Certification vs not and the role of the profesional organization

Jolie, BSN · Sep 7, 2011

You'll find plenty of opinions on this thread:

https://allnurses.com/general-nursing-discussion/should-i-report-613923.html

"Should I Report This?" Yet Another Bullying Thread

geocachingRN · Sep 7, 2011

Thanks Jolie, but unless I'm reading the thread wrong, it seems the prevailing flow is that unless a patient is directly in harms way and I see it, it's none of my business. Not sure that applies here. In fact, proper licensing and credentialing is a minimum requirement and if not met leaves everyone at great risk if something goes wrong.

llg, PhD, RN · Sep 7, 2011

I think there is a good chance that she will get her old job back -- assuming that the employers liked her as much as you think they did and she does, indeed get the required credentials. In their eyes, she will be the one they want -- and you will be back on the job market. I recommend keeping your eyes open for another opportunity.

That doesn't mean I think you did anything wrong is working with those trying to see to it that the school districts only hire those nurses with the appropriate credentials. You did what you thought was best. If she keeps harrassing you, talk to an attorney and consider filing charges against her.

I wish you the best of luck. Sometimes, doing the right thing comes at a price.

Jolie, BSN · Sep 7, 2011

I chose not to write a response right away because I have mixed feelings about your situation, and I wanted to refresh my memory of your previous post on this subject.

https://allnurses.com/school-nursing/school-nursing-credential-557967.html

Here's one for you:

A local district hired a school nurse who did not have a school nurse credential. They wrote a contract instead and call her a district nurse. Interestingly, in California there are rules about calling someone a school nurse, but not a district nurse. She is doing almost everything a school nurse does. Get this, no one is able to enforce the that the school district follow California Ed Code on this! The California Department of Education directed me to the School Nurse Consultant who directed me to the office of California Teacher Credentialing (who is the responsible body school nurse for credentialing, who has done nothing) and NASN,(who will write a letter). BUT nobody seems to have any teeth regarding enforcement.

Does anyone else wonder about this? Why should people pay more than 10K to get a credential when there is no oversight?

I understand and appreciate your frustration and concern for someone you believe to be practicing without the proper licensing and credentials. As I understand it, you do not question this person’s status as a licensed RN, but are contesting her lack of School Nurse certification, which is required in CA for practice under the title and job description of School Nurse. So just to clarify, must all nurses practicing in any CA school be certified as School Nurses, or are there designations for School Nurses (who must be certified) and non-certified nurses who practice in a somewhat lesser capacity than a certified School Nurse? Is it possible that she is not practicing in role of a School Nurse and therefore is not in violation of CA code? You state that she is doing “almost everything” that a School Nurse does. What are the limits of her practice? They may be within the state guidelines for a non-certified nurse working in a school.

I will never argue against furthering one’s education and obtaining formal credentials, but wish to assert that doing so is no guarantee of higher standards of care or superior care of clients. School nursing is unique in that some states require certification for practice, whereas I know of no jurisdiction that requires similar certification for any other specialty of registered nursing, in-patient or out-patient. (I’m not including APN practice.) While enhanced knowledge and experience is a worthy goal of certification, to be honest, we must acknowledge that certification for school nurses exists at least as much to satisfy the academic hierarchy and union expectations of school district employees. It is no coincidence in your scenario that the governing body which issued the cease and desist order to the non-certified nurse was the teacher certifying body, and not the BON (responsible for nurse qualifications and quality of care). To assert that only a certified nurse can capably practice in a school setting is to ignore the vast majority of districts nationwide that provide quality care to their student and adult populations at the hands of non-certified nursing staff, as well as to ignore the very practice in CA of granting temporary practice permission to nurses in the process of obtaining their formal certification. Quality of health screening and IEP representation does not come about via school certification. It comes about by way of education, experience, and professionalism, none of which are gained solely thru the certification process, and none of which is the sole turf of nurses. Many states include educators in their vision and hearing screening training programs.

Your previous post details the lengths to which you and others went to inquire about this nurse’s role. When you did not receive the answers you desired, you developed a formal, multi-pronged approach to gain support for her ouster, which you indicate stemmed from your fears that other districts would craft similar positions, eliminating the need for certified school nurses. Nowhere did I read that concern for quality of care was your motivator, but job security. I can certainly understand the driving desire to protect one’s job, but I believe it’s a bit disingenuous to base the argument on “quality” now, when that didn’t even get a mention in your first post.

We are only hearing one side of the story. I’m sure you would acknowledge that the nurse in question would probably tell a very different story of your group’s attempts to have her disqualified from her position. No doubt she responded defensively. You would, too, if you felt that your job was threatened. In fact, it sounds as though the tables have turned a bit. I don’t understand your question as to why the letter you sent to the superintendent was made available to her. If someone were writing a letter to your boss, trying to get you dismissed, wouldn’t you expect to be able to read and rebut the letter?

I’m sorry for your situation. No doubt it is uncomfortable. My only advice is to conduct yourself professionally and gracefully and form good relationships with your co-workers. When this nurse completes her education (I don’t understand the dig about public health.) and reapplies, you will need all the allies you can find.

geocachingRN · Sep 7, 2011

Thank you for your well thought out response Jolie. I truly appreciate it. Now that I'm in the district instead of looking at it from the outside, there were many, many things that were not done, or not done correctly. Tacit permission was granted for questionable policies that I quickly put a halt to. It's hard to judge quality from the outside when the only communication is "butt out"

I do find the certification process to be onerous and costly, coming in around 8k, in comparison to other states, however it has been well worth it in learning Ed Code and more importantly making connections with more knowledgeable nurses. I've worked with an MSN trained 15 year experienced nurse who is great at assessing, but still needed to learn the things taught in the program. Yet so many people think that it's ok to buck the state standards because other states do things differently. I didn't make the law, However, I do think the process is there for a reason. If one disagrees they should work to change the law. But if a nurse does not believe the law, code, or certification is relevant, to the point where they feel they have the right to work without it, then what else will be considered arbitrary? I realize mentors, practice and good skills will make for good school nurses and good assessments and IEPS. Which is why I spent my first two years in a district with other school nurses learning the ropes. I am still learning about what I don't know and expect it will take 3-5 years to get a handle on this job.

As to our group's methodology, if there was a clear procedure for reporting and investigating school nurses and holding the district and ourselves accountable then there would not have been this problem. This is why standards exist and are so very important. Many nurses are on their own and their district trusts that they are doing the right thing without knowledge of what school nurses actually do and without oversight. I can say that from what I've experienced so far in the district, and of her personally, it was the correct decision.

As to job security, yes, I agree, no one wants to carry the big stick when the rules are being broken. I certainly didn't and yet a new standard was being set. In a state back east, the nurses were taken off the certificated scale and ADN nurses were hired instead. I don't want to go down that path. My old boss did eliminate the my school nurse position at the end of the year and I was offered a less appealing job, which I would have stuck with if no other option presented itself but it did. I had several conversations regarding ethics, and much reflecting on my integrity before I applied. It was the right decision. I'm no shining beacon of light and I'm not perfect, but I do have a great network and mentors.

I agree that my knowledge and conduct as the health professional will win the day and I'm hoping the icky stalker behavior will go away. I've already talked to the HR person.