Question: Conduct a search in several job listing websites for your location. Count the advertisements for RNs. How many employers are represented? Think of all the different healthcare agencies in the community. Do the ads represent most of them, some of them, or only a few of the potential employers of nurses? Of those listed, how many specify backgrounds or experiences beyond that which a new graduate would have? How many specify the shift or work schedule? If wages are noted, what is the range of wages quoted? Reflect on your own expectations for employment after graduation. How do your expectations compare with what you find in these advertisements?
Chapter 3
Credentials for Healthcare
Providers
Copyright © 2023 Wolters Kluwer Health | Lippincott Williams & Wilkins
Introduction
❖Credentials
o Provide information regarding qualifications and
whether standards have been met
❖Quality improvement
❖Certification
o Credentials awarded by educational institutions,
legal licenses awarded by governmental body,
recognition by a professional organization
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Approval and Accreditation of Institutions
and Programs
❖Accreditation of educational institutions
o Major way to know an institution or program
provides quality education
❖Government approval of nursing programs
o Requirement to be eligible to take NCLEX exam
❖Accreditation of nursing education programs
o Helps to strengthen uniform national standards
for nursing education; can be specialized
❖Accreditation of continuing education programs
o Ensures meets appropriate standards
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Credentials for Individuals
❖Diplomas, Degrees, and Certificates of Completion
o Depends on type of program as to which is
awarded on completion
❖Licensure
o Legal credential; each state differs as to
requirement of obtaining a license
❖Certification
o Usually awarded by independent professional
organization; granted on completing educational
program and passing standardized exam
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Question #1
❖Is the following statement true or false?
❖Credentials are written proof of qualifications and
include diplomas awarded by professional groups.
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Answer to Question #1
❖False
❖Rationale: Credentials are written proof of
qualifications and may include diplomas awarded by
educational programs, certification, or registration
by professional groups, and legal licenses awarded
by governmental agencies.
Copyright © 2023 Wolters Kluwer · All Rights Reserved
Nursing Licensure in the United States #1
❖The History of Licensure in Nursing
o One of major concerns of ANA was
establishment of legal licensure for nurses
o Led to Nurse Practice Act
o Mandatory licensure became a major focus;
happened first in New York in 1947; is standard
today in United States, Canada, and most other
countries
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Nursing Licensure in the United States #2
❖Current Nursing Licensure Laws
o Purpose: protect the public, set minimal
qualifications and competencies for safe entrylevel practitioners
o Each jurisdiction’s legislature establishes a
licensure law
o Proposed changes occur through legislative
process through an elected member who has
been persuaded that change is in the best
interest of the public
o Nurses have potential to influence decisions
regarding healthcare
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Nursing Licensure in the United States #3
❖Rules and Regulations
o Administrative law
o State board of nursing
❖Nursing Licensure Law Content
o ANA formulated first model nursing practice act
for states to follow
o NCSBN updated its entire model act and model
rules and regulations in 2014
o Must carefully read Nurse Practice Act in state
you will be working; each are slightly different
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Nursing Licensure in the United States #4
❖State Licensure Laws for Nursing
o Purpose
o Definitions and Scope of Practice
o Qualifications for Licensure Applicants
o Titling
o License Renewal and Continuing Competence
Requirements
o Nursing Education Programs
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Nursing Licensure in the United States #5
❖State Licensure Laws for Nursing (cont.)
o Grounds for Disciplinary Action
o Exceptions
o Administrative Provisions
o Grandfathering
❖Sunset Laws and Nurse Practice Acts
❖Advanced Practice Registered Nurses (APRN)
o Nurse practitioners, nurse anesthetists (CRNA),
nurse–midwives (CNM), clinical nurse specialists
(CNS)
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Nursing Licensure in the United States #6
❖ The Role of the State Board of Nursing
o Establishes standards for licensure
o Examines and licenses applicants
o Provides for interstate endorsement
o Renews licenses, grants temporary licenses, and provides
for inactive status as requested
o Enforces disciplinary codes
o Provides rules for revocation of license
o Regulates specialty practice
o Establishes standards and curricula, and approves nursing
education programs
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Question #2
❖Is the following statement true or false?
❖Permissive licensure requires that all individuals who
wish to practice in the field be licensed to practice.
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Answer to Question #2
❖False
❖Rationale: Permissive licensure allows for those
meeting certain standards voluntarily to be licensed,
whereas mandatory licensure requires that all
individuals who wish to practice in the field be
licensed to practice.
