Florida Nurse Practice Act: Laws and Rules for Florida Nurses

Function

The Florida Nurse Practice Act comprises 2 main parts, as mentioned below.

• Part 1: Nurse Practice Act (sections 464.001-464.027).[2017 Florida Statutes]
• Part 2: Certified Nursing Assistants (sections 464.201-464.208).

Section 464.002 establishes minimum requirements for safe nursing practice, stating that professionals who fail to meet these competency standards or pose a danger to the public are prohibited from practicing nursing in Florida.[Chapter 464]

Section 464.003 provides legal definitions relevant to the Florida Nurse Practice Act and clarifies the terminology used.[2024 Florida Statutes]

Legal Definitions Reflected in the Nurse Practice Act (Section 464.003)

• Accredited program: A prelicensure education program for practical or professional nurses conducted in the United States at an educational institution located in Florida, another state, or the District of Columbia. This program must be accredited by a specialized nursing accrediting agency recognized by the US Secretary of Education to approve nursing education programs.[2017 Florida Statutes]

• Advanced or specialized nursing practice: In addition to professional nursing practice, advanced or specialized nurses perform advanced-level nursing activities approved by the board, following post-basic specialized training, education, and experience. Advanced practice registered nurses (APRNs) may carry out nursing diagnoses, nursing treatments, medical diagnoses and treatments, and prescribe medications. They operate under the authorization of an established supervision protocol. According to the regulations, a copy of this protocol may need to be filed with the department and must meet the requirements outlined in section 458.348.

• Advanced practice registered nurse: An individual licensed in Florida to practice as a professional nurse who also holds a license in advanced nursing practice. This category includes certified nurse practitioners, certified registered nurse (RN) anesthetists, certified nurse midwives (CNMs), psychiatric nurses, and clinical nurse specialists (CNSs). 

• Approved program: A prelicensure educational program for practical or professional nurses conducted in Florida by an educational institution approved under section 464.019. This term also encompasses programs that are currently on probationary status. 

• Board: Refers to the Board of Nursing.

• Clinical preceptor: A licensed practical nurse (LPN) or registered nurse employed at a training facility who serves as a role model and clinical resource for students currently enrolled in an approved program during a specified period. 

• Clinical simulation: A replication of clinical practice that employs strategies to teach theory, pharmacology, skills, technology, and assessment in a setting designed to mimic real-life scenarios closely. These simulations are facilitated by a clinical preceptor. 

• Clinical training: Students receive direct experience with patients (clients) receiving nursing care or in a simulated clinical setting, where they engage in activities related to delivering direct nursing care. This training allows students to apply, integrate, and refine their skills and abilities based on scientific principles and theory-based concepts.

• Community-based clinical experience: Clinical experience aligned with the curriculum that focuses on the care of groups, families, and individuals, with primary goals of promoting wellness, preventing illness, and maintaining health.

• Curriculum: A structured sequence of courses and learning experiences that forms the foundation of a nursing education program.

• Department: Department of Health.

• Graduate passage rate: The percentage of graduates from a program who take the National Council of State Boards of Nursing Licensure Examination for the first time within a calendar year. These data are compiled by the contract testing service of the National Council of State Boards of Nursing. 

• Licensed practical nurse: An individual licensed in Florida or holding an active multistate license to practice practical nursing under section 464.0095.

• Nursing diagnosis: The recognition of deviations based on observations and evaluations of mental or physical conditions, including signs and symptoms of illness, behaviors, and reactions to treatment, used to determine whether the findings are normal or abnormal.

• Nursing treatment: The establishment and implementation of nursing regimens designed to provide care and comfort, prevent illness, and promote restoration, education, and health maintenance for individuals.

• The practice of practical nursing: This involves delivering care to individuals who are injured or ill, including administering medications and treatments to promote wellness, prevent illness, and maintain health. LPNs practice under the direct supervision of registered nurses and licensed independent providers, such as physicians, dentists, or podiatrists. LPNs are accountable for decisions made based on their education and nursing experience. 

• The practice of professional nursing involves the application of substantial specialized knowledge, skills, and judgment to care for injured or ill individuals, drawing on principles from biological, psychological, physical, and social sciences. Professional nurses administer treatments and medications as prescribed or authorized by licensed practitioners legally permitted to do so under state laws. Additionally, they supervise and educate other healthcare personnel on tasks such as medication administration, procedures, and the underlying theories guiding these actions.

• Probationary status: The designation assigned to an approved program placed on probation per section 464.019.

• Registered nurse: An individual licensed to practice professional nursing in Florida or holding an active multistate license under section 464.0095.

• Required passage rate: The minimum graduate passage rate mandated for an approved program, as outlined in section 464.019(5)(a).

Board of Nursing Information Reflected in the Nurse Practice Act (Section 464.004)

• The Board of Nursing, created by the Department of Health, consists of 13 members appointed by the governor and confirmed by the Senate.[2017 Florida Statutes]

• Among these 13 members, 7 must be registered nurses residing in Florida and have practiced nursing for at least 4 years.

• A registered nurse member must be an APRN, 1 member must be a nurse educator from an approved program, and 1 member must be a nurse executive.

• Among the 13 board members, 7 must represent various diverse practice areas within the nursing profession.

• Among the 13 board members, 3 must be LPNs who reside in Florida and have been actively practicing practical nursing for at least 4 years before their appointment.

• Among the 13 board members, 3 must be residents of Florida who have never held a nursing license and have no affiliation with the nursing profession (laypersons).

• At least 1 board member must be of age 60 or older.

• No lay member may have any financial interest in or connection to any healthcare agency, healthcare facility, or insurer.

• The governor appoints successors for 4-year terms as the current members' terms expire.[2016 Florida Statutes, Chapter 464]

• The executive director designee may serve as the state administrator of the Nurse Licensure Compact in accordance with the requirements outlined in section 464.0095.

• As stated in section 464.005, the official Board of Nursing headquarters will be maintained in Tallahassee.[2017 Florida Statutes]

• Rulemaking authority, as stated in section 464.006, grants the board the power to enact and implement rules based on sections 120.536(1) and 120.54.[2024 Florida Statutes]

Licensure by Examination Information Reflected in the Nurse Practice Act (Section 464.008)

Individuals seeking licensure as registered nurses or LPNs must apply to the Department of Health to take the licensure exam and complete the application process, including the actions listed below. See Florida Nursing Licensing.

• Paying the application fee set by the board, which should not exceed $150.

• Paying the examination fee set by the board, not exceeding $75, plus the actual per-applicant cost to the Department of Health for purchasing the exam from the National Council of State Boards of Nursing or a similar entity.

• Submitting sufficient information to the Department of Health for a statewide criminal records check through the Department of Law Enforcement for applications filed on or after October 1, 1989.

• Maintaining good physical and mental health.

• Holding a high school diploma or its equivalent.

• Graduating from a state-approved program or a prelicensure nursing education program deemed by the board to be of equivalent merit program is required.

• Graduating on or after July 1, 2009, from a fully accredited program or before July 1, 2009, from a prelicensure nursing education program whose graduates were eligible for examination is required.

• Completing professional nursing education courses equivalent to those in a practical nursing education program satisfies the educational requirement for licensure as an LPN.

• Being able to communicate in English may require undergoing an examination to determine proficiency.

Important information about the licensure examination include:

• Applicants who pass the exam and meet the educational requirements are eligible for licensure by the state of Florida as a registered professional nurse or LPN unless denied under section 464.018.

• Upon meeting all licensure requirements outlined by the board, including those under section 464.0095, applicants may request a multistate license from the Department of Health, subject to licensure and application fees.

• Applicants who fail the licensure exam 3 consecutive times, regardless of location or jurisdiction, must complete a board-approved remedial course before reattempting the exam.

• The exam must be scheduled within 6 months following the successful completion of the approved remediation program.[2017 Florida Statutes]

• Graduates of approved programs must take the exam within 6 months or enroll in and successfully complete a board-approved preparatory course. State or federal financial aid cannot cover the cost of the course.

Licensure by Endorsement Information Reflected in the Nurse Practice Act (Section 464.009)

The Florida Department of Health issues licenses by endorsement to professional nurses or LPNs who fulfill the following board’s requirements:[Florida Nursing Licensing]

• The applicant must complete the application process and pay the board-set fee, which shall not exceed $100.

• A valid license to practice practical or professional nursing must be held in another state or US territory, with licensure requirements equivalent to or more stringent than those of Florida.

• The applicant must meet the requirements outlined in section 464.008 and either pass a regional, state, or national exam of equal or greater rigor than Florida’s exam, or demonstrate active nursing practice in another state, US territory, or jurisdiction for at least 2 of the past 3 years, with the license in good standing.

