1. Chapter 5 The Evolution of Licensure, Certification, and Nursing Organizations
Joseph T. Catalano

2. History of Nursing Licensure
Until the early 20th century, nursing licensure seemed unnecessary.
Florence Nightingale was opposed to licensure.
Felt that the graduates of her school were already highly qualified
Believed that licensure would lower the standards to be more inclusive
Understood that it would be controlled by medical doctors (MDs)

3. History of Nursing Licensure (cont’d)
There was a wide variety in the quality of nurses.
Anyone could claim to be a nurse.
The nursing care provided was poor quality.
The public gradually became disenchanted with nurses.

4. History of Nursing Licensure (cont’d)
1901: International Council of Nurses
Passed resolution to have each state set up a licensure and examination procedure
New York state was first
Presented a licensure bill to the legislature
Developed an examination board (state board of nursing) composed of nurses
Received much opposition from untrained nurses and MDs

5. History of Nursing Licensure (cont’d)
April 24, 1903, licensure became law in New York.
Established educational standards
Required minimum 3-year program
Schools had to register with the regents
Five nurses chosen for the state board
Set rules and regulations for licensure examination
Had power to revoke licenses for cause
Licensure was permissive, not mandatory, until 1938

6. History of Nursing Licensure (cont’d)
A few other states quickly followed New York.
Most had less stringent laws
North Carolina
New Jersey
Virginia
Considered a major achievement
Laws were passed at a time when women could not vote.
There were few laws for the regulation of MDs.

7. Types of Licensure
Permissive licensure: allowed people to practice as registered nurses (RNs) as long as they did not use the title.
Protected the title RN
Allowed people to practice nursing without a license
Texas was last state to require mandatory licensure (1985)
Mandatory licensure: protects both the title and the practice; now adopted in all states.

8. Types of Licensure (cont’d)
Institutional licensure: allows the institution (hospital, nursing home, etc.) to decide what qualifications are necessary and who can work as a nurse.
Institution’s 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.

9. Types of Licensure (cont’d)
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

10. Role of Licensure
Licensure is a legal act by the state to recognize that a licensed person is safe to practice.
Primary function is to protect public safety.
Establishes only minimal levels of competency.
Each state can establish its own criteria in its state practice act (most are similar).
Current movement toward national licensure.

11. 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.
There are still some problems to be worked out.
Who disciplines wayward nurses?
Who gets the money?

12. National Licensure (cont’d)
States with or planning mutual recognition
Arizona New Jersey
Arkansas North Carolina
Delaware North Dakota
Georgia South Dakota
Illinois Texas
Iowa Utah
Maryland Virginia
Mississippi Wisconsin
Nebraska

13. National Licensure (cont’d)
If you live in a non-compact state, you need a license to practice in that state; for example, if you live in Oklahoma and want to practice in Arkansas, you must also get an Arkansas license.
The compact does not affect military personnel (covered by federal law).
Nurses must obtain and renew their licenses in their primary state of residence.

14. National Licensure (cont’d)
Nurses who err are investigated by the state (remote or home) in which they made the error.
Remote states may deny the nurse privileges to practice in that state only.
Only the nurse home (resident) state board can take action against his or her license.
Compact states will have instantaneous (at least quick) access to nurse information (current investigations, discipline history, etc.).

15. National Licensure (cont’d)
For more information about mutual recognition, contact the National Council of State Boards of Nursing:
Do you think it’s a good idea?
What are some of the problems?

16. Advanced Practice Licensure
Nationally, there are some problems.
There is no uniformity among the states in the legal recognition of certification for advanced practice nurses.
Some states (e.g., New York) recognize almost all certifications and have guidelines for them in their nurse practice acts.
Other states have little recognition and few guidelines.

17. Advanced Practice Licensure (cont’d)
What do you think is the role of advanced practice nurses in the health-care system today and in the future?
What can be done to standardize Advanced Practice RN (APRN) licensure and practice?
Should it be standardized?
Will the Doctor of Nursing Program (DNP) requirement help or hurt advanced practice nurses?

18. APRN Consensus Model (LACE)
Licensure, Accreditation, Certification, and Education (LACE)
Developed by the APRN Consensus Work Group and the National Council of State Boards of Nursing (NCSBN) APRN Advisory Committee in 2008
Addresses the lack of common definitions regarding APRN practice, the ever-increasing numbers of specializations, the inconsistency in credentials and scope of practice, and the wide variations in education for APRNs

19. APRN Consensus Model (LACE) (cont’d)
Goal = implement the APRN Model of Regulation in all states by 2015.
One of the first tasks accomplished by the NCSBN was to develop a uniform definition of the APRN role.
The benefit of the model is that it would permit nurses to move to another state and still practice at the same level.
Does not require a program to offer a Doctor of Nursing Practice (DNP) degree.

