- Email: [email protected]
Who is deciding in which direction nursing is headed?
Editorial
Who is deciding in which direction nursing is headed? Nursing is sort of like a pushmi-pullyu.Do you remember Dr Dolittle's two-headed animal who was going both ways at once? Nursing sometimes seems in this predicament. At its spring meeting, the National Council of State Boards of Nursing (NCSBN) distributed a draft for a model nursing practice act. When the 45-page document is final, it will be distributed to individual state boards for them to use as a guide, if they wish, in revising their nursing practice acts. Modelacts such as this are usuallydesigned to reform laws that are out of date or for some reason inadequate. In the introduction, the NCSBN comments that some nursing practice acts are out of date, some omit essential provisions, and some are internally inconsistent. The council sees a need for enough uniformity among states so that the practice of nursing can be viewed in a similar manner throughout the nation. The model act would serve as a standard by which the comprehensiveness and effectiveness of state nursing laws could be assessed. The NCSBN acknowledges that some of the provisions are novel and even futuristic. And rightfullyso, but some of these provisionshave caused a stir among nurses. As you may remember, the NCSBN used to be affiliated with the American Nurses' Association (ANA) but established itself as an independent entity in 1978. Members are the state boards of nursing. Although it is probably appropriate that the NCSBN be autonomous, it
does appear that in some instances the two groups are working against each other. For example, ANA has developed a mechanism for accrediting continuing education, but to its frustration, some state boards of nursing do not recognize that accreditation. We discussed the model nursing practice act at a recent PAC meeting. (PAC is the Professional Advisory Committee made up of nurses on the Headquarters staff.) The AORN Board members have also commented on the draft. As we discussed the document, it again appeared that the NCSBN and ANA were going in two different directions. Some of the issues addressed in the model nursing practice act, such as titles and competencies, will be coming up for discussion at the next ANA convention in Washington, DC, June26 to July 2, 1982. Will the NCSBN be making its recommendations independent of the decisions of the professional organization? As you recall, ANA has been grappling with the issue of entry into practice. The professional organization has taken a position advocating two levels, one professional, one assisting. But when it came to putting titles on these two groups, the issue was too controversial. At the last ANA convention in 1980, action was postponed. But not to worry. The NCSBN offers some new titles: licensed nurse (LN) and licensed affiliate nurse (LAN).Thelicensed nurse would practice at the professionallevel, the licensed affiliate nurse at the paraprofessional level. The LAN's functions are quite limited, except that this person can provide health teaching and counseling. Surprisingly, the document completely sidesteps the question of what would be the educational preparationof either group.
AORN Journal, October 1981, Vol.34, No 4
585
Based on the responses here, we doubt that this suggestionfor new titles is going to be any more popular than those of ANA. Critics of the document have trouble with some of the definitions of terms. The definition of nursing, for example, makes no distinction between the functions of the two levels of nurses. “Specialists” are defined as practitioners who “choose to focus their practice in a particular area of nursing in which they have specialized knowledge.” Although the term “specialist” is still used in a variety of ways, ANA has been attempting to give that word a precise meaning based on specific educational and practice requirements. “Competency” is broadly defined as “performing skillfully and proficiently the functions within the role of the licensee and demonstrating the interrelationship of essential knowledge, judgment, attitudes, values, and skills.” “Skillfully” and “proficiently” are subjective terms and difficult to measure. This model practice act introduced a new concept in licensing-a “limited license.” This would permit a person to practice nursing in a restricted capacity and would apply to those with a handicap or nurses who had been subjected to disciplinaryaction by the board. In our discussion, some felt that restrictionsbased on a physical limitationshould be up to the institution. The question of temporary licenses generated some heat. One person opposed a temporary license for new graduates until they had passed the first licensing exam, but another with a background in nursing administration thought it was only realistic. The titles? TLN and TLAN. Two proposals in the document have rattled the cages of some nurses, but perhaps unjustifiably. One is the provision that state boards of nursing should accredit nursing education programs. Many do not realize that there are two kinds of accreditation, mandatory and voluntary. States have always approved nursing education programs as part of their function of safeguarding public health, safety, and welfare. A nursing school cannot operate without state approval or accreditation. State accreditation would not replace or conflict with the voluntary accreditation of the National League for Nursing. Another concern that has been voiced is
586
over the provision that the state boards should set standards for nursing practice. But through rules and regulations, state boards of nursing now set standards as part of their legal function of protectingthe public from incompetent practitioners. Again, this does not negate or replace voluntary standards set by the profession. Although nursing organizations have not been asked specifically to comment on the draft, AORN will send a response to NCSBN based on the Board comments and PAC discussion. What use is made of the final version of the model nursing practice act will probably depend on how acceptable it is to the majority of nurses. In the meantime, perhaps nursing might want to consider adopting the pushmi-pullyu as its mascot.
Elinor S Schrader Editor
ECRI offers seminar on OR environment ECRI will be presenting a seminar entitled “Current Issues in Operating Room Technology” this fall. The seminar will be presented in Minneapolis (Oct 31), Pittsburgh (Nov 12), and Houston (Nov 14). The program will include detailed discussion of specific areas of the operating room environment.The objective of the program is to give the registrant information and skills necessary to make the OR safer for both patients and staff. Information The seminar is intended for surgeons, anesthesiologists,nurse anesthetists, clinical and biomedical engineers, BMETs, safety officers, risk managers, OR nurses, OR supervisors, and administrators.The programs will be sponsored by the Medical MalpracticeJoint Underwriting Association of Massachusetts and the Western Massachusetts Society of Hospital Engineers, the Risk Management Foundationof Harvard Medical Institution, North Star Casualty Services Inc, the Hospital Association of Pennsylvania,and ECRI.
