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

[elijahvegas, ASN, RN, EMT-P]

If youre not a nurse, if you dont sign your name and put RN (or lpn) after your name, you're not a nurse. Period.

[prunejuice&BPs]

When I first started at the VA it was common that the nurses aides referred to themselves as Nurses to the vets. I complained about this and the aides were very incensed that their title was being questioned. Eventually the VA did put a stop to this but like everything with the government it took years. But it had more than likely been going on for many years.

[Shellaaay10x]

I work for the school district. I am an LVN. There are credentialed nurses(msn), the support nurses (RN or lvn) and the health clerks. I work as a support nurse at the schools. My tag says "licensed vocational nurse" and my name. Most support nurses are there to give medications, specifically injections. There are health clerks that are "trained" to give meds, but really irks me because other than working for the school they do not have any prior medical experience. Even when no nurses are there, the office staff are "trained" by the credentialed nurses to give meds. It really irks me but whatever. The office staff at the schools just call us the school nurse, even if the health clerk is working. However when I was orienting with the credentialed nurse, she would actually go around and let them know that yes, I am an actual nurse. I am not a health clerk, and I have my nursing license. When I call parents, I tell them I am the school NURSE for the day, but if they have other important inquiries regarding the health of their child at school, I specifically tell them that I will inform the "CREDENTIALED NURSE" (my boss) about it. But since I've been working, everyone just assumes the Heath clerks are nurses. kids don't know that they aren't, they just assume that they are. So majority of the time they don't correct them. However whenever I sign off on medications, I always sign my name and my LVN afterwards so they know that yes, I am a nurse and I gave the meds and I am responsible for any reactions that this child may have (which most of office staff or health clerks probably don't know specific reactions to certain meds that some of these students are on. Which is scary because they are just passing pills not knowing exactly what they are.) *sigh*

[SFnursetobe12]

Coming from the Veterinary Field I find this interesting. In Vet medicine we have Veterinary Assistants (unlicensed personnel) and technicians (Registered Veterinary Technicians). It would drive me crazy when the word technician was thrown around to anyone. Since we legally can't call ourselves nurse, technician is the highest title under a Doctor. When talking to people I would have to say I was "like a nurse" but for animals when describing my career. I went to school passed my courses, med calc exams, clinicals, and externship. I have an AS degree in veterinary technology, I passed my state boards and do continuing education to keep my license valid. I've found the word "nurse" in the veterinary field concerning. I say this because it is used casually. When my cat was hospitalized I was told his nurse would come on the phone. So, is the person unlicensed? an RVT? I'd like to know who I'm talking to. Just like I would expect a medical assistant to describe themselves as so and an LVN or RN to call them self a nurse. That being said, I wish there was a way for RVT's to call themselves a veterinary nurse. Technicians have the educational background I stated above, I've induced & monitored anesthesia, placed ET tubes, IV's, sutured patients (yes, all this is within the scope of practice) I can go on and on... But most important, provided the best care I could for patients and their families. One day when I'm an RN I can finally (as per the law) call myself a nurse when working as an RVT :)

[WinterLilac]

Can someone explain the difference (if any) between an LPN and LVN? I'm in Australia and thought they both meant the same thing (I put down that I'm an LPN thinking it means the same as an Enrolled Nurse since AN doesn't allow for other titles).

Here in Australia we have Enrolled Nurses (EN) and Registered Nurses (RN). Enrolled Nurses complete an 18 month full-time technical college (Tafe) course. Registered Nurses complete a 3 year university Bachelors degree. Both EN's and RN's are required to be registered through AHPRA (Australian Health Practitioner Regulatory Agency) which is a yearly registration requiring a minimum of 20 continual professional development hours and I think around 5-10 employed hours as a nurse. Without an AHPRA registration, you cannot practice nor call yourself a 'Nurse' as it is a protected title here in Australia. There is no such thing as a 'Student Nurse', we are called 'Nursing Students'.

No office admin, nursing assistants, carers, support workers etc are ever called Nurses and would be told not to call them self a nurse should they have the grandiose to do so.

[normazaline]

LPN = low paid nurse

RN = refreshments and narcotics

[Nurse Beth, MSN]

Can someone explain the difference (if any) between an LPN and LVN? I'm in Australia and thought they both meant the same thing (I put down that I'm an LPN thinking it means the same as an Enrolled Nurse since AN doesn't allow for other titles).

