The Nurse Practice Act of Florida includes Part I Nurse Practice Act (ss. 464.001-464.027)[Flsenate.gov, 2017] and Part 2 Certified Nursing Assistants (ss. 464.201-464.208). Section 464.002 ensures minimum requirements for safe practice are met, further stipulating that falling below minimum competency, or if present a danger to the public, are prohibited from practicing nursing in the State of Florida.[Flsenate.gov, 2017] Section 464.003 provides some legal definitions related to the nurse practice act and terminology used.[Floridalegislature, 2018]
Legal Definitions Reflected in the Nurse Practice Act Section 464.003
- Accredited Program: Prelicensure education program of practical or professional nurses conducted in the United States at an institute of education (located in Florida, another state, or District of Columbia) and is accredited by a specialized nursing accrediting agency with national recognition by the United States Secretary of Education to approve nursing education programs.[flsenate.gov, 2017]
- Advanced or Specialized Nursing Practice: In addition to professional nursing practice these nurses perform advanced-level nursing acts approved by the board after postbasic specialized training, education, and experience. The advanced practice registered nurse may perform specific actions; i.e., nursing diagnosis, nursing treatment, medical diagnosis and treatment, prescription, and operate according to authorization within the guidelines of an established protocol of supervision. By rule, a copy of the protocol may be required to be filed with the department and meet requirements under s. 458.348.
- Advanced Practice Registered Nurse: Any individual licensed in the state of Florida to practice as a professional nurse and who holds a license in advanced nursing practice; i.e., certified nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, psychiatric nurses, and clinical nurse specialists.
- Approved Program: A prelicensure educational program for practical or professional nurses conducted in the state of Florida by an educational institution approved under s. 464.019. This term includes programs on a probationary status.
- Board: Refers to the Board of Nursing
- Clinical Preceptor: A licensed practical nurse or a registered nurse who is an employee at a training facility that serves as a role model and a resource clinically during a specified period of time to students enrolled currently in an approved program.
- Clinical Simulation: A replication of clinical practice using a strategy that teaches theory, pharmacology, skills, technology, and assessment as close to a real setting with a clinical preceptor as possible to duplicate.
- Clinical Training: Direct experience with patients (clients) receiving nursing care or in a simulation setting of clinical experiences related to the delivery of direct nursing care. The student gains the chance to apply, integrate, and refine skills and abilities specific to scientific principles and theory-based concepts.
- Community-Based Clinical Experience: Experience focused on activities in correlation with the curriculum that involve the care of groups, families, and persons as a primary intention of promoting wellness, illness prevention, and health maintenance.
- Curriculum: Planned courses and learning experiences prepared in a sequential manner that is the core of the nursing education program.
- Department: Department of Health
- Graduate passage rate: Reflects the percentage of graduates from a program who take the National Council of State Boards of Nursing Licensure Examination for the first time during a calendar year. The contract testing service of the National Council of State Boards of Nursing compiles the data.
- Licensed practical nurse: Any individual licensed in the state of Florida or holding an active multistate license to practice practical nursing under s. 464.0095.
- Nursing Diagnosis: Recognition of deviations based on observations and evaluations of mental or physical conditions, signs, and symptoms of illness, behaviors, and reactions to treatment to determine if are normal or abnormal findings.
- Nursing Treatment: Establishing and implementing nursing regimens for care and comfort for prevention of illness, and the restoration, education and health maintenance of individuals.
- The Practice of Practical Nursing: Reflects acts carried out in the care of the injured or those having an illness including medication administration and treatments to promote wellness and illness prevention and maintain health. Practical nurse practices under the direct supervision of a registered nurse and licensed independent provider such as a physician, dentist, and podiatrist. A practical nurse is accountable for decisions made based on the individual's education and experience in nursing.
- The Practice of Professional Nursing: Requires substantial specialized knowledge, skills, and judgment to perform acts of care for the injured or ill with a basis in the application of principles related to biological, psychological, physical, and social sciences. A professional nurse administers treatment and medications as prescribed or authorized by a licensed practitioner authorized by state laws to prescribe the drugs and treatments. Professional nurses offer supervision and education of other personnel in the acts described such as medication administration and procedures and the theory behind the action.
- Probationary Status: Reflects the state of an approved program placed on this status under s. 464.019.
- Registered Nurse: Reflects an individual licensed in the state of Florida or holding an active multistate license to practice professional nursing under s. 464.0095.
- Required Passage Rate: Reflects the graduate passage rate mandated for an approved program according to s. 464.019(5)(a).