20. APRN Consensus Model (LACE) (cont’d)
LACE serves as a means for those who are seeking to adopt the APRN Consensus Model to be able to debate the concepts, requirements, and methods of implementation.
The ultimate goal of LACE is to provide a general consensus for the implementation of the APRN Consensus Model.
The Affordable Care Act (ACA) recognizes APRNs as equal partners in providing health care at multiple levels, but particularly in the area of primary care.

21. Nursing Organizations
National nursing organizations need the participation and membership of all nurses in order to claim that they are truly representative of the profession.
A large membership allows the organization to speak with one voice when making its values about health-care issues known to politicians, physicians’ groups, and the public in general.
Support Client Safety

22. The National League for Nursing
Purpose
To maintain and improve the standards of nursing education
Membership
Open to individual nurses
Primary membership is agency membership, usually through schools of nursing

23. The National League for Nursing (cont’d)
Services and activities
Accrediting nursing schools
Testing and test development
Evaluating new graduate nurses
Supplying career information, continuing education workshops, and conferences for all levels of nursing
Publishing a wide range of literature and videotapes covering current issues in health care
Compiling statistics about nursing, nurses, and nursing education

24. The American Association of Colleges of Nursing
Purposes
Established to help colleges with schools of nursing work together to improve the standards for higher education for professional nursing
Developed standards for the accreditation of baccalaureate schools of nursing

25. The American Association of Colleges of Nursing (cont’d)
Membership
Only deans and directors of programs that offer baccalaureate or higher degrees in nursing with an upper-division nursing major are permitted membership in the American Association of Colleges of Nursing (AACN).

26. The American Nurses Association
Purposes
Improvement of the standards of health and access to health-care services for everyone
Improvement and maintenance of high standards for nursing practice
Promotion of the professional growth and development of all nurses, including economic issues, working conditions, and independence of practice

27. The American Nurses Association (cont’d)
Membership in the American Nurses Association (ANA) is undergoing major changes.
Individual nurses join a state organization and through the state organization they indirectly become a member of the ANA.
Proposed: nurses can directly join ANA without going through the state first.
Out of 3,000,000 nurses, only 200,000 belong.

28. The American Nurses Association (cont’d)
Other services
The ANA Amercian Nurses Credentialing Center (ANCC) provides testing and certification of advanced practice nurses.
Provides standardization for and recognition of these practitioners by the public, physicians, or lawmakers.
Establishes and continually updates standards of nursing practice.

29. The American Nurses Association (cont’d)
Other services (cont’d)
Established the official code of ethics that guides professional practice.
The ANA Political Action Committee (ANA-PAC) carries out economic and political activities in the halls of Congress and offices of legislators.

30. The National Student Nurses’ Association
Purposes
Help maintain high standards of education in schools of nursing.
Educate high-quality nurses who will provide excellent health care.
Students’ ideas, concerns, and needs are extremely important to nursing educators.

31. The National Student Nurses’ Association (cont’d)
Membership
Membership consists of all nursing students in registered nurse programs.
Students can join at the local, state, or national level or at all levels if desired.
Dues are low, with a discount for the first year’s membership.

32. The National Student Nurses’ Association (cont’d)
Other services
Develops and provides workshops, seminars, and conferences on current issues in nursing and health care, including
Ethical and legal concerns
Pharmacology
Test-taking skills
Professional growth

33. The National Student Nurses’ Association (cont’d)
Other services (cont’d)
Develop professional identity.
Learn professional behaviors.
Develop professional attitudes.
Experience firsthand the operation, activities, and benefits of a professional organization.
All nursing students should be encouraged to belong to this organization.

34. The International Council of Nurses
Membership
Consists of national nursing organizations
Serves as the international organization for professional nursing
The ANA is one member among 104 nursing associations around the world.

35. The International Council of Nurses (cont’d)
Goals
Improve health and nursing care throughout the world.
Coordinate efforts with the United Nations and other international organizations.
Improve social and economic welfare of nurses.
Monitor how government and politics affect the nursing profession and health care.

36. Sigma Theta Tau
Honors the organization that was established in colleges and universities to recognize individuals who have demonstrated leadership or made important contributions to professional nursing.
It is international, and candidates are selected from among senior nursing students or graduate or practicing nurses.

37. Sigma Theta Tau (cont’d)
Focuses on scholarly activities and research.
Local chapters collect and distribute funds to nurses who are conducting nursing research.
Holds educational conferences and recognizes those who have made contributions to nursing.

38. Special-Interest Organizations
Usually organized according to clinical practice area.
Organizations exist for almost every clinical specialty and subspecialty known in nursing, such as obstetrics/gynecology, critical care, operating room, emergency department, and occupational health, as well as lesser-known areas, such as flight nursing, urology, and cosmetic surgery.

39. Special-Interest Organizations (cont’d)
Another focal area for these organizations is education and ethics.
They may focus on the common ethnic group, cultural, or religious backgrounds of nurses.
They promote the personal and professional growth of their membership.

40. Special-Interest Organizations (cont’d)
Establish the standards of practice for the particular specialty area.
Provide educational services for their members.
Should nurses belong to these organizations?
The answer is yes, but only after they belong to the ANA!