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California proposal would seriously alter nursing profession
Legislation
California proposal would seriously alter nursing profession The California legislature is considering a bill that would radically change the state’s licensing system for nursing. If Senate Bill 666 becomes law: Registerednurses would no longer be in a position to determine their qualifications or scope of practice. 0 Work experience and competencytesting could be substituted for education as qualifications for RN and licensed vocational nurse (LVN) licensure. For example, an LVN could become an RN by working for a specified time and then taking a test. She would not have to return to school. Mandatory continuing education for nurses would be repealed. The bill is the result of a project to overhaul the state’s system for for regulating health care providers. (See AORN Journal, March 1979, 688-693.) Presently, nurses are regulated by two boards and two departments. Because this leads to ”duplicative and uncoordinated regulation of nursing education and practice,” the state’s Department of Consumer Affairs proposed that nursing activities be consolidated under one board, to be named the Board of Nursing Services. The eleven-member board would include three consumers, two RNs, two LVNs, two nurse assistants, and two licensed psychiatric technicians. Simple arithmetic shows that RNs would never compose a majority for any decision. (The present RN board of nine members has three consumers, five RNs, and one physician.)
854
a
This new consolidated nursing board would have the power to determine scope of practice for all the nursing categories. They would also have jurisdiction over qualifications for licensure and content of nursing education programs. Although the present scope of practice for registered nurses is retained in the bill, the board would have the power to expand the scopes of practice for LVNs and psychiatric technicians. It would be possible for them to rule that the scope of practice for LVNs is the same as that of RNs. The bill would retain the three types of generic RN education programs (associate degree, diploma, and baccalaureate). But work experience and competency testing could be substituted for education. In a careerladder structure, nurse assistants could become LVNs, and LVNs could become RNs without more education. To promote career mobility further, the curriculum for LVNs would have to be entirely incorporated into all RN generic programs. As the law now stands, LVNs may qualify for RN licensure by taking 30 additional units within a specifiedtime. The state argues that only afew LVNs do this-about 15 a year. Registered nurse education could be offered in any health care or education facility. It would not have to be affiliated with colleges, universities, or junior colleges. For example, an RN program might be offered in a high school district’s adult continuing education program. The new Board of Nursing Services would have the authority to determine subjects of study and the amount of education necessary for minimum clinical competence. They would also be charged with approving the generic education programs in the state. Also, they
AORN Journal, November 1979,Vol30, No 5
would set the length of work experience necessary to progress up the career ladder. A statewide nursing shortage and long waiting lists for some schools of nursing are state government’s rationales for introducing the bill. The state says some schools maintain three-year waiting lists with no preference given for previous nursing education or experience. Lack of career mobility is another problem the state is seeking to correct. Minorities, woman heads of families, and those already employed in nursing are having difficulty advancing in their careers. The state reports that less than 1% of the state’s Hispanic population is in the upper levels of nursing, and only 2.7% of RNs are black. California’s population is 15.8% Hispanic and 7.7% black. Meanwhile, the National League for Nursing (NLN) has reportedthat applicationsto nursing schools and waiting lists declined dramatically in 1978. Nationwide, there was a 16% decrease in those applying to RN education programs. The decrease in applications in turn reduced waiting lists. For RN education programs, waiting lists dropped 13%, and for practical nurse programs, waiting lists dropped 18%. Whether this trend is reflected in California