Laws and Rules: Florida Board of Nursing

All forms, information, and the Florida Administrative Code (FAC) included in this course are located on the Florida Board of Nursing (FBN) website. Nurses may upgrade their licenses to include multistate practice via the application found at DH-MQA 5024, 04/22 (FAC, 2022).

A nursing license can be obtained by examination, endorsement, and the Compact Act. Graduates of international nursing programs or nursing programs in jurisdictions that are not members of the National Council of State Boards of Nursing (NCSBN) have additional requirements for licensure.

An advanced practice registered nurse (APRN) can be registered as an autonomous APRN by completing the Autonomous APRN Registration with Financial Responsibility document, form DH5050-MQA-07/2020 (FAC, 2021). Dispensing is defined as selling medicinal drugs. Practitioners who write prescriptions and provide samples are not dispensing.

APRNs who dispense medication must register with the Board of Nursing by submitting a completed Dispensing Application for APRN, form number DH-MQA 1185, 10/18. That form is available here (FAC, 2021).

The Florida Department of Health Division Medical Quality Assurance (2020) is responsible for license renewal for nursing professionals. Nurses licensed in Florida must renew their licenses online every two years.You may receive a reminder, but it is your responsibility to renew.

Renewal information is on the FBN website. You may renew and verify the status of your renewal online at the Florida Health Medical Quality Assurance website. The online renewal allows immediate printing of license verification. The Department of Health, Medical Quality Assurance, will verify a practitioner's continuing education record in the state-mandated CEBroker electronic tracking system at the time of renewal. CEUfast.com automatically reports your contact hours. You can enter your contact hours for courses that you take that are not automatically reported. To review the status of your continuing education hours for renewal, go to the CEBroker Login.

During the two-year license renewal cycle, 24 contact hours are required for licensed practical nurses (LPNs), registered nurses (RNs), and APRNs. The courses on CEUfast.com meet all the FBN requirements and are automatically reported to CEBroker.

The following continuing education courses are mandatory, and they count towards the total 24 contact hours required for renewal: a two-hour course in the prevention of medical errors, one one-hour course in human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) prior to the first renewal, a two-hour course in Florida laws and rules, two hours on human trafficking, and a two-hour course in recognizing impairment in the workplace every other renewal cycle.A two-hour course in domestic violence is required every third renewal cycle. The domestic violence course does not count in the 24-hour renewal requirement (FBN, 2023). Continuing education requirements have exceptions for partial practice in a renewal period or special circumstances (FBN, 2023).

An RN who also holds a current license as an LPN may satisfy the continuing education requirement for renewal of both licenses by completing the RN requirements. An RN with an APRN license may satisfy the continuing education requirement for both licenses by completing appropriate continuing education for an RN or may satisfy up to 50% of the continuing education requirement by completing continuing medical education coursework equivalent to the required contact hours (FAC, 2020).

APRNs are required to complete three hours in the safe and effective prescription of controlled substances every renewal cycle. APRNs who are registered for autonomous practice must complete ten additional contact hours at the graduate level for a nurse practitioner or continuing education. CEUfast identifies these graduate-level continuing education courses as autonomous practice courses for renewal or initial application (FBN, 2023).

Certified nursing assistants (CNAs) are required to complete a minimum of 24 hours of in-service training every two years. That should include at least, Bloodborne Pathogens, Infection Control, Domestic Violence, Medical Record Documentation and Legal Aspects Appropriate to Nursing Assistants, Resident Rights, Communication with Cognitively Impaired Clients, Cardiopulmonary Resuscitation (CPR) skills, and Medical Error Prevention and Safety (FBN, 2023).

An APRN practices with a supervising physician using established protocols approved by the physicians. They can prescribe, dispense, administer, or order any drug. The exception is prescribing or dispensing controlled substances; a master's or doctoral degree in a clinical nursing specialty with training in specialized skills is needed. When a patient is in a facility, the APRN can order any medication for administration.

APRNs initiate therapies for certain conditions and perform additional functions. They can order diagnostic tests and physical or occupational therapy. The scope allows APRNs to perform activities within their specialty, including managing selected medical problems and initiating, monitoring, or altering therapies for uncomplicated acute illnesses. They monitor and manage patients with stable chronic diseases, establish behavioral problems, diagnose, and make treatment recommendations (Regulation of Professions and Occupation [RPO], 2018).

