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© 2008 National Council of State Boards of Nursing, Inc. (NCSBN®) Printed in the United States of America All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of NCSBN. Address inquiries in writing to NCSBN Permissions, 111 E. Wacker Drive, Suite 2900, Chicago, IL 60601-4277. NCSBN®, NCLEX®, NCLEX-RN® NCLEX-PN® Nursys®, are registered trademarks of NCSBN and NNAAP™ and TERCAP™ are trademarks of NCSBN. Although every attempt has been made to verify the accuracy of the information contained in this work, there may be errors or omissions, both typographical and in content, due to inaccuracies in the source materials or human error. While such inaccuracies are not intentional, NCSBN disclaims all warranties, express or implied, as to the accuracy, validity, and completeness of the content and information contained herein. ISBN #0-9796795-3-2 Table of Contents 5 About the Authors 7 Foreword 9 List of Abbreviations 13 Chapter One: Early Regulation 31 Chapter Two: Coming Together 59 Chapter Three: Council to Council 69 Chapter Four: Governance 107 Chapter Five: Communications 115 Chapter Six: Public Policy 131 Chapter Seven: Model Nursing Laws and Regulations 159 Chapter Eight: Education 183 Chapter Nine: Examinations 229 Chapter Ten: Interstate Mobility 253 Chapter Eleven: Advanced Nursing Practice 273 Chapter Twelve: Nursing Assistive Personnel 293 Chapter Thirteen: Enforcement 313 Chapter Fourteen: Research and Evaluations 331 Chapter Fifteen: Awards, Recognitions and Celebrations 343 Appendix A: Evolution of Goals and Objectives (1986 – 2001) 347 Appendix B: Staff Members (1978 – 2003) 355 Appendix C: Board of Directors (1978 -2003) 359 Appendix D: Evolution of Definitions of Nursing 363 Appendix E: Images and Supporting Documents 391 Endnotes 467 Index ABOUT THE AUTHORS Corinne F. Dorsey is a former nursing consultant, member of the Virginia Board of Nursing (1969–1979), and executive director for the Virginia Board of Nursing (1981–1995). Dorsey followed with keen interest and support the work of the Special Task Force—State Boards of Nursing that led to the organization of the National Council of State Boards of Nursing, Inc. (NCSBN®) in 1978. During her employment with the Virginia Board, Dorsey volunteered for appointment to committees of NCSBN and served on or chaired a committee from 1982 until her retirement in 1995, beginning with six years on the Bylaws Committee, first as a member and then as chair for five years. During that time she also chaired the special Bylaws Committee that completed the first revision of the NCSBN Bylaws. Other committee work included chairing the Subcommittee to Study the Regulation of Advanced Nursing Practice and serving as a member of the Practical/Vocational Nurse Competencies Subcommittee of the Nursing Practice and Education Committee and as a member of the Executive Director Orientation Program Task Force. With Richard Morrison she wrote an article in Issues entitled “Virginia Studies Access and Barriers to the Services of Nurse Practitioners” and she authored A History of the Virginia Board of Nursing 1903-2003. She has been honored by NCSBN with the R. Louise McManus Award, by the Virginia Nurses Association with its prestigious Nancy Vance Award, by the Medical College of Virginia Alumni Association of Virginia Commonwealth University (MCVAA of VCU) with its Hodges-Kay Service Award, and by the Nursing Division of the MCVAA of VCU with an Outstanding Nursing Alumnus Award. Dorsey has applied her avid interest in nursing history as well as her knowledge and experience to the endeavor of coauthoring this history with her friend and colleague, Joyce Schowalter. Joyce M. Schowalter is the former executive director of the Minnesota Board of Nursing (1973–1999) and served on the American Nurses Association Council of State Boards of Nursing representing Minnesota until NCSBN was established. As a member of Area II she participated in the early planning that resulted in the establishment of the Special Task Force—State Boards of Nursing. Upon the formation of NCSBN she was elected to the board of directors and served the maximum six years in the offices of Area II director, vice president, and president. Throughout the years she chaired the Bylaws Committee, served on a test service evaluation committee and an ad hoc test security investigation team, and was part 6 Dorsey · Schowalter of several test service negotiating teams. She was also a member of the 1990 Executive Director Search Committee and chaired the Executive Directors’ Network Planning Group (1994–1996). With Eileen McQuaid Dvorak, she wrote a chapter on the role of NCSBN in consumer protection for the second edition of Current Issues in Nursing, published by Blackwell Scientific Publishers, Inc. in 1985. Two relevant speaking engagements include a presentation of viewpoints on visions for the regulatory system at