is not known. Proposals in Senate Bill 666 run counter to accepted principles of nursing education and the regulation of professions. Nursing has traditionally been defined as a profession with a scientific body of knowledge. In its model curriculum for nursing in the operating room, AORN states, “Nursing is a science and derives a large portion of this knowledge base from the natural and behavioral sciences and from the humanities and social sciences” (Surgical Experience, 1978, p 11). Removing RN education programs from higher education institutions where these subjects are taught is not consistent with that philosophy. The proposedcompositionof the board,with a majority of non-RNs, also violates the concept that professional nurses are responsible for the supervision of lesser prepared personnd. One definition of a profession is that it is self-regulating. With a board composed primarily of non-RNs, the profession would no longer have the authority to control scope of practice, qualifications for licensure, or education programs.A state’s Nursing PracticeAct is
856
the major law governing nursing practice. If RNs no longer have legal authority over their own practice, nursing could change radically, and they would be powerless to prevent it. The California Nurses’ Association (CNA) has announcedits oppositionto the bill. JoAnn Smith, CNA legislative representative, said CNA would meet in September with other nursing organizations to make lobbying plans. Patricia Hunter-Crabbe, legislative chairman and president-elect of AORN of San Diego County (Calif), reports the chapter has been actively involved in opposing the bill. They have been meeting with CNA and ten local groups. “SB 666 seeks to address a problem of supply and demand, which is not the purpose of licensing laws,” said Vickie Pierce, RN, a chapter member and staff nurse at Sharp Memorial Community Hospital, San Diego. “It appears to me that our governor is interested in only one thing: to increase the number of nurses and save money. I approve of these concerns but not at the expense of our patients.” “It’s inconceivablethat a law can be passed that would substitute for education experience without consideration for the quality or content,” JoAnn Stuebing, RN, chapter president, said. Lorraine Tatton, member of the AORN Legislative Committee and AORN of San Jose (Calif) said her chapter is also concerned. OR nurses in the area are asking how the bill would affect their interstate mobility. One AORN member said she was“extreme1y disappointed in the leadership of this state,” and another said, “I feel that the licensing process should be as closely controlled as it is for dentists, physicians,or veterinary medicine.” No similar measures have been proposed for other professions. California nurses are urged to write for a copy of the bill to Legislative Bill Room, Room 1149, State Capitol, Sacramento, Calif 95814. Then contact your chapter or CNA to get involved.
AORN Journal, November 1979,Vol30, No 5
Patricia Allen Associate editor
California proposal would seriously alter nursing profession The California legislature is considering a bill that would radically change the state’s licensing system for nursing. If Senate Bill 666 becomes law: Registerednurses would no longer be in a position to determine their qualifications or scope of practice. 0 Work experience and competencytesting could be substituted for education as qualifications for RN and licensed vocational nurse (LVN) licensure. For example, an LVN could become an RN by working for a specified time and then taking a test. She would not have to return to school. Mandatory continuing education for nurses would be repealed. The bill is the result of a project to overhaul the state’s system for for regulating health care providers. (See AORN Journal, March 1979, 688-693.) Presently, nurses are regulated by two boards and two departments. Because this leads to ”duplicative and uncoordinated regulation of nursing education and practice,” the state’s Department of Consumer Affairs proposed that nursing activities be consolidated under one board, to be named the Board of Nursing Services. The eleven-member board would include three consumers, two RNs, two LVNs, two nurse assistants, and two licensed psychiatric technicians. Simple arithmetic shows that RNs would never compose a majority for any decision. (The present RN board of nine members has three consumers, five RNs, and one physician.)