Board of Nursing Information as Reflected in the Nurse Practice Act Section 464.004
- Created by the Department of Health [flsenate.gov, 2017]
- Consists of thirteen members appointed by the Governor and confirmed by the Senate
- Seven of the 13 members must be registered nurses who reside in the State of Florida and engaged in the practice of nursing for at least four years
- One registered nurse member must be an advanced practice registered nurse
- One registered nurse member must be a nurse educator of an approved program
- One registered nurse member must be a nurse executive
- The seven board members shall reflect various diverse practice areas within the nursing profession
- Three members of the board of the thirteen total must be licensed practical nurses who reside in the State of Florida and engaged in the practice of practical nursing for at least four years prior to the appointment
- Three members of the board of the 13 total must be residents of the State of Florida and have never held a nursing license or are in no way affiliated or connected with the nursing profession (layperson)
- One member of the board must be over age 60
- No lay member can have a financial interest with or be connected to any agency related to healthcare, health care facility, or insurer
- Governor appoints successors for terms of four years as the terms of members expire [flsenate.gov, 2016]
- The executive director designee may serve as the state administrator of the Nurse Licensure Compact based on requirements under s. 464.0095
- Official Board headquarters as stated in section 464.005 will be maintained in Tallahassee [flsenate.gov, 2017]
- Rulemaking authority as stated in 464.006 gives the board the authority to enact rules and implement based under ss. 120.536(1) and 120.54 [floridalegislature, 2018]
Licensure by Examination Information Reflected in the Nurse Practice Act Section 464.008
- Persons seeking licensure as a registered nurse or practical nurse shall apply to the Department of Health to take the licensure exam.
- Complete application process [floridanursing.gov, 2018]
- Pay application fee set by the board not to be more than $150
- Pay examination fee set by the board, not to be more than $75 plus the actual per applicant cost to the Department of Health for the purchase of the exam from the National Council of State Boards of Nursing or a similar entity.
- Provided sufficient information on or after October 1, 1989, submitted to the Department of Health for criminal records check statewide through the Department of Law Enforcement.
- Possess good physical and mental health
- Has a high school diploma or equivalent
- Graduated from a program approved by the state or from a prelicensure nursing education program determined by the board to be of equal merit to an approved program.
- Graduated on or after July 1, 2009, from a program fully accredited or graduated before July 1, 2009, from a prelicensure nursing educational program whose graduates were eligible for examination.
- Professional nursing education program courses completed in equal measure to a practical nursing education program used to meet the educational requirement for a license as a licensed practical nurse.
- Able to communicate in English and may be subject to an examination to determine proficiency.
- An applicant that passes the exam and meets the educational requirements are entitled to licensure by the State of Florida as a registered professional nurse or a licensed practical nurse based on applicability and unless denied under to s. 464.018.
- A multistate license from the Department of Health requested if all licensure requirements met as set forth by the board in addition to the requirements under s. 464.0095. A licensure fee and application fee will apply.
- Failure of the licensure examination 3 consecutive times, regardless of location or jurisdiction was taken, will be required to complete a remedial class approved by the board before may schedule a re-examination attempt.
- The exam scheduled within 6 months of approved remediation program successful completion [flsenate.gov, 2017]
- Applicants graduating from approved programs required to take the exam within 6 months or must enroll and complete successfully in an approved prep course by the board. Cost, of course, cannot be paid with state or federal financial aid.
Licensure by Endorsement Information Reflected in the Nurse Practice Act Section 464.009
- Department of Health issues the license by endorsement to practice professional or practical nurses who meet the requirements set forth by the board.[floridanursing.gov, 2018]
- Complete application process and provide a fee set by the board and not to exceed $100.
- Must hold a valid license to practice practical or professional nursing in another state or the United States territory subject to equivalent or more stringent requirements than those of the State of Florida.
- The applicant meets the requirements set forth under s. 464.008 and has completed and passed a regional, state, or national examination of equal substantial value or more stringent than the exam given by the Department of Health or has practiced nursing actively in another state, US territory or jurisdiction for 2 of the past 3 years and the license is in good standing.
- Applicant must complete Florida laws and rules course that is approved by the board within 6 months of initial licensure.
- Have a national criminal history check submitted to the board and board determines no criminal history.[flsenate.gov, 2017]
- An applicant for licensure by endorsement relocating due to official military orders of a spouse who holds an active license in another state and is a member of the Nurse Licensure Compact is deemed to have satisfied requirements set forth by the board in the sections as mentioned earlier. A license by endorsement after appropriate application, fees, and a criminal background check issued.
- Follow State Board specific requirements for fingerprinting process and criminal histories.
- An applicant who is under investigation in another state, US territory or jurisdiction cannot be issued a license by endorsement if the act in violation of chapter 456. When investigation completed, provisions under s. 464.018 apply.
- The application process is electronic and provides notifications and status updates. A license issued within thirty days of all requirements met, documents received and providing no violation of statutes exist.
- If holding a multistate license that is active in another state and falls under s. 464.0095 requirements for licensure by endorsement may be waived.[leg.state.fL.us, 2018]
Nurse Licensure Compact Information Reflected in the Nurse Practice Act Section 464.0095
ARTICLE I FINDINGS AND DECLARATION OF PURPOSE
- Public Health and safety affected by the degree of compliance and effectiveness of enforcement activities related to state nursing licensure laws. Violation of laws may result in public injury or harm.
- Greater coordination and cooperation among states needed relating to nursing licensure and regulation (nurses are more mobile).
- Technological advances (telenursing, online education) and new practice modalities make individual state nurse licensure laws complex and difficult to navigate.
- Compact nursing allows for technological advances such as telenursing, distance education, and new practice modalities.[ncsbn.org, 2018]
- Duplicative licensure is redundant for traveling nurses. Compact licensure decreases redundancy.
