Are You Really a Nurse?

[Nurse Beth]

Test Your Knowledge

Before reading the article, take the short true or false poll at the bottom of the article to test your knowledge.

Do you cringe when people use the word "nurse" loosely? Or worse, refer to themselves as a "nurse" when they are neither a Registered Nurse (RN) nor a Licensed Practical (or vocational) Nurse?

I do. I cringe. As an RN who worked hard to pass the National Council Licensure Examination (NCLEX) and just as hard to pass the pre-requisites of organic chemistry, anatomy and physiology, I support protecting the title of nurse and restricting its use to those who have done the same.

Nursing Assistants

Technically Certified Nursing Assistants (CNAs) are certified, not licensed, although the terms are often used interchangeably.

Certified means the person has received specialized training. Certification requirements vary state-to-state but usually the person has received 12-16 weeks of training and taken an exam.

Licensed means the person has passed a standardized nationwide exam (NCLEX) and may practice nursing under a scope of practice defined by state law.

Medical Assistants

Medical Assistants are trained to work in office settings, but they are not licensed and are not nurses. Medical Assistants may give injections, change dressings, and more because they perform under the direction and supervision of a doctor (or other licensed provider).

In other words, they cannot perform these functions independently.

Office Staff

The term "nurse" is often used to include anyone employed in a doctor's office.

The perception of nurses as handmaidens led to any female associated with a doctor in a helping capacity being called a "nurse".

Ironically, doctors rarely employ RNs because of the cost.

Receptionists in a doctor's office have been known to refer to themselves as "nurses" or allow patients to do so. They should politely correct people who refer to them as "nurse", the same as teacher's aides should correct those who call them teachers and paralegals should correct those who call them lawyers.

Graduates of approved nursing schools/programs

Persons who have completed an approved nursing school but have not passed the National Council Licensure Exam (NCLEX) are not nurses and may not refer to themselves as nurses.

Completing an approved nursing program of study is required in order to sit boards (NCLEX) but does not confer a nursing license. A nursing license is issued after successfully passing the NCLEX.

It's possible to hold a Bachelor's degree of Science in Nursing (BSN) and not be a nurse.

A BSN is an academic degree, but schools do not issue nursing licenses. States issue nursing licenses.

Licensure

Practitioners of nursing must have a license to practice nursing and to represent themselves as a nurse.

A license is a state's grant of legal authority to practice a profession within a designated scope of practice.

The only people that are licensed to practice nursing are:

• Licensed Practical Nurses (LPNs)
• Licensed Vocational Nurses (LVNs)
• Registered Nurses (RNs)

Nursing regulates its profession through licensing in that the NCLEX is uniform across all states.

A nursing license is like a driver's license in that it is:

• Issued by the state
• Granted to those who meet requirements
• Renewed at regular intervals
• Required to drive (practice)

"Restricting use of the title "nurse" to only those individuals who have fulfilled the requirements for licensure as outlined in each state's nurse practice act is a protection for the public against unethical, unscrupulous, and incompetent practitioners. Nurse practice acts describe entry-level qualifications such as education, practice standards and code of conduct for continued privilege to practice nursing." American Nurses Association 2013.

Public safety

Licensing is intended to protect the public.

Many do not realize that it is a punishable offense to represent one's self as an RN, LVN, LPN, if not licensed by the state. Impersonating a nurse is a crime.

For example, California Business & Professions Code states:

"In the interest of public safety and consumer awareness, it shall be unlawful for any person to use the title "nurse" in reference to himself or herself and in any capacity, except for an individual who is a registered nurse or a licensed vocational nurse"

Real Problem

Part of the problem is that the public does not know what nurses do. Even doctors do not always differentiate and refer to medical assistants as "my nurse".

The concept of what nurses do is vague, and so is the term "nurse".

We will never be fully respected as a profession as long as we are not successful at articulating to the public just what it is we do. Do you agree? I'd love to hear your thoughts because I think it's material for another post.

