why do nursing licensing laws exist?


As nursing boards developed standards to define nursing practice and prevent unqualified persons from practicing, licensure became mandatory and each state developed an examination process toward that end (Damgaard et al., 2000). The period of suspension may be actual suspension, during which time the nurse is not permitted to work, or stayed (temporarily set aside) during which time the nurse is permitted to work while remaining on probation. The scope of nursing practice has greatly expanded but remains state-specific at all levels of practice. I received a license in another state but I never worked there. Nursing organizations, such as the American Nurses Association (ANA), view these efforts as a divisive attempt to restrict the practice of other providers and presume authority over all professions. The defense of a licensee may be compromised when the BON has information which the licensee is unable to access. While the median annual wage for a registered nurse working in a hospital setting according to the BLS was $77,730 or $37.37 per hour. Credentials, registration and licensure A nursing license is a credential granted by an individual state. Those states and territories that have adopted such alternative to discipline programs may require the absence of patient harm for nurses to qualify for participation. They are frequently appointed by the governor or some other state selection method. Evidence of board disciplinary action may be admissible in medical malpractice lawsuits, or in criminal prosecution. These advisory opinions may be released independently or in conjunction with other organizations. v. Jack O’Connell, et al. In these circumstances, nurses may unknowingly make statements against their interest. A professional license is also a valuable asset that requires zealous protection and skilled advocacy. If you paid for your licence by Direct Debit or TV Licensing payment card, your refund will be automatically processed. However, nursing has a unifying ethos: In assessing a patient, nurses do not just consider test results. In 1903, North Carolina created the first board of nursing (BON) and enacted a Nurse Practice Act (NPA). The most severe penalty, revocation, is reserved for cases in which the BON believes the nurse presents a serious danger to the public and cannot be rehabilitated to safely practice. When laws are broken, citizens are guaranteed the right to a fair trial with fair consequences established. National Council of State Boards of Nursing. This deference is based upon a rationale that the BON’s unique nursing expertise distinguishes it as the most qualified body to render decisions. American Nurses Association, et al. Such surrender still constitutes a disciplinary action tantamount to revocation. Home Health, Home Services, and Home Nursing Agency Licensing Act. Typically the requirements include graduation from an accredited program, English proficiency, clinical practice experience or a refresher course, and good moral character. The goal of The Joint Commission survey and accreditation process is to improve patient outcomes through improved performance. Members of each state BON met collectively with members of the American Nurses Association (ANA) Council on State Boards of Nursing. Licenses may also be suspended. While the NCSBN could provide an enormous amount of guidance, much of the Council’s published materials are restricted to board members and unavailable to the practicing nurse. To confirm that this is the case, state boards will perform licensure verification. Medicare and Medicaid are government health insurance programs for qualifying individuals. Nebulous areas of practice should be identified to the BON, and advisory opinions should be requested. Licensure is one method of validating knowledge and competence. The ANA endorses these programs, stating, in part, that, “alternative approaches have been demonstrated to be at least as effective in protecting the public safety as more antiquated punitive methods. A nurse currently licensed in one jurisdiction may be granted a license in another jurisdiction without retaking the NCLEX upon meeting certain conditions. The Nursing Practice Act can only be changed by legislation enacted by the Texas Legislature which convenes for 140 days every two years. Variations in state laws for APRNs and the confusion they have created for both nurses and consumers has led a coalition of nursing organizations led by the NCSBN to develop the Consensus Model for APRN Regulation, which is an attempt to standardize APRN licensure requirements and scope of … 4. Most licensed premises do not go this far, but many applied for licences in 2005 that allowed them longer opening hours than before. Only newly hired individuals or contracted individuals that fit in the above category are required to have a fingerprint background check. Nursing practice must be compliant with the NPA and the nursing licensure compact administrative rules of each state. Laws that apply anywhere in Australia. Health care professionals work within the boundaries of state licensing rules which vary from one state to another, often restrict what nurses and other non-physician health care workers can do, and determine to what extent they must be supervised by physicians. The practice of nursing is regulated at the state level through administrative rules (laws) and civil procedures. Appealing board decisions is a difficult, expensive, and frequently unsuccessful process. While some regulations may overlap from state to state, it is important to know exactly what your desired licensing board will require of you. Those standards include nursing performance elements such as policies and procedures, safety initiatives, reporting mechanisms, communication systems, sentinel events, quality improvement practices, staffing effectiveness, credentialing, and other performance indicators. 