- Uniformity in licensure amongst states promotes an environment of safety for the public. Safety and protection of the health of the public rest with the individual states.
- Compact licensure encourages the cooperation of states in the area of regulation and licensure of nurses.
- Facilitates the exchange of information among states; investigation, regulation, and adverse actions.
- Each state has the authority to hold a nurse accountable for all individual state practice laws governed by the state where the patient or client is located at the time of service and care delivery.
- Provides for uniform licensure requirements thus enhancing interstate practice opportunities.[leg.state.fL.us, 2018]
ARTICLE II DEFINITIONS
- Adverse action: Imposed actions by a licensing board or other authority against a nurse administratively, equitably, civilly, or criminally. This includes actions against an individual or multistate license; i.e., suspension, probation, revocation, monitoring of the person licensed, cease and desist orders, limited the practice of the licensee, or any other action on a license affecting the authorization to practice.
- Alternative program: Nondisciplinary monitoring program that must have approval from the licensing board.
- Commission: Interstate Commission of Nurse Licensure Compact Administrators established by as a result of the compact.
- Compact: Nurse Licensure Compact established, recognized, and entered into by the state under the compact.
- Coordinated Licensure Information System: Collection, sharing, and storing of data by an integrated process. A non-profit organization under control and composed of the licensing board which assists in enforcement activities related to nursing licensure laws.
- Current Significant Investigative Information: Investigative information that prompts a licensure board to perform a preliminary inquiry, allows the nurse time to respond as required by individual state law, has grounds to believe, and if proven, represents more than a minor infraction. Investigative information can be indicative that a nurse represents an immediate threat to the public's safety and overall health regardless of the notification of the nurse or opportunity to respond to the claim.
- Encumbrance: Suspension of, limitation on, or revocation of the ability to practice nursing at full capacity and without restrictions imposed by a board of licensure.[flsenate.gov, 2017]
- Home State: The party-state that is the nurse's primary resident state.
- Multistate License: License to practice as a registered nurse (RN) or a licensed practical/vocational nurse (LPN/LVN) issued by the home state licensure board. This license authorizes the nurse to practice in all party states under a multistate licensure privilege.
- Multistate Licensure Privilege: Legal authorization permitting an RN, LPN, or LVN to practice nursing in a remote state with a multistate license.
- Party State: Any state that has adopted the compact.
- Remote State: A party state that is not a home state.
- Single-State License: License issued by a party state which authorizes practice only in the issuing state and does not include a multistate licensure privilege.
- State: State, possession, or territory of the United States or the District of Columbia.
- State Practice Laws: A party state's rules, regulations, and laws that govern nursing practice and define the scope of that practice, allowing methods and grounds to impose discipline on the nurse holding the license.[leg.state.fL.us, 2018]
ARTICLE III GENERAL PROVISIONS AND JURISDICTION
- A multistate license to practice recognizes the ability to practice on a multistate licensure privilege.
- A party-state has to have procedures in place to obtain and take into consideration criminal history records and fingerprints from the Federal Bureau of Investigation and state criminal database.
- Meets home state licensure requirements; i.e., graduated from a board-approved program pre-licensure, home state's renewal or initial licensure requirements such as continuing education.
- Graduated from a foreign nursing pre-licensure program approved by the applicable country accrediting entity and approved by a credentialing agency approved by the state board.
- Passed a board-approved English proficiency exam if foreign program not taught in English or English is not the primary language of the applicant.
- Has passed the NCLEX-RN or PN examination or predecessor exam.
- The license is unencumbered (no holds, no limits, active).
- No felony convictions or has been found guilty of a felony by a federal or state court.
- No misdemeanor offenses related to the practice of nursing as determined on a case by case basis. Can not be currently enrolled in an alternative program and must self-disclose if currently is participating in this type of program.
- Has a valid United States social security number.[ncsbn.org, 2018]
- A home state must be notified if any party state takes adverse action against a multistate licensure privilege.
- The nurse practicing in a party state must comply with the practice laws in that state where the client or patient located at the time care delivered. The nurse is subject to the jurisdiction of the licensing board, the rule of law, and the courts of the party-state where the patient or client are located at the time of service.
- A single-state license is not affected by the compact with regards to requirements established by the party-state.
- A nurse who changes the primary state of residence after the effective date of the compact must meet all applicable requirements to obtain a multistate license from a new home state.
- Failure to meet requirements can result in the multistate license revocation.
ARTICLE IV APPLICATIONS FOR LICENSURE IN A PARTY STATE
- The licensing board in the issuing party state through the coordinated licensure information system will determine if the person applying has ever held or currently holds a license issued by another state. Verification of any encumbrances identified or current participation in an alternative program.
- A nurse may hold a multistate license, issued by the home state, in only one-party state at a time.
- Change in primary residence by the applicant by moving from one-party state to another party state means the nurse must apply for licensure in the new home state. The multistate license issued prior to the home state shall be deactivated according to applicable rules.
- A multistate license cannot be issued by the new home state until the nurse provides satisfactory proof of a change in their primary state of residence to the new home state. All requirements for licensure must be met by the new home state before the multistate license issued.
- In the event, a nurse changes the primary state where they reside by relocating from a party state to a nonparty state, the multistate license by the home state issued before the move will convert to a single-state license valid only in the former home state.
