Is nursing a profession or merely a role?

Keeping professional nursing portable

By Karen Zander, RN, MS, CS, CMAC, FAAN

Kathleen Bower, DNSc, RN

Principals and Co-owners

The Center for Case Management

South Natick, MA

The New Hampshire State Board of Nursing recently denied nurse case managers the renewal of their RN licenses on the grounds that they did not meet the state’s active practice requirement because employers could fill their case management position with a non-nurse case manager. The board believes it made the decision as a quality control action to protect consumers.

The Center for Case Management commends New Hampshire’s active practice requirement. However, with all due respect and a long and strong commitment to professional nursing, we would like to question the logic of this ruling. Ironically, the question has little to do with case management and everything to do with the age-old quandary of the definition of nursing: Is nursing a profession or a role?

Nursing is a profession in which scientific and nonscientific knowledge are used to help people achieve their highest levels of wellness and comfort; i.e., outcomes. On the other hand, roles are externally defined because they are negotiations regarding deliverables (or outcomes), processes to achieve them, and a span of control. "Case manager," along with countless other positions, such as instructor, administrator, and nurse practitioner, are roles. Roles include tasks that may overlap, such as documentation, communication, family support, and monitoring vital signs. Ironically, with attention to self-care, many tasks nurses perform in various roles should be transferred to patients and families as they become skilled.

If a nurse in New Hampshire is hired in the role of director, as is the director of pharmacy or the director of laboratories, does that make the nurse less of a nurse? Similarly, does it make a nurse less of a nurse if an LPN or a nurses’ aide or a doctor comforts a patient in pain? Was Florence Nightingale not a professional nurse because she functioned as CEO and statistician?

Logically, if a nurse is hired as a case manager, isn’t the nurse still a nurse who is filling a case manager role? In fact, when a nurse is a case manager, the nurse is using the nursing process at the individual and population levels to manage clinical and financial outcomes while reducing risk.

The Center for Case Management would hope that the last thing any board of nursing would want is a profession determined by employers’ definitions of roles. By necessity, employers are always in the process of restructuring and redefining roles. As nurses, we count on state boards to affirm the legitimacy of being a registered professional nurse, while supporting the widest array of employment opportunities in which patients can benefit from our multitalented services. The art and science of nursing must remain professionally defined, personally applied, and economically portable.