1. Identify the current content of the Florida Statutes Chapter 464: Nurse Practice Act.
2. Describe the current content of the Florida Statutes Chapter 456: The Health Professions.
3. Discuss the current rules in Chapter 64B9 of the Florida Administrative Code.
Nurses work in a variety of healthcare environments. Each nurse needs to be knowledgeable about his or her state’s Nurse Practice Act and the current laws and rules that govern the practice of nursing. The Florida Board of Nursing specifies the continuing education requirements that must be met to satisfy nursing license renewal requirements. Nursing licenses in Florida are renewed biennially (every two years). This course, mandated by 64B9-5.013 of the Florida Administrative Code, will discuss the current laws and rules that govern the practice of nursing in Florida. Specifically, Chapters 464 and 456 of the Florida Statues, as well as the rules in Division 64B9 of the Florida Administrative Code. Included at the end of this course are a list of web-based resources and references for learners who want to explore additional information on the laws and rules that pertain to the practice of nursing. This course is appropriate for Registered Nurses, Licensed Practical Nurses, Clinical Nurse Specialists and Advanced Registered Nurse Practitioners.
The purpose of the nurse practice act is to ensure that every nurse practicing in the state of Florida meets the minimum competencies for safe practice to protect the public (464.002).
There are several definitions in 464.003 that nurses need to be familiar with to differentiate levels of nursing practice in Florida:
Advanced Registered Nurse Practitioner: any person licensed in this state to practice professional nursing and certified in advanced or specialized nursing practice, including certified registered nurse anesthetists, certified nurse midwives, and nurse practitioners.
Clinical Nurse Specialist: any person licensed in this state to practice professional nursing and certified in clinical nurse specialist practice.
Licensed Practical Nurse: any person licensed in this state to practice practical nursing.
Registered Nurse: any person licensed in this state to practice professional nursing.
It is important to differentiate the practice of professional nursing from the practice of professional nursing as defined in 464.003. Please see the table below which compares and contrasts each level of nursing practice:
The NLC allows nurses who hold a valid multistate license to practice across state lines in other enhanced Nurse Licensure Compact States. This enables nurses holding a valid multistate license to practice across state lines via telehealth. Nurse educators possessing a valid multistate license are able to teach via distance education in all extended Nursing License Compact states. The multistate license is advantageous for nurses who are responding to disasters. Nurses who are military spouses benefit from possessing an active multistate license as their spouse moves to different duty stations and states.
The department shall renew a license upon receipt of the renewal application and fee. Nursing licenses are renewed biennially (every two years).
According to Florida Statute 464.013 as part of the renewal requirements, the board shall by rule prescribe up to 30 hours of continuing education for each biennium. A nurse who is certified by a health care specialty program accredited by the National Commission for Certifying Agencies or the Accreditation Board for Specialty Nursing Certification is exempt from continuing education (CE) requirements. Not included in the exemption from CE requirements, each person licensed or certified will be required to complete a two-hour CE course on human trafficking for every biennial license renewal on or after January 1, 2019 (464.013).
The Florida Center for Nursing, established by Florida Statute 464.0195, focuses on nursing workforce issues, including supply and demand, recruitment and retention. The goals of the Florida Center for Nursing include:
· Developing a statewide strategic plan for nursing manpower in Florida
· Convening stakeholders, including nurses, other health care providers, business, industry, consumers and legislators to
o Review and comment on FCN data analysis
o Recommend systemic changes
o Promote excellence in nursing such as magnet recognition
The practice of a certified nursing assistant includes: assisting with activities of daily living, personal care, assisting with mobility, toileting and elimination, data gathering (vital signs, intake and output), reporting abnormal signs and symptoms, cardiopulmonary resuscitation, post mortem care and documenting the care provided by the nursing assistant (464.201).
The Florida Board of Nursing regulates the practice of certified nursing assistants. Certification requirements include: demonstrating competency by achieving a minimum score on both the written and skills portion of the nursing assistant competency exam and passing of a background screening within ninety days of applying. A nursing assistant who is currently certified in another state and has not been found to have committed abuse, neglect or exploitation in that state is eligible to apply for certification in Florida (464.203).
To be eligible for renewal, a certified nursing assistant must complete the renewal application, pay the renewal fee and complete twenty-four hours of in-service education and maintain documentation to prove compliance.
Each licensee must maintain a current address on file with the Board of Nursing and is required to notify the Board in writing within sixty days of any change of address. The change of address can be done via logging on to the Florida Department of Health Division of Medical Quality Assurance web portal.
