Laws and Rules Governing Florida Nursing Barbara B

Laws and Rules Governing Florida Nursing Barbara B. Phillips, DNS, GNP-BC Morse. Life Health Systems, Inc. West Palm Beach, FL

Objectives • Discuss the legislative purpose of the Nurse Practice Act • Identify specific laws & rules r/t practice of nursing • Describe the levels of nursing practice & general scope of each level • Review requirements for continuing licensure • Articulate the discipline process as it r/t nursing

Nurse Practice Act • Legislated to safeguard the public • Purpose: – Ensure minimum safety requirements met by every nurse practicing in Florida

Introduction • Nurse Practice Act passed June 7, 1913 – Safeguard public – Ensure minimum safety requirements for nurses • Florida Statute 464 – Scope, licensing, certification, violations, & penalties • Florida Statute 465 – general provisions for all health professions • Title 64 B 9

Where is Nurse Practice Act? • FBON website “Resources” page • Florida Statutes & Administrative Codes • Or: http: //www. floridasnursing. gov/resources/ • Email: Info@Floridas. Nursing. gov • Phone: 850. 245. 4125

Standards of Practice • • Licensed Practical Nurse (LPN) Professional Nurse (RN) Clinical Nurse Specialist (CNS) Advanced Registered Nurse Practitioner

Standards of Practice • • LPN RN CNS ARNP

Licensed Practical Nurse (LPN) • Perform selected acts: – Treatments – RX – Health promotion/Illness prevention • Works under direction of: – RN – MD – DO – Podiatrist – DDS or DMD

Registered Nurse (RN) • Using specialized knowledge, judgment, skill • Observation, assessment, nsg dx, planning, intervention, & evaluation of care • Administer RX & treatments • Supervise/teach other personnel

Clinical Nurse Specialist (CNS) • Advanced Practice Nursing Including: – Assess health of individuals & families – Dx human responses – Plan health promotion; disease prevention; therapeutic intervention – Implement interventions based on expertise within scope – Coordinate/evaluate health care

Advanced Registered Nurse Practitioner (ARNP) • Certified in advanced/specialized nsg practice • Nsg dx & treatment • Medical dx & treatment defined by Joint Committee • Standing Protocols – Under supervision of MD, DO, Dentist • Malpractice Insurance • Rule 64 B 9 -4. 011 submit “Dispensing Application for ARNP” to FBON

Continuing Licensure in Florida • Biennial renewal – 24 hrs CE – Approved 2 hour course on Prevention of Medical Errors – 2015 – two hour course on Laws and Rules – Every 6 years must complete 2 hour course on Domestic Violence – HIV/Aids completed prior to FIRST renewal

Continuing Licensure in Florida • Inactive status – No intent to practice – Renew q 2 yr • Reactivate license – Apply and pay fee – Disclosure – Proof of CE for all inactive periods • Refresher course – Required after 2 consecutive inactive cycles

Rule 64 B 9 -1. 013 • All licensed nurses must provide FBON: – Current address – Current place of practice – When moving notify within 60 days

Florida DOH

MQA: renew, update mailing address & practice location • • • www. flhealthsource. com Click on Licensee/Provider Click on Practitioner Login Select your profession Enter account ID & password (case sensitive) Click on “Login”

Places of Practice • • • Acute Care facility LTC facility Rehabilitation facility Clinic Doctor’s office HHA Educational Institution Independent nsg practice office Correctional facility etc

Ethical & Legal issues • ANA Code of Ethics for Nurses – Framework for ethical analysis & decision making – http: //nursingworld. org/Main. Menu. Categories/Ethics Standards/Codeof. Ethicsfor. Nurses/Code-of-Ethics. pdf • Major Ethical Issues – Patient centered care – Advocacy – Delegation – Self care – Supporting colleagues and profession

Legal Issues • Laws governing nursing practice are different from ethical decision making framework • Laws pertain to: – Documentation – Licensure – Standards of care – Define scope of practice – Accountability

Negligence/Malpractice • 4 Elements must be established: – Duty: The nurse owed a duty to meet a particular standard of care – Breach of Duty: Nurse failed to perform the duty owed – Causation: Causal connection between RN’s failure & patient’s injury – Damages: Injury occurred for which monetary compensation is adequate relief

