The intent of this position statement is to provide a rationale for the New York State Nurses Association (NYSNA) advocating for public protection through the elimination of the illegal practice of nursing.
It is the position of the New York State Nurses Association that:
The nursing profession is dynamic and continually evolves in response to the shifting needs, demands and resources of society (DiLillo & Adams, 2002). It is a profession with a distinct body of knowledge, hospital and university-based education, specialized practice, evidence-based standards, a social contract, and code of ethics (ANA, 2004). Nursing’s Social Policy Statement, Second Edition (2003), provides a contemporary definition of nursing:
Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.
In order to provide the care defined by the Social Policy Statement, one must successfully complete the requirements set forth by the New York State Education Department (NYSED) and Board of Regents. Since 1891, the Board of Regents has overseen the preparation, licensure, disciplinary process and practice of the professions. The purpose of the Regents is to ensure public protection, quality professional preparation and fairness to all professionals (Office of the Professions Professional Regulation, n.d.).
To ensure public protection, the NYSED grants a license to individuals who have successfully completed an approved education program, passed a standardized exam (NCLEX), and satisfied other licensure requirements (including “good moral character”). When RNs or LPNs are granted licenses they are authorized to practice nursing according to the New York State Education Law, Article 139 Nursing (Nurse Practice Act).
The profession of nursing is regulated legally by the individual nurse and by the nursing profession. The Nurse Practice Act was enacted by the legislature to define the scope and regulate the professional practice of nursing for the purpose of protecting the public. Self-regulation occurs when nurses remain accountable for maintaining current knowledge, skills, and abilities to practice competently. Professional regulation occurs as nursing defines its practice base, contributes to nursing research, establishes nursing education systems, develops the structures through which nursing services are delivered, and develops quality review mechanisms, such as codes of ethics, peer review, credentialing and standards of practice (ANA, 2003).
As many healthcare entities simultaneously seek to meet the needs of patients and cut costs, nurses are often replaced with task-oriented unlicensed assistive personnel (UAP). These entities not only disregard the Nurse Practice Act by allowing the UAP to practice nursing illegally, but, frequently, they even exert excessive influence to change licensing laws to allow UAPs greater latitude. According to the NYSED, the illegal practice of nursing is a threat to the public and challenges state resources. The NYSED determines that illegal practice is committed by, “…any person or entity who practices one of the licensed professions without a license authorizing him/her to practice, and/or who falsely represents him/herself as authorized to practice such a profession (Office of the Professions Unauthorized Practice, n.d).”
The utilization of UAPs inappropriately poses a significant risk to the public. The American Nurses Association (ANA) and many state “constituent member associations” are at the forefront of safeguarding nursing’s scope of practice against efforts to substitute insufficiently educated and unregulated unlicensed assistive personnel for RNs and LPNs (Bruser & Whittaker, 1998). The proliferation of titles to describe various UAPs contributes to public confusion. Activities of the UAP are defined by job descriptions, lack standardized training, and are not regulated through codified scopes of practice. UAPs are frequently instructed by facilities, other licensed healthcare providers, or other UAPs to perform complex nursing functions where judgment is required.
While the specific titles, “registered professional nurse” and “licensed practical nurse” are protected by law, unlicensed individuals may currently use the title “nurse” alone or in any combination other than that specifically protected by law, without any sanction, undermining the credibility of licensed nurses. Ensuring that the title “nurse” can only be used by RNs and LPNs affirms the value of the nursing profession and safeguards consumers against misrepresentation by unlicensed individuals.
The New York State Nurses Association recommends that:
Note: The use of the term “patient” anywhere in this document is intended to be generic and refers to the recipient of nursing care.
To learn more about the appropriate utilization of unlicensed assistive personnel you may wish to review NYSNAs position statement: Registered Professional Nursing’s Utilization of Unlicensed Assistive Personnel.
Former title: Illegal/Unlicensed Practice. Approved by Board of Directors 06/03/92 and 09/14/95. New title and position statement reviewed and approved by the Expanded Council on Nursing Practice on 03/10/06. New title in 2006 approved by the BOD on 06/08/06.
American Nurses Association. (2003). Nursing's social policy statement. Washington, DC: Author.
American Nurses Association. (2004). Nursing: Scope and standards of practice. Washington, DC: Author.
Bruser, S., & Whittaker, S. (1998). Quality watch. Diluting nurses’ scope of practice. Retrieved January 10, 2006, from http://www.nursingworld.org/ajn/1998/oct/qual108a.htm
DiLillo, A., & Adams, F. W. (2002). Continuing education: scope of practice: the responsibility of the registered nurse in making practice decisions. Connecticut Nursing News, 75(3), 6-9, 11.
Office of the Professions. (n.d.). Unauthorized practice of the professions. Retrieved January 17, 2006, from http://www.op.nysed.gov/unauthorizedpractice.htm
Office of the Professions. (n.d.). Professional regulation in New York State. Retrieved February 10, 2006, from http://www.op.nysed.gov/aboutop.htm
For more information on nursing practice, contact NYSNA's Education, Practice and Research Program at 518.782.9400, ext. 282 or by e-mail.