Florida Nursing Laws and Rules of the Board

EDUCATIONAL OBJECTIVES:


1. Describe the legislative purpose for the Nurse Practice Act.
2. Verbalize specific laws and rules related to the practice of nursing and nursing assisting.
3. Identify the pertinent levels of nursing practice in the State and the general scope of practice of each.
4. Discuss the general requirements for continuing licensure in the State.
5. Differentiate between ethical and legal practice.
6. Discuss the process for discipline related to nursing practice.
7. Create a professional plan for career maintenance and development within the limits of the law.

Disclaimer:
This course is not intended to offer legal advice or to provide a substitute for legal advice. While laws are frequently cited within the text of this paper, you should be aware that laws can be interpreted differently depending on the specific situation. This is a course which will provide you with an understanding of basic ethical issues which nurses often face but if you find yourself in a difficult situation in which you do not clearly understand what you should do, it is of vital importance that you take the matter seriously and consult your licensing board, with colleagues, an attorney, or an ethics review committee. It is much wiser to do this prior to trying a method you think is appropriate only to find that you have violated ethical and legal rules and put yourself in legal danger. 
The following is a compilation of the content of Chapters 456 and 464 of the Florida Statutes and the rules in Title 64B9 of the Florida Administrative Code.

Purpose of the Nurse Practice Act.
The legislative purpose in enacting the Nurse Practice Act is to ensure that every nurse practicing in Florida meets minimum requirements for safe practice. Nurses who fall below minimum competency or who otherwise present a danger to the public shall be prohibited from practicing in Florida.

Laws and rules related to the practice of nursing.
Violations and Penalties

 Each of the following acts constitutes a felony of the third degree,
(1) Practicing advanced or specialized, professional, or practical nursing unless holding an active license or certificate to do so.
(2) Using or attempting to use a license or certificate which has been suspended or revoked.
(3) Knowingly employing unlicensed persons in the practice of nursing.
(4) Obtaining or attempting to obtain a license or certificate by misleading statements or knowing misrepresentation.

Each of the following acts constitutes a misdemeanor of the first degree:
(1) Using the name or title
Nurse
Registered Nurse
Licensed Practical Nurse
Clinical Nurse Specialist
Certified Registered Nurse Anesthetist
Certified Nurse Midwife
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.
(2) Knowingly concealing information relating to violations of this part..

Sexual misconduct 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.

The following acts constitute grounds for denial of a license or disciplinary action:
(1) 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.
(2) 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.
(3) Being convicted or found guilty of, or entering a plea of nolo contendere to, regardless of adjudication, a crime in any jurisdiction which directly relates to the practice of nursing or to the ability to practice nursing.
(4) Being found guilty, regardless of adjudication, of any of the following offenses:

A forcible felony.
theft, robbery, and related crimes.
fraudulent practices.
lewdness and indecent exposure.
assault, battery, and culpable negligence.
child abuse.
protection from abuse, neglect, and exploitation.
    child abuse, abandonment, and neglect.

(5) Having been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, any offense prohibited  or having committed an act which constitutes domestic violence.
(6) 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.
(7) False, misleading, or deceptive advertising.
(8) Unprofessional conduct, as defined by board rule.
(9) Engaging or attempting to engage in the possession, sale, or distribution of controlled substances.
(10) 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.
 (11) 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 professionals consultant.
(12) 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.
(13) Failing to report to the department any licensee 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 or a health maintenance organization certificated in which the nurse also provides services.
(14) Failing to meet minimal standards of acceptable and prevailing nursing practice, including engaging in acts for which the licensee is not qualified by training or experience.
 (15) The board may enter an order denying licensure or imposing

Disciplinary Proceedings.

(1) Unprofessional conduct shall include:
(a) Inaccurate recording; or
(b) Misappropriating supplies or equipment; or
(c) Leaving a nursing assignment without advising licensed nursing personnel; or
(d) Practicing as a registered or practical nurse or as a certified nursing assistant in the State of Florida with a delinquent license for no more than 90 days; or
(e) Acts of negligence either by omission or commission; or
(f) Submitting the attestation of 24 hours of continuing education and one hour continuing education on domestic violence for licensure renewal when the licensee has not attended or completed all such hours in the biennium; or
(g) Failure of an ARNP dispensing practitioner to comply with the registration and compliance requirements of Rule 64B9-4.011; or
(h) Stealing from a patient;
(i) Violating the integrity of a medication administration system or an information technology system.
(2) Failing to meet or departing from minimal standards of acceptable and prevailing nursing practice shall include, but not be limited to, the following:
(a) Falsifying or altering of patient records or nursing progress records, employment applications or time records; or
(b) Administering medications or treatments in negligent manner; or
(c) Misappropriating drugs; or
(d) Violating the confidentiality of information or knowledge concerning a patient; or
(e) Discrimination on the basis of 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; or
(f) Engaging in fraud, misrepresentation, or deceit in taking the licensing examination; or
(g) 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; or
(h) Impersonating another licensed practitioner, or permitting another person to use his certificate for the purpose of nursing for compensation; or
(i) Acts of gross negligence, either by omission or commission; or
(j) Exercising influence on a patient in such a manner as to exploit the patient for financial gain of the licensee or a third party; or
(k) Testing positive for any drugs on any drug screen when the nurse does not have a prescription and legitimate medical reason for using such drug; or
(l) Violation of a Board order entered in a licensure proceeding; or
(m) Providing false or incorrect information to the employer regarding the status of the license; or
(n) Practicing beyond the scope of the licensee’s license, educational preparation or nursing experience; or
(o) Using force against a patient, striking a patient, or throwing objects at a patient; or
(p) Using abusive, threatening or foul language in front of a patient or directing such language toward a patient.

