licensure and nurse practice, the ins and outs

LICENSURE AND THE NURSING PRACTICE ACT

• PROFESSOR • JOE R. LACHER,

M.S.N.,R.N.C.N.A.• ASSOCIATE

PROFESSOR

CREDENTIALING

• DOCUMENT THAT VERIFIES

LEVEL OF ACADEMIC ACHIEVEMENT

LEVEL OF COMPETENCE

LICENSURE

• Process in which government (State) agency grants permission to an individual to practice nursing

• Purpose is to protect the public

• Granted by statutory law by the state legislators.

NURSING REGULATION

• Is the governmental oversight provided for nursing practice in each state.

• Nursing is regulated because it is one of the health professions that pose risk of harm to the public if practiced by someone who is unprepared and incompetent.

• The public may not have sufficient information and experience to identify an unqualified health care provider, and is vulnerable to unsafe and incompetent practitioners.

• Through regulatory processes, the government permits only individuals who meet predetermined qualifications to practice nursing.

• The board of nursing is the authorized state entity with the legal authority to regulate nursing.

• Legislatures enact the Nurse Practice Act for a state.

• The Nurse Practice Act typically:

• Defines the authority of the Board of Nursing, its composition and powers

• Defines nursing and the boundaries of the scope of nursing practice

• Identifies types of licenses and titles

• States the requirements for licensure

• Protects titles

• Identifies the grounds for disciplinary action

• Boards of nursing are authorized to develop administrative rules and regulations that are used to clarify or make the statutes more specific.

• Rules and regulations must be consistent with the Nurse Practice Act, cannot go beyond the law, and, once enacted, have the force and effect of law.

• Public comment periods are provided to allow nurses, students and the public to participate in the rule-making process by submitting written comments or participating in rule-making hearings.

BOARDS OF NURSING

• Nearly 100 years ago, boards of nursing were established by state government to protect the public’s health by overseeing and ensuring the safe practice of nursing.

• Board of nursing achieve this mission by establishing the standards for safe nursing care and issuing licenses to practice nursing.

• Once a license is issued, the board’s job continues by monitoring licensees’ compliance to state law and taking action against the licenses of those nurses who have exhibited unsafe nursing practice.

• Individuals who serve on a board of nursing are appointed to their position. (In Texas by the Governor)

• State law dictates the membership of the board of nursing, which usually includes a mix of registered nurses, licensed practical/vocational nurses, advanced practice registered nurses, and consumers.

• Together, they met often to oversee board of nursing activities and to take disciplinary action on nurses licenses as necessary.

• The boards of nursing in the 50 states, the District of Columbia, and five United States territories—Guam, Virgin Islands, Puerto Rico, American Samoa, and the Northern Mariana Islands—comprise the membership of the National Council of State Boards of Nursing.

• Four states have two boards of nursing, one for registered nurses and one for licensed practical/vocational nurses: California, Georgia, Louisiana, and West Virginia. Texas had two boards till Feb of 2004.

• Texas now has one board of nursing for both RNs and LVNs.

REGULATION OF NURSING

• Under the supervision of the Executive Branch of State Government

• Board of Nurse Examiners appointed by the Governor are delegated the responsibility of administering and implementing the Nurse Practice Act.

BOARD OF NURSE EXAMINERS

• Grants licensure

• Exercises legal control over schools of nursing

• Monitors and controls the practice of nursing

FUNCTIONS OF BOARD OF NURSE EXAMINERS

• Has authority to:

• Administer the nursing practice act

• Adopt rules necessary to implement the act

• To deny, suspend or revoke a license to otherwise discipline a licensee, or to deny an application for licensure

LICENSURE

• In order to practice nursing in the United States:

• Must complete nursing education• Must successfully complete the National

Council Licensure Examination for Registered Nurses (NCLEX)

• Then can say is Registered Nurse and sign RN after name

LICENSURE

• OBTAINED BY”• EXAMINATION• ENDORSEMENT• North Dakota is only state that does not

accept endorsement. N. D. requires BSN for RN

• A.D.N. required for Practical Nurse (LPN/LVN)

CERTIFICATION

• A voluntary process in which an individual who is licensed to practice has a predetermined standard for specialty practice

• Beyond initial licensure

• Necessary for advanced practice

NURSING PRACTICE ACT

• The statutory law that defines the practice of nursing.

• Amplified by the BNE Rules and Regulations

• THE NATIONAL COUNCIL LICENSURE EXAMINATION

PURPOSE

• Ensure public protection

• Measures competencies needed to perform safely and effectively as a new registered nurse

• Tests for entry level nursing

NCLEX – RN

FOCUSES ON

• CLIENTS NEEDS

NCLEX – RN TEST PLAN

• Health Promotion and Maintenance– Growth and Development Through the Life

– Number of questions in this Client needs area will decrease

– There will no longer be subcategories

– All this content will be related to normal health promotion

– New Topic: Self care which used to be an integrated thread will now be tested in this client needs area

NCLEX – RN TEST PLAN

• Psychological Integrity

• Number of questions in this client needs area will decrease

• There will no longer be subcategories

• New Topic: Cultural awareness which used to be an integrated thread will now be tested in this client needs area

NCLEX – RN TEST PLAN

• Physiological Integrity• Number of questions in this client needs

area will increase• There will be an increase emphasis on

pharmacology questions• Subcategory: Basic Care and Comfort –

New Topic;– Alternative and complementary therapies

Physiological Integrity cont.