In addition to maintaining a current address on file with the Board of Nursing, each licensee must maintain a current place of practice on file with the Board. A place of practice is defined as one of the following: acute care facility, long-term care facility, rehabilitation facility, clinic, physician’s office, home health care agency, educational institution, office of independent nursing practice, correctional facility, mental health facility, occupational health facility, managed healthcare organization or insurance company, community health facility, or other (64B9-1.013).
Continuing education requirements for nurses licensed in Florida are specified in Chapter 64B9-5. During each biennium (24 months) all RN’s LPN’s, ARNP’s and CNS’s licensed in the state of Florida must earn 1 contact hour for each calendar month of the licensure cycle. A contact hour is defined as 60 minutes of instruction. Contact hours can be earned in no less than one half hour (.5) increments. Mandatory continuing education course requirements are part of the total contact hour requirement include:
· 2 contact hour course on prevention of medical errors each biennium
· 1 contact hour course on HIV/AIDS in the first biennium only (one-time requirement)
· 2 contact hour course on Florida Laws and Rules
· 2 contact hour course on recognizing impairment in the workplace initially and then every other biennium (every 4 years)
· 2 contact hour course on Domestic Violence every third biennium (every 6 years) in addition to the total 24 contact hour requirement for a total of 26 contact hours
· 2 contact hour course on human trafficking each biennium effective biennial renewal on or after January 1, 2019
Nurses licensed in Florida are required to maintain records of the continuing education earned each biennium. Nurses are encouraged to maintain their continuing education records using CE Broker. Nurses have the option of registering for a free account or a professional account with CE Broker. The free CE Broker account allows licensees to report continuing education course completions manually. To establish a CE Broker account or to report continuing education hours earned go to CE Broker.
A licensed nurse who is presenting a continuing education course as either the course lecturer or author of the course materials may earn up to twelve continuing education (CE) contact hours per biennium (64B9-5.006). Criteria to earn CE as an author or lecturer include:
· Earn credit for the portion of the course written or presented up to total hours awarded for that course
· Credit is awarded to the lecturer for the initial presentation only
· The program offering must conform to Board of Nursing standards for objectives, subject matter, and teaching methods
· CE credit is given for publications of CE offerings
· Credit awarded conforms to the sixty (60) minute contact hour rule
Chapter 64B-6 addresses reactivation of inactive nursing licenses in Florida. An inactive license is renewed each biennium by paying the required fee. A nurse can reactivate an inactive license by completing a reactivation application form available from the Florida Board of Nursing website here.
Should a license be inactive for more than two biennial licensure cycles and the licensee has not been practicing nursing in any jurisdiction for two years immediately prior to the application for reactivation, the applicant will be required to complete a nursing remedial course as specified in Rule 64B9-3.0025 of the Florida Administrative Code. The remedial course must be a Board approved program, must include at a minimum 80 hours of didactic instruction and 96 hours of clinical instruction in medical surgical nursing and any specialty practice area of the licensee (64B9-6.003).
Violations of the laws or rules that pertain to nursing can result in disciplinary action. The disciplinary action depends on the type and severity of the violation committed by the nurse. Disciplinary action can range from denial to suspension to revocation of a nurse’s license. Depending upon the violation a fine and other disciplinary penalty will be imposed upon the nurse.
A citation is defined as an instrument that is served upon a licensee in order to assess a penalty. According to Florida Administrative Code Chapter 64B9-8.003 the first instance of failure to report a misdemeanor to the Board in writing within 30 days of the licensee being convicted or found guilty of, entered a plea of nolo contendere (no contest) a crime in any jurisdiction, in violation of Florida Statute 456.072 results in a penalty of $100.00.
A costly citation resulting in a penalty of $1,500, is as follows: providing to another individual a confidential password, access code, keys, or other entry mechanisms, which results in a violation of, or threatens the integrity of a medication administration system or an information technology system (64B9-8.003). This could explain why both academic and hospital-based nurse educators reinforce the importance of protecting your passwords and not sharing your password under any circumstance with another individual in the workplace.