A certified registered nurse anesthetist (CRNA) practices with a supervising physician using established protocols approved by the physicians. They provide care before, during, and after anesthesia. This involves determining the health status of the patient, risk factors, and anesthetic management. They make decisions about the appropriate type of anesthesia, order pre-anesthetic medication, and render the patient insensible to pain during the performance of procedures. Their practice includes regional, spinal, and general anesthesia, inhalation agents and techniques, intravenous (IV) agents and techniques, and hypnosis.

The CRNA orders or performs monitoring procedures while supporting life functions during anesthesia; this includes induction and intubation, using mechanical support devices, and managing fluid, electrolytes, and blood component balances. They recognize and treat abnormal patient responses to anesthesia, adjunctive medication, or other forms of therapy. CRNAs manage a patient while in the post-anesthesia recovery area. They also place special peripheral and central venous and arterial lines for blood sampling and monitoring (RPO, 2018).

A certified nurse midwife (CNM) practices with a supervising physician using established protocols approved by the physicians. When the delivery is performed in a patient's home, they perform superficial minor surgical procedures and manage the patient during labor and delivery, including amniotomy, episiotomy, and repair. They order, initiate, and perform appropriate anesthetic procedures. CNM practice also includes postpartum examination, ordering medications, providing family-planning services, and well-woman care. CNMs manage the medical care of a normal obstetrical patient and the initial care of a newborn patient (RPO, 2018).

A clinical nurse specialist (CNS) uses established protocols to assess the health status of individuals and families, diagnose human responses to actual or potential health problems, and coordinate health care. They also plan for health promotion, disease prevention, and therapeutic intervention. The CNS can implement therapeutic interventions including, but not limited to, direct nursing care, counseling, teaching, and collaboration with other licensed healthcare providers (RPO, 2018).

A psychiatric nurse practitioner uses established protocols to prescribe psychotropic controlled substances (RPO, 2018).

If registered for autonomous practice, CNMs may engage in autonomous practice. APRNs engaged in autonomous practice provide primary care, including family medicine, general pediatrics, and general internal medicine (RPO, 2020).

Autonomous practice nurses perform the general functions of an APRN related to primary care, admitting, managing, and discharging patients from the facility. They can provide a signature, certification, stamp, verification, affidavit, or endorsement that is required to be provided by a physician, except they may not issue a physician certification for medical marijuana. Autonomous practice nurses cannot perform any surgical procedure other than a subcutaneous procedure (RPO, 2020).

RNs work under the direction of a Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), Physician Assistant (PA), APRN, podiatrist, or dentist. An RN's scope of practice is observation, assessment, nursing diagnosis, planning, intervention, and evaluation of care. It also includes health teaching and counseling, promotion of wellness, maintenance of health, and prevention of illness of others. RNs administer medications and treatments as prescribed. They supervise and teach other personnel in the theory and performance of healthcare (RPO, 2022).

LPNs work under the direction of an RN, MD, DO, podiatrist, or dentist. They make decisions based on their education and experience. An LPN's scope of practice is the administration of treatments and medications as prescribed, promotion of wellness, maintenance of health, and prevention of illness of others. They can also teach general principles of health and wellness to the public and students other than nursing students (RPO, 2022).

An LPN can be involved in IV therapy if they have completed an approved course and demonstrate competency. Therapeutic infusion of substances through a venous peripheral system includes observing, initiating, monitoring, and discontinuing IVs. They also maintain, regulate, and adjust IV therapy. The LPN is responsible for documenting, planning, intervening, and evaluating the IV (FAC, 2023).

Aspects of IV therapy outside the LPN's scope of practice include initiating blood and blood products, cancer chemotherapy, plasma expanders, and investigational drugs. They also cannot mix IV solutions or give IV pushes, except heparin and saline flushes. These therapies may be included under the direct supervision of the RN or physician (FAC, 2020). Direct supervision means the supervisor has to be in the facility and physically available if needed.

LPNs provide IV Therapy under the direction of an RN. That means the RN has delegated the IV functions to an LPN. The RN does not have to be in the facility (FAC, 2023).

A CNA works under the supervision of an RN or LPN.A CNA does not practice independently and cannot perform any task requiring specialized nursing knowledge, judgment, or skills.

A CNA who has completed medication administration training and demonstrated competency may administer prescription medication. CNAs can only administer medication in a nursing home, home health, or county detention facility.The approved administration routes are oral, transdermal, ophthalmic, otic, inhaled, and topical (RPO, 2023b).A CNA who administers medication must complete two hours of in-service training in medication administration and medication error prevention every year.

