Florida Laws and Rules Nursing CE Course

APRNs practicing autonomously must also demonstrate financial responsibility to pay claims and any associated costs arising from the rendering of or failure to render nursing care. They must obtain and maintain professional liability coverage and an unexpired, irrevocable letter of credit payable to the APRN as the beneficiary for any judgments indicating liability and awarding damages to be paid by the APRN. These requirements do not apply to APRNs practicing as an agent of the state or federal government, an APRN who is inactive, an APRN practicing with teaching duties at an accredited school or teaching hospital, or an APRN who is not practicing autonomously (FNPA, 2020, s 464.0123).

Renewal of Nursing License or Certificate

Nursing licenses in the state of Florida are renewed every 2 years. The department shall renew a license upon receipt of the renewal application and fee. Continuing education is required for renewal. A nurse who is certified by a health care specialty program accredited by the National Commission for Certifying Agencies or the Accreditation Board for Specialty Nursing Certification is exempt from most of these continuing education requirements. The criteria for programs must be approved by the board (FNPA, 2020, s 464.013). 

Titles and Abbreviations (Restrictions and Penalties)

Only a person who holds a professional nursing license in Florida or a multi-state license may use the title Registered Nurse and the abbreviation RN. Only a person who holds a practical nursing license in Florida or a multi-state license may use the title Licensed Practical Nurse or the abbreviation LPN. Graduates of pre-licensure nursing education programs may use the term Graduate Nurse and the abbreviation GN. Nurses with a license to practice as clinical nurse specialists may use that title or the abbreviation CNS. Nurses who hold a valid nurse anesthetist license in Florida may use the title Certified Registered Nurse Anesthetist or the abbreviation CRNA or the title nurse anesthetist. Nurse-midwives with valid licenses in Florida may use the title Certified Nurse Midwife or the abbreviation CNM. Nurses with a valid license to practice as an Advanced Practice Registered Nurse may use that title and the abbreviation APRN. It is unlawful to practice or advertise any of these titles or to take any action that would lead the public to believe that a person was authorized to practice or perform nursing services unless authorized to do so. A violation of this rule is considered a misdemeanor of the first degree (FNPA, 2020, s 464.015).

Reporting Adverse Incidents by APRNs

When an adverse event occurs while a patient is in the direct care of an APRN, a report must be sent to the licensing board by certified mail within 15 days of the incident. If an adverse event occurs while the patient is not in the direct care of the APRN, the report must be postmarked within 15 days of discovering the incident or 15 days from the date the incident should have been discovered. An adverse event or incident is an event over which the APRN could exercise control and is associated with a nursing intervention, not the original condition for which the nursing intervention occurred. Any of the following injuries is considered an adverse event/incident:

• a condition that requires the transfer of a patient to a hospital 
• a permanent physical injury to the patient
• the death of a patient

The department will review the adverse incident and determine whether the conduct of the APRN contributed to the event. The board may take disciplinary action if determined to be necessary (FNPA, 2020, s 464.0155).

Retired Volunteer Nurse Certificate

Retired LPNs or RNs who desire to volunteer with indigent, underserved, or critical need populations in Florida may apply to the board for a retired volunteer nurse certificate. A completed application, verification of the previous licensure, and proof that the applicant meets the requirements for licensure are required. Retired volunteer nurses work under the direct supervision of the director of a county health department, a physician, an APRN, or an actively licensed RN. They must comply with the same minimum standards of practice and are subject to disciplinary actions. The scope of practice for certified volunteers is limited to primary and preventative health care. A retired volunteer nurse cannot administer controlled substances, supervise other nurses, or receive monetary compensation. A retired volunteer nurse certificate is valid for 2 years and may be renewed as long as eligibility requirements continue to be met (FNPA, 2020, s 464.0205).