ARTICLE V ADDITIONAL AUTHORITY VESTED IN PARTY STATE LICENSING BOARDS
- A licensing board or state agency may take adverse action against a multistate licensure privilege to practice within that party state; i.e., issuing cease and desist orders, investigations, issuing subpoenas.
- Only a home state has the authority to take adverse action against a nursing license issued by the home state. State laws of the home state will be applied to determine the appropriate action taken against the licensee.
- The Licensing board or state agency will report the conclusions of investigations to the administrator of the coordinated licensure information system immediately. The administrator will notify the new home state of any action if the nurse has changed the primary state of residence.
- The compact administrator of a party state provides all investigative documents and information upon request by another party state.[leg.state.fL.us, 2018]
- If the adverse action was taken by a home state against a multistate license holder, the multistate licensure privilege to practice in all other party states deactivated until all encumbrances removed from the multistate license.
- The compact does not override the party state's decision to participate in an alternative program instead of adverse action. The licensing board in the home state will deactivate the multistate licensure privilege under the multistate license during the licensee's participation in the alternative program.
ARTICLE VI COORDINATED LICENSURE INFORMATION SYSTEM AND EXCHANGE INFORMATION
- All party states will participate in a coordinated license information system
- Disciplinary action reported to the license information system by all party states
- Licensure information reported to the license information system and shared under the compact between party state licensing boards
- Adverse action reported immediately by all licensing boards
- Personal identifying data obtained from the coordinated licensure information system by a party state licensure board can't be shared with nonparty states or disclosed to other individuals except to the extent permissible by the laws governing the party-state contributing the data.
- Any data contributed to the coordinated licensure information system expunged by law by the party-state at a later date will be removed from the coordinated licensure information system.
ARTICLE VII ESTABLISHMENT OF THE INTERSTATE COMMISSION OF NURSE LICENSURE COMPACT ADMINISTRATORS
- The party states establish a joint public entity known as the Interstate Commission of Nurse Licensure Compact Administrators
- The compact does not waive sovereign immunity except to the extent it is waived in the party states
- Each party state has one administrator
- The executive director of the state licensure board is deemed the administrator or appoints a designee
- Vacancies filled according to party state law where the vacancy exists
- Each administrator gets one vote related to the adoption of rules and bylaw creation
- The commission meets at least once during a calendar year
- All meetings are open to the public and public notices posted
- Closed nonpublic meetings are permitted under certain circumstances; i.e., failure of a party state to comply with compact obligations, the disclosure of trade secrets, litigation anticipated, negotiation of contracts, accusing a person of criminal wrongdoing or invasion of privacy risk.
- The commission must conveniently publish rules and bylaws on the commission's website. Amendments posted.
- Purchase and maintain insurance bonds[leg.state.fL.us, 2018]
ARTICLE VIII RULEMAKING
- Rules or amendments adopted at a regular or special meeting of the commission
- Before the adoption of a final rule, a notice will be placed on the commission's website at least sixty days before with information on the proposed rule unless in the event of an emergency
- If anyone wants to dispute the rule they can comment written or orally
- If no interested individual appears at the hearing, the commission can proceed with the adoption of the proposed rule
ARTICLE IX OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCEMENT
- Oversight by each party state
- A state may be terminated from the compact if fails to correct a default
ARTICLE X EFFECTIVE DATE, WITHDRAWAL, AND AMENDMENT
- The compact becomes valid and binding on the date of legislative enactment of the compact into law by no fewer than twenty-six states or on December 31, 2018
- All party states to this compact which were parties to the prior Nurse Licensure Compact are deemed to have withdrawn from the previous compact within six months after the effective date of the new compact
- Compact can be amended by party states
ARTICLE XI CONSTRUCTION AND SEVERABILITY
- The compact provisions are severable if deemed unconstitutional in any party state or of the United States
Licensure of Advanced Practice Registered Nurses; Fees; Controlled Substance Prescribing Reflected in the Nurse Practice Act Section 464.012
- Current license to practice professional nursing or has an active multistate license to practice professional nursing under s. 464.0095
- Certification by a specialty board deemed appropriate
- Graduation from a program resulting in a master's degree in a nursing clinical specialty area with preparation in specialized practitioner skills.
- The board provides the appropriate requirements for advanced practice registered nurses by rule of law for the advanced nursing practices; i.e., certified nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, psychiatric nurses, and clinical nurse specialists.
- Established protocols must be maintained on-site at the location or locations where an advanced practice registered nurse practices relating to authorization and functions performed.
- The advanced practice registered nurse (APRN) must enter into a supervisory protocol with at least one physician within the physician group practice
- Advanced practice registered nurses may carry out functions within an established framework; i.e., prescribe, dispense, administer, or order any medication.
- An APRN may prescribe or dispense a controlled substance as defined in s. 893.03 only if the advanced practice registered nurse has graduated from a master’s or doctoral degree program in a clinical nursing specialty area with training in specialized practitioner skills.[flsenate.gov, 2017]
- An advanced practice registered nurse may order diagnostic tests, order occupational and physical therapy, manage selected medical problems, and coordinate health care as appropriate and necessary. The advanced practice registered nurse evaluates the patient or client for the effectiveness of the care provided.
