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Laws and Rules: Florida Board of Nursing

2 Contact Hours
Florida Nurse Practice Act
This course is applicable for the following professions:
Advanced Registered Nurse Practitioner (ARNP), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Nursing Student, Registered Nurse (RN)
This course will be updated or discontinued on or before Monday, March 28, 2022
Course Description
This course is designed to keep Florida nurses practicing within the guidelines of the Florida Nurse Practice Act. After completing this CE, nurses will well versed in the documentation standards required by the state. They will understand the changes required for nurses to renew their licenses as of 2015.
CEUFast Inc. did not endorse any product, or receive any commercial support or sponsorship for this course. The Planning Committee and Authors do not have any conflict of interest.

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To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Julia Tortorice (RN, MBA, MSN, NEA-BC, CPHQ)

Outcomes

The purpose of this course is to prepare nurses to practice within the parameters of the Florida Nurse Practice Act.

Objectives

At the conclusion of this course, the learner will be able to:

  1. Identify the location of forms and information related to nursing licensure and renewal.
  2. Maintain expected levels of continuing education.
  3. Discuss nursing documentation standards.
  4. Apply delegation standards.
  5. Identify LPN IV therapy standards.

Florida Nursing Licensure

All forms, information, and the Florida Administrative Code included in this course are located at the Florida Board of Nursing (FBN) website

A Nursing license can be obtained by examination, endorsement, and 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. 

APRN

  1. Education Requirements:
    • (a) Applicants who graduated on or after October 1, 1998, must have completed requirements for a master’s degree or post-master’s degree certification.
    • (b) Certified Registered Nurse Anesthetist applicants who graduated on or after October 1, 2001, must have completed requirements for a master’s degree program.
    • (c) Applicants who graduated prior to the applicable date are exempt from this requirement.
    • (d) Graduates from either a certificate or currently closed program should submit supporting documentation that demonstrates program compliance with Board guidelines.
  2. After July 1, 2006, applicants for licensure as an Advanced Practice Registered Nurse pursuant to section 464.012(1), F.S., shall submit proof of national advanced practice certification from an approved nursing specialty board.

A Nurse currently licensed in Florida may upgrade their licenses to include multi-state practice by submitting a Multi-State License Upgrade Application, Form DH-MQA 5024, obtained at here or from the Board office or on the Florida Board of Nursing website.

Dispensing Practitioners

Dispensing is defined as selling medicinal drugs. Practitioners who write prescriptions and provide samples are not dispensing.

APRNs who prescribe medication must register with the Board of Nursing by submitting a completed Dispensing Application for Advanced Practice Registered Nurse (APRN), form number DH-MQA 1185, 10/18. That form is available here, or from FBN or FBN website.1

The APRN dispensing practitioner must comply with all state and federal laws and regulations applicable to all dispensing practitioners under Section 465.0276, F.S.  Compliance includes the use of the FAC 64B9-4.016 Controlled Substances Formulary and FAC 64B9-4.017 Standards for the Prescribing of Controlled Substances for the Treatment of Acute Pain.1

License Renewal

The Florida Department of Health Division Medical Quality Assurance (MQA) is responsible for license renewal for nursing professionals. Nurses licensed in Florida must renew every two years, either with an online or by mail option. Renewal reminders are mailed out to holders of a Florida license, so be sure to keep the state Board of Nursing appraised of any address change. On the postcard, which comes approximately six weeks prior to renewal date, will be a reminder of the website for online renewals along with the address and fees due for those who prefer to utilize mail.

The MQA renewal website requires a password and user ID, which are issued at the time of original licensure. If you have misplaced your documents, simply follow the help links present on the website. Do remember that as a health professional important documentation should be retained, and not much trumps license paperwork in importance.

Online Nursing Renewal2
  • You may renew and verify the status of your renewal online at www.flhealthsource.gov.
  • Your ID and Password can also be reset at www.flhealthsource.gov, or you may call 850-488-0595 for assistance.
  • The online renewal allows immediate printing of license verification. Renewal by mail, please allow 1-2 weeks for receipt of your new nursing license.
  • The Department of Health, Medical Quality Assurance, will verify a practitioner’s continuing education record in the state-mandated electronic tracking system at the time of renewal.

If the required continuing education has been met, proof of licensure will be posted promptly on the state verification website or posted within one to two weeks of receiving your mailed renewal.

Continuing Education Requirements

During the two year license renew cycle, 24 contact hours are required. The courses on ceufast.com meet all the FBN requirements.

The following courses are mandatory every two-year renewal cycle.1

The following continuing education courses are mandatory, and they count towards the total 24 contact hours required for renewal:

  1. A two-hour course in the prevention of medical errors
  2. A one hour course in HIV/AIDS
  3. A two-hour course in Florida laws and rules
  4. A two-hour course on human trafficking

A two-hour course in recognizing impairment in the workplace is required every other renewal cycle.1 A two-hour course in domestic violence every third renewal cycle. The domestic violence course does not count in the 24-hour renewal requirement. That renewal period, the nurse will complete 26 contact hours.1

Continuing education is not required for the first renewal cycle after license by examination. This exemption applies to a person who is licensed by endorsement during a renewal period if that person was licensed in the original state of licensure by successful completion of an acceptable licensure examination during that biennium.1 

A licensee who was endorsed, reactivated, or reinstated in the middle of a renewal cycle is required to complete one contact hour for each calendar month remaining in the renewal period. If the renewal period is equal to or less than six months, no contact hours are required.1

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 who holds 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 contact hours required.1

A nurse who is the spouse of a member of the Armed Forces that was absent from Florida due to the spouse’s duties with the Armed Forces shall be exempt from continuing education requirements. The licensee must show satisfactory proof of the absence and the spouse’s military status.1

If you serve as an expert witness and probable cause panel member, there are additional requirements outlined in 64B9-5.007.1

The Florida Department of Health employs an online verification system to confirm the completion of continuing education at the time of renewal. This tracking system checks its records when you renew, and if the required course work is present, the renewal process is allowed to continue. If the requisite hours or specified training are not present, you will be prompted to report completions through the state-contracted CE Broker online service before being allowed to continue your license renewal.  A nurse can check there progress toward completion of contact hours at here.

CEUfast.com automatically reports your contact hours to CE Broker the day you complete the course. Some CE providers do not report completed contact hours to CE Broker. It will be up to you to be on top of items that you need to enter by hand into the electronic verification system. Each license holder can report completed hours by logging here.

Nursing Documentation Standards

Documentation that is poor, filled with errors, or appears falsified comprises some of the most frequent complaints filed against a nurse's license. In Florida, the Board of Nursing and the Department of Health take such matters very seriously.

The Florida Department of Education details in its curriculum structure the need for nursing programs to place emphasis on demonstrating procedures for accurate documentation and record-keeping in nurses' training.

Accurate documentation of care is necessary to meet the legal and ethical aspects of quality patient care. Clear, accurate, and succinct charting journals the course of care and provides the foundation for shared information about client and disease management.

Nursing Documentation
  • Be definite in what you record. No conjectures, guesses, or opinions. Avoid phrasing, such as “appears to…”
  • Document regular or “baseline” observations. Without knowing what is normal for each individual, it is impossible to recognize problems and address them in a timely manner
  • Use quantifiable data when describing. If a measuring tool is not handy, it is acceptable to use a reference to common items such as “the size of a pencil eraser,” etc.
  • Every intervention warrants an evaluation of response to it
  • Avoid medicalese. Write as you speak without resorting to jargon unless the terms are in everyday use and easily understood by anyone reading the note
  • Be timely in your documentation. It is easy to forget details in the bustle of business
  • Late notes happen. Should you need to document something out of time, do it properly and in an orderly manner by first documenting when you are making the late note, then log the actual time the event occurred. Never be deceptive and “back-date” or fake that you are writing at an earlier time.
  • Flow Charts need to be filled. Every organization has flow charts, do not leave them blank. Also, whenever an unusual event occurs, remember to go to the chart to document your findings.
  • Remember – “If you did not write it down, you did not do it. If you did not do it, you were negligent.”

If an RN or ARNP in private practice, dies or leaves the practice, there are additional document maintenance requirements noted in 64B9-11.001.

Delegation

Delegation can be a difficult concept with multiple nuances. RNs can delegate. LPNs can supervise or assign, but they cannot delegate. APRNs must delegate tasks just as other RNs would. APRNs may not delegate as physicians do. Training is not the same as delegating. Your responsibility to a trainee ends when his or her training is complete.

In the delegation process, the delegator must use nursing judgment to consider the suitability of the task or activity to be delegated.

  • Factors to weigh in selecting the task or activity include1:
    • Potential for patient harm
    • The complexity of the task
    • Predictability or unpredictability of outcome including the reasonable potential for a rapid change in the medical status of the patient
    • Level of interaction required or communication available with the patient
    • Resources both in equipment and personnel available in the patient setting
  • Factors to weigh in selecting and delegating to a specific delegate include1:
    • Routine assignments of a CNA or UP
    • Validation or verification of the education and training of the delegate

Delegation Principles3

  • Right task
    • Appropriate activities for the specific level of practice
  • Right circumstances
    • Match the complexity of the activity with the competency, training, of delegee and level of supervision needed or available
  • Right person
    • Instruct, assess, verify and identify the competency of an individual for the task
  • Right direction and communication
    • Situation specific communications include:
      • Specific data to be collected, method and timeliness for reporting
      • Specific activities to be performed and client-specific instruction and limitations
      • Expected results or potential complications and the timeline for communicating such information
  • Right supervision and evaluation
    • Supervise performance of the activity or assign supervision to other licensed nurses

Tasks Prohibited from Delegation

The RN or licensed practical nurse shall not delegate1:

  • Those activities not within the delegating or supervising nurse’s scope of practice.
  • Nursing activities that include the use of the nursing process and require the special knowledge, nursing judgment, or skills of a registered or practical nurse, including:
    • The initial nursing assessment or any subsequent assessments;
    • The determination of the nursing diagnosis or interpretations of nursing assessments;
    • Establishment of the nursing care goals and development of the plan of care; and,
  • Evaluation of progress in relation to the plan of care.
  • Those activities for which the certified nursing assistant (CNA) or unlicensed personnel (UP)  has not demonstrated competence.

Supervision by Licensed Practical Nurses (LPN) in Nursing Home Facilities

  • The LPNs working in a nursing home qualify to supervise by meeting all of the following requirements1:
    • Completing a minimum of thirty (30) hour post-basic education course prior to accepting any supervisory assignments.
    • A work history of no less than six months of full-time clinical nursing experience in a hospital or nursing home.
  • An RN provides supervision of the LPN.
  • Tasks and activities shall be delegated by the LPN to the CNA or UP based on the following1:
    • The task/activity is within the area of responsibility of the nurse delegating the task. The task/activity is within the knowledge, skills, and ability of the nurse delegating the task.
    • The task/activity is of a routine, repetitive nature and shall not require the CNA or UP to exercise nursing knowledge, judgment, or skill.
  • The CNA or UP can perform the task/activity with the degree of care and skill that would be expected of the nurse.

CNA Authorized Duties

A CNA can provide care and assist clients with the following tasks. 

  1. Tasks associated with personal care1:
    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
  2. Tasks associated with maintaining mobility1:
    1. Ambulating
    2.  Transferring
    3. Transporting
    4. Positioning
    5. Turning
    6. Lifting
    7. Performing range of motion exercises
    8. Maintaining body alignment
  3. Tasks associated with nutrition and hydration1:
    1. Feeding and assisting the resident with eating
    2. Assisting the resident with drinking
  4. Tasks associated with elimination1:
    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
  5. Tasks associated with the use of assistive devices:
    1. Caring for dentures, eyeglasses, contact lenses, and hearing aids
    2. Applying or donning established or previously fitted and adjusted prosthetic and orthotic devices
    3. Applying or donning previously fitted and adjusted orthotic braces
    4. Applying previously fitted 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
  6. Tasks associated with maintaining environment and resident safety, including:
    1. Handling of blood and body fluid
    2. Cleaning resident care areas
  7. 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
    7. Recognition of and reporting of abnormal resident findings, signs, and symptoms
    8. Post mortem care
  8. Tasks associated with resident socialization, leisure activities, reality orientation, and validation techniques
  9. Tasks associated with end of life care
  10. Tasks associated with basic first aid, CPR skills, and emergency care
  11. Tasks associated with compliance with resident’s/patient’s rights
  12. Tasks associated with daily documentation of CNA services provided to the resident

CNAs will work with the knowledge of and awareness of a client's rights and developmental level. A CNA shall not perform any task which requires specialized nursing knowledge, judgment, or skills.