MEDICAL RECORDS

Medical Records of Deceased Nurse.
(1) Each Registered Nurse (RN) or Advanced Registered Nurse Practitioner (ARNP) engaged in private practice, who maintains possession of client/patient medical records, shall ensure that the executor, administrator, personal representative or survivor of such RN or ARNP shall arrange to maintain those medical records in existence upon the death of the RN or ARNP for a period of at least two (2) years from the date of the death of the RN or ARNP.
(2) Within one (1) month from the date of death of the RN or ARNP, the executor, administrator, personal representative or survivor shall cause to be published in the newspaper of greatest general circulation in the county where the RN or ARNP practice, a notice indicating to the clients/patients of the deceased RN or ARNP that the nurse’s medical records are available to the clients/ patients or their duly constituted representative from a specific person at a certain location.
(3) At the conclusion of a 22-month period of time from the date of death of the RN or ARNP or thereafter the executor, administrator, personal representative or survivor shall cause to be published once during each week for four (4) consecutive weeks, in the newspaper of greatest general circulation in the county where the RN or ARNP practiced, a notice indicating to the clients/patients of the deceased nurse that client/patient records will be disposed of or destroyed one (1) month or later from the last day of the fourth week of publication of notice.

Records of Nurses Relocating or Terminating Practice.

(1) The Board of Nursing and the Legislature recognize the need for maintenance and retention of medical records in order to protect and serve clients/patients. For that reason, the Legislature has directed the Board of Nursing to promulgate rules setting standards that will provide a minimum requirement for retention and disposition of client/patient records of nurses relocating and terminating practice. However, the Board of Nursing is concerned that the promulgation of these rules may mislead the licensed nurses. Paragraph (2) of this rule sets forth standards which, if not met, will constitute a violation of Sections 456.058 and 464.018, Florida Statutes, and will subject the nurse to disciplinary proceedings. Nurses should retain medical records as long as needed not only to serve and protect clients/patients, but also to protect themselves against adverse actions. The times specified in paragraph (2) below may well be less than the length of time necessary for protecting the nurses. Furthermore, the times stated may fall below the community standards for retention in specific communities and practice settings and for specific client/patient needs. For these purposes, nurses may wish to seek advice from private legal counsel or their insurance carrier.

(2) Each Registered Nurse (R.N.) or Advanced Registered Nurse Practitioner (A.R.N.P.) engaged in private practice, who maintains possession of client/patient medical records, shall, when terminating or relocating practice in such a manner as to no longer be reasonably available to clients/patients, notify each client/patient of such termination or relocation and unavailability. Such notification shall consist of at least causing to be published, in the newspaper of greatest general circulation in each county in which the nurse practices or practiced, a notice which shall contain the date of termination or relocation and an address at which medical records may be obtained. Such notice shall be published no less than 4 times over a period of at least 4 weeks. In addition, the nurse shall place in a conspicuous location in or on the facade of the nurse’s office, a sign, announcing the termination or relocation of the practice. The sign shall be placed at least thirty (30) days prior to the termination or relocation and shall remain until the date of termination or relocation. Both the notice and the sign shall advise the clients/patients of their opportunity to transfer or receive their medical records. Furthermore, each such licensee shall see that client/patient records are maintained and may be obtained by the client/patient for a minimum of 2 years after the termination or relocation of practice.

ADMINISTRATION OF INTRAVENOUS THERAPY BY LICENSED PRACTICAL NURSES
Statement of Intent and Purpose.

