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

[MrChicagoRN, RN]

When you retire from being a police officer...are you still a police officer?

When you sold cars in college, and now you nurse...are you still an auto-sales rep?

When you played football in college, and you're now 60, are you still a football player?

If you are not an active practitioner of something...you ain't that thing.

Tell it to the Marines.

[Here.I.Stand, BSN, RN]

Tell it to the Marines.

Never met a former Marine myself.

[CaffeinePOQ4HPRN, BSN, MSN, LPN, RN]

I'm a Registered Practical Nurse (currently in the process of completing my BScN) and I've had many people refer to me as an assistant, or nurse's assistant . I've experienced a good chunk of the public that think LPNs and RPNs are assistants, or akin to an unregulated care provider. Which I have to admit is insulting. As an RPN I have earned the proper qualifications, met the legal requirements, and jumped through to become a Nurse, and earn the privilege to call myself one. I will correct someone once (when referred to as an assistant), after that I just ignore them and get back to work... but it is a PITA to have to consistently re-education people that RPNs are Nurses. Yes we can do our job. Yes we have a brain.

Nurse” is a legally protected title. It is illegal for anyone to call themselves a Nurse if they are not one, to do so is to be considered a Nurse impostor. Nurse impostors (or illegal practitioners”) claim to be nurses although they do not have the proper qualifications. In my province, The College maintains a public list of illegal practitioners and subsequent criminal charges/prosecution for illegally using the title.

[Esme12, ASN, BSN, RN]

When you retire from being a police officer...are you still a police officer?

When you sold cars in college, and now you nurse...are you still an auto-sales rep?

When you played football in college, and you're now 60, are you still a football player?

If you are not an active practitioner of something...you ain't that thing.

I am going to guess that you are not close to retirement and have not been a nurse a very long time.

I have been a nurse a long time...37 years. I have an active nursing license in my present state and an inactive license in my originating school state. I am not active at the bedside any longer and yes....I am still a nurse.

My Aunt who is 94 years old has long since retired but we all refer to her as a retired nurse and listen avidly to her stories of the "old days" and she is shocked at the "new fangled things" we do as nurses.

Yes...to the day I am 6ft under and then it will be in my epitaph....Devoted daughter, Loving wife, Best Mommy, Greatest Grandma, Beloved Aunt, downright dedicated good nurse.

[Esme12, ASN, BSN, RN]

Never met a former Marine myself.

I have....once a Marine always a Marine....Sempre Fi

[Nurse Beth, MSN]

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.

The public has a right to know what the title "nurse" means.

Hence licensure.

[Catcar1963]

Exactly my thoughts about it

[moldyoldyrn]

Instead of calling yourself a nurse call yourself an RN. That is a more definitive statement. I have a BSN and a Masters degree, I am licensed by the state to practice and that practice is determined by a set of laws which define what I can and cannot do. I hardly think that CNAs can say all that about their practice. Please do not misunderstand me, I deeply value CNAs and have worked with many dynamite men and women who have a vast body of knowledge and their powers are amazing. They can sometimes get patients to do what no one else can manage. They work incredibly hard and do things for patients that should get them nominated for sainthood. They, however, do not have the education to be an RN. They could if they wanted to. I respect CNAs and LPNs for what they do and how they manage to do it. but that does not make them an RN. I have seen the presence of the RN dwindle in MDs offices and it's not always a good thing. While the Certified Medical Assistant that works with my Family MD is nice, she is not good at injections and failed with my PPD because she did not make a bleb, she simply injected the serum too deep for a reaction. When I mentioned it at the clinic to the manager(notice I did not say I complained) I was brushed off by the MD and RN. Did I go back, no. Unfortunately other people may suffer the same experience and not know any better about the quality. I maintain that there is a place for the RN and cutting back on the public's exposure to an RN during a medical encounter is being cheated. The RN should be the baseline. CNAs and LPNs are wonderful and fulfill a necessary role in health care and yet they are not RNs. they have neither the education nor the license. SO for me call me not a nurse but an RN. I means I have both the education and the license.

[smartnurse1982]

Instead of calling yourself a nurse call yourself an RN. That is a more definitive statement. CNAs and LPNs are wonderful and fulfill a necessary role in health care and yet they are not RNs. they have neither the education nor the license. SO for me call me not a nurse but an RN. I means I have both the education and the license.

We nurses have to be mindful of education of UAP's,because I know some Medical Assistants that have Associates Degrees from the local community college.

Most times nurses usually go to school longer and have college degrees moreso than UAP's,but that is changing as pointed out above.

The bolded can make other nurses angry depending on context.

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.

[elikat02, ADN, LPN]

I'm an LPN and briefly worked for a company that hired mostly MOA's. The MOA that was training/ orienting me referred to herself as a nurse - even the providers called the MOA's nurses. When we were out of earshot at lunch, I asked her why they call the MOA's nurses when they are not nurses. Her reply - and I quote - "Yes we are - we know a lot more than what's coming out of those schools these days that have the nerve to call themselves nurses". I told her that I am, in fact a nurse, and I have the license to prove it. Some of the MOA's had no formal schooling and picked up their "skills" in the offices they worked in. Cheap labor - cheaper than hiring a nurse. The other thing that made me cringe was that they didn't wash their hands (or their equipment) in between patients! We were in a room with a patient that had scabies and I was observing her taking the patient's bp. Not only did she not wash her hands (or wear gloves), she didn't clean her equipment afterwards!!! I took a moment and asked her about this and her reply, "We don't have time for that." I went to the "manager" to explain what happened and her reply, "She's been a "nurse" longer than you - I think she knows what she's doing". Needless to say I made a call to the health department and didn't continue my career there.

[Shortcake_BSn]

To simply call myself "the RN" is not sufficient enough to the general public. I had a friend of my mothers tell me that she honestly didn't know the difference between a RN, a LPN, or a CNA. They were all letters being thrown around to her.

As I stated earlier, I work in a physicians office where everyone is the nurse. They all described themselves as nurses as their job description, when they call patients to respond to messages, and to the physicians, whom also call them nurses. As someone else stated, most of their training was on the job. They have been there ten plus years. I was told that one of the medical assistants was pretty much a nurse because she went to Lpn school, she just couldn't pass her boards. The phone nurse is a medical assistant. There are about seven medical assistants, two LPNs, and four RNs in the office, yet we are all nurses. And because I am the new nurse on the block, I am constantly referred to as the medical assistant's that has been there forever sidekick or have patients tell me that she's my supervisor.

I love my coworker and she is really great at what she does but the fact that they are all perfectly fine with illegally calling themselves nurses makes me uncomfortable working there.

[Jewelsforme]

Ok, here is my biggest gripe about titles in the medical field. People actually get away with allowing patients or family or other coworkers address them as Nurse or Doctor when they are NOT trained, licensed or registered. I saw a PA wear a tag with MD after his name, and he did not correct patients who called him "Dr. so and so." I even worked in Hospice (am an RN) and while visiting a patient at an assisted living facility, young women who were new employees were given laminated I.D. TAGS to wear, with their photos and names on them, and N.A. or CNA after their names when they had zero medical training at all. Oh, the irks I felt. I wrote a letter to the state about this and hope they got that straightened out because it is an absolute intentional crime, a lie to impersonate or to present oneself as anyone other than what you really are. Many of the gals wearing the false title tags at the care facility had English as a second language but the administration were all born and raised in the USA and knew what they were doing. I hope the state fined them. They were trying to impress family members who visited to see if they wanted to place their loved ones into that facility which gave the false appearance of having more "trained staff" than they really had. Arrrrrrrgh!