A nurse practice act (NPA) is enacted by all states and territories. The state’s legislature enacts each state’s NPA. The NPA itself cannot provide the required guidance to the nursing profession. So, a board of nursing (BON) is established by each NPA to make administrative rules and regulations for the proper clarification of the law. Table 1 mentions items included in all NPAs.

Table 1: Participants of NPA

F 2: Floigurerida Laws and Rules (Source: www.ce.ucf.edu)

In Florida, standards to practice as a nurse are categorized in the Florida Statutes (F.S.) and Florida Administrative Code (F.A.C.). In the Florida Statutes, state laws are structured into a code comprised of titles, chapters and sections are collected permanently. Any change in the statutory material by laws is updated in the Florida Statutes annually.

The only legislative purpose of the NPA is “to guarantee that minimum requirements for safe practice should be met by every nurse practicing in this state. It is the judicial intent that nurses who do not meet the minimum criteria for competency shall be banned to practice in this state.”

Figure 3: Florida Statutes and Laws (Source: www.slideshare.net)

The Florida Board of Nursing (BON) gives licenses to nurses for practicing in Florida and is under the authority of the Florida Department of Health. The BON is sponsored and maintained by compulsory licensure dues paid by nurses who want to practice in the state of Florida.

According to the role of the Health department, health professions should be controlled for the protection of the health, care and well-being of the public with the help of police powers of the state. In the following conditions, professions should be controlled when:

• Their uncontrolled practice is harmful for the health, care and well-being of the public, and when the risk to harm is identifiable and clearly shows the anticompetitive impact that is due to un-regulation.

• Effective protection is not provided to the public by other means i.e. other state statutes, local laws or central legislation.

• No availability of less restrictive means of regulation.

13 members are included in the Florida Board of Nursing. All members should belong to the state of Florida. The details of members are as follows:

• There are seven registered nurses who are practicing as professional nurses for at least four years. Following nurses must be included:

• Advanced registered nurse practitioner one in number

• A nurse educator of an approved program

• An executive nurse

• Practical nurses, three in number, whose practice is more than four years before appointment

• Three members who do not have a license to practice and never attached to the nursing practice

These members are selected and appointed by the governor for duration of four years.

Figure 4: Florida Board of Nursing (Source: www.floridanursing.gov)

The Florida Board of Nursing is authorized by the NPA to apply rules and regulations to the following members:

• Registered nurses

• Practical nurses

• Certified nurse assistants

• Certified nurse-midwives

• Nurse practitioners

• Clinical nurse specialists

• Registered nurse first assistants

• Certified registered nurse anesthetists

It is the responsibility of BON to license, monitor, educate and rehabilitate its licensees to guarantee their suitability and competency in giving healthcare services to the public of Florida. To enact the rules mentioned in the Florida Administrative Code is the responsibility of the BON.

All the administrative rules for the state of Florida are officially compiled in the Florida Administrative Code [1]. The publishing of the F.A.C. are overseen and updated by the Department of State weekly.

According to the Nurse Practice Act, the Florida Center for Nursing is created to “manage issues regarding the supply and demand for nursing, along with issues of analysis, holding and consumption of resources of nursing workforce.”

The Florida Center for Nursing is a workforce center made in the Florida Statute to provide solutions to cover the nursing shortage in Florida. It is the main aim to notify and update about the issues and solutions of nursing shortage. The sufficient supply of care providers for the health of Floridians all over the state is ensured by the Center by scrutinizing and reporting on the nursing workforce.

There is a separate board of directors in the Center and funds are collected by the fees deposited for licensure and renewal of licensure.

In a profession, its members create associations to provide different types of services for its members. Continuing education, judicial support, collective bargaining and information about the profession are often included in these services.

In Florida, the Florida Nurses Association and other specialty associations such as nurse practitioners are included in professional associations. The boards of trustees chosen by members typically run the associations.

The mission of the Florida Nurses Association is “to oblige and support all registered nurses by professional development, sponsorship and the promotion of fineness at every step of professional nursing practice.”

Legal authorization is the main difference between the Florida Board of Nursing and professional organizations. There is no legal authority for professional organizations, while there is a legal authority for the Florida BON that is recognized by the NPA with the clear-cut function of enhancing and caring the health of Floridians by providing safe nursing practice.

