The Florida Statutes are organized into 58 Titles, each with a number of Chapters. Title XXXII, Regulation of Professions and Occupations, contains 39 chapters. Chapter 456 describes general provisions relating to health occupations and professions.

A second chapter specifically related to nursing and certified nursing assistants—Chapter 464—contains regulations related to the practice of nursing in the state of Florida and is divided into two parts:

• Part I: Nurse Practice Act
• Part II: Certified Nursing Assistants

456: Health Professions and Occupations

In the United States, the states have the primary responsibility for regulating the health professions. State governments have a particular interest in regulating professions when there is a potential to harm the public’s health, safety, or welfare if the profession is practiced by unqualified professionals (CLEAR, 2006). Regulations are broadly consistent from state to state.

In Florida, these regulations for health professions and occupations are found in Title XXXII of the Florida Statutes. Title XXXII contains laws that regulate professions and occupations in the State of Florida, ranging from attorneys-at-law to private investigate services. Chapter 456, in 86 parts, outlines the provisions related to professional practice for all health occupations and professions in Florida (Florida Legislature, 2016).

You can access Chapter 456 in its entirety here.

464: Nursing

Chapter 464, part I, contains Florida’s Nurse Practice Act. The laws contained in it provide safe parameters within which to work, as well as provisions intended to protect patients from unprofessional and unsafe nursing practice. Florida nurses and certified nursing assistants covered by this chapter are responsible for understanding the laws and rules that govern and define their scope of practice.

Since their humble beginnings in the early 1900s, nurse practice acts have been revised, updated, and modernized. Gone are rules related to moral character, marriage restrictions, pregnancy, and age limits. Added are updated definitions of professional nursing, educational requirements, and regulations for certified nursing assistants, licensed practical nurses, registered nurses, advanced registered nurse practitioners, and clinical nurse specialists.

Computerized licensure databases have been developed, as have rules related to continuing nursing education, chemical dependency, delegation, and criminal background checks, among other additions. Because nursing scope of practice and responsibilities vary from state to state, nurses in the United States are responsible for knowing the regulatory requirements for nursing and the nurse practice act in every state in which they are practicing (NCSBN, 2016).

Part I: The Florida Nurse Practice Act

Each state and territory of the United States, including Florida, has a law called the Nurse Practice Act (NPA) that is enforced by the state’s nursing board. Nurses are required to understand and comply with the laws and related rules of their own NPA in order to maintain their licenses (NCSBN, 2016a). All of the more than 300,000 registered and licensed practical nurses in Florida are governed by and work under the Florida Nurse Practice Act (NPA).

The NPA establishes rules and laws for the practice of nursing in Florida. It describes and establishes the minimal acceptable standards for safe and effective nursing practice by RNs, LPNs, certified nurse-midwives, certified nurse practitioners, certified registered nurse anesthetists, and clinical nurse specialists in any setting.

In general, nurse practice acts describe:

• Authority, power and composition of a board of nursing
• Education program standards
• Standards and scope of nursing practice
• Types of titles and licenses
• Requirements for licensure
• Grounds for disciplinary action, other violations and possible remedies (NCSBN, 2016a).

The sole legislative purpose in enacting this part is to ensure that every nurse practicing in Florida meets the minimum requirements for safe practice. 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 Florida.

Part I of Chapter 464 (Nurse Practice Act) is contained within 25 sections:

• 464.001 Short title.
• 464.002 Purpose.
• 464.003 Definitions.
• 464.004 Board of Nursing; membership; appointment; terms.
• 464.005 Board headquarters.
• 464.006 Rulemaking authority.
• 464.008 Licensure by examination.
• 464.009 Licensure by endorsement.
• 464.0095 Nurse Licensure Compact.
• 464.0096 Nurse Licensure Compact; public records and meetings exemptions.
• 464.0115 Certification of clinical nurse specialists.
• 464.012 Certification of advanced registered nurse practitioners; fees; controlled substance prescribing.
• 464.013 Renewal of license or certificate.
• 464.014 Inactive status.
• 464.015 Titles and abbreviations; restrictions; penalty.
• 464.016 Violations and penalties.
• 464.017 Sexual misconduct in the practice of nursing.
• 464.018 Disciplinary actions.
• 464.019 Approval of nursing education programs.
• 464.0195 Florida Center for Nursing; goals.
• 464.0196 Florida Center for Nursing; board of directors.
• 464.0205 Retired volunteer nurse certificate.
• 464.022 Exceptions.
• 464.027 Registered nurse first assistant.