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Obtaining a Nursing License #1
❖ Licensure by Examination
o Required to take appropriate examination (NCLEX-RN or
NCLEX-PN)
o Standardized exam to be taken by all new graduates
administered through computerized adaptive testing
o Covers client need categories (safe effective care
environment, health promotion and maintenance,
psychosocial integrity, physiologic integrity) and
subcategories
o Covers integrated processes: nursing process, caring,
communication and documentation, teaching/learning, and
culture and spirituality
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Obtaining a Nursing License #2
❖Licensure by Endorsement
o Process of obtaining nursing license in a new
state while already licensed in another state
o Each state differs as to criteria for new licensure
o May need to hold licenses in several states
based on situation
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Obtaining a Nursing License #3
❖ Mutual Recognition of Licensure
o Receive RN license in home state and allowed to legally
practice in additional states without obtaining licenses for
those states
o Must follow Nurse Practice Act of client’s location
o Many healthcare organizations operate across state
boundaries, decrease cost of licensing for nurses
o Better enables telenursing opportunities
o Concerns
▪ Requirements for maintaining licensure
▪ Disciplinary processes differs among states
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Revocation or Limitation of a License
❖ License may be revoked by state board of nursing,
designated disciplinary board, or court of law based on
specific reasons stated in the Nurse Practice Act.
❖ Board may provide license with conditions, suspend a
license until certain conditions are met, or revoke a license
completely.
❖ Decision may be appealed in court of law in most states.
❖ If determined actions constitute a felony, obligated to report
to criminal authorities for prosecution.
❖ Individual being investigated should have an attorney; may
be covered by malpractice insurance.
❖ It is your responsibility to know the Nurse Practice Act in
each state you care for clients.
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Question #3
❖Is the following statement true or false?
❖The American Nurses Association is the
administrative agency that has the authority to
carry out the provisions of the Nurse Practice Act.
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Answer to Question #3
❖False
❖Rationale: The state boards of nursing (or their
equivalent) are the administrative agencies that
have the authority to carry out the provisions of the
Nurse Practice Act.
Copyright © 2023 Wolters Kluwer · All Rights Reserved
Licensure for Graduates of Foreign
Nursing Schools #1
❖Must meet two requirements
o Have a visa that permits employment
o Obtain a state license to practice nursing
❖Must provide verification that nursing education
meets state requirements and must take
appropriate NCLEX exam
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Licensure for Graduates of Foreign
Nursing Schools #2
❖ CGFNS International (Commission on Graduates of Foreign
Nursing Schools)
o Provides special visa for nurses after reviewing education,
evaluation of current and previous licenses, assessment of
English language proficiency, and completion of CGFNS
exam or NCLEX-RN
❖ International Centre on Nurse Migration
o Project of CGFNS and ICN
o Works on policies worldwide that affects nurse migration,
collects and reports data on nurse migration, serves as
resource for those working with regulations regarding
nurse migration
Copyright © 2023 Wolters Kluwer · All Rights Reserved
Nursing Licensure Around the World
❖Education and licensure differ greatly around the
world
❖Practice patterns and expectations also differ
❖If interested in international nursing:
o Consider language proficiency
o Educational backgrounds
❖Contact organizations involved in international
healthcare
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Certification in Nursing
❖Certification provides evidence of specialized clinical
knowledge and ability beyond the basic level
❖Certification as nurse practitioner may be used as
basis for legal approval for the ARNP role
❖American Nurses Credentialing Center Certification
o See Box 3.2
❖Other Nursing Certifications Available
❖Certification for Licensed Practical Nurse
o Available for long-term care
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The Future of Credentialing in Healthcare
#1
❖The ideal credential clearly communicates
qualifications and competence
❖Institutional Control of Credentials
o Belief that licensing institution instead of
individuals would be an adequate safeguard for
the public
o Belief that specific competencies should be
certified instead of entire field of practice
o Site-based examination and site-based
certification
o Is not without concerns
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The Future of Credentialing in Healthcare
#2
❖National Academy of Medicine Recommendations
and the Future of Approval/Accreditation
o Promotes higher education for RNs, changes to
scope of practice for APRNs
o Recommended core competencies
▪ Delivering client-centered care
▪ Working as part of interdisciplinary teams
▪ Practicing evidence-based healthcare
▪ Focus on quality improvement
▪ Using information technology
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Question #4
❖Is the following statement true or false?
❖The goal of credentials is to clearly communicate the
necessary qualifications and competence of the
individual.
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Answer to Question #4
❖True
❖Rationale: The use of credentials is to inform others
that the individual with the credential has met the
necessary qualifications and is competent to
complete the task associated with that credential.
Copyright © 2023 Wolters Kluwer · All Rights Reserved
Question #5
❖Is the following statement true or false?