Exceptions

    The rules that are established in the Nurse Practice Act should not be construed to prohibit the following:

• the care of the sick by friends or family
• assistance by anyone in the case of emergency
• the practice of nursing students enrolled in approved schools of nursing
• the practice of nursing by graduates of pre-licensure nursing education programs pending the result of the first licensure examination
• any nurse practicing in accordance with the practices and principles of the Church of Christ, Scientist (the rules of the board do not apply to any sanitarium, nursing home, or rest home operating under the practices and principles of the Church of Christ, Scientist)
• the practice of any qualified nurse licensed under another state and employed by the United States government
• any nurse licensed under another state or territory of the United States from performing nursing services in Florida for 60 days after furnishing employer evidence of current licensure and submitting the application and fees for Florida licensure (For nurses relocating due to a spouse’s military orders, this period is extended to 120 days.)
• the reimbursement for services or establishment of independent practices of nurses practicing within their scope of practice
• the practice of nurses enrolled in board-approved remedial courses (FNPA, 2020, s 464.022)

Part 2: CNA Practice Act

A certified nursing assistant (CNA) is certified in the duties of a CNA, which include providing care to and assisting patients with tasks related to the activities of daily living. These tasks can be associated with personal care, maintaining mobility, nutrition, toileting, and elimination, gathering data such as vital signs and intake and output, reporting abnormal signs and symptoms, cardiopulmonary resuscitation, postmortem care, and documentation of care. A registry of CNAs is maintained by the board (Florida CNA Practice Act [FCPA], 2020, s 464.201). 

The Florida Board of Nursing will issue a certificate to practice as a CNA to anyone who demonstrates a minimum competency to read and write, successfully passes a background screening, has successfully completed an approved training program, and has received a minimum score on the nursing assistant competency examination. The applicant must have a high-school diploma or an equivalent and be at least 18 years of age. A CNA certified in another state who is listed in the CNA registry and has not been found to have committed abuse, neglect, or exploitation may receive a Florida certificate to practice as a CNA (FCPA, 2020, s 464.203). Delegation to unlicensed assistive personnel such as CNAs is discussed in the Nurse Practice Act.

Part 3: Florida Administrative Code Title 64B9

The administrative code is a set of laws and acts put forth by the legislation of the state of Florida. Administrative Code Division 64 contains laws pertaining to the Department of Health. Administrative Code Title 64B9 pertains only to the Board of Nursing.

Requirements for Licensure

Any licensure application may not be used for more than 1 year from the original application submission date. A new application and fee shall be required for any applicant who still wishes to seek licensure. Courses in HIV/AIDS and domestic violence required by 456.031 and 456.033 for initial licensure must be taken within 2 years preceding the licensure application (Florida Administrative Code [FAC], 2020, s 64B9-5.002). 

Continuing Education Requirements

Licensees should retain certificates of attendance and other records to document the completion of the continuing education requirement for 4 years. The board will randomly audit some licensees as is necessary to ensure the continuing education requirements are met. Failure to document compliance with the continuing education requirements or the furnishing of false or misleading records regarding compliance shall be grounds for disciplinary action (FAC, 2020, s 64B9-5.002).

Every 2 years, 1 contact hour must be earned for each calendar month during the licensure cycle. Specific required continuing education courses are summarized in Table 3.

(FAC, 2020, s 64B9-5.002)

Nurses licensed by examination within a biennium (2-year licensure period) are exempt from the continuing education requirement for their first biennium. This exemption will also apply to a nurse who is licensed by endorsement during a biennium if that nurse was licensed in their original state of licensure by the successful completion of the licensure examination during that biennium. A nurse who is licensed by endorsement or whose license was reactivated or reinstated during a biennium shall be required to accrue 1 contact hour for each calendar month remaining in the biennium after their licensure, reactivation, or reinstatement. No contact hours are required if the time remaining in the biennium is 6 months or less. This exemption or limitation shall only apply if the license is renewed on time at the end of the biennium, and it does not apply if the license is suspended, revoked, or becomes inactive at the end of the biennium (FAC, 2020, s 64B9-5.002).

An RN who also holds a current license as an LPN may satisfy the continuing education requirement for renewal of both licenses by completing appropriate continuing education for an RN. An RN who also holds a current 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 by these rules (FAC, 2020, s 64B9-5.002).

