What is the Nurse Practice Act?

Keith Carlson, BSN, RN, NC-BC

Keith Carlson, BSN, RN, NC-BC

If we put a dollar in a special bank account every time a nursing student rolled their eyes when a professor or clinical instructor mentioned the Nurse Practice Act, we would likely have a scholarship fund the size of the state treasury of Rhode Island. Although talking about the Nurse Practice Act in your state may seem like an abstraction not even worth considering when all you want to do is pass the NCLEX or land your next job, it’s actually a profoundly important document that can literally alter how you practice the art and science of nursing for years to come. 

For good reason, licenses to do many things are governed by laws passed by the legislatures of the various states of this country in order to protect citizens and promote order. From fishing and driving licenses to those issued to nurses or respiratory therapists to practice their specific professions, licensing is a legislative tool that can help the rest of us to feel relatively confident in the competence of those holding such credentials. 

As the National Council of States Boards of Nursing (NCSBN) states: 

All states and territories have enacted a nurse practice act (NPA). Each state’s NPA is passed by the state’s legislature. But the NPA itself is insufficient to provide the necessary guidance

for the nursing profession. Therefore, each NPA establishes a board of nursing (BON) that has the authority to develop administrative rules or regulations to clarify or make the law more

specific. Rules and regulations must be consistent with the NPA and cannot go beyond it. These rules and regulations undergo a process of public review before enactment. Once enacted, rules and regulations have the full force and effect of law.

Although the specificity of NPAs varies among states, all NPAs include:

  • definitions
  • authority, power, and composition of a BON
  • educational program standards
  • standards and scope of nursing practice
  • types of titles and licenses
  • protection of titles
  • requirements for licensure
  • grounds for disciplinary action, other violations, and possible remedies

As you can see, the NPA is a comprehensive document when it comes to the practice of the profession of nursing.

Why a Nurse Practice Act?

The United States Constitution does not make provisions for the licensing of professionals like nurses, thus this responsibility falls to individual states. According to the National Council of State Boards of Nursing, the first move to legitimize the title of nurse in an official manner occurred in 1903 in North Carolina. 

States’ and territories’ legislative acts to regulate the profession of nursing do not simply create the laws governing what nurses can and cannot do; they also, as stated above, make provisions for the establishment of state boards of nursing to do the daily work of making sure nursing is practiced according to those laws. In addition, a nurse practice act (NPA) dictates who can legally call themselves a nurse, which in and of itself decreases potential confusion among the public, and instills trust in the fact that someone calling themselves a nurse actually is one. 

If a nurse wants to understand what their scope of practice is in terms of any aspect of working and acting in the capacity of a nurse, their state’s nurse practice act is the document that has the final say in that regard. This key document is also referenced frequently in legal cases that may question whether a registered or advanced practice nurse was acting within their scope of practice when something went awry during patient care or a complaint was lodged against them. And if a nurse also seeks to understand how standards are established for educational programs for nurses, the nurse practice act also has a hand in that aspect of the nursing profession. 

Trust, regulation, education, disciplinary action, and much more are governed by each state’s NPA for very good reason. 

Your State’s Nurse Practice Act

If you’re moving from one state to the next — or perhaps practicing across state lines because you live near the border and can legally practice in both — knowing the differences between those two state’s nurse practice acts may come into play in your various roles. 

And if you run into disciplinary action — perhaps for a serious medication error or narcotic diversion — the NPA in your state will have a direct impact on how those disciplinary actions are carried out. 

Meanwhile, the scope of supervision of assistive personnel such as LPNs and CNAs — and the responsibility borne by the licensed nurse thereby — may also come under the jurisdiction of the NPA. And even the fees you pay when applying for a license will be dictated by the NPA. 

Legislative Action and the NPA

At any time during the legislative process, a bill may be submitted by an interested party in relation to the nurse practice act of that state. For instance, a professional organization may undertake to hire lobbyists who have the charge of working to somehow “dilute” or alter the NPA so that nurses may retain a narrower scope of practice. 

For example, perhaps nurses can perform bedside ultrasounds in a certain state but that state’s licensed ultrasound technicians and radiologists feel that this is an overstep on the part of the NPA; they can lobby to have the NPA changed during the state’s legislative session so that nurses lose the legal authority to perform such a service. Such situations have occurred, and unless nurses are attuned to the importance of their NPA, they can stand to lose ground in terms of their scope practice. 

In another situation, professional medical organizations representing physicians may feel threatened by the growing scope of practice — and market share — enjoyed by nurse practitioners and advanced practice registered nurses in that state. In such an instance, a multi-year lobbying battle may ensue in which the physician group (or multiple groups) undertake a campaign to decrease APRNs’ ability to practice with partial or complete autonomy. There is clear evidence that such battles have already taken place as APRNs gain ground nationwide. 

Since the NPA is a legislative document that represents binding legal agreements, it also figures that the NPA can also easily become a legal battleground over which politically astute nurses and nursing organizations will fight in order to retain nurses’ collective gains throughout the decades. 

The NPA is Ours          

In the end, the NPA belongs to the nurses of each state, and the onus is on nurses, individually and collectively, to take ownership of this crucial document and assiduously work to refine, expand, and improve it over time. 

Nurses’ right to practice with a sense of professional agency and relative autonomy can consistently be on the line in certain states, and understanding the NPA, what it means to one’s career, and what it means to the profession as a whole is a profound and meaningful aspect of being a nurse in the 21st century. 

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