ULL Nurs 100 SI 12 Unit 6 Regulation of nursing practice – Flashcards

Pins and Registries Early care givers were identified by habits Nursing pins identifies graduates from a particular school of nursing Florence Nightingale started the practice of keeping a list (registry) of graduates in 1860

Throughout history, nurses/caregivers were recognized and acknowledged for their skills and achievements. Over the years, nurses/caregivers have had various forms of identification. Early caregivers in the medieval period, such as those in the monasteries and convents, were identified by the habits they wore. During the Crusades, the adornment of the Maltese Cross was added to the habits. During the Renaissance, the symbol was modified into family coat of arms and were awarded to nurses that provided responsible health care. The nursing pin or badge has continued to evolve over time, each school with their own unique design. Today's nursing school pin identifies the school from which the nurse has graduated and may incorporate the school logo or seal, etc. The nursing pin symbolizes the school's philosophy, beliefs and aspirations. It is evidence of achievement, learning and skills. In addition to nursing pins, nurses around the world were also identified by their school of nursing cap. Nightingale started the tradition of maintaining a registry of all graduates in 1860. Registries of nurses provided institutions, as well as patients, with a system of identifying graduates of particular nursing programs. These list proclaimed to all the skills and knowledge of graduates. These helped to distinguish educated and trained nurses from the lay practitioner and local citizens who provided care to the ill and inform.

A better system (than registries) for ensuring minimal standards/competency among all nurses across settings became necessary Graduate nurses, physicians, and hospitals set criteria for licensure of nurses in the US The primary purpose of licensure is protection of the public

Each program kept a registry of their graduates. As nursing programs proliferated, variations developed among the programs. Entry criteria differed, and many educational programs were structured to meet specific employer needs (remember most nursing programs were hospital based). Registries were no longer sufficient. A better system that ensured consistent minimum standards/competency across settings was needed. Nurses began a worldwide educational campaign explaining the purposes and safeguards inherent in licensure.

Attempts made to license Nurses in the United States

International Council of Nurses passed a resolution that each nation and state examine and license its nurses.

North Carolina, New Jersey, New York, and Virginia were the first to institute permissive licensure

All states had permissive licensure

Early licensure --Permissive licensure - permissive licenses permitted but did not require nurses to become registered. Educational standard-2years of training. State boards were established, rules for examination and also revocation of the license were developed. Each state's licensure examinations varied in content, length, and format and included written, oral, and practice components. There was considerable variability among states in nursing education requirements, the licensure examinations, and the nurse practice acts themselves. Nurses not passing the examination could not use the title of RN.

These early regulations served two purposes: Protect the public from unskilled practitioners Provide legal sanctions to protect the title of RN

Mandatory licensure New York was the first state

Standardized examination for licensure the National League for Nursing (NLN) administered the first State Board Test Pool Examination

National Council Licensure Examination [NCLEX]

Computerized Adaptive Testing [CAT]

The State Board Test Pool Examination format continued for 30 years, many nurses still in practices today took these examinations. 1982-The NCLEX was a revised standardized test that included all nursing content within one section of the examination and the format was changed to present questions in a nursing process format. In 1994 paper and pencil testing was replaced with computerized adaptive testing (CAT). Computer adaptive testing is a test administering technique that uses computer technology and measurement theory. As a candidate answers questions on the examination, CAT adapts to the level of the candidate's knowledge, skills, and ability. Candidates have ample opportunity to demonstrate their competence because the examination does not end until stability of the pass or fail result is certain or times runs out.

National Council of State Boards of Nursing To ensure public protection, NCSBN Member Board jurisdictions require a candidate for licensure to pass an examination that measures the competencies needed to perform safely and effectively as a newly licensed, entry-level nurse. Two examinations NCLEX - RN NCLEX - PN

Each state develops rules and regulations [laws]to govern the practice of nursing within that state written and passed by legislator American Nurses Association (ANA) and later the National Council of State Boards of Nursing (NCSBN) provided a template for nurse practice acts

Widespread variability in nurse practice acts prompted the ANA and later (NCSBN) to design model nurse practice acts. The first was published in 1915. The mode acts as a template for states to follow. The most recent revision of the model practice act and administrative rules was in 2004 From these models each state or jurisdiction developed a unique practice act. Each state board of nursing has established rules and regulations to govern the practice of nursing within that state. Just as other sections of state codes are written and passed by legislators, so is the nurse practice act of each state. The NCBSN maintains a database which contains available NPAs from 49 states, the District of Columbia, and four U.S. territories (Guam, the Northern Mariana Islands, Puerto Rico and the Virgin Islands). Maryland's NPA is not available, per state restrictions.