• A board-approved Florida laws and rules course must be completed within 6 months of initial licensure.

• Applicants must submit to a national criminal history check, with the board determining that no criminal history is present.[2017 Florida Statutes]

• An applicant relocating due to the official military orders of a spouse who holds an active license in another state and is a member of the Nurse Licensure Compact is considered to have satisfied the requirements set forth by the board in the previously mentioned sections. A license by endorsement will be issued upon submission of the appropriate application, fees, and completion of a criminal background check.

• Applicants must adhere to the specific requirements set by the state board for the fingerprinting process and criminal history checks.

• If an applicant is under investigation in another state, US territory, or jurisdiction, they cannot be issued a license by endorsement if the act violates Chapter 456. Once the investigation is completed, the provisions under section 464.018 will apply.

• The application process is conducted electronically, and notifications and status updates are provided. Once all requirements are met, documents are received, and no statutory violations exist, a license will be issued within 30 days. 

• If an applicant holds an active multistate license in another state, the requirements for licensure by endorsement under Florida Statutes 464.0095 may be waived.[2024 Florida Statutes]

Nurse Licensure Compact Information Reflected in the Nurse Practice Act (Section 464.0095)

Article I: Findings and Declaration of Purpose

• Compliance with and the effectiveness of enforcement activities related to state nursing licensure laws significantly influence public health and safety. Violations of these laws can lead to public injury or harm.

• As nurses become increasingly mobile in their practice areas, states need to coordinate and cooperate more closely regarding nursing licensure and regulation.

• Technological advancements, such as telenursing, online education, and new practice modalities, have made navigating individual state nurse licensure laws complex and challenging.

• Compact nursing supports these technological advancements, including telenursing, distance education, and new practice modalities.[NCSBN.org]

• Duplicative licensure is redundant for traveling nurses, while compact licensure helps reduce this redundancy.

• Uniform licensure among states fosters a safer environment for the public. However, the responsibility for ensuring public health safety ultimately lies with the individual states.

• Compact licensure enhances cooperation among states in regulating and licensing nurses and facilitates the exchange of information regarding investigations, regulations, and adverse actions.

• Each state has the authority to hold a nurse accountable for compliance with its individual practice laws, as governed by the state where the patient or client is located at the time of service and care delivery. This framework establishes uniform licensure requirements, thereby enhancing interstate practice opportunities.[2024 Florida Statutes]

Article II: Definitions

• Adverse action: Actions taken by a licensing board or other authority against a nurse, which may be administrative, equitable, civil, or criminal in nature. This includes actions against an individual or multistate license, such as suspension, probation, revocation, monitoring of the licensed person, cease-and-desist orders, limitations on the licensee's practice, or any other actions affecting the authorization to practice. 

• Alternative program: A nondisciplinary monitoring program that requires approval from the licensing board.

• Commission: The Interstate Commission of Nurse Licensure Compact administrators was established as a result of the compact.

• Compact: The Nurse Licensure Compact was established, recognized, and entered into by the state under the compact.

• Coordinated licensure information system: A system for collecting, sharing, and storing data through an integrated process. This system is managed by a nonprofit organization governed by the licensing board, which aids in enforcement activities related to nursing licensure laws.

• Current significant investigative information: Investigative information that triggers a licensure board to conduct a preliminary inquiry. This information allows the nurse time to respond as mandated by individual state law and provides grounds for the belief that, if proven, represents more than a minor infraction. Investigative information may indicate that a nurse poses an immediate threat to public safety and health, regardless of whether the nurse has been notified or allowed to respond to the allegation.  

• Encumbrance: The suspension, limitation, or revocation of a nurse’s ability to practice without restrictions imposed by a licensing board.[2017 Florida Statutes]

• Home state: The party state where the nurse holds primary residence.

• Multistate license: A license issued by the home state licensure board allowing registered nurses, LPNs, or licensed vocational nurses (LVNs) to practice in all party states under a multistate licensure privilege.

• Multistate licensure privilege: Legal authorization for a registered nurse, LPN, or LVN to practice nursing in a remote state using a multistate license.

• Party state: Any state that has adopted the compact.

• Remote state: A party state, not the nurse's home state.

• Single-state license: A license issued by a party state that authorizes practice only within the issuing state and does not include a multistate licensure privilege.

• State: A state, possession, or territory of the United States or the District of Columbia.

• State practice laws: The rules, regulations, and laws of a party state that govern nursing practice, define its scope, and provide the methods and grounds for imposing discipline on the nurse holding the license.[2024 Florida Statutes]

Article III: General Provisions and Jurisdiction

A multistate license enables practice under a multistate licensure privilege with the following requirements:

• Each party state must establish procedures for obtaining and reviewing criminal history records and fingerprints from the Federal Bureau of Investigation and the state criminal database.

• Applicants must meet home state licensure criteria, including graduating from a board-approved pre-licensure program and satisfying renewal or initial licensure requirements, such as continuing education. 

• Graduates of a foreign nursing pre-licensure program must have completed a program accredited by the relevant accrediting entity in their country and have their credentials verified by a credentialing agency approved by the state board.

• Passing a board-approved English proficiency exam is required for applicants whose foreign program was not taught in English, or if English is not their primary language.

• The applicant has passed the National Council Licensure Examination for Registered Nurses (NCLEX-RN) or Practical Nurses (NCLEX-PN) or a predecessor exam.

• The license is active and unencumbered, meaning it has no holds or restrictions.

• The applicant has no felony convictions and has not been found guilty of a felony in federal or state court.

• The applicant must have no misdemeanor offenses related to nursing practice as determined on a case-by-case basis.

• The applicant is not currently enrolled in and must disclose any participation in an alternative program.

• The applicant must have a valid US Social Security Number.[NCSBN.org]

• The 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 follow the state's practice laws where the client or patient is located during care delivery. The nurse is under the jurisdiction of the licensing board, legal rules, and courts of the party state where the patient or client is located at the time of service.

• A single-state license is unaffected by compact requirements established by the party state. 

• If a nurse changes their primary state of residence after the compact’s effective date, they must meet all applicable requirements to obtain a multistate license from the new home state.

• Failure to meet these requirements may lead to revocation of the multistate license.

Article IV: Applications for Licensure in a Party State

• Through the coordinated licensure information system, the licensing board in the issuing party state will determine if the applicant has ever held or currently holds a license in another state, including verification of any identified encumbrances or current participation in an alternative program.

• A nurse may hold a multistate license issued by their home state in only one party state at a time.

• When an applicant changes their primary residence, such as by moving from one party state to another, the nurse must apply for licensure in the new home state. The multistate license from the former home state will be deactivated in accordance with applicable rules.

• The new home state cannot issue a multistate license until the nurse provides satisfactory proof of a change in primary residence. All licensure requirements set by the new home state must be fulfilled before the multistate license can be issued.

• If a nurse changes their primary state of residence by relocating from a party state to a nonparty state, the multistate license issued by the former home state will convert to a single-state license, valid only in that original 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. This may include issuing cease-and-desist orders, conducting investigations, and issuing subpoenas.

• Only the home state has the authority to take adverse action against a nursing license issued by that state, and the laws of that state will determine the appropriate action against the licensee.

• The licensing board or state agency will immediately report the conclusions of investigations to the administrator of the coordinated licensure information system. If the nurse has changed their primary state of residence, the administrator will notify the new home state of any actions taken.

• The compact administrator of a party state will provide all investigative documents and information upon request from another party state.[2024 Florida Statutes]

• If a home state takes adverse action against a multistate license holder, the multistate licensure privilege to practice in all other party states is deactivated until all encumbrances on the multistate license are resolved.

• The compact does not supersede a party state's decision to allow participation in an alternative program instead of taking adverse action. During the licensee's participation in the alternative program, the licensing board in the home state will deactivate the multistate licensure privilege associated with the multistate license.

Article VI: Coordinated Licensure Information System and Exchange of Information

• All party states must participate in a coordinated licensure information system.

• Disciplinary actions must be reported to the licensure information system by all party states.

• Licensure information is reported to the licensure information system and shared among party-state licensing boards under the compact.

• All licensing boards must report adverse actions immediately.

• Personal identifying data obtained from the coordinated licensure information system by a party state licensure board cannot be shared with nonparty states or disclosed to other individuals except as permissible by the laws governing the party state that contributed the data.

• Any data contributed to the coordinated licensure information system that is later expunged by law by the party state will be removed from the system.

Article VII: Establishment of the Interstate Commission of Nurse Licensure Compact Administrators

• The party states will establish a joint public entity, 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 shall have an administrator.

• The executive director of the state licensure board will serve as the administrator or may appoint a designee.