• Subcategory: Pharmacological and Parenteral Therapies _ New Topic:

• Dosage calculation• Subcategory: Reduction in risk potential – New

Topic• Monitoring for conscious sedation• Subcategory: Physiological adaptation – New

topic• Illness management

INTEGRATED CONCEPTS AND PROCESSES

• The integrated concepts and processes, which were threads in the NCLEX_RN 2001 Test Plan, will now be called “Integrated Processes” in the NCLEX-RN 2004 Test Plan. These content areas, considered fundamental to nursing practice, will include:

• NURSING PROCESS

• CARING

• COMMUNICATION AND DOUCMENTATION

• TEACHING/LEARNING

• As previously noted, Self Care and Cultural awareness, which were formerly considered integrated concepts, have now been moved to within other client needs categories.

DISTRIBUTION OF CONTENT

• Categories Percentage of

» Test Question

DISTRIBUTION OF CONTENT

• Safe, Effective Care Environment

• Management of Care 13-19%

• Safety and Infection Control 8-14%

DISTRIBUTION OF CONTENT

• Health Promotion and Maintenance

• 6-12%

DISTRIBUTION OF CONTENT

• Psychosocial Integrity

• 6-12%

DISTRIBUTION OF CONTENT

• Physiological Integrity

• Basic Care and Comfort 6-12%

• Pharmacological and

• Parenteral Therapies 13-19%

• Reduction of Risk Potential 13-19%

• Physiological adaptation 11-17%

COGNITIVE LEVEL

• Includes questions that are– Knowledge– Comprehension– Application– analysis

COGNITIVE LEVEL

MAJORITY OF QUESTIONS ARE APPLICATION AND/OR ANALYSIS

EXAMINATION

Reflects Entry-Level Nursing PracticeIdentified by: 2002 Job Analysis Study of

Newly Licensed, Entry-Level Registered Nurses

DEVELOPMENT OF TEST QUESTIONS

• NURSES NOMINATED BY BOARD WRITE QUESTIONS

• QUESTIONS ARE REVIEWED BY PANEL OF EXPERTS

• QUESTIONS ARE REVIEWED BY BOARD AND NATIONAL COUNCIL EXAMINATION COMMITTEE

DEVELOPMENT OF TEST QUESTIONS

• QUESTIONS ARE TESTED IN ACTUAL EXAM

NCLEX EXAM

• THE EXAM WILL BE TAKEN ON A COMPUTER

• YOU ONLY NEED TWO KEYS– THE SPACEBAR– THE “ENTER” KEY

NCLEX EXAM

• OPPORTUNITY TO PRACTICE BEFORE THE EXAM

• NO PENALTY FOR GUESSING• MAY TAKE TIME TO REVIEW RESPONSE

BEFORE YOU CONFIRM YOUR ANSWER• MAY NOT PROCEED TO NEXT SCREEN

WITHOUT ANSWERING CURRENT QUESTION.

NCLEX EXAM

• CAN NOT GO BACK AND CHANGE ANSWERS

LENGTH OF EXAM

– MINIMUM OF 75 QUESTIONS– MAXIMUM OF 265 QUESTIONS– Of these items, 15 are pretest items and are not

scored.– MAXIMUM OF Sic (6) HOURS

COMPUTER

• THE COMPUTER WILL STOP TESTING– AT THE END OF SIX (6) HOURS– WHEN MAXIMUM NUMBER OF

QUESTIONS HAVE BEEN ANSWERED– AFTER MINIMUM NUMBER OF

QUESTIONS HAVE BEEN ANSWERED

COMPUTER

• THE COMPUTER WILL STOP TESTING– WHEN THE CANDIDATE’S LEVEL OF

PERFORMANCE HAS BEEN ESTABLISHED WITH CERTAINTY

NCLEX QUESTIONS

• THE NUMBER OF QUESTIONS AND THE LENGTH OF TIME SPENT ON THE EXAMINATION WILL VARY FOR EACH INDIVIDUAL CANDIDATE

• Most candidates finish in less than two and a half hours.

NCLEX QUESTIONS

• NEITHER THE LENGTH OF TIME THAT YOU ARE TESTED NOR THE NUMBER OF QUESTIONS THAT YOU ANSWER ARE AN INDICATION OF PASSING OR FAILING

NCLEX EXAM

• COMPUTERIZED ADAPTIVE TEST– The exam has various levels of difficulty– The examination selects the level of difficulty

of the next question based on the correctness of candidate’s response to the current question.

NCLEX EXAM

• CRITERION REFERENCES STANDARD– PASSING OR FAILING DEPENDS ON THE

CANDIDATE’S LEVEL OF PERFORMANCE IN RELATION TO THE ESTABLISHED POINT THAT REPRESENTS ENTRY-LEVEL COMPETENCE

•GOOD LUCK