6. Many nursing boards release opinions regarding scope of practice, professional misconduct definitions, or delegation questions to clarify the board’s position on certain matters. A complex regulatory system of state licensure … Some BONs make telephone calls to licensees. Public health codes are laws enacted to promote community health and safety. The NPA exists to govern and regulate the profession of licensed nurses, set standards for the approval of nursing schools in Missouri, determine the scope of practice of licensed nurses, and define who may use the title of registered nurse (R.N.) Nursing is a profession that can cause public harm if practiced incorrectly, which means it needs to be regulated by the government. Some cases may be resolved through informal procedures, while others require formal hearings. In:; 2000, September 8. The development of nursing licensure laws closely follows the advancement of women’s roles in the struggle for suffrage and women’s increased visibility related to war time service. In 15 states, a section of the naturopathic medical board examinations is on homeopathy. The American Diabetes Association (ADA) and the parents of several diabetic students brought a class-action lawsuit claiming that the California Department of Education (CDE) violated the educational rights of diabetic students. Crime, justice and law; Collection Drugs licensing This series brings together all documents relating to drugs licensing. Non-punitive peer assistance programs may provide an alternative to discipline but have not been uniformly adopted by all jurisdictions. The application process for nursing educational programs has become progressively more competitive. American Medical Association House of Delegates. They exist to provide standardization and consistency. While external regulatory schemes impact all health care providers, it is the internal process of self-regulation that greatly influences nursing practice and defines nursing as an autonomous profession. In doing so, the nurse must understand that the forfeiture of the license is permanent. This exam, upon completion of the nursing program, measures a student's readiness for the NCLEX-RN or NCLEX-PN state board licensure … This gave way to the National Council of State Boards of Nursing (NCSBN) in 1978. This sharp-end focus fails to account for the dangerous systems in which nurses practice and compromises the error-analysis process necessary to prevent recurrence. Such requirements typically include continuing education, clinical practice, the absence of a criminal record, and continued good moral character. Personal policies may provide the coverage for disciplinary actions and licensure defense that employer policies do not. Alternatives to discipline programs may address impairment from mental illness as well as from chemical addiction. degrees) and doctors of osteopathic medicine (holders of D.O. Nurses may also sign agreements with the BON not understanding the long-term collateral impact of doing so. The initial qualifications for licensure, continuing educational requirements, disciplinary procedures, complaint resolution processes, professional misconduct or unprofessional conduct definitions, mandatory reporting requirements, and specific scopes of practice are determined at the state level. Government oversight of licensed nurses by a body of nursing experts is intended to keep patients safe by ensuring competence. The scope of practice for all levels of nursing has evolved and expanded considerably since the first NPA was enacted. An initial professional license issued by a nursing board is valid for the licensee’s lifetime, but the licensee must periodically register that license to continue practicing. Nurses must remain within the specific scope of practice in the state in which they are practicing (the state in which the patient is located). The Nurse Practice Act Have you read your Nurse Practice Act lately? Impaired Nurse Resource Center. Nurses placed on the exclusion list may not be employed by any employers receiving state or federal funding. Licensing for doctors and nurses ensures proper training of the people who look after us, and who often have our lives in their hands. Nurses may also be fined, and/or ordered to attend corrective education. When evaluating groups that use terrorist tactics, it is necessary to look beyond surface similarities and identify these heterogeneous characteristics. Drink driving — you’re breaking the law if you drive and your blood alcohol concentration equal to or more than 0.05. In:; 2010. The main purpose of professional standards is to direct and maintain safe and clinically competent nursing practice. BON advisory opinions are often unavailable or inadequate. The Governor can also convene special sessions of the Texas Legislature for the purpose of addressing issues such as school finance, tax reform or other issues. The court system generally supports the exclusive authority of the BON but will consider conflicts between employment practices and BON directions. The Nursing Practice Act can be amended during a special session but amendment of the NPA during a … The nurse