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

[2bgoodnow]

I like this response, and I agree with that! When it comes to patient care, are we (nurses) concern about our title or things that we can do for our patients? An ego bigger than the whole world does not make me a better nurse the way I look at it. I have been a LVN, now RN-BSN, PHN, CHPN, and now going for my MSN, but those may not mean anything to anybody until I show my patients what I can do for them for their best interests. Sorry!

[2bgoodnow]

"Legally, yes, there can be issues. Personally? No. I don't care if Raggles the Wino huddled in the parking lot calls themselves a nurse. It doesn't make my job any harder, nor does it affect compensation for doing my job, so I don't care. I did not become a nurse to satisfy any aspect of ego."

I like this response, and I agree with that! When it comes to patient care, are we (nurses) concern about our title or things that we can do for our patients? An ego bigger than the whole world does not make me a better nurse the way I look at it. I have been a LVN, now RN-BSN, PHN, CHPN, and now going for my MSN, but those may not mean anything to anybody until I show my patients what I can do for them for their best interests. Sorry!

[CatCare]

Techs are referred to as veterinary nurses in the UK and other areas. A Career in Veterinary Nursing - BVNA

If they have gone through training and licensure I don't see why that should be problematic.

[Daisy4RN]

It is important that only LVN or RN's use the term nurse. Otherwise it diminishes the profession. It totally urks me when someone is called, or calls themselves a nurse when they are clearly not. When a patients family etc. tells me they are a nurse, I respond with, Oh, are you a LVN or a RN, shuts um up every time.

[Floyd Nightingale]

reply to CatCare on previous page -

I was having lunch and listening to a group of young people at the next table who were obviously techs. I got a little steamed when they started talking about passing meds, where can techs pass meds?, and I looked and they were wearing t-shirts from a local dog daycare center that offered grooming, boarding and, apparently, veterinary services.

Can they call themselves nurses somewhere? I dunno, but I wouldn't have the first idea of what end of a dog to start on so I'll grant them the privilege by default.

[MrChicagoRN, RN]

I completely agree. I knew a lot of my classmates who did not pass the NCLEX exam but because they had graduated, still called themselves nurses. Another peeve of mine is when CNAS call themselves nurses because "It's in their name". So I've been told. They always want to be included in "Nurses" meetings.

"I'm Dwight Shuppe, Assistant Manager at Dunder Mifflin."

"no Dwight, you are assistant to the manager."

"It's the same thing...Assistant Manager."

"No, Dwight..."

[OCNRN63, 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

I've been an RN in Pennsylvania for 30+ years; I was never forbidden to identify myself as an RN, and I have worked for different employers over the years.

I agree that 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.

[FolksBtrippin, BSN, RN]

Sorry to burst the bubble, but calling oneself a nurse without being an RN or LPN/LVN is not a punishable offense in every US state.

The terms "graduate nurse" and "student nurse" are used frequently where I live and no one died.

Relax.

[GitanoRN, BSN, MSN, RN]

Needless to say, this situation ceased to exist in the facility where I work. Having said that, several years ago doctors, PA's, patients and their relatives couldn't tell who? was who? since all departments wear scrubs. Therefore, we "Nurses" RN's, LPN's and LVN's decided to vote for our own color of scrubs in order to distinguished one nurse from any other medical staff. For example: all RN's including ADN, AAS,ASN, BSN, MSN, plus all other specialties of RN's voted for black scrubs w/2 white stripes on the sleeves. Furthermore, the LPN's decided to go with the same scrubs but in a "Turquoise"color the "Techs" decided on a Hunter Green, the Medical Assistants Purple" color, and housekeeping kept their Gray color scrubs. At this level, pamphlets are giving to patients and relatives once they visit our facility, indicating the scrubs color with a picture of each individual color and their status. Moreover, on every patients room there is a visible picture indicating the above mentioned next to "Your Nurse name is, and today's date. Unquestionably, our new medical staff, patients and their relatives no longer address a housekeeping or any other personnel as a nurse by mistake. On the other hand, there were a few RN's that didn't care for the color assignment because Hmm' how should I phrase this... they felt that they would be call upon more often. However, the majority was all for it.

