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

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

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

Education Requirements:
1. Applicants who graduated on or after October 1, 1998, must have completed a master's degree or post-master's degree certification requirements.
2. Certified Registered Nurse Anesthetist applicants who graduated on or after October 1, 2001, must have completed a master's degree program requirements.
3. Applicants who graduated prior to the applicable date are exempt from this requirement.
4. Graduates from either a certificate or currently closed program should submit supporting documentation demonstrating program compliance with Board guidelines.
After July 1, 2006, applicants for licensure as an Advanced Practice Registered Nurse pursuant to section 464.012(1), FS, 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 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 (FAC, 2020).

The APRN dispensing practitioner must comply with all state and federal laws and regulations applicable to all dispensing practitioners under Section 465.0276. FS Compliance includes using 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 (FAC, 2020).

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 keep the state Board of Nursing appraised of any address change. The postcard, which comes approximately six weeks prior to the renewal date, will be a reminder of the website for online renewals and the address and fees due for those who prefer to utilize mail.

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

Online Nursing Renewal (FHMQA, 2020)
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 within one to two weeks of receiving your mailed renewal.

Continuing Education Requirements

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

Every two-year renewal cycle, the following courses are mandatory (FAC, 2020).

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
A one hour course in HIV/AIDS
A two-hour course in Florida laws and rules
A two-hour course on human trafficking

A two-hour course in recognizing impairment in the workplace is required every other renewal cycle (FAC, 2020). A two-hour course in domestic violence every third renewal cycle. The domestic violence course does not count in the 24-hour renewal requirement. The nurse will complete 26 contact hours (FAC, 2020).

Continuing education is not required for the first renewal cycle after license by examination. This exemption applies to a person licensed by endorsement during a renewal period if that person was licensed in the original state of licensure by completing an acceptable licensure examination during that biennium (FAC, 2020).

A licensee who was endorsed, reactivated, or reinstated in the middle of a renewal cycle must complete one contact hour for each calendar month remaining in the renewal period. No contact hours are required if the renewal period is equal to or less than six months (FAC, 2020).

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 (FAC, 2020).

A nurse who is the spouse of a member of the Armed Forces absent from Florida due to the spouse's duties with the Armed Forces shall be exempt from continuing education requirements. The licensee must prove the absence and the spouse's military status (FAC, 2020).

If you serve as an expert witness and probable cause panel member, additional requirements are outlined in 64B9-5.007 (FAC, 2020).

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 their progress toward the completion of contact hours 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 emphasize demonstrating procedures for accurate documentation and record-keeping in nurses' training.

Accurate documentation of care is necessary to meet quality patient care's legal and ethical aspects. 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 promptly. 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 orderly 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 in. 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, additional document maintenance requirements are 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 include (FAC, 2020).:
- 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 include (FAC, 2020).:
- 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 delegate (FAC, 2020).:

Those activities are 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 with 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 the following requirements (FAC, 2020).:
- 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.
The LPN shall delegate tasks and activities to the CNA or UP based on the following (FAC, 2020).:
- The task/activity is within the area of responsibility of the nurse delegating the task. The task/activity is within the nurse's knowledge, skills, and ability to delegate tasks.
- 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 expected of the nurse.

CNA Authorized Duties

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

Tasks associated with personal care (FAC, 2020).:
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
Tasks associated with maintaining mobility (FAC, 2020).:
1. Ambulating
2. Transferring
3. Transporting
4. Positioning
5. Turning
6. Lifting
7. Performing range of motion exercises
8. Maintaining body alignment
Tasks are associated with nutrition and hydration (FAC, 2020).:
1. Feeding and assisting the resident with eating
2. Assisting the resident with drinking
Tasks associated with elimination (FAC, 2020).:
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
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 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
Tasks associated with maintaining environment and resident safety, including:
1. Handling of blood and body fluid
2. Cleaning resident care areas
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
Tasks associated with resident socialization, leisure activities, reality orientation, and validation techniques
Tasks associated with the end of life care
Tasks associated with basic first aid, CPR skills, and emergency care
Tasks associated with compliance with resident's/patient's rights
Tasks associated with daily documentation of CNA services provided to the resident

CNAs will work with knowledge 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, 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 a return demonstration (FAC, 2020).

Insert a peripheral IV
Remove IV catheters
Set up and use IV pumps
Maintain an IV site
Administer IV fluids and medications
Accurately assess an IV site
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 following (FAC, 2020).:

Initiation of blood and blood products
Initiation or administration of cancer chemotherapy
Initiation of plasma expanders
Initiation or administration of investigational drugs
Mixing IV solution
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 that 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 the 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 includes (FAC, 2020).:

Inaccurate recording
Misappropriating drugs, supplies, or equipment
Leaving a nursing assignment without advising licensed nursing personnel
Stealing from a patient
Violating the integrity of a medication administration system or an information technology system
Falsifying or altering patient records or nursing progress records, employment applications, or time records
Violating the confidentiality of information or knowledge concerning a patient
Discriminating based on race, creed, religion, sex, age, or national origin in the rendering of nursing services as it relates to the human rights and dignity of the individuals
Engaging in fraud, misrepresentation, or deceit in taking the licensing examination
Impersonating another licensed practitioner or permitting another person to use his certificate to practice nursing
Providing false or incorrect information to the employer regarding the status of the license
Practicing beyond the scope of the licensee's license, educational preparation, or nursing experience
Using force against a patient, striking a patient or throwing objects at a patient
Using abusive, threatening, or foul language in front of a patient or directing such language toward a patient
Accepting a gift from a patient, the value of which exceeds the employer's policy regarding gifts
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 describe 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.

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