Florida Nurses Laws and Rules

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Contact Hours: 2

This online independent study activity is credited for 2 contact hours at completion.

Course Purpose

To provide nurses in the state of Florida an overview of current laws as they relate to the Nurse Practice Act of Florida.

Overview

The Florida Board of Nursing is a regulatory body that ensures individuals are qualified to practice nursing in the State of Florida through verification of education, discipline, licensure, and rehabilitation. Nurses who are licensed in the state of Florida are held to a minimal practice standard of providing safe, culturally competent care to all patients in a variety of healthcare settings. This learning topic provides an overview of Chapter 464 of the Florida Nurse Practice Act as described in the Florida statutes, as it is the responsibility of the nurse who provides care in Florida to know the rules and laws as they relate to healthcare in the state.

Objectives

Upon completion of the independent study, the learner will be able to:

  1. Describe the process for nursing licensure in Florida
  2. Identify the various specialties and classifications of the Florida nurse
  3. Describe the purpose and functions of the Nurse Practice Act of Florida

Policy Statement

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Disclosures

Fast CE For Less, Inc. and its authors have no disclosures. There is no commercial support.

Fast Facts: Florida Nurse Rules and Laws

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Introduction

Healthcare providers have certain ethical and legal obligations related to healthcare delivery. Ethical dilemmas arise regarding palliative care, organ procurement, religious beliefs, cultural considerations, assisted suicide, informed consent, and the disclosure of medical conditions. The American Nurses Association (ANA) provides a Code of Ethics for Nurses with 9 provisions.² According to this 2015 Code of Ethics for Nurses with Interpretive Statements by the ANA, provision 1 addresses respect for human dignity, the nature of healthcare, the right to self-determination, and relationships with patients or colleagues. Provision 2 highlights collaboration, the primacy of the patient’s interests, professional boundaries, and conflicts of interests for nurses.           

Provision 3 offers information on the protection of patient rights related to the critical issues, such as privacy and confidentiality, human participation in research, nursing while impaired, performance standards, acting on questionable practice, and professional responsibility in promoting a safety culture. Provision 4 discusses authority, responsibility, and accountability. Clinical judgment and decision making are vital components of this provision, as well as delegation and task assignment. Provision 5 focuses on personal health promotion and well-being, integrity preservation, and continual professional growth. 

Provision 6 explores responsibility for the healthcare environment, moral virtue, and ethical obligations. Provision 7 profiles contributions through scholarly inquiry, research, professional practice standards and development, and policy development. Provision 8 examines health as a universal right and obligations to human rights in a variety of settings. Provision 9 looks at the integrity of the profession and integrating social injustice.

In 2017, a Gallup poll ranked nurses as the most trusted profession. This distinctive honor comes with a moral and ethical responsibility to practice within the laws and rules of the Nurse Practice Acts of one’s state or territory. Often, aspects of the Code of Ethics for Nurses provide a framework for nursing laws, codes, and rules. A nurse has a responsibility to know the essential elements of these laws as they relate to and guide safe nursing practice. The Florida Department of State’s Administrative Code will further assist nurses in this knowledge.

The Florida Board of Nursing is a regulatory body that ensures individuals are qualified to practice nursing in the State of Florida through verification of education, discipline, licensure, and rehabilitation.³ Nurses who are licensed in the state of Florida are held to a minimal practice standard of providing safe, culturally competent care to all patients in a variety of healthcare settings.  A nurse who fails to maintain the minimum practice standard must forfeit licensure, resulting in the inability to practice nursing in the state of Florida. The Nurse Practice Act, enacted by the Florida Legislature, provides a framework for providing safe, professional nursing care and offers a layer of protection to the individuals seeking such care.

Nurse Practice Acts, enacted by all states and territories, were created over 100 years ago to protect the public and establish rules and regulations to ensure the laws specific to the nursing profession were clear. All state boards must follow the laws enacted by the legislature and adopted in the Nurse Practice Act of each state or territory. Rules and regulations that are enacted by the state boards have the full scope of the law and are enforceable.⁴ A nurse who holds a license in Florida must be familiar with Florida’s Nurse Practice Act that is set forth by law. Requirements change and a nurse professional is responsible for knowing the current rule of law and cannot claim ignorance if a problem arises. A misunderstanding or ignorance of the law does not erase responsibility and is not a plausible excuse. The content of this independent study is derived from the 2019 Florida Statutes.⁴

Part I of the Nurse Practice Act

The Nurse Practice Act of Florida includes Part I Nurse Practice Act, and Part 2 Certified Nursing Assistants.⁴ Part I Nurse Practice Act ensures minimum requirements for safe practice are met. It further stipulates that nurse professionals who fall below minimum competency or present a danger to the public, are prohibited from practicing nursing in the State of Florida. Section 464.003 provides some legal definitions related to the nurse practice act and terminology used⁴:

Nurse Practice Act Section 464.003 Legal Definitions
Accredited ProgramA prelicensure education program of practical or professional nurses that is conducted in the United States at an institute of education and is accredited by a specialized nursing accrediting agency with national recognition by the United States Secretary of Education to approve nursing education programs.
Advanced or Specialized Nursing PracticeNurses who perform advanced-level nursing acts in addition to professional nursing practice, and are approved by the board after specialized training, education, and experience. The advanced practice registered nurse may perform specific actions, such as nursing diagnosis and treatment, medical diagnosis and treatment, prescription, and operate according to authorization within the guidelines of an established protocol of supervision. By rule, a copy of the protocol may be required to be filed with the department and meet requirements.
Advanced Practice Registered NurseAny individual licensed in the state of Florida to practice as a professional nurse and who holds a license in advanced nursing practice, such as certified nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, psychiatric nurses, and clinical nurse specialists. 
Approved Program A prelicensure educational program for practical or professional nurses conducted in the state of Florida by an educational institution approved. This term includes programs on a probationary status. 
Board Refers to the Board of Nursing
Clinical PreceptorA licensed practical nurse or a registered nurse who is an employee at a training facility that serves as a role model and a clinical resource during a specified period to students enrolled currently in an approved program.
Clinical SimulationA replication of clinical practice using a strategy that teaches theory, pharmacology, skills, technology, and assessment as close to a real setting with a clinical preceptor as possible. 
Clinical TrainingDirect experience with patients receiving nursing care or in a simulation setting of clinical experiences where the student gains the chance to apply, integrate, and refine skills and abilities specific to scientific principles and theory-based concepts. 
Community-Based Clinical ExperienceExperience that focuses on activities the coincides with curriculum that involves the care of people, families, or groups, as a primary intention of promoting wellness, illness prevention, and health maintenance.
CurriculumPlanned courses and learning experiences prepared in a sequential manner that is the core of the nursing education program.
DepartmentDepartment of Health
Graduate Passage RateReflects the percentage of graduates from a program who take the National Council of State Boards of Nursing Licensure Examination for the first time during a calendar year. The contract testing service of the National Council of State Boards of Nursing compiles the data. 
Licensed Practical NurseAny individual licensed in the state of Florida or holding an active multistate license to practice practical nursing.
Nursing DiagnosisRecognition of deviations based on observations and evaluations of mental or physical conditions, signs and symptoms of illness, behaviors, and reactions to treatment to determine they if are normal or abnormal findings.
Nursing TreatmentEstablishing and implementing nursing regimens of care and comfort for prevention of illness, and the restoration, education, and health maintenance of individuals.
The Practice of Practical NursingReflects acts carried out in the care of the injured or those having an illness including medication administration and treatments to promote wellness and maintain health. The practical nurse works under the direct supervision of a registered nurse or licensed independent provider such as a physician, dentist, and podiatrist. A practical nurse is accountable for decisions made based on the individual’s education and experience in nursing. 
The Practice of Professional NursingRequires substantial specialized knowledge, skills, and judgment to perform acts of care for the injured or ill with a basis in the application of principles related to biological, psychological, physical, and social sciences. A professional nurse administers treatment and medications as prescribed or by a licensed practitioner who is authorized by state laws to prescribe the drugs and treatments. Professional nurses offer supervision and education of other personnel in such acts as medication administration and procedures.
Probationary StatusReflects the state of an approved program placed on this status.
Registered NurseReflects an individual licensed in the state of Florida or holding an active multistate license to practice professional nursing.
Required Passage RateReflects the graduate passage rate mandated for an approved program.  