You can access Part I of Chapter 464 (Nurse Practice Act) in its entirety here.

Part II: Certified Nursing Assistants

Part II of Chapter 464 establishes training and certification requirements for certified nursing assistants in Florida. The certification of nursing assistants is the responsibility of the Florida Board of Nursing, which establishes minimum qualification and training requirements for certification. Under this part, the nursing board also establishes rules for the denial, suspension, or revocation of certification and decides disciplinary and corrective actions.

Chapter 464.201 of the Florida Statutes describes the role of a nursing assistant:

“Certified nursing assistant” means a person who meets the qualifications specified in this part and who is certified by the board as a certified nursing assistant.

“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.

The regulations related to practice as a certified nursing assistant in Florida are contained within nine sections:

• 464.201 Definitions.
• 464.202 Duties and powers of the board.
• 464.203 Certified nursing assistants; certification requirement.
• 464.204 Denial, suspension, or revocation of certification; disciplinary actions.
• 464.205 Availability of disciplinary records and proceedings.
• 464.206 Exemption from liability.
• 464.207 Penalties.
• 464.208 Background screening information; rulemaking authority.

You can access Part II of Chapter 464 (Certified Nursing Assistants) in its entirety here.

Recent Florida Legislation, Nurse Practice Act

During every session of the Florida Legislature there is potential for legislation to be passed that affects the nursing profession. The Florida Board of Nursing website provides current information about legislative changes (potential and finalized), how they will affect licensed nurses, and provides links to additional information.

A number of important changes were made in 2016. In March, for example, legislation was passed that put the Nurse Licensure Compact in place with the stipulation that it will take effect on December 31, 2018 or when 26 other states have joined the compact, whichever comes first. Chapters 464.0095 and 464.0096 (listed above) were added as a result of that legislation.

Also in 2016, the legislation establishing the Council on Certified Nursing Assistants was repealed, so chapter 464.2085 was deleted from statute and related changes were made. Other recent legislation has addressed continuing education requirements, licensing requirements, and practice issues affecting certain ARNPs.

It is critical for licensed nurses to keep themselves up to date on the laws and regulations that affect their licensure and professional practice. It has been noted in multiple situations affecting nurses that ignorance of the law will not protect them from its consequences. The Nurse Licensure Compact is a particularly good example of the importance of staying informed.

The Nurse Licensure Compact (NLC) “allows nurses to have one multistate license, with the ability to practice in both their home state and other compact states.” Currently 25 states have joined the compact. The NLC has benefits for nurses, employers, and the profession and helps to address the increasingly mobile workforce in healthcare. At the same time, a nurse is required by the compact to follow the nurse practice act and all other laws in place in the state where they are working, regardless of the laws in their home state (NCSBN, 2016d). Additional information about the NLC is available here.

Levels of Nursing Practice in Florida

In Florida, each level of nursing practice has a specific designation that is legally protected. The designations are described in Florida Statutes Chapter 464.003 (Definitions). They include:

• Registered Nurse (RN)
• Licensed Practical Nurse (LPN)
• Clinical Nurse Specialist (CNS)
• Advanced Registered Nurse Practitioner (ARNP) (this definition specifically includes the following designations)
  • Certified Registered Nurse Anesthetist (CRNA)
  • Certified Nurse Midwife (CNM or nurse midwife)
  • Nurse Practitioners

Chapter 464.015 (Titles and abbreviations; restrictions; penalty) addresses all the specific titles and abbreviations and when they can be used, including the designations Graduate Nurse (GN) and Graduate Practical Nurse (GPN), which are not included in section 464.003 (Definitions). The Florida Board of Nursing provides additional guidance on these two designations here.

