Radical Changes Proposed for Nursing Profession, from Licensing to Scope of Practice

Planning the development of a strategic plan to restructure nursing education

During 2000 and 2001, Sigma Theta Tau International conducted a series of meetings for development of a consensus document among a number of nursing organizations concerning the needed restructuring of U.S. nursing practice and education.

This project built on preliminary discussions among many of those organizations regarding:

  • Nursing's difficulty in attracting young people.
  • Perceived inadequacies in nursing practice, education and credentialing.

Sigma Theta Tau International is a nursing research and leadership organization that focuses on the learning and professional development of nurses.

The Project

Sigma Theta Tau International conducted its project work largely through the auspices of the Nursing Practice and Education Consortium, a group founded in 1997 that comprised 10 nursing organizations. Consortium member representatives held four workshops and five conference calls in 2000 to draft, review and produce a consensus report.

Twenty-five to 40 participants attended the meetings, with a core group of 20 who attended all four workshops. A conflict management consultant firm — Trustee Leadership Development Inc. of Indianapolis, Ind. — facilitated the sometimes sharp discussions among participants during the meetings.

In 1999, prior to this grant project, four Nursing Practice and Education Consortium members — the American Nursing Association, the National Council of State Boards of Nursing, and the National League for Nursing, and the National Council of State Boards of Nursing — had withdrawn from the consortium in disagreement over consortium discussions of this subject. However, they rejoined the consortium for a December 2000 meeting, at which consensus regarding the project report draft was reached.

A panel of experts in the field — including educators, hospital administrators, licensing officials, health policy experts and physicians — critiqued the draft report, met with project participants, and offered guidance during the project.

Key Results

  • The project resulted in a 13-page series of ideas entitled Vision 2020 for Nursing: A Strategic Work Plan to Transform US Nursing Practice and Education. The report envisions nursing practice, education and credentialing that:
    • Distinguish among specific sets of nursing education or training and competencies.
    • Ensure the development of nursing as a career that will attract new entrants.

    To accomplish those goals, according to the report, nursing education, practice and licensing should be categorized into four different scopes of practice that reflect nurses' training and education.
    • Scope A nurses would be unlicensed care providers.
    • Scopes B and C would have separate and distinct licensure — scope B requiring a post-licensure internship and scope C a residency.
    • Graduate education would be required for practice in scope D, and individuals would move from scope C to scope D via such graduate education.

    Although it is not specified in the "Vision 2020" document, scope C nurses are independent practitioners and lead in evidence-based practices. Scope D nurses perform sophisticated, advanced-practice roles and/or focus on scholarship and research.

    The report also called for a number of strategic outcomes within the nursing field, including:
    • A regulatory and credentialing system to match the envisioned transformation to the field.
    • Demonstration projects enacted with participation by education, practice, and regulatory bodies.
    • A communication effort to inform the public about the field's change.


Sigma Theta Tau International sent 300 copies of the "Vision 2020" draft report to coalition members, and the draft appears online at the organization's Web site as well as other Nursing Practice and Education Consortium member Web sites linked to it.

Four Nursing Practice and Education Consortium participants in the project made a presentation about cooperation among nursing organizations at the American Academy of Nursing annual meeting November 2, 2000, in San Diego, Calif., four consortium participants in the project made a presentation about cooperation among nursing organizations. Articles that deal with ideas found in the document appeared in three issues of Sigma Theta Tau International's quarterly journal, Reflections on Nursing Leadership.

The Nursing Practice and Education Consortium has met via phone conferences every two to three months since the most recent meeting in December 2000. The "Vision 2020" document has been presented to several nursing organization boards and focus groups. A face-to-face meeting of consortium members on May 12–13, 2002, in Indianapolis, continued the work of the "Vision 2020" document initiatives.


The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $50,000.