❖Certification as a nurse practitioner may be used as
a basis for legal approval for the advanced
registered nurse practitioner role.
Copyright © 2023 Wolters Kluwer · All Rights Reserved
Answer to Question #5
❖True
❖Rationale: Certification provides evidence of
specialized clinical knowledge and ability beyond the
basic level. Certification as a nurse practitioner may
be used as a basis for legal approval for the
advanced registered nurse practitioner role.
Copyright © 2023 Wolters Kluwer · All Rights Reserved
Chapter 4
Making Professional Goals a
Reality
Copyright © 2023 Wolters Kluwer Health | Lippincott Williams & Wilkins
Employment Opportunities Today
❖ Long-term outlook for all nursing positions is excellent as per
the U.S. Bureau of Labor Statistics (2020).
❖ Although the predicted nursing shortage did not develop as
thought, many parts of United States are still experiencing a
lack of qualified nurses.
❖ Flexibility is a key factor when deciding your location; only
60% of positions are located in hospitals.
❖ Choosing a facility that offers mentoring and orientation will
better assist the new graduate to adjust to the role of an RN.
❖ Some options do not include providing direct client care.
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Competencies of the New Graduate #1
❖ Identified by Nursing Organizations
o National Council of State Boards of Nursing Competencies
(NCSBN)
▪ Management of care
▪ Safety and infection control
▪ Health promotion and maintenance
▪ Psychosocial integrity
▪ Basic care and comfort
▪ Pharmacologic and parenteral therapies
▪ Reduction of risk potential
▪ Physiologic adaptation
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Competencies of the New Graduate #2
❖Identified by Nursing Organizations (cont.)
o National League for Nursing Competencies (NLN)
▪ Developed comprehensive statement of
expected outcomes and competencies at each
level of nursing education
o Competencies expressed by Other Groups
▪ American Association of Colleges of Nursing
(AACN) developed document with essentials
for education
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Competencies of the New Graduate #3
❖ Employer Expectations Regarding Competencies
o Possess necessary theoretic background
o Use nursing process in systematic way
o Recognize own abilities and limitations
o Effective communication skills
o Work effectively with UAP
o Accurate and complete documentation
o Proficiency in basic technical nursing skills
o Basic skills in information technology
o Work ethics and function at acceptable speed
Copyright © 2023 Wolters Kluwer · All Rights Reserved
Question #1
❖Is the following statement true or false?
❖While the specific competencies for an RN may vary
among employer, the basics are the same.
Copyright © 2023 Wolters Kluwer · All Rights Reserved
Answer to Question #1
❖True
❖Some employers or positions may require more
specific competencies for some positions due to the
level of care of the client; however, basic
competencies are similar in all positions when
fulfilling the position of a nurse.
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Personal Career Goals
❖Focusing your goals
o What do you want to do?
❖Setting your goals
o Short-term goals
o Long-term goals
❖Maintaining and enhancing your competence
o Continuing education
o Computer instruction programs
o Self-directed study
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Making Goals Reality #1
❖To obtain a nursing position
o Identify potential employers
o Develop professional résumé
o Write appropriate letters to employers
o Complete the application
o Interview effectively using both in-person and
online strategies
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Making Goals Reality #2
❖Successful interviewing
o Learn about the organization.
o Dress appropriately.
o Arrive a bit early.
o Be self-confident, maintain eye contact, remain
attentive throughout interview.
o Take copies of all appropriate documentation.
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Making Goals Reality #3
❖Successful interviewing (cont.)
o Be prepared with answers for possible questions
(See Box 4.5).
o Answer all questions directly and clearly.
o Clarifying statements and questions may help to
provide needed data, while specific details rather
than generalities are often received more
favorably.
o Approach problem-solving questions by using
the nursing process.
o Prepare questions to ask the interviewer.
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Making Goals Reality #4
❖Follow-up strategies
o Send a brief thank-you note.
o Contact interviewer in one week for update.
o Continue to contact the employer for possible
positions if not initially hired but still desire to
work for them.
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Making Goals Reality #5
❖Resignation
o Always remain professional.
o Give plenty of notice so replacement can be
found.
o Will affect references.
o Always try to leave with appropriate professional
relationships intact.
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Question #2
❖Is the following statement true or false?
❖To make the best impression, interview questions
should be answered directly and clearly.
Copyright © 2023 Wolters Kluwer · All Rights Reserved
Answer to Question #2
❖True
❖Rationale: To make the best impression, interview
questions should be answered directly and clearly.
The use of clarifying statements and questions may
help to assure that you are providing needed data,
while specific details rather than generalities in your
response often are received more favorably.
Approaching problem-solving questions using the
nursing process provides a pattern for effective
response.
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