• Vacancies will be filled according to the laws of the party state where the vacancy occurs.

• Each administrator is entitled to a vote regarding the adoption of rules and the creation of bylaws.

• The commission meets at least once each calendar year.

• All meetings are open to the public, and public notices are posted.

• Closed nonpublic meetings are permitted under certain circumstances, including the failure of a party state to comply with compact obligations, disclosure of trade secrets, anticipated litigation, contract negotiation, accusations of criminal wrongdoing, or risks of invasion of privacy.

• The commission must conveniently publish its rules and bylaws on its website, including any amendments.

• The commission must purchase and maintain insurance bonds.[2024 Florida Statutes]

Article VIII: Rulemaking

• Rules or amendments are adopted during a regular or special meeting of the Interstate Commission.

• Unless there is an emergency, a notice regarding the proposed rule will be posted on the commission's website at least 60 days before the adoption of a final rule.

•  Any individual disputing the rule may submit comments either in writing or orally.

• If no interested parties appear at the hearing, the commission may proceed with the adoption of the proposed rule.

Article IX: Oversight, Dispute Resolution, and Enforcement

• Each party state shall provide oversight.

• A state may be terminated from the compact if it fails to correct a default.

Article X: Effective Date, Withdrawal, and Amendment

• The compact becomes valid and binding on the date of legislative enactment by at least 26 states or on December 31, 2018.

• All party states to this compact that were also parties to the previous Nurse Licensure Compact are considered to have withdrawn from the prior compact within 6 months following the effective date of the new compact.

• The compact may be amended by the party states.

Article XI: Construction and Severability

• The compact's provisions are severable if found to be unconstitutional in any party state or the United States.

Licensure of Advanced Practice Registered Nurses, Fees, Controlled Substance Prescribing Reflected in the Nurse Practice Act (Section F.S. 464.012)

• Under section 464.0095, APRNs must hold a current professional nursing license or an active multistate license to practice professional nursing.

• Certification must be obtained from an approved specialty board that is deemed appropriate.

• APRNs must also graduate from a program that grants a master’s degree in a clinical nursing specialty with training in advanced practitioner skills.

• The board establishes requirements for APRNs by law, including certified nurse practitioners, certified registered nurse anesthetists (CRNAs), CNMs, psychiatric nurses, and CNSs. 

• Established protocols outlining the authorizations and functions of APRNs must be maintained on-site at each location where they practice.

• APRNs must enter a supervisory protocol with at least one physician within the physician group practice.

• APRNs are authorized to perform functions within an established framework, including prescribing, dispensing, administering, or ordering medications. 

• APRNs may prescribe or dispense a controlled substance, as defined in section 893.03, only if they have graduated from a Master’s or doctoral program in a clinical nursing specialty with training in advanced practitioner skills.[2017 Florida Statutes]

• APRNs may order diagnostic tests, prescribe occupational and physical therapy, manage certain medical conditions, coordinate healthcare, and evaluate the effectiveness of care provided to the patient or client.

• Additional functions are determined by rule section 464.003(2).

• A certified nurse practitioner may 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.

• A certified nurse practitioner is authorized to initiate, monitor, or adjust treatment for certain uncomplicated acute illnesses.

• A certified nurse practitioner may also treat and monitor patients or clients with stable chronic diseases.

• CRNAs may perform functions as authorized by established protocols approved by the medical staff at the institution where anesthetic services are provided. CRNAs are permitted to determine the patient’s health status, assess risk factors, order preanesthetic medications, and support life functions during anesthesia. Additionally, CRNAs may place central venous and peripheral catheters and arterial lines if permitted under protocol. According to protocol, CRNAs may also order and administer spinal, regional, and general anesthesia. Furthermore, the CRNA is trained to recognize and treat cardiac arrhythmias during anesthesia and to assist in managing patient care in the postanesthesia recovery unit. 

• CNMs operate under authorized protocols approved by the medical staff at the healthcare institution where services are provided or under physician backup coverage for home deliveries.

• CNMs may perform minor superficial surgical procedures, prescribe appropriate medications, conduct postpartum exams, and offer family-planning services. Additionally, a CNM can manage labor and delivery, oversee routine obstetrical care, and provide initial newborn care.

• CNSs operate under established protocols and may diagnose human responses to actual or potential health issues while planning for disease prevention. A key aspect of the CNS's role involves health promotion and therapeutic intervention planning in collaboration with the patient or client within defined frameworks. Based on the CNS’s area of expertise and within the scope of advanced nursing practice, therapeutic interventions may include counseling, direct nursing care, teaching, and collaboration with other licensed healthcare providers.

• A psychiatric nurse who meets the requirements outlined in section 394.455(35) and operates within an established protocol with a psychiatrist may prescribe psychotropic controlled substances to treat mental disorders.

• The board may impose an application fee of up to $100 and a biennial renewal fee of up to $50.

• The board will establish a committee to recommend a controlled substances formulary outlining which substances an APRN may be restricted from prescribing or may prescribe only for specific uses or in limited quantities. The committee must include 3 licensed APRNs recommended by the board, 3 physicians licensed under Chapters 458 or 459 with experience working with APRNs and recommended by the Board of Medicine, and 1 pharmacist licensed under Chapter 465 who holds a Doctor of Pharmacy degree and is approved by the Board of Pharmacy.

• The APRN will be informed about the controlled substances bill designating section 464.012 of the Florida Statutes as the “Barbara Lumpkin Prescribing Act."[Final Bill Analysis]

Renewal of License or Certificate Reflected in the Nurse Practice Act (Section 464.013)

• The Department of Health will renew a license upon receipt of a renewal application and the appropriate fee.

• Biennial renewal of licenses is required.[2017 Florida Statutes]

• The board, by rule, prescribes up to 30 hours of continuing education biennially as a condition for license or certificate renewal.

• Nurses certified by a healthcare specialty program accredited by the National Commission for Certifying Agencies or the Accreditation Board for Specialty Nursing Certification are exempt from continuing education requirements, provided the criteria for these programs are approved by the board.

• ARNPs certified under section 464.012 must complete at least 3 hours of continuing education on the safe and effective prescription of controlled substances from a board-approved entity.

• The board will require each individual licensed or certified under this chapter to complete a 2-hour continuing education course on human trafficking, as defined in section 787.06(2). All licensees must complete this course for each biennial licensure renewal on or after January 1, 2019.[Florida Board of Nursing, RN]

Inactive Status Reflected in the Nurse Practice Act (Section 464.014)

• The Department of Health may not reactivate a license until the delinquent or inactive licensee has paid any applicable biennial renewal fees, delinquent fees, and a reactivation fee.

• The board has adopted rules related to the application procedures for inactive status and the reactivation process.[2017 Florida Statutes]

Titles and Abbreviations; Restrictions; Penalty Reflected in the Nurse Practice Act (Section 464.015)

• Only individuals who hold a license to practice professional nursing in this state or possess a multistate license under section 464.0095, or those performing nursing services under the exception outlined in section 464.022(8), may use the title "Registered Nurse" and the abbreviation "RN."[2017 Florida Statutes]

• Only individuals who hold a license in this state or a multistate license under section 464.0095 to practice as a licensed practical nurse, or who perform practical nursing services pursuant to the exception set forth in section 464.022(8), may use the title "Licensed Practical Nurse” and the abbreviation “LPN.”

• Only individuals who are graduates of prelicensure nursing education programs listed in section 464.008(1)(c) may use the term “Graduate Nurse” and the abbreviation “GN,” pending the results of the first licensure examination for which they are eligible.

• Only individuals who are graduates of prelicensure nursing education programs listed in section 464.008(1)(c) may use the term “Graduate Practical Nurse” and the abbreviation “GPN,” pending the results of the first licensure examination for which they are eligible.

• Only individuals with valid certificates to practice as clinical nurse specialists in this state may use the title “Clinical Nurse Specialist” and the abbreviation “CNS.”

• Only individuals with valid certificates to practice as certified registered nurse anesthetists in this state may use the title “Certified Registered Nurse Anesthetist” and the abbreviations “CRNA” or “Nurse Anesthetist.”

• Only individuals with hold valid certificates to practice as certified nurse midwives in this state may use the title “Certified Nurse Midwife” and the abbreviations “CNM” or “nurse midwife."

• Only individuals with valid certificates to practice as advanced registered nurse practitioners in this state may use the title “Advanced Registered Nurse Practitioner” and the abbreviation “ARNP.”

