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Florida Law & The Professional Nurse Update

Author: Donna Thomas

 

Florida Law & The Professional Nurse Update | Copyright © 2009 CEUFast.com


Course Contents

 

Purpose

This program is a review of Florida laws and regulations that govern the practice of nursing in Florida for Licensed Practical Nurses, Registered Nurses, Clinical Nurse Specialists and Advanced Registered Nurse Practitioners. This program includes content on Chapters 456 and 464 of the Florida Statutes and the rules in Title 64B9 of the Florida Administrative Code and meets the one-time Florida Board of Nursing requirement.

 

Objectives

The Participant upon completing this course will be able to:

1. Describe the sole legislative purpose in enacting the Nurse Practice Act as stated in Chapter 464 under Title XXXII.
   
2. Define five specific acts requiring substantial specialized knowledge that a professional nurse performs in the "Practice of Professional Nursing."
   
3. Describe and define the five rights of delegation and the nurses' responsibility when delegating specific duties in the healthcare setting.
   
4. Explain how a professional nurse renews her/he/his license or certificate.
   
5. Describe the process and at least 5 grounds for disciplinary action according to the guidelines in the Nurse Practice Act.

 

Introduction

The professional nurse today has more responsibilities than ever, including compliance with laws and regulations that are closely scrutinized. Consequently, each year the Florida Board of Nursing disciplines hundreds of nurses who unwittingly violate the Nurse Practice Act and fail to protect their licenses from administrative and legal disciplinary actions.

Title XXXII, Regulation of Professions and Occupations under Chapter 464 covers the area of Nursing and describes the Nurse Practice Act (ss.464.001-464.027). In this course references will be made to regulations in Subtitle 64IB9 of the Florida Administrative Code.

The Florida Nurse Practice Act is a series of statutes, which are revised and passed annually by the Florida Legislature. These statutes only apply to registered nurses, licensed practical nurses, and advanced nurse practitioners. Certified Nursing Assistants (CNAs) are included in another part of chapter 464. Unlicensed Assistive Personnel (UAPs) are not included in chapter 464.

Regulatory agencies involved in the implementation of the Florida Nurse Practice Act include the Department of Health (Department), Florida's Health Care Administration, and the Florida Board of Nursing (Board). Under the Nurse Practice Act, the Board of Nursing was granted authority to carry out the Codes' intent by implementing regulations.

 

Definitions of Nursing

Title XXXII - Regulation of Professions and Occupations (Florida statutes, 2009)

Chapter 464 - Nursing

464.02 Purpose. - The sole legislative purpose in enacting this part is to ensure that every nurse practicing in this state meets minimum requirements for safe practice. It is the legislative intent that nurses who fall below minimum competency or who other wise present a danger to the public shall be prohibited from practicing in this state.

464.003 Definitions. - As used in this part:

1) "Department" means the Department of Health.
   
2) "Board" means the Board of Nursing.
   
3) "Practice of professional nursing"
   
a) Means the performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to:
   
i) The observation, assessment, nursing diagnosis, planning, intervention, and evaluation of care; health teaching and counseling of the ill, injured, or infirm; and the promotion of wellness, maintenance of health, and prevention of illness of others.
   
ii) The administration of medications and treatments as prescribed or authorized by a duly licensed practitioner authorized by the laws of this state to prescribe such medications and treatments.
   
iii) The supervision and teaching of other personnel in the theory and performance of any of the above acts.
   
b)  "Practice of Practical Nursing" means the performance of selected acts, including the administration of treatments and medications, in the care of the ill, injured, or infirm and the promotion of wellness, maintenance of health, and prevention of illness of others under the direction of a registered nurse, a licensed physician, a licensed podiatric physician, or a licensed dentist. The professional nurse and the practical nurse shall be responsible and accountable for making decisions that are based upon the individual's educational preparation and experience in nursing
   

(Not stated in the Nurse Practice Act are the specific guidelines that must be followed so that licensed practical nurses can legally give Intravenous medications. These are listed in the Florida Administrative Code Subtitle 64B9.)

   
c) "Advanced or specialized nursing practice," means, in addition to the practice of professional nursing, the performance of advanced-level nursing acts approved by the board which, by virtue of post basic specialized education, training, and experience, are proper to be performed by an advanced registered nurse practitioner. Within the context of advanced or specialized nursing practice, the advanced registered nurse practitioner may perform acts of nursing diagnosis and nursing treatment of alterations of the health status. The advanced registered nurse practitioner may also perform acts of medical diagnosis and treatment, prescription, and operation which are identified and approved by a joint committee…
   
i) "Nursing diagnosis" means the observation and evaluation of physical or mental conditions, behaviors, signs and symptoms of illness, and reactions to treatment and the determination as to whether/he such conditions, signs, symptoms, and reactions represent a deviation from normal
   
ii) "Nursing treatment" means the establishment and implementation of a nursing regimen for the care and comfort of individuals, the prevention of illness, and the education, restoration, and maintenance of health.

(Not stated in the Nurse Practice Act is the information that must be included in protocols between an ARNP and a physician. These requirements are listed in the Florida Administrative Code, Subtitle 64B9.)

 

Thus these definitions are in concise terms.

 
4) "Registered nurse" means any person licensed in this state to practice professional nursing.
   
5) "Licensed practical nurse" means any person licensed in this state to practice practical nursing
   
6) "Clinical nurse specialist" means any person licensed in this state to practice professional nursing and certified in clinical nurse specialist practice.
   
7) "Advanced registered nurse practitioner" means any person licensed in this state to practice professional nursing and certified in advanced or specialized nursing practice.
   
8) "Approved program" means a nursing program conducted in a school, college, or university, which is approved by the board pursuant to s. 464.019 for the education of nurses.

 

Delegation of Responsibilities

As the national shortage of licensed nursing personnel expands, more Certified Nursing Assistants. (C.N.A.s) and UAPs are being hired to care for patients in healthcare facilities. Part two 464.202-464-2085 of the Florida Statute concerns the Certified Nursing Assistants. An individual who wants to be a CNA must complete a course of training conducted by a public sector or private sector educational center licensed by the Department of Education to implement the basic curriculum for nursing assistants which is approved by the Department of Education. Beginning October 1, 2000, the board shall assume responsibility for approval of training programs under this paragraph. The board shall maintain, or contract with or approve another entity to maintain, a state registry of certified nursing assistants.

464.202 Duties and powers of the Board of Nursing

These licensed and unlicensed personnel are now accountable to the Board of Nursing. Similarly, healthcare Institutions are hiring foreign trained nurses with unknown training and skills. The licensed professional registered nurse is then asked to supervise and delegate responsibilities to this diverse staff, and the registered nurse has ultimate responsibility and accountability for care provided to patients (Mikos, Collins, McAuliffe, & Money, 2002). The nurse is responsible and answerable for the actions or the failure to act of self or others to whom there was a delegation.

The principles of delegation to and supervision of UAPs are defined by the National Council of State Boards of Nursing, and are mirrored in Florida Law in sections 464B9-l6.001-16.004 of the Florida Administrative Code. Sections 464B9-16.001-16.004 regulates the extent of and manner in which LPNs may supervise other LPNs and CNAs in Nursing homes, but only under the supervision of an RN. LPNs may only supervise within their own scope of practice.

The registered nurse must not delegate any activity that requires assessment, evaluation, and nursing judgment commiserate with the professional nurse's scope of practice. However, implementation of some parts of the nursing process may be delegated. CNAs do not replace the registered nurse but rather assist him/her. CNAs are not permitted to delegate their assignment to anyone else.

Licensed nurses must use good judgment, common sense, and consider the suitability of the task for the person being delegated the task. The following five rights of delegation serve as a guide to assist the licensed nurse in making the best decisions when delegating tasks (Mikos, et. al. 2002).

1. Right Task: The task is within a persons training, experience and scope of practice.
   
2. Right Circumstances: The task is performed in an appropriate setting with adequate resources.
   
3. Right Person: The delegator is at the right level of profession to delegate and is delegating a task to a person at the right level of profession to perform the task. The person delegated to must have shown competency for that task.
   
4. Right Communication: A concise, clear description of the task is communicated at the person's level of understanding, including an explanation of the objectives, limits and expectations.
   
5. Right Supervision: The task is within the Scope of Practice of the delegator and the delegator provides appropriate monitoring, intervention, evaluation and feedback.

 

Board of Nursing

The Board of Nursing is the governing authority for nursing practice, licensure and disciplinary actions.

464.004 Board of Nursing, membership; appointment, terms (Florida statutes, 2009)

1) The Board of Nursing is created within the department and shall consist of 13 members to be appointed by the Governor and confirmed by the Senate.
   
2) Seven members of the board must be registered nurses who are residents of this state and who have been engaged in the practice of professional nursing for at least 4 years, including at least one advanced registered nurse practitioner, 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, three members of the board must be licensed practical nurses who are residents of this state and who have been actively engaged in the practice of practical nursing for at least 4 years prior to their appointment. The remaining three members must be residents of the state 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

As you can see, the Board's membership is meant to be diverse and representative of all nurses in the state and consumers. The Board's permanent location is Tallahassee, but it rotates the meeting sites around the State. The meeting schedule is available online at http://www.doh.state.fl.us/mqa/nurshome/nha_meeting.html. A review of disciplinary cases and informal discipline hearings is presented at each board meeting.

 

Licensure Requirements

Licensure requirements cover diverse aspects of practice and preparation. Included are fee, language requirements, examination stipulations and certification processes.

IMPORTANT NOTICE:
Pursuant to Section 456.0635, Florida Statutes, you are being notified that effective July 1, 2009, health care boards or the department shall refuse to issue a license, certificate or registration and shall refuse to admit a candidate for examination if the applicant has been (Garcia, 2009, p 1):

1. Convicted or plead guilty or nolo contendre to a felony violation regardless of adjudication of: chapters 409, 817, or 893, Florida Statutes; or 21 U.S.C. ss. 801-970 or 42 U.S.C. ss 1395-1396, unless the sentence and any probation or pleas ended more than 15 years prior to the application.

2. Terminated for cause from Florida Medicaid Program (unless the applicant has been in good standing for the most recent five years).

3. Terminated for cause by any other State Medicaid Program or the Medicare Program (unless the termination was at least 20 years prior to the date of the application and the applicant has been in good standing with the program for the most recent five years).

Some of the boards, or the department where there is no board, are in the process of updating questions on licensure applications. Please continue to use the application, as it currently appears online until rules are adopted that will allow the department to replace these applications with updated versions.

CHAPTER 409
SOCIAL WELFARE
SOCIAL AND ECONOMIC ASSISTANCE


CHAPTER 817
FRAUDULENT PRACTICES
PART I

FALSE PRETENSES AND FRAUDS, GENERALLY (ss. 817.02-817.569)
PART II

CREDIT CARD CRIMES (ss. 817.57-817.685)
PART III

CREDIT SERVICE ORGANIZATIONS (ss. 817.7001-817.706)
PART IV

CREDIT COUNSELING SERVICES (ss. 817.801-817.806)

CHAPTER 893
Drug Abuse Prevention and Control
Title 21 United States Code (USC) ss. 801-970 - pertain to public health & welfare, Medicare, etc.
Title 42 United States Code (USC) ss. 1395-1396 - pertain to controlled substances

Here is the link for the United States Code search page:
http://uscode.house.gov/search/criteria.shtml

464.008 Licensure by examination (Florida statutes, 2009).

1) Any person desiring to be licensed as a registered nurse or licensed practical nurse shall apply to the department to take the licensure examination. The department shall examine each applicant who:
   
a) Has completed the application form and remitted a fee set by the board not to exceed $150 and has remitted an examination fee set by the board not to exceed $75 plus the actual per applicant cost to the department for purchase of the examination from the National Council of State Boards of Nursing or a similar national organization.
   
b) Has provided sufficient information on or after October 1, 1989, which must be submitted by the department for a statewide criminal records correspondence check through the Department of Law Enforcement.
   
c) Is in good mental and physical health, is a recipient of a high school diploma or the equivalent, and has completed the requirements for graduation from an approved program, or its equivalent as determined by the board, for the preparation of registered nurses or licensed practical nurses, whichever is applicable. Courses successfully completed in a professional nursing program which are at least equivalent to a practical nursing program may be used to satisfy the education requirements for licensure as a licensed practical nurse.
   
d) Has the ability to communicate in the English language, which may be determined by an examination given by the department. Each applicant who passes the examination and provides proof of meeting the educational requirements specified in subsection (1) shall, unless denied pursuant to s. 464.018, be entitled to licensure as a Registered Professional Nurse or a Licensed Practical Nurse, whichever is applicable
   
2) Any applicant who fails the examination three consecutive times, regardless of the jurisdiction in which the examination is taken, shall be required to complete a board-approved remedial course before the applicant will be approved for reexamination. After taking the remedial course, the applicant may be approved to retake the examination up to three additional times before the applicant is required to retake remediation. The applicant shall apply for reexamination within 6 months after completion of remediation. The board shall by rule establish guidelines for remedial courses.

464.009 Licensure by endorsement (Florida statutes, 2009).

1) The department shall issue the appropriate license by endorsement to practice professional or practical nursing to an applicant who, upon applying to the department and remitting a fee set by the board not to exceed $100, demonstrates to the board that he or she/he:
   
a) Holds a valid license to practice professional or practical nursing in another state of the United States, provided that, when the applicant secured his or her/he original license, the requirements for licensure were substantially equivalent to or more stringent than those existing in Florida at that time; or
   
b) Meets the qualifications for licensure in s. 464.008 and has successfully completed a state, regional, or national examination which is substantial equivalent to or more stringent than the examination given by the department
   
c) Has actively practiced nursing in another state, jurisdiction, or territory of the United States for 2 of the preceding 3 years wit without having his or her license acted against by the licensing authority of any jurisdiction. Applicants who become licensed pursuant to this paragraph must complete within 6 months after licensure a Florida laws and rules course that is approved by the. Once the department has received the results of the national criminal history check and has determined that the applicant has no criminal history, the appropriate license by endorsement shall be issued to the applicant.
   
2) Such examinations and requirements from other states shall be presumed to be substantially equivalent to or more stringent than those in this state. Such presumption shall not arise until January 1, 1980. However, the board may, by rule, specify states the examinations and requirements of which shall not be presumed to be substantially equivalent to those of this state.
   
3) An applicant for licensure by endorsement who is relocating to this state pursuant to his or her military-connected spouse's official military orders and who is licensed in another state that is a member of the Nurse Licensure Compact shall be deemed to have satisfied the requirements of subsection (1) and shall be issued a license by endorsement upon submission of the appropriate application and fees and completion of the criminal background check required under subsection.
   
4) The applicant must submit to the department a set of fingerprints on a form and under procedures specified by the department, along with a payment in an amount equal to the costs incurred by the Department of Health for the criminal background check of the applicant. The Department of Health shall submit the fingerprints provided by the applicant to the Florida Department of Law Enforcement for a statewide criminal history check, and the Florida Department of Law Enforcement shall forward the fingerprints to the Federal Bureau of Investigation for a national criminal history check of the applicant. The Department of Health shall review the results of the criminal history check, issue a license to an applicant who has met all of the other requirements for licensure and has no criminal history, and shall refer all applicants with criminal histories back to the board for determination as to whether/he a license should be issued and under what conditions.
   
5) The department shall not issue a license by endorsement to any applicant who is under investigation in another state for an act which would constitute a violation of this part or chapter 456 until such time as the investigation is complete, at which time the provisions of s. 464.018 shall apply.
   
6) The department shall develop an electronic applicant notification process and provide electronic notification when the application has been received and when background screenings have been completed, and shall issue a license within 30 days after completion of all required data collection and verification. This 30-day period to issue a license shall be tolled if the applicant must appear before the board due to information provided on the application or obtained through screening and data collection and verification procedures.

464.115 Certification of clinical nurse specialists (Florida statutes, 2009).

1) Any nurse seeking certification as a clinical nurse specialist must apply to the department and submit proof that he or she holds a current license to practice professional nursing, a master's degree in a clinical nursing specialty, and either:
   
a) Proof of current certification in a specialty area as a clinical nurse specialist from a nationally recognized certifying body as determined by the board; or
   
(b) Proof that he or she holds a master's degree in a specialty area for which there is no certification within the clinical nurse specialist role and specialty and proof of having completed 1,000 hours of clinical experience in the clinical specialty for which he or she is academically prepared, with a minimum of 500 hours of clinical practice after graduation. The applicant for certification as a clinical nurse specialist must submit an affidavit to the Board of Nursing affirming the required hours of clinical experience. Falsification of the affidavit constitutes grounds for discipline in accordance with s. 464.018(1)(f).
   
2) The board shall certify, and the department shall issue a certificate to, any nurse who fulfills the qualifications of this section. The board shall establish an application fee not to exceed $75 and a biennial renewal fee not to exceed $75.
   
3) The board may adopt rules necessary to administer this section pursuant to ss. 120.536(1) and 120.54.
   

464.012 Certification of Advanced Registered Nurse Practitioners; fees (Florida statutes, 2009).

1) Any nurse desiring to be certified as an advanced registered nurse practitioner shall apply to the department and submit proof that he or she/he holds a current license to practice professional nursing and that he or she/he meets one or more of the following requirements as determined by the board-
   
a) Satisfactory completion of a formal post basic educational program of at least one academic year, the primary purpose of which is to prepare nurses for advanced or specialized practice.
   
b) Certification by an appropriate specialty board. Such certification shall be required for initial state certification and any recertification as a registered nurse anesthetist or nurse midwife. The board may by rule provide for provisional state certification of graduate nurse anesthetists and nurse midwives for a period of time determined to be appropriate for preparing for and passing the national certification examination.
   
c) Graduation from a program leading to a master's degree in a nursing clinical specialty area with preparation in specialized practitioner skills. For applicants graduating on or after October 1, 1998, graduation from a master's degree program shall be required for initial certification as a nurse practitioner under paragraph (4) (c). For applicants graduating on or after October 1, 2001, graduation from a master's degree program shall be required for initial certification as a registered nurse anesthetist under paragraph (4) (a).
   
2) The board shall provide by rule the appropriate requirements for advanced registered nurse practitioners in the categories of certified registered nurse anesthetist, certified nurse midwife and nurse practitioner.
   
3) An Advanced Registered Nurse Practitioner shall perform those functions authorized in this section within the framework of an established protocol. A practitioner currently licensed under chapter 458, chapter 459, or chapter 466 shall maintain supervision for directing the specific course of medical treatment. Within the established framework, an advanced registered nurse practitioner may.
   
a) Monitor and alter drug therapies.
   
b) Initiate appropriate therapies for certain conditions.
   
c) Perform additional functions as may be determined by rule in accordance with S464.003 (3) (c).
   
d) Order diagnostic tests and physical and occupational therapy
   
4) In addition to the general functions specified in subsection (3), an Advanced Registered Nurse Practitioner may perform the following acts within his or her/he specialty.
   
a) The Certified Registered Nurse Anesthetist may, to the extent authorized by established protocol approved by the medical staff of the facility in which the anesthetic service is performed, perform any or all of the following:
   
i) Determine the health status of the patient as it relates to the risk factors and to the anesthetic management of the patient through the performance of the general functions.
   
ii) Based on history, physical assessment, and supplemental laboratory results, determines, with the consent of the responsible physician, the appropriate type of anesthesia within the framework of the protocol.
   
iii) Order under the protocol preanesthetic medication.
   
iv) Perform under the protocol procedures commonly used to render the patient insensible to pain during the performance of surgical, obstetrical, therapeutic, or diagnostic clinical procedures. These procedures include ordering and administering regional, spinal, and general anesthesia; inhalation agents and techniques; intravenous agents and techniques; and techniques of hypnosis.
   
v) Order or perform monitoring procedures indicated as pertinent to the anesthetic health care management of the patient.
   
vi) Support life functions during anesthesia health care, including induction and intubation procedures, the use of appropriate mechanical supportive devices, and the management of fluid, electrolyte, and blood component balances.
   
vii) Recognize and take appropriate corrective action for abnormal patient responses to anesthesia, adjunctive medication, or other forms of therapy.
   
viii) Recognize and treat a cardiac arrhythmia while the patient is under anesthetic care.
   
ix) Participate in management of the patient while in the post anesthesia recovery area, including ordering the administration of fluids and drugs.
   
x) Place special peripheral and central venous and arterial lines for blood sampling and monitoring as appropriate.
   
b) The Certified Nurse Midwife may, to the extent authorized by an established protocol which has been approved by the medical staff of the health care facility in which the midwifery services are performed, or approved by the nurse midwife's physician backup when the delivery is performed in a patient's home, perform any or all of the following:
   
i) Perform superficial minor surgical procedures.
   
ii) Manage the patient during labor and deliver to include anatomy, episiotomy, and repair.
   
iii) Order, initiate, and perform appropriate anesthetic procedures.
   
iv) Perform postpartum examination.
   
v) Order appropriate medications.
   
vi) Provide family-planning services and well- woman care.
   
vii) Manage the medical care of the normal obstetrical patient and the initial care of newborn patient.
   
c) The Nurse Practitioner may perform any of the following acts within the framework of established protocol.
   
i) Manage selected medical problems.
   
ii) Order physical and occupational therapy.
   
iii) Initiate, monitor, or alter therapies for certain uncomplicated acute illnesses.
   
iv) Monitor and manage patients with stable chronic diseases
   
v) Establish behavioral problems and diagnosis and make treatment recommendations.
   
vi) The board shall certify, and the department shall issue a certificate to, any nurse meeting the qualifications in this section. The board shall establish an application fee not to exceed $100, biennial renewal fee not to exceed $50. The board is authorized to adopt such other rules as are necessary to implement the provisions of this section.

All employing agencies must verify that licensed personnel have a valid license. Most employers suspend employment until the employee presents a valid license for verification.

464.013 Renewal of license or certificate (Florida statutes, 2009).

1) The department shall renew a license upon receipt of the renewal application and fee.
   
2) The department shall adopt rules establishing a procedure for the biennial renewal of licenses.
   
3) The board shall by rule prescribe continuing education not to exceed 30 hours biennially as a condition for renewal of a license or certificate. The criteria for programs shall be approved by the board.

Specific continuing education requirements are not stated in the Nurse Practice Act. The requirements are listed in the Florida Administrative Code, Subtitle 64B9.

All Florida-licensed RN's and LPNs are now in a 24-month renewal cycle and must complete 24 hours of appropriate continuing education during each renewal period. One (1) contact hour is required for each calendar month of the licensure cycle, including two (2) hours on Prevention of Medical Errors. HIV/AIDS is now a one-time, 1-hour CE requirement to be completed prior to the first renewal. Domestic Violence CE is now a 2-hour requirement every third renewal. For example, if you renew your license on January 31, 2007, you are required to complete the Domestic Violence CE before the January 31, 2011 renewal.

Nurses may choose to place their license on inactive status. When a license is inactive, the nurse is not obligated to renewal or continuing education requirements. An inactive license must be activated before the nurse can resume practice.

464.014 Inactive status (Florida statutes, 2009).

1) The board shall adopt rules relating to application procedures for inactive status, to the biennial renewal of inactive licenses, and to the reactivation of licenses. The board shall prescribe by rule an application fee for inactive status, a renewal fee for inactive status, a delinquency fee, and a fee for the reactivation of a license. None of these fees may exceed the biennial renewal fee established by the board for biennial renewal of an active license.
   
2) The department may not reactivate a license unless the inactive or delinquent licensee has paid any applicable biennial renewal or delinquency fee, or both, and a reactivation fee.

Special administrative rules are contained in the statute to allow retired nurses to volunteer in the community.

464.0205 Retired volunteer nurse certificate (Florida statutes, 2009).

1) Any retired practical or registered nurse desiring to serve indigent, underserved, or critical need populations in this state may apply to the department for a retired volunteer nurse certificate by providing:
   
a) A complete application.
   
b) Verification that the applicant had been licensed to practice nursing in any jurisdiction in the United States for at least IO years, had retired or plans to retire, intends to practice nursing only pursuant to the limitations provided by the retired volunteer nurse certificate, and has not committed any act that would constitute a violation under s. 464.018(l).
   
c) Proof that the applicant meets the requirements for licensure under s. 464.008 or s. 464.009.
   
2) All related administrative costs shall be borne by the applicant.
   
3) The board may deny a retired volunteer nurse certificate to any applicant who has committed, or who is under investigation or prosecution for, any act that would constitute a ground for disciplinary action under s. 464.018.
   
4) A retired volunteer nurse receiving certification from the board shall:
   
a) Work under the direct supervision of the director of a county health department, a physician working under a limited license issued pursuant to s. 458.317 or s. 459.0075, a physician licensed under chapter 458 or chapter 459, an advanced registered nurse practitioner certified under s. 464.012, or a registered nurse licensed under s. 464.008 or s. 464.009.
   
b) Comply with the minimum standards of practice for nurses and be subject to disciplinary action for violations of s. 464.018, except that the scope of practice for certified volunteers shall be limited to primary and preventive health care, or as further/he defined by board rule
   
c) Work only in a setting for which there are provisions for professional liability coverage for acts or omissions of the retired volunteer nurse.
   
d) Provide services under the certificate only in settings whose sponsors have been approved by the board.
   
5) A retired volunteer nurse receiving certification from the board shall not:
   
a) Administer controlled substances.
   
b) Supervise other nurses.
   
c) Receive monetary compensation.
   
6) A retired volunteer nurse certified under this section may practice only in board-approved settings in public agencies or institutions or in nonprofit agencies or institutions meeting the requirements of s. 501 (c)(3) of the Internal Revenue Code, which agencies or institutions are located in areas of critical nursing need as determined by the board. Determination of underserved areas shall be made by the board after consultation with the Department of Health, the Department of Children and Family Services, the Agency for Health Care Administration, and the Department of Elderly Affairs; however, such determination shall include, but not be limited to, health manpower shortage areas designated by the United States Department of Health and Human Services. The sponsoring agencies desiring to use certified retired volunteer nurses shall submit to the board verification of their status under s. 501 (c)(3) of the Internal Revenue Code, the sites at which such volunteer nurses would work, the duties and scope of practice intended for such volunteer nurses, and the training or skills validation for such volunteer nurses.
   
7) The retired volunteer nurse certificate shall be valid for 2 years, and a certificate holder may reapply for a certificate so long as the certificate holder continues to meet the eligibility requirements of this section. Any legislatively mandated continuing education on specific topics must be completed by the certificate holder prior to renewal; otherwise, the provisions of s. 464.013 do not apply.

The Florida Nurse Practice Act does not list every task nurses are responsible for, but provides that nurses at all levels are responsible for making decisions based on their educational preparation and experience in nursing. So, the scope of practice can vary from nurse to nurse. The Board of Nursing takes this variable scope of practice into consideration in making their final decisions in disciplinary proceedings.

464.015 Titles and abbreviations; restrictions; penalty (Florida statutes, 2009).

1) Only persons who hold licenses to practice professional nursing in this state or who are performing nursing services pursuant to the exception set forth in s. 464.022(8) shall have the right to use the title "Registered Nurse" and the abbreviation "R.N."
   
2) Only persons who hold licenses to practice as licensed practical nurses in this state or who are performing practical nursing services pursuant to the exception set forth in s. 464.022(8) shall have the right to use the title "Licensed Practical Nurse" and the abbreviation "L.P.N."
   
3) Only persons who are graduates of approved programs or the equivalent may use the term "Graduate Nurse" and the abbreviation "G.N.," pending the results of the first licensure examination for which they are eligible.
   
4) Only persons who are graduates of approved programs or the equivalent may use the term "Graduate Practical Nurse" and the abbreviation "G.P.N., "pending the results of the first licensure examination for which they are eligible.
   
5) Only persons who hold valid certificates to practice as advanced registered nurse practitioners in this state shall have the right to use the title "Advanced Registered Nurse Practitioner" and the abbreviation "A.R.N.P."
   
6) No person shall practice or advertise as, or assume the title of, registered nurse, licensed practical nurse, or advanced registered nurse practitioner or use the abbreviation "R.N.," "L.P.N.," or "A.R.N.P." or take any other action that would lead the public to believe that person was certified as such or is performing nursing services pursuant to the exception set forth in s. 464.022 unless that person is licensed or certified to practice as such.
   
7) A violation of this section is a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083.

464.016 Violations and penalties (Florida statutes, 2009).

1) Each of the following acts constitutes a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or S. 775.084:
   
a) Practicing advanced or specialized, professional or practical nursing, as defined in this part, unless holding an active license or certificate to do so.
   
b) Using or attempting to use a license or certificate which has been suspended or revoked.
   
c) Knowingly employing unlicensed persons in the practice of nursing.
   
d) Obtaining or attempting to obtain a license or certificate under this part by misleading statements or knowing misrepresentation.
   
2) Punishable as provided in s. 775.082 or s. 775.083:
   
a) Using the name or title "Nurse," "Registered Nurse," "Licensed Practical. Each of the following acts constitutes a misdemeanor of the first degree Nurse," "Advanced Registered Nurse Practitioner," or any other name or title which implies that a person was licensed or certified as same, unless such person is duly licensed or certified.
   
b) Knowingly concealing information relating to violations of this part. Sexual misconduct in the practice of nursing. --The nurse- patient relationship is founded on mutual trust. Sexual misconduct in the practice of nursing means violation of the nurse-patient relationship through which the nurse uses said relationship to induce or attempt to induce the patient to engage, or to engage or attempt to engage the patient, in sexual activity outside the scope of the practice or the scope of generally accepted examination or treatment of the patient. Sexual misconduct in the practice of nursing is prohibited.

Patients are particularly vulnerable to acts of sexual misconduct because of the physical exposure, potential for varied level of consciousness of the patient and the expectation that a caregiver can be trusted. Sexual misconduct in the practice of nursing may include inducement or the attempted inducement of the patient to engage in sexual activity outside the scope of the practice or sexual activity outside of the generally accepted examination or treatment of the patient.

464.018 Disciplinary actions (Florida statutes, 2009).

1) The following acts constitute grounds for denial of a license or disciplinary action, as specified in s. 456.072(2):
   
a) Procuring, attempting to procure, or renewing a license to practice nursing by bribery, by knowing misrepresentations, or through an error of the department or the board.
   
b) 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.
   
c) Being convicted or found guilty of, or entering a plea of nolo contenders to, regardless of adjudication, a crime in any jurisdiction which directly relates to the practice of nursing or to the ability to practice nursing.
   
d) Being found guilty, regardless of adjudication, of any of the following offenses:
   
i) A forcible felony as defined in chapter 776.
   
ii) A violation of chapter 812, relating to theft, robbery, and related crimes.
   
iii) A violation of chapter 817, relating to fraudulent practices.
   
iv) A violation of chapter 800, relating to lewdness and indecent exposure.
   
v) A violation of chapter 784, relating to assault, battery, and culpable negligence.
   
vi) A violation of chapter 827, relating to child abuse.
   
vii) A violation of chapter 415, relating to protection from abuse, neglect, and exploitation.
   
viii) Violation of chapter 39, relating to child abuse, abandonment, and neglect.
   
e) Having been found guilty of, regardless of adjudication, or entered a plea of nolo contenders or guilty to, any offense prohibited under s. 435.03 or under any similar statute of another jurisdiction; or having committed an act which constitutes domestic violence as defined in s. 741.28.
   
f) Making or filing a false report or record, which the licensee knows to be false, intentionally or negligently failing to file a report or record required by state or federal law, willfully impeding or obstructing such filing or inducing another person to do so. Such reports or records shall include only those, which are signed in the nurse's capacity as a licensed nurse.
   
g) False, misleading, or deceptive advertising.
   
h) Unprofessional conduct, which shall include, but not be limited to, any departure from, or the failure to conform to, the minimal standards of acceptable and prevailing nursing practice, in which case actual injury need not be established.
   
i) Engaging or attempting to engage in the possession, sale, or distribution of controlled substances as set forth in chapter 893, for any other than legitimate purposes authorized by this part.
   
j) Being unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, or chemicals or any other type of material or as a result of any mental or physical condition. In enforcing this paragraph, the department shall have, upon a finding of the secretary or the secretary's designee that probable cause exists to believe that the licensee is unable to practice nursing because of the reasons stated in this paragraph, the authority to issue an order to compel a licensee to submit to a mental or physical examination by physicians designated by the department. If the licensee refuses to comply with such order, the department's order directing such examination may be enforced by filing a petition for enforcement in the circuit court where the licensee resides or does business. The licensee against whom the petition is filed shall not be named or identified by initials in any public court records or documents, and the proceedings shall be closed to the public. The department shall be entitled to the summary procedure provided in s 51.011. A nurse affected by the provisions of this paragraph shall at reasonable intervals be afforded an opportunity to demonstrate that she/he or he can resume the competent practice of nursing with reasonable skill and safety to patients
   
k) Failing to report to the department any person who the licensee knows is in violation of this part or of the rules of the department or the board; however, if the licensee verifies that such person is actively participating in a board-approved program for the treatment of a physical or mental condition, the licensee is required to report such person only to an impaired professional consultant.
   
l) Knowingly violating any provision of this part, a rule of the board or the department, or a lawful order of the board or department previously entered in a disciplinary proceeding or failing to comply with a lawfully issued subpoena of the department.
   
m) Failing to report to the department any licensee under chapter 458 or under chapter 459 who the nurse knows has violated the grounds for disciplinary action set out in the law under which that person is licensed and who provides health care services in a facility licensed under chapter 395, or a health maintenance organization certificated under part I of chapter 641, in which the nurse also provides services.
   
n) Violating any provision of this chapter or chapter 456, or any rules adopted pursuant thereto.
   
2) The board may enter an order denying licensure or imposing any of the penalties in s. 456.072(2) against any applicant for licensure or licensee who is found guilty of violating any provision of subsection (1) of this section or who is found guilty of such person has complied with all the terms and conditions set forth in the final order and that such person is capable of safely engaging in the practice of nursing.
   
3) The board shall not reinstate the license of a nurse who has been found guilty by the board on three separate occasions of violations of this part relating to the use of drugs or narcotics, which offenses involved the diversion of drugs or narcotics from patients to personal use or sale
   
4) The board shall by rule establish guidelines for the disposition of disciplinary cases involving specific types of violations. Such guidelines may include minimum and maximum fines, periods of supervision or probation, or conditions or probation or re-issuance of a license.

Inaccurate recording includes making a false report, putting inaccurate times on notes, signing off medications as given before they are given and omitting reports as required by federal or state laws. Accurate, legible, concise and complete documentation is essential in providing safe, high quality care in the delivery of healthcare services (Mikos, et. al., 2002).

Types of unprofessional conduct stated in the Florida administrative Code, Section 64B9-8.005 are the following (Mikos, 2002):

1. Practicing beyond the scope of the licensee's license, educational preparation or nursing experience.
   
2. Failure to conform to the minimal standards of acceptable prevailing nursing practice, regardless of whether/he or not actual injury to a patient was sustained.
   
3. Practicing registered nursing or practical nursing in the State of Florida without a current license or time limited permission by the Board to be employed.
   
4. Engaging in fraud, misrepresentation, or deceit in taking the licensing examination.
   
5. Impersonating any applicant or acting as proxy for the applicant in any examination required for the issuance of a license.
   
6. Impersonating another licensed practitioner, or permitting another person to use his certificate for the purpose of nursing for compensation.
   
7. Aiding and abetting the practice of registered nursing or practical nursing by any person not licensed as a registered nurse or a licensed practical nurse.
   
8. Providing false or incorrect information to the employer regarding the status of the status of the license.
   
9. Violation of a Board order entered in a licensure proceeding.
   
10. Failure of an ARNP dispensing practitioner to comply with the registration and compliance requirements of Rule 6409-4.011.
   
11. Testing positive for any drugs under Chapter 893 on any pre-employment or employer ordered drug screen when the nurse does not have a prescription and legitimate medical reason for using such drug.
   
12. Submitting the attestation of 24 hours of continuing education and one hour continuing education on domestic violence for licensure renewal under Rule 64B-3.013 when the licensee has not attended or completed all such hours in the biennium.
   
13. Discrimination on the basis or race, creed, religion, sex, age or national origin, in the rendering of nursing services as it relates to human rights and dignity of the individuals.
   
14. Exercising influence on a patient in such a manner as to exploit the patient for financial gain of the licensee or a third party.
   
15. Acts of negligence, gross negligence, either/he by omission or commission.
   
16. Inaccurate recording.
   
17. Leaving a nursing assignment without advising licensed nursing personnel.
   
18. Violating the confidentiality of information or knowledge concerning a patient.
   
19. Misappropriating supplies, and equipment.

Complaints about a nurse can be filed from many sources such as a nurse's employer, regulatory officials, a dissatisfied patient or a family member. Nurses are advised to attend at least one board meeting to understand how the disciplinary process works. The Department of Health has the burden of proof in a disciplinary case and any thing the nurse says or writes can be used against her/he. The following is a flow chart of the process.

  
 

If a nurse receives a notice of a licensure investigation she/he/he should consult with an attorney who is knowledgeable about the Florida law governing healthcare professionals. The nurse is notified of the complaint in writing on a complaint form that lists the allegations and violations of the Nurse Practice Act. Documentation related to the accusations may or may not be included. The nurse is not obligated to speak or respond to the investigator, but is encouraged to cooperate with the investigator and to communicate with the investigator in writing.

If the board determines that a violation of the Nurse Practice Act has occurred, the notice to the nurse should include an official administrative complaint outlining the alleged violation, probably a proposed settlement, and an election of rights form. The election of rights form describes the hearing rights available to the nurse.

The nurse can request an informal hearing before the Board. Informal hearings are limited to providing only testimony to "mitigating circumstances" about why the violation occurred. The only hearing option that allows the nurse to "dispute" the alleged allegations is in a formal hearing held before an administrative law judge (Mikos, et. al., 2002).

Penalties may include a reprimand, fine, practice restrictions, probation, suspension or revocation of the license or a combination of penalties.

 

Ways to Stay out of Trouble
   
1. Review the types of Unprofessional Conduct listed in this course. The majority of discipline cases reviewed by the board involve some form of unprofessional conduct.
   
2. Attend at least one Florida Board of Nursing meeting and witness a disciplinary action meeting.
   
3. Understand the Florida Board of Nursing stance on abandonment (section 64B9-8.005(1) © of the Florida Administrative code). Abandonment is considered unprofessional conduct, which constitutes grounds for denial of a license or disciplinary action. Abandonment includes:
   
a. Leaving a nursing assignment before advising licensed nursing personnel.
   
b. Withdrawal of services/care without provision of qualified coverage.
   
c. Failure to provide competent intervention if patient's condition changes.
   
d. When working for an agency under common law, the entity (agency) usually assumes the duty not to abandon the patient.
   
e. In Florida, once a nurse accepts responsibility for an assignment, she/he cannot leave or cease care until relief is available. Dire emergencies can be evaluated by the board on a case-by-case basis. If the board does not consider the emergency as a reason to abandon the patient, disciplinary action can be taken.
   
4. A charge of unprofessional conduct can result even if there was no harm or injury to the patient.
   
5. A charge of negligence must demonstrate that an injury has occurred as a result of a nursing error.
   
6. When receiving verbal orders from a physician over the phone, make sure you repeat the order to the doctor. It is preferable to have a second nurse listen in. Both of you should then sign the order. Remember to time date and sign the orders. Verify the physician's name and print it correctly on the orders.
   
7. If a medication order seems wrong, check with the pharmacist and your supervisor. The pharmacist may call the doctor to clarify the order if it is unusual. If a nurse refuses to give a medication, she/he must let the physician and her/he supervisor know.
   
8. If you make a mistake when charting, neatly cross out the statement and write error, date and sign above the cross out. Never use white out on an official document.
   
9. If entering a late note, you must write "late note", date and sign it.
   
10. Do not write anything referring to the completion of an incident report in the medical record.
   
11. Maintain a patient's confidentiality.

Note: If a nurse changes her/he address it is "the nurse's" responsibility to notify the Board of Nursing within 30 days of the new address.

 

Exceptions to the Nurse Practice Act

464.022 Exceptions. - No provision of this part shall be construed to prohibit (Florida statutes, 2009):

1) The care of the sick by friends or members of the family without compensation, the incidental care of the sick by domestic servants, or the incidental care of non-institutionalized persons by a surrogate family.
   
2) Assistance by anyone in the case of an emergency.
   
3) The practice of nursing by students enrolled in approved schools of nursing.
   
4) The practice of nursing by graduates of approved programs or the equivalent, pending the result of the first licensing examination for which they are eligible following graduation, provided they practice under direct supervision of a registered professional nurse. The board shall by rule define what constitutes direct supervision.
   
5) The rendering of services by nursing assistants acting under the direct supervision of a registered professional nurse.
   
6) Any nurse practicing in accordance with the practices and principles of the body known as the Church of Christ Scientist; nor shall any rule of the board apply to any sanitarium, nursing home, or rest home operated in accordance with the practices and principles of the body known as the Church of Christ Scientist.
   
7) The practice of any legally qualified nurse or licensed attendant of another state who is employed by the United States Government, or any bureau, division, or agency thereof, while in the discharge of official duties.
   
8) Any nurse currently licensed in another state from performing nursing services in this state for a period of 60 days after furnishing to the employer satisfactory evidence of current licensure in another state and having submitted proper application and fees to the board for licensure prior to employment. The board may extend this time for administrative purposes when necessary.
   
9) The rendering of nursing services on a fee-for-service basis, or the reimbursement for nursing services directly to a nurse rendering such services by any government program, commercial insurance company, hospital or medical services plan, or any other third-party payor.
   
10) The establishment of an independent practice by one or more nurses for the purpose of rendering to patients nursing services within the scope of the nursing license.
   
11) The furnishing of hemodialysis treatments in a patient's home, using an assistant chosen by the patient, provided that the assistant is properly trained, as defined by the board by rule, and has immediate telephonic access to a registered nurse who is licensed pursuant to this part and who has dialysis training and experience.
   
12) The practice of nursing by any legally qualified nurse of another state whose employment requires the nurse to accompany and care for a patient temporarily residing in this state for not more than 30 consecutive days, provided the patient is not in an inpatient setting, the board is notified prior to arrival of the patient and nurse, the nurse has the standing physician orders and current medical status of the patient available, and prearrangements with the appropriate licensed health care providers in this state have been made in case the patient needs placement in an inpatient setting.
   
13) The practice of nursing by individuals enrolled in board- approved remedial courses.

 

Conclusion

Additional Florida laws impact the nursing profession and practice. Specific requirements explaining patient's bill of rights, confidentiality, etc. can be found in both Florida and Federal law. The patients bill of rights states that patients have the right to be informed; the right to refuse any treatment as long as they are competent; the right to privacy; and the right to minimal standards of care (Mikos, et. al., 2002).

This course has only reviewed aspects of the nurse practice act specific to Florida. Practice laws differ from state to state. However, the basic tenets of law and nursing responsibility that were taught in nursing school apply everywhere. Ignorance of the rules and regulations is not a defense!

 

Reference

Florida Statutes 2008, Title XXXI1, Chapter 464. Retrieved May 10, 2009 from
http://Flsenate.gov/Statutes/index.crm?App_mode=Display_Statutes

Florida Administrative Code, Sections 64B9-14.001 to 12.003; National Council of State Boards of Nursing, Inc.

Florida Statutes Nursing 2008. Retrieved May 4, 2009 from http://Statutes & Constitution: Search Statutes: Online Sunshine.

Garcia, R. (2009) Changes to 456.0635, Florida Statutes, Email from the executive director of the Florida Board of Nursing, 8/18/2009.

Mikos, C., Collins, S., McAuliffe, D., Money, P. (2002) Florida Nursing Law: An Update. Bert Rodgers Schools Continuing Education Course.

Nursing Law Alerts, 2008. Retrieved May 5, 2009 from http://www.carsonco.net/page9/page9.html

Nursing Law Reports, 2008. Retrieved May 7, 2009 from http://www.carsonco.net/page9/page9.html