Off the Charts

By Shawn Kennedy, MA, RN, AJN editor-in-chief

Amanda Trujillo

Our prior post on the Amanda Trujillo case elicited many comments, on a variety of themes. There were also referrals and crosslinks to other sites supporting, analyzing, and weighing in on the situation, including statements from the Arizona Nurses Association and the ANA, and a post on a physician blog, “White Coat’s Call Room,” which has vowed to carry all the details once the case is decided.

One complaint raised by several people in response to our post was that the Arizona Board of Nursing wasn’t supporting Amanda. State nursing or medical boards are regulatory boards that exist to ensure the protection of the public and to regulate professional practice according to the law (in nursing’s case, according to nursing practice acts). They do not aim to protect the individual nurse, but to assure that all those who claim to be nurses are eligible to claim that title and practice within their scope of practice as defined by law.

Some historical context: Regulatory boards were set up back in the early 1900s, after nursing associations successfully lobbied for registration laws to keep out unqualified women who posed as nurses. In 1903, North Carolina was the first state to enact a nurse practice act; by the mid-1920s, all 48 states had laws regulating who could practice and who could use the title “registered nurse.”

Thus, boards of nursing are intended to protect the consumer and the standards of the profession.

While I agree with several comments saying that nurses should be able to practice within the full scope of their education and training, as recommended by the Institute of Medicine Report on the Future of Nursing, what’s also important to keep in mind is that we must do so in accordance with the law—which unfortunately may not always measure up to our ideals or accurately reflect actual professional practice.

Nurses and state associations need to work to change the law where it needs to be changed—and there are many people who devote themselves to making such change happen—but until the law does change, this is how nurses’ actions will be judged, whatever other motives may appear to be in play or not.

(Editor’s note: A few readers have misconstrued the last paragraph as implying a judgment in the Amanda Trujillo case. This is by no means the intended meaning. The focus here is a more general look at the roles of boards of nursing and the importance for all nurses of not leaving themselves vulnerable to accusations of going beyond their scope of practice, as it has been defined in a particular state’s practice acts.)