Interview with Wendie Howland, MN RN-BC CRRN CCM CNLCP LNCC
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5 Things to Know About Registered Nurse Licensure
Wendie Howland is just about as certified as one nurse can be. Her complete list of credentials are: Registered Nurse – Board Certified, certified in nurse case management; CCM, certified in case management; CRRN, certified in rehabilitation nursing; CNLCP, certified in nurse life care planning; and LNCC, certified in legal nurse consulting. In addition to those qualifications, she has taught nursing, served on exam writing teams for two nursing specialties, and is currently the owner and principal of Howland Health Consulting, a legal nurse consulting life care planning business. Now that’s a lot of nursing knowledge!
Howland uses her nursing experience and expertise to consult nurses on the legal aspects of the field, as well as life care planning (an outline of care, including medical and therapy treatment, future projections, equipment and transportation, among other things). She started her education at Boston University, earning her Bachelor of Science degree in nursing. She then earned her Master of Nursing in Physiological Nursing from the University of Washington in Seattle.
As editor of the Journal of Nurse Life Care Planning and the Journal of Legal Nurse Consulting, Howland is constantly encountering current events and issues that nurses around the country are facing. Her expertise has also led her to speak at CMSA (Case Management Society of America) and the AALNC (American Association of Legal Nurse Consultants). She also conducts webinars on various subjects—most recently on rebutting defense objections to life care planning.
Enjoy our full interview with Wendie Howland, who has compiled her top things to know about RN licensure, based on her extensive career as a nurse and working with nursing colleagues.
eLearners: In your opinion, what are the top most important things to know about licensure for RNs?
- You don’t go to school to obtain an RN license; schools do not issue licenses. States do.
- Graduating from your properly-accredited program allows you to apply to the state board of nursing for permission to sit for the licensure exam, the NCLEX (National Council Licensure Examination).
- Unlike a driver's license, one can hold multiple state licenses. License from another state (State 2) can be pursued by contacting the board of nursing in the target state and finding out what their requirements are (other than holding a valid RN license from State 1). Some may require passing a course in recognizing and reporting abuse of elder/child/vulnerable citizens, a background check, fingerprinting, or (and this is a surprise to many people) proof of graduation from a program that meets their quality requirements. There are some schools that do not meet quality requirements in all states; their graduates, even if having passed NCLEX and holding a valid RN license in their State 1, will have to do remedial education to obtain licensure in some State 2s.
- Although many people are scared to death about losing a nursing license, state boards of nursing generally do not restrict or revoke a nursing license easily. The usual reasons for these actions are felonies, drug diversion, and gross patient endangerment/abuse. No nurse is perfect; any nurse who tells you she’s never made a medication error or forgotten to chart something is lying or delusional. These sorts of human errors may get you counseled, and repeated actions like these or interpersonal issues may get you fired, but chances are you won’t lose a license over them.
- EVERY nurse should consider having malpractice insurance. Some folks will say that they have heard that only people with insurance get sued, under the "deep pockets" theory of litigation, or that the hospital's insurance will cover you for nursing malpractice. Neither is true. The problem is that if your hospital has a judgment against them for something you did, and they don't pay it, their insurance carrier pays it. And then, no matter what the hospital promises you, the insurance carrier is entitled by law to recover their losses from you, and don't think they won't. My dad wrote insurance on hospitals for years and told me never, never, never go "bare" (without my own insurance) unless I was perfectly comfortable living under a bridge, with no real estate, no money, and no car.
Yes, I know, there are laws protecting some assets under bankruptcy. But they could garnish your wages more or less in perpetuity, and that wreaks havoc on your credit rating. (Did you know that credit ratings are checked when you apply for jobs?) Decent malpractice insurance is good protection for short money.
Make sure the policy you buy is clear to you: Does it cover you only while it's in force (while you're still paying for it), or does it cover you for things that happened while you were paying for it in the past, even if you aren't working now and don't think you need insurance? Be sure it pays for your own lawyer, too, or supplies one to defend you (never, never, NEVER rely on the hospital's lawyer to defend you-- conflict of interest there; they may not have your best interests at heart no matter what they say).
eLearners: What’s the difference between licensure and certification as it applies to RNs?
The first thing to know is that "RN" is not a certification, it's a licensure granted by an individual state board of nursing to people who pass the basic examination, the NCLEX.
eLearners: What’s the difference between nursing specialty certification and a nursing certificate?
There's a big difference between a nursing specialty certification and a certificate granted by an educational program. Certification is a credential earned by someone who has experience in a field. This requires education hours to learn about the field and its competencies at a high level. The certification examination is administered by a legally separate entity from the specialty nursing organization. Prerequisites to sit the examination are typically active and unrestricted RN licensure, several years in practice in the field (not just being an RN), and often, submission of a written work product.
