Nursing Licensure, Legislation and Nurse Practice Acts
The status of women in society is inextricably tied to the development of nursing as a profession. The development of nursing licensure laws closely follows the advancement of women’s roles in the struggle for suffrage and women’s increased visibility related to war time service. This project will explore these parallels.
Credentials, registration and licensure
A license differs from certification or registration. Registration requires a practitioner only register their intent to practice within a jurisdiction. Registration does not restrict the use of the professional title; consequently an unregistered practitioner can use the title.
Certification is a credential provided by an organization rather than the state and is usually granted after an applicant has completed an approved course of study and passed and examination. Certification does not confer the same legal rights to the holder as does a license. Some states use the term certified and registered interchangeably.
History of Nursing Licensure
In 1893, several nursing leaders arranged to meet at the Columbian Exposition in Chicago, Illinois to discuss these important issues affecting nursing practice. In 1896, this group became the procurer to the American Nursing Association (the Nurses’ Associated Alumnae of the United States and Canada). One of their primary aims was to promote nursing licensure. The first proposed laws advocated permissive licensure of nurses. The situation was so dire in the late 19th century that the first president of the American Nurses Association, Isabel Hampton Robb, lamented that
Permissive Nursing Licensure
Permissive licensure allowed nurses to choose whether or not to obtain the additional registered nurse credential. Permissive licensure provided the public with protection by establishing a way for the public to identify a qualified practitioner. Permissive licensure did not protect the title “nurse”. Any one could call themselves a nurse, however in order to be called a “registered nurse” the practitioner had to complete the requirements determined by the state.
North Carolina passed the first permissive licensure legislation in 1903. Prior to 1903, anyone could call themselves a nurse and practice nursing. By 1923, all 48 states had permissive licensure legislation. Women did not receive the right to vote until 1920 which means nursing organizations were lobbing legislators for permissive licensure laws in a time when most nurses could not vote. The magnitude of their accomplishment becomes more apparent when one realizes that without the promise of the votes of constituent nurses in the legislator’s home district, most law makers were uninterested in helping nursing leaders pass licensure laws.
Permissive licensure was the first step toward professional autonomy but nursing leaders continued to pursue mandatory licensure as a requirement for nursing practice. After permissive licensure statutes were enacted, most nursing school graduates sought and received licenses to use the title “Registered Nurse.” The majority of the nurses practicing who were not licensed were either nursing school graduates who failed the licensing examination or foreign educated nurses. The permissive licensure system continued to allow anyone to call themselves a nurse and practice nursing as long as they didn’t use the title “Registered Nurse.”
Mandatory Nursing Licensure
New York enacted the first mandatory licensure legislation for nurses in 1947. The law was originally passed in 1935 but enforcement was delayed due to the shortage of nurses during World War II. Today all 50 states and territories of the United States require that nurses be licensed in their practice state. The terms registered nurse and licensed practical (vocational) nurse are now legally protected titles. No one can call themselves a nurse without passing a licensing examination and meeting the requirements set by each individual state.
An interesting footnote to nursing licensure is that Florence Nightingale did not support licensure for nurses. She felt that only continuing education could ensure the competence of nurses not an examination taken once upon entry into nursing practice.
Timeline of Nursing Licensure
Governors State University - Adventure of the American Mind Partner
Shirley K. Comer Rn, Msn, JD.
Governors State University
Last Updated on April 11, 2007