- Perform additional functions as may be determined by rule s. 464.003(2).
- Order any medication for administration to a patient in an institution licensed under chapter 395 or part II of chapter 400, notwithstanding any provisions of chapter 465 or chapter 893.
- The certified nurse practitioner may initiate, monitor, or alter treatment for some uncomplicated acute illnesses
- The certified nurse practitioner may manage and monitor patients or clients with stable chronic diseases
- The certified registered nurse anesthetist (CRNA) may perform functions to the extent authorized by established protocols approved by the medical staff at the institution in which the anesthetic service performed. The CRNA may determine the health status of the patient and any risk factors they pose, order pre-anesthetic medications, and support life functions during anesthesia. A CRNA may place central venous and peripheral catheters, and arterial lines if covered under the protocol. A CRNA, according to protocol, may order and administer spinal, regional, and general anesthesia. A CRNA recognizes and treats cardiac arrhythmias while under anesthesia, and assists in the management of care of the patient while in the postanesthesia recovery unit.
- The certified nurse-midwife (CNM) works under authorized protocols approved by the medical staff at the healthcare institution in which the services are performed or approved by the physician backup coverage when home delivery performed.
- The CNM may perform superficial minor surgical procedures, order appropriate medications, perform postpartum exams, and provide family-planning services. The CNM manages the patient during labor and delivery and oversees the medical care of the normal obstetrical patient and initial newborn care.
- The clinical nurse specialist (CNS) works under established protocols. The CNS may diagnose human responses to actual or potential health problems, and plan for disease prevention. Planning for health promotion and therapeutic intervention while collaborating with the patient or client is part of the role of the CNS within some established frameworks. Therapeutic interventions are implemented based on the area of expertise of the CNS and fall within the scope of advanced nursing practice; i.e., counseling, direct nursing care, teaching, and collaborating with other licensed health care providers.
- A psychiatric nurse, meeting the requirements in s. 394.455(35), within an established protocol with a psychiatrist, may prescribe psychotropic controlled substances for the treatment of mental disorders.
- The board shall impose an application fee not to exceed $100 and a biennial renewal fee not to exceed $50.
- The board establishes a committee to recommend a controlled substances formulary that an APRN may not prescribe or may prescribe only for specific uses or in limited amounts. The committee must consist of three licensed APRNs with board recommendation, three physicians licensed under chapter 458 or chapter 459 who have experience with APRNs and be recommended by the Board of Medicine, and a pharmacist licensed under chapter 465 who is a doctor of pharmacy and is approved by the Board of Pharmacy.
- The APRN will be aware of the controlled substances bill that designates s. 464.012, F.S., as the “Barbara Lumpkin Prescribing Act.”[flsenate.gov, 2016]
Renewal of License or Certificate Reflected in the Nurse Practice Act Section 464.013
- The Department of Health shall renew a license upon receipt of a renewal application and appropriate fee
- Biennial renewal of licenses [flsenate.gov, 2017]
- The board by rule prescribes up to thirty hours of continuing education biennially as a condition for renewal of a license or certificate
- A nurse who is certified by a health care specialty program accredited by the National Commission for Certifying Agencies or the Accreditation Board for Specialty Nursing Certification is exempt from continuing education requirements. The criteria for programs must be approved by the board
- ARNPs certified under s. 464.012 must complete at least three hours of continuing education on the safe and effective prescription of controlled substances by a board-approved entity.
- The board shall require each person licensed or certified under this chapter to complete a 2-hour continuing education course on human trafficking, as defined in s. 787.06(2). All licensees must complete this course for every biennial licensure renewal on or after January 1, 2019.[floridasnursing.gov, 2017]
Inactive Status Reflected in the Nurse Practice Act Section 464.014
- The Department of Health may not reactivate a license unless the delinquent or inactive licensee has paid any applicable biennial renewal, delinquent fees, and a reactivation fee
- The board has adopted rules related to the application procedures for inactive status and reactivation process [flsenate.gov, 2017]
Titles and Abbreviations; Restrictions; Penalty Reflected in the Nurse Practice Act Section 464.015
- Only a person who holds a license in this state or a multistate license under s. 464.0095 to practice professional nursing or who performs nursing services under the exception set forth in s. 464.022(8) may use the title “Registered Nurse” and the abbreviation “R.N.”[flsenate.gov, 2017]
- Only a person who holds a license in this state or a multistate license according to s. 464.0095 to practice as a licensed practical nurse or who performs practical nursing services pursuant to the exception set forth in s. 464.022(8) may use the title “Licensed Practical Nurse” and the abbreviation “L.P.N.”
- Only persons who are graduates of prelicensure nursing education programs listed in s. 464.008(1)(c) may use the term “Graduate Nurse” and the abbreviation “G.N.,” pending the results of the first licensure examination for which they are eligible.
- Only persons who are graduates of prelicensure nursing education programs listed in s. 464.008(1)(c) may use the term “Graduate Practical Nurse” and the abbreviation “G.P.N.,” pending the results of the first licensure examination for which they are eligible.
- Only persons who hold valid certificates to practice as clinical nurse specialists in this state may use the title “Clinical Nurse Specialist” and the abbreviation “C.N.S.”