The state regulates the practice of nursing to provide protection to the members of the public in need of nursing care. According to the law written in the state’s Nurse Practice Act, safe and skilled nursing practice is stranded. As nursing is an active practice, many questions are asked about certain tasks whether these are in the nurse’s scope of practice or not. The following points should be consistent for all nursing care:

• Nurse’s preparation

• Education

• Experience

• Knowledge

• Established competency

• Laws and rules leading nursing

Figure 5: Patient’s safety (Source: www.photo.pds.org)

Any person who holds a license to practice as a practical nurse in Florida is known as licensed practical nurse (LPN) [2]. Performance of selected acts are included in the practice of practical nursing and mentioned below:

• Administration of treatments

• Medications for the care of ill or injured person

• Promotion of wellness

• Maintenance of health

• Prevention of illness

The performance of a practical nurse should be under the kind supervision of any one of the following persons:

• a registered nurse

• a licensed physician

• a licensed osteopathic physician

• a licensed podiatric physician

• a licensed dentist

A practical nurse can make decisions on the basis of education preparation and nursing experience.

Any person who has a license to practice professional nursing in Florida is known as a registered nurse (RN). In the practice of professional nursing, the acts with extensive specified knowledge and judgment are performed and nursing skill according to the applied principles of psychological, biological, social and physical sciences is required. The things mentioned in the given table should be included:

Table 2: The Practice of Professional Nursing

A professional nurse can make decisions on the basis of nursing education, experience and skills.

The definition of nursing diagnosis is the observation and analysis of physical or psychological conditions, attitudes, signs and symptoms of disease, and responses to treatment and the decision whether these conditions and responses to treatment are deviated from the standard protocol or not.

Nursing diagnosis is included in the scope of practice of RN. A nursing treatment is defined as the establishment and enactment of a nursing regimen for the well-being of the individuals, stoppage of illness and improvement in knowledge, reestablishment and maintenance of health.

Figure 6: Professional Nursing Practice (Source: www.annanurse.org)

Any person who is having a license to practice professional nursing in Florida and certified to practice in advanced or specialized nursing is known as advanced registered nurse practitioner (ARNP). Following nurses are included in ARNPs:

• Certified registered nurse anesthetists

• Certified nurse midwives

• Nurse practitioners

In advanced nursing practice, acts of nursing diagnosis and nursing treatment for the management of the patients’ problems can be performed by the advanced registered nurse practitioner. As defined by the BON, medical diagnosis, treatment and operation can also be performed by the ARNP. According to the established framework, following things can be performed by the ARNP:

• Monitoring and alteration of drug therapies

• Initiation of suitable therapies for certain conditions

• Prescription of diagnostic tests and occupational therapy

According to the protocol approved by the medical staff of the healthcare facility, following acts mentioned in the table should be performed by the certified registered nurse anesthetist:

Table 3: Certified Registered Nurse Anesthetist

Figure 7: Certified registered Nurse Anesthetist (Source: www.fana.org)

Following acts mentioned in the table can be performed by the certified nurse midwife within the established protocol by the healthcare facility while performing delivery in a patient’s home:

Table 4: Certified Nurse Midwife

Following acts can be performed by the nurse practitioner within the context of established protocol:

• Management of the selected medical issues

• Prescription of the physical and occupational therapy

• Initiation, monitoring and alteration of therapies for some uncomplicated acute diseases

• Monitoring and management of patients with stable chronic ailments

• Establishment of behavioral problems and diagnosis

• Planning of treatment recommendations

A person who is having a license to practice professional nursing in Florida and certified for nurse specialist practice is known as clinical nurse specialist (CNS). In clinical nurse specialist practice, nursing care of advanced practice to individuals and groups is delivered and managed. The CNS should have following abilities:

• Assessment of the health status of individuals and families using proper methods for the population

• Diagnosis of human responses to potential health issues

• Planning for health promotion, disease prevention and intervention therapeutically with the patient

• Implementation of therapeutic interventions (nursing care, counseling and teamwork with other licensed healthcare providers) according to the advanced nursing practice

• Coordination with the healthcare regarding the effectiveness of care to the patient

The use of RN first assistants having qualifications for assistants at surgery to get quality and cost-effective surgical intervention in the state is encouraged by Florida Statutes. The qualifications for registered nurse first assistants are mentioned in the given table:

Table 5: Qualifications for Certified Registered Nurse First Assistant

It is mandatory for each healthcare institution to establish specific procedures to appoint and reappoint the registered nurse first assistant staff members.