(1) The “practice of practical nursing”  Florida Statutes, includes the “administration of treatments and medication,” under direction, and holds the licensed practical nurse “responsible and accountable for making decisions based upon the individual’s educational preparation and experience in nursing.” As medical science advances and the demands for health care in Florida grow, the scope of nursing practice, in general, and of the practice of practical nursing, in particular, is expanding. It has become necessary that the licensed practical nurse, when qualified by training and education and when approved by the institution at which the licensed practical nurse is employed, engage in the limited administration of intravenous therapy both to serve the public and to allow the professional nurse to better perform those acts requiring professional nursing specialized knowledge, judgment and skill.
(2) The purpose of this rule is to protect the public by ensuring the availability of intravenous therapy and its competent administration in the care of the ill, injured or the infirm. In keeping with the purpose, this rule authorizes the qualified licensed practical nurse to administer those aspects of intravenous therapy within the scope of practice of the licensed practical nurse, enumerates those aspects of intravenous therapy outside the scope of practice of the licensed practical nurse, and sets out the educational and/or competency verification necessary to administer, under direction, limited forms of intravenous therapy.

Aspects of Intravenous Therapy Outside the Scope of Practice of the LPN.
                                                                                                                                     
(1) Aspects of intravenous therapy which are outside the scope of practice of the licensed practical nurse unless under the direct supervision of the registered professional nurse or physician and which shall not be performed or initiated by licensed practical nurses without direct supervision include the following:
(a) Initiation of blood and blood products;
(b) Initiation or administration of cancer chemotherapy;
(c) Initiation of plasma expanders;
(d) Initiation or administration of investigational drugs;
(e) Mixing IV solution;
(f) IV pushes, except heparin flushes and saline flushes.
(2) Although this rule limits the scope of licensed practical nurse practice, it is appropriate for licensed practical nurses to care for patients receiving such therapy.

Authority for the LPN to Administer Limited Forms of Intravenous Therapy.

(1) With the exception of those aspects of intravenous therapy deemed outside the scope of practice of the licensed practical nurse and subject to the approval of the institution at which the licensed practical nurse is employed, any licensed practical nurse who meets the competency knowledge requirements is authorized to administer intravenous therapy under the direction of a registered professional nurse.
(2) Individuals who have completed a Board approved prelicensure practical nursing education program, professional nursing students who qualify as graduate practical nurses, or licensed practical nurses who have not completed the specified course may engage in a limited scope of intravenous therapy under the direction of a registered nurse, physician or dentist. This scope includes:
(a) Perform calculation and adjust flow rate;
(b) Observe and report subjective and objective signs of adverse reactions to IV administration;
(c) Inspect insertion site, change dressing, and remove intravenous needle or catheter from peripheral veins.
(d) Hanging bags or bottles of hydrating fluid.

Competency and Knowledge Requirements Necessary to Qualify the LPN to Administer IV Therapy.

(1) Contents. The board endorses the Intravenous Therapy Course Guidelines issued by the Education Department of the National Federation of Licensed Practical Nurses, November, 1983. The intravenous therapy education must contain the following components:
(a) Policies and procedures of both the Nurse Practice Act and the employing agency in regard to intravenous therapy. This includes legalities of both the Licensed Practical Nurse role and the administration of safe care. Principles of charting are also included.
(b) Psychological preparation and support for the patient receiving IV therapy as well as the appropriate family members/ significant others.
(c) Site and function of the peripheral veins used for veinpuncture.
(d) Procedure for vein puncture, including physical and psychological preparation, site selection, skin preparation, palpation of veins, and collection of equipment.
(e) Relationship between intravenous therapy and the body’s homeostatic and regulatory functions, with attention to the clinical manifestations of fluid and electrolyte imbalance.
(f) Signs and symptoms of local and systemic complications in the delivery of fluids and medications and the preventive and treatment measures for these complications.
(g) Identification of various types of equipment used in administering intravenous therapy with content related to criteria for use of each and means of troubleshooting for malfunction.
(h) Formulas used to calculate fluid and drug administration rate.
(i) Methods of administering drugs intravenously and advantages and disadvantages of each.
(j) Principles of compatibility and incompatibility of drugs and solutions.
(k) Nursing management of the patient receiving drug therapy, including principles of chemotherapy, protocols, actions, and side effects.
(l) Nursing management of the patient receiving blood and blood components, following institutional protocol. Include indications and contraindications for use; identification of adverse reactions.
(m) Nursing management of the patient receiving parenteral nutrition, including principles of metabolism, potential complications, and physical and psychological measures to ensure the desired therapeutic effect.
(n) Principles of infection control in IV therapy, including aseptic technique and prevention and treatment of iatrogenic infection.
(o) Nursing management of special IV therapy procedures that are commonly used in the clinical setting, such as heparin lock, central lines, and arterial lines.
(p) Glossary of common terminology pertinent to IV fluid therapy.
(q) Performance check list by which to evaluate clinical application of knowledge and skills.
(2) Central Lines. The Board recognizes that through appropriate education and training, a Licensed Practical Nurse is capable of performing intravenous therapy via central lines under the direction of a registered professional nurse. Appropriate education and training requires a minimum of four (4) hours of instruction. The requisite four (4) hours of instruction may be included as part of the thirty (30) hours required for intravenous therapy education specified in subsection (4) of this rule. The education and training required in this subsection shall include, at a minimum, didactic and clinical practicum instruction in the following areas:
(a) Central venous anatomy and physiology;
(b) CVL site assessment;
(c) CVL dressing and cap changes;
(d) CVL flushing;
(e) CVL medication and fluid administration;
(f) CVL blood drawing; and
(g) CVL complications and remedial measures. Upon completion of the intravenous therapy training via central lines, the Licensed Practical Nurse shall be assessed on both theoretical knowledge and practice, as well as clinical practice and competence. The clinical practice assessment must be witnesses by a Registered Nurse who shall file a proficiency statement regarding the Licensed Practical Nurses ability to perform intravenous therapy via central lines. The proficiency statement shall be kept in the Licensed Practical Nurses personnel file.