- Only persons who hold valid certificates to practice as a certified registered nurse anesthetists in this state may use the title “Certified Registered Nurse Anesthetist” and the abbreviations “C.R.N.A.” or “nurse anesthetist.”
- Only persons who hold valid certificates to practice as certified nurse-midwives in this state may use the title “Certified Nurse Midwife” and the abbreviations “C.N.M.” or “nurse-midwife."
- Only persons who hold valid certificates to practice as advanced registered nurse practitioners in this state may use the title “Advanced Registered Nurse Practitioner” and the abbreviation “A.R.N.P.”
- A person may not practice or advertise as or assume the title of, registered nurse, licensed practical nurse, clinical nurse specialist, certified registered nurse anesthetist, certified nurse-midwife, or advanced registered nurse practitioner or use the abbreviation “R.N.,” “L.P.N.,” “C.N.S.,” “C.R.N.A.,” “C.N.M.,” or “A.R.N.P.” or take any other action that would lead the public to believe that person was authorized by law to practice as such or is performing nursing services pursuant to the exception set forth in s. 464.022(8) unless that person is licensed, certified, or authorized under s. 464.0095 to practice as such.[flsenate.gov, 2018]
- A violation of this section is a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083.
Violations and Penalties Reflected in the Nurse Practice Act Section 464.016
- Each of the following acts constitutes a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084: Practicing advanced or specialized, professional, or practical nursing, as defined in this part, unless holding an active license or certificate to do so. Using or attempting to use a license or certificate which has been suspended or revoked. Knowingly employing unlicensed persons in the practice of nursing. Obtaining or attempting to obtain a license or certificate under this part by misleading statements or knowing misrepresentation.[flsenate.gov, 2017]
- Each of the following acts constitutes a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083: Using the name or title “Nurse,” “Registered Nurse,” “Licensed Practical Nurse,” “Clinical Nurse Specialist,” “Certified Registered Nurse Anesthetist,” “Certified Nurse Midwife,” “Advanced Registered Nurse Practitioner,” or any other name or title which implies that a person was licensed or certified as same unless such person is duly licensed or certified. Knowingly concealing information relating to violations of this part.[flsenate.gov, 2018]
Sexual Misconduct in the Practice of Nursing Reflected in the Nurse Practice Act Section 464.017
- Mutual trust is the basis for the nurse-patient relationship.[flsenate.gov, 2017]
- Sexual misconduct in the practice of nursing means violation of the nurse-patient relationship through which the nurse uses said relationship to induce or attempt to induce the patient to engage or to engage or attempt to engage the patient, in sexual activity outside the scope of the practice or the scope of generally accepted examination or treatment of the patient. Sexual misconduct in the practice of nursing is prohibited.[leg.state.fl.us, 2018]
Disciplinary Actions Reflected in the Nurse Practice Act Section 464.018
The following acts constitute grounds for denial of a license or disciplinary action, as specified in ss. 456.072(2) and 464.0095:
- Procuring, attempting to procure, or renewing a license to practice nursing or the authority to practice practical or professional nursing pursuant to s. 464.0095 by bribery, by knowing misrepresentations, or through an error of the department or the board.
- Having a license to practice nursing revoked, suspended, or otherwise acted against, including the denial of licensure, by the licensing authority of another state, territory, or country. Being convicted or found guilty of, or entering a plea of guilty or nolo contendere to, regardless of adjudication, a crime in any jurisdiction which directly relates to the practice of nursing or to the ability to practice nursing.
- Being convicted or found guilty of, or entering a plea of guilty or nolo contendere to, regardless of adjudication, any of the following offenses:
- A forcible felony as defined in chapter 776.[flsenate.gov, 2017]
- A violation of chapter 812, relating to theft, robbery, and related crimes.
- A violation of chapter 817, relating to fraudulent practices.
- A violation of chapter 800, relating to lewdness and indecent exposure.
- A violation of chapter 784, relating to assault, battery, and culpable negligence.
- A violation of chapter 827, relating to child abuse.
- A violation of chapter 415, relating to protection from abuse, neglect, and exploitation.
- A violation of chapter 39, relating to child abuse, abandonment, and neglect.
- For an applicant for a multistate license or a multistate license holder under s. 464.0095, a felony offense under Florida law or federal criminal law.
- Having been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, any offense prohibited under s. 435.04 or a similar statute of another jurisdiction; or having committed an act which constitutes domestic violence as defined in s. 741.28.
- This list not exhaustive, and additional information related to denial of a license and disciplinary action found on the Florida Legislature website.[leg.state.fl.us, 2018]
Approval of Nursing Education Programs Reflected in the Nurse Practice Act Section 464.019
- The board will publish on its internet website a list of accredited programs in the State of Florida and the graduate passage rates of each program for the most recent two calendar years.
- The internet website data updated at least quarterly.
- Any nursing program placed on probation must disclose in writing to the applicants and current students the probationary status. The notice must explain the implications of the program's probationary status on the students and applicants.
- More information on approval of nursing education programs can be found on the Florida Legislature website as mentioned above.[flsenate.gov, 2017]
Florida Center for Nursing; Goals Reflected in the Nurse Practice Act Section 464.0195
- The Florida Center for Nursing established to address issues of supply and demand for nursing which includes retention, recruitment, and utilization of nurse workforce resources.
