Part One: WHO WE ARE
There are extremely odd times present in the U.S. these days, especially when it comes to accessing health care.
Although it’s quite unusual to find independent practice Registered Nurses, we are present and available. We are the registered nurses (RNs) who have grown tired of being little more than licensed pawns in a fragile and sometimes disempowering health care industry, and have grown disillusioned because we became RNs to help people. We put aside our families and our lives to attend college to earn the right to take a grueling national examination with no guarantee of passing. We’ve studied psychology, anatomy and physiology, mathematics, disease processes, chemistry, pharmacy and spent at least two and sometimes four years getting ready for this. After we’ve passed the exam, we are now licensed and ready to learn.
Although most of us follow the bedside hospital route into our practice, some of us decide to step away from the employee-relationship to health care and wellness support and form our own practices.
“Wait. What?” you may wonder, and you would be right to do so.
Registered Nurses do have what are called “independent” licenses. That means we can make assessments, judgements, and guide health care processes. Those with LPN or LVN status cannot legally do this, but an RN can sign after them.
Here is a basic outline of what an RN’s private practice is based on.
Registered Nurse Diagnoses. An RN can follow a protocol that we all learned in nursing college but don’t routinely use to its full extent as employees.
There are well over two hundred different nursing diagnoses at this point (February 2017), spread over categories such as Adult Health, Adolescent Health, Child Health, Maternal-Neonatal Health, Geriatric Health, Psychiatric and Mental Health, Community-Based Health, and Wellness. A nurse may specialize as he or she desires in private practice, guided by published criteria, grounded in peer-reviewed research, and the nurses’ individual experience and knowledge base.
Nursing diagnoses are made in a very specific process, and after an assessment is made. Nursing diagnoses may be made for a particular status, or for the RISK of a particular status. It’s the RISK part that I would like to emphasize in this post.
When to intervene? Most of us do not go to see a physician, nurse practitioner, physician assistant or specialist on a fairly routine basis, or when we are concerned about the way our health is headed. We would like someone knowledgeable to speak with, but who would that be?
Health Coaches. Did you know that this title is not regulated in any way? You can pay $5000 to go through a one-year program at Institute for Integrative Nutrition (IIN), pay another $200 to $300 to the American Association for Drugless Practitioners (AADP) and market your services saying you are a Certified Holistic Health Coach, Board Certified. It sounds nice – but the drawbacks are worth noting. I have personally known individuals who (although unlicensed) give medical advice, suggest stopping medications, promote the ingestion of essential oils with no knowledge of health history or medication history, and promote sales of their oils, vitamins, equipment, or ongoing “consultations” that turn out to be very expensive. In fact, some of them are very good, some of them are very dangerous. I know this because I went through this program. Wouldn’t it be safer to retain the services of a licensed profession who has a national certification (that is, one you cannot just pay for, buy, or use because you like it) in health promotion services? I absolutely think so.
Your licensed, certified, RN. The RNs that are in private practice might be a more trustworthy choice for your personal wellness and health support. We counsel, coach, and can advise.
- Licensure. This means that every RN has had the same basic preparation in their education, and have passed the same national licensing exam, the NCLEX-RN.
- Public Records. Every state has different databases, but if any action has been taken against a licensed professional, it’s generally available to the public. And rightly so. We are supposed to be held accountable for the actions we take as specifically licensed individuals.
- Nurse Practice Act. Each state also has a nurse practice act, outlining what RNs can and cannot do, they review complaints with investigations, and either absolve or confirm and assess the basis of complaints. In my home state of Washington, for example we have a scope of practice decision tree that RNs, LPNs, and ARNPs use to delineate what can and cannot be done at each practice level as a general guide. Here is where you can see such a tool and then find what your own state has for practice. http://www.doh.wa.gov/portals/1/Documents/Pubs/609305.pdf
- Recourse. If you are abused, swindled, or otherwise egregiously treated by a licensed individual, you have recourse by filing a complaint if it comes to that. This is what we have as individual freedoms, and how licensing works to protect the public good.
Certifications for RNs and Education. When you look for an independent RN for health promotion or wellness interventions, I recommend asking the prospective RN if they have certifications. Be sure to get the name of the certification, the letters of the certification, and do your own due diligence. Check the license to be sure there are no blemishes or restrictions. Check the certifications to be sure they are professionally legitimate, have a requirement for continuing education, and are not fake certifications that can be purchased. Some to look for could include:
RHC – This is registered health coach. It is earned through a two-step process. First, is a written examination which grants a certification called Chronic Condition Profession (CCP) and attests to the person’s knowledge base. The second step is a practical review of the person’s technique through recordings or videos of actual encounters that are peer-reviewed until the practical use of the knowledge base is achieved. Very few professional earn this. Here is the site to evaluate: http://www.healthsciences.org/registered-health-coach
CCM – Certified Case Manager. This professional designation means the RN has learned the process of pulling-together the many different parts of a person’s health and can help guide the person through the maze of health care options and processes. Here is the site so you evaluate the CCM credential: https://ccmcertification.org/
Board Certified Holistic Nurse – The RN will have different letters, depending on their college education credential. For example – basic certification versus advanced certification. Holistic nurses have to study and meet the criteria for national testing and focus on the whole person and bringing awareness of a disease process into the full lived experience, for example. They focus on body, spirit and mind in their assessments and in their counseling. Some are also coaches. Many Holistic Nurses practice alternative healing techniques like aromatherapy, energy healing or yoga, for example. You can read about Holistic Nurse certifications here: http://www.ahncc.org/
RN – Registered Nurse designation. The nurse who uses this without a college degree stated is usually the graduate of an associate degree program, or who went to a three year hospital based internship + college program.
BSN, RN – Bachelor of Sciences Nursing prepared RN. About one-third of RNs today go through a bachelor degree program as their basic educational preparation.
MSN, RN – Master of Sciences, Nursing prepared RN. Sometimes also called MN for Master of Nursing. These RNs earned a Master’s degree and some can be nurse practitioners, some assist with research projects, some are Nurse Educators, and others are Holistic Nurses.
DNP, PhD, RN – Doctorally prepared RNs. The Doctor of Nursing Practice, or the PhD in nursing are prized degrees for advanced practice. Some states now required this for nurse practitioners. Some of these nurses are educators, some are lead scientists in research projects, and some are Chief Nursing Officers in hospital chains or Directors of Education at Nursing Colleges.
A word about Patient Advocacy – all nurses are, by licensure, patient advocates. We put the welfare of the patient as a priority over convenience or dangerous practices we see. There are also professional designations and in-depth training available for RNs to become a patient advocate specialist. As a professional RN, I have always subscribed to the high calling of advocacy and take it very seriously.
What if the RN is not licensed in my state? Generally, in order to practice as an RN with a client, the nurse must be licensed in the state that the client resides in. Each nurse is responsible for knowing the laws and practice limitations they have. However: if you decided (for example) to retain the services of a Washington State RN and you live in Oregon, the nurse can either have a license in that state, OR can tell you that he or she cannot practice as an RN with you, but can continue the relationship as a health advocate or health coach. (This is a general rule, and not a legal position or advice.)
© Lizzie Bennett
Lizzie Bennett is a Registered Nurse and Ordained Minister of some years and owns Three Moons Medicine™ as her private counseling and coaching practice, a blog, educational forum, Facebook page, and outreach to support others on their journey.
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