854
a
This new consolidated nursing board would have the power to determine scope of practice for all the nursing categories. They would also have jurisdiction over qualifications for licensure and content of nursing education programs. Although the present scope of practice for registered nurses is retained in the bill, the board would have the power to expand the scopes of practice for LVNs and psychiatric technicians. It would be possible for them to rule that the scope of practice for LVNs is the same as that of RNs. The bill would retain the three types of generic RN education programs (associate degree, diploma, and baccalaureate). But work experience and competency testing could be substituted for education. In a careerladder structure, nurse assistants could become LVNs, and LVNs could become RNs without more education. To promote career mobility further, the curriculum for LVNs would have to be entirely incorporated into all RN generic programs. As the law now stands, LVNs may qualify for RN licensure by taking 30 additional units within a specifiedtime. The state argues that only afew LVNs do this-about 15 a year. Registered nurse education could be offered in any health care or education facility. It would not have to be affiliated with colleges, universities, or junior colleges. For example, an RN program might be offered in a high school district’s adult continuing education program. The new Board of Nursing Services would have the authority to determine subjects of study and the amount of education necessary for minimum clinical competence. They would also be charged with approving the generic education programs in the state. Also, they
AORN Journal, November 1979,Vol30, No 5
would set the length of work experience necessary to progress up the career ladder. A statewide nursing shortage and long waiting lists for some schools of nursing are state government’s rationales for introducing the bill. The state says some schools maintain three-year waiting lists with no preference given for previous nursing education or experience. Lack of career mobility is another problem the state is seeking to correct. Minorities, woman heads of families, and those already employed in nursing are having difficulty advancing in their careers. The state reports that less than 1% of the state’s Hispanic population is in the upper levels of nursing, and only 2.7% of RNs are black. California’s population is 15.8% Hispanic and 7.7% black. Meanwhile, the National League for Nursing (NLN) has reportedthat applicationsto nursing schools and waiting lists declined dramatically in 1978. Nationwide, there was a 16% decrease in those applying to RN education programs. The decrease in applications in turn reduced waiting lists. For RN education programs, waiting lists dropped 13%, and for practical nurse programs, waiting lists dropped 18%. Whether this trend is reflected in California is not known. Proposals in Senate Bill 666 run counter to accepted principles of nursing education and the regulation of professions. Nursing has traditionally been defined as a profession with a scientific body of knowledge. In its model curriculum for nursing in the operating room, AORN states, “Nursing is a science and derives a large portion of this knowledge base from the natural and behavioral sciences and from the humanities and social sciences” (Surgical Experience, 1978, p 11). Removing RN education programs from higher education institutions where these subjects are taught is not consistent with that philosophy. The proposedcompositionof the board,with a majority of non-RNs, also violates the concept that professional nurses are responsible for the supervision of lesser prepared personnd. One definition of a profession is that it is self-regulating. With a board composed primarily of non-RNs, the profession would no longer have the authority to control scope of practice, qualifications for licensure, or education programs.A state’s Nursing PracticeAct is
856
the major law governing nursing practice. If RNs no longer have legal authority over their own practice, nursing could change radically, and they would be powerless to prevent it. The California Nurses’ Association (CNA) has announcedits oppositionto the bill. JoAnn Smith, CNA legislative representative, said CNA would meet in September with other nursing organizations to make lobbying plans. Patricia Hunter-Crabbe, legislative chairman and president-elect of AORN of San Diego County (Calif), reports the chapter has been actively involved in opposing the bill. They have been meeting with CNA and ten local groups. “SB 666 seeks to address a problem of supply and demand, which is not the purpose of licensing laws,” said Vickie Pierce, RN, a chapter member and staff nurse at Sharp Memorial Community Hospital, San Diego. “It appears to me that our governor is interested in only one thing: to increase the number of nurses and save money. I approve of these concerns but not at the expense of our patients.” “It’s inconceivablethat a law can be passed that would substitute for education experience without consideration for the quality or content,” JoAnn Stuebing, RN, chapter president, said. Lorraine Tatton, member of the AORN Legislative Committee and AORN of San Jose (Calif) said her chapter is also concerned. OR nurses in the area are asking how the bill would affect their interstate mobility. One AORN member said she was“extreme1y disappointed in the leadership of this state,” and another said, “I feel that the licensing process should be as closely controlled as it is for dentists, physicians,or veterinary medicine.” No similar measures have been proposed for other professions. California nurses are urged to write for a copy of the bill to Legislative Bill Room, Room 1149, State Capitol, Sacramento, Calif 95814. Then contact your chapter or CNA to get involved.
AORN Journal, November 1979,Vol30, No 5
Patricia Allen Associate editor