This article is available as online continuing education at RNCE.org . Introduction Dr. Barnum raises several compelling issues in her piece on Licensure, Certification, and Accreditation while positing questions as to their future relevance to the profession as they stand today. Fifty years ago, outcome measures were not understood. Quality improvement has brought them to the fore. Actually, Barnum makes a case that states really are serving in this capacity nominally.
States serve primarily as a register of record.
They could impose additional requirements or practice restrictions as well for the graduate who cannot demonstrate minimum competency in all other desired areas. This difference has been hampered, she says, by the rigidity associated with waivering or grandfathering of present RNs. I'm convinced, as Barnum, that this change will not be reached by consensus without grandfathering as long as associate degree and diploma nurses outnumber the baccalaureates for entry positions, as they will surely continue to do through several decades. With the massive reforms in health care delivery and market forces in search of efficient and productive quality outcomes, employers care more for needed competencies than the breed, hybrid, degree or credential. The professional entry has changed over time, with added complexity and knowledge, and will likely continue to do so.