IntroductionThe Florida Board of Nursing is a regulatory body that ensures individuals are qualified to practice nursing in the State of Florida in several vital ways; i.e., licenses, disciplines, educates, monitors, and rehabilitates. Nurses are held to a minimal standard to ensure safe, competent care delivered to all patients in a variety of healthcare settings.[NCSBN.org, 2018] Failure to maintain this minimum practice standard will forfeit licensure and result in the inability to practice nursing in the state. The Nurse Practice Act, enacted by the Florida Legislature, provides a framework for providing safe, professional nursing care and offers a layer of protection to the individuals seeking such care.[Floridalegislature, 2018] Show
Nurse Practice Acts, enacted by all territories and states of the United States beginning over 100 years ago to protect the public, provide for established boards of nursing which have full authorization to create rules and regulations that ensure the laws are specific to the nursing profession and offer a sense of clarity. Board rules must follow the laws enacted by the legislature and adopted in the Nurse Practice Act of each state or territory. Rules and regulations promulgated by the board have the full effect of the law and are enforceable.[NCSBN.org, 2018] A nursing professional must be familiar with their state's specific nurse practice act set forth by law. Requirements change and a healthcare professional is responsible for knowing the current rule of law and cannot claim obtuseness if a problem arises. A misunderstanding or ignorance of the law does not erase responsibility and is not a plausible excuse.[1]
FunctionThe Nurse Practice Act of Florida includes Part I Nurse Practice Act (ss. 464.001-464.027)[Flsenate.gov, 2017] and Part 2 Certified Nursing Assistants (ss. 464.201-464.208). Section 464.002 ensures minimum requirements for safe practice are met, further stipulating that falling below minimum competency, or if present a danger to the public, are prohibited from practicing nursing in the State of Florida.[Flsenate.gov, 2017] Section 464.003 provides some legal definitions related to the nurse practice act and terminology used.[Floridalegislature, 2018] Legal Definitions Reflected in the Nurse Practice Act Section 464.003
Board of Nursing Information as Reflected in the Nurse Practice Act Section 464.004
Licensure by Examination Information Reflected in the Nurse Practice Act Section 464.008
Licensure by Endorsement Information Reflected in the Nurse Practice Act Section 464.009
Nurse Licensure Compact Information Reflected in the Nurse Practice Act Section 464.0095 ARTICLE I FINDINGS AND DECLARATION OF PURPOSE
ARTICLE II DEFINITIONS
ARTICLE III GENERAL PROVISIONS AND JURISDICTION
ARTICLE IV APPLICATIONS FOR LICENSURE IN A PARTY STATE
ARTICLE V ADDITIONAL AUTHORITY VESTED IN PARTY STATE LICENSING BOARDS
ARTICLE VI COORDINATED LICENSURE INFORMATION SYSTEM AND EXCHANGE INFORMATION
ARTICLE VII ESTABLISHMENT OF THE INTERSTATE COMMISSION OF NURSE LICENSURE COMPACT ADMINISTRATORS
ARTICLE VIII RULEMAKING
ARTICLE IX OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCEMENT
ARTICLE X EFFECTIVE DATE, WITHDRAWAL, AND AMENDMENT
ARTICLE XI CONSTRUCTION AND SEVERABILITY
Licensure of Advanced Practice Registered Nurses; Fees; Controlled Substance Prescribing Reflected in the Nurse Practice Act Section 464.012
Renewal of License or Certificate Reflected in the Nurse Practice Act Section 464.013
Inactive Status Reflected in the Nurse Practice Act Section 464.014
Titles and Abbreviations; Restrictions; Penalty Reflected in the Nurse Practice Act Section 464.015
Violations and Penalties Reflected in the Nurse Practice Act Section 464.016
Sexual Misconduct in the Practice of Nursing Reflected in the Nurse Practice Act Section 464.017
Disciplinary Actions Reflected in the Nurse Practice Act Section 464.018 The following acts constitute grounds for denial of a license or disciplinary action, as specified in ss. 456.072(2) and 464.0095:
Approval of Nursing Education Programs Reflected in the Nurse Practice Act Section 464.019
Florida Center for Nursing; Goals Reflected in the Nurse Practice Act Section 464.0195
Florida Center for Nursing; Board of Directors Reflected in the Nurse Practice Act Section 464.0196
Retired Volunteer Nurse Certificate Reflected in the Nurse Practice Act Section 464.0205
Exceptions Reflected in the Nurse Practice Act Section 464.022 No provision of this part shall be construed to prohibit:[flsenate.gov, 2017]