According to Chapter 64B9-8.0045 and Florida Statute 456.73 minor violations as determined by the Board of Nursing include:
· False, deceptive or misleading advertising
· Issuance of a worthless bank check to the Board
· Failure to report address change to the Board
· Improper use of a nursing title under Florida Statute 464.015, providing no practice issue was involved and no criminal prosecution resulted
Per Chapter 64B9-8.005 unprofessional conduct includes:
· Inaccurate recording
· Misappropriating drugs, supplies or equipment
· Leaving nursing assignment without notifying licensed nursing personnel
· Stealing from a patient
· Violating the integrity of a medication administration system or an information technology system
· Falsifying or altering of patient records, nursing progress records, employment application or time records
· Violating the confidentiality of information or knowledge concerning a patient
· Discriminating on the basis of race, creed, religion, sex, age or national origin in the rendering of nursing care
· Engaging in fraud, misrepresentation or deceit in taking the licensing examination
· Impersonating another licensed practitioner, or allowing another person to use his certificate to practice nursing
· Providing false or incorrect information to employer regarding license status
· Practicing beyond the scope of a licensee’s license, educational experience or nursing experience
· Using force against a patient, striking a patient or throwing an object at a patient
· Using abusive, threatening or foul language in front of a patient
· Accepting a gift from a patient the value of which exceeds the employer’s gift policy
· Knowingly obtaining or using or attempting to obtain or use a patient’s property
Florida Statute 464.017 defines sexual misconduct in the practice of nursing as violation of the nurse-patient relationship through which the nurse uses said relationship to induce or attempt to induce to engage, to engage or attempt to engage the patient, in sexual activity outside the scope of the practice or the scope of generally accepted examination or treatment of the patient. Sexual misconduct in the practice of nursing is prohibited. Sexual Misconduct in the practice of a healthcare profession is a disqualification for licensure (Florida Statute 456.063).
The Intervention Project for Nurses (IPN) is categorized by the Florida Board of Nursing as an alternative to discipline program. Florida Statute 456.076 addresses impaired practitioner programs. According to Florida Administrative Code Chapter 64B9-8.006, in licensure and disciplinary matters involving impairment, the applicant or licensee may be referred to IPN, in addition to other disciplinary action. For nurses in Florida the impaired practitioner program is the Intervention Project for Nurses (IPN). The IPN in Florida was initially established in 1983. The IPN program objectives include:
Any person suspecting a nurse’s ability to provide safe nursing care may report this nurse to the Florida Department of Health (DOH) or the Intervention Project for Nurses(IPN). There is a mandatory reporting law that requires all nurses to report any suspected impairment on practice to the DOH or the IPN. For more information on the Intervention Project for Nursing click here.
The Board of Nursing has the authority to suspend an individual’s nursing license as part of the disciplinary process. The licensee must demonstrate compliance with terms and conditions of the final order and demonstrate the present ability to engage in the safe practice of nursing in order to have his or her suspended nursing license reinstated (64B9-8.001 FAC).
As outlined in 64B9-8.001, evidence that demonstrates the licensee’s present ability to engage in the safe practice of nursing may include:
· Completion of Board approved CE courses
· Participation in nursing education programs such as a nurse refresher course
· Submit evaluations of mental or physical examinations
· Completion of treatment program to alleviate alcohol or other chemical dependencies, including aftercare or a plan to continue treatment
· Other – education, employment background, references, successful completion of criminal sanctions imposed by the courts, other factors that demonstrate rehabilitation and present ability to engage in the safe practice of nursing
According to 64B9-8.012, F. A. C., the Board of Nursing authorizes mediation to resolve a first instance of
· Issuing a worthless bank check to the Board for licensure fee(s)
· Failure to report address changes as required by 64B9-1.013 Florida Administrative Code
· Failure to pay fines and investigative costs by the time ordered
· Failure to timely submit documentation of continuing education
· Failure to update practitioner profile within 15 days as required by 456.042 Florida Statutes
“The administration of intravenous therapy is the therapeutic infusion and/or injection of substances through the venous peripheral system, consisting of activity which includes observing, initiating, monitoring, discontinuing, maintaining, regulating, adjusting, documenting, planning, intervening and evaluating” (64B9-12.002 F. A. C.).
Licensed Practical Nurses in Florida who have completed a Board of Nursing approved post- graduate Intravenous Therapy course. The course must be at a minimum thirty contact hour continuing education course. This course must be taught by a currently licensed registered nurse with teaching experience and professional nursing experience which includes intravenous therapy. The course must be followed by supervised clinical practice in intravenous therapy to verify clinical competence of the LPN who has completed the didactic component of the course. The LPN’s employer is responsible for verifying his or her clinical competence, based on an established agency protocol. A signed statement of a Florida registered nurse is required as documentation to verify the LPN’s clinical competence (64B9-12.005 F. A. C.).
According to 64B9-12.004 F. A. C. the licensed practical nurse who has completed the required Board approved post graduate course IV therapy course and has demonstrated clinical competency, as specified in 64B9-12.005 F. A. C., can administer intravenous therapy under the direction of a registered professional nurse*.