may elect to attend a formal hearing rather than agree to a Consent Order if the settlement agreement offers a disciplinary action the nurse considers too harsh. The technical competence and knowledge required for safe practice are not enhanced by removing a clinician from the workforce. In:; 2009. Many BONs are considering this issue in home care as well as school settings. The individual may no longer represent himself or herself as a nurse. Rules and regulations for nursing practice may also be found in public health and general business laws. Why Do We Need Policies And Procedures In Healthcare Settings? In: BONs do not always advise licensees that they can and should seek legal representation at all stages of the process. National Council of State Boards of Nursing. Decision Editor: Laurence G. Branch, PhD More than 1.6 million Americans, mostly seniors, live in nursing facilities. BONs are given their authority through state laws or administrative procedure acts. Occupational licensing laws require workers to submit verification of training, testing and education—and often pay associated fees—before beginning a job in their chosen field. Educational requirements have been standardized and modernized, as has the examination process (NCSBN, 2009b). Some states have separate licensing boards for registered nurses and licensed practical or vocational nurses, while other states have unified boards for regulating all nurses. He or she then may be allowed to schedule an appointment to take the National Council Licensure Exam (NCLEX-RN or NCLEX-PN). Published 10 January 2013 From: Home Office. As stated on the HHS website, “[T]he Department of Health and Human Services (HHS) is the United States government’s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves” (HHS, 2009). The composition and authority of each board, the methodology for addressing complaints, the definition of professional misconduct, and the qualifications for remaining in good standing are examples of state-specific regulation. This nature is often overlooked because of the emotional connotations from the label of terrorism. OIG exclusions and data bank listings may render a nurse unable to work, even when holding a license in good standing. Public safety cannot be attained in the absence of nursing advocacy. Most people understand the need for legal representation to protect their freedom and physical possessions in criminal or civil lawsuits, yet many nurses try to represent themselves with the BON. Approximately 38 states participate in NURSYS®, an online process for providing immediate verification information to the requesting board. Advanced practice nursing, as with RN, LPN/LVN, or nursing attendant practice, remains within the regulatory purview of each state or territory. 7. Those who are sick, infirm, young, elderly, disabled, or in any manner unable to advocate for themselves may be endangered by unqualified practitioners. To comply with their legislative mandate to protect the public, BONs define the required elements of nursing education. For more options see the Hawaii Board of Nursing Professional and Vocational Licensing: Hawaii Board of Nursing Professional and Vocational Licensing Division: Idaho: New Continuing Competency Requirements (effective with the 2019 renewal) In order to renew, a licensee shall complete or comply with at least two of any of the learning activities listed below within the two year renewal … Long after the BON has resolved the complaint, the licensee may continue to experience sequelae. Although professional licensing boards are entrusted with keeping the public safe, there is no evidence basis that the current regulatory system for BONs is effective in improving nursing practice. The primary function of a BON is protection of the health, safety, and welfare of the public and maintenance of the public’s trust in the profession by ensuring that those individuals who engage in the conduct described in the Nurse Practice Act are properly trained and licensed. Once we have received this information in a signed form from the person in charge of your scheme, you don't need to do anything else and you will be added to the scheme. Successful completion of the examination is required to be granted an initial licensure. While the matter was pending, the California Board of Registered Nursing issued a public statement (CBRN, 2007) in which nurses were advised to adhere to the NPA and practice in accordance with the Board’s standards. In the United States, a national certification is available for the Certified Professional Midwife but national midwifery licensing does not exist as it does in many other countries. 2001). All nurses should independently maintain professional liability insurance rather than relying on employer coverage. The American Diabetes Association (ADA) intervened in the lawsuit, arguing that federal disability laws entitled diabetic students to insulin administration as a component of their educational rights. The state in which an applicant seeks licensure (by reciprocity or endorsement) must confirm that the applicant is, in fact, a licensee in good standing in another jurisdiction. There were more than 17,000 nursing facilities, with a total of over 1,834,000 beds in 1998 (AHCA 1999). In:; 2005, September 21. BONs that fail to distinguish between intentional misconduct and inevitable human error perpetuate an ineffective response to adverse events by blaming the end user, or direct provider for the error. 