[Longleggedstar]

Legally, yes, there can be issues. Personally? No. I don't care if Raggles the Wino huddled in the parking lot calls themselves a nurse. It doesn't make my job any harder, nor does it affect compensation for doing my job, so I don't care. I did not become a nurse to satisfy any aspect of ego.

Personally, I'm the same I started nursing right out of high school, I got my LPN and then went on to get my RN. As an LPN I worked in LTC and all the patients called the CNA's nurses. I guess at the time I was so young it just didn't really matter. I was just trying to do my job and not kill anybody as the years went by I've just kind of accepted that some people make that mistake. In the big scheme of things call me janitor just don't touch my pay!

[oldtiredmicn]

I totally agree with all the comments but want to remind many that have in the past (and some currently still do) turn there badge so no one can read their name or status. I've seen this a lot in the office setting but much more in the hospital setting. Since a lot of facilities have replaced the pin on name-pin with the plastic ID badge it is happening more. I think a lot of this is a fear of liability - the idea that if they can't see your name or status you are immune and have privacy. Not so!

I was a corpsman who out of the service took the boards and became an LVN but was working in an expanded role as an ER Tech. I was told to remove my LVN pin and do not wear a name pin that said LVN but ER Tech. That riled me and we got that policy changed. When I got my RN and passed the boards I was defensive when someone called me orderly or Doctor. I always corrected them. Nursing in general has allowed so many of our responsibilities to be take over by other specialties - we used to do the breathing treatments and respiratory assessments, we used to do the EKG's and actually interpret the rhythm strip. We used to be the resource for info about medications. We used to give out information and discharge plans and write care plans. Now that is being done by other specialties or even worse yet by some COMPUTER - that has absolutely no caring or compassion and we as advocates for our patients have passed to the shadows to allow less involvement and work. We have allowed the changes. We have allowed the watering down of our profession. When I first started in this profession I was called a Male-Nurse. No I wasn't!!! I was a NURSE and I am still even though retired! Proud of the title - proud of the work - and proud of my job!

[Longleggedstar]

I totally agree with all the comments but want to remind many that have in the past (and some currently still do) turn there badge so no one can read their name or status. I've seen this a lot in the office setting but much more in the hospital setting. Since a lot of facilities have replaced the pin on name-pin with the plastic ID badge it is happening more. I think a lot of this is a fear of liability - the idea that if they can't see your name or status you are immune and have privacy. Not so!

I was a corpsman who out of the service took the boards and became an LVN but was working in an expanded role as an ER Tech. I was told to remove my LVN pin and do not wear a name pin that said LVN but ER Tech. That riled me and we got that policy changed. When I got my RN and passed the boards I was defensive when someone called me orderly or Doctor. I always corrected them. Nursing in general has allowed so many of our responsibilities to be take over by other specialties - we useQUOTEdo the breathing treatments and respiratory assessments, we used to do the EKG's and actually interpret the rhythm strip. We used to be the resource for info about medications. We used to give out information and discharge plans and write care plans. Now that is being done by other specialties or even worse yet by some COMPUTER - that has absolutely no caring or compassion and we as advocates for our patients have passed to the shadows to allow less involvement and work. We have allowed the changes. We have allowed the watering down of our profession. When I first started in this profession I was called a Male-Nurse. No I wasn't!!! I was a NURSE and I am still even though retired! Proud of the title - proud of the work - and proud of my job!

Oh yeah! I forgot about the people who don't show their badges on purpose. And you say Allowed our professions to be taken over by other specialties? I say we fought then did a thank you praise the lord holy dance! Maybe you had it way worse, but to be honest I don't think its watered down at all with all the new procedures and regulations everyday in the ICU is full of patient and paperwork task up to my neck!