Scope of Practice outlines the activities nurses can legally perform within the jurisdiction (Cherry p. 76). Click on the tree to go to LSBN decision tree. Basically, if someone does not possess the skills (ie, did not learn in school or did not have specific additional training and demonstrate competency) then they cannot perform. The Nurse Practice act does not list specific skills. Some may say to ask the charge nurse or fellow nurse, some may even say to ask the Physician (wrong answer) or they may think that because the physician orders it, then we can do it. Bottom line-you are responsible not to overstep your scope of practice! Each nurse is accountable for knowing the definition and scope of practice within their jurisdiction/state and practice accordingly.

Purpose of Act Protection of the health and safety of citizens Protect the title of RN Definition of Nursing and Scope of Practice Licensure Requirements Renewal of Licensure Mandatory Continuing Education Sunset legislation may be included Ensures that legislation is current & reflects the needs of the public Ensures NPA must be reviewed by specific date, if not reviewed, automatically rescinded

Components of nurse practice acts-each act begins with a purpose. All nurse practice acts contain two vital purposes: 1-ensure protection to the public health, safety and welfare, and 2-protect the title of the RN. Each NPA defines the practice of professional nursing. It delineates the scope of practice---meaning each act outlines the activities the nurse may legally perform in that state/jurisdiction. The scope of practice is based on the content of the formal education and the level of the nurse. It is different for the RN and LPN/LVN and Advanced Practice Registered Nurse. Each NPA conveys the requirements and procedures necessary for initial entry into nursing practice or nursing licensure. This includes verification of the applicants graduation from the nursing program. It may also include a review of prior legal convictions, recreational drug abuse, etc. Anyone considering practice as a nurse needs to meet licensure requirements prior to practice. After initial licensure, NPA informs of necessary requirements and information needed for license renewal. Every nurse is expected to remain competent to practice via various means of mandatory continuing education. Details of the number of continuing hours and the specific content of continuing education coursework is provide in the NPA and varies from state-to-state.

Reported to the state nursing board

Regulatory board of nurses and consumers to administer the NPA Ensure safe practice Grant and renewal of licensure Addressing concerns of practice

An important section of every NPA is the designation of a regulatory board of nurse and consumers to administer the act. Often the responsibility of the state board of nursing. NPA gives guidelines for this. Membership of the state board of nursing; in most cases, appointed by the governor's office. Names may be suggested for consideration. This board of nursing A major responsibility of the board of nursing is addressing concerns about a nurses' practice. the impact that the LSBN has on their education and how some of the social behaviors can have a detrimental impact on completion of their educations. OUIs and arrest are sent directly to the LSBN by the Louisiana State Troopers. A criminal background investigation is required for admittance into clinical and for licensure

1. Applicants for licensure, reinstatement, or the right to practice as a student nurse shall be denied approval for licensure, for reinstatement, to receive a temporary working permit, to be eligible for NCLEX-RN, or to enter or progress into any clinical nursing course, if the applicant has pled guilty, nolo contendere, "best interest of," been convicted of, or committed a: a. "crime of violence" as defined in R.S. 14:2(13), or any of the following crimes: first degree feticide, second degree feticide, aggravated assault with a firearm, stalking, false imprisonment-offender armed with a dangerous weapon, incest, aggravated incest, molestation of a juvenile, sexual battery of the infirm; or b. crime which involves distribution of drugs.

Regulatory board for the state of LA Located in Baton Rouge, LA Annual license renewal for RN January of every year Current cost $80.00 Continuing education Full-time employment >1600 hours - 5 contact hours Part-time employment 160 hr - 10 contact hr Part-time or unemployed <160 hr - 15 hr

Military and Government nurses Foreign nurse Graduates International practice

Nurses who are employees of the US government who practice in governmental facilities may practice in other jurisdictions other than the state in which they are licensed in without additional licensure requirements. Foreign nurse graduates in addition to showing evidence of completing their original education program must disclose any restrictions on their licensure, demonstrate competency in English and the ability to take and pass the NCLEX-RN examination. In order to sit for the NCLEX - RN, foreign nurses must first pass an examination administered by the Commission on Graduates of Foreign Nursing which is given in English and test the knowledge required to practice in this country. UL nurses who wish to practice in other countries must contact the International Council of Nurses or the nursing regulatory board of the country in which they wish to practice. Each country has specific laws and regulations governing nursing practice that must guide the practice of the UL nurse.