Upon completion of the intravenous therapy training via central lines, the Licensed Practical Nurse shall be assessed on both theoretical knowledge and practice, as well as clinical practice and competence. The clinical practice assessment must be witnesses by a Registered Nurse who shall file a proficiency statement regarding the Licensed Practical Nurses ability to perform intravenous therapy via central lines. The proficiency statement shall be kept in the Licensed Practical Nurses personnel file.

(3) Providers: The LPN/IV education must be sponsored by a provider of continuing education courses approved by the Board. To be qualified to teach any such course, the instructor must be a currently licensed registered nurse in good standing in this state, have teaching experience, and have professional nursing experience, including IV therapy. The provider will be responsible for issuing a certificate verifying completion of the requisite number of hours and course content.

(4) Educational Alternatives. The cognitive training shall include one or more of the following:
(a) Post-graduate Level Course. In recognition that the curriculum requirements mandated for practical nursing programs are extensive and that every licensed practical nurse will not administer IV Therapy, the course necessary to qualify a licensed practical nurse to administer IV therapy shall be not less than a thirty (30) hour post-graduate level course teaching aspects of IV therapy.
(b) Credit for Previous Education. The continuing education provider may credit the licensed practical for previous IV therapy education on a post-graduate level is tested by and competency demonstrated to the provider.
(c) Nontraditional Education. Continuing education providers may select nontraditional education alternatives for acquisition of cognitive content. Such alternatives include:

  1. Interactive videos;
  2. Self study;
  3. Other nontraditional education that may be submitted to the Board for consideration and possible approval. Any continuing education providers using nontraditional education must make provisions for demonstration of and verification of knowledge.

(5) Clinical Competence. The course must be followed by supervised clinical practice in intravenous therapy as needed to demonstrate clinical competence. Verification of clinical competence shall be the responsibility of each institution employing a licensed practical nurse based on institutional protocol. Such verification shall be given through a signed statement of a Florida licensed registered nurse.

Scope of Practice

"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 limited to:

  1. 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.
  2. 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.
  3. 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 osteopathic 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.
(c) "Clinical nurse specialist practice" means the delivery and management of advanced practice nursing care to individuals or groups, including the ability to:

  1. Assess the health status of individuals and families using methods appropriate to the population and area of practice.
  2. Diagnose human responses to actual or potential health problems.
  3. Plan for health promotion, disease prevention, and therapeutic intervention in collaboration with the patient or client.
  4. Implement therapeutic interventions based on the nurse specialist's area of expertise and within the scope of advanced nursing practice, including, but not limited to, direct nursing care, counseling, teaching, and collaboration with other licensed health care providers.
  5. Coordinate health care as necessary and appropriate and evaluate with the patient or client the effectiveness of care.

(d) "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 appropriately 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 composed of three members appointed by the Board of Nursing, two of whom must be advanced registered nurse practitioners; three members appointed by the Board of Medicine, two of whom must have had work experience with advanced registered nurse practitioners; and the State Surgeon General of the department or the State Surgeon General's designee. Each committee member appointed by a board shall be appointed to a term of 4 years unless a shorter term is required to establish or maintain staggered terms. The Board of Nursing shall adopt rules authorizing the performance of any such acts approved by the joint committee. Unless otherwise specified by the joint committee, such acts must be performed under the general supervision of a practitioner licensed under chapter 458, chapter 459, or chapter 466 within the framework of standing protocols which identify the medical acts to be performed and the conditions for their performance. The department may, by rule, require that a copy of the protocol be filed with the department along with the notice required by s. 458.348.
(e) "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 such conditions, signs, symptoms, and reactions represent a deviation from normal.
(f) "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.

(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, including certified registered nurse anesthetists, certified nurse midwives, and nurse
practitioners.