Registered Nurse First Assistant Reflected in the Nurse Practice Act Section 464.027
A registered nurse first assistant must meet the qualifications set forth by the board:
PART II of the Nurse Practice Act Certified Nursing Assistants (ss. 464.201-464.208) Definitions Reflected in the Nurse Practice Act Section 464.201
Duties and Powers of the Board Reflected in the Nurse Practice Act Section 464.202
Certified Nursing Assistants; Certification Requirement Reflected in the Nurse Practice Act Section 464.203
Denial, Suspension, or Revocation of Certification; Disciplinary Actions Reflected in the Nurse Practice Act Section 464.204 The following acts constitute grounds for which the board may impose disciplinary sanctions as specified in subsection (2):
When the board finds any person guilty of any of the grounds outlined in subsection (1), it may enter an order imposing one or more of the following penalties:
The board may, upon the request of a certificate holder, exempt the certificate holder from disqualification of employment in accordance with chapter 435 and issue a letter of exemption. The board must notify an applicant seeking an exemption from disqualification from certification or employment of its decision to approve or deny the request within thirty days after the date the board receives all required documentation.[leg.state.fl.us, 2018] Availability of Disciplinary Records and Proceedings Reflected in the Nurse Practice Act Section 464.205
Exemption from Liability Reflected in the Nurse Practice Act Section 464.206
Penalties Reflected in the Nurse Practice Act Section 464.207
Background Screening Information; Rulemaking Authority Reflected in the Nurse Practice Act Section 464.208
Issues of ConcernAnother Florida Statute, Chapter 456, discusses general provisions of health professions and occupations and is an issue of concern. A healthcare professional must be aware of the laws outlined in this chapter of legislation. The Florida Legislature covers these laws in sections 456.001 to 456.50. Below, we will highlight some of these Florida Statutes underscored in Chapter 456. A comprehensive list and reference found on the Florida Senate website.[flsenate.gov, 2018] 456.001 Definitions
456.003 Legislative Intent And Requirements
456.004 Department Powers and Duties
456.008 Accountability and Liability of Board Members
456.012 Board Rules; Final Agency Action and Challenges
456.0135 General Background Screening Provisions
456.014 Public Inspection of Information Required From Applicants; Exceptions and Examination Hearing
456.017 Examinations
456.018 Penalty for Theft or Reproduction of an Examination
456.019 Restriction on Requirement of Citizenship
456.021 Qualification of Immigrants for Examination to Practice a Licensed Profession or Occupation
456.025 Fees, Receipts, and Disposition Legislative intent dictates that all costs of regulating health care professions and practitioners shall be borne solely by licensees and licensure applicants. It is also the intent of the Legislature that fees should be reasonable and not serve as a barrier to licensure. Moreover, it is the Legislative intent that the department operates as efficiently as possible and regularly report to the Legislature additional methods to streamline operational costs.
456.026 Annual Report Concerning Finances, Administrative Complaints, Disciplinary Actions, and Recommendations
456.028 Consultation With Postsecondary Education Boards Before the Adoption of Changes to Training Requirements.
456.032 Hepatitis B or HIV Carriers
456.0361 Compliance with Continuing Education requirements
456.0495 Reporting Adverse Incidents Occurring in Planned Out-of-Hospital Births For purposes of this section, the term “adverse incident” means an event over which a physician licensed under chapter 458 or chapter 459, a nurse-midwife certified under part I of chapter 464, or a midwife licensed under chapter 467 could exercise control and which associated with an attempted or completed planned out-of-hospital birth, and results in one or more of the following injuries or conditions:
Beginning July 1, 2018, a physician licensed under chapter 458 or chapter 459, a nurse-midwife certified under part I of chapter 464, or a midwife licensed under chapter 467 who performs an attempted or completed planned out-of-hospital birth must report an adverse incident, along with a medical summary of events, to the department within 15 days after the adverse incident occurs.