3. When something distracts us from our primary focus, it can be, understandably, frustrating. Nurses should go to their BON’s website periodically to monitor such communications. The BON may find violations that can be addressed by issuing a letter of reprimand, but no other action. Chapter 66 Nursing Licensure and Regulation Edie Brous “[T]he liberty component of the Fourteenth Amendment's Due Process Clause includes some generalized due process right to choose one's field of private employment, but a right which is nevertheless subject to reasonable government regulation.” —United States Supreme Court, Conn v. Laws help outline what a person can or cannot do, what crimes violate acceptable practices and manners in which others should be treated. Outdated nursing licensure laws are a serious healthcare challenge, but we can address it together. The ANA, the California Nurses Association (CNA), and the California School Nurses Association (CSNA) challenged this legal advisory in court, arguing that the directive could not be followed as it violated the California NPA (ANA, 2008). degrees). Do you understand your Scope of Practice? Through the critical thinking exemplified in the nursing process (see below), nurses use their judgment to integrate objective data with subjective experience of a patient’s biological, physical and behavioral needs. Click here for info on YOUR STATE'S nurse practice act. This chapter will provide an overview of the regulatory processes, both those that are internal to nursing and those that impose obligations from outside the profession. Why IP Law Is Growing . Home states and remote states communicate through a coordinated database, and both may take disciplinary action against a licensee when indicated. Though nurses may have different specialties, levels of education or job descriptions, nursing standard practices are essentially the same across the board. The quality of care in U.S. nursing homes has been a recurrent matter of public concern and policy attention for more than thirty years. Hughes v. Freeman Health System, 283 S.W.3d 797 (Mo. Public health laws exist at the local, state, and federal level and may be enforced by civil or criminal penalties. The Nurse Practice Act is a set of laws which protect the public from harm. The “right to a speedy trial” in the criminal system, as well as the standards and goals that move civil suits forward on mandated schedules, do not exist in the administrative setting. Resolution 204: Midwifery Scope of Practice and Licensure. If contacted by telephone, nurses should advise the BON that they wish to speak with counsel before making any statements or signing any papers. Why do we have alcohol laws? Practice deficiencies are not corrected by levying fines or publishing disciplinary actions on the Internet. American Medical Association House of Delegates. And, as more chronically ill people were cared for at home after Medicare became law in 1965, more and more professional nurses were sought to care for the sick in their homes. An organization’s protocols may be used to establish the practice standards to which the nurse will be held. + All facilities that provide health care services must comply with licensing laws. 11. Let's dive into full practice authority and why nurse practitioners in 28 states have barriers to practice without a collaborative agreement with a physician. Medicare is a federally-administered program available to persons 65 or older, persons under 65 with certain disabilities, and persons of all ages with end-stage renal disease. Nursing is regulated at the state level. The integrity of all HHS programs is protected by the Office of the Inspector General (OIG) through audits and exclusion lists, as discussed in the following paragraphs. The ANA has resolved to work with these few states to pursue the legislative and regulatory modifications necessary to implement an ‘alternative to discipline’ model for impaired nurses” (ANA, 2010). A temporary suspension may be all that is required for OIG exclusion. The nurse whose patient is not injured by the identical error may be a less cautious provider and actually pose a greater risk to patients but receives a lighter penalty with this approach. However, nursing has a unifying ethos: In assessing a patient, nurses do not just consider test results. Home states and remote states communicate through a coordinated database, and both may take disciplinary action against a licensee when indicated. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), American Academy of Nurse Practitioners [AANP], 2006, American Nurses Association, et al., 2008,,,,,,,,, Policy Approaches to Address Health Disparities, Learning the Ropes of Policy, Politics, and Advocacy, How Government Works: What You Need to Know to Influence the Process, Nursing Education Policy: The Unending Debate over Entry into Practice and the New Debate over Doctoral Degrees, Policy and Politics in Nursing and Healthcare. The Joint Commission. The public is not kept safe by imposing a harsher penalty on a nurse because the patient was injured. It is essential to know how state laws interact with each other and with tribal and federal laws. In yet other states, BONs are hybrid organizations, functioning as institutions that are partially independent and partially affiliated with other agencies. The use of a medical model, as opposed to a punitive model in addressing mental illness and/or chemical addiction is preferable because it is more consistent with the board’s stated goal of protecting the public. Practice alerts may also be released advising