Nurse Practice Act Section 464.003 Legal Definitions

Accredited ProgramA prelicensure education program of practical or professional nurses that is conducted in the United States at an institute of education and is accredited by a specialized nursing accrediting agency with national recognition by the United States Secretary of Education to approve nursing education programs.
Advanced or Specialized Nursing PracticeNurses who perform advanced-level nursing acts in addition to professional nursing practice, and are approved by the board after specialized training, education, and experience. The advanced practice registered nurse may perform specific actions, such as nursing diagnosis and treatment, medical diagnosis and treatment, prescription, and operate according to authorization within the guidelines of an established protocol of supervision. By rule, a copy of the protocol may be required to be filed with the department and meet requirements.
Advanced Practice Registered NurseAny individual licensed in the state of Florida to practice as a professional nurse and who holds a license in advanced nursing practice, such as certified nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, psychiatric nurses, and clinical nurse specialists. 
Approved Program A prelicensure educational program for practical or professional nurses conducted in the state of Florida by an educational institution approved. This term includes programs on a probationary status. 
Board Refers to the Board of Nursing
Clinical PreceptorA licensed practical nurse or a registered nurse who is an employee at a training facility that serves as a role model and a clinical resource during a specified period to students enrolled currently in an approved program.
Clinical SimulationA replication of clinical practice using a strategy that teaches theory, pharmacology, skills, technology, and assessment as close to a real setting with a clinical preceptor as possible. 
Clinical TrainingDirect experience with patients receiving nursing care or in a simulation setting of clinical experiences where the student gains the chance to apply, integrate, and refine skills and abilities specific to scientific principles and theory-based concepts. 
Community-Based Clinical ExperienceExperience that focuses on activities the coincides with curriculum that involves the care of people, families, or groups, as a primary intention of promoting wellness, illness prevention, and health maintenance.
CurriculumPlanned courses and learning experiences prepared in a sequential manner that is the core of the nursing education program.
DepartmentDepartment of Health
Graduate passage rateReflects the percentage of graduates from a program who take the National Council of State Boards of Nursing Licensure Examination for the first time during a calendar year. The contract testing service of the National Council of State Boards of Nursing compiles the data. 
Licensed practical nurseAny individual licensed in the state of Florida or holding an active multistate license to practice practical nursing.
Nursing DiagnosisRecognition of deviations based on observations and evaluations of mental or physical conditions, signs and symptoms of illness, behaviors, and reactions to treatment to determine they if are normal or abnormal findings.
Nursing TreatmentEstablishing and implementing nursing regimens of care and comfort for prevention of illness, and the restoration, education, and health maintenance of individuals.
The Practice of Practical NursingReflects acts carried out in the care of the injured or those having an illness including medication administration and treatments to promote wellness and maintain health. The practical nurse works under the direct supervision of a registered nurse or licensed independent provider such as a physician, dentist, and podiatrist. A practical nurse is accountable for decisions made based on the individual’s education and experience in nursing. 
The Practice of Professional NursingRequires substantial specialized knowledge, skills, and judgment to perform acts of care for the injured or ill with a basis in the application of principles related to biological, psychological, physical, and social sciences. A professional nurse administers treatment and medications as prescribed or by a licensed practitioner who is authorized by state laws to prescribe the drugs and treatments. Professional nurses offer supervision and education of other personnel in such acts as medication administration and procedures.
Probationary StatusReflects the state of an approved program placed on this status.
Registered NurseReflects an individual licensed in the state of Florida or holding an active multistate license to practice professional nursing.
Required Passage RateReflects the graduate passage rate mandated for an approved program.  

Nurse Practice Act Section 464.004: Board of Nursing Information

The Board of Nursing is created within the department of health and consists of 13 members that are appointed by the Governor and confirmed by the Senate. Of the 13 members of the board who are confirmed by the Senate, seven members must be registered nurses who reside in Florida and must have worked as a professional nurse for at least 4 years. Of the seven registered nurses who are board members confirmed by the Senate, there must be at least one advanced practice registered nurse, one nurse educator member of an approved program, and one nurse executive. These seven board members should be representative of the diverse areas of practice within the nursing profession. In addition to the seven registered nurses who are board members confirmed by the Senate, there must be three members who are licensed practical nurses. The licensed practical nurses must also reside in Florida and have 4 years of experience working as a practical nurse prior to their appointment. The remaining three members must be residents of Florida who have never been licensed as nurses and who are in no way connected with the practice of nursing. No person may be appointed as a lay member who is in any way connected with or has any financial interest in any health care facility, agency, or insurer. At least one member of the board must be 60 years of age or older. The term for each appointment is four years, and each member must serve until their successor is appointed. The Governor of Florida is responsible for appointing successors when the terms of the current members expire. All provisions of chapter 456 relating to activities of the board will apply. The executive director of the board appointed, or their designees may serve as the state administrator of the Nurse Licensure Compact. Rulemaking authority gives the board the authority to enact rules and implement them. Official Board headquarters will be maintained in Tallahassee.

Nurse Practice Act Section 464.004 Legal Definitions

The Board of Nursing is created within the department of health and consists of 13 members that are appointed by the Governor and confirmed by the Senate. Of the 13 members of the board who are confirmed by the Senate, seven members must be registered nurses who reside in Florida and must have worked as a professional nurse for at least 4 years. Of the seven registered nurses who are board members confirmed by the Senate, there must be at least one advanced practice registered nurse, one nurse educator member of an approved program, and one nurse executive. These seven board members should be representative of the diverse areas of practice within the nursing profession. In addition to the seven registered nurses who are board members confirmed by the Senate, there must be three members who are licensed practical nurses. The licensed practical nurses must also reside in Florida and have 4 years of experience working as a practical nurse prior to their appointment. The remaining three members must be residents of Florida who have never been licensed as nurses and who are in no way connected with the practice of nursing. No person may be appointed as a lay member who is in any way connected with or has any financial interest in any health care facility, agency, or insurer. At least one member of the board must be 60 years of age or older. The term for each appointment is four years, and each member must serve until their successor is appointed. The Governor of Florida is responsible for appointing successors when the terms of the current members expire. All provisions of chapter 456 relating to activities of the board will apply. The executive director of the board appointed, or their designees may serve as the state administrator of the Nurse Licensure Compact. Rulemaking authority gives the board the authority to enact rules and implement them. Official Board headquarters will be maintained in Tallahassee.

Nurse Practice Act Section 464.008: Licensure by Examination Information

Any person who desires to become licensed as a registered nurse or licensed practical nurse must apply to the Department of Health take the licensure examination. The department will examine any applicant who:

  • Has as completed the application and submitted a fee established by the Board of Nursing and has remitted an examination fee set by the Board of Nursing plus the actual per applicant cost to the Department of Health for the purchase of the examination from the National Council of State Boards of Nursing or a similar national organization.
  • Has provided sufficient information on or after October 1, 1989, which includes information that must be submitted by the Department of Health for a statewide criminal record check through the Department of Law Enforcement.
  • Is in good mental and physical health, has earned a high school diploma or the equivalent, and has completed the requirements for:
    • Graduation from an approved program
    • Graduation from a prelicensure nursing education program that the board determines is equivalent to an approved program
    • Graduation on or after July 1, 2009, from an accredited program
    • Graduation before July 1, 2009, from a prelicensure nursing education program whose graduates at that time were eligible for examination.

