1. Nursing licensure and certification began as voluntary but became mandatory to protect the public and establish standards. State boards of nursing develop rules for licensure, while certification is granted by nursing organizations in specific specialties. 2. Early attempts at licensure in the 1890s failed due to lack of support, but by the 1920s all states had licensure requirements. Mandatory licensure began in 1947 with standardized exams following. 3. Nurse practice acts define nursing scope and requirements. They establish licensing boards and are revised through political processes involving nurses and other stakeholders. Delegation and certification are also addressed in some acts.

1. Chapter 4
Nursing Licensure
and Certification
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

2.  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 patients with the means to ascertain
the skills and knowledge of graduates
• Distinguished nurses from lay practitioners and local citizens
who provided care to the ill and infirm
The History of Nursing Licensure
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

3.  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)
3Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

4.  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)
4Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

5.  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”
• Define nursing and scope of practice for RN, description of
advanced practice nursing, requirements for prescriptive
authority for advanced practice, nursing education, compact
guidelines, and process for disciplinary actions
 1923: all states had instituted examinations for
permissive licensure
The History of Nursing Licensure
(cont'd)
5Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

6.  Mandatory licensure
 1947: New York first state to require mandatory
licensure
 1950: NLN administered first State Board Test Pool
Examination, a standardized examination for
licensure
 1982: first NCLEX examination
 1994: paper-and-pencil test replaced by computerized
adaptive testing
The History of Nursing Licensure
(cont'd)
6Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

7.  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)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 7

8.  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
Components of Nurse
Practice Acts
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9.  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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10.  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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11. 1. Components of Nurse Practice Acts include:
A. Definition of professional nursing
B. Certification requirements
C. Education requirements
D. Current NCLEX-RN plan
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12.  1976—California first state to institute mandatory
continuing education for licensure or renewal
 Mandatory continuing education
 Designated clinical practice hours
 Portfolios
 Continuing education requirements are found in
nurse practice acts and in rules and regulations
Continued Competency
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13.  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
13Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

14.  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)
14Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

15.  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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16.  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)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 16

17.  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
Certification
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18. • 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)
18Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

19.  ANCC
 Offers certification in 25 areas of specialty nursing
 Certified more than 250,000 nurses as of 2009
• 80,000 Advanced Practice Registered Nurses
 Purpose
 Recognizes excellence in nursing practice
 Nongovernmental agencies, usually professional
nursing organizations, grant certification
 Requirements and practice opportunities vary
markedly
Certification (cont'd)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 19

20.  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)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 20

21.  Current issues in certification
 Legal issues of scope of practice for advanced
practice nurses
 Reimbursement for nursing services
 Federal regulations allow direct reimbursement for
some nursing services, yet state and local practices
vary
Certification (cont'd)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 21

22. 2. When one differentiates between licensure and certification,
it should be known that:
A. Licensure recognizes advanced practice competence and
knowledge.
B. Certification recognizes entry-level competence and
knowledge.
C. Certification requires only successful completion of a
standardized examination, whereas licensure requires
completion of a set number of clinical hours to be
completed during the nursing education process.
D. Licensure is administered via state boards of nursing,
whereas certification is granted by nongovernmental
agencies.
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23. Delegation of Authority to Others
 Nurse practice acts establish legal
definitions of delegation
 Guidelines for delegation developed by
nursing organizations
23
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

24. Mutual Recognition Model
 Nurse licensure compact (NLC): formed in
1997 by individual states to allow nurses to
practice in more than one state without
applying for multiple licenses
24
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

25.  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
New Issue in Advanced Practice
Nursing
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 25