AORN Journal, October 1981, V o l 3 4 , No 4
Who is deciding in which direction nursing is headed? Nursing is sort of like a pushmi-pullyu.Do you remember Dr Dolittle's two-headed animal who was going both ways at once? Nursing sometimes seems in this predicament. At its spring meeting, the National Council of State Boards of Nursing (NCSBN) distributed a draft for a model nursing practice act. When the 45-page document is final, it will be distributed to individual state boards for them to use as a guide, if they wish, in revising their nursing practice acts. Modelacts such as this are usuallydesigned to reform laws that are out of date or for some reason inadequate. In the introduction, the NCSBN comments that some nursing practice acts are out of date, some omit essential provisions, and some are internally inconsistent. The council sees a need for enough uniformity among states so that the practice of nursing can be viewed in a similar manner throughout the nation. The model act would serve as a standard by which the comprehensiveness and effectiveness of state nursing laws could be assessed. The NCSBN acknowledges that some of the provisions are novel and even futuristic. And rightfullyso, but some of these provisionshave caused a stir among nurses. As you may remember, the NCSBN used to be affiliated with the American Nurses' Association (ANA) but established itself as an independent entity in 1978. Members are the state boards of nursing. Although it is probably appropriate that the NCSBN be autonomous, it
does appear that in some instances the two groups are working against each other. For example, ANA has developed a mechanism for accrediting continuing education, but to its frustration, some state boards of nursing do not recognize that accreditation. We discussed the model nursing practice act at a recent PAC meeting. (PAC is the Professional Advisory Committee made up of nurses on the Headquarters staff.) The AORN Board members have also commented on the draft. As we discussed the document, it again appeared that the NCSBN and ANA were going in two different directions. Some of the issues addressed in the model nursing practice act, such as titles and competencies, will be coming up for discussion at the next ANA convention in Washington, DC, June26 to July 2, 1982. Will the NCSBN be making its recommendations independent of the decisions of the professional organization? As you recall, ANA has been grappling with the issue of entry into practice. The professional organization has taken a position advocating two levels, one professional, one assisting. But when it came to putting titles on these two groups, the issue was too controversial. At the last ANA convention in 1980, action was postponed. But not to worry. The NCSBN offers some new titles: licensed nurse (LN) and licensed affiliate nurse (LAN).Thelicensed nurse would practice at the professionallevel, the licensed affiliate nurse at the paraprofessional level. The LAN's functions are quite limited, except that this person can provide health teaching and counseling. Surprisingly, the document completely sidesteps the question of what would be the educational preparationof either group.
AORN Journal, October 1981, Vol.34, No 4
585
Based on the responses here, we doubt that this suggestionfor new titles is going to be any more popular than those of ANA. Critics of the document have trouble with some of the definitions of terms. The definition of nursing, for example, makes no distinction between the functions of the two levels of nurses. “Specialists” are defined as practitioners who “choose to focus their practice in a particular area of nursing in which they have specialized knowledge.” Although the term “specialist” is still used in a variety of ways, ANA has been attempting to give that word a precise meaning based on specific educational and practice requirements. “Competency” is broadly defined as “performing skillfully and proficiently the functions within the role of the licensee and demonstrating the interrelationship of essential knowledge, judgment, attitudes, values, and skills.” “Skillfully” and “proficiently” are subjective terms and difficult to measure. This model practice act introduced a new concept in licensing-a “limited license.” This would permit a person to practice nursing in a restricted capacity and would apply to those with a handicap or nurses who had been subjected to disciplinaryaction by the board. In our discussion, some felt that restrictionsbased on a physical limitationshould be up to the institution. The question of temporary licenses generated some heat. One person opposed a temporary license for new graduates until they had passed the first licensing exam, but another with a background in nursing administration thought it was only realistic. The titles? TLN and TLAN. Two proposals in the document have rattled the cages of some nurses, but perhaps unjustifiably. One is the provision that state boards of nursing should accredit nursing education programs. Many do not realize that there are two kinds of accreditation, mandatory and voluntary. States have always approved nursing education programs as part of their function of safeguarding public health, safety, and welfare. A nursing school cannot operate without state approval or accreditation. State accreditation would not replace or conflict with the voluntary accreditation of the National League for Nursing. Another concern that has been voiced is
586
over the provision that the state boards should set standards for nursing practice. But through rules and regulations, state boards of nursing now set standards as part of their legal function of protectingthe public from incompetent practitioners. Again, this does not negate or replace voluntary standards set by the profession. Although nursing organizations have not been asked specifically to comment on the draft, AORN will send a response to NCSBN based on the Board comments and PAC discussion. What use is made of the final version of the model nursing practice act will probably depend on how acceptable it is to the majority of nurses. In the meantime, perhaps nursing might want to consider adopting the pushmi-pullyu as its mascot.
Elinor S Schrader Editor
ECRI offers seminar on OR environment ECRI will be presenting a seminar entitled “Current Issues in Operating Room Technology” this fall. The seminar will be presented in Minneapolis (Oct 31), Pittsburgh (Nov 12), and Houston (Nov 14). The program will include detailed discussion of specific areas of the operating room environment.The objective of the program is to give the registrant information and skills necessary to make the OR safer for both patients and staff. Information The seminar is intended for surgeons, anesthesiologists,nurse anesthetists, clinical and biomedical engineers, BMETs, safety officers, risk managers, OR nurses, OR supervisors, and administrators.The programs will be sponsored by the Medical MalpracticeJoint Underwriting Association of Massachusetts and the Western Massachusetts Society of Hospital Engineers, the Risk Management Foundationof Harvard Medical Institution, North Star Casualty Services Inc, the Hospital Association of Pennsylvania,and ECRI.
AORN Journal, October 1981, V o l 3 4 , No 4