456.057 Ownership and Control of Patient Records; Reports or Copies of Records to be Furnished and Disclosure of Information Except as otherwise provided in this section and in s. 440.13(4)(c), such records may not be furnished to, and the medical condition of a patient may not get discussed with, any person other than the patient, the patient’s legal representative, or other health care practitioners and providers involved in the patient’s care or treatment, except upon written authorization from the patient. However, such records furnished without written permission under the following circumstances:
456.0575 Duty to Notify Patients
456.068 Toll-free Telephone Number for Reporting of Complaints
456.0721 Practitioners in Default on a Student L oan or Scholarship Obligations, Investigation, Reporting
456.38 Practitioner Registry for Disasters and Emergencies
Clinical SignificanceAs healthcare providers, we have certain ethical and legal obligations related to care delivery. Ethical dilemmas arise regarding palliative care, organ procurement, religious beliefs, cultural considerations, assisted suicide, informed consent, and the disclosure of medical conditions. The American Nurses Association (ANA) provides a Code of Ethics for Nurses with 9 provisions.[ANA, 2015] According to this 2015 Code of Ethics for Nurses with Interpretive Statements by the ANA, provision 1 addresses respect for human dignity, the nature of healthcare, the right to self-determination, and relationships with patients or colleagues. Provision 2 highlights collaboration, the primacy of the patient's interests, professional boundaries, and conflicts of interests for nurses.[2][3][4][5] Provision 3 offers information on the protection of patient rights related to the critical issues; i.e., privacy and confidentiality, human participation in research, nursing while impaired, performance standards, acting on questionable practice, and professional responsibility in promoting a safety culture. Provision 4 discusses authority, responsibility, and accountability. Delegation and assignment of tasks fall under this provision. Clinical judgment and decision making are vital components of this provision. Provision 5 focuses on personal health promotion and well-being, integrity preservation, and continual professional growth. Provision 6 explores environmental moral virtue and ethical obligations. Responsibility for the healthcare environment plays a role in this provision. Provision 7 profiles contributions through scholarly inquiry, research, professional practice standards and development, and policy development. Provision 8 examines health as a universal right and obligations to human rights in a variety of settings. Provision 9 looks at the integrity of the profession and integrating social injustice. In 2017, a Gallup poll ranked nurses as the most trusted profession. This distinctive honor comes with a moral and ethical responsibility to practice within the laws and rules of the Nurse Practice Acts of one's state or territory. Often, aspects of the Code Of Ethics for Nurses provide a framework for nursing laws, codes, and rules. A nurse has a responsibility to know the essential elements of these laws as they relate to and guide safe nursing practice. The Florida Department of State's Administrative Code will further assist nurses in this knowledge.[6][7] Other IssuesThe Florida Department of State’s Administrative Code, Register and Laws Section is the point rules put into effect get filed by state regulatory agencies. Agency rulemaking governed by Chapter 120, Florida Statutes, the Administrative Procedures Act. Regulations published in the Florida Administrative Code.[flrules.org, 2010] Florida Administrative Code Section 64B9 by the Florida Department of State provides information and laws governing certain essential elements of nursing licensure and professional conduct.[flrules.org, 2018] 64B9-2.021 Curriculum Guidelines
64B9-2.022 Clinical Training
64B9-3.002 Qualifications for Examination
64B9-3.008 Licensure by Endorsement
64B9-3.016 Multi-State License Upgrade
64B9-15.0045 Certified Nursing Assistant Renewal Fee
64B9-5.002 Continuing Education Requirement
The following continuing education courses are a mandatory part of the hours required in subsection (1), at the stated time periods:
64B9-8.005 Unprofessional Conduct Unprofessional conduct includes:
64B9-4.004 Requirements for Documentation A Registered Nurse applying for initial certification as an Advanced Registered Nurse Practitioner shall submit with a completed application the following:
Advanced registered nurse practitioners licensed after July 1, 2006, and all certified registered nurse anesthetists, certified nurse midwives, and psychiatric nurses must supply documentation of national certification by a national nursing specialty board identified in subsection 64B9-4.002(2), F.A.C., or documentation of certification by a specialty board that meets the requirements set forth in subsection 64B9-4.002(3), F.A.C., by submitting one of the following:
64B9-8.003 Citations
64B9-15.008 Testing and Competency Evaluation
64B9-15.0097 Notice of Non-Compliance – Minor Violations
The Board designates the following as minor violations for which a Notice of Non-Compliance may be issued for the first violation thereof:
64B9-4.0025 Provisional Certification
64B9-15.0096 Mediation The Board finds that mediation is an acceptable resolution for the first instance of the following violations:
64B9-15.0095 Citation for Certified Nursing Assistants
Enhancing Healthcare Team OutcomesLaws are dynamic, amended and enacted as the legislative need arises. A healthcare provider must be versed in current practice standards and rules outlined in their states Nurse Practice Act. A scope of practice defined, and a framework set for the delegation of duties and safe patient care environments. Professional ethics and legislation a guide in the murky waters of the current healthcare setting of multiple comorbidities, polypharmacy, and the opioid crisis.[8] Review QuestionsReferences1.Haahr A, Norlyk A, Martinsen B, Dreyer P. Nurses experiences of ethical dilemmas: A review. Nurs Ethics. 2020 Feb;27(1):258-272. [PubMed: 30975034] 2.Fowler MD. Literature, Gossip, Lore: On Being a Good Nurse. J Christ Nurs. 2019 Apr/Jun;36(2):77. [PubMed: 30865086] 3.Turner M. If It Is Newsworthy, It Is Ethics-Worthy: Living in the Code of Ethics for Nurses. Creat Nurs. 2018 Aug;24(3):143-151. [PubMed: 30567755] 4.Haddad LM, Geiger RA. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 22, 2022. Nursing Ethical Considerations. [PubMed: 30252310] 5.Sabone M, Mazonde P, Cainelli F, Maitshoko M, Joseph R, Shayo J, Morris B, Muecke M, Wall BM, Hoke L, Peng L, Mooney-Doyle K, Ulrich CM. Everyday ethical challenges of nurse-physician collaboration. Nurs Ethics. 2020 Feb;27(1):206-220. [PubMed: 31014168] 6.Baughman C. Achieving Incremental Outcomes to Reach Goals. J Contin Educ Nurs. 2019 May 01;50(5):193-195. [PubMed: 31026316] 7.Fowler MD. In the Beginning...There Was Nursing Ethics. J Christ Nurs. 2019 Jan/Mar;36(1):14. [PubMed: 30531507] 8.McCarty CA, Barnes R, Thomas M, Sande J, Ouellette A. Ethics Committees: Team Perspectives and Organizational Responses. J Christ Nurs. 2019 Jul/Sep;36(3):180-184. [PubMed: 30585882] Which statement by the nurse indicates understanding of the major factors influencing the increase in health care costs?Which statement by the nurse indicates understanding of the major factors influencing the increase in health care costs? "Health care expenditures are exceeding the cost of the gross domestic product (GDP) in excess of 14%."
What is the Florida Nurse Practice Act quizlet?The purpose of the Nurse Practice Act is to encourage the growth and expansion of hospitals and training schools. According to the Nurse Practice Act, the practice of practical nursing may be conducted under the direction of a registered nurse, licensed dentist, or licensed physician.
Which action by the nurse shows an understanding of the ethical principle of autonomy?Which action by the nurse shows an understanding of the ethical principle of autonomy? Allowing a patient the right to make decisions regarding his health care even if the nurse does not agree with his decisions.
Which one of the following persons would nurses be most accountable to professionally?Nurses and midwives are accountable both legally and professionally for their practice, that is, for the decisions they make and the consequences of those decisions. Nurses and midwives are accountable to the patient, the public, their regulatory body, their employer and any relevant supervisory authority.
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