Chapter 3
Nursing Licensure
and Certification
Wendy Stoelting-Gettelfinger
The Regulation of
Nursing Practice
• Board of nursing (BON)
– State-specific licensing or regulatory body.
– Sets standards for safe nursing care.
– Decides scope of practice for nurses.
– Issues a license to a qualified nurse.
The Regulation of
Nursing Practice, cont.
• National Council of State Boards of
Nursing (NCSBN)
– Representatives from all state and
territories.
– Adopted guiding principles for nursing
regulation.
The Regulation of
Nursing Practice, cont.
• Nurse practice acts (NPAs)
–
–
–
–
State or territorial statutes.
Define legal limits for practice of nursing.
Identify requirements for licensure.
NCSBN Model Nursing Practice Act and
Model Nursing Administrative Rules.
Nurse Practice Act
and Administrative Rules
• NCSBN maintains database on website
(http://www.ncsbn.org/contactbon.htm).
– Electronic contact information for state
boards of nursing
Nurse Practice Act and
Administrative Rules, cont.
• Five rights of delegation
–
–
–
–
–
Right task
Under the right circumstances
To the right person
With right directions and communication
Under the right supervision and evaluation
History of State Boards and
Their Regulatory Functions
• 1903: North Carolina first state to pass
a nursing regulation law.
• 1900s: States initiated governmentestablished boards of nursing.
History of State Boards and
Their Regulatory Functions, cont.
• Functions of state boards of nursing
– Issue licenses and manage renewal
process.
– Establish nursing practice standards.
– Regulate advanced practice nursing.
– Approve operation of nursing education
programs.
History of State Boards and
Their Regulatory Functions, cont.
• Functions of state boards of nursing
– Investigate complaints against licensed
practitioners.
– Hold disciplinary hearings, suspending or
revoking licensure if necessary.
– Promulgate all rules related to regulation
of nursing practice.
Nurse Licensure and Advance
Practice Registered Nurse Compact
• Compacts
– Allow nurses to practice and communicate
with patients across state lines.
– States must enter into an NLC in order to
achieve mutual recognition.
– Mutual recognition model.
History of the Nurse
Licensure Compact
• 1996: NCSBN Delegate Assembly.
• 2000: Nurse Licensure Compact
Administrators (NLCA) organized.
• 2015: NCSBN Delegate Assembly
adopted enhanced compact language.
Nursing Licensure
• Form of credentialing or regulatory
method.
• Addresses both qualification and
disciplinary activities.
• Each state’s or territory’s BON grants
licensure within that jurisdiction.
History of Nursing Licensure
• 1903: North Carolina first to enact
nurse practice act.
• 1923: All states enacted nurse practice
acts.
• 1955: ANA model definition of nursing.
• 1982: National Council Licensure
Examination for Registered Nurses
(NCLEX-RN).
Requirements for
Nursing Licensure
• National Council Licensure
Examination for Registered Nurses
(NCLEX-RN)
• NCLEX for Practical Nurses
(NCLEX-PN)
– Measures competencies for licensed,
entry-level nurses.
Certification
• Form of credentialing.
• Demonstrates attainment of increased
knowledge.
• Organizations can also be certified.
• “Magnet status”
– Based on strength and quality of nursing
• Positive nursing experience benefits.
Differences Between
Licensure and Certification
• Certification
– Granting of credentials.
– Implies only specialized skill or knowledge
set associated with specific professional
status.
• Licensure
– Implies a legal status.
– Form of legal certification.
Regulation of Advanced
Practice Registered Nurses
• NCSBN recommends APRN
certification examinations for APRN
credentialing.
– Depends on each state’s NPA.
• 2008: Consensus Model for APRN
Regulation: Licensure, Accreditation,
Certification and Education (LACE
Model)
Standard of Care
• Legal concept all nurses should
understand.
• Standard or measure of behavior.
• Accepted reasonable practice of care.
• Failure could endanger health, safety,
and welfare of public.
• Malpractice actions.
Official Resources for
Determining Standards of Care
•
•
•
•
•
•
•
State statues and administrative codes
Nurse practice acts
American Nurses Association
The Joint Commission
State and federal case law
Hospital policies
Specialty nurse organizations