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 covers general provisions relating to health occupations and professions, and Section 456.076 specifically addresses impaired-practitioner programs. That section lays out the structure and elements of these programs, including requirements for providers within the programs, services to be offered, and details of confidentiality requirements and disciplinary actions.

Chapter 464 specifically focuses on nursing and certified nursing assistants and contains regulations on the practice of nursing in the state of Florida. This chapter is divided into two parts:

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

The laws contained in Chapter 464, Part I, 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.

Of particular importance to this course is Chapter 464: “Section 464.018, Disciplinary actions” is referred to as Florida’s mandatory reporting law and it contains the following:

1. The following acts constitute grounds for denial of a license or disciplinary action…:
   1. 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. In enforcing this paragraph, the department shall have, upon a finding of the State Surgeon General or the State Surgeon General’s designee that probable cause exists to believe that the licensee is unable to practice nursing because of the reasons stated in this paragraph, the authority to issue an order to compel a licensee to submit to a mental or physical examination by physicians designated by the department. If the licensee refuses to comply with such order, the department’s order directing such examination may be enforced by filing a petition for enforcement in the circuit court where the licensee resides or does business. The licensee against whom the petition is filed shall not be named or identified by initials in any public court records or documents, and the proceedings shall be closed to the public. The department shall be entitled to the summary procedure provided in s. 51.011. A nurse affected by the provisions of this paragraph shall at reasonable intervals be afforded an opportunity to demonstrate that she or he can resume the competent practice of nursing with reasonable skill and safety to patients.
   2. 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, a person who the licensee knows is unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, chemicals, or any other type of material, or as a result of a mental or physical condition, may be reported to a consultant operating an impaired practitioner program as described in s. 456.076 rather than to the department.
   3. 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.
   4. Failing to report to the department any licensee under chapter 458 or under chapter 459 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 under chapter 395, or a health maintenance organization certificated under part I of chapter 641, in which the nurse also provides services.

Paragraphs (p) and (q) address additional items specific to practice for advanced practice registered nurses and psychiatric nurses.

Florida Administrative Code Requirements

Administrative codes are intended to assist state departments and divisions in carrying out certain duties mandated in statute and are organized by department/division/chapter/rule. Administrative code provides a place to codify details to help a department carry out specific activities and does not necessarily cover every item contained in the statute. Important to the discussion at hand are those that concern continuing education requirements (Florida Statutes Chapter 464) and the impaired practitioners program (Florida Statutes Chapter 456).

Rules for Meeting Chapter 464—Continuing Education Requirements

Chapter 64B9-5 Continuing Education Requirements

(under the Department of Health/Board of Nursing)

Rule No. 64B9-5.002 states that, effective August 1, 2017 nurses must complete a 2-hour course on Recognizing Impairment in the Workplace and must do so every other biennium thereafter in order to maintain their licenses.

Rule No. 64B9-5.014 states that the course must cover, at a minimum, the following areas:

1. Identifying the signs of impairment in the workplace;
2. Employer initiatives to promote safety and provide assistance;
3. The essential steps to make a report or referral;
4. Mandatory reporting law, Section 464.018, F.S.;
5. Treatment programs for impaired practitioners, Section 456.076, F.S.; and,
6. Impairment treatment.

Rules for Meeting Chapter 456—Impaired Practitioners Program

Chapter 64B31 Impaired Practitioners Program

(under the Department of Health)

Rule No. 64B31-10.001 contains the following

1. Definitions:
   1. An Approved Impaired Practitioner Program is designated by the department through contract with a consultant to initiate intervention, recommend evaluation, and refer impaired practitioners to treatment providers or treatment programs and monitor the progress of impaired practitioners in treatment. Approved impaired practitioner programs do not provide medical services.
   2. Consultants operate approved impaired practitioner programs which receive allegations of licensee impairment, personally intervene or arrange intervention with licensees, refer licensees to approved treatment programs or treatment providers, evaluate treatment progress, and monitor continued care provided by approved programs and providers.
   3. A treatment program is approved by a designated impaired practitioner program and must be a nationally accredited or state licensed residential, intensive outpatient, partial hospital or other program with a multidisciplinary team approach with individual treatment providers treating licensees depending on the licensee’s individual diagnosis and treatment plan that has been approved by an approved impaired practitioner program. A treatment provider is approved by a designated impaired practitioner program and must be a state licensed or nationally certified individual with experience treating specific types of impairment.
2. The Department designates Intervention Project for Nurses (IPN) and Professionals Resource Network (PRN) as the Approved Impaired Practitioner Programs. Approved impaired practitioner programs also serve as consultants.

American Nurses Association Code of Ethics

The American Nurses Association (ANA) Code of Ethics directly addresses impaired practice in two subsections of Provision 3, which reads:

The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.

In subsection 3.5, Protection of Patient Health and Safety by Acting on Questionable Practice, the Code’s interpretive statement says:

Nurses must be alert to and must take appropriate action in all instances of incompetent, unethical, illegal, or impaired practice or actions that place the rights or best interest of the patient in jeopardy.

It further notes that nurses must be familiar with the ANA Code of Ethics, standards of practice, all relevant laws and regulations, and their employer’s policies and procedures (ANA, 2015).

In subsection 3.6, Patient Protection and Impaired Practice, the guidelines note that

Nurses must protect the patient, the public, and the profession from potential harm when practice appears to be impaired.

Nurses must follow the policies of their employer as well as professional guidelines and the law. In situations of impaired practice, they must advocate for fair treatment of and support for colleagues in recovery. If impaired practice threatens the safety of patients, self, or others, a nurse must report this to the appropriate authorities (ANA, 2015).

In a 2017 presentation to the NCSBN-IRE conference, the director of the Florida Intervention Project for Nurses (IPN) emphasized certain elements in discussion of subsection 3.6:

[The need to be] vigilant in protecting patients, the public, and the profession; the duty to protect patients, and the need to assure assistance to nurses needing help.

Other writers emphasize these same ideas (Smith, 2017; Alunni-Kinkle, 2015).