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Florida Nursing Practice Act: Laws and Rules

Author: David Tilton

 

Florida Nursing Practice Act: Laws and Rules | Copyright © 2014 CEUFast.com


 

Purpose

The purpose of this course is to prepare nurses to practice within the parameters of the Florida Nurse Practice Act.

 

Objectives

At the conclusion of this course, the learner will be able to:

1. Maintain expected levels of continuing education necessary to hold a nursing license in the state of Florida.
   
2. Prepare for the nursing registration and licensure process in the state of Florida.
   
3. Identify documentation standards required of nurses in the state of Florida.
   
4. Describe professional standards regarding drug misuse or abuse in the state of Florida.
   
5. Demonstrate awareness of the change in processing for the CE required to re-license for Florida nurses.
   
6. Discuss the upcoming 2015 requirement of 2-hours CE pertaining to Florida Nursing Law.

 

Florida Nursing Licensure by Examination

The nursing profession covers a wide spectrum of care. It is no wonder that training to be a nurse may also widely differ. Florida is a license by examination state, allowing graduates from state board approved prelicensure nursing programs, or programs determined by the Florida Board of Nursing to be equivalent to an approved program, to take the license examination for registered nurse or licensed practical nurse (Title XXXII ss.464, 2014).

The Florida Department of Health (FDOH) appraises each person applying for the licensing examination to determine eligibility for testing. Steps needed to apply, and qualifications necessary, include the following:

1. Submission to the Florida Department of Health of the examination application form and fee. As of the end of 2013 the fee limits set by the legislature are capped so as not to exceed $75, plus the actual per applicant cost to the FDOH for the National Council of State Boards of Nursing examination. The total cost to the applicant is $150 or less.
   
2. Submission of sufficient information for a statewide criminal records check through the Florida Department of Law Enforcement.
   
3. Endorsement that the applicant is in good physical and mental health, has received a high school diploma or equivalent, and has graduated from an approved prelicensure nursing program or equivalent.
   
4. Has the ability to communicate in the English language, which may be determined by examination.

One item specific to Florida's Nursing Statute, Title XXXII subsection 464 of the Florida Professions and Occupations Statutes, has potential for confusion. This is the flexibility that the FDOH has been granted by the state legislature, allowing nurses who have attended but not completed a registered nursing program. The intent is that certain individuals be allowed to apply for licensure by examination as a licensed practical nurse, not as a registered nurse, as long as these applicants provide documentation to show they have completed sufficient courses within a registered nursing education program at least equivalent to a practical nursing education program, and that they meet the other requirements set by the state for licensure. When all of the required pieces fall into place, Florida is happy to allow them the opportunity to gain licensure by examination.

Licensure testing is not a cakewalk. Florida utilizes nationally recognized testing materials and practices furnished by the National Council of State Boards of Nursing, or an equivalent organization. Should a nurse applicant for license fail the examination three consecutive times, regardless of where or when the exam was taken, completion of a remedial course approved by the Florida Board of Nursing is required before allowing another try at the examination. A further set of three unsuccessful attempts, warrants approved remediation.

 

Florida Nursing Licensure by Endorsement

Already a practicing professional nurse? Florida welcomes you! The Florida Department of Health has the ability to grant a nursing license to current holders from other jurisdictions, provided they demonstrate to the Florida Board of Nursing the following qualifications:

1. Endorsement applicant holds a valid license to practice professional or practical nursing in a territory or state of the United States.
   
2. Requirements present at the time and place of the endorsement applicant's original licensure were substantially equivalent, or exceeded, those of Florida at that same period of time.
   
3. Endorsement applicant meets the same qualifications set for a license by examination applicant, including but not limited to, successfully completing a state or national nursing examination equivalent or more stringent than that given by the FDOH.

The Florida Department of Health has the flexibility to waive proof of previous license by examination as long as the applicant for endorsement has actively practiced nursing in another state, jurisdiction, or territory of the United States for two of the preceding three years without issues against their license. If this waiver is used, completion of a Florida laws and rules course approved by the board will be required along with a national criminal history check (Title XXXII ss.464, 2014).

Military family members relocating to Florida pursuant to a spouse's deployment are not penalized. On proof of a current license in another state that is a member of the Nurse Licensure Compact, you will be deemed to have satisfied the requirements of endorsement and need only file the appropriate application, fees, and pass a fingerprint background check.

Be aware, the Florida Department of Health will not issue a license by endorsement to anyone who is under investigation in any jurisdiction for matters related to the practice of nursing.

 

Florida Certification of Advanced Nurse Practitioners

Licensure as a registered nurse in Florida is the foundation for certification for advanced registered nurse practitioner status. After meeting registered nurse licensing requirements, one or more of the following will be needed, as determined by the Florida Board of Nursing:

1. Completion of a formal post-basic education program for advanced or specialized practice of at least one academic year.
   
2. Certification by an appropriate specialty board.
   
3. Graduation from a master's degree nursing clinical specialty program.
   
4. A relationship of supervision with a monitoring physician.

 

Florida Nursing Education Standards

Throughout the Florida Statutes that refer to nurses are references to the level of nursing education mandated by the state. Educational institutions who wish to offer nurses training or prelicensure professional nursing programs must meet strict standards in order to practice in Florida.

In 2009 the Florida Legislature waded into the Nursing Education field, modifying, expanding, and changing the way the education of nurses was to be conducted. Many significant changes resulted from this, at times unwelcome, intrusion by government into education administrations (OPPAGA, January 2013).

From the end of 2009 to the beginning of 2013, the Florida Office of Program Policy Analysis and Government Accountability records the following changes measured in nursing education:

  172 new nursing education programs approved, a 104% increase.
   
  Nursing student numbers increased by 79%.
   
  Enrollment in nursing programs increased by 54%.
   
  Students graduating from nursing programs increased by 28%.

The Florida Board of Nursing keeps a close eye on education. In 2012 eleven nursing programs were placed on probation for failing to meet the minimum average graduate licensure exam passage rate set by the state legislature. If a program shows a state license exam success rate 10% or greater below the national average for two consecutive calendar years, the board requires a corrective action plan and closely watches to see if the training pulls its passage rate up within the following two years.

State statutes specify that at least half of practical, associate, or diploma nursing education be devoted to clinical training. Also, at least forty percent of the longer bachelor's degree training must comprise clinical learning and hands-on experience. These high standards focus on skills practice, supported by theory and expert supervision. Topics mandated during training encompass:

  Nutrition
   
  Human growth and development
   
  Medical
   
  Surgical
   
  Obstetrics
   
  Geriatric
   
  Mental health
   
  Pharmacology
   
  Medication administration
   
  Legal aspects of nursing

With a further focus on theoretical instruction and clinical application in interpersonal relationships and leadership skills, professional role and function, plus health teaching and counseling skills in professional nursing education programs (Title XXXII ss.464, 2014).

 

Florida Nursing Documentation Standards

Documentation that is poor, filled with errors, or appears falsified comprise some of the most frequent complaints filed against a nurse's license. In Florida, the Board of Nursing and Department of Health take such matters very seriously (Indest III, GF, July 8, 2013).

The Florida Department of Education details in its curriculum structure the need for nursing programs to place an emphasis on demonstrating procedures for accurate documentation and record keeping in nurses training (Curriculum Framework, 2012).

Accurate documentation of care is necessary to meet legal and ethical aspects of quality patient care. Clear, accurate and succinct charting, journals the course of care and provides the foundation for shared information about client and disease management.

Nursing Documentation

  Be definite in what you record. No conjectures, guesses or opinions. Avoid phrasing such as "appears to".
   
  Document regular or "baseline" observations. Without knowing what is normal for each individual it is impossible to recognize problems and address them in a timely manner.
   
  Use quantifiable data when describing. If a measuring tool is not handy it is acceptable to use reference to common items such as "the size of a pencil eraser" etc.
   
  Every intervention warrants an evaluation of response to it.
   
  Avoid medicalese. Write like you speak, without resorting to jargon unless the terms are in common use and easily understood by anyone reading the note.
   
  Be timely in your documentation. It is easy to forget details in the bustle of business.
   
  Late notes happen. Should you need to document something out of time do it properly and in an orderly manner by first documenting when you are making the late note, then detailing the actual time the event occurred. Never be deceptive and "back-date" or fake that you are writing at an earlier time.
   
  Flow Charts need filled. Every organization has flow charts, do not leave them blank. Also, whenever an unusual event occurs remember to also go to the chart to document your findings.
   
  Remember "If you did not write it down, you did not do it. If you did not do it, you were negligent".
 

(Indest, GF., The Florida Nursing Law Manual, 2008)

 

Florida Nursing License Renewal

The Florida Department of Health Division, Medical Quality Assurance (MQA) is responsible for license renewal for nursing professionals. Nurses licensed in Florida must renew every two years, either with an online or by mail option. Renewal reminders are mailed out to holders of a Florida license, so be sure to keep the state Board of Nursing apprised of any address change. On the postcard, which comes approximately six weeks prior to the renewal date, will be a reminder of the website for online renewals along with the address and fees due for those who prefer to utilize mail.

The MQA renewal website requires password and user IDs, which are issued at the time of the original licensure. If you have misplaced your documents simply follow the helps present on the website. Do remember that as a health professional, important documentation should be retained, and not much trumps license paperwork in importance.

Florida Online Nursing Renewal

  You may renew online at www.flhealthsource.gov.
   
  Your ID and Password can also be reset at www.flhealthsource.gov or you may call 850-488-0595 for assistance.
   
  Online renewal allows immediate printing of license verification. If renewing by mail, please allow 1-2 weeks for receipt of your new nursing license.
   
  Individuals or employers can verify the status of your renewal at the following website: http://ww2.doh.state.fl.us/IRM00PRAES/PRASLIST.ASP or call the Communication Services Unit, 850-488-0595, to verify the status of a nursing license.
   
  The Department of Health, Medical Quality Assurance will verify a practitioner's continuing education record in the state mandated electronic tracking system at the time of renewal.

(Florida Nursing Renewal, 2013)

Providing the required continuing education has been met, proof of licensure will be posted promptly on the state verification website or posted within one to two weeks of receiving your mailed renewal.

 

Florida Nursing Continuing Education Requirements

Florida requires continuing professional learning as a component of licensure. In the Florida Administrative Code (FAC) Rule 64B9-5, appropriate continuing education is described as: Planned offerings designed to enhance learning and promote the continued development of knowledge, skills, and attitudes consistent with contemporary standards for nursing practice (FAC 64B9-5., January 3, 2012).

Licensed Practical Nurses, Registered Nurses, Clinical Nurse Specialists and Advanced Registered Nurse Practitioners will need 24 hours of appropriate continuing education (CE) during each renewal period, including 2 hours relating to prevention of medical errors. In addition to the 24 hours of general nursing focused CE, every third renewal an additional 2 hours of domestic violence CE must be completed for a total of 26 hours in that renewal cycle.

Don't Panic CE Rule of Thumb

Note that Florida follows what I refer to as a "Don't Panic" rule regarding Continuing Education requirements. Essentially, if you make a disciplined effort to collect One Hour of CE every month, by and large, you can meet your relicensure requirements without the panicked frenzy of training many nurses go through in the 90-days before a relicense date.

Remember that time spent in Orientation to a new workplace Does NOT count toward mandated CE in Florida.

(FAC 64B9-5., January 3, 2012)

The Florida Department of Health employs an online verification system to confirm completion of continuing education at the time of renewal. This tracking system checks its records when you renew, and if the required course work is present allows the renewal process to continue. If the requisite hours or specified trainings are not present you will be prompted to report completions through the state contracted CE Broker online service before being allowed to continue your license renewal. Some CE providers will report your completions to the tracking system for you, some will not. It will be up to you to be on top of items that you need to enter by hand into the electronic verification system. Each license holder can report completed hours by logging into MQA Services using the user id and password assigned at the time of original licensure. Also the sites at www.flhealthsource.com or www.CEatRenewal.com will be able to direct you to the CE Broker tracking system where you can create a free basic account (Florida Health CE/CME at Renewal, 2012).

NEW 2015 Florida Nursing CE Requirement

  Each license holder is required to complete a two hour course on the laws and rules that govern the practice of nursing in Florida.
   
  To count for renewal, the Florida Laws and Rules course must include content on Chapters 456 and 464 of the Florida Statutes and the rules in Title 64B9 of the Florida Administrative Code.

(FAC 64B9-5., January 3, 2012)

 

Florida Nursing Discipline Process

Every health profession has a mechanism for ensuring that acceptable standards are being maintained by practitioners. In Florida, the state Board of Nursing has been granted the authority by law to investigate nurses having the appearance of violating practice standards or those against whom allegations have been made. Florida laws and rules that describe the standard of practice for nurses include; Chapter 456 of the Florida Statutes, which addresses all licensed health professionals, Chapter 464 of the Florida Statutes which contains the Florida Nurse Practice Act, and Chapter 64B9 of the Florida Administrative Code, which contains Practice Rules sponsored by the Board of Nursing.

It is interesting to note that complaints filed against nurses by Florida employers include the areas of; Substandard performance, poor or falsified documentation, and drug theft or diversion. Accusations that may prompt a Hearing before the Board of Nursing can cover a wide range of concerns (Indest III, GF, July 8, 2013).

Florida Statute 464.018 Disciplinary Actions Examples

  Grounds for denial of license or disciplinary action;
   

       

License by bribery or misrepresentation
   
        License revoked, suspended or acted against
   
        Conviction of any crime related to nursing
   
        Being found guilty of;
   
Forcible felony
   
Theft, robbery, or related charge
   
Lewdness, indecent exposure
   
Assault, battery, culpable negligence
   
Protection actions related to abuse, neglect, exploitation
   
Child or elder abuse, abandonment, or neglect
   

       

Domestic violence
   
        Making or filing a false report or record
   
        False, misleading, or deceptive advertising
   
        Unprofessional conduct
   
        Possession, sale, or distribution of a controlled substance
   
        Inability to practice nursing due to alcohol, drugs, narcotics, or other chemicals
   
        Failing to report any individuals in violation of the rules of the FDOH or state nursing board

(2013 Florida Statutes, November 2013)

While there are several options which the Board of Nursing might take, depending on the results of an individual appraisal process and discipline hearing, one route available in Florida for nurses struggling with impairment is the Intervention Project for Nurses (IPN).

Established by the state legislature in 1983, the Intervention Project for Nurses allows a treatment and guidance alternative to those struggling with the misuse or abuse of alcohol or drugs, or who have a mental or physical condition that might affect their ability to practice nursing safely and with proficiency.

IPN is a free resource for nurses licensed in Florida, and provides referrals to Board approved addiction, mental health, or other treatment providers. The staff at IPN assists nurses, working alongside them with ongoing support, and should a disciplinary action already be present, goes with the nurse to hearings, confirming that they are engaged in the recovery process. (IPN, May 2013).

 

Conclusion

The state of Florida needs nurses, and is a good place to work. Clear, consistent standards are present describing nursing duties, education, and expectations. Whether seeking a license to practice nursing by exemption or examination, those considering making Florida their home can find a worthwhile career choice as a nurse in the sunshine state.

 

Reference

2013 Florida Statutes. (November 2013). "464.018 Disciplinary Actions". The Florida Senate. Retrieved from http://www.flsenate.gov/Laws/Statutes/2013/464.018 April 2, 2014

Austin, C. (January 18, 2014). "Nursing Education". The Ledger. Retrieved from http://www.theledger.com/article/20140118 February 12, 2014

Curriculum Framework. (August 9, 2012). "Practical Nurse". Florida Department of Education. Retrieved from https://www.fldoe.org March 31, 2014

FAC 64B9-5. (January 3, 2012). "Continuing Education Requirements". Florida Department of State, Florida Administrative Code and Florida Administrative Register. Retrieved from https://www.flrules.org/gateway/ChapterHome.asp?Chapter=64B9-5 March 4, 2014
Florida Health CE/CME at Renewal, (2012). "CE at Renewal". CE Broker Continuing Education Portfolio. Retrieved from http://www.ceatrenewal.com April 5, 2014

Florida Nursing Renewal, (2013). "Renewal FAQs". Florida Board of Nursing. Retrieved from http://floridasnursing.gov/nursing-faqs/renewal April 3, 2014

Indest III, GF. (July 8, 2013). "Traveling Nurses Must Have Appropriate Professional Liability Insurance". Nursing Law Blog. Retrieved from http://nursinglawblog.wordpress.com/2013/07/08/traveling-nurses-must-have-appropriate-professional-liability-insurance March 3, 2014

Indest, GF, (2008). The Florida Nursing Law Manual. Altamonte Springs, Fla.

IPN, (May 2013). "Intervention Project for Nurses", Retrieved from http://www.ipnfl.org/ipnfaq.html April 5, 2014

OPPAGA, (January 2013). "Florida's Nursing Education Programs Continued to Expand in 2012 with Increases in Program Capacity, Student Enrollment, and Graduates". OPPAGA. The Florida Legislature Office of Program Policy Analysis & Government Accountability. Retrieved from http://www.oppaga.state.fl.us February 23, 2014

Title XXXII ss.464. (2013). "FL Statutes - Title XXXII Regulation of Professions and Occupations Section 464 Nursing". Retrieved from http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0464/0464.html March 30, 2014.