Recertification (usually required every three to five years) generally requires evidence of continuing education in the field, research publication, teaching, and/or other work that shows the person holding the credential is remaining current. The American Nurses Credentialing Center (ANCC) offers certification in a wide variety of RN practice, nurse practitioner, and clinical nurse specialist areas. The Accreditation Board for Specialty Nursing Certification (ABSNC) peer-reviews nursing specialty organizations and approves their certification examinations after reviewing their methodology, role delineation studies that define the specialty practice for which the examination applies, and other qualities.
A certificate is awarded after someone completes an educational program. Unlike certification, there is no requirement for work in the field; thus certificates do not give any information about whether the holder has functioned at an expert level. Certificates are usually granted by a for-profit educational program. If any testing is involved, it is given by that program (for a fee). Recertification is dependent on taking continuing education programs offered by the same entity (more fees involved); most do not accept anyone else's coursework.
Many programs say they offer "certification." However, this is often untrue. To tell the difference, look at the prerequisites to take the certificate course of study. Can you enroll in the program without prior experience? Certificate, not certification. Note that certification examinations are offered by certification boards associated with national nursing specialty organizations. Certificates are issued by private entities.
eLearners: How have your licensures and certifications helped you professionally?
In my early years, I was a certified critical care nurse and this definitely opened doors for me when I applied for work and, later, for graduate school. After I made the move to case management, the CCM and RN-BC opened more doors for me, making it possible to learn what I needed to know when, years after that, I wanted to start my own independent business. Valid certifications give the holder credibility. They can’t be bought; they must be earned. They testify to a nurse’s commitment to learning, years of practice, and expertise gained in it.
eLearners: Do you have any advice for prospective RNs who are preparing to take their licensure or certification exams?
Graduate with an excellent command of the science and theory of what nurses do, and a good sense that nursing is far, far more than “following doctor’s orders.” Own that. Understand the “why” of everything. NCLEX (and nursing) expects you'll have some level of baseline fact knowledge, of course, but is also concerned that you know how to think about using them when you have them.
- Do you need to get more information? Why?
- Do you understand what's important in a scenario or question, and what's not? Why?
- Do you know what's expected? Why?
- Do you know the effect of a drug? Why do we care?
- Do you know what a lab value means? Why do we care?
Why, why, why. It's the basis of everything we do, it's the foundation of critical thinking in three little letters. It's not something you have to do just to pass NCLEX, it's something every nurse has to do every day of a professional life.
Certification: Actively practice in a specialty. Join a professional organization in it. Meet people, talk to them, ask them how they got to where they are. Learn what the requirements are for certification—they’re usually found in a link at the specialty association’s website. Identify the criteria to be sure you’re earning a certification and not a certificate, regardless of what they call it. If a prep course is a good idea, take it; if not, recognize that several years of high-level practice in a field should be adequate preparation for an exam. Get the examination blueprint from the site, and bone up on anything you’re not fully confident about.
eLearners: How important is continuing education for RN professionals?
Nursing school only prepares you for basic, minimum practice necessary to take the NCLEX and pursue your first job. We hope they have also impressed upon you the need to be a lifelong learner and how to do that, because YOU have to keep learning for the rest of your life. Why? Because we are autonomous.
We are not a subservient profession.
While nurses are legally required to implement parts of the medical plan of care (but not all, such as physical therapy, lab, diagnostic imaging, dietary), much of what nursing does is independent of physicians. We have an independent and autonomous set of legal and professional standards, diagnoses, activities, and responsibilities related to patient care in myriad settings, not just hospitals and nursing homes. Nurses are held to standards for assessment, planning, implementation/delegation, and evaluation for nursing plans of care independent of the medical plan of care. Fulfilling these actions require considerable education and continuing learning.
eLearners: What are the challenges and rewards of the nursing?
Oh, students are rarely exposed to the true breadth of what we do, so they have no idea of what opportunities and rewards are out here. That’s understandable, because all they really know about nursing is the very distorted image depicted in the media (I’m talking about you, House and ER) and the limited exposure they get to hands-on patient care in clinicals or perhaps personal experience with family members or themselves, also tending to be in facilities or clinics.
I haven’t done bedside care for years, but I have never spent a day not practicing as a nurse, and valued for my knowledge of all things related. An education in nursing is such a marvelous beginning. You could do so much with it. If you love bedside care, you could do it for a lifetime. If you love teaching—well, all nurses do teaching, it’s part of your undergraduate requirements. I teach attorneys and other people about health-related topics all the time. If you want to manage to extend your influence and reach, you can. If you want to work independently, you can. If you want to be in a big organization, you may. You can learn something new every day. You can do research and spread the word. You can work with individuals one-on-one, or you can find that your work touches huge numbers of people you will never meet. You see birth, death, and all of life. It’s all out here. It’s such a privilege.
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