CNA Duties

Certified Nursing Assistant Authorized Duties.
(1) A certified nursing assistant shall provide care and assist residents with the following tasks related to the activities of daily living only under the general supervision of a registered nurse or licensed practical nurse:
(a) Tasks associated with personal care:

  1. Bathing;
  2. Dressing;
  3. Grooming;
  4. Shaving;
  5. Shampooing and caring for hair;
  6. Providing and assisting with oral hygiene and denture care;
  7. Caring for the skin;
  8. Caring for the feet;
  9. Caring for the nails;
  10. Providing pericare;
  11. Bed making and handling linen;
  12. Maintaining a clean environment.

(b) Tasks associated with maintaining mobility:

  1. Ambulating;
  2. Transferring;
  3. Transporting;
  4. Positioning;
  5. Turning;
  6. Lifting;
  1. Performing range of motion exercises;
  2. Maintaining body alignment.

(c) Tasks associated with nutrition and hydration:

  1. Feeding and assisting the resident with eating;
  2. Assisting the resident with drinking.

(d) Tasks associated with elimination:

  1. Toileting;
  2. Assisting with the use of the bedpan and urinal;
  3. Providing catheter care;
  4. Collecting specimens;
  5. Emptying ostomy bags, or changing bags that do not adhere to the skin;
  6. Bowel and bladder training.

(e) Tasks associated with the use of assistive devices:

  1. Caring for dentures, eyeglasses, contact lenses, and hearing aids;
  2. Applying established prosthetic and orthotic devices;
  3. Applying braces;
  4. Applying antiembolus stockings;
  5. Assisting with wheelchairs, walkers, or crutches;
  6. Using comfort devices such as pillows, cradles, footboards, wedges, and boots;
  7. Assisting with and encouraging the use of self-help devices for eating, grooming, and other personal care tasks;
  8. Utilizing and assisting residents with devices for transferring, ambulation, alignment, and positioning;
  9. Using restraints.

(f) Tasks associated with maintaining environment and resident safety, including handling of blood and body fluid and cleaning resident care areas.
(g) Tasks associated with data gathering:

  1. Measuring temperature, pulse, respiration, and blood pressure;
  2. Measuring height and weight;
  3. Measuring and recording oral intake;
  4. Measuring and recording urinary output, both voided and from urinary drainage systems;
  5. Measuring and recording emesis;
  6. Measuring and recording liquid stool.

(h) Recognition of and reporting of abnormal resident findings, signs, and symptoms.
(i) Post mortem care.
(j) Tasks associated with resident socialization, leisure activities, reality orientation, and validation techniques.
(k) Tasks associated with end of life care.
(l) Tasks associated with basic first aid, CPR skills, and emergency care.
(m) Tasks associated with compliance with resident’s/patient’s rights.
(n) Tasks associated with daily documentation of certified nursing assistant services provided to the resident.
(2) A certified nursing assistant shall perform all tasks with knowledge of and awareness of a resident’s/patient’s rights and developmental level.
(3) A certified nursing assistant shall not perform any task which requires specialized nursing knowledge, judgment, or skills.
(4) A certified nursing assistant may receive additional training beyond that required for initial certification and upon validation of competence in the skill by a registered nurse may perform such skills as authorized by the facility.
(5) A certified nursing assistant shall not work independently without the supervision of a registered nurse or a licensed practical nurse.

In-Service Training Requirements for Certified Nursing Assistants.
(1) Each certified nursing assistant must complete a minimum of 12 hours of in-service training each calendar year. For candidates certified during the calendar year, the minimum in-service hours required shall be prorated at the rate of 1.0 hours per month from the month of initial certification to the end of the calendar year.
(2) Every 2 years, in-service training hours shall include, but are not limited to, the following areas:
(a) HIV/AIDS, Infection Control;
(b) Domestic Violence;
(c) Medical Record Documentation and Legal Aspects Appropriate to Nursing Assistants;
(d) Resident Rights;
(e) Communication with Cognitively Impaired Clients;
(f) CPR Skills; and
(g) Medical Error Prevention and Safety.
(3) After meeting the requirement in subsection (2), health care career/technical courses in a college, university, or approved nursing program may be used to meet the hour requirement in subsection (1).

(4) A certified nursing assistant is exempt from the in-service education requirement in subsection (1) if the certified nursing assistant was on active duty with the Armed Forces for 6 months or more during the calendar year, and was in good standing with the Board at the time active duty began. However, this exemption will not arise on the basis of the performance of short periods of active duty (such as summer or weekend drills) by a member of the Armed Forces Reserves. Duty in the United States Public Health Service is not considered duty in the Armed Forces.

(5) A certified nursing assistant 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 in-service hour requirements. The certified nursing assistant must show satisfactory proof of the absence and the spouse’s military status.
(6) Each certified nursing assistant must retain in-service compliance records for a period of 4 years and submit records to the Board if required for auditing.