• An individual may not practice or advertise as or assume the title of a Registered Nurse, Licensed Practical Nurse, Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, Certified Nurse Midwife, or Advanced Registered Nurse Practitioner or use the abbreviation “RN,” “LPN,” “CNS,” “CRNA,” “CNM,” or “ARNP,” respectively, or take any other action that would lead the public to believe that the individual is authorized by law to practice as such or is performing nursing services pursuant to the exception outlined in section 464.022(8) unless that person is licensed, certified, or authorized under section 464.0095 to practice in that capacity.[2024 Florida Statutes]

• A violation of this section constitutes a first-degree misdemeanor, which is punishable in accordance with section 775.082 or 775.083.

Violations and Penalties Reflected in the Nurse Practice Act (Section 464.016)

Each of the acts mentioned below constitutes a third-degree felony, punishable in accordance with sections 775.082, 775.083, or 775.084.

• Practicing advanced or specialized, professional, or practical nursing, as defined in this part, without holding an active license or certificate to do so.

• Using or attempting to use a license or certificate that 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.[2017 Florida Statutes]

Each of the acts mentioned below constitutes a first-degree misdemeanor, punishable in accordance with section 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 that implies licensure or certification unless the individual is duly licensed or certified.

• Knowingly concealing information related to violations of this part.[2024 Florida Statutes]

Sexual Misconduct in Nursing Practice Reflected in the Nurse Practice Act (Section 464.017)

• Mutual trust forms the foundation of the nurse-patient relationship.[2017 Florida Statutes]

• Sexual misconduct in nursing practice refers to the violation of the nurse-patient relationship, wherein a nurse exploits that relationship to induce, or attempt to induce, a patient to engage in sexual activity. This includes engaging or attempting to engage the patient in sexual activity outside the scope of practice or generally accepted examination or treatment. Such sexual misconduct in the practice of nursing is prohibited.[2024 Florida Statutes]

Disciplinary Actions Reflected in the Nurse Practice Act (Section 464.018)

The following acts are grounds for license denial or disciplinary action, as outlined in sections 456.072(2) and 464.0095:

• Procuring, attempting to procure, or renewing a nursing license or the authority to practice practical or professional nursing under section 464.0095 through bribery, intentional misrepresentation, or by error of the department or the board.

• Having a nursing license revoked, suspended, or otherwise sanctioned, including denial of licensure, by the licensing authority of another state, territory, or country. 

• Being convicted, found guilty, or entering a plea of guilty or nolo contendere, regardless of adjudication, to any crime in any jurisdiction that directly relates to nursing practice or impacts the ability to practice nursing, including any of the following offenses:
  • A forcible felony, as defined in Chapter 776.[2017 Florida Statutes]
  • 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 applicants seeking a multistate license or current multistate license holders under section 464.0095, any felony offense under Florida law or federal criminal law.
  • Being found guilty, regardless of adjudication, or entering a plea of nolo contendere or guilty to any offense prohibited under section 435.04, a similar statute of another jurisdiction, or any act constituting domestic violence as defined in section 741.28.

This list is not exhaustive; additional information regarding license denial and disciplinary actions is available on the Florida Legislature website.[2024 Florida Statutes]

Approval of Nursing Education Programs Reflected in the Nurse Practice Act (Section 464.019)

• The board publishes a list of accredited nursing programs in Florida on its website, including graduate passage rates for each program over the 2 most recent calendar years.

• The data on the internet website should be updated at least quarterly.

• Nursing programs placed on probation must provide written disclosure of their probationary status to both applicants and current students. The notice must explain the program's probationary status implications for the students and applicants. 

•  Additional information on the approval of nursing education programs is available on the Florida Legislature website.[2017 Florida Statutes]

Florida Center for Nursing: Goals Reflected in the Nurse Practice Act (Section 464.0195)

• The Florida Center for Nursing was established to address nursing supply and demand issues, emphasizing retention, recruitment, and the effective utilization of nursing workforce resources. 

• The Florida Center for Nursing's primary goal is to develop a strategic plan for the state's nursing workforce. 

• The Florida Center for Nursing will evaluate the impact of Florida’s participation in the Nurse Licensure Compact under section 464.0095. 

• The Florida Center for Nursing will convene diverse groups, including representatives from nursing, interprofessional healthcare providers, business, industry, educators, legislation, and consumers, to review and provide feedback on the data prepared for the Center. These groups will recommend systemic changes and strategies for implementation, evaluate the effectiveness of the changes implemented, and report their findings to the legislature and other relevant parties.

• The Florida Center for Nursing may request data from the board, which must provide any information it holds regarding nurses licensed in this state or those holding a multistate license under section 464.0095, including information reported to the board by employers of such nurses, provided that personal identifying information is excluded.[2017 Florida Statutes]

Florida Center for Nursing: Board of Directors Reflected in the Nurse Practice Act (Section 464.0196)

• The Florida Center for Nursing is governed by a policy-setting board of directors, which must consist of 16 members, with a simple majority representing diverse practice locations.

• The president of the Senate recommends 4 members, including 1 registered nurse nominated by the Florida Organization of Nurse Executives and 1 representative from the hospital industry suggested by the Florida Hospital Association.

• The speaker of the House of Representatives recommends 4 members, including 1 registered nurse proposed by the Florida Nurses Association and 1 representative from the long-term care industry.

• The governor recommends 4 members, and 2 of them must be registered nurses.

• The board of governors recommends 1 nurse educator who must be a dean of a College of Nursing at a state university.[2017 Florida Statutes]

Retired Volunteer Nurse Certificate Reflected in the Nurse Practice Act (Section 464.0205)

• Registered nurses or LPNs who are retired and wish to serve indigent, underserved, or critically needy populations may apply for a retired volunteer nurse certificate from the Department of Health.

• Applicants must provide proof of meeting the requirements under section 464.008 or 464.009.

• A retired volunteer nurse must operate under the direct supervision of one of the following—the director of the Department of Health in the county, a physician with a limited license as per section 458.317 or 459.0075, a physician licensed under Chapter 458 or 459, an APRN licensed under section 464.012, or a registered nurse licensed under section 464.008 or 464.009.[2017 Florida Statutes]

Exceptions Reflected in the Nurse Practice Act (Section 464.022)

No provision of this part shall be construed to prohibit:

• Assistance by anyone in an emergency situation.

• Nursing practice by individuals enrolled in board-approved remedial courses.

• Any nurse practicing in accordance with the practices and principles of the Church of Christ Scientist shall not be subject to the board's rules, nor shall any board rule apply to any sanitarium, nursing home, or rest home operated under these practices and principles.

• The practice of any legally qualified nurse or licensed attendant from another state employed by the US government or any of its bureaus, divisions, or agencies while discharging their official duties.

• The establishment of independent practices by 1 or more nurses to provide nursing services to patients within the scope of their nursing licenses.

This list is not exhaustive and can be found in its entirety on the Florida Legislature's website.[2017 Florida Statutes][2024 Florida Statutes]

Registered Nurse First Assistant Reflected in the Nurse Practice Act (Section 464.027)

• The Nurse Practice Act encourages physicians and hospitals to use qualified registered nurse first assistants who meet the qualifications of "assistants at surgery" to deliver quality, cost-effective surgical care to Florida’s healthcare recipients.

• Perioperative nursing encompasses nursing practices in which the nurse provides preoperative, intraoperative, and postoperative care to surgical patients.

• Each healthcare facility must establish specific procedures for the appointment and reappointment of registered nurse first assistants and procedures for granting, revising, and renewing their clinical privileges.

A registered nurse first assistant must meet the qualifications established by the board, which include:

• Holding a valid registered nurse license.

• Having a certification in perioperative nursing.

• Completing a board-approved registered nurse first assistant program and possessing the relevant certificate.[2017 Florida Statutes]

PART II of the Nurse Practice Act: Certified Nursing Assistants (Sections 464.201-464.208)

Definitions reflected in the Nurse Practice Act (section 464.201) are mentioned below.

• Approved training programs: A training course conducted by a public or private educational center, licensed by the Department of Education, that implements the primary curriculum for nursing assistants and has received Department of Education approval.

• Certified nursing assistant: An individual who meets the qualifications set by the Board of Nursing and has been certified by the board as a certified nursing assistant.

• The practice of a certified nursing assistant: Certified nursing assistants provide care and assist individuals with tasks related to activities of daily living, including personal care, nutrition, hydration, mobility, toileting, elimination, use of assistive devices, safety, cleanliness, and postmortem care. Certified nursing assistants also gather data, report abnormal signs and symptoms, deliver end-of-life care, perform cardiopulmonary resuscitation and emergency care, and support socialization and reality orientation. A registered nurse must validate the competency of certified nursing assistants in performing these skills.[2012 Florida Statutes, Chapter 464]

Duties and Powers of the Board Reflected in the Nurse Practice Act (Section 464.202)

• The board maintains a public state registry of certified nursing assistants, accessible to certificate holders, employers, and other state agencies.

