 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. 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. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  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.  American Nurses Credentialing Center (ANCC)  Offers certification in 25 areas of specialty nursing  Had certified more than 200,000 nurses as of 2006 Certification

18. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Purpose  Recognizes excellence in nursing practice  Nongovernmental agencies, usually professional nursing organizations, grant certification  Requirements and practice opportunities vary markedly. Certification

19. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  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

20. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Current Issues in certification  Legal issues of scope of practice for advanced practice nurses  Reimbursement for nursing services Certification