Mutual Recognition Model One multistate license allows you to practice in your home state & other participant states without applying for multiple licenses Still responsible for following laws and regulations of each state in which they practice Greatly facilitates interstate practice, telehealth programs, and movement of nurses to areas of shortage Maintains a national database with information on individual nurses' practice & disciplinary actions NCSBN maintains a list of current NLC states Nurse licensed in one state wants to obtain licensure to practice in a second state that is not a participant of NLC Must 1st check the NPA related to licensure for endorsement Can expect to pay state license fee and follow procedures of endorsement of their initial license before practicing [This allows a nurse licensed in one state to obtain licensure to practice in a second state without examination] Concerns related to monitoring nurses' practice in multiple jurisdictions, nurse privacy and due process rights

differences in practice requirements in different states may cause nurses confusion as to their rights and responsibilities. Nurses have the ability to practice across state lines without applying for multiple licenses If state is not a participant of NLC, the nurse wishing to work in that state [in addition to her home state] can expect to pay that state license fee and follow procedures of endorsement of their initial license before practicing. This allows a nurse licensed in one state to obtain licensure to practice in a second state without examination.

Licensure establishes minimal levels of practice Certification recognizes excellence in practice Certification is awarded by nongovernmental agencies ANCC - central organization for certification of nurses -logo- 'Innovate. Involve. Inspire.' Other specialty organizations offer certification examinations as well

Certification began as a voluntary effort controlled by professional nursing organizations. State agencies were not involved in the credentialing process. This is still the case, although state nurses practice acts do include requirements for nurses to practice in advanced roles. Certification recognizes excellence in practice. It is a way to validate your nursing knowledge/expertise and skills. 'ANCC is the world's largest and most prestigious nurse credentialing organization, and a subsidiary of the American Nurses Association (ANA)' 'The mission of the American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association (ANA), is to promote excellence in nursing and health care globally through credentialing programs' http://www.nursecredentialing.org/

of individual states establish the legal definitions of appropriate delegation practices.

The primary purpose of licensure

The first field of nursing practice to certify advanced practitioners was

Nurses who practice in a compact state are responsible for knowing the laws and regulations of

are included in nurse practice acts so that the act must be reviewed by a specific date. If the act is not renewed, it is automatically rescinded

write and pass nurse practice acts, similar to other sections of states' codes

In most cases, members of the state board of nursing are appointed by the

Nurse practice acts vary according to

do not have to be licensed in every state in which they practice nursing

Voluntary process by which schools of nursing are approved to conduct nursing education programs.

Legal title for nurses who are prepared by education and have the competence to conduct independent practice; advanced practice nursing is based on knowledge and skills acquired through basic nursing education, along with licensure as a registered nurse (RN) and graduate education and experience that includes advanced nursing theory, physical assessment, and psychosocial assessment and treatment of illness. This title applies to nurse practitioners (NPs), certified nurse midwives (CNMs), certified registered nurse anesthetists (CRNAs), and clinical nurse specialists (CNSs).

Professional organization that represents all registered nurses.

An independent agency of the American Nurses Association that conducts certification examinations and certifies advanced practice nurses.

Process by which nurses are recognized for advanced education and competence.

A term of law. In the context of the Nurse Licensure Compact, a state that has established an agreement with other states that allows nurses to practice within the state without an additional license. Interstate compacts are enacted by state legislatures.

A subsidiary of the American Association of Colleges of Nursing (AACN) that is responsible for accrediting baccalaureate and higher degree nursing programs.

A variety of initiatives designed to ensure nurse knowledge, skills, and expertise beyond initial licensure.

Statutory process by which previously licensed persons are included without further action in revisions or additions to Nursing Practice Acts.

Professional organization that represents nurses in countries around the world.

The original program whereby nurses who are licensed in one state seek licensure in another without undergoing repeat examination. Requirements are included in state Nursing Practice Acts or in accompanying rules and regulations.

Educational requirements imposed by individual states for renewal of a license.

Program developed by the National Council of State Boards of Nursing, Inc. The Nurse Licensure Compact program establishes interstate compacts so that nurses who are licensed in one jurisdiction may practice in other compact states without duplicate licensure.

Organization whose membership consists of the board of nursing of each state or territory.

Professional organization whose members represent multiple disciplines. The NLN conducts many types of activities, including accreditation of nursing education programs.

Statute in each state and territory that regulates the practice of nursing.

Appointed board within each state that is charged with the responsibility of administering the Nursing Practice Act of that particular state.

Statutes that provide for revocation of laws if not reviewed and renewed within a specified time period.