A CNA can provide care with tasks related to personal care, maintaining mobility, nutrition and hydration, and elimination. They also perform tasks related to the use of assistive devices, maintaining environment and resident safety, and data gathering (FAC, 2020). CNAs participate in resident socialization, leisure activities, reality orientation, and validation techniques. Their tasks include end-of-life care, basic first aid, CPR skills, and emergency care. CNAs are responsible for compliance with patients' rights and documenting their information. A CNA receiving additional training and demonstrating competence may perform other tasks authorized by the facility (FAC, 2020).

Delegation can be a difficult concept with multiple nuances. RNs can delegate. LPNs can supervise or assign, but they cannot delegate. APRNs delegate tasks just as other RNs do. APRNs do not delegate as physicians do because training is different from delegating. In delegation, use nursing judgment to consider the suitability of the task or activity to the individual being delegated.

Before delegation, an RN does initial and ongoing assessments of the patients. Considerations of the RN before delegating a task to a CNA or home health aide (HHA) are the complexity of the task and the experience, skill, and competency of the individual. The patient, guardian, or healthcare surrogate must consent to work with any healthcare worker (FAC, 2024). Other considerations before delegation to a CNA or HHA are if the task is routine, has a sequence of steps, has little or no change between patients, and has a predictable outcome. They cannot be delegated tasks that endanger a patient or include assessment, interpretation, or clinical judgment (RPO, 2023a).

FBN has the authority by law to investigate nurses who appear to be violating practice standards or those against whom allegations have been made. FBN is also authorized to implement disciplinary action. You have the right to see the complaint, respond to the complaint, attend the disciplinary hearing, and bring a lawyer if you wish.

There are several options that the FBN might take depending on the results of an individual appraisal process and discipline hearing. One option available in Florida for nurses struggling with impairment is the Intervention Project for Nurses (IPN).

The IPN allows a treatment and guidance alternative to those struggling with the misuse or abuse of alcohol or drugs or who have a mental or physical condition that might affect their ability to practice nursing safely and with proficiency. The IPN is a free resource for nurses licensed in Florida and provides referrals to board-approved addiction, mental health, or other treatment providers. The staff at IPN assists nurses, working alongside them with ongoing support, and should a disciplinary action already be present, goes with the nurse to hearings, confirming that they are engaged in the recovery process.

Jason, RN, is making assignments at Morning Glory Nursing Home. The LPN called in sick. The staff that day was four CNAs and one UAP. Jason needs another staff member to administer medication. Two of the CNAs have completed medication administration training, but only one CNA, Dan, has demonstrated competency. Jason assigns Dan to administer the oral, transdermal, and topical medication for that shift. This assignment allows Jason time to administer the medications Dan cannot and still complete his admissions and assessments. However, several admission tasks were deferred to the next shift. This plan was not the best solution, but it was acceptable given the available resources.

The state of Florida needs nurses, and it is an excellent place to work. Clear, consistent standards are present describing nursing duties, education, and expectations. Whether seeking a license to practice nursing by exemption or examination, those considering making Florida their home can find a worthwhile career choice as a nurse in the sunshine state.

• Florida Administrative Code (FAC). (2020). Division: 64B9. Florida Administrative Code. Visit Source.
• Florida Administrative Code (FAC). (2021). 64B9-4.020: Autonomous Advanced Practice Registered Nurse (APRN) Registration. Florida Administrative Code. Visit Source.
• Florida Administrative Code (FAC). (2022). Rule: 64B9-3.016: Multi-State License Upgrade. Florida Administrative Code. Visit Source.
• Florida Administrative Code (FAC). (2023). 64B9-12.002: Definitions. Florida Administrative Code. Visit Source.
• Florida Administrative Code (FAC). (2024). 64B9-14.0015: Delegated Tasks. Florida Administrative Code. Visit Source.
• Florida Health Medical Quality Assurance. (2020). Health Care Resources for Consumers & Providers. Florida Health Medical Quality Assurance. Visit Source.
• Florida Board of Nursing. (2023). Renewal Information. Florida Board of Nursing. Visit Source.
• Regulation of Professions and Occupation (2018). §464.012: Licensure of advanced practice registered nurses; fees; controlled substance prescribing. The Florida Senate. Visit Source.
• Regulation of Professions and Occupation. (2020). §464.0123: Autonomous practice by an advanced practice registered nurse. The Florida Senate. Visit Source.
• Regulation of Professions and Occupation. (2022). §464.003: Definitions. The Florida Senate. Visit Source.
• Regulation of Professions and Occupation. (2023a). §464.0156: Delegation of duties. The Florida Senate. Visit Source.
• Regulation of Professions and Occupation. (2023b). §464.2035: Administration of medication. The Florida Senate. Visit Source.