A person who has specific qualifications mentioned in the Florida Statutes and has certificate of certified nursing assistant from the BON is known as a certified nursing assistant (CNA). Providing nursing care and assisting persons to complete tasks related to routine living activities is under the practice of a certified nursing assistant. These tasks are mentioned in the table:

Table 6: Tasks of Certified Nursing Assistants

While assigning tasks to the unlicensed assistive personnel (UAPs), the rules from the Florida Administrative Code should be followed by registered nurses and LPNs. UAPs are those persons who don’t have license from the Division of Health Quality Assurance of the Health Department but assigned to work as an assistant to the registered nurse or licensed practical nurses for providing the health care services to the patients. UAPs are:

• CNAs

• Home health aides

• Patient care technicians

• Surgical assistants

• Patient care assistants

When a task is to be delegating, nursing judgment is essential for the suitability of the task and activity to be assigned. Following factors mentioned in the table should be assessed before delegating the task or activity:

Table 7: Factors Analysis before delegating tasks to UAPs

For delegating a task to a specific delegate, following factors should be assessed:

• Routine tasks of the UAP

• Authentication or confirmation of the learning and training of the delegate

Communication to the UAP should be included in the delegation process. In communication, following factors are included:

• Identification of the task or activity

• The expected or desired outcome

• Limitations of authority

• The time frame for the delegation

• Nature of the supervision required

• Verification of delegate’s understanding of assignment

• Verification of monitoring and supervision

The tasks or activities mentioned in the given table should not be delegated by the RN or LPN as directed by the licensed professional.

Table 8: Delegations of Tasks Prohibited

Florida Board of Nursing monitors the Florida nursing licenses and the renewal of the license is required after every two years.

Figure 8: Licensure Renewal (Source: www.floridanursing.gov)

Earning of the one contact hour of continuing education is necessary for every calendar month of the licensure cycle during each biennium [3]. If a person is licensed by examination within a biennium, requirement of the continuing education is exempt for that biennium. The requirement of the continuing education for renewal of both licenses may be satisfied by a RN who is having a current license as an LPN by finalizing suitable continuing education for an RN. The requirement of the continuing education is exempt for a licensee at the time of renewal if the active duty was performed within six months of the date of renewal by the licensee with the Armed Forces.

Figure 9: Armed Forces Licensing (Source: www.floridanursing.gov)

To document the accomplishment of the requirement of the continuing education, four years certificates of attendance should be retained by the licensee. For the assurance of the completion of the continuing education requirement, licensees would be checked by the BON randomly. Disciplinary action should be taken against those persons who are failed to document the completion of the continuing education requirement or provided false information regarding compliance.

A two-hour course on the topic of prevention of medical errors must be completed by all licensees as a requirement of the initial licensure and biennial renewal.

Fees should be deposited to the BON when the license is renewed. A person who is having a license for nursing practice should inform the current address to the BON because any notice required by law should be sent by the Board or its agent. If a licensee changes the address, he/she is bound to inform the board in writing about the new address within 60 days of changing old address. The current place of practice should also be mentioned on the file with the BON by each licensee. Following places are included in the places of practice:

• Acute care facilities

• Long-term care facilities

• Rehabilitation facilities

• Clinics

• Physicians’ office

• Home health care agencies

• Educational institutions

If a licensee does not renew the license at the end of the prescribed biennium, delinquent status would be automatically reverted. All continuing education must be completed and delinquency fee must be paid to get renewal of the license.

The application may be given to the Department by the licensee for the placement of his/her license on inactive status. An application form is provided by the Board and application fee for the inactive status is deposited to the Board along with application form filled by the licensee. The Department considers the applications for inactive status only during the biennium license renewal period. It is against the laws to practice nursing when the license is inactive or delinquent.

It is governed by laws to do nurses practice within a society. Ethical standards of care are also followed by nurses at all times. So, it is essential for nurses to understand the basis of law in the U.S and the association between law and ethics in the nursing practice.

Ethical principles are taken as universal guides for behavior. On the other hand, rules about specific situations are mentioned in laws. An authority has power to make these rules obeyed by imposing.

The subject is changed when the word ethics is heard by the people due to the controversial views about it. Even so, caring persons especially nurses are significantly concerned with ethics. Ethics is a subdivision of philosophy in which the justice or injustice of human and its good or bad effects are concerned. Ethics refer to the ability of people to make selections about their attitude.

Ethical Perspectives

In prescriptive ethics, an advice is offered to the people about the decision what is good or bad behavior. Two different perspectives are being done under it: teleological and deontological.

In teleological perspective, end result of an action determines the rightness or wrongness of an act. This term is derived from a Greek work teleos meaning “end”. If others are harmed by the end results, wrong or bad act is considered. If others are benefited by the end results, good or right act is considered.

In deontological perspective, it is taught to the human beings to obey fixed laws by accepting mortality. It is derived from Greek word deontos meaning “duty to obey”. Despite the situation or end results, some acts are innately right or wrong. So, ethical decision-making is simplified by the deontological perspective after resolving the matter of justifying situations.

Ethical principles are considered as fundamental by which decisions are made by people. To measure the behavior of people, certain principles or criteria have been designed. Five ethical principles are followed in the practice of healthcare professionals:

• Respect for human life and dignity

• Beneficence

• Autonomy

• Honesty

• Justice

Respect for human life and dignity is considered as one of the most basic principle of ethics. When it is applied to nursing, nurses should follow the following mentioned things in given table.