A nurse who is the spouse of a member of the Armed Forces and 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 (FAC, 2020, s 64B9-5.002). 

Any licensed nurse who is presenting a continuing education course as either the lecturer or the author of the course materials may earn a maximum of 12 contact hours of continuing education credit per biennium. The criteria to earn continuing education credits as a lecturer or author include:

• the nurse receives credit for the portion of the offering presented or authored;
• credit is awarded to the lecturer or author for the initial presentation of each program only, as repeat presentations shall not be granted credit;
• the continuing education program must conform to the board’s standards for learner objectives, subject matter, and teaching methods;
• continuing education credit is given for publication of continuing education offerings; and
• the number of contact hours awarded as the lecturer or author will be based on the 60-minute contact hour rule (FAC, 2020, s 64B9-5.002).

APRNs licensed under section 464.013 must complete at least 3 hours of continuing education on the safe and effective prescription of controlled substances. The hours must be offered by a statewide professional association of physicians in this state accredited to provide educational activities designated for the American Medical Association (AMA) Physician’s Recognition Award Category, the American Nurse Credentialing Center (ANCC), the American Association of Nurse Anesthetists (AANA), or the American Association of Nurse Practitioners (AANP). It may be offered in a distance-learning format. Additionally, APRNs in Florida must complete at least 2 hours of continuing education on the epidemic of human trafficking. Otherwise, APRNs that are certified by a health care specialty program accredited by the National Commission for Certifying Agencies or the Accreditation Board for Specialty Nursing Certification is exempt from continuing education requirements (FNPA, 2020, s 464.013).

Reactivation of an Inactive Nursing License 

A nurse with an inactive license may renew their license by submitting a fee for renewal of inactive status. The amount of the fee is currently $55 and is specified in rule 64B9-7.001 of the Florida Administrative Code. An inactive license may be reactivated by accessing the nurse’s account through the online portal. If a nurse has had an inactive license for more than two consecutive biennial licensure cycles, and the nurse has not been practicing nursing in any jurisdiction for the 2 years immediately preceding the application for reactivation, the applicant will be required to complete a remedial nursing course with a clinical component appropriate to the nurse’s licensure level. The remedial course must be given at a board-approved program and must include at least 80 hours of didactic education and 96 hours of clinical experience in medical/surgical nursing and any specialty area of practice of the nurse seeking re-licensure (FAC, 2020, s 64B9-6.003). 

Discipline

The legislature created the Board of Nursing to protect the public from nurses who do not meet the minimum requirements to practice safely or who pose a danger to the public. The suspensions, restrictions of practice, and conditions of probation used by the board are listed under sections 464.018 and 456.072 of the Florida Statutes. They include but are not limited to suspension, submission of mental or physical examinations, counseling, completion of continuing education, fees or fines, probationary conditions, evaluation and treatment in the Intervention Project for Nurses, or a requirement for direct supervision. Fees and fines may range from $250 to $10,000 per incident (FAC, 2020, s 64B9-8.006).

Citation

A citation is served upon a licensee to assess a penalty (FAC, 2020, s 64B9-8.003). A citation will contain the subject’s name, address, license number, a brief factual statement, the sections of the law allegedly violated, and the penalty imposed. A citation differs from discipline taken upon a nurse’s license. The nurse may choose to dispute the citation instead of accepting it. If the subject disputes the citation, procedures set forth in section 456.073 will be followed. However, if the nurse does not dispute the matter with the department within 30 days after the citation is served, the citation becomes a public order. The first offense does not constitute discipline, but a second or subsequent offense will constitute discipline (Health Professions and Occupations [HPO], 2020, s 456.073). The first instance of any of the following occurrences is designated as a citation violation by the Board and will result in a penalty of $100. These include:

• failure to report a misdemeanor to the board in writing within 30 days after the licensee has been convicted or found guilty of, or entered a plea of no contention to, regardless of adjudication, a crime in any jurisdiction in violation of section 456.072(1)(x) of the Florida Statutes; or
• a first offense of failing to consult the prescription drug monitoring system as required by section 893.055(8) of the Florida Statutes.