 "Practice of a certified nursing assistant" means providing care and assisting persons with tasks relating to the activities of daily living. Such tasks are those associated with personal care, maintaining mobility, nutrition and hydration, toileting and elimination, assistive devices, safety and cleanliness, data gathering, reporting abnormal signs and symptoms, postmortem care, patient socialization and reality orientation, end-of-life care, cardiopulmonary resuscitation and emergency care, residents' or patients' rights, documentation of nursing-assistant services, and other tasks that a certified nurse assistant may perform after training beyond that required for initial certification and upon validation of competence in that skill by a registered nurse. This subsection does not restrict the ability of any person who is otherwise trained and educated from performing such tasks.

Any disciplinary action taken against the certified nursing assistant. The registry shall be accessible to the public, the certificate holder, employers, and other state agencies. The board shall adopt by rule testing procedures for use in certifying nursing assistants and shall adopt rules regulating the practice of certified nursing assistants and specifying the scope of practice authorized and the level of supervision required for the practice of certified nursing assistants. The board may contract with or approve another entity or organization to provide the examination services, including the development and administration of examinations. The board shall require that the contract provider offer certified nursing assistant applications via the Internet, and may require the contract provider to accept certified nursing assistant applications for processing via the Internet. The board shall require the contract provider to provide the preliminary results of the certified nursing examination on the date the test is administered. The provider shall pay all reasonable costs and expenses incurred by the board in evaluating the provider's application and performance during the delivery of services, including examination services and procedures for maintaining the certified nursing assistant registry.

ARNP

Standards for Protocols.

(1) An Advanced Registered Nurse Practitioner shall only perform medical acts of diagnosis, treatment, and operation pursuant to a protocol between the ARNP and a Florida-licensed medical doctor, osteopathic physician, or dentist. The degree and method of supervision, determined by the ARNP and the physician or dentist, shall be specifically identified in the written protocol and shall be appropriate for prudent health care providers under similar circumstances. General supervision by the physician or dentist is required unless these rules set a different level of supervision for a particular act. The number of persons to be supervised shall be limited to insure that an acceptable standard of medical care is rendered in consideration of the following factors:
(a) Risk to patient;
(b) Educational preparation, specialty, and experience of the parties to the protocol;
(c) Complexity and risk of the procedures;
(d) Practice setting; and
(e) Availability of the physician or dentist.
(2) A written protocol signed by all parties, representing the mutual agreement of the physician or dentist and the ARNP, shall include the following, at a minimum:
(a) General Data.

1. Signatures of individual parties to the protocol;
a. Name, address, ARNP certificate number;
b. Name, address, license number, and DEA number of the physician or dentist;

  1. Nature of practice, practice location, including primary and satellite sites; and
  2. Date developed and dates amended with signatures of all parties

(b) Collaborative Practice Agreement.

  1. A description of the duties of the ARNP.

Dispensing Practitioners.
(1) Those ARNP’s whose protocols permit them to dispense medications for a fee must register with the Board of Nursing.
(2) The ARNP dispensing practitioner must comply with all state and federal laws and regulations applicable to all dispensing practitioners.

A description of the duties of the physician or dentist (which shall include consultant and supervisory arrangements in case the physician or dentist is unavailable).
The management areas for which the ARNP is responsible, including

a. The conditions for which therapies may be initiated,
b. The treatments that may be initiated by the ARNP, depending on patient condition and judgment of the ARNP,
c. The drug therapies that the ARNP may prescribe, initiate, monitor, alter, or order.

  1. A provision for annual review by the parties.
  2. Specific conditions and a procedure for identifying conditions that require direct evaluation or specific consultation by the physician or dentist. The parties to the protocol, to insure an acceptable standard of supervision and medical care, will decide the detail and scope needed in the description of conditions and treatments, and in doing so will consider the factors listed in subparagraphs (1)(a) through (e) above.

(3) The original of the protocol and the original of the notice shall be filed with the Department yearly, and a copy of the protocol and a copy of the notice required shall be kept at the site of practice of each party to the protocol. Any alterations to the protocol or amendments should be signed by the ARNP and a Florida-licensed medical doctor, osteopathic physician, or dentist and filed with the Department within 30 days of the alteration to be kept in the Department for filing purposes only. After the termination of the relationship between the ARNP and the supervising professional, each party is responsible for insuring that a copy of the protocol is maintained for future reference for a period of four years.

Continuing Education - Required Courses

HIV/AIDS.

(1) All licensees shall submit confirmation to the Board, on a form provided by the Board, that they have successfully completed an approved course on Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS).

(2) Licensees who prior to July 1, 1989 complied with the HIV/AIDS course requirement must complete a one hour HIV/AIDS course. Such confirmation shall be submitted with the licensee’s biennial licensure renewal.

(3) Applicants for licensure who graduated from schools of nursing whose curriculum included a course on HIV/AIDS may submit verification of completion of such course to the Board for compliance with this rule.

(4) Applicants for initial licensure must submit proof of completion of a three hour HIV/AIDS course under this rule.