Table 9: Respect for human life and dignity

Beneficence is a term used in a sense for doing something worthy to give benefit to others and keeping professional competence. When it is applied to nursing, nurses should follow the following mentioned things in given table.

Table 10: Beneficence

Autonomy means having right of self-determination, liberation and independence. The principle of autonomy is carried out by nurses for providing exact and scientific facts to patients and helping them to make decisions by understanding the information. When it is applied to nursing, nurses should follow the following mentioned things in given table.

Table 11: Autonomy

Honesty is a term in which truth is told even when bad news about the condition or treatment is conveyed. When it is applied to nursing, nurses should follow the following mentioned things in given table.

Table 12: Honesty

Justice is fairness and equivalence and impartial treatment of patients is required. When it is applied to nursing, nurses should follow the following mentioned things in given table.

Table 13: Justice

A dilemma is a confusing problem in which a choice amongst contradictory alternatives is required. In ethical dilemma, a choice amongst two or more opposed actions based upon ethical principles is required.

For the resolution of ethical dilemmas, all the facts mentioned below should be evaluated carefully:

• Applicable laws

• Consultation with all concerned parties

• Appraisal of the decision makers’ ethical position

Figure 10: Ethical Dilemmas (Source: www.slideshare.net)

In these days, ethical dilemmas are more common in healthcare facilities. Ethical committees are made by many institutions for the resolution of these perplexing problems. Healthcare professionals, ethicists and lawyers are included in ethical committees. Ethical decision-making process is used to resolve ethical dilemmas.

Table 14: Ethical Decision Making Process

The formal statements in which standards about the ethical behavior of group members are set forth are called codes of ethics. In reality, a code of ethics is subscribed by the members of a profession is one of the hallmarks of that profession. Every member of a profession should read, understand and accept the ethical standards of its profession. For the proper understanding of the values and standards of nurses, a Code of Ethics for Nurses with Interpretive Statements is published by the American Nurses Association. ANA revises and updates this document on regular basis.

Figure 11: Florida Legal and Ethical Aspects of Nursing (Source: www.opensesame.com)

Laws are taken from ethical principles and are restricted to specific situations. Rules of conduct are established by laws and power is granted to an authority for the enforcement of laws.

The State of Florida has power for the creation and enforcement of laws regarding the profession of nursing. The division of power is similar in states as well as the federal government:

• Laws are made by the legislative branch on the behalf of people

• These laws are interpreted by the judicial branch and disputes are adjudicated to run justice without prejudice.

• By using the policy power of the state, the laws are administered and enforced by the executive branch.

Figure 12: Standards of Nursing Practice (Source: www.slideplayer.com)

Citations, denial of licenses or disciplinary action are the results of violations of nursing laws and rules.

The health and welfare of public are protected by the Florida Board of Nursing by confirming the safe nursing practice. If the nursing related Florida Laws are violated, the Board of Nursing files the complaints.

The authority of the BON decides about the misconduct or unsafe practice and action against it. Serious actions are taken against violations because patient’s life may be at risk due to it. So, it is the responsibility of every nurse to understand the scope of practice and other requirements according to the law.

Figure 13: Florida Nursing Code of Ethics (Source: www.images.frompo.com)

Citations are applied to the following violations of Florida law mentioned in table below:

Table 15: Citations to the Violations of Florida Law

Figure 14: Unenlightened Nurse(Source: www.vactruth.com)

Following mentioned things should be included in unprofessional conduct:

Table 16: Unprofessional Conduct

Following mentions acts are the ground for disciplinary action according to Florida Statute [4]:

Table 17: Acts for the Disciplinary Action

In disciplinary action, following action may be taken:

• Citations

• Fines

• Probation

• Suspension

• Revocation of licenses

The standards for the competent nursing practice and promoting the safety of patient are set by Florida Board of Nursing. By doing this, the Board of nursing achieves the mission of promoting and protecting the health of citizens through safe nursing practice.

1. Brown LM, Hyer K, Polivka-West L. A comparative study of laws, rules, codes and other influences on nursing homes' disaster preparedness in the Gulf Coast states. Behav Sci Law 2007;25(5):655-75.

2. Curriculum Framework. (August 9, 2012). “Practical Nurse”. Florida Department of Education. Retrieved from https://www.fldoe.org. [Accessed on March 20, 2014].

3. Austin, C. (January 18, 2014). “Nursing Education”. The Ledger. Retrieved from http://www.theledger.com/article/201418. [Accessed on March 23, 2014].

4. 2013 Florida Statures. (November 2013). “464.018 Disciplinary Actions”. The Florida Senate. Retrieved from http://www.flsenate.gov/Laws/Statutes/2013/464.018. [ Accessed on April 2, 2014].