the December 1995 conference jointly sponsored by NCSBN and the Citizen Advocacy Center as well as the provision of a historical perspective and genesis of nursing regulation during the last 100 years as part of NCSBN’s Institute of Regulatory Excellence in January 2004. A recipient of the R. Louise McManus Award, Schowalter brought a wealth of information and experience to the compilation of this book as she assisted the primary author, Corinne Dorsey. FOREWORD We were asked to write a review of the first 25 years of the National Council of State Boards of Nursing, Inc. (NCSBN®) soon after the celebration of its 25th anniversary. That anniversary coincided with the centennial observation of the 1903 enactment of the first four state laws to regulate nurses in the United States. Although the work is focused on the establishment of NCSBN in 1978 and events during the ensuing 25 years, we decided to include general information from the 75 preceding years to provide an overview of the history of regulation in nursing. The American Journal of Nursing (AJN), from the first issue in 1900 through December 1978, provided the major source of information for the first two chapters. The editorials, articles, and proceedings of national meetings found in these publications were invaluable resources. We selected significant quotations from this source to introduce many of the chapters or to add interest within the chapters as appropriate to the topic under discussion. Chapter 3 presents information from meetings of the American Nurses Association (ANA) Council of State Boards of Nursing and the papers of the Special Task Force—State Boards of Nursing. The latter was created in 1977 to plan for a free-standing organization that became NCSBN. Papers presented to NCSBN by Frances Waddle, Mildred Schmidt, Helen (Pat) Keefe, Sharon Weisenbeck, Sidney Willig, and others were reviewed and used to expand our background. The booklets published by NCSBN on the occasion of the celebration of the 5th, 10th, 20th, and 25th anniversaries provided insights into the work of the Special Task Force along with copies of correspondence from the members that were used in preparing these booklets. We also viewed videos of interviews with Elaine Ellibee and Mildred Schmidt. All available minutes of meetings of the NCSBN Board of Directors and the NCSBN Delegate Assembly; the Book of Reports and Business Book; Issues, The Council Connector, Insight, and the many issues of the Newsletter to the Member Boards served as the primary NCSBN resources for the information in Chapters 4 through 15. In addition, we reviewed NCSBN position papers, concept papers, monographs, reports of research, and the NCSBN Web site. Unfortunately the minutes of the meetings of the board of directors between the meeting of June 12, 1981, and the meeting of March 8 and 10, 1982, could not be located. While uncertain as to what may have been included that was not identified in other resources, we believe that the decision to change the name of the licensing examination 8 Dorsey · Schowalter was made during this time. We have also relied on our personal notes, files, and recollections as well as the files of the boards of nursing at which we each formerly worked, Virginia for Corinne and Minnesota for Joyce. Throughout this history we used the terms state board of nursing or board of nursing consistent with the NCSBN definition of a state board of nursing as found in the 2003 NCSBN Bylaws. That definition is the following: “A state board of nursing is the governmental agency empowered to license and regulate nursing practice in any state, territory or political subdivision of the United States of America.” Although we have used abbreviations extensively throughout, we have tried to define each at its first usage in each chapter and have included a List of Abbreviations at the beginning of the book. Many persons assisted us during the past several years as we gathered material for this history. Kathy Apple, chief executive officer of NCSBN, frequently responded to questions and provided a continuing interest and support to us. Dawn Kappel, director of Marketing and Communications for NCSBN, has been our primary contact. We are grateful for her response to our many questions, her assistance in locating information, and her work in helping to finalize this publication. Several other current and former NCSBN staff members, our colleagues—both current and former executive officers of the member boards—have assisted us as well. We also wish to acknowledge the assistance of Jodi Koste, associate professor and archivist at the Tompkins-McCaw Library at Virginia Commonwealth University in Richmond, Virginia. She facilitated our review of the bound volumes of the AJN from 1900 to 1978 and other references housed at Tompkins-McCaw Library. Koste also provided a CD-ROM containing the illustrations from the AJN that are found in Chapters 1 and 2.