editorial Institutional Licensure in Lieu of Individual Professional Licensure Stand up and be counted before the issue is resolved! Institutional licensnre in lieu of individual professional licemure, now at issue in the health care field, presents a threat to patient safety and to the nursing profession, particularly in the present, unpolished packages offered hy its proponents.

With the increase of allied health personnel, some individuals and various national organizations have called for a moratorium on licensing to study licensing of new categories of health personnel and to reexamine existing health personnel licensing procedures.

Institutional licensure in lieu of individual professional licensure is a concept that has been articulated as an alternative to the existing health personnel licensing procedures. Basically, this concept proposes that independent health practitioners such as physicians, osteopathic physicians and dentists should maintain individual licensure. All other health personnel, including nurses, are considered dependent practitioners and should be licensed by their employer institutions.

Health care organizations who have considered a change in licensure methods have concluded that further study is necessary. The American Hospital Association issued a Statement on Licensure of Health Care Personnel in November 1970 which called for further study of the concept of institutional licensure. In June 1971, HEW released a report on Licensure and Related Health Personnel Credentialing which also said the licensure procedures and processes need more study and investigation. The American Medical Association’s report, Licensure of Health Occupations, released in December 1970, concurred that licensure should be restudied.

Perhaps the principal argument against the proposed institutional licensure method is the lack of evidence that it would solve any of the alleged problems of the current system or that it would effect any benefits to patients that the present system cannot provide. W e should always be willing to adopt a new method in health care that would improve patient care, but we must first be shown evidence that the new way is better. So far, no studies have been completed toward tha t end. While there are no proven, concrete benefits of institutional licensure to patient care and to the nursing profession, there are certain advantages to the current system of state licensure which are not guaranteed by institutional licensure.

State boards for licensing nurses have representatives of the nursing profession who are qualified to approve the standards and judge the qualifications of applicants for our profession. Under institutional licensure, the privilege of judging the knowledge and skills of the nurse would probably be granted to the hospital administration. W e have no guarantee that nurses would be as involved in setting the nurse licensing standards as they now are under our present system.

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Furthermore, if hospital administration was responsible for setting licensing standards for all dependent practitioners within the institution, it is possible that the hard, cold economics of “who can be hired for the least amount of money to accomplish the most work” could well become an influential factor. This may make it more desirable to hire a person less qualified than a nurse, and minimal standards may even become more minimal.

Benefits of standardization of safe levels of nursing performance may also be jeopardized by institutional licensure. State board examinations for licensure of nurses guarantee patients that each licensed nurse has met certain education requirements and is competent to practice nursing according to nationally recognized criteria for established safe levels of practice. If standards are set by each institution for that institution, each could conceivably formulate its own set of requirements for practice. What assurance would the patient then have that the nurses’ competency at any given institution had been judged by sound criteria?

Institutional licensure could also allow an institution to recognize only its own requirements for nursing practice. Many believe this would limit the job opportunities of the nurse by limiting her geographic mobility. In contrast, standardization of state board examinations allows reciprocity among states and facilitates interstate movement of nurses. Geographic mobility of nursing manpower throughout the health care system is a product of standardization of state licensure; it also benefits the public.

The proposed programs for institutional licensure that would take away the nurse’s personal license constitute, in effect, a diminution of the nurse’s personal accountability (inherent in our present licensing system) and her integrity as a professional person.

There is a consensus among nurses tha t they should have the right to regulate and direct their own profession. But if requirements for practice are set by institutions, there is no guarantee that the nurse will maintain, much less increase, her voice in her own professional destiny.

She desires to continue defining her own functions and standards. The scope of her activity is expanding with specialized and advanced levels of nursing practice. She has proven her professional concern with patient care by initiating, through her professional organizations, programs for continuing education and plans for peer review. She is legally and morally accountable for her own practice of nursing. She is a professional in her own right and deserves such recognition and independence that is allied with her own license. She does not deserve the lessening of autonomy that could result if individual institutions are allowed further control over her professional activities.

I have not attempted to answer those arguments which have been presented in favor of institutional licensure since the negative aspects of the proposed programs at this time are sufficient to prevent acceptance by the nursing profession. I urge all OGN nurses to do their part to strongly oppose any legislation or other efforts favoring institutional licensure. EDITOR

Mar/April 1973 JOGN Nursing