Disciplinary Actions • BON created to assure protection of public • Violations of the Board laws are punishable by disciplinary action • Penalties are in addition to results of legal or civil proceedings • Acts requiring disciplinary or legal action are outlined in sections 464. 016, 464. 017, and 464. 018 of the Nurse Practice Act

464. 015 Title & Abbreviations • • • Registered Nurse/RN Licensed Practical Nurse/LPN Graduate Nurse/GN Graduate Practical Nurse/GPN Clinical Nurse Specialist/CNS Certified Registered Nurse Anesthetist/CRNA Certified Nurse Midwife/CNM Advanced Registered Nurse Practitioner/ARNP Nurse

Section 464. 016: Felonies • Practicing advanced or specialized, professional, or practical nursing unless holding an active license or certificate • Using or attempting to use a suspended or revoked license • Knowingly employing unlicensed persons in the practice of nursing • Obtaining or attempting to obtain a license or certificate by misleading statements or misrepresentation

1 st Degree Misdemeanors • Using title “Nurse”, “Registered Nurse”, “Licensed Practical Nurse”, “Clinical Nurse Specialist”, “Certified Registered Nurse Anesthetist”, “Certified Nurse Midwife”, “Advanced Registered Nurse Practitioner” or any other name/title that implies person is licensed or certified unless they are duly licensed or certified. • Knowingly concealing information r/t violations of 464. 016

Sexual Misconduct • Violation of nurse/patient relationship where nurse induces or attempts to induce pt to engage in sexual activity outside the scope of the practice or scope of generally accepted examination or treatment of patient • Sexual misconduct is prohibited in the practice of nursing • Grounds for disciplinary action

Disciplinary Action • Attempting to procure/renew license by bribery, misrepresentation, error of the Board • Revoked, suspended, acted against license by another state, territory, or country • “Nolo Contendere” plea directly r/t practice of nursing

Disciplinary Action (con’t) • Guilty of: – Forcible felony – Theft, robbery, & related crimes – Fraudulent practices – Lewdness & indecent exposure – Assault, battery, & culpable negligence – Child abuse, abandonment, & neglect – Abuse, neglect, & exploitation

Disciplinary Action • Making/filing false report/record, intentionally or negligently failing to file as required by state/federal law or willfully obstructing or impeding another to file • False, misleading, or deceptive advertising • Unprofessional conduct • Engaging or attempting to engage in possession, sale, or distribution of controlled substances for other than legitimate purpose

Disciplinary Action • Unable to practice safely due to illness, ETOH, Rx, narcotics, other chemicals • Failure to report above abuse • Knowingly violating any provision, rule, or lawful order of the Board entered in a disciplinary proceeding • Failure to comply with lawful subpoena • Failure to meet minimal stds of prevailing practice

Board Recourse Refusal to certify or certify with restrictions Suspension or permanent revocation Restriction of practice or license Admin fee not to exceed 10 K/count or separate offense • Reprimand or letter of concern • Probation subject to Board conditions • •

Board Recourse • Corrective action • Admin fine for violations of patient rights • Refund of fees billed & collected from patient or 3 rd party • Require practitioner undergo remedial education

Board Recourse • 3 strikes and you’re out

Intervention Project for Nurses (IPN) • IPN is affiliate of FNA • To make referral &/or confidential consultation: 1. 800. 840. 2720 • Authorized by FL Statute 464/465 to assist nurses whose practice is affected.

Will participation in IPN protect my license from discipline by the FBON? • RN reported ONLY to IPN: agrees to participate & successfully completes IPN = file closed & kept confidential • RN reported to IPN & DOES NOT agree: information forwarded to DOH • RN reported to IPN & DOH: disciplinary process proceeds & may result in disciplinary action

Statistics • November 2013 - >360 Florida nurses were disciplined – Suspension = 58% – Voluntary surrender = 20% – Revocation = 6. 5% • Responsible for all costs associated with the order