The second instance of the following shall result in a penalty of $100: 

• failure to report an address change in violation of rule 64B9-1.013 of the Florida Administrative Code, provided the licensee was not ordered to do so in a board disciplinary order; or
• failure to submit updates of required information in practitioner profile within 15 days after the final activity that renders such information a fact, as required by section 456.042 of the Florida Statutes.

Sharing a confidential password, access code, keys, or another entry mechanism that results in a violation of or threatens the integrity of a medication administration system or information technology system will result in a penalty of $1,500. In addition to the fine, the nurse will be required to complete a 2-hour continuing education course in legal aspects of nursing within 60 days of receiving the citation (FAC, 2020, s 64B9-8.003).

Minor Violations

Chapter 64B9-8.0045 and the Florida Statute 456.073 state that minor violations are determined by the Board of Nursing to include:

• false, deceptive, or misleading advertising
• issuing a worthless bank check to the board
• failure to report an address change to the board
• improper use of a nursing title under Florida Statute 464.015, providing no practice issue was involved, and no criminal prosecution occurred

Unprofessional Conduct

Unprofessional conduct defined by Chapter 64B9-8.005 includes:

• inaccurate recording and documentation
• misappropriation of medications, supplies, or equipment
• leaving assigned patients 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 of patient records or nursing progress records, employment applications, or time records
• violating HIPAA requirements
• discriminating on the basis of race, creed, religion, sex, age, or national origin in the rendering of nursing services as it relates to human rights and dignity of individuals
• engaging in fraud, misrepresentation, or deceit in taking the licensing examination
• impersonating another licensed practitioner or permitting another person to use a certificate for the purpose of practicing nursing
• providing false or incorrect information to the employer regarding the status of the license
• practicing beyond the scope of a 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 if the value exceeds the employer’s policy regarding gifts
• knowingly obtaining, using, or attempting to obtain or use a patient’s property with the intent to deprive the patient of the use or to benefit someone other than the patient (FAC, 2020, s 64B9-8.005)

Sexual Misconduct

Florida prohibits sexual misconduct amongst nurses. The nurse-patient relationship should be premised on mutual trust, and sexual activities or a sexual relationship with a patient is perceived as taking advantage of and exploiting that trust. Florida Statute 464.017 states that sexual misconduct in nursing is a violation of the nurse-patient relationship through which the nurse uses said relationship to induce or attempt to induce the patient to engage, or to engage or attempt to engage the patient, in sexual activity outside the scope of the practice or the scope of generally accepted examination or treatment of the patient. Sexual misconduct in the practice of nursing is prohibited (FNPA, 2020, s 464.017). 

Reinstatement of a Suspended License

In some instances, the Board of Nursing will find it appropriate to suspend an individual’s nursing license as part of the disciplinary process. To achieve reinstatement of a suspended license, a nurse must submit all proof of suspensions, restrictions, or conditions being met (FAC, 2020, s 64B9-8.006). The board will not reinstate the license of a nurse until it is satisfied that the nurse has complied with all the terms and conditions noted in the final order and is capable of safely engaging in the practice of nursing. The terms and conditions of reinstatement will vary depending on the violation. The board will also not reinstate the license of a nurse who has been found guilty by the board on three separate occasions of violations related to the use of drugs or narcotics if these offenses involve the diversion of drugs or narcotics from patients for personal use or sale (FNPA, 2020, s 464.018).

Mediation

Florida Administrative Code section 64B9-8.012 states that the board allows mediation as an acceptable resolution for the first instance of the following violations:

• issuance of a worthless bank check to the department or the board for initial licensure or renewal of a license provided the nurse does not practice on a delinquent license
• failure to report address changes required by Rule 64B9-1.013 of the Florida Administrative Code
• failure to pay fines and investigative costs by the time ordered
• failure to submit timely documentation of completion of continuing education imposed by a board order or audit
• failure to update a practitioner profile within 15 days as required by Section 456.042 of the Florida Statutes

Intravenous Therapy by LPNs

According to Florida Administrative Code 64B-12.001, the administration of intravenous (IV) therapy is “the therapeutic infusion and/or injection of substances through the peripheral venous system, consisting of activity which includes observing, initiating, monitoring, discontinuing, maintaining, regulating, adjusting, documenting, planning, intervening, and evaluating” (FAC, 2020, s 64B-12.001). 