- The Florida Center for Nursing's primary goal is to develop a strategic plan for the nursing workforce in the State of Florida.
- The Florida Center for Nursing will assess the impact of the State of Florida's participation in the Nurse Licensure Compact under s. 464.0095.
- The center will convene a variety of groups representative of nurses, health care providers in other professions, business, industry, educators, legislators, and consumers to review and comment on data prepared for the center. These groups will recommend systemic changes and strategies to implement, evaluate the effectiveness of the changes implemented, and report findings to the legislature and others.
- The center may request from the board, and the board must provide to the center upon its request, any information held by the board regarding nurses licensed in this state or holding a multistate license under s. 464.0095 or information reported to the board by employers of such nurses, other than personal identifying information.[flsenate.gov, 2017]
Florida Center for Nursing; Board of Directors Reflected in the Nurse Practice Act Section 464.0196
- The Florida Center for Nursing governed by a policy-setting board of directors.
- The board must have sixteen members with a simple majority of the board being representative of diverse practice locations.
- Four members recommended by the President of the Senate, one must be a registered nurse recommended by the Florida Organization of Nurse Executives, and one a representative of the hospital industry recommended by the Florida Hospital Association
- Four members recommended by the Speaker of the House of Representatives, one must be a registered nurse recommended by the Florida Nurses Association, and one representative from the long-term care industry
- Four members recommended by the Governor, two must be registered nurses
- One nurse educator recommended by the Board of Governors who is a dean of a College of Nursing at a state university.[flsenate.gov, 2017]
Retired Volunteer Nurse Certificate Reflected in the Nurse Practice Act Section 464.0205
- Any retired registered or practical nurse desiring to serve indigent, underserved, or critical need populations may apply to the Department of Health for a retired volunteer nurse certificate.
- The applicant must provide proof of meeting the requirements set forth under s. 464.008 or s. 464.009.
- A retired volunteer nurse must work under direct supervision of the county health department director, a physician working under a limited license issued according to s. 458.317 or s. 459.0075, a physician licensed under chapter 458 or chapter 459, an advanced practice registered nurse licensed under s. 464.012, or a registered nurse licensed under s. 464.008 or s. 464.009.[flsenate.gov, 2017]
Exceptions Reflected in the Nurse Practice Act Section 464.022
No provision of this part shall be construed to prohibit:[flsenate.gov, 2017]
- Assistance by anyone in the case of an emergency
- The practice of nursing by individuals enrolled in remedial courses approved by the board.
- Any nurse practicing in accordance with the practices and principles of the body known as the Church of Christ Scientist; nor shall any rule of the board apply to any sanitarium, nursing home, or rest home operated in accordance with the practices and principles of the body known as the Church of Christ Scientist.
- The practice of any legally qualified nurse or licensed attendant of another state who is employed by the United States Government, or any bureau, division, or agency thereof, while in the discharge of official duties.
- The establishment of an independent practice by one or more nurses to render nursing services to patients within the scope of the nursing license.
- This list not exhaustive and found in its entirety on the website for the Florida Legislature.[leg.state.fl.us, 2018]
Registered Nurse First Assistant Reflected in the Nurse Practice Act Section 464.027
- Encourages the use of registered nurse first assistants who meet the qualifications as "assistants at surgery" by physicians and hospitals to provide quality, cost-effective surgical intervention to health care recipients of the State of Florida.
- Perioperative nursing means a practice of nursing in which the nurse provides preoperative, intraoperative, and postoperative nursing care to surgical patients.
- Each health care facility must establish specific procedures for the appointment and reappointment of a registered nurse first assistant staff member and for granting, revising, and renewing their clinical privileges.
A registered nurse first assistant must meet the qualifications set forth by the board:
- Holds a registered nurse license
- Certified in perioperative nursing
- Successful completion of a registered nurse first assistant board-approved program and holds the certificate [flsenate.gov, 2017]
PART II of the Nurse Practice Act Certified Nursing Assistants (ss. 464.201-464.208)
Definitions Reflected in the Nurse Practice Act Section 464.201
- Approved Training Programs: A training course conducted by a public or private sector educational center licensed by the Department of Education to implement the basic curriculum for nursing assistants which must be approved by the Department of Education.
- Certified Nursing Assistant: a person who meets the qualifications specified by the Board of Nursing and who has been certified by the board as a certified nursing assistant.
