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

[1indat]

I have been a licensed nurse since 1979, first as an LPN and an RN since 1982. That being said, I think getting upset over something like a CNA being called "nurse" is a little silly. As long as the unlicensed person does not attempt to act in the role of the nurse, I have no issue. Honestly, I believe we should be focused on meeting the needs of the patients in our care. They don't care what we are. They do care if we can help them in their time of need.

[lpnsrock01]

Earlier this year there was a story with photos circulating on facebook about two medics who were very unprofessional with a newborn baby in the hospital they worked at. I posted the comment, "They are medics not nurses". I had a couple medics take me to task saying all the things they can do in a combat setting. I know what they can do, my son is a medic in the Army. But he cannot call himself a nurse, he is not a nurse and he cannot practice as a nurse outside the military setting. I worked hard to get my LPN and was not belittling the work combat medics do... but they are still not a nurse. While my youngest was in school, I had to pick her up and drop off some papers in the office. I overheard the women talking about the "nurse" who had to put a bandaid on her cut she got while in school. I asked the them, if she was an LPN or RN, was looking to change jobs, and was told she was a CNA. I told them, you cannot call her a nurse. You are misrepresenting her as someone who has education that a CNA doesn't have to have to get their certificate. They got offended, until I told them it is illegal for a person who is not a nurse to say they are. SMH.

I cringe when CNA's talk about their license... it is not a license it is a certificate, bit difference. Maybe I am wrong. Or maybe it is time that people who are not nurses stop telling people they are.

[redopal]

I will always consider myself a nurse even though I am now retired. I initially graduated from a diploma school in 1971 then returned to school in 1990 for my BSN. The time was so far between my programs I had to repeat all my sciences and a lot of other courses to graduate. Proudest thing I ever did!

[Orion81RN]

My exact title and patient/family understanding of my role & scope of practice as an RN directly affects my work.

I'm taking a break from bedside and am currently doing private duty. The mother of my last case did not allow me to practice to the fullest extent of my license. To her, I was a babysitter. She didn't let us nurses use the cough assist machine which my pt desperately needed, prime the line for G-tube feedings let alone change the G-tube/Mic key button, call in prescription refills, use any clinical judgement (to her, it was not our place to do so,) and so on and so on.

I was sticking it out til I found another case. Then one day, a few weeks ago, the mom decided to hold her feeding for the day and give Pedialyte. Ok, no problem. I called to obtain the order to write it down as is my job. Because obviously I can't hold anything or give anything I don't have an order for. I was waiting for the call back when the mom stormed into the room and reamed me out big time. I had just missed the call from the nurse from the dr office. So the nurse apparently then called the mom. The mom yelled at me saying I am NOT to speak with any nurse, doctor, any provider about her daughter.

Now, before she used our services, she had been paying a non-licensed caregiver to care for her daughter. So it is EXTREMELY important that the general public has some idea of the difference between a nurse and a CNA or MA. To this bat-nuts crazy woman, my calling to obtain the official order was akin to a babysitter calling her daughter's doctor.

I finished my shift and obviously didn't return. She didn't even let us nurses know when her daughter had doctor's appointments.

It has nothing to do with ego on my part. I simply want people to understand that I don't just blindly follow doctor's orders. That I'm licensed to do much more than administer meds and change diapers. Not for ego, but to DO MY JOB. From now on when I go meet a family for a potential case, I'm specifically asking the parents what their expectations are of their nurses when it comes to care. If they say, oh just suction, give meds and change diapers, that will be a red flag to me to question further what they would allow me to do.

[RebelGirl]

I worked in a specialty office and overheard the MAs introduce themselves to patients as nurses over and over and over. When I reported it to our supervisor, I was told it would be addressed BUT NEVER WAS. IT IS FRAUD AND ILLEGAL. I am a RN with a BSN and worked my ass off to achieve my license and degrees. I would never even consider introducing myself to patients as a PA, NP or DR. I left the position. The utter disrespect for the nursing profession was evident in so many ways there.

[emt20685]

I really like this article. I have been in the medical holding different titles for over 18 years. Every time achieved a different title I was very proud of myself but I would also correct people when they would call me the wrong title. I first started as an EMT then I became an CNA/GNA. While working in the hospital as a CNA/GNA some people would call me a nurse but I would quickly correct them. Currently I am an LPN and I just got accepted to the LPN to RN program I am excited and scared at the same time. But the one thing I hate more than anything is when anyone tells me "you're JUST an LPN" I never claimed to be anything higher than what I have achieved but I am not just an LPN. I AM a nurse and proud of it and when I get my RN I am going to be proud of that. What i want people to also learn from this is that people shouldn't claim to be what you're not but people shouldn't degrade what people have achieved.

Kelly

[Paws2people]

A nurse in my mind follows this path: Go to nursing school, graduate, take NCLEX, pass, receive license, get job.

Once you pass the NCLEX and get a license, you are a nurse.

[PNCC2001]

You need to read the Wisconsin Statutes again. "'Nurse' without amplification means only a Registered Nurse". 'Licensed Practical' Nurse is an amplification. Wound Care Nurse is an amplification, etc. It does not say that only RNs are nurses. But you are right, that each state's licensing board has their own regulations and they are not standard across the U.S.

[LittleOldLadyWho, ADN, BSN, LPN, RN]

On 12/22/2016 at 1:42 AM, smartnurse1982 said:

That is unreliable in some situations.

Maybe they were licensed in another state?

There are all sorts of situations were someone is a nurse in another state but for some reason is not licensed in the state they reside in now.

That is why I think we should have a national registry of nurses vs individual state boards.

There is a national registry of nurses!

NURSYS.COM

[LittleOldLadyWho, ADN, BSN, LPN, RN]

On 12/22/2016 at 1:42 AM, smartnurse1982 said:

That is unreliable in some situations.

Maybe they were licensed in another state?

There are all sorts of situations were someone is a nurse in another state but for some reason is not licensed in the state they reside in now.

That is why I think we should have a national registry of nurses vs individual state boards.

NURSYS.COM

[Rose_Queen, BSN, MSN, RN]

2 hours ago, BombiRose said:

There is a national registry of nurses!

NURSYS.COM

But not all states participate for advanced practice.

https://www.nursys.com/LQC/LQCJurisdictions.aspx

[Nigelene]

I did not know one could have a Bachelor's in nursing and not be a nurse...can someone please explain