• The board establishes rules for testing procedures to certify nursing assistants. The board also regulates the practice of certified nursing assistants, defines their scope of practice, and establishes the necessary levels of supervision requirements.[2012 Florida Statutes, Chapter 464]

Certified Nursing Assistants: Certification Requirements Reflected in the Nurse Practice Act (Section 464.203)

• The board will issue a certificate to practice as a certified nursing assistant to anyone who demonstrates minimum competency in reading and writing and successfully passes the required background screening as per section 400.215. If the individual has completed the required background screening under section 400.215 or 408.809 within 90 days before applying for the certificate, and their background screening results are not retained in the clearinghouse established under section 435.12, the board will waive the requirement for an additional background screening. Additionally, the individual must fulfill any further requirements specified by the board.[2024 Florida Statutes]

• If an applicant fails to pass the nursing assistant competency examination in 3 attempts, they are not eligible for reexamination unless they complete an approved training program.

• Certification as a nursing assistant may be renewed if the assistant does not allow 24 consecutive months to pass without performing any nursing-related services for monetary compensation. If a nursing assistant does not provide any nursing-related services for financial compensation for 24 consecutive months, they must complete a new training and competency evaluation program or a new competency evaluation.

• A certified nursing assistant must maintain a current address with the board, as required by section 456.035.

• A certified nursing assistant must complete 24 hours of in-service training every biennium and retain documentation to demonstrate compliance with this subsection.[2024 Florida Statutes]

• The department will renew a certificate upon receiving the renewal application and payment of a biennial fee, which shall be no less than $20 and no more than $50. The department will also adopt rules to establish 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 a certification or an exemption, or possessing or attempting to possess certification or letter of exemption, through bribery, misrepresentation, deceit, or an error of the board.

• Intentionally violating any provision of this chapter, Chapter 456, or the rules adopted by the board.

When the board determines that an individual is guilty of the grounds specified in subsection (1), it may issue an order imposing 1 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, retraining, or compliance with the department’s impaired practitioner program operated by a consultant as described in section 456.076.

Upon the request of a certificate holder, the board may exempt them from disqualification of employment per Chapter 435 and issue a letter of exemption. The board must notify an applicant seeking an exemption from disqualification for certification or employment of its decision to approve or deny the request within 30 days of receiving all required documentation.[2024 Florida Statutes]

Availability of Disciplinary Records and Proceedings Reflected in the Nurse Practice Act (Section 464.205)

• Under section 456.073, any complaints or records maintained by the department regarding the discipline of a certified nursing assistant and any proceedings held by the board to discipline a certified nursing assistant shall remain open and available to the public.[2012 Florida Statutes, Chapter 464]

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 indicated in the certified nursing assistant registry, or whose name appears on a criminal screening report from the Department of Law Enforcement, the employer is not civilly liable for that termination. Additionally, a cause of action for damages may not be brought against the employer, regardless of whether the employee has applied for an exemption from the board under section 464.204(3). 

• No monetary liability shall arise, and a cause of action for damages may not be brought against any licensed facility, its governing board, or its members, medical staff, disciplinary board, agents, investigators, witnesses, employees, or any other person for any action taken in good faith and without intentional fraud while carrying out this section.[2024 Florida Statutes]

Penalties Reflected in the Nurse Practice Act (Section 464.207)

• Knowingly or intentionally failing to disclose a material fact used to determine qualifications for voluntary or paid employment or certification regulated under this part constitutes a first-degree misdemeanor. This offense is punishable as specified in section 775.082 or 775.083 and includes using false statements, misrepresentations, impersonations, or other fraudulent means in any application.[2012 Florida Statutes, Chapter 464]

Background Screening Information: Rulemaking Authority Reflected in the Nurse Practice Act (Section 464.208)

• The Agency for Healthcare Administration must grant the board electronic access to its background screening records and database.

• An employer or their agent may only use criminal or juvenile records concerning vulnerable adults to determine whether an individual meets the requirements of this part. Documents and information obtained by the board will remain confidential and exempt from section 119.07(1).

• In cases where the requirements of the Omnibus Budget Reconciliation Act of 1987, as amended, conflict with this part regarding the certification of nursing assistants, the federal requirements will take precedence for facilities certified to provide care under Title XVIII (Medicare) or Title XIX (Medicaid) of the Social Security Act.[2024 Florida Statutes]

Issues of Concern

Chapter 456 of the Florida Statutes addresses general provisions related to healthcare professions and occupations, which is an important area of concern. Familiarity with the laws in this chapter is essential, as it encompasses sections 456.001 to 456.50. A detailed list and references are available on the Florida Senate website.[2018 Florida Statutes, Chapter 456]

Definitions (Section 456.001)

• Board: This term refers to any commission, board, or other statutorily created entity authorized to exercise regulatory or rulemaking functions within the department. However, for sections 456.003 to 456.018, 456.022, 456.023, 456.025 to 456.033, and 456.039 to 456.082, "Board" specifically refers to a board or statutory entity authorized to perform regulatory or rulemaking functions within the Division of Medical Quality Assurance.

• Healthcare practitioner: This term refers to any person licensed under Chapters 457, 458, 459, 460, 461, 462, 463, 464, 465, 466, and 467; parts I, II, III, V, X, XIII, and XIV of Chapter 468, Chapters 478 and 480; and part II and III of Chapters 483, 484, 486, 490, and 491.

• Profession: This term refers to any activity, occupation, profession, or vocation regulated by the department within the Division of Medical Quality Assurance.

More definitions are found on the Florida Senate website.[2018 Florida Statutes, Chapter 456]

Legislative Intent and Requirements (Section 456.003)

• The Legislature intends that individuals within the department who may engage in any lawful profession are entitled to do so if they meet the necessary qualifications.

• The Legislature further asserts that the regulation of such professions is justified solely to protect public health, safety, and welfare under the state's police powers.

• Unless expressly authorized by statute, the duties granted to the boards do not permit enlarging, modifying, or contravening the lawful scope of practice of the profession regulated by the boards. This subsection shall not prohibit the boards, or the department in the absence of a board, from taking disciplinary action or issuing a declaratory statement.

The complete list is available on the Florida Senate website.[2018 Florida Statutes, Chapter 456]

Powers and Duties of the Department (Section 456.004)

• The department must collaborate with the Department of Revenue to establish an automated process for periodically sharing information about current licensees with the Department of Revenue, which serves as the state's Title IV-D agency. This subsection intends to support the state's public policy concerning child support, as outlined in section 409.2551. The department must suspend or deny the license of any licensee found noncompliant with a support order, subpoena, order to show cause, or written agreement with the Department of Revenue under section 409.2598. Upon receiving notification from the court or the Department of Revenue that the licensee has complied with the terms of the support order, the department will issue or reinstate the license without additional fees. The department is not liable for any license denial or suspension resulting from executing its duties under this subsection.

• The Department of Health collaborates with the Agency for Health Care Administration and the judicial system to recover Medicaid overpayments by the Medicaid program. The Department of Health is responsible for investigating and taking legal action against healthcare practitioners who have failed to remit amounts owed to the state for Medicaid overpayments, as stipulated in a final order, judgment, stipulation, or settlement.

Additional information is available on the Florida Senate website.[2018 Florida Statutes, Chapter 456]

Accountability and Liability of Board Members (Section 456.008)

• Each board member is accountable to the governor for adequately performing their duties as a board member.

• The governor investigates any legally sufficient complaint or unfavorable written report regarding the actions of the board or its members, regardless of whether the complaint is submitted to the governor, department, or board itself.

• The governor may suspend any board member from office for malfeasance, misfeasance, neglect of duty, drunkenness, incompetence, permanent inability to perform official functions, or the commission of a felony.

Additional information is available on the Florida Senate website.[2018 Florida Statutes, Chapter 456]

Board Rules: Final Agency Action and Challenges (Section 456.012)

• The State Surgeon General holds the legal authority to challenge any rule or proposed rule of a board within their jurisdiction under section 120.56.

Additional information is available on the Florida Senate website.[2018 Florida Statutes, Chapter 456]

General Background Screening Provisions (Section 456.0135)

• Applications for initial licensure submitted on or after January 1, 2013, under Chapters 458, 459, 460, 461, and 464; section 465.022; part XIII of Chapter 468; or Chapter 480, must include fingerprints processed according to procedures established by the department through a vendor approved by the Department of Law Enforcement along with the fees imposed for the initial screening and retention of fingerprints. 