References

American Nurses Association. 2013. Title "Nurse" Protection. Accessed December 16, 2016. Title "Nurse" Protection

California Business & Professions Code. Division 2. Healing Arts. Chapter 1. General Provisions. Article 7.5. Health Care Practitioners Cal Bus & Prof Code 680 (2003). Accessed December 16, 2016. Title "Nurse" Protection: Summary of Language by State

[moldyoldyrn]

OH NO, we should not ignore it. This just lit me up, sorry but you do not ignore it. When I was in the military I work for a time in Newborn Nursery and helped the postpartum women with breastfeeding and infant care. These were very young mothers. They had hired a civilian CNA, a male because there was a lot of heavy lifting on L&D at times and sometimes heavy equipment that needed to be moved. At first he was good, no issues. After a few months one of the mothers asked me about the "male RN". I did a little scouting out and found he was putting on a name tag that said RN when the babies would go out to the unit. We were still fighting the battle over the babies being with the mothers full time. It turns out he was "helping" the breast feeding moms. Needless to say he did not last very long and was reported to the state board, this was in California. This is not a nicey-nicey thing it is a patient safety and confidentiality thing. As an RN I am bound by law to assure that certain standards are met. If an RN does not do that they are in violation of standards. CNAs work under RNs and we have to assure that they meet requirements and do their jobs. I have worked with many CNAs that I respect and trust, even with my own life, some have more knowledge than a lot of RNs in their selected fields but as an RN I have to be able to trust that the CNA will come to me to report and ask and not take off on their own and try to manage a problem beyond their scope. I worked with one CNA who had extensive experience with spinal cord patients and she was dynamite to have on my team. And yet she never, ever over stepped her bounds, she always reported to the RN and was invaluable as a support to those staff who had never worked with spinal cord injuries. I trusted and valued her, she was one in a million. She would tell you her opinion and she was rarely wrong, but she respected the RNs enough to make sure we all knew what she saw and what she thought and then let us decide what needed to be done. I cannot tell you how many times she ran interference with problem patients and how well she knew her role. That is the kind of person I want on my team, not some one who acts as if they know more than they actually know.

[Ebon510]

The quiz would not come up on the article Are you a nurse? Disappointed

[showbizrn]

What a cuckoo Nurse Educator!

YIPES!

[imenid37]

There was a mom at my kids' school who was the alpha everything AKA a bossy know it all! She liked to tell people that she was a "nurse." In fact, she was a medical assistant. When I first met her, I did not know that she was not really a nurse. I asked her if she was an RN or LPN. That is when she told me that she was a medical assistant, which was "pretty much the same as being a nurse." Her justification was that she "did a lot of the same things as nurse do." I told her that I did a lot of the same things an OB doc does and asked what might happen if I told people I was a physician. I have even delivered a few babies. She was very annoyed! I also threw in that it is not legal to refer to oneself as a nurse, if one is not, in many states! After that she avoided me. I wonder why?

[riggy3, MSN, RN]

OCNRN63 I just reread what I wrote.... needed to be more specific. Yes.. The RNs could wear a brass or some other kind of name tag we provided, and introduce ourselves as an RN.

Around this same time the hospitals began to eliminate the nursing cap and white uniforms making it more difficult to determine the skill level of the Nursing provider. The caps were dirty too but that is another problem we can skip..

In the mid 80s when the financial impact of the new DRGs/HMOs was unknown, Scared hospitals were laying off nursing staff and not hiring. Then, except for the Physicians, the Hospital provided ID badges did not have titles on them especially when the professional Nursing staff were getting replaced by unlicensed providers (NA, PCA)

There were nurse marches in the late 80s and 90s, in Harrisburg, PA. and other areas of the USA to establish mandatory Nursing, medical staff identification and RN patient ratio.

Around the mid to late 90s is when legislation required hospitals to consistently identify skill of staff.

Hospitals in this area adopted standard color frames, the RN a red frame, LPN a green frame around the ID badge.

The practice of not identifying the RN/LPN was for the very reason you mentioned giving the false impression of staff levels.

" in the past it may have been the practice in some institutions to try to muddy the waters, so to speak, and give patients and family the false impression that staffing levels were better than they really were." OCNRN63

[moldyoldyrn]

Good for you for confronting her. Too many times these imposters get away with the scam of being a "nurse" by just acting as if they are one. After all people do it on TV all the time. Put a little white hat on your head and it's simple, you just parade around as if you know what you are doing. I think the public is finally getting a much truer and accurate picture of how important RNs are to healthcare in general. Nurses are recognized as the number 1, yes #1, ethical and trustworthy group of people for like the 16th year in a row. But I really feel that the presence of NPs, RNs with Clinical Specialties and clinical expertise are impacting how the public views us. We are no longer just pill pushers and some one who calls the doctor. I had a Physical Therapists tell me that our jobs are "just alike", well in some aspects that is true, they have essentially the same process as the Nursing Process(ADPIE) but they do not and cannot have the same connection with a patient that an RN has which is to take care of those functions that are so intimate and essential to life itself. They are wonderful practitioners and change people's lives but they don't stand over a patient and monitor their very life minute by minute. It just is not the same thing, similar and like unto but not the same. I guess impostors will always be with us, the point is to shine a light on it, confront it and don't put up with it. I worked hard for my license and had it for 45 years, all of them clean. I'll be damned if some one is going to push through the door and claim to be an RN or LPN without the propers to prove it. In addition, even if some one does have the education and license to be a "Nurse" they better ACT like one. I really don't care what they look like or how they dress, they have to ACT as they should, as a professional who knows what they are doing.