(5) Persons reactivating an inactive or lapsed license or seeking reinstatement of a suspended or revoked license must submit proof of completion of a three hour HIV/AIDS course under this rule prior to licensure. However, if the person submits proof of completion of the HIV/AIDS course equivalent to the requirements prior to July 1, 1989, and taken prior to the 1989 biennial renewal cycle, only a one hour course shall be required.

(6) To receive Board approval, each course on HIV/AIDS shall consist of at least one hour of classroom instruction or an equivalent home study program and shall include the following subject areas:
(a) Modes of transmission;
(b) Infection control procedures;
(c) Clinical management;
(d) Prevention;
(e) Florida law on AIDS and the impact on testing, confidentiality, and treatment.

(7) Applicants for initial licensure, upon showing of good cause by affidavit, shall be given six months from the date of licensure to complete the HIV/AIDS course. Good cause includes applicants for endorsement or examination who have been residing outside of Florida or have been on active military service.

Domestic Violence.

All licensees must complete a one hour course on domestic violence. This is in addition to the continuing education hours required for biennial renewal. Applicants for initial licensure, upon showing of good cause by affidavit, shall be given six months from the date of licensure to complete the Domestic Violence course. Good cause includes applicants for endorsement or examination who have been residing outside of Florida or have been on active military service.

Prevention of Medical Errors.

(1) All licensees must complete a two hour course on prevention of medical errors as part of the total hours of continuing education required for initial licensure and biennial renewal.
(2) To receive Board approval, each course on prevention of medical errors shall consist of a minimum of at least two (2) hours of classroom or an equivalent home study program and shall include at a minimum the following subject areas:
(a) Factors that impact the occurrence of medical errors,
(b) Recognizing error-prone situations,
(c) Processes to improve patient outcomes,
(d) Responsibilities for reporting,
(e) Safety needs of special populations,
(f) Public education.

End of Life.

(1) In lieu of completing a course in HIV/AIDS education or Domestic Violence a licensee may complete a course in end-of-life care or palliative health care.
(2) To receive Board approval, each course on end of life or palliative care shall consist of at least one hour of classroom instruction or an equivalent home study program and shall include, at a minimum, any of the following subject areas:
(a) Palliative care vs. curative.
(b) Rights of patients to self determination/decision making.
(c) Emotional, psycho/social, spiritual, and family issues.
(d) Pain management/comfort.
(e) Legal/ethical issues.
(f) Advanced Directives.
(g) Available choices/options for care.
(h) Applicable Florida laws.

CeBroker.com is used by the Florida Board of Nursing and its licensees to report Continuing Education credit.

Address of Record and Place of Practice.

(1) Each person holding a license must maintain on file with the Board of Nursing the current address at which any notice required by law may be served by the Board or its agent. Within 60 days of changing this address, whether or not within this state, the licensee shall notify the Board in writing of the new address at which the licensee may be served with notices or other documents.
(2) Each person holding a license issued must maintain on file with the Board of Nursing the current place of practice. Place of practice is defined as one of the following:
(a) Acute care facility;
(b) Long-term care facility;
(c) Rehabilitation facility;
(d) Clinic;
(e) Physician’s office;
(f) Home health care agency;
(g) Educational institution;
(h) Office of independent nursing practice;
(i) Correctional facility;
(j) Mental health facility;
(k) Occupational health facility;
(l) Managed health care organization or insurance company;
(m) Community health facility;
(n) Other

5. Differentiate between ethical and legal practice.
Legal issues have a specific law behind them, which will result in legal consequences if not followed. Ethics are the rules of conduct recognized in the nursing profession and typically set forth by an association such as the ANA.

Disciplinary Guidelines; Range of Penalties

(1) The legislature created the Board to assure protection of the public from nurses who do not meet minimum requirements for safe practice or who pose a danger to the public. The suspensions, restrictions of practice, and conditions of probation used by the Board in discharging its duties shall include, but are not limited to, the following:

(a) Suspension until appearance before the Board or for a definite time period and demonstration of ability to practice safely.
(b) Suspension until appearance before the Board, or for a definite time period, and submission of mental or physical examinations from professionals specializing in the diagnosis or treatment of the suspected condition, completion of counseling, completion of continuing education, demonstration of sobriety and ability to practice safely.
(c) Suspension until fees and fines paid or until proof of continuing education completion submitted.
(d) Suspension until evaluation by and treatment in the Intervention Project for Nurses. In cases involving substance abuse, chemical dependency, sexual misconduct, physical or mental conditions which may hinder the ability to practice safely, the Board finds participation in the IPN under a stayed suspension to be the preferred and most successful discipline.
(e) Suspension stayed so long as the licensee complies with probationary conditions.
(f) Probation with the minimum conditions of not violating laws, rules, or orders related to the ability to practice nursing safely, keeping the Board advised of the nurse’s address and employment, and supplying both timely and satisfactory probation and employer/supervisor reports.
(g) Probation with specified continuing education courses in addition to the minimum conditions. In those cases involving unprofessional conduct or substandard practice, including recordkeeping, the Board finds continuing education directed to the practice deficiency to be the preferred punishment.
(h) Probation with added conditions of random drug screens, abstention from alcohol and drugs, participation in narcotics or alcoholics anonymous, psychological counseling, the prohibition on agency work, or the requirement that work must be under direct supervision on a regularly assigned unit.
(i) Personal appearances before the Board to monitor compliance with the Board’s order.
(j) Administrative fine and payment of costs associated with probation or professional treatment.