Additional details can be found on the Florida Senate website.[2018 Florida Statutes, Chapter 456]

Public Inspection of Information Required From Applicants: Exceptions and Examination Hearing (Section 456.014)

• All information required by the department from any applicant is considered a public record and is open to public inspection under section 119.07, except for financial information, medical records, school transcripts, examination questions, answers, papers, grades, and grading keys. These items remain confidential and are exempt from section 119.07(1). Disclosure or access to this information is restricted to the program director of an approved or accredited program (as outlined in section 464.019(6)), board members, the department, and staff members with a bona fide need to know. Any information provided to the department by another agency exempt from Chapter 119 or deemed confidential will maintain its exempt or confidential status under applicable law while held by the department or agency.

Further details are available on the Florida Senate website.[2018 Florida Statutes, Chapter 456]

Examinations (Section 456.017)

• For each examination developed or administered by the department or a contracted vendor, an accurate record of each applicant's examination questions, answers, papers, grades, and grading keys must be maintained for at least 2 years following the examination. After this period, records must be maintained or destroyed according to the provisions in Chapters 119 and 257. This requirement does not apply to national examinations approved and administered under this section.

This list can be found on the Florida Senate website.[2018 Florida Statutes, Chapter 456]

Penalty for Theft or Reproduction of an Examination (Section 456.018)

• In addition to or in lieu of any disciplinary action under section 456.072, the theft of an examination, whether in whole or in part, or the act of reproducing or copying any examination administered by the department—regardless of the extent or method—constitutes a third-degree felony. This offense is punishable as provided in sections 775.082, 775.083, or 775.084.[2024 Florida Statutes]

Restriction on Requirement of Citizenship (Section 456.019)

• An individual may not be disqualified from practicing a state-regulated occupation or profession solely due to a lack of US citizenship.[2024 Florida Statutes]

Qualification of Immigrants for Examination to Practice a Licensed Profession or Occupation (Section 456.021)

• This section aims to promote the participation of foreign-speaking residents of Florida who are qualified to engage in their professions, thereby enhancing the quality of services available to all individuals in the state.

This information is available on the Florida Senate website.[2018 Florida Statutes, Chapter 456]

Fees, Receipts, and Disposition (Section 456.025)

• The Legislature mandates that licensees and licensure applicants cover the expenses of regulating healthcare professions and practitioners. Fees are intended to remain reasonable and should not create barriers to licensure. Additionally, the Legislature emphasizes that the department should operate as efficiently as possible, with a responsibility to report regularly on potential methods to reduce operational costs.

• If a licensee requires or requests duplicate licenses, the board—or the department in the absence of a board—may impose a fee, as set by rule, up to $25 before issuing the duplicate.

 This information can be found on the Florida Senate website.[2018 Florida Statutes, Chapter 456]

Annual Report Concerning Finances, Administrative Complaints, Disciplinary Actions, and Recommendations (Section 456.026)

• The department is directed to prepare and submit a report to the Senate president and the House of Representatives speaker by November 1 of each year. This report shall include financial information and any additional details requested by the Legislature. The report will also include statistics and relevant information organized by profession.

This information can be found on the Florida Senate website.[2018 Florida Statutes, Chapter 456]

Consultation With Postsecondary Education Boards Before the Adoption of Changes to Training Requirements (Section 456.028)

• Any state agency or board that regulates a profession or occupation must consult with the Commission for Independent Education, the Board of Governors of the State University System, and the State Board of Education before changing the training requirements for entry into that profession or occupation. 

• The consultation should allow the educational boards to provide insights on the potential impact of the proposed changes, particularly regarding the duration needed to complete the training program and the associated financial implications.

• Consultation with an educational board is required only when the training institution falls under its jurisdiction.[2024 Florida Statutes]

Hepatitis B or HIV Carriers (Section 456.032)

• The department and each relevant board within the Division of Medical Quality Assurance are authorized to establish procedures for managing, counseling, and providing additional services to healthcare professionals within their jurisdictions who are infected with hepatitis B or HIV.

• Any individual licensed by the department or employed by a healthcare facility who contracts a blood-borne infection is afforded a rebuttable presumption that the infection was acquired during the course and scope of their employment. This presumption applies, provided the individual promptly reports any significant exposure, as defined in section 381.004(1)(f), to blood or body fluids to their supervisor or the facility's risk manager.

• The employer may test the blood or body fluid to determine whether it carries the same infection the employee contracted.

• The employer may rebut the presumption through a preponderance of the evidence. Unless specifically outlined in this subsection, no presumption exists that a blood-borne infection is a job-related injury or illness.[2018 Florida Statutes, Chapter 456]

Compliance With Continuing Education Requirements (Section 456.0361)

• The department will implement an electronic tracking system to monitor licensees' compliance with continuing education requirements, verifying full compliance at the time of license renewal application. This tracking system will be integrated into the department's overall licensure and renewal process.

• The department cannot renew a license unless the licensee has met all applicable continuing education requirements. This provision does not prevent the department or boards from imposing additional penalties under the relevant Professional Practice Act or applicable rules for noncompliance with continuing education requirements.

• The department may establish rules to implement this section.[2018 Florida Statutes, Chapter 456]

Reporting Adverse Incidents Occurring in Planned Out-of-Hospital Births (Section 456.0495)

For this section, an "adverse incident" refers to any event within the control of a physician licensed under Chapter 458 or 459, a nurse midwife certified under part I of Chapter 464, or a midwife licensed under Chapter 467 associated with an attempted or completed planned out-of-hospital birth, which results in 1 or more of the following injuries or conditions:

• A maternal death occuring during delivery or within 42 days postpartum.

• The transfer of a maternal patient to a hospital intensive care unit (ICU).

• A maternal patient experiencing hemorrhagic shock or requiring a transfusion of more than 4 units of blood or blood products.

• A fetal or newborn death, including stillbirth, associated with an obstetrical delivery.

• The transfer of a newborn to a neonatal ICU due to a traumatic physical or neurological birth injury, including any degree of brachial plexus injury.

• A transfer of a newborn to a neonatal ICU within the first 72 hours after birth if the newborn remains in the unit for more than 72 hours or any other injury as determined by department rule.

Beginning July 1, 2018, any physician licensed under Chapter 458 or 459, nurse midwife certified under part I of Chapter 464, or midwife licensed under Chapter 467 who performs an attempted or completed planned out-of-hospital birth must report any adverse incident, along with a medical summary of events, to the department within 15 days of the incident.

• The department will review each incident report to determine whether it involves conduct by a healthcare practitioner that may warrant disciplinary action under section 456.073. The appropriate regulatory board is responsible for taking necessary disciplinary action; if no such board exists, the department will handle it.

• The department shall adopt rules to implement this section and develop a reporting form for adverse incidents.[2018 Florida Statutes, Chapter 456]

Ownership and Control of Patient Records: Reports or Copies of Records to be Furnished and Disclosure of Information (Section 456.057)

Except as otherwise provided in this section and section 440.13(4)(c), patient records may not be disclosed, nor may a patient's medical condition be discussed with anyone other than the patient, the patient's legal representative, or other healthcare practitioners and providers involved in the patient's care or treatment, unless there is written authorization from the patient. However, records may be disclosed without written permission under the following circumstances:

• To any person, firm, or corporation that provided or facilitated the patient's care or treatment with the patient's consent.

• When a physical examination is required under rule 1.360, Florida Rules of Civil Procedure, copies of medical records must be provided to both the defendant and the plaintiff.

• In any civil or criminal action, unless otherwise prohibited by law, medical records may be disclosed upon a subpoena from a court of competent jurisdiction, with appropriate notice to the patient or their legal representative by the requesting party seeking such records.

• Medical records may be furnished for statistical and scientific research if the information is abstracted to protect patient privacy or if written consent is obtained from the patient or their legal representative.

• Medical records may also be shared with a regional poison control center to treat or evaluate poisoning incidents, manage poison cases, or meet data collection and reporting obligations under section 395.1027 and the certification requirements for poison control centers established by federal law.

• Medical records may be provided to the Department of Children and Families, its agents, or contracted entities for investigations or services related to abuse, neglect, or exploitation cases involving children or vulnerable adults.

This list can be found on the Florida Senate website.[2018 Florida Statutes, Chapter 456]

Duty to Notify Patients (Section 456.0575)

• Licensed healthcare practitioners must personally inform each patient, or a designated representative under s 765.401(1), of any adverse incidents that result in serious harm. However, notifying a patient about an outcome that led to injury does not serve as an admission of liability and cannot be used as evidence.

