As I've listened to the discussion about credentials I was reminded of the
book Novice to Expert by Patricia Benner.  This is a wonderful book that
describes how a nurse grows in practice.  A nurse begins at the basic level
(novice) at this point she is a bran new student, going slowly, soaking up
books and trying to keep up with her program, next she takes her board exam
and becomes an advanced beginner and is seen as marginally acceptable (she
still needs lots of guidance ie a preceptor/mentor). Next,after two or three
years or practice she may reach the competant stage. At this stage the nurse
can gather from experience and deal with most situations.  The next stage,
proficient, finds the nurse that can anticipate, plan, and adapt to
situations.  Then finally a nurse, hopefully reaches the expert stage.   This
nurse has an extensive knowledge in the field and many related fields, she
operates from guided intuision and a feel for the whole problem.
After 20 years in nursing I have experienced or observed all these levels and
as I find myself at the advanced beginner stage again, I must say that we
need measurable levels of competancy ie the exam.  This exam must be seen as
the most basic step.  From this step we must reach out and learn, teach,
mentor each other to begin the process to expert.  Lactnet is a wonderful way
to begin.

Linda
Clarkston, wa