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

[riggy3, MSN, RN]

Current practice in Pennsylvania an LPN or RN wears identification to clearly show LPN or RN this equates to licensure. Years ago we were not allowed to identify ourselves as an RN this was a gimmick by the hospital to pass off the assistants to the patients as Nurses. I remember going to legislators to get this change made.

The only person who should be called a Nurse is the LPN or RN. I worked hard for my BSN, MSN, RN. I encourage all nurses to speak up when someone misrepresents themselves. Nurse aides, CNA and Medical Assistants are not not Nurses

[K8JAJ8]

I'm sorry, but I completely disagree. When Raggles the wino calls himself a nurse, it damages the reputation of your profession and the respect it demands. That not only makes your job harder, but it will affect your compensation when providers hire less qualified individuals because the patients can't tell the difference anyway.

I worked too hard to call myself a nurse.

[LovingLife123]

I think it also comes down to the public and MAs and other UAPs not understanding the role of a nurse. They say, well, I do the same things a nurse does thinking it's all about the small things we do, like ivs, blood draws, giving injections, taking vitals. They don't see what we actually do.

They don't see that we are always assessing. Yes, I draw labs. But it's what I do with those lab results that's important. What does my patient need based on those results. Yes, I take vitals. But what do I do based on those results with vitals? What if that patients BP is 60/40? A UAP is not trained on how to look at that and know what to do.

Yes, we report the results to the physician but I better know what the heck is going on with my patient when I call. A front office person or a MA does not know what to do with that and I think that's where the education needs to come in.

They don't understand that I'm constantly assessing my patient. Since it's something they don't always see us doing, our most important job gets lost on the public and UAPs.

[Floyd Nightingale]

Everybody is a nurse. I know this because everybody tells me they're a nurse. It's usually a friend or family member of a patient that I'm preparing to draw blood from and start an IV on, or give meds to, or whatever. The nurse friend becomes the liaison or advocate who explains to the patient and other friends or family what I'm doing. It usually ends with "wait, that's not a butterfly!". No, it's a 20g angiocath.

A coworker once told me she handled it with "I'm giving you labetolol, your "nurse" friend can tell you what it's for an any side effects it may have." Yes, I work with some evil nurses, some of whom are actually licensed.

Further inquiry always reveals that the nurse is actually a medical assistant, or is on the waiting list for nursing school, or is thinking about taking a phlebotomy class, or watches Gray's Anatomy/Scrubs/ER/whatever, or has a cousin whose neighbor's ex-fiance's brother-in-law met a nurse one time. All that gives everybody free reign to tell me what to do.

Oh, and anybody else notice that every time you go out the topic of conversation between the waiter/waitress and the bartender is where they are on the waiting list for nursing school. Here's a tip: if you're a lousy waitress you'll make for a lousy..., oh never mind.

Then there was the tech I worked with. She was pre-med, which apparently gave her license to sign off orders with an MD after her name. She was something of a problem. The other techs hated her because she had some education while the rest of them, well, I think they found them at a bus station or someplace similar. And then I heard that she had an affair with a physician but it went bad and she filed grievances, maybe a lawsuit, and it ended up in the papers. Don't get me started on the people who end up being ED techs. I'm picturing the ad - no intelligence or decision making skills or common sense required, must be able to question directives and argue, laziness a plus...

[Extra Pickles]

Then there was the tech I worked with. She was pre-med, which apparently gave her license to sign off orders with an MD after her name. She was something of a problem.

Something of a problem?? then again she'd only be a problem for a very short time where I work as she would have been fired for fraud, misrepresentation and anything else anyone could throw at her as she was being hurled out the door onto her butt.