(2) The Board sets forth below a range of disciplinary guidelines from which disciplinary penalties will be imposed upon practitioners and applicants for licensure guilty of violating Chapters 464 and 456, F.S. The purpose of the disciplinary guidelines is to give notice to licensees and applicants of the range of penalties which will normally be imposed upon violations of particular provisions. The disciplinary guidelines are based upon a single count violation of each provision listed. Multiple counts of violations of the same provision or the rules promulgated thereto, or other unrelated violations will be grounds for enhancement of penalties. All penalties set forth in the guidelines include lesser penalties, i.e., reprimand and or course-work which may be included in the final penalty at the Board’s discretion.
 
Career Maintenance

It is important to take care of yourself. Nurses who are having problems within their own families, use alcohol or drugs inappropriately, are having emotional problems, or simply need a vacation are the most likely people to make minor and major errors in their work of patients. This may occur from the distraction caused by the nurse's own problems or from unconscious motives which are more likely to be enacted when one is not at one's best and inhibitions are lowered.

Stay in touch with changes in laws through professional organizations and stay updated on the Florida Statutes. Maintain your memberships and attend meetings on a regular basis. This will also help you make and maintain friendships with other nurses.

Look at your mail at a time when you can do some reading. Instead of stacking the journal you just got, scan through the articles and read the ones that interest you. You could impress your colleagues at professional meetings by dropping names and you could even try out some of the new techniques you read about and develop some skill with timing.

Most importantly, do your paperwork. It gives you time to reflect on what you are doing with the patient and it relieves you of all the guilt you have felt for not keeping up with it. It is also illegal to fail to do it. Do not underestimate how much time this takes. Completing HIPAA notes can become very quick and efficient if you have a system and do them regularly. On the other hand, trying to recreate the important points of a session from hastily sketched notes during an intense session at the end of the week is nearly impossible. You remember that it was an important session but often lose the crucial meaning which was derived from the work done that day. While all this seems self-evident, it is important to recognize that keeping notes for anything other than an aid to treatment in most cases was rare until HIPAA was imposed only a few years ago. Know your limitations.

HIPAA:

HIPAA stands for the Health Insurance Portability and Accountability Act. When this act was initially proposed by Senators Kassenbaum and Kennedy, it was seen as a means to protect individuals who were changing jobs or using a private insurance plan while self-employed from being denied insurance because of previous illness. During the Act’s passage through Congress, it has become quite different than the authors of the initial proposal envisioned.

At this time, HIPAA provides standards for protecting the records and privacy of individuals by making the transmission of electronic claims (billing) secure, by providing rules for the secure storage of patient records, streamlining the insurance billing process, and actually protecting some records. It is no longer a means for protecting patient records from being denied insurance due to a previous diagnosis or prescription which would be seen by an insurance company as “risky.” People who have had previous illnesses continue to have their insurance applications denied because insurance companies have access to vital data such as the diagnosis, treatment administered, and prognosis. In short, the information provided in the patient’s Protected Health Information is more than adequate for an insurance company to determine whether the patient in question will be covered by an insurance company. Most large group policies are required by law to admit all individuals working within the company to be provided with health insurance, regardless of previous illness.  (Senator Nancy Kassenbaum)

The main problem lies with those individuals who must obtain private health insurance. They generally must supply the insurance company to which they apply with information about their previous medical and psychological care and provide permission for the insurance company to access those care records. Obtaining private insurance, such as one would do when self-employed or working for a small company which is not required to cover its employees by law, requires that an individual have a health record which is virtually clean of all major illnesses. Providing a prospective insurance company with the Private Health Information no longer protects the patient in any way from being denied coverage. In fact, it seems to simplify the records so insurance companies can quickly decide whether or not to cover an applicant.

HIPPA provides standards for the storage of all health care information including the transmission of electronic claims to protect the individuals’ records from others who may have improper access to unprotected electronic transmission. Thus, anyone who is using electronic transmission, including Medicare providers, and providers for insurance which require electronic transmission, must use protected electronic transmission only. HIPAA also was designed to streamline the insurance claims process by standardizing both claims and records.

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