Here in Australia we have Enrolled Nurses (EN) and Registered Nurses (RN). Enrolled Nurses complete an 18 month full-time technical college (Tafe) course. Registered Nurses complete a 3 year university Bachelors degree. Both EN's and RN's are required to be registered through AHPRA (Australian Health Practitioner Regulatory Agency) which is a yearly registration requiring a minimum of 20 continual professional development hours and I think around 5-10 employed hours as a nurse. Without an AHPRA registration, you cannot practice nor call yourself a 'Nurse' as it is a protected title here in Australia. There is no such thing as a 'Student Nurse', we are called 'Nursing Students'.

No office admin, nursing assistants, carers, support workers etc are ever called Nurses and would be told not to call them self a nurse should they have the grandiose to do so.

Licensed Practical Nurses (LPNs) are called Licensed Vocational Nurses (LVNs) in the state of California. LPNs and LVNs sound very much like Enrolled Nurses (ENs) in Austraiia

[Feelgood RN]

The first time I went to get patients for nursing school I showed up at the hospital in slacks and a button up shirt. 3 people stopped me and wanted an opinion from a Dr. I kindly informed them that I was a nursing student and had no authority or enough knowledge to help them at this time.

Doctors and RN's should fight to protect their status. We have worked hard for our degrees and our knowledge. Staff at doctors offices that are called nurses that do not correct patients can shed bad light on the RN title as they may not follow the guidelines or safety techniques that a nurse would. I currently work on a reservation and many of the population assume I am a doctor due to my sex. I have always and will continue to assert that I am in fact a nurse and that the Dr would be in to see them in a timely manner.

Basic professional respect is all that I feel is needed. Don't call yourself something you're not. As much as I'd like to be a sheriff on my drive to work I can't just pull someone over and do it

[EDnurseNY]

This issue has nothing to do with our egos or how hard we worked to become nurses. It is a matter of professional credibility and public safety. The public has a legal right to know who is providing any aspect of their care. They should not be allowed to believe a nurse is providing them anything unless an actual nurse is doing the providing. Whoever misrepresents him or herself as a nurse is committing an act of fraud.

Think about it this way: you go to your doctor's office and a nice man in a white coat comes in, examines you and makes some recommendations. Then you find out he is the janitor. So? He works in a doctor's office, so he must know as much as a doctor by now, right? But you're not buying it, because he isn't a doctor.

Yeeahh...I went to my dermatologist's office and a medical assistant took my vitals and went over my med list. She told me to stop taking/avoid one of my medications. I was pretty mad about that. She had no standing to give medical or medication advice. I'm still kicking myself that I didn't speak up, since other people might not understand that she hasn't had the education or licensure allowing her to advise on things like that and might trust her advice. My doctors and I work together to determine the best med course for me, not her.

[sevensonnets]

I was in the middle of a personal health crisis once and left a message on the nurse call line for my doctor. The person who called me back identified herself as Dr. H's nurse and stated that he had told her to call in a script for an antibiotic which I am allergic to as well as another med not even relevant to my illness. It made no sense whatsoever. Turns out she didn't even talk to my doctor, just called in the antibiotic of her own choice. There's more to the story of course but she doesn't work there anymore. She was also calling in prescriptions to pharmacies for friends and family. She should've picked another victim. Moral of story: Don't mess with a real nurse where my health and wellbeing are concerned----I will take you down!

[la_chica_suerte85, BSN, RN]

Here in Washington, nursing assistants are licensed by our DOH to practice as nursing assistants.

Interestingly, the site for licensing/certification equates licensing and certification. It's kind of confusing. It also states that, in order to work in a nursing home, one must be registered with the DOH as a certified nursing assistant. That's not quite the same as being an LPN/RN. That said, they really lay out the standards and practices of nursing assistants and I think that's a pretty important thing you can't find in other states.

[la_chica_suerte85, BSN, RN]

While I'm an RN and a new grad, I still have a hard time recognizing within myself that I have the responsibilities and am now, finally, after all this work, allowed to say that I am an RN. It's funny that other people who don't have the guts/financial means/intellectual ability to become an LVN/RN have no problem assuming the title of 'nurse' while I'm over here still feeling a little bit like a fraud when I sign my charts with 'RN' after my name.

Ultimately, I hope that as nursing comes more into the forefront as a science, the public begins to recognize what nurses actually do, what work we are capable of doing and are actively doing and that, while we ultimately are responsible for all care that is given, we definitely need help from phlebotomists/CNAs/UAPs/etc. to get things done.