the nursing community and the public at large of rule changes or urgent issues. Some states have an additional category of license surrender called “Voluntary Relinquishment.” This is a form of surrender unrelated to disciplinary action, in which the licensee is retiring, moving out of state, or for other reasons choosing not to practice nursing in the state. Nurses must remain within the specific scope of practice in the state in which they are practicing (the state in which the patient is located). “[T]he liberty component of the Fourteenth Amendment’s Due Process Clause includes some generalized due process right to choose one’s field of private employment, but a right which is nevertheless subject to reasonable government regulation.”, —United States Supreme Court, Conn v. Gabbert, 526 U.S. 286, 291(1999). Nurses must study and adhere to their state’s continuing education requirements, scope of practice, definitions of professional misconduct, reporting requirements, and standards of practice. Although nurses may represent themselves, it is strongly advised that they seek legal counsel when responding to Board inquiries, even when the allegations appear baseless. Complaints. Sets of laws enacted to protect the public specify the scope of practice for nursing attendants, LPN/LVNs, RNs, and APNs; outline the authority of the Board; define professional misconduct; and detail the investigation and disciplinary processes for resolving complaints. Due process rights in agencies differ substantially from due process rights in a court of law. Graduation from a school that is accredited in one state may not meet the requirements for licensure in another state. The CDE settled with the parents and issued a “Legal Advisory on the Rights of Students with Diabetes in California’s K-12 Public Schools” in which local education agencies were required to train non-licensed volunteers to administer insulin. Reputation damage is very difficult to overcome. In:; 2009b. As opposed to latent-error focus, which does positively impact patient safety, such active-error focus has a paradoxical and perverse effect on patient safety initiatives. Additionally, the nurse may be required to explain criminal activity or disciplinary actions in the home state. “That's a big problem, because managers are critical for providing the support needed to do this and for providing role models.” Education is a big factor, Melnyk points out. The law also helps the three branches of the government to sustain equity. It serves as the umbrella organization for such agencies as the Centers for Medicare and Medicaid (CMS), the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and the Office for Civil Rights (OCR), among others. In:; 2010. The BON may close the file if its investigation finds no violations. More to Consider. (American Nurses Association, et al., 2008). Resolution 814: Limited Licensure Health Care Provider Training and Certification Standards. When implemented appropriately, the state-mandated testing, training and educational requirements of occupational licensure can mitigate potentially harmful health and safety risks for the public. This project will explore these parallels. The inability to practice for several years may make an eventual return to practice logistically impossible, regardless of licensure status. This is true for healthcare workers who have to sacrifice some of the time they have to deliver care to patients in order to comply with hospital policies and procedures. Privacy and confidentiality provisions of the administrative statutes are sometimes written or interpreted in such a manner as to prevent even the target of the investigation from obtaining all evidentiary materials. For example, in Utah, a minor of reproductive age has a right to confidential reproductive health care. The government has an obligation to protect its most vulnerable citizens. Nursing practice must be compliant with the NPA and the nursing licensure compact administrative rules of each state. Today there are 60 constituent member boards (including all 50 states and some U.S. territories). Health care law is a great learning avenue for registered nurses, because it creates opportunities for them to continue to promote wellness by advocating for patients in other capacities, if they so desire. The power to license rests with individual states/ territories. Nursing standards of practice, also known as standards of care, are guidelines that nurses can use to determine what they should and should not do when caring for patients. The licensee must meet the board’s registration requirements to be issued a registration certificate. The BON may offer the nurse an opportunity to settle the matter informally, rather than conducting a full hearing. Medical societies frequently react to advancements in nursing practice by challenging BON authority to define expanded roles, particularly regarding advanced practice roles. NPAs and administrative rules vary from state to state and nurses are legally obligated to comply with the licensing requirements in the state where the nurse is practicing. The health care facility may choose to conduct a fingerprint background check for its current employees, licensed individuals and volunteers but the facility is not required to by law. Medicaid, Medicare and quite allot of other funds that flow to state and local governments, hospitals, nursing homes and so forth come with rules, laws, regulations and so forth. A member of the lay public may not have the ability to recognize and protect himