The Florida Nurse Practice Act is Part I of Chapter 464: Nursing, of Title XXXII: Regulation of Occupations and Professions. The Nurse
Practice Act states:
“The sole legislative purpose of enacting this part is to ensure that every nurse practicing in this state meets minimum requirements for safe practice.”
The Nurse Practice Act provides basic information, relevant to the state of Florida, on the state’s definition of what nursing is, the basic duties and responsibilities of each type of nursing professional, how nurses should be educated and trained, how they should be licensed, how they should be certified, continuing education requirements, and the disciplinary process as it pertains to nurses. The Nurse Practice act also states: “It is the legislative intent that nurses who fall below minimum competency or who otherwise present a danger to the public shall be prohibited from practicing in thisstate.”
The Nurse Practice Act is not a technical document that provides instructions and standards for performing specific nursing actions. The Nurse Practice Act offers a general overview of the laws, rules, and regulations that pertain to nursing and nursing practice in the state of Florida in the following areas:
There are specifics regarding the nature and scope of nursing practices for each of the recognized areas of practice (i.e., A.P.R.N, graduate nurse). But the Nurse Practice Act only provides, for the most part, broad definitions of what nursing professionals can and cannot do. The Nurse Practice Act also notes that an individual nurse can practice within the constraints of the Nurse Practice Act, but also within the constraints of that individual’s education, experience, and the rules and regulations of a specific health care facility. Two examples of how nursing is defined in the Nurse Practice Act are provided in this course. These are from Chapter 464, Part 1, Section 464.03: Definitions. The first pertains to Registered Nurses, the second toLicense Practical Nurses.
“Practice of professional nursing” 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 limitedto:
“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; 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 osteopathic physician, a licensed podiatric physician, or a licensed dentist; and the teaching of general principles of health and wellness to the public and to students other than nursing students. A practical nurse is responsible and accountable for making decisions that are based upon the individual’s educational preparation and experience innursing.
The Nurse Practice Act is available online at several links, such as:http://www.doh.state.fl.us/mqa/nursing/info_PracticeAct.pdf.
Administrative codes are rules and regulations formulated by government agencies. This section covers the Florida state Department of Health administrative code.
The Florida Administrative Code 64B9, administered by the Department of Health, contains rules and regulations that apply to the profession of nursing. There are 15 sections in Administrative Code 64B9. Some of the information in sections 1-9 and 11-16 (there is no
Section 10) is duplicated in the Florida Nurse Practice Act, but some of the sections and some of the information contained in Administrative Code 64B9 are not. The 15 sections are listed here.
The information contained in the different sections of Code 64B9 is relatively specific, as highlighted below.
the institution at which the licensed practical nurse is employed, any licensed practical nurse who meets the competency knowledge requirements of Rule 64B9-12.005, F.A.C., below, is authorized to administer intravenous therapy under the direction of a registered professional nurse.
Administrative Code 64B9 can be viewed online at https://www.flrules.org/gateway/Organization.asp?OrgNo=64B9.
Throughout this course there will be notations such as 64B9-8.005: Unprofessional conduct or 464.015: Titles –
abbreviations, restrictions, penalty. These indicate that a part of the text has been derived from a specific section of the Nurse Practice Act or the Florida Administrative Code.
The state of Florida recognizes and defines the following types of nursing professionals or nursing ancillary personnel and defines their scopes of practice.
An Advanced Registered Nurse Practitioner is defined as any person who is licensed in the state to practice professional nursing and certified in advanced or specialized nursing practice including certified registered nurse anesthetists, certified nurse midwives, certified nurse practitioner, or clinical nurse specialist. The proper abbreviations for these titles are A.R.N.P., C.R.N.A., C.N.M., C.N.P., and C.N.S. (464.015: Titles and abbreviations, restrictions, penalty).
To practice as an A.R.N.P., a nurse must complete a post-basic education program of at least one-year duration that will lead to a master’s degree with preparation in specialized skills, and possess a certification that has been granted by a specialty certification board. An A.R.N.P. in Florida can practice as a C.R.N.A., a C.N.M., a C.N.P., or aC.N.S.
When the requirements have been fulfilled, the A.R.N.P. is allowed to:
1) Monitor and alter drug therapies,
2) Order diagnostic tests, occupational therapy, and physical therapy, 3) initiate appropriate therapies for certain conditions,
4) manage selected medical problems,
5) Initiate, monitor, or alter therapies for certain uncomplicated acute illnesses,
6) monitor and manage patients with stable, chronic diseases,
7) establish behavioral problems and diagnosis and make treatment recommendations,
8) perform acts of medical diagnosis, treatment, prescription, and operation if these are identified and approved by a special committee of the Board of Nursing, and
9) perform additional functions if they are identified by rule.
In addition to the general functions specified in subsection (3), an advanced registered nurse practitioner may perform specific acts and functions appropriate to, and within his or her specialty, i.e., C.R.N.A., a C.N.M., a C.N.P., or a C.N.S. The list of these is specialty responsibilities are quite long and they will not be listed here; interested readers should refer to the Florida Statutes and Chapter464.
|A Florida A.R.N.P. may only perform medical acts of diagnosis, treatment, and operation pursuant to a protocol between theA.R.P.N and a Florida- licensed medical doctor, osteopathic physician, or dentist. Appropriate arrangements for supervision of the A.R.N.P. must be made: specifics on these arrangements can be found in 64B9-4.010 Standards for Protocols.|
The requirements for certification as a C.R.N.A and the basic scope of practice are identical to those of the basic scope of practice of the
A.R.N.P. C.R.N.A.s must be certified by the NBCRNA (National Board of Certification & Recertification of Nurse Anesthetists)
The requirements for certification as a C.N.M and the basic scope of practice are identical to those of the basic scope of practice of the
A.R.N.P. C.N.M.s must be certified by the AMCB (American Midwifery Certification Board).
The requirements for certification as a C.N.S. and the basic scope of practice are identical to those of the basic scope of practice of the
A.R.N.P. The certification boards that are considered acceptable are for a
C.N.S. are 1) the Oncology Nursing Certification Corporation, 2) American Association of Critical Care Nurses,
3) American Nurses Credentialing Center, and 4) the National Board for Certification of Hospice and Palliative Nurses.
|Practitioners who are allowed to dispense medications must apply to state Board of Nursing, and practitioners who dispense must comply with all state and federal laws and regulations as they apply to dispensing practitioners.|
The requirements for certification as a C.N.P. and the basic scope of practice of a C.N.P. are identical to those of the A.R.N.P. The C.N.P. must obtain certification through one of the following: 1) American Nurse Credentialing Center if the C.N.P. will be practicing as an Adult Nurse Practitioner, Family Nurse Practitioners, Gerontological Nurse Practitioner, Pediatric Nurse Acute Care Nurse Practitioner, or Psychiatric Mental Health Nurse Practitioner (Adult or Family),
2) American Academy of Nurse Practitioners if the C.N.P. will be practicing as an Adult-Gerontology Primary Care NP, 3) National Certification Corporation if the C.N.P. will be practicing as a Neonatal Nurse Practitioner or a Women’s health Nurse practitioner, and
A Graduate Nurse is defined as someone who is a graduate of an approved nursing program or nursing or an equivalent who has not yet taken and passed the licensure examination for which that person is eligible. The title may be abbreviated as G.N. (464.015: Titles and abbreviations, restrictions, penalty).
A Graduate Practical nurse is defined as someone who is a graduate of an approved nursing program or an equivalent who has not yet taken the licensure examination for which that person is eligible. The title may be abbreviated as G.P.N. (464.015: Titles and abbreviations, restrictions, penalty. A Graduate Nurse or Graduate Practical Nurse can practice nursing only if 1) the nurse has applied for the licensing
examination and has been authorized by the State Board of Nursing to practice as a Graduate Nurse or Graduate Practical Nurse, and 2) is directly supervised by a Registered Nurse (64B9-3.003).
|Direct supervision is defined as an R.N. physically on the premises and immediately available if needed. A Graduate Nurse/Graduate Practical Nurse can administer intravenous therapy if that person is under the direct supervision of a registered nurse, a physician, or a dentist. (64B9-12.004)|
A Licensed Practical Nurse is defined as any person who is licensed in the state to practice practical nursing; the title may be abbreviated as
L.P.N. An L.P.N. is often allowed to perform essentially anything an
R.N. might do, but the L.P.N. must be under the direct supervision of an R.N., a licensed physician, a licensed osteopathic physician, a
licensed podiatric physician, or a licensed dentist. More specifically, an
L.P.N. can perform selected acts, including the administration of treatments and medications, in the care of the ill, injured, or infirm, 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 osteopathic physician, a licensed podiatric physician, or a licensed dentist, and the teaching of general principles of health and wellness to the public and to students other than nursing students.
A practical nurse is responsible and accountable for making decisions that are based upon the individual’s educational preparation and experience in nursing (464.003 Definitions). An L.P.N., if qualified by training and education and approved by his/her place of employment, can administer intravenous medications. There are limits to this practice, and a brief listing of these are outlined below.
An L.P.N. may act in a supervisory role in nursing home facilities if certain requirements are met (64B9-16.003 Competency and Knowledge Requirements Necessary to Qualify the LPN to Supervise in Nursing Home Facilities; and, 64B9-16.004 Delegation of Tasks Prohibited).
A Registered Nurse is defined as any person licensed in the state to practice nursing, and the title may be abbreviated as R.N. The term registered nurse and professional nurse are used interchangeably in the Nurse Practice Act. The scope of practice of a registered nurse in the state of Florida is defined as:
…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:
wellness, maintenance of health, and the prevention of illness of others, 4) the administration of medications and treatments as prescribed by a duly licensed practitioner authorized by the laws of this state to prescribe such medications and treatments, and 5) the supervision and teaching of other personnel in the theory and performance of any of the above acts (464. 003 Definitions).
Registered Nurses are not allowed to diagnose, prescribe medications or dispense medications unless the R.N. is an A.P.R.N. (It should be noted that the term dispense is not synonymous with administer).
A Certified Nursing Assistant (C.N.A.) must go through an approved program, take a written exam and a clinical skills test, and can then receive certification if the examined skills and the test are successfully completed. The C.N.A. is then allowed to perform his/her duties while under the direct supervision of an R.N. or an L.P.N. or other licensed professional (64B9-15.001: Definitions).
Under certain circumstances, the C.N.A. may practice under the supervision of an R.N. or an L.P.N., if that person is not present but can easily be contacted when need for consultation or advice. A Certified Nursing Assistant provides basic care to patients: a complete list responsibilities and scope of practice of a C.N.A. can be found in the Nurse Practice Act, section 64B9-15.002, Certified Nursing Assistant Authorized Duties. The R.N. or L.P.N. may not delegate the
Nursing is a profession and is governed by rules and ethics, and the expression of these is typically called professional conduct. Nurses are also obviously guided and constrained by the rules of conduct and the laws of our society. Some actions or behaviors may be considered unethical and unprofessional but may not be illegal – but a nurse who participated in unethical or unprofessional behavior could be punished and/or sanctioned by the Board of Nursing. And some actions and behaviors are unethical, unprofessional, and illegal, and would be subject to punishment by the criminal justice system.
The overlap between unethical or unprofessional and illegal can be complicated, and the specific differences between ethical and legal – what constitutes one as opposed to another – are not discussed.
Punishments for infractions are clearly outlined, but the State Board of Nursing and the criminal justice system consider many factors when deciding on punishments. These factors include the danger to the public, previous infractions, the length of time the nurse has practiced, the damage that has been caused, and any attempts by the nurse to correct or stop the behavior in question.
Most of the information provided in the following sections has been gleaned from the Chapter 64B9, Hearings, Proceedings, Conferences, Discipline, Sections 64B90-8.001 to 8.014 (located online at https://www.flrules.org/gateway/ChapterHome.asp?Chapter=64B9-8).Information on Criminal Offenses and Denial of License was gleaned from Title XXXII: Regulation of the Professions and Occupations.
Chapter 464, Nursing: Section, 464:016 Violations and Penalties (accessed at: http://floridasnursing.gov/resources/).Details about the
discipline process is in 64B9-8.001, The Probable Cause Panel, 64B9- 8.006, Section 64B9-8.006, Disciplinary Guidelines, Range of Penalties, Aggravating and Mitigating Circumstances.
This section covers actions considered to be unprofessional conduct in the practice of nursing in Florida under Chapter 64B9, Section 64B9- 8.005: Unprofessional Conduct.
regarding the status of the license
A citation is defined as a summons to appear before a court, governing body, etc. A citation can be issued and a fine of $100 can be levied if a nurse has committed any of the following acts (Chapter 64B9-8, Section 64B9-8.003 Citations).
The Board designates the first instance of the following as citation violations, which shall result in a penalty of $100.00: False, deceptive or misleading advertising in violation of Section 464.018(1)(g), F.S., provided no criminal prosecution resulted and no practice issue was involved. In addition, violations would include 1) Improper use of a nursing title under Section 464.015, F.S., provided no practice issue was involved or no criminal prosecution resulted and 2) Unprofessional conduct as defined in subsection 64B9-8.005(15), F.A.C., using abusive, threatening or foul language in front of a patient or directing such language toward a patient.
The Board designates the second instance of the following as citation violations, which shall result in a penalty of $100.00: Issuance of a worthless bank check to the Department or to the Board in violation of Section 464.018(1)(a), F.S., provided the licensee does not continue
to practice on an inactive license or the check was not in payment of a Board ordered administrative fine. The following failures to comply with Board rules associated with varied citations and fines are outlined in the Florida board of nursing rules and regulations for nursing practice.
The Board designates a citation violation, which shall result in a penalty of $250.00 for second-time failure to complete continuing education hours within the biennium. In addition to the fine, the licensee will be required to complete the number of hours necessary to meet the biennial requirements not completed within 6 months of the issuance of the citation.
The Board designates the first instance of the following a citation
violation, which shall result in a penalty of $1,500: 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. In addition to the fine dompletion of a 2-hour course in the legal aspects of nursing is required within 60 days of issuance of the citation.
The following are considered minor violation (Chapter 64B9-8, Section 64B9-8.0045: Minor Violations).
Sexual contact between a nurse and a patient is unethical, unprofessional, and can be punishable by the Nursing Board and the criminal justice system (Section 464.017: Sexual misconduct in the
practice of nursing).
The following acts are considered to be a felony of the third degree, punishable as provided in the Florida Statutes s. 775.082, s. 775.083, or s. 775.084 (464:016 Violations and Penalties):
Each of the following acts constitutes a misdemeanor of the first degree, punishable as provided in Florida Statutes s. 775.082 or s. 775.083:
The disciplinary guidelines are lengthy and complex and they will not be fully covered; readers are referred to 64B9-8.006: Disciplinary Guidelines, Range of Penalties, Aggravating and Mitigating Circumstances, which may be found online at: https://www.flrules.org/gateway/RuleNo.asp?title=HEARINGS,%20PROCEEDINGS,%20CONFERENCES,%20DISCIPLINE&ID=64B9-8.006.
A license to practice nursing in the state of Florida can be denied or a license can be removed/suspended (Section 464.018: Disciplinary Actions). The following are grounds for denial of a license or disciplinary action. The list is not all-inclusive: see 466.018 for more information, using this link – http://floridasnursing.gov/resources/. The Chapters refer to Florida Statutes.
knows is in violation of this part or of the rules of the department or the board.
A license to practice nursing may be denied or an existing license suspended if a nurse is “… unable to practice nursing with reasonable skill and safety to patients by reason of … use of alcohol, drugs, narcotics …” (464:018). The disciplinary process for this infraction is explained in the Section 64B9-8.006: Disciplinary Guidelines, Range of Penalties, Aggravating and Mitigating Circumstances. Section 64B9- 8.014: Continuous Sobriety also addresses this issue. Online resources for impaired nurses and safe nursing practice are available at
Denial and/or suspension of a nursing license because of impairment involves professional discipline and possibly criminal penalties, and it is a complex issue. For more information, the reader is referred the Florida Board of Nursing, Intervention Project for Nurses. The Nurse Practice Act and Chapter 64B9 provide general, but not complete information about nurse impairment.
The following requirements must be met to maintain nursing licensure in Florida (649B-5.002: Continuing Education Requirement). Section 64B9-3.013 also has specific information about appropriate subject matter, faculty qualifications, and the clinical component of continuing education programs, record keeping, and other rules/regulations about the process.
During each biennium, one contact hour must be earned for each calendar month of the licensure cycle. These education courses are a mandatory part of the hours required in subsection (1) at the stated time periods, and consist of:
First Biennium Renewal: LPNs and RNs initially licensed by examination during the current biennium are exempt from the general CEU requirements for the first renewal. Those licensees must complete 2 hours of Medical Error, 2 hours in Florida laws and rules, 2 hours of Recognizing Impairment in the Workplace, and 1 hour of HIV/AIDS.
LPNs and RNs initially licensed by endorsement during the current biennium and took the exam in another state within the biennium are exempt from general CEU hours. Those licensees must complete 2 hours of Medical Error, 2 hours in Florida laws and rules, 2 hours of Recognizing Impairment in the Workplace and 1 hour of HIV/AIDS. Initial licenses that were issued for less than 24 months are required to complete 1 hour for each month that the license was valid for; these hours must include the required hours listed above.
First licenses are not generally valid for a full two years. If your Florida license was not issued for the full two year biennium you must complete 1 hour of CE for each month that you hold the license.
A registered nurse who also holds a current license as a licensed practical nurse may satisfy the continuing education requirement for renewal of both licenses by completing appropriate continuing education for a registered nurse. A registered nurse who also holds a current ARNP certificate may satisfy the continuing education requirement for both licenses by completing appropriate continuing education for a registered nurse, or may satisfy up to 50% of the continuing education requirement by completing continuing medical education coursework equivalent to the contact hours required by these rules.
A nurse who is the spouse of a member of the Armed Forces and was
caused to be absent from Florida due to the spouse’s duties with the Armed Forces shall be exempt from continuing education requirements. The licensee must show satisfactory proof of the absence and the spouse’s military status.
Continuing education is a requirement for nurses, and a citation can be issued and a fine of $100 can be levied if a nurse has not completed the continuing education requirements. This includes 1) Failure to complete a Board ordered continuing education course by the time ordered, provided the course had been completed by the time the citation issues, 2) Failure when requested to document full compliance with the continuing education requirements, provided that all continuing education courses had been timely completedhas committed any of the following acts, and 3) A citation can be issued and fine of $250 can be levied if a nurse is found to have a first-time failure to complete continuing education hours within the biennium. In addition to the fine, the licensee will be required to complete the number of hours necessary to meet the biennial requirements not completed within 6 months of the issuance of the citation (64B9- 8.003: Citations). More information about continuing education and license renewal can be found on the Florida Board of Nursing website using this link:http://www.ceatrenewal.com/.
It should be noted here that the American Nurses Association (ANA) has issued a statement: Call for Action: Nurses Lead and Transform Palliative Care. This statement has several parts and one is a recommendation that continuing education in palliative care be a requirement for license renewal by encouraging state boards of nursing with continuing education re-licensure requirements to
mandate inclusion of palliative care content. At the time of this writing, the state of Florida does not require that nurse have continuing education in palliative care as a requirement for re-licensure.
License renewal requires filling out a renewal application (by mail or on-line) and paying a renewal fee. Information on the renewal process can be found on the Florida Board of Nursing website using this link:http://www.floridasnursing.gov/renewals/.