- The Practice of a Certified Nursing Assistant: providing care and assisting persons with tasks relating to the activities of daily living; i.e., personal care, nutrition, hydration, mobility, toileting, elimination, assistive devices, safety, cleanliness, and postmortem care. Certified Nursing Assistants gather data, report any abnormal signs and symptoms, provide end of life care, cardiopulmonary resuscitation and emergency care, and provide for socialization and reality orientation. A registered nurse must validate competency related to the performance of skills.[flsenate.gov, 2012]
Duties and Powers of the Board Reflected in the Nurse Practice Act Section 464.202
- Maintains a state registry of certified nursing assistants
- The registry is accessible to the public, the certificate holder, employers, and additional state agencies
- The board adopts rules for testing procedures to certify nursing assistants
- The board adopts rules regulating the practice of certified nursing assistants, provides a scope of practice, and sets the level of supervision requirements.[flsenate.gov, 2012]
Certified Nursing Assistants; Certification Requirement Reflected in the Nurse Practice Act Section 464.203
- The board shall issue a certificate to practice as a certified nursing assistant to any person who demonstrates a minimum competency to read and write and successfully passes the required background screening pursuant to s. 400.215. If the person has successfully passed the required background screening pursuant to s. 400.215 or s. 408.809 within 90 days before applying for a certificate to practice and the person’s background screening results are not retained in the clearinghouse created under s. 435.12, the board shall waive the requirement that the applicant successfully passes an additional background screening pursuant to s. 400.215. The person must also meet additional requirements specified by the board.[flsenate.gov, 2018]
- If an applicant fails to pass the nursing assistant competency examination in three attempts, the applicant is not eligible for reexamination unless the applicant completes an approved training program.
- Certification as a nursing assistant, by this part, may be renewed until the nursing assistant allows twenty-four consecutive months to pass during which period the nursing assistant fails to perform any nursing-related services for monetary compensation. When a nursing assistant fails to deliver any nursing-related services for financial compensation for twenty-four consecutive months, the nursing assistant must complete a new training and competency evaluation program or a new competency evaluation program.
- A certified nursing assistant shall maintain a current address with the board under s. 456.035.
- A certified nursing assistant must complete twenty-four hours of in-service training during each biennium. The certified nursing assistant will maintain documentation demonstrating compliance with this subsection.[leg.state.fl.us, 2018]
- The department shall renew a certificate upon receipt of the renewal application and imposition of a fee of not less than $20 and not more than $50 biennially. The department shall adopt rules establishing a procedure for the biennial renewal of certificates.
Denial, Suspension, or Revocation of Certification; Disciplinary Actions Reflected in the Nurse Practice Act Section 464.204
The following acts constitute grounds for which the board may impose disciplinary sanctions as specified in subsection (2):
- Obtaining or attempting to get certification or an exemption, or possessing or trying to possess certification or a letter of exemption, by bribery, misrepresentation, deceit, or through an error of the board.
- Intentionally violating any provision of this chapter, chapter 456, or the rules adopted by the board.
When the board finds any person guilty of any of the grounds outlined in subsection (1), it may enter an order imposing one or more of the following penalties:
- Denial, suspension, or revocation of certification.
- Imposition of an administrative fine not to exceed $150 for each count or separate offense.
- Imposition of probation or restriction of certification, including conditions such as corrective actions as retraining or compliance with the department’s impaired practitioner program operated by a consultant as described in s. 456.076.
The board may, upon the request of a certificate holder, exempt the certificate holder from disqualification of employment in accordance with chapter 435 and issue a letter of exemption. The board must notify an applicant seeking an exemption from disqualification from certification or employment of its decision to approve or deny the request within thirty days after the date the board receives all required documentation.[leg.state.fl.us, 2018]
Availability of Disciplinary Records and Proceedings Reflected in the Nurse Practice Act Section 464.205
- Under s. 456.073, any complaint or record maintained by the department under the discipline of a certified nursing assistant and any proceeding held by the board to discipline a certified nursing assistant shall remain open and available to the public.[flsenate.gov, 2012]
Exemption from Liability Reflected in the Nurse Practice Act Section 464.206
- If an employer terminates or denies employment to a certified nursing assistant whose certification is inactive as shown on the certified nursing assistant registry or whose name appears on a criminal screening report of the Department of Law Enforcement; the employer is not civilly liable for such termination, and a cause of action may not be brought against the employer for damages, regardless of whether the employee has filed for an exemption from the board under s. 464.204(3).
- There may not be any monetary liability on the part of, and a cause of action for damages may not arise against, any licensed facility, its governing board or members thereof, medical staff, disciplinary board, agents, investigators, witnesses, employees, or any other person for any action taken in good faith without intentional fraud in carrying out this section.[flsenate.gov, 2018]
Penalties Reflected in the Nurse Practice Act Section 464.207
- It is a misdemeanor of the first degree, punishable as provided under s. 775.082 or s. 775.083, for any person, knowingly or intentionally, to fail to disclose, by false statement, misrepresentation, impersonation, or other fraudulent means, in any application for voluntary or paid employment or certification regulated under this part, a material fact used in making a determination as to such person’s qualifications to be an employee or certificate holder.[flsenate.gov, 2012]
Background Screening Information; Rulemaking Authority Reflected in the Nurse Practice Act Section 464.208
- The Agency for Health Care Administration must allow the board electronic access its background screening records and database.
- An employer, or an agent thereof, may not use criminal records or juvenile records relating to vulnerable adults for any purpose other than determining if the person meets the requirements of this part. Such documents and information obtained by the board shall remain confidential and exempt from s. 119.07(1).
- If the requirements of the Omnibus Budget Reconciliation Act of 1987, as amended, for the certification of nursing assistants are in conflict with this part, the federal requirements shall prevail for those facilities certified to provide care under Title XVIII (Medicare) or Title XIX (Medicaid) of the Social Security Act.[flsenate.gov, 2018]