*“Under the direction of the registered professional nurse” means the registered professional nurse has delegated intravenous therapy functions to a qualified licensed practical nurse. The registered nurse does not in all instances have to be on the premises in order for the licensed practical nurse to perform the delegated functions (64B9-12.002 F. A. C.)
According to 64B9-12.003 F.A. C., aspects of intravenous therapy that are outside of the scope of practice for LPN’s unless under the direct supervision* of the registered nurse or physician and which shall not be performed or initiated by licensed practical nurses without direct supervision include:
· Initiation of blood and blood products
· Initiation or administration of cancer chemotherapy
· Initiation of plasma expanders
· Initiation or administration of investigational drugs
· Mixing IV solution
· IV pushes, except heparin flushes and saline flushes
* direct supervision is defined as the registered nurse or physician is on the premises and immediately available
UAP function in the patient care environment by assisting registered nurses and licensed practical nurses in the provision of patient care services through regular assignments and delegated tasks under the supervision of a nurse (64B9-14.001 F. A. C.)
Patient safety is a priority when determining appropriate tasks or activities that can be delegated to UAP. According to 64B9-14.002 F. A. C. delegation should be based upon:
· Potential for patient harm
· Complexity of the task
· Predictability or unpredictability of the outcome, reasonable potential for a rapid change in medical status
· Level of interaction/communication required with the patient
Both the normal assignments of the UAP and validation of the UAP’s education and training are factors to consider when delegating to UAP. The nurse who delegates to UAP must communicate the task or activity, the expected outcome, limits of authority and time frame. The nurse who delegates remains responsible for total nursing care and supervision of the UAP.
Nursing activities that include the use of the nursing process and require the knowledge, nursing judgement, or skills of the RN or LPN cannot be delegated to UAP. Activities that are not within the delegating or supervising scope of practice cannot be delegated to UAP (64B9-14.003 F. A. C.)
Marybeth is a licensed practical nurse who works on a fast-paced Medical Surgical unit at a local community hospital. She carpools to work with Steve, who lives in her neighborhood and is married to her childhood best friend, Kate.
Steve, a registered nurse who works on this unit with Marybeth. He is standing in front of the computer reviewing his assigned patient’s electronic medical records for laboratory results and new physician orders. He has two newly admitted patients in his assignment, one patient scheduled for discharge at 0845, and one patient who is scheduled for surgery that morning. Mr. Smith is the patient scheduled for discharge. He has several morning medications that need to be administered before he is discharged.Steve, appears rushed and harried. He looks at Marybeth and says “Marybeth, I can’t remember password to access the computerized medication administration system. I know Information Technology will be slammed this time of day, just like they are every morning. I don’t want to run behind. The wheelchair transport driver has arrived to pick up Mr. Smith, I don’t want to keep him waiting and I am too busy to be running behind this morning. Can you do me a huge favor and give me your password so that I can give Mr. Smith his morning medications?”
What should Kate do?
Marybeth tells Steve “I know we are good friends, but you know I can’t give my password to anyone. You know that’s against hospital policy. I also just completed the Florida Board of Nursing CE course on Florida Laws and Rules and I remember that a nurse can face serious disciplinary action from the Board of Nursing for doing so. I believe it’s a citation and a $1,500. penalty.”
Marybeth continues telling Steve “You call Information Technology to request that your password be reset. Let them know that it’s a priority. I will be happy to access the computerized medication system sign out, administer, and document the administration of Mr. Smith’s morning medications. You’re always willing to help me when I get busy on the unit and I’m happy to help.”
This course focuses of the Florida Laws and Rules that govern the practice of nursing, specifically the current content of Chapters 456 and 464 of the Florida Statutes and the rules in Title 64B9 of the Florida Administrative Code. The websites listed below provide a ready resource for the nurse to access the most current information.
This website contains information about multistate licensure, including updates on which states are part of the NLC.
This website contains information on the Florida’s designated impaired practitioner program for nurses, including the history of the IPN, participant information and employer information.
This website provides information on nursing workforce issues in Florida.
This website contains information on Continuing Education courses for nurses in Florida. Nurses establish a basic or professional account to track their completed continuing education courses required for nursing license renewal.
This website contains information on nursing licensure and renewal. The resources tab provides a link to the full text of the current Florida Statutes and Administrative Codes that govern the practice of nursing in Florida.
Puente, J. (2017). The enhanced Nurse Licensure Compact. American Nurse Today, 12(10), 50-53.