34 unit 1 | Professional Considerations
malpractice. This can result in the nurse losing his
or her license and perhaps even facing a wrongful
death suit due to an error in judgment.
Nurses practice under state or provincial
(Canada) nurse practice acts. These state that nurses
are held accountable for the safety of their clients
Once a nurse accepts an assignment for the client,
that nurse becomes liable under his or her license.
Many states are working to create legislation
restricting mandatory overtime for nurses.
Licensure
Licensure is defined by the National Council of
State Boards of Nursing as the “process by which an
agency of state government grants permission to an
individual to engage in a given profession upon
finding that the applicant has attained the essential
degree of competency necessary to perform a
unique scope of practice” (NCSBN, 2007). Licenses
are given by a government agency to allow an indi-
vidual to engage in a professional practice and use a
specific title. State boards of nursing issue nursing
licenses, thus limiting practice to a specific jurisdic-
tion (Blais, Hayes, Kozier, & Erb, 2006).
Licensure can be mandatory or permissive.
Permissive licensure is a voluntary arrangement
whereby an individual chooses to become licensed
to demonstrate competence. However, the license is
not required to practice. Mandatory licensure
requires a nurse to be licensed in order to practice.
In the United States and Canada, licensure is
mandatory.
Qualifications for Licensure
The basic qualification for licensure requires grad-
uation from an approved nursing program. In the
United States, states may add additional require-
ments, such as disclosures regarding health or
medications that could affect practice. Most states
require disclosure of criminal conviction.
Licensure by Examination
A major accomplishment in the history of nursing
licensure was the creation of the Bureau of State
Boards of Nurse Examiners. The formation of this
agency led to the development of an identical exam-
ination in all states. The original examination, called
the State Board Test Pool Examination, was created
by the testing department of the National League
for Nursing. This was done through a collaborating
contract with the state boards. Initially, each state
determined its own passing score; however, the
states did adopt a common passing score. The
examination is called the NCLEX-RN and is used
in all states and territories of the United States.
This test is prepared and administered through a
testing company, Pearson Professional Testing of
Minnesota (Ellis & Hartley, 2004).NCLEX-RN
The NCLEX-RN is administered through com-
puterized adaptive testing (CAT). Candidates must
register to take the examination at an approved
testing center in their area. Because of a large test
bank, CAT permits a variety of questions to be
administered to a group of candidates. Candidates
taking the examination at the same time may not
necessarily receive the same questions. Once a can-
didate answers a question, the computer analyzes
the response and then chooses an appropriate ques-
tion to ask next. If the question was answered cor-
rectly, the following question may be more difficult;
if the question was answered incorrectly, the next
question may be easier.
The minimum number of questions is 75, and
the maximum is 265. Although the maximum
amount of time for taking the examination is
5 hours, candidates who do well or those who are
not performing well may finish as soon as 1 hour.
The test ends once the analysis of the examination
clearly determines that the candidate has success-
fully passed, has undoubtedly failed, has answered
the maximum number of questions, or has reached
the time limit (NCSBN, 2007). The computer
scores the test at the time it is taken; however, can-
didates are not notified of their status at the time of
completion. The information first goes to the test-
ing service, which in turn notifies the appropriate
state board. The state board notifies the candidate
of the examination results.
Nursing practice requires the application of
knowledge, skills, and abilities (NCSBN, 2007).
The items are written to Bloom’s taxonomy and are
organized around client needs to reflect the candi-
dates’ ability to make nursing decisions regarding
client care through application and analysis of
information. The examination is organized into
four major client need categories. Two of these cat-
egories, safe and effective care and physiological
needs, include subdivisions (NCSBN, 2007).
Integrated processes incorporate “nursing process,