[smartassmommy]

I can't wait to finish school, survive the NCLEX, and legally use the title of nurse. Until then I will happily tell you that I am the PCA helping your nurse take care of you.

[Lokeylady]

The expectations associated with the role of a Nurse is very different than those associated with an Assistsnt and it's unfair and potentially dangerous to mislead people about credentials! CNA means there is a nurse, every shift, who is responsible for the CNA's work...they carry the liability for the care provided by a CNA because CNA's work under a Nurses license. Aaaand it's illegal-so yeah-there's that too! People should be proud enough of their hard work to claim their rightful title without embellishment! But if someone feel it's important to be referred to as a Nurse, then they should put in the schooling and pass the NCLEX and earn the Nurse title..earning that title may clarify the importance of clearly differentiating roles and titles to our patients. Nurses rely on CNA's for ADL cares and data collection-but that is just the tip of the iceberg in relation to providing competent and holistic care! First, I was a Paraprofessional, then a PCA, then a TMA, then a CNA/NAR, then an LPN and currently an RN-each title carried a tremendous workload, and was essential to the "big picture", but at no time should the lines of scope of practice or titles be blurred-and it wasn't until I completed my RN program, that I acquired appreciation for those clearly defined titles and associated roles. 😉

[retiredmednurse]

For example,I was an Lpn working in LTC. I needed an ambulance to pick up a resident for an emergency. I was the only nurse,Rn or Lpn, there. The EMT told me in a very harsh voice"I need the RN to sign this". The document he wanted me to sign also had a spot for "Rn signature" on it. I could not legally sign it,because while i was the nurse i was not an Rn.

Could you have called an RN to get an order to "Transfer [Mr. B] via ambulance to such-hospital"? This way you could sign the signature line as T.O.V. Ms. Winters, RN/ (your name) LPN' and write it a second time in the chart to cover yourself. (TOV=telephone order verified)

[Guest219794]

I have a Master's in nursing, an NCLEX pass and a license to practice nursing in two states. I have to frequently remind my husband that I do not work "in the medical field". But when he referred to the vet tech as "the nurse" I did not come unhinged. I knew of whom he was speaking. He knows she is not an RN. She knows she is not an RN. The cat did not care. It was just the best way he could describe her job. I think most people do know who is a professional nurse (RN) and who isn't, they are just using a colloquialism for a job description. I don't think it demeans me or my profession. Military medics get called "doc" all the time and I have never heard a physician fall apart over it.

While I agree with your attitude, and the overall sentiment, I disagree with your conclusion. My wife is smart, well educated and has several degrees, none of them remotely medical. She often has no idea what level of training a healthcare employee has on her rare medical visits. When I accompany her, I am surprised at how seldom a person identifies themselves by name and credentials- something I do in every initial interaction.

I recently had a post surgical complication. The receptionist told me she would connect me to a nurse. While speaking with the medical assistant, I explained the issues as if I was speaking to a nurse. (I thought I was.) When she got back to me, it became clear that A- my actual concerns were not conveyed to the doc. B- I was not, in fact, speaking with a nurse. Had I known, I would have not addressed her as a nurse.

[Orion81RN]

The veterinary techs at my vet's office are referred to as "nurses".

I asked the vets why this is - their mumbled incoherent logic for this amounted to the techs being "female helpers".

Aaaaaaarrrrgghhh

That's exasperating on a few levels. If a male were hired, would they call them "male helpers?" I think not.

It's annoying but understandable that your average layperson would not know if the person assisting you in a doctor's office exam room is a nurse or an MA. But who would be confused by "vet tech?" No one. Female helper.... pffft

[GaleSRN, BSN, RN]

I totally agree with this. I have corrected my own doctor when he refers to his MA as a nurse. I worked hard and it took 5 years of education for me to earn the right to call myself "nurse". People also do not know that you have to maintain high standards in your personal life as well in order to maintain your license. I think we owe it to ourselves and our fellow Nurses to defend the title. MDs do not refer to their PAs as doctors, or even as colleagues. They refer to them as their PA.