Mediation – Rule 64 B 9 -8. 012 • Mediation is acceptable resolution for 1 st offense of Failure to: – Respond timely to CE audit – Issue worthless bank check for initial licensure/renewal IF licensee does not practice on delinquent license – ***Report address changes*** – Pay fines & investigative costs timely – Timely submit proof documentation of ordered CE – Update practitioner profile within 15 days – Complete CE hours within applicable biennium

Exceptions to Nurse Practice Act Care by friends or family Emergency Students in approved school of nursing GN practice Nursing assistants under RN supervision In accordance with practices/principles of Church of Christ Scientist • Working for government • • •

Exceptions con’t • Nurse licensed in another state practicing for 60 days • Relocating to Florida – 120 days • Fee for service nursing • Independent practice within scope • In home hemodialysis assistant* • Temporary care out of state<31 days • Care provided by persons enrolled inboard approved remedial courses

Conclusion • FBON meetings q 2 months • Open to public • More info: – Call: 850. 488. 0595 – http: //www. floridanursing. gov – info@floridanursing. gov – practice issues or questions

References • • • American nurses association. Code of ethics for nursing with interpretive statements. Available at http: //nursingworld. org/Main. Menu. Categories/Ethics. Standards/Codeof. Ethicsfor. Nurses/Code-of-Ethics. pdf. Accessed November 26, 2013. Florida administrative code. Division: 64 B 9. Board of Nursing. Available at https: //www. flrules. org/gateway/Division. asp? Div. ID=332. Accessed December 3, 2013. Florida board of nursing. Nurse practice act. Available at http: //www. doh. state. fl. us/mqa/nursing/info practice. Act. pdf. Accessed November 26, 2013. Florida department of health. Florida board of nursing: nurse practice act; chapter 464 Florida statutes; rules of the board of nursing; chapter 64 B 9 Florida administrative code (2007). Florida medical quality assurance services. Final order and emergency action search. Available at http: //ww 2 doh. state. fl. us/finalordernet. Accessed November 27, 2013. Florida nurses’ association. A brief history of the beginnings of the Florida nurses’ association. Available at http: //www. floridanurse. org/Resources/documents/Historyof. Florida. Nurses. Association. doc. Accessed November 21, 2013. 2012 Florida statutes. 456. 072: grounds for discipline; penalties; enforcement. Available at http: //www. leg. state. fl. us/Statutes/index. cfm? App mode-Display Statute&Search String=&URL=04000499/0456/Sections/04569. 072. html 2012 Florida statues chapter 464 nursing. Available at http: //www. flsenate. gov/Laws? Statutes/2012/Chapter 464/All. Accessed December 20, 2012 Luce, JM. Medical malpractice and the chest physician. Chest. 2008; 134(5): 1044 -1050. Registered nurse: areas of specialization. Available at: http: //flahec. org/hlthcareers/rn. htm. Accessed December 6, 2013. Florida lpn. Available at: http: //lpn. com/state/florida-lpn. Accessed December 6, 2013.

Test Your Knowledge! • The purpose of the Nurse Practice Act is to encourage the growth and expansion of hospitals and training schools. – True – False

• The Nurse Practice Act consists of Chapter 464 of the Florida Statutes. – True – False

• The Nurse Practice Act governs the practice of registered nurses, licensed practical nurses, advanced registered nurse practitioners, and clinical nurse specialists. – True – False

• According to the Nurse Practice Act, the practice of practical nursing may be conducted under the direction of a registered nurse, licensed dentist, or licensed physician. – True – False

• The diagnosis of human responses to actual or potential health problems is a part of the scope of practice for licensed practical nurses. – True – False

• At least 40 hours of continuing education must be completed every biennium in order to maintain a nursing license in Florida. – True – False

• Apology is one of the elements that must be established for a ruling of malpractice. – True – False

• Using the name or title “Registered Nurse” without being duly licensed or certified is considered a misdemeanor in the first degree under the Nurse Practice Act. – True – False

• Nurses who have been found guilty on three (3) separate occasions of violations relating to the use of drugs or narcotics involving the diversion of drugs or narcotics from patients to personal use or sale shall not be eligible for reinstatement of licensure. – True – False

Contact Info • Barbara B Phillips 561. 312. 3455 • bphillips@morselife. org