The complete list is available on the Florida Senate website.[2018 Florida Statutes, Chapter 456]

Toll-Free Telephone Number for Reporting Complaints (Section 456.068)

• The Agency for Health Care Administration will establish a toll-free number for the public to report complaints concerning medical services or treatment provided by healthcare professionals.[2024 Florida Statutes]

Practitioners in Default on Student Loan or Scholarship Obligations: Investigation and Reporting (Section 456.0721)

• The Department of Health must obtain information from the US Department of Health and Human Services to investigate and take action against healthcare practitioners who fail to repay a student loan or meet scholarship service obligations under section 456.072(1)(k).

• The department shall receive a monthly list of practitioners in default from the US Department of Health and Human Services and necessary information to investigate complaints pursuant to section 456.073. 

• The department may obtain evidence for investigations and prosecutions from any financial or educational institution that provided loans or education to the practitioner.

• As part of the annual report required by section 456.026, the department must report to the Legislature the number of practitioners in default, the outcomes of investigations and prosecutions, and the total fines collected from practitioners prosecuted for violations under section 456.072(1)(k).[2018 Florida Statutes, Chapter 456]

Practitioner Registry for Disasters and Emergencies (Section 456.38)

• The Department of Health may include a question on certification or licensure forms for healthcare practitioners, as defined in section 456.001, inquiring whether they are willing to provide healthcare services in special needs shelters or assist disaster medical assistance teams during major disasters or emergencies. Practitioners who respond affirmatively will have their names maintained in a department registry specifically for healthcare practitioners available for disaster and emergency response.[2024 Florida Statutes]

Clinical Significance

Healthcare providers have specific ethical and legal responsibilities related to healthcare delivery. Ethical dilemmas may arise in areas such as palliative care, organ donation, patient abandonment, religious and cultural beliefs, assisted suicide, informed consent, and the disclosure of medical conditions. The American Nurses Association (ANA) Code of Ethics for Nurses outlines 9 provisions to guide nursing practice [nursingworld.org].

The 2015 Code of Ethics for Nurses with Interpretive Statements by ANA outlines the following key principles:

• Provision 1 emphasizes respect for human dignity, the nature of healthcare, the right to self-determination, and fostering positive relationships with patients and colleagues.[2][3][4] 

• Provision 2 highlights the importance of collaboration, prioritizing patient interests, maintaining professional boundaries, and managing conflicts of interest. Please see StatPearls' companion resource, "Nursing Ethical Considerations," for more information.[4][5][6][7][8]

• Provision 3 focuses on safeguarding patient rights in critical areas, including privacy and confidentiality, human participation in research, practicing nursing while impaired, maintaining performance standards, addressing questionable practices, and upholding a professional duty to promote a culture of safety.[9] 

• Provision 4 emphasizes the importance of authority, responsibility, and accountability, particularly in delegating and assigning tasks.[10] Clinical judgment and decision-making are vital components of this provision.

• Provision 5 highlights the importance of personal health promotion, well-being, maintaining integrity, and ongoing professional growth.[11] 

• Provision 6 addresses healthcare practitioners' environmental, moral, and ethical obligations, emphasizing their responsibility for upholding a safe and supportive healthcare environment.[11] 

• Provision 7 highlights the contributions of nurses through scholarly inquiry, research, commitment to professional practice standards, and active participation in policy development.[12] 

• Provision 8 addresses health as a universal right and emphasizes the obligation to uphold human rights in all healthcare settings.

• Provision 9 emphasizes maintaining the integrity of the nursing profession and the responsibility to address social injustices within healthcare.

In 2017, a Gallup poll ranked nurses as the most trusted profession, underscoring their moral and ethical responsibility to practice within the legal framework (laws and regulations) established by their state's or territory's Nurse Practice Act. The Code of Ethics for Nurses serves as a foundational framework for nursing laws, codes, and regulations, guiding safe and ethical practice. Nurses are responsible for understanding the essential elements of these laws as they relate to safe nursing care. The Florida Department of State Administrative Code further reinforces the importance of this knowledge for nursing practice.[13][14]

The Florida Department of State Administrative Code, Register, and Laws Section serves as the rulemaking authority enacted by state regulatory agencies. This agency rulemaking is governed by Chapter 120 of the Florida Statutes, known as the Administrative Procedures Act, with regulations published in the Florida Administrative Code.[FLrules.org, About Us] Florida Administrative Code section 64B9, established by the Florida Department of State, outlines the laws and regulations that govern essential aspects of nursing licensure and professional conduct.[FLrules.org]

Other Issues

Curriculum Guidelines (64B9-2.021)

• All nursing programs seeking approval from the Board of Nursing must adhere to the curriculum framework established by the Florida Department of Education.

• The curriculum for professional nursing programs leading to a bachelor's degree must include at least 40% clinical training.

• The curriculum for professional nursing programs that result in an associate's degree or a diploma must consist of at least 50% clinical training.

This list is not exhaustive; additional information is available on the Florida Department of State Administrative Code website.[Rule 64B9-2.021 History]

Clinical Training (64B9-2.022)

• Clinical learning experiences must be integral to the overall curriculum and directly related to concurrent theoretical instruction.

• Clinical training must take place within the United States, the District of Columbia, or a US territory and include experiences in long-term care, acute care, and community-based care settings.

• A clinical instructor may directly supervise no more than 12 students unless a written agreement with the training site allows for a maximum of 18 students.

• Indirect supervision is allowed for community-based clinic experiences if the clinical instructor is reachable by telephone. However, invasive or complex nursing activities require approval from the community-based clinical site to ensure proper monitoring.

• Up to 50% of each clinical training category—long-term care, acute care, and community-based care—may be completed through simulation, provided it is supplemented with traditional clinical experience.

• Traditional clinical experience includes observation, hands-on patient care, and interaction within interprofessional healthcare teams.

• Simulation encompasses activities that replicate clinical practice, including scenarios with high- and medium-fidelity manikins, standardized patients, role-playing, skills stations, and computer-based critical thinking exercises.

• Debriefing is an essential part of the simulation process following these experiences.

This list is not exhaustive; additional information is available on the Florida Department of State Administrative Code website.[Rule 64B9-2.022 History]

Qualifications for Examination (64B9-3.002)

• Applicants seeking certification to take the licensure examination must submit a completed Nursing Licensure by Examination Application, demonstrating that they meet the qualifications outlined in the Nurse Practice Act, Chapter 464, Florida Statutes. 

• Forms are available from the Florida Board office or the board's website.[Florida Nursing Licensing]

• Qualifications include a high school diploma or an equivalent.

• For graduates of an approved nursing program, a notice of graduation or proof of completion of the program's requirements is required.

• For graduate nursing programs outside the United States, applicants must obtain a report from a credentialing agency that meets the requirements outlined in rule 64B9-3.014, FAC.

• If the applicant is a graduate of a foreign prelicensure education program not taught in English, or if English is not their native language, successful completion of a board-approved test of proficiency in English as a foreign language is required.[Rule 64B9-3.002 History]

Licensure by Endorsement (64B9-3.008)

• Individuals applying for licensure by endorsement must submit a completed Nursing Licensure by Endorsement Application, along with verification of licensure forms from the original state or territory where they were licensed and from any state or territory where they currently hold an active license. The applicant is also required to pay the necessary fee.

• To apply for endorsement under section 464.009(1)(a) of the Florida Statutes, the applicant must demonstrate current licensure in another US state and provide evidence of the licensure requirements from the original state at the time of initial licensure.

• Applicants who have not actively practiced nursing in the past 5 years must complete a remedial course specified in rule 64B9-3.0025, FAC, before being granted licensure.

This list is not exhaustive; additional information is available on the Florida Department of State Administrative Code website.[64B9-3.008 History]

Multistate License Upgrade (64B9-3.016)

• Registered nurses and LPNs in Florida can upgrade their licenses to allow multistate practice by submitting a Multistate License Upgrade Application to the board. Forms are available on the board's website.[Florida RN Renewals]

Certified Nursing Assistant Renewal Fee (64B9-15.0045)

• The fee for renewing a Certified Nursing Assistant Certificate, as specified in section 464.203(8) of the Florida Statutes, is $50.00.[Rule 64B9-15.0045 History]

Continuing Education Requirement (64B9-5.002)

• During each biennium, licensees must earn 1 contact hour for each calendar month of the licensure cycle.[Florida RN Renewals]

• Individuals licensed by examination within a biennium are exempt from the continuing education requirement for that period. This exemption also applies to those licensed by endorsement during a biennium if they were initially licensed by completing an acceptable licensure examination. Licensees who endorse into the State of Florida or whose licenses were reactivated or reinstated during a biennium must accrue 1 contact hour for each calendar month remaining in the biennium after licensure, reactivation, or reinstatement. However, no hours are required if 6 months or less remain in the biennium. This exemption or limitation applies only if the license is renewed promptly at the end of the biennium and does not apply if the license is suspended, revoked, or becomes inactive by the end of the biennium.

• A registered nurse who also holds a current LPN license can fulfill the continuing education requirement for the renewal of both licenses by completing the appropriate continuing education for registered nurses. Furthermore, a registered nurse with a current ARNP certificate may meet the continuing education requirement for both licenses by completing the required continuing education for registered nurses or by fulfilling up to 50% of the continuing education requirement through continuing medical education coursework that is equivalent to the contact hours mandated by these rules.

• A nurse who is the spouse of a member of the Armed Forces and is absent from Florida due to the spouse's official military duties is exempt from continuing education requirements. The licensee must provide satisfactory proof of the absence and the spouse's military status.

The following continuing education courses are mandatory and must be completed as part of the hours required in subsection 1 within the specified timeframes:

• A 2-hour course in preventing medical errors must be completed each biennium.
• A 1-hour course in HIV and AIDS is required in the first biennium only.
• A 2-hour course in Florida laws and rules must be completed each biennium.
• A 2-hour course in recognizing impairment in the workplace is required every other biennium after the first.
• A 2-hour course on human trafficking is required for biennial renewal on or after January 1, 2019, and in each biennium thereafter.
• A course in domestic violence is required every third biennium.[Rule 64B9-5.002 History]

Unprofessional Conduct (64B9-8.005)

Unprofessional conduct includes:

• Inaccurate recording. 

• Misappropriation of drugs, supplies, or equipment.

• Leaving a nursing assignment without notifying licensed nursing personnel or abandoning a patient.

• Stealing from a patient, including identity theft. 

• Violating the integrity of a medication administration system or an information technology system.

• Falsifying or altering patient records, nursing progress records, employment applications, or time records.

• Violating the confidentiality of information or knowledge concerning a client or patient. 

• Discriminating based on race, creed, religion, age, sex, or national origin in the delivery of nursing services violates the principles of human rights and the dignity of the individuals.

• Engaging in fraud, misrepresentation, or deceit during the licensing examination.

• Impersonating another licensed clinician or permitting another person to use one's certificate to practice nursing.

• Providing inaccurate or false information to an employer about the status of one's nursing license.

• Practicing outside the scope of the licensee's licensure, educational preparation, or nursing experience.

• Using force against a patient, such as striking or throwing objects at them.

• Using abusive, threatening, or foul language in front of a patient or directing such expressions toward a patient.

• Accepting a gift from a patient or client that exceeds the value set by the employer's policy regarding gifts.[Rule 64B9-8.005 History]

• Knowingly obtaining, using, or attempting to obtain a patient's property to temporarily or permanently deprive the patient of the use, benefit, or possession of their funds, assets, or property or to benefit someone other than the patient.

Requirements for Documentation (64B9-4.004)

A registered nurse applying for initial certification as an advanced registered nurse practitioner must submit the following with a completed application:

• Acceptable proof of satisfactory educational program completion, including an official transcript from the registrar sent directly to the board, indicating successful completion of a formal post-basic program or a master's degree in a clinical nursing specialty.

• A verification form prescribed by the board, submitted by the director of the advanced nursing program, indicating successful completion and bearing the official school seal.

Advanced registered nurse practitioners licensed after July 1, 2006, as well as all CRNAs, CNMs, and psychiatric nurses, must submit documentation of national certification from a nursing specialty board specified in subsection 64B9-4.002(2), FAC, or documentation of certification from a specialty board that meets the requirements outlined in subsection 64B9-4.002(3), FAC.

This documentation may be submitted in one of the following formats:

• A copy of the recertification or original specialty board certificate.

• Other documentary evidence of certification by an appropriate specialty board or verification from the specialty association of certification.[Rule 64B9-4.004 History]

Citations (64B9-8.003)

• A citation is an instrument that meets the requirements outlined in section 456.077, Florida Statutes, and is served upon a licensee to impose a penalty as established by this rule.

• The board designates the first instance of the following as a citation violation, incurring a penalty of $100.00. Failure to report a misdemeanor to the board in writing within 30 days after the licensee has been convicted, found guilty, or entered a plea of nolo contendere—regardless of adjudication—for any crime in any jurisdiction, in violation of section 456.072(1)(x), Florida Statutes.

• The board designates the second instance of the following as a citation violation, incurring a penalty of $100.00. Failure to report an address change, in violation of rule 64B9-1.013, FAC, provided the licensee was not ordered to do so in a board disciplinary order. Additionally, failure to submit updates of required information in the practitioner profile within 15 days after the final activity renders such information a fact, as required by section 456.042, Florida Statutes.

• The board designates the first instance of the following as a citation violation, incurring a penalty of $1500. Providing another individual with a confidential password, access code, keys, or other entry mechanisms that compromise or threaten the integrity of a medication administration system or information technology system. In addition to the fine, the licensee must complete a 2-hour continuing education course in the legal aspects of nursing within 60 days of the citation issuance.[Rule 64B9-8.003 History]

Testing and Competency Evaluation (64B9-15.008)

• The Certified Nursing Assistant Examination includes both written and clinical skills tests, both of which must be passed within 2 years for certification. If results from either the written exam or clinical skills test are over 2 years old, they become invalid, and both tests must be retaken.

• The recommended minimum passing level for each task for the clinical skills examination is set at 3 standard errors of measure below the mean. This minimum passing level varies according to the difficulty of the items selected by the testing service for each version of the examination and is established by the testing service based on its expertise. To pass the clinical skills test, the candidate must achieve a minimum passing score on each of the 5 tasks included in the examination form.

• If a person applying fails to pass the nursing assistant competency examination in 3 attempts, they are not eligible for reexamination unless they complete an approved training program.

This list is not exhaustive; additional information is available on the Florida Department of State Administrative Code website.[Rule 64B9-15.008 History]

Notice of Noncompliance: Minor Violations (64B9-15.0097)

• A Notice of Noncompliance is a notification issued by the Department of Health to a licensee as the initial response to a minor violation. This notice does not include a fine or other disciplinary penalty.[Rule 64B9-15.0097 History]

The board designates the following as minor violations for which a Notice of Noncompliance may be issued for the first violation:

• Failure to notify the department of an address change within 60 days, in violation of section 464.203(6), Florida Statutes, provided the failure does not constitute noncompliance with a board order.

• False, deceptive, or misleading use of the certified nursing assistant title, in violation of section 456.072(1)(a), Florida Statutes, provided no criminal prosecution resulted and no practice issue was involved.

Further resources are available from the board on their official website.[Florida Nursing Resources]

Provisional Certification (64B9-4.0025)

• Applicants for certification as CRNAs, psychiatric nurses, or CNMs may apply for provisional state certification before receiving certification from the relevant professional or national nursing specialty board.

• Each applicant for provisional state certification must have graduated from an approved educational program as outlined in rule 64B9-4.002, FAC.

• The provisional ARNP certification is valid for 12 months. This certification will expire if the applicant does not submit specialty board certification within 12 months from the date the provisional ARNP certification was granted.[Rule 64B9-4.0025 History]

Mediation (64B9-15.0096)

The board recognizes mediation as an acceptable resolution for the first instance of the following violations:

• Issuance of a worthless bank check to the department or the board for initial licensure or renewal of a license, provided the licensee does not practice on a delinquent license.

• Failure to report a change of address for more than 30 days but less than 60 days, in violation of section 464.203(6), Florida Statutes, provided the failure does not constitute noncompliance with a directive from the board.[Rule 64B9-15.0096 History]

Citation for Certified Nursing Assistants (64B9-15.0095)

• "Citation" refers to an instrument that complies with the requirements outlined in section 456.077, Florida Statutes, and is served upon a licensee to impose a penalty in an amount specified by this rule.

• Instead of following the disciplinary procedures outlined in section 456.073, Florida Statutes, the Department of Health may issue a citation to the subject within 6 months of filing the complaint that serves as the basis for the citation. All citations require the respondent to correct the violation, if it is remediable, within a specified period and impose any necessary obligations to remedy the offense.

• The board designates the following as a citation violation, which will result in a penalty of $25.00. A first-time failure to report a misdemeanor to the board in writing within 30 days after the licensee has been convicted, found guilty, or entered a plea of nolo contendere to, regardless of adjudication, a crime in any jurisdiction, in violation of section 456.072(1)(x), Florida Statutes.[Rule 64B9-15.0095 History]

Enhancing Healthcare Team Outcomes

Laws are dynamic, with amendments and enactments occurring as legislative needs arise. Healthcare providers must remain informed of current practice standards, the rules outlined in their state's Nurse Practice Act, and the Florida Department of State Administrative Code, which governs essential elements of nursing licensure and professional conduct.[Flrules.org]