A CNA may receive additional training beyond that required for initial certification and upon validation of competence in the skill by an RN may perform such skills as authorized by the facility.

A CNA shall not work independently without the supervision of an RN or a licensed practical nurse.

LPN Administration of Intravenous Therapy

An LPN can be involved in IV therapy if they have completed an approved course with return demonstration.1

  1. Insert a peripheral IV
  2. Remove IV catheters
  3. Set up and use IV pumps
  4. Maintain an IV site
  5. Administer IV fluids and medications
  6. Accurately assess an IV site
  7. Respond to complications of IV therapy

Aspects of intravenous therapy that are outside the scope of practice of the LPN unless under the direct supervision of the RN or physician, include the following1:

  1. Initiation of blood and blood products
  2. Initiation or administration of cancer chemotherapy
  3. Initiation of plasma expanders
  4. Initiation or administration of investigational drugs
  5. Mixing IV solution
  6. IV pushes, except heparin flushes and saline flushes

Discipline Process

FBN has the authority by law to investigate nurses having the appearance of violating practice standards or those against whom allegations have been made. FBN is also authorized to implement disciplinary action.

There are several options which the Board of Nursing might take depending on the results of an individual appraisal process and discipline hearing.

Florida Statute 464.018 Disciplinary Actions Examples
  • Grounds for denial of license or disciplinary action:
    • License by bribery or misrepresentations
    • License revoked, suspended or acted against
    • Conviction of any crime related to nursing
    • Being found guilty of:
      • Forcible felony
      • Theft, robbery, or related
      • Lewdness, indecent exposure
      • Assault, battery, culpable negligence
      • Child or Elder abuse
      • Protection actions related to abuse, neglect, exploitation
      • Child abuse, abandonment, neglect
    • Domestic violence
    • Making or filing a false report or record
    • False, misleading, or deceptive advertising
    • Unprofessional conduct
    • Possession, sale, distribution of a controlled substance
    • Inability to practice nursing due to alcohol, drugs, narcotics, chemicals
    • Failing to report any individuals in violation of the rules of department or board.

Another option available in Florida for nurses struggling with impairment is the Intervention Project for Nurses (IPN). 

The Intervention Project for Nurses 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. 

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.

Unprofessional Conduct

Unprofessional conduct includes1:

  1. Inaccurate recording
  2. Misappropriating drugs, supplies or equipment
  3. Leaving a nursing assignment without advising licensed nursing personnel
  4. Stealing from a patient
  5. Violating the integrity of a medication administration system or an information technology system
  6. Falsifying or altering of patient records or nursing progress records, employment applications or time records
  7. Violating the confidentiality of information or knowledge concerning a patient
  8. Discriminating based on 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
  9. Engaging in fraud, misrepresentation, or deceit in taking the licensing examination
  10. Impersonating another licensed practitioner, or permitting another person to use his certificate for the purpose of practicing nursing
  11. Providing false or incorrect information to the employer regarding the status of the license
  12. Practicing beyond the scope of the licensee’s license, educational preparation or nursing experience
  13. Using force against a patient, striking a patient, or throwing objects at a patient
  14. Using abusive, threatening, or foul language in front of a patient or directing such language toward a patient
  15. Accepting a gift from a patient, the value of which exceeds the employer’s policy regarding gifts
  16. Knowingly obtaining or using or attempting to obtain or use a patient’s property with the intent to temporarily or permanently deprive the patient of the use, benefit, or possession of the funds, assets, or property, or to benefit someone other than the patient

Conclusion

The state of Florida needs nurses and 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.

References

  1. Florida Administrative Code, 64B9. (January 2, 20). Retrieved 3/7/20. Visit Source.
  2. Florida Health Medical Quality Assurance. (2020). Retrieved 3/7/20. Visit Source.
  3. Texas Board of Nursing. (2018). Practice-Delegation Resource Packet. Retrieved 3/7/20. Visit Source.

Select one of the following methods to complete this course.

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