[Extra Pickles]

I don't know why people think it isn't any big deal if a non-nurse calls herself a nurse when we all agree it is a big deal when a non-physician calls herself a physician. Then again I really do know why, it's because nursing is still looked down on as a job instead of a career, and as menial on-the-job learned training instead of professional education and knowledge. People still ask about where nurses had their training and where doctors went to medical school. People see doctors as being medical professionals with degrees and residencies to earn them the honor of being an MD or DO but they see nurses as being something like doctors' helpers who follow orders really well and fill out forms and such. It's disheartening to see how little the public understands of what we do and how we got to the levels of education and practice so many of us have today.

so year it's annoying when Betty Boop, who once took a semester of a nursing program before flunking out, calls herself the Office Nurse where she works as a receptionist, but it's not hard to understand why the public doesn't see the difference. Betty Boop, Office Nurse told her to put ice on that bruise and by golly she feels much better, isn't Betty an awesome nurse? So here we are.

[Lanie_82NS]

I just recently graduated a nursing program. I'm working as a grad Nurse but make sure to identify to everyone that I'm not yet a nurse because in haven't sat for boards. It makes me so mad (especially in my drs office) to see a ma referring to her/himself as a nurse.

[FlyMurse, BSN, RN]

I hate when pt's or family members say "yeah I used to be a nurse" and they're clearly lying. Then I look them up and find nothing on the BON website. And my PCP's office used to refer to the MAs as the doctors nurses. I think the recording says assistants now. Drives me crazy! We worked so hard to get where we are and these people just throw the term around.

[Carabella]

I'm sorry, but I completely disagree. When Raggles the wino calls himself a nurse, it damages the reputation of your profession and the respect it demands. That not only makes your job harder, but it will affect your compensation when providers hire less qualified individuals because the patients can't tell the difference anyway.

I worked too hard to call myself a nurse.

Totally agree!

[Extra Pickles]

sitting here quietly enjoying the image of Raggles the Wino with a stethoscope. And etoh pads lol.

[FlyMurse, BSN, RN]

Further inquiry always reveals that the nurse is actually a medical assistant, or is on the waiting list for nursing school, or is thinking about taking a phlebotomy class, or watches Gray's Anatomy/Scrubs/ER/whatever, or has a cousin whose neighbor's ex-fiance's brother-in-law met a nurse one time...

I don't even ask anymore. It gives them the satisfaction of thinking I actually care. I just correct them every chance I get, which is usually pretty frequent.

And yes, I think laziness is a must for all ED techs. Must be taught in orientation. Though we do have a few good ones I will say. Working with them is a bonus.

[ZEBRA57]

It is critical to restrict the use of the term NURSE to registered licensed nurses. It is just as critical that we find a way to permit our colleagues & patients to recognize our status. I have been a REGISTERED NURSE since 1969!! (full disclosure) I am still working part time in an acute care hospital in Canada in Ambulatory Day Clinics as a NURSE CLINICIAN. In the "old" days :) nurses wore caps ---- now relegated to antiquity. :) We were also required to wear our school pins. The essential defining feature of the cap was a "black band" which was only worn by Registered Nurses. It was easily seen & patients & doctors alike knew you were a NURSE. Today we must wear hospital ID tags but these are not easily legible & all hospital staff wears tags not just nurses. It is essentially a security measure.

Now we find ourselves in a situation, in which not even nurses, know who the other nurses are in other units. A patient in any setting has a right to know when he/she is receiving care from a professional licensed nurse & when it is an auxiliary staff.

We have the same problem here in doctors offices & institutions outside hospitals, that direct care is often provided by some other staff because nurses are considered too expensive. The law here states that these people are prohibited from calling themselves nurses.

However, the patients often assume that these individuals are nurses and no one corrects this error.

We have all worked hard for our education & ongoing updates in our knowledge base. We bring this to our professional interactions & relationships, plus there is a rather arduous code for professional conduct & responsibilities. ALL this needs to be protected & respected.

It is not a problem for doctors to expect to be acknowledged. Why is this an issue when NURSES expect to be recognized as the licensed professional that they are? To you we who have come before, toss the torch of our profession & now it is your turn to hold it high!!