LPNs in Florida who have completed a board-approved prelicensure practical nursing education program, professional nursing students who qualify as graduate practical nurses, or LPNs who have not completed the specified course under Rule 64B9-12.005 Florida Administrative Code may engage in a limited scope of IV therapy under the direction of an RN, a physician, or a dentist. “Under the direction of an RN” means the RN has delegated the IV therapy to the qualified LPN. The RN does not always have to be on the premises for the LPN to perform the delegated task. This scope includes:

• performing calculations and adjusting flow rates
• observing and reporting subjective and objective signs of adverse reactions to IV administration
• inspecting the insertion site, changing the dressing, and removing an IV needle or catheter from peripheral veins
• hanging bags or bottles of hydrating fluid

LPNs in Florida who have completed a board-approved 30-credit hour post-graduate course on IV therapy may administer IV therapy without these limitations but still under the direction of an RN. The course must be taught by a licensed RN with teaching experience and clinical experience with IV therapy. The course must also be offered by a continuing education provider who is already approved by the board. Following the course, the LPN will complete supervised clinical practice to verify their competence. LPNs’ employers are responsible for verifying their clinical competence. A signed statement by an RN licensed in Florida is required to verify the LPN’s clinical competence. This expanded scope includes the ability to initiate most intravenous infusion medications, but not the delivery of most IV push medications (FAC, 2020, s 64B9-12.005, s 64B9 12.002)

The board has also approved LPNs with the appropriate education and training to perform IV therapy via central lines under the direction of an RN. A minimum of 4 hours of instruction is considered appropriate education and training in this respect. The required 4 hours may be included as part of the 30-credit hour IV therapy course. Upon completion of the IV therapy training via central lines, the LPN shall be assessed on their knowledge and competence. The LPN must be assessed by an RN who will need to file a proficiency statement regarding the LPN’s ability to perform IV therapy via central lines. The proficiency statement should be kept in the LPN’s personnel file (FAC, 2020, s 64B9-12.002).

Aspects of IV Therapy Outside of the LPN’s Scope of Practice

Regardless of training, some aspects of IV therapy fall outside the scope of practice of an LPN unless they operate under the direct supervision of an RN or physician. The following actions should not be performed or initiated by LPNs without direct supervision:

• initiation of blood and blood products
• initiation or administration of cancer chemotherapy
• initiation of plasma expanders
• initiation or administration of investigational drugs
• mixing IV solutions
• IV pushes, except heparin or saline flushes

While this rule limits the scope of the LPN practice, it is appropriate for LPNs to care for patients receiving any of these listed therapies, even if the LPNs are not administering the therapy. For these therapies, direct supervision by the RN or physician is defined as the RN or physician being on the premises and immediately available (FAC, 2020, s 64B9-12.003).

Delegation to Unlicensed Assistive Personnel (UAP)

Unlicensed assistive personnel (UAP) are defined as persons who do not hold licensure but who have been assigned to function in an assistive role to RNs or LPNs in the provision of patient care services through regular assignments or delegated tasks or activities and under the supervision of a nurse. In the delegation process, the nurse must use nursing judgment to consider the appropriateness of the task or activity to be delegated. Factors to weigh in determining the suitability of a task for delegation include:

• potential for patient harm
• the complexity of the task
• predictability or unpredictability of outcome, also considering the potential for a rapid change in the patient’s medical status 
• level of interaction or communication with the patient
• equipment and personnel available

Factors to consider when selecting and delegating to a specific UAP include:

• normal assignments of the UAP
• verification of the education and training of the delegate

The nurse must include communication that identifies the task or activity, the expected outcomes, the limits of authority, and the time frame. The nurse must also verify the UAP’s understanding of the assignment at the time of delegation. A nurse who delegates tasks to UAP remains ultimately responsible for the patient’s nursing care and supervision of the UAP (FAC, 2020, s 64B9-14.002).

Activities that are not included in the nurse’s scope of practice, activities that require nursing judgment or the nursing process, and activities for which the UAP has not demonstrated competence should not be delegated to the UAP. Nursing skills that should not be delegated include assessments of the patient, determination of a nursing diagnosis, interpretation of assessments, development of the plan of care, and evaluation of patient progress (FAC, 2020, s 64B9-14.003). 

Case Scenario

Melinda is an LPN working on a medical-surgical unit at a local community hospital. Donna is an RN who works on the same unit as Melinda. Melinda and Donna live in the same neighborhood and are close, longtime friends. Donna is standing in front of a computer, reviewing her assigned patient’s electronic medical records for new orders and diagnostic test results. She has two new patients waiting for admission, a patient scheduled for discharge, and a patient scheduled for surgery. Mr. Hill is the patient scheduled for discharge. He has several morning medications that need to be administered before he can be discharged.

Donna appears rushed and anxious. She looks at Melinda and states, “Melinda, I cannot remember my password to access the medication administration records. I know the Information Technology desk will be so busy right now. I don’t want to get behind. The transporter has arrived to pick up Mr. Hill for discharge, and I don’t want to keep him waiting. Can you do me a favor and let me use your password to get into Mr. Hill’s records so I can give him his medications?”

What should Melinda do?

Melinda replies to Donna, “You know I consider you a friend, Donna, but you also know I cannot give anyone my password. That is against hospital policy. I just completed the Florida Board of Nursing CE course on Florida Laws and Rules. A nurse can face serious disciplinary actions from the Board of Nursing if they share their password and allow others to access the medication administration system — a citation and a $1,500 penalty.”

Melinda wants to help Donna but does not want to give out her password. She suggests, “Why don’t you call Information Technology and ask for your password to be reset. Let them know to make it a priority. In the meantime, I can access the medication administration record, administer, and document Mr. Hill’s medications for you. I am more than happy to help, so you don’t get behind.”

Later that day, Donna notices Melinda delegating vital signs to Whitney, the new UAP. Donna knows that Whitney has not been approved for many skills and is not considered competent yet in obtaining blood pressure and oxygen saturation. 

What should Donna do?

Donna pulls Melinda aside and says, “I noticed that you asked Whitney to obtain some of your patients’ vital signs. I didn’t know if you were aware that she hadn’t been checked off on obtaining blood pressure or oxygen saturation readings yet.” 

Melinda now feels anxious and rushed. She tells Donna, “Whitney is going to have to learn sometime. I am too busy right now with a patient who isn’t doing well. I have another who is requesting pain medication. I just don’t have the time to focus on routine vital signs at this moment.” 

Donna replies, “You helped me earlier, so I will go assist Whitney with obtaining the patient’s vital signs. Maybe we can help her get this competency checked-off so that we can all safely delegate this task to her in the future.”

References

Bullough, B. (1976). The law and expanding nursing role. American Journal of Public Health, 66(3), 249-254. https://doi.org/10.2105/AJPH.66.3.249

Division 64B9, Chapters 1-16, Florida Administrative Code & Florida Administrative Register. (2020). https://www.flrules.org/gateway/Organization.asp?OrgNo=64B9

Health Professions and Occupations: General Provisions, Florida Statutes, ss 456.031-456.033, 456.073-456.077 (2020). http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0456/0456ContentsIndex.html

Florida CNA Practice Act, Florida Statutes, ss 464.201-464.208 (2020). http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0464/0464PARTIIContentsIndex.html

Florida Nurse Practice Act, Florida Statutes, ss 464.001-464.027 (2020). http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0464/0464PARTIContentsIndex.html

Martin, E., & Zolnierek, C. (2020). Beyond the nurse practice act: Making a difference through advocacy. Online Journal of Issues in Nursing, 25(1). https://doi: 10.3912/OJIN.Vol25No01Man02

Russel, K. (2017). Nurse practice acts guide and govern: Update 2017. Journal of Nursing Regulation, 8(3), 18-25.