In addition to the levels of nursing practice described above, section 464.027 addresses the intent to “encourage the use of registered nurse first assistants who meet the qualifications of this section as ‘assistants at surgery’ by physicians and hospitals to provide quality, cost-effective surgical intervention to health care recipients” in Florida. A registered nurse first assistant is any person who is licensed as a registered nurse, certified in perioperative nursing, and holds a certificate from, and has successfully completed, a recognized program.

Registered Nurse

“Registered nurse” means any person licensed in the State of Florida to practice professional nursing. Section 464.003 of the Florida Statutes reads in part, “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:

• 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.
• 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.
• The supervision and teaching of other personnel in the theory and performance of any of the acts described in this subsection.

A professional nurse is responsible and accountable for making decisions that are based upon the individual’s educational preparation and experience in nursing.

Advanced or Specialized Nursing Practice

Chapter 464.003 of the Florida Statutes reads in part, “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 as authorized within the framework of an established supervisory protocol. “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.

A clinical nurse specialist is any person licensed in this state to practice professional nursing and certified in clinical nurse specialist practice. “Clinical nurse specialist practice” means the delivery and management of advanced practice nursing care to individuals or groups, including the ability to:

• Assess the health status of individuals and families using methods appropriate to the population and area of practice.
• Diagnose human responses to actual or potential health problems.
• Plan for health promotion, disease prevention, and therapeutic intervention in collaboration with the patient or client.
• 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.
• Coordinate health care as necessary and appropriate and evaluate with the patient or client the effectiveness of care.

Licensed Practical Nurse

A licensed practical nurse (as defined in Chapter 464.003 of the Florida Statutes) is any person licensed in the State of Florida to practice practical nursing. “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 in nursing.

The parts of the Florida Statutes relating to levels of nursing practice (464.015) can be read here. The section related to the definition of levels of nursing (464.003) can be read here.

Scope and Standards of Practice

The job responsibilities of healthcare providers are defined by their scope of practice. A scope of practice (a standard) defines the procedures and actions that are permitted by law for licensed individuals of certain professions. It restricts the practice of a licensed professional to what the law permits for specific education, experience, and demonstrated competency. Scopes of practice are defined in each state’s nurse practice act and certain assumptions can be made about a profession’s scope of practice:

• Public protection should have top priority in scope of practice decisions, rather than professional self-interest.
• Changes in scope of practice are inherent in our current healthcare system.
• Collaboration between healthcare providers should be the professional norm.
• Overlap among professions is necessary.
• Practice acts should require licensees to demonstrate that they have the requisite training and competence to provide a service (NCSBN, 2012).

In Florida, the scope of practice for registered nurses and licensed practical nurses is defined in Chapter 464, Part I of the Florida Statutes—the Nurse Practice Act. This section provides definitions for nursing diagnosis, nursing treatment, practice of practical and professional nursing, and other definitions describing the scope of practice for nursing professionals.

Registered nurses are expected to use their education and judgment to ensure patient safety by reviewing and clarifying orders (in some instances, they can refuse to implement an order). RNs have specific and well-defined responsibilities that are distinct from those of an LPN or a CNA.

A registered nurse is expected to apply the nursing process in the practice of nursing. The steps of the nursing process are cyclical in nature so that the nurse’s actions are directed by the client’s changing status throughout the process. The nursing process involves the use of critical thinking and clinical judgment for each client under the registered nurse’s care. The nursing process includes:

• Standards of assessment
• Analysis and reporting
• Planning
• Implementation
• Evaluation

The nurse may collaborate with the client, family, significant others, and other members of the healthcare team in applying the steps of the nursing process.

Registered nurses may choose to receive specialized education and training that allows them to practice as a clinical specialist, nurse anesthetist, nurse midwife, or nurse practitioner. These specialties have scopes of practice that differ from that of a registered nurse.