Courses successfully completed in a professional nursing education program that are at least equivalent to a practical nursing education program may be used to satisfy the education requirements for licensure as a licensed practical nurse.

The applicant must also be able to communicate in English, which may be determined by an examination given by the Department of Health. Each applicant who provides proof of meeting the educational requirements, unless denied, passes the examination will be entitled to licensure as a registered professional nurse or a licensed practical nurse, whichever is applicable. Once licensure is obtained, any provider who resides in Florida and meets the criteria for multistate licensure may request the issuance of a multistate license from the department of health. A nurse who holds a single-state license in Florida and applies to the department for a multistate license must meet the eligibility criteria for a multistate license and must pay an application and licensure fee to change the licensure status. Regardless of the licensure obtained, the department of health will distinguish a multistate license from a single-state license.

Any applicant who fails the examination for licensure three consecutive times, regardless of the jurisdiction in which the examination is taken, will be required to complete a board-approved remedial course before the applicant can be approved for reexamination. After taking the remedial course, the applicant may be approved to retake the licensure examination up to three additional times before the applicant is required to retake the remediation course. The applicant must apply for reexamination within 6 months after completing the remediation course. The board will by rule, establish guidelines for remedial courses.

If an applicant who graduates from an approved program does not take the licensure examination within 6 months after graduation, he or she must enroll in and successfully complete a board-approved licensure examination preparatory course. The applicant is responsible for all costs associated with the course and may not use state or federal financial aid for such costs. The board will by rule, establish guidelines for licensure examination preparatory courses.

A person holding an active multistate license in another state is exempt from the licensure requirements of this section.

Nurse Practice Act Section 464.009: Licensure by Endorsement Information

The Department of Health issues a license by endorsement to practice professional or practical nursing to those who meet the requirements set forth by the Board of Nursing.  For the license to be endorsed the nurse must complete the application process and provide a fee set by the Board of Nursing. They also must hold a valid license to practice practical or professional nursing in another state or territory of the United States that has equivalent or more stringent requirements than those of the State of Florida. Also, the applicant must meet the requirements set forth through completion and passage of a regional, state, or national examination of equal value or more stringent exam that is administered by the Department of Health, or has practiced nursing actively in another state, US territory or jurisdiction for 2 of the past 3 years. The licensee must also be in good standing and complete a Florida laws and rules course that is approved by the board within 6 months of initial licensure. Additionally, they must have a national criminal history check submitted to the Board of Nursing for the board to determine that there is no history of  criminal activity. Any applicant for licensure by endorsement who is relocating due to official military orders of a spouse who holds an active license in another state and is a member of the Nurse Licensure Compact is deemed to have satisfied requirements set forth by the board Follow State Board specific requirements for fingerprinting process and criminal histories.

Any applicant who is under investigation in another state, US territory or jurisdiction cannot be issued a license by endorsement if the act is in violation of chapter 456; Health Professions and Occupations: General Provisions.

Nurse Practice Act Section 464.0095: Nurse Licensure Compact Information

The Nurse Licensure Compact is hereby enacted into law and entered by the state of Florida with all other jurisdictions legally joining as follows:

Article I Findings and Declaration of Purpose

The party states find that:

  • The health and safety of the public are affected by the degree of compliance and  effectiveness of enforcement activities related to state nurse licensure laws.
  • Violations of nurse licensure and other laws regulating the practice of nursing may result in injury or harm to the public.
  • The expanded mobility of nurses and the use of advanced communication technologies as part of the nation’s health care delivery system require greater coordination and cooperation among states in the areas of nurse licensure and regulation.
  • New practice modalities and technology make compliance with individual state nurse licensure laws difficult and complex.
  • The current system of duplicative licensure for nurses practicing in multiple states is cumbersome and redundant for both nurses and states.
  • Uniformity of nurse licensure requirements throughout the states promotes public safety and public health benefits.

The general purposes of this compact are to:

  • Facilitate the states’ responsibility to protect the public’s health and safety.
  • Ensure and encourage the cooperation of party states in the areas of nurse licensure and regulation.
  • Facilitate the exchange of information among party states in the areas of nurse regulation, investigation, and adverse actions.
  • Promote compliance with the laws governing the practice of nursing in each jurisdiction.
  • Invest all party states with the authority to hold a nurse accountable for meeting all state practice laws in the state in which the patient is located at the time care is rendered through the mutual recognition of party state licenses.
  • Decrease redundancies in the consideration and issuance of nurse licenses.
  • Provide opportunities for interstate practice by nurses who meet uniform licensure requirements.

Article II Definitions

Adverse actionAdministratively, equitably, civilly, or criminally imposed actions by a licensing board or other authority against a nurse. This includes actions against the individual or multistate license; such as monitoring of the person licensed, limited the practice of the licensee, probation, suspension, revocation, cease and desist orders, or any other action on a license affecting the authorization to practice. 
Alternative programNondisciplinary monitoring program that must have approval from the licensing board.
CommissionInterstate Commission of Nurse Licensure Compact Administrators established because of the compact.
CompactNurse Licensure Compact that is entered, established, recognized, and by the state under the compact.
Coordinated Licensure Information SystemCollection, sharing, and storing of data by an integrated process. It is a non-profit organization under control and composed of the licensing board which assists in enforcement activities related to nursing licensure laws.
Current Significant Investigative InformationInvestigative information that prompts a licensure board to perform a preliminary inquiry, allows the nurse time to respond as required by individual state law, has grounds to believe, and if proven, represents more than a minor infraction. Investigative information can be indicative that a nurse represents an immediate threat to the public’s safety and overall health regardless of the notification of the nurse or opportunity to respond to the claim.  
EncumbranceSuspension, limitation, or revocation of the ability to practice nursing at full capacity and without restrictions imposed by a board of licensure.
Home State The party-state that is the nurse’s primary resident state.
Multistate LicenseLicense to practice as a registered nurse (RN) or a licensed practical/vocational nurse (LPN/LVN) issued by the home state licensure board. This license authorizes the nurse to practice in all party states under a multistate licensure privilege.
Multistate Licensure PrivilegeLegal authorization permitting an RN, LPN, or LVN to practice nursing in a remote state with a multistate license.
Party StateAny state that has adopted the compact.
Remote StateA party state that is not a home state.
Single-State LicenseLicense issued by a party state which authorizes practice only in the issuing state and does not include a multistate licensure privilege.
StateState, possession, or territory of the United States or the District of Columbia.
State Practice LawsA party state’s rules, regulations, and laws that govern nursing practice and define the scope of that practice, allowing methods and grounds to impose discipline on the nurse holding the license.[  

Article III General Provisions and Jurisdiction

A multistate license to practice registered or licensed practical/vocational nursing that was issued by a home state will be recognized by each party state participating in compact. Also, each party state must have procedures in place for considering the criminal history of applicants for initial multistate licensure or licensure by endorsement. These procedures must include fingerprints submission or other biometric-based information to obtain an applicant’s criminal history information from both the Federal Bureau of Investigation and the agency responsible for retaining that state’s criminal records.

For an applicant to obtain or retain a multistate license in the home state, each party state; the state that has adopted the compact, must ensure the applicant fulfills the following criteria:

  • Meets the home state’s qualifications for licensure or renewal of licensure.
  • Has graduated or is eligible to graduate from a licensing board-approved RN or LPN/VN program.
  • Has graduated from a foreign RN or LPN/VN program that has been approved by the authorized accrediting body in country it is located and has been verified by a licensing board-approved credentials review agency. The foreign RN or LPV/LVN program must be comparable to a Florida Board approved program.
    • If the applicant is a graduate of a foreign program that was not taught in English, or if English is not the applicant’s native language, then they must successfully pass a licensing board-approved English proficiency examination that includes the components of reading, speaking, writing, and listening.
  • Has successfully passed an NCLEX-RN or NCLEX-PN Examination or a recognized predecessor.
  • Is eligible for or holds an active, unencumbered license.
  • Has applied for licensure or licensure by endorsement, which includes fingerprints or other biometric data for the purpose of obtaining criminal history information from the Federal Bureau of Investigation and the agency responsible for retaining that state’s criminal records.
  • Has not been convicted or found guilty of a felony offense under applicable state or federal criminal law.
  • Has not been convicted or found guilty of a misdemeanor offense related to the practice of nursing as determined on a case-by-case basis.
  • Is not currently enrolled in an alternative program.
  • Is subject to self-disclosure requirements regarding current participation in an alternative program.
  • Has a valid United States social security number.

All party states may, in accordance with existing state due process law, take adverse action against a nurse’s multistate licensure privilege, such as revocation, suspension, probation, or any other action that affects the nurse’s authorization to practice under a multistate licensure privilege, including cease and desist actions. If a party state takes adverse action against a nurse’s multistate license privilege, it must promptly notify the administrator of the licensure information system, who then must notify the home state of any actions taken.

A nurse practicing in a party state must follow the laws of the state where the patient is located at the time care is provided. The practice of nursing is not limited to patient care; it includes all nursing practice as defined by laws in the state where the patient is located. Working in a party state subjects a nurse to the jurisdiction of the licensing board, the courts, and the laws where the patient is located at the time care is provided. If a nurse does not reside in a party state, they can apply for a party state’s single-state license instead of a multi-state license.

A nurse whose home state is part of a multistate compact may renew the license if the new home state meets the requirements to obtain a multistate license. A nurse who fails to satisfy the multistate licensure requirements by the effective date will become ineligible to retain or renew a multistate license. This will result in revocation or deactivation of the nurse’s multistate license.

Article IV Applications for Licensure in a Party State

The licensing board in the issuing party state will determine if the person applying has ever held or currently holds a license issued by another state. This verification includes the identification of restrictions or participation in an alternative program.

A nurse may hold a multistate license in one party state (a state that has adopted the compact) at a time. If a nurse changes their primary residence from one party state to another, they must apply for licensure in the new home state. This will result in the multistate license being deactivated. To obtain a new multistate license, the nurse must provide satisfactory proof of a change in their state of residence. Also, if a nurse relocates to a state that in not a part of a multistate license compact, the multistate license will convert to a single state license that will only be valid in previous state of residence.

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 state, which includes issuing investigations, subpoenas, or cease and desist orders. Although action may be taken against a multistate license, only a home state has the authority to act against a nursing license issued by the home state. The home state licensing board or state agency will then report conclusions of any investigations to the administrator of the coordinated licensure information system, such as Nursys. If the nurse relocates to another state, the administrator will also notify the new home state of any actions. If the action taken by a home state is against a multistate license holder, the multistate licensure privilege to practice in all other party states will be deactivated until all restrictions are removed from the multistate license. This does not, however prevent a party state’s request for participation in an alternative program instead of adverse action. If an alternative program is agreed upon, the licensing board in the home state will deactivate the multistate licensure during the nurse’s participation in an alternative program.

Article VI Coordinated Licensure Information System and Exchange Information

All party states will participate in a coordinated license information system, such as Nursys, and all-party state licensing boards will be notified of any disciplinary action reported to the license information system.

Personal information that is obtained by a party state licensure board from the coordinated licensure information system will not be shared with nonparty states or disclosed to other individuals, except to the extent permissible by the laws governing the party-state contributing the data. If any data that is provided to the coordinated licensure information system is expunged by law, the data will be removed from the coordinated licensure information system.

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

The party states will establish a joint public entity known as the Interstate Commission of Nurse Licensure Compact Administrators, where each party state will have one administrator who is the executive director of the state licensure board. The functions of the administrator include voting that is related to rules and bylaws. If the position becomes vacant, it will be filled according to the party state laws where the vacancy exists.

The commission in accordance with the administrator, meets at least once a year to hold meetings that are open to the public. Closed nonpublic meetings are permitted under certain circumstances, for example in anticipated litigation, negotiation of contracts, criminal accusations, or failure of a party state to comply with compact obligations. The commission must conveniently publish rules and bylaws on the commission’s website.

 Article VIII Rulemaking

Rules or amendments may be adopted at regular or special meetings of the commission, however, a notice with information on the proposed rule must be placed on the commission’s website at least sixty days before rule is finalized with the exception of emergent circumstances.

Article IX Oversight, Dispute Resolution, and Enforcement

A state may be terminated from the compact if it fails to correct a default recognized by the commission. Termination of membership will be imposed only after all other means of securing compliance have been exhausted.

Article X Effective Date, Withdrawal, and Amendment

A compact will become valid and binding on the date of legislative enactment no fewer than twenty-six states. All party states in the compact who were party states in the prior Nurse Licensure Compact will be withdrawn from the previous compact once the new compact is enacted.

Article XI Construction and Severability

A party state can leave the compact if the provisions are deemed unconstitutional in any party state or of the United States.

Nurse Practice Act Section 464.012 Licensure of Advanced Practice Registered Nurses; Fees; Controlled Substance Prescribing

An advanced practice registered nurse is one who holds a current license to practice professional nursing or has an active multistate license to practice professional nursing. An advanced practice registered nurse also must have graduated from a specialty program with a master’s degree and earned a certification by a specialty board. The Board of Nursing provides the appropriate requirements for advanced practice registered nurses by rule of law for the advanced nursing practices. Advanced practice registered nurses include certified nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, psychiatric nurses, and clinical nurse specialists. 

The advanced practice registered nurse (APRN):

  • Must work with at least one physician within a physician group practice.
  • May prescribe, dispense, administer, or order any medication, including controlled substances within an established framework upon graduation and certification in a specialty area that has specialized skills
  • May order diagnostic tests, order occupational and physical therapy, manage selected medical problems, coordinate health care as appropriate and evaluate the patient for the effectiveness of the care provided.
  • May initiate, manage, or alter treatment for uncomplicated acute illnesses and stable chronic diseases.
  • Will be aware of the controlled substances bill that designates s. 464.012, F.S., as the “Barbara Lumpkin Prescribing Act.” There are several specialties within advanced practice nursing, including:
    • The certified registered nurse anesthetist (CRNA) may:
      • Perform functions to the extent authorized by established protocols approved by the medical staff at the institution in which the anesthetic service performed.
      • Determine the health status of a patient and any risk factors they pose.
      • Order pre-anesthetic medications, and support life functions during anesthesia.
      • Place central venous and peripheral catheters, and arterial lines if covered under the protocol.
      • Order and administer spinal, regional, and general anesthesia.
      • Recognizes and treat cardiac arrhythmias while under anesthesia.
      •  Assist in the management of care of the patient while in the postanesthesia recovery unit. 
    • The certified nurse-midwife (CNM):
      • Works under authorized protocols approved by the medical staff at the healthcare institution in which the services are performed or approved by the physician backup coverage when home delivery performed.
      • May perform superficial minor surgical procedures, order appropriate medications, perform postpartum exams, and provide family-planning services.
      • Manages the patient during labor and delivery and oversees the medical care of the normal obstetrical patient and initial newborn care. 
  • The clinical nurse specialist (CNS) :
    • Works under established protocols.
    • May diagnose human responses to actual or potential health problems, and plan for disease prevention.
    • Based on the area of expertise, the CNS may plan for health promotion and therapeutic intervention while collaborating with the patient, such as counseling, direct nursing care, teaching, and collaborating with other licensed health care providers. 
    • A psychiatric nurse:
      • May prescribe psychotropic controlled substances for the treatment of mental disorders.

The Board of Nursing establishes a committee to recommend a controlled substance formulary that an APRN may or may not prescribe for specific uses or in limited amounts. The committee must consist of three licensed APRNs with board recommendations, three physicians who have experience with APRNs and be recommended by the Board of Medicine, and a pharmacist who is a Doctor of Pharmacy and is approved by the Board of Pharmacy.

Nurse Practice Act Section 464.013: Renewal of License or Certificate

The Department of Health will renew a license or certificate after it receives an application and the appropriate fees, and after 30 hours of continuing education, which includes a 2-hour continuing education course on human trafficking. The continuing education must be completed biennially  and ARNPs must complete at least three hours of continuing education on the safe and effective prescription of controlled substances by a board-approved entity prior to license renewal.

Nurse Practice Act Section 464.014: Inactive Status

The Department of Health may not reactivate a license unless the delinquent or inactive unless all fees are paid any applicable biennial continuing education requirements are completed.

Nurse Practice Act Section 464.015: Titles and Abbreviations; Restrictions; Penalty

Only a person who holds a license in the state of Florida or a multistate license to practice professional nursing or who performs nursing services may use the title “Registered Nurse” and the abbreviation RN and only a person who is a licensed practical nurse or who performs practical nursing services may use the title “Licensed Practical Nurse” and the abbreviation LPN Likewise, only those who are graduates of prelicensure nursing education programs may use the term “Graduate Nurse” and the abbreviation GN pending the results of the first licensure examination for which they are eligible, and only those who are graduates of prelicensure nursing education programs may use the term “Graduate Practical Nurse” and the abbreviation GPN pending the results of the first licensure examination for which they are eligible. Registered nurses who hold certificates in the following areas may use the following titles:

  • Clinical Nurse Specialist and the abbreviation CNS
  • Certified Registered Nurse Anesthetist and the abbreviations CRNA or nurse anesthetist.
  • Certified Nurse Midwife and the abbreviations CNM or nurse-midwife.
  • Advanced Registered Nurse Practitioner and the abbreviation ARNP

One cannot practice, advertise, or assume the title of registered nurse, licensed practical nurse, clinical nurse specialist, certified registered nurse anesthetist, certified nurse-midwife, or advanced registered nurse practitioner, or use the abbreviation RN, LPN, CNS, CRNA CNM or ARNP or take any other action that would lead the public to believe they are authorized by law to practice or perform nursing services unless that person is licensed, certified, or authorized to practice as such. One who is found to be in violation will result in  a misdemeanor of the first degree, punishable by law.

Nurse Practice Act Section 464.016: Violations and Penalties

Each of the following acts constitutes a felony of the third degree, punishable by law:

  •  Practicing advanced or specialized, professional, or practical nursing without a license.
  • Using or attempting to use a suspended or revoked license or certificate
  • Obtaining or attempting to obtain a license or certificate with false information.
Nursing Reflected in the Nurse Practice Act Section 464.017: Sexual Misconduct

Mutual trust is the basis for the nurse-patient relationship. Sexual misconduct in the practice of nursing means violation of the nurse-patient relationship through which the nurse uses the relationship to induce the patient to engage in sexual activity outside the scope of generally accepted examination or treatment of the patient. Sexual misconduct in the practice of nursing is prohibited.

Nurse Practice Act Section 464.018: Disciplinary Actions

The following acts constitute grounds for denial of a license or disciplinary action.

  • Procuring or renewing a license to practice professional or practical nursing through bribery, making false statements, or through an error of the department or the board.
  • Having a license to practice nursing revoked, suspended, or otherwise acted against, including the denial of licensure, by the licensing authority of another state, territory, or country.
  • Being convicted, found guilty, or entering a plea of guilty or nolo contendere, regardless of adjudication, including a crime in any jurisdiction which relates to the practice of nursing or to the ability to practice nursing, including:
    • A forcible felony.
    • Abuse, neglect, and exploitation.
    • Assault, battery, and culpable negligence.
    • Child abuse.
    • Domestic violence.
    • Fraudulent practices.
    • Lewdness and indecent exposure.
    • Theft, robbery, and related crimes.
  • This list not exhaustive, and additional information related to denial of a license and disciplinary action found on the Florida Legislature website.

Nurse Practice Act Section 464.019: Approval of Nursing Education Programs

The Board of Nursing will publish on its internet website a list of accredited programs in the State of Florida and the graduate passage rates of each program for the most recent two calendar years.

  • Any nursing program placed on probation must notify applicants and current students the probationary status in writing. The notice must explain the implications of the program’s probationary status on the students and applicants.
Nurse Practice Act Section 464.0195: Florida Center for Nursing; Goals

The Florida Center for Nursing was established to develop a strategic plan for the Florida nursing workforce, and address issues in retention, recruitment, and utilization of nurses.

Nurse Practice Act Section 464.0196: Florida Center for Nursing; Board of Directors

The Florida Center for Nursing is governed by a policy-setting board of 16 members of diverse practice locations. The members are as follows:

  • Four members recommended by the President of the Senate including:
    • One registered nurse recommended by the Florida Organization of Nurse Executives.
    • One a representative of the hospital industry recommended by the Florida Hospital Association
  • Four members recommended by the Speaker of the House of Representatives including:
    • One registered nurse recommended by the Florida Nurses Association
    • One representative from the long-term care industry
  • Four members recommended by the Governor including:
    • Two registered nurses
    • One nurse educator recommended by the Board of Governors who is a dean of a College of Nursing at a state university.
Nurse Practice Act Section 464.0205: Retired Volunteer Nurse Certificate

Any retired registered or practical nurse desiring to serve indigent, underserved, or critical need populations must meet the requirements set forth by the governing body and apply to the Department of Health for a retired volunteer nurse certificate.  Once certification is granted, retired volunteer nurse may work under direct supervision of the county health department director, a physician, an advanced practice registered nurse or a registered nurse.

Nurse Practice Act Section 464.022: Exceptions

No provision of this part should be understood to prevent:

  • Assistance by anyone in the case of an emergency
  • The practice of nursing by anyone enrolled in remedial courses approved by the board.
  • Any nurse practicing in accordance with the practices and principles of the body known as the Church of Christ Scientist, sanitarium, nursing home, or rest home operated in accordance with the practices and principles of the body known as the Church of Christ Scientist.
  • The practice of any legally qualified nurse or licensed attendant of another state who is employed by the United States Government, or any bureau, division, or agency.
  • The establishment of an independent practice by one or more nurses to render nursing services to patients within the scope of the nursing license.
  • This list not exhaustive and found in its entirety on the website for the Florida Legislature.
Nurse Practice Act Section 464.027: Registered Nurse First Assistant

This policy encourages the use of registered nurse first assistants who meet the qualifications as surgery assistants by physicians and hospitals to provide quality, cost-effective surgical interventions those in need of health care in the State of Florida. This title includes perioperative nursing; a practice of nursing where the nurse provides preoperative, intraoperative, and postoperative care to surgical patients. Each health care facility must establish specific procedures for the appointment and reappointment of a registered nurse first assistant staff member and for granting, revising, and renewing their clinical privileges.

Qualifications set forth by the board to become a registered nurse first assistant include:

  • A registered nurse licenses
  • Certification in perioperative nursing
  • Successful completion of a registered nurse first assistant board-approved program
Part II of the Nurse Practice Act: Certified Nursing Assistants

Nurse Practice Act Section 464.201: Definitions

Approved Training ProgramsA training course conducted by a public or private sector educational center licensed by the Department of Education to implement the basic curriculum for nursing assistants.
Certified Nursing AssistantA person who meets the qualifications specified by the Board of Nursing and who has been certified by the board as a certified nursing assistant.
The Practice of a Certified Nursing AssistantProviding care and assistance with tasks relating to the activities of daily living, such as personal care, nutrition, hydration, mobility, toileting, elimination, assistive devices, safety, cleanliness, and postmortem care. Certified Nursing Assistants gather data, report any abnormal signs and symptoms, provide end of life care, cardiopulmonary resuscitation, and emergency care, and provide for socialization and reality orientation. A registered nurse must validate competency related to the performance of skills.  
Nurse Practice Act Section 464.202: Duties and Powers of the Board

The Board of Nursing maintains a state registry of certified nursing assistants that is accessible to the public, the certificate holder, employers, and additional state agencies. The board of nursing adopts rules for testing procedures to certify nursing assistants and rules that regulate the practice of certified nursing assistants, provides a scope of practice, and sets the level of supervision requirements.

Nurse Practice Act Section 464.203: Certified Nursing Assistants; Certification Requirement

The Board of Nursing will issue a certificate to practice as a certified nursing assistant to any person who demonstrates a minimum competency to read and write and successfully passes the required background screening. When one successfully passes the background screening within 90 days of applying for a certificate to practice and the background screening results are not retained in the clearinghouse, the board of nursing will waive the requirement that the applicant successfully passes an additional background screening. Certification as a nursing assistant may be renewed as long the nursing assistant does not allow twenty-four consecutive months to pass where they fail to work as a nursing assistant. When a nursing assistant fails to deliver any nursing-related services for financial compensation for twenty-four consecutive months, the nursing assistant must complete a new training and competency evaluation program.

If an applicant fails to pass the nursing assistant competency examination after three attempts, the applicant will not be eligible for reexamination unless the they complete an approved training program.

Nurse Practice Act Section 464.204: Denial, Suspension, or Revocation of Certification; Disciplinary Actions

The following acts constitute grounds for which the board of nursing may impose disciplinary sanctions:

  • Obtaining or attempting to get a certification, trying to possess certification or a letter of exemption through bribery, misrepresentation, deceit, or through an error of the board.
  • Intentionally violating any provision or rules adopted by the Board of Nursing.

When the Board of Nursing finds an individual guilty of any of the grounds may enter an order imposing one or more of the following penalties:

  • Denial, suspension, or revocation of certification.
  • Imposition of an administrative fine.
  • Imposition of probation or restriction of certification.

Upon request of a certificate holder,  the board of nursing  may exempt the certificate holder from disqualification of employment and issue a letter of exemption. The board must notify an applicant its decision to approve or deny the request within thirty days after the date the board receives all required documentation.

Nurse Practice Act Section 464.205: Availability of Disciplinary Records and Proceedings

Any complaint or discipline record of a certified nursing assistant that is maintained by the department will remain open and available to the public.

Nurse Practice Act Section 464.206: Exemption from Liability

An employer will not be civilly liable if it terminates employment of a certified nursing assistant whose certification is inactive or whose name appears on a criminal screening report of the Department of Law Enforcement. No action may not be taken against the employer for damages, regardless of whether the certified nursing assistant has filed for an exemption from the board of nursing. There also be will not be any monetary liability for damages against any licensed facility, its governing board or members, medical staff, disciplinary board, agents, investigators, witnesses, employees, or any other person.

Nurse Practice Act Section 464.207: Penalties

It is a misdemeanor of the first degree punishable by law, if an individual knowingly fails to disclose through false statements, misrepresentation, impersonation, or any other fraudulent means, an application for employment or certification.

Nurse Practice Act Section 464.208: Background Screening Information; Rule making Authority

An employer  may not use criminal or juvenile records relating to vulnerable adults for any purpose other than determining if the person meets the requirements of employment. Such documents and information obtained by the board shall remain confidential and exempt.

If the requirements of the Omnibus Budget Reconciliation Act of 1987, as amended, for the certification of nursing assistants are in conflict, the federal requirements will prevail for facilities certified to provide care under Title XVIII (Medicare) or Title XIX (Medicaid) of the Social Security Act.

Florida Statute Chapter 456

Another Florida Statute, Chapter 456, discusses general provisions of health professions and occupations and is an issue of concern. A healthcare professional must be aware of the laws outlined in this chapter of legislation. The Florida Legislature covers these laws and some of these Florida Statutes underscored in Chapter 456 will be discussed below.

456.001 Definitions

BoardAny commission or board, or other statutorily created entity that is authorized to exercise regulatory or rulemaking functions, within the department that is authorized to exercise regulatory or rulemaking functions, within the Division of Medical Quality Assurance.
Healthcare practitionerAny person licensed to provide health services
ProfessionAny activity, occupation, profession, or vocation regulated by the department in the Division of Medical Quality Assurance.

Nurse Practice Act Section 456.003: Legislative Intent and Requirements

The intent of the Legislature is to allow individuals desiring to engage in lawful profession regulated by the department to be able to do so. The Legislature further believes that lawful professions should be regulated to preserve the health, safety, and welfare of the public.

Nurse Practice Act Section 456.004: Department Powers and Duties

The purpose of this subsection is to promote the public policy of the state of Florida relating to child support and work cooperatively with the Department of Revenue to establish an automated method for periodically disclosing information relating to current licensees to the Department of Revenue, the state’s Title IV-D agency. When directed, the department will suspend or deny the license of any licensee found not to comply with a support order, a subpoena, an order to show cause or a written agreement with the Department of Revenue. The department will  issue or reinstate the license without additional charge to the licensee when notified by the court or the Department of Revenue that the licensee has complied with the terms of the support order. The department is not liable for any license denial or suspension resulting from the discharge of its duties under this subsection.

The Department of Health will investigate and prosecute health care practitioners who have not returned amounts owed to the state for an overpayment from the Medicaid program under a final order, judgment, or stipulation or settlement.

Nurse Practice Act Section 456.008: Accountability and Liability of Board Members

Each board member is held accountable to the Governor of Florida for the proper performance of duties as a member of the board. The Governor will investigate any legally sufficient complaint or written report that concerns the actions of the board or its members. If claims are founded, the Governor may suspend from office any board member for malfeasance, misfeasance, neglect of duty, drunkenness, incompetence, permanent inability to perform his or her official functions, or commission of a felony.

Nurse Practice Act Section 456.012 Board Rules: Final Agency Action and Challenges

The State of Florida Surgeon General has legal standing to challenge any rule of a board under its jurisdiction.

Nurse Practice Act Section 456.0135: General Background Screening Provisions

An application for initial licensure received on or after January 1, 2013 must include fingerprints through a vendor approved by the Department of Law Enforcement and fees imposed for the initial screening and retention of fingerprints. 

Nurse Practice Act Section 456.014: Public Inspection of Information Required from Applicants; Exceptions and Examination Hearing

Any applicant’s information that is required by the department must be a public record and must be open to public inspection. This excludes financial information, medical information, school transcripts, examination questions, answers, papers, grades, and grading keys, which are confidential. Any information supplied to the department by any other agency which is confidential will remain confidential under the applicable law while in the custody of the department or the agency.

Nurse Practice Act Section 456.017: Examinations

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 key kept for a period of not less than two years immediately following the examination, and record must be maintained or destroyed This subsection does not apply to national examinations approved and administered under this section.

Nurse Practice Act 456.018: Penalty for Theft or Reproduction of an Examination

The theft of an examination in whole or in part or the act of reproducing or copying any examination administered by the department, constitutes a felony of the third degree, punishable by law.

Nurse Practice Act 456.019: Restriction on Requirement of Citizenship

An individual will  not be disqualified from practicing an occupation or profession regulated by the state solely because they are not a United States citizen.

Nurse Practice Act 456.021: Qualification of Immigrants for Examination to Practice a Licensed Profession or Occupation

It is the declared purpose of this section to encourage the use of foreign-speaking Florida residents who are duly qualified to become active in their professions so that all people in the state of Florida may receive better services.

Nurse Practice Act 456.025: Fees, Receipts, and Disposition

The costs of regulating health care professions and practitioners are the responsibility of licensees and licensure applicants; however, fees should be reasonable and not serve as a barrier to licensure. If a duplicate license is required or requested by the licensee, there may be a fee associated with the duplicate license.

Nurse Practice Act 456.026: Annual Report Concerning Finances, Administrative Complaints, Disciplinary Actions, and Recommendations

The department is directed to prepare and submit a report to the President of the Senate and the Speaker of the House of Representatives by November 1 of each year. In addition to finances and any other information the Legislature may require, the report must also include statistics and relevant information on each profession.

Nurse Practice Act 456.028: Consultation with Postsecondary Education Boards Before the Adoption of Changes to Training Requirements

Any state agency or board that has jurisdiction over the regulation of 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 instituting any changes to training requirements regarding entry into a profession or occupation. This consultation must allow the educational board to make suggestions on the impact of the proposed changes, which may include the time needed to complete the training program, and the fiscal impact of the changes.

Nurse Practice Act 456.032: Hepatitis B or HIV Carriers

The department and each appropriate board within the Division of Medical Quality Assurance will have the authority to establish procedures to handle, counsel, and provide other services to healthcare professionals with hepatitis B or human immunodeficiency virus. Also, any person who is licensed by the department or employed by a healthcare facility and contracts a blood-borne infection must have a presumption that the illness was contracted in the course of employment, and report it to a supervisor or facility risk manager. The employer may test a sample of the blood or body fluid to determine it has the same disease contracted by the employee. The employer may, however, deny the claim by the preponderance of the evidence of the blood or body fluid sample not matching the same disease contracted by the employee.

Nurse Practice Act 456.0361: Compliance with Continuing Education requirements

The department will establish an electronic continuing education tracking system to monitor licensee compliance with continuing education requirements and to determine if a licensee is in full compliance with the requirements at the time of his or her application for license renewal. The tracking system will integrate into the department’s licensure and renewal process. The department may not renew a license until the licensee complies with all continuing education requirements. The department may also impose penalties for failure to comply with continuing education requirements.

Nurse Practice Act 456.0495: Reporting Adverse Incidents Occurring in Planned Out-of-Hospital Births

For purposes of this section, the term “adverse incident” means an event over which a physician or a nurse-midwife is associated with an attempted or completed planned out-of-hospital birth, and results in one or more of the following injuries or conditions:

  • A maternal death that occurs during delivery or within 42 days after delivery.
  • The transfer of a maternal patient to a hospital intensive care unit.
  • A maternal patient experiencing hemorrhagic shock or requiring a transfusion of more than four units of blood or blood products.
  • A fetal or newborn death, including a stillbirth, associated with an obstetrical delivery.
  • A transfer of a newborn to a neonatal intensive care unit due to a traumatic physical or neurological birth injury, including any degree of a brachial plexus injury.
  • A transfer of a newborn to a neonatal intensive care unit within the first 72 hours after birth if the newborn remains in such unit for more than 72 hours or any other injury as determined by department rule

Beginning July 1, 2018, a physician or a nurse-midwife who performs an attempted or completed planned out-of-hospital birth must report an adverse incident, along with a medical summary of events, to the department within 15 days after the adverse incident occurs. The department will review each incident report and determine whether the incident involves conduct by a healthcare practitioner who is subject to disciplinary action. If disciplinary action must be taken, it will be enforced by the appropriate regulatory board or by the department if no such board exists.

Nurse Practice Act 456.057: Ownership and Control of Patient Records; Reports or Copies of Records to be Furnished and Disclosure of Information

Records may not be furnished to anyone, and the medical condition of a patient may not get discussed with any person other than the patient, the patient’s legal representative, or other health care providers involved in the patient’s care or treatment, except upon written authorization from the patient. Records may be furnished without written permission under the following circumstances:

  • To any person, firm, or corporation that has procured or provided such care or treatment with the patient’s consent.
  • When a physical examination is necessary, in which case copies of the medical records furnished to both the defendant and the plaintiff.
  • In any civil or criminal action, unless otherwise prohibited by law, upon the issuance of a subpoena from a court of competent jurisdiction and proper notice to the patient or the patient’s legal representative by the party seeking such records.
  • For statistical and scientific research, provided the information is abstracted in such a way as to protect the identity of the patient or provided written permission received from the patient or the patient’s legal representative.
  • To a regional poison control center for purposes of treating a poisoning episode under evaluation, case management of poison cases, or compliance with data collection and reporting requirements and the professional organization that certifies poison control centers per federal law.
  • To the Department of Children and Families, its agent, or its contracted entity, for investigations of or services for cases of abuse, neglect, or exploitation of children or vulnerable adults.

Nurse Practice Act 456.0575: Duty to Notify Patients

Every licensed healthcare provider must inform each patient about adverse incidents that result in serious harm. Notification of outcomes of care that result in injury to the patient under this section does not constitute an acknowledgment of admission of liability.

Nurse Practice Act 456.068: Toll-free Telephone Number for Reporting of Complaints

The Agency for Health Care Administration will establish a toll-free telephone number for public reporting of complaints relating to medical services or treatment provided by healthcare professionals.

Nurse Practice Act 456.0721: Practitioners in Default on a Student Loan or Scholarship Obligations, Investigation, Reporting

The Department of Health will obtain necessary information to investigate and prosecute healthcare providers for failing to repay a student loan or comply with scholarship service obligations. To carry out this task, the department  will obtain a list of default healthcare practitioners from the United States Department of Health and Human Services each month, along with the information necessary to investigate a complaint. The department may also obtain evidence to support the investigation and prosecution from any financial institution

Nurse Practice Act 456.38: Practitioner Registry for Disasters and Emergencies

The Department of Health may include on its forms for the certification or licensure of healthcare providers an inquiry of who could assist the department in the event of a disaster by asking if the provider would be available to provide health care services in special needs shelters or to help staff disaster medical assistance teams during times of major disaster or emergency. The names of providers who answer yes will be maintained by the department as a registry for disasters and emergencies.

Florida Administrative Code Section 64B9

Florida Administrative Code Section 64B9 by the Florida Department of State provides information and laws governing essential elements of nursing licensure and professional conduct. These include:

64B9-2.021 Curriculum Guidelines

  • All nursing programs requesting the Florida Board of Nursing approval must abide by the Florida Department of Education curriculum framework.
  • At least 40% of the curriculum for bachelor’s degree nursing programs must consist of clinical training.
  • At least 50% of the curriculum for associate’s degree and diploma nursing programs must consist of clinical training.

64B9-2.022 Clinical Training

Clinical learning experiences must be in the United States, the District of Columbia, or a territory of the United States. The experiences must consist of activities that include observation, hands-on experience with patients, and interaction with an interprofessional team, and must also include experience in long-term care, acute care, and community-based care. During clinical experience, a 1:12 clinical instructor to student ratio must be maintained, except during simulation. Simulation consists of activities or events replicating clinical practice using scenarios, high-fidelity manikins, medium-fidelity manikins, standardized patients, role-playing, skills stations, and computer-based critical thinking situations. Simulation may account for 50% of clinical training when accompanied by traditional clinical experience. Indirect supervision is allowed for community-based, noninvasive clinic experiences when the clinical instructor is available by telephone, however this excludes any complicated nursing activity. Any invasive or complicated nursing activity must be approved by the community based clinical site.

64B9-3.002 Qualifications for Examination

An applicant seeking certification to take the licensure examination must submit a completed Nursing Licensure by Examination Application demonstrating that they meet the qualifications prescribed by the Nurse Practice Act, Chapter 464. Qualifications include a high school diploma or an equivalent of a high school diploma and a notice of graduation or completion of the requirements for graduation from an approved nursing program. Graduates from foreign countries must obtain a report by a credentialing agency that meets the requirements of Rule 64B9-3.014, F.A.C. and complete a board approved test of proficiency of English if English is not the native language.

64B9-3.008 Licensure by Endorsement

Anyone applying for licensure by endorsement must submit a completed Nursing Licensure by Endorsement Application, verification of licensure forms from the original state or territory in which licensure obtained, and from a territory or state in which the person applying holds an active license and pay the required fee. When applying for endorsement, an individual will be required to show current licensure in another state of the United States. Any applicant who has not been in active practice of nursing within the past five years will be required to take a remedial course before licensure is granted.

64B9-3.016 Multi-State License Upgrade

Registered and practical nurses currently licensed in Florida may upgrade their licenses to include multi-state practice by submitting a Multi-State License Upgrade Application to the board.

64B9-15.0045 Certified Nursing Assistant Renewal Fee

For renewal of Certified Nursing Assistant Certificate, the fee is $50.00.

64B9-5.002 Continuing Education Requirement

During each 2-year period one contact hour must be earned for each calendar month of the licensure. Anyone licensed by examination within a 2-year period is exempt from the continuing education requirement for that biennium. This exemption applies to anyone who is licensed by endorsement during the 2-year period if they were licensed in another state by successful licensure examination. A licensee who has endorsed into the State of Florida during a 2-year period or had a  license that was reactivated or reinstated will be required to accrue one contact hour for each month  that remains in the 2 year period after licensure, reactivation, or reinstatement. This exemption or limitation will only apply if the license is renewed at the end of the 2-year period and does not apply if the license is suspended, revoked, or is inactive.

An RN who also holds a current license as an LPN may meet the continuing education requirement for renewal of both licenses by completing appropriate continuing education for an RN license. An RN who also holds a current ARNP certificate may satisfy the continuing education requirement for both licenses by completing the proper continuing education for an RN or may satisfy up to fifty percent of the continuing education requirement by completing continuing medical education coursework equivalent to the contact hours required by these rules.

A nurse who is the spouse of a member of the Armed Forces will be exempt from continuing education requirements. The licensee must show proof in a satisfactory manner of the spouse’s military status.

The following continuing education courses are a mandatory part of the hours required in subsection (1), at the stated time periods:

  • A two-hour course in the prevention of medical errors each 2-year period
  • A one-hour course in HIV/AIDS in the first biennium only
  • A two-hour course in Florida laws and rules each 2-year period
  • A two-hour course in recognizing impairment in the workplace every other biennium after that
  • For biennial renewal on or after January 1, 2019, a two-hour course on human trafficking, and each biennium after that
  • A course in domestic violence every third biennium.

64B9-8.005 Unprofessional Conduct

Unprofessional conduct includes:

  • Accepting a gift from a patient or client the value of which exceeds the employer’s policy regarding gifts.
  • Discriminating by one’s race, creed, religion, age, sex, or national origin, in the delivery of nursing services as it relates to human rights and dignity of the individuals
  • Engaging in fraud, misrepresentation, or deceit in taking the licensing examination
  • Falsifying or altering of patient records or nursing progress records, employment applications or time records
  • Impersonating another licensed practitioner, or permitting another person to use his certificate to practice nursing
  • Inaccurate recording 
  • Knowingly obtaining or using or attempting to obtain or use a patient’s property with the intent to temporarily or permanently deprive the patient of the use, benefit or possession of the funds, assets or property, or to benefit someone other than the patient.
  • Leaving a nursing assignment without advising licensed nursing personnel
  • Misappropriating drugs, supplies or equipment
  • Practicing beyond the scope of the licensee’s license, educational preparation, or nursing experience
  • Providing incorrect or false information to the employer regarding the status of the license
  • Stealing from a patient 
  • Using abusive, threatening, or foul language in front of a patient or directing such expression toward a patient
  • Using force against a patient, striking a patient, or throwing objects at a patient
  • Violating confidentiality of information or knowledge concerning a client or patient 
  • Violating the integrity of a medication administration system or an information technology system

64B9-4.004 Requirements for Documentation

A Registered Nurse applying for initial certification as an Advanced Registered Nurse Practitioner must complete an application and the following: submit proof of satisfactory completion of an educational program, which consists of an official copy of transcripts that denotes successful completion of the program, and a verification form submitted by the director of the advanced nursing program indicating successful completion with the official school seal is a requirement.

Advanced Practice Registered Nurse licensed after July 1, 2006, and all certified registered nurse anesthetists, certified nurse midwives, and psychiatric nurses must supply documentation of national certification by a national nursing specialty or documentation of certification by a specialty by submitting a copy of the recertification or original specialty board certificate or other documentary proof which evidences certification by an appropriate specialty board.

64B9-8.003 Citations

  • “Citation” means an instrument that is served upon a licensee for the purpose of assessing a penalty in an amount established by this rule.
  • The Board designates the first instance of the following as citation violations, which will result in a penalty of $100.00: failure to report a misdemeanor in writing within 30 days after the licensee has been convicted or found guilty, or entered a plea of nolo contendere regardless of adjudication to the Board.  The second instance of the following as citation violations, will result in a penalty of $100.00; failure to report an address change, to submit updates of required information within 15 days.
  • The Board designates the first instance of the following a citation violation, which will result in a penalty of $1,500: Providing a confidential password to another person, accessing a code, keys, or other entry mechanisms, which results in a violation or threatens the integrity of a medication administration system or an information technology system. In addition to the fine, the licensee will be required to complete a 2-hour continuing education course in legal aspects of nursing within 60 days of the issuance of the citation.

64B9-15.008 Testing and Competency Evaluation

The Certified Nursing Assistant Examination must consist of the Written Exam and a Clinical Skills Test. Both the Written Exam and the Clinical Skills Test must be passed within a two-year period to achieve certification. Results on either the Written Exam or the Clinical Skills Test which are over two years old are invalid, and both the Written Exam and the Clinical Skills Test will need to be repeated. The minimum passing level for each task is Three Standard Errors of Measure below the mean for the Clinical Skills Test. The minimum passing level of the Clinical Skills Test varies depending on the difficulty of the items selected by the testing service for each form of the examination. The candidate must have a minimum passing score on each of the five tasks on an examination form to pass the Clinical Skills Test. If a person applying fails to pass the nursing assistant competency examination in three attempts, the applicant will not be eligible for reexamination unless the applicant completes an approved training program.

64B9-15.0097 Notice of Non-Compliance – Minor Violations

  • A Notice of Non-Compliance is a notification by the Department of Health issued to a licensee as a first response to a minor violation. It is not accompanied by a fine or another disciplinary penalty.

The Board designates the following as minor violations for which a Notice of Non-Compliance may be issued for the first violation:

  • Failure to notify the Department of an address change for more than sixty days.
  • False, deceptive, or misleading use of a certified nursing assistant title.

64B9-4.0025 Provisional Certification

Before certification by the appropriate professional or national nursing specialty board, applicants for certification as certified registered nurse anesthetists, psychiatric nurses, or certified nurse-midwives may apply for provisional state certification. Each applicant for provisional state certification must be a graduate of an appropriate educational program. The provisional ARNP certification is valid for twelve months and will expire if no specialty board certification submitted within twelve months of the date granting provisional ARNP certification.

64B9-15.0096 Mediation

The Board finds that mediation is 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 thirty days but less than sixty days, provided the failure does not constitute a failure to comply with a directive from the Board.

64B9-15.0095 Citation for Certified Nursing Assistants

“Citation” means an instrument that is served upon a licensee to assess a penalty. The Department of Health may issue a citation to the licensee within six months of the filing of a complaint. All citations require the licensee to correct a violation within a specified period.

Conclusion

Laws are dynamic, amended and enacted as the legislative need arises. A healthcare provider who is licensed in Florida must be versed in current practice standards and rules outlined in the Florida Nurse Practice Act; a scope of practice that is defined, and has a framework that is set for the delegation of duties and safe patient care environments. The act provides a resource for professional ethics and a guide for current legislation in healthcare settings in the state of Florida.

References
  1. Baughman, C. (2019). Achieving incremental outcomes to reach goals. The Journal of Continuing Education in Nursing, 50(5), 193-195. https://doi.org/10.3928/00220124-20190416-02
  2. Code of ethics for nurses. (n.d.). ANA. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/
  3. (n.d.). Florida Board of Nursing – Licensing, Renewals & Information. https://floridasnursing.gov/
  4. The Florida Senate. (n.d.). Calendar for 6/9/2020 – The Florida Senate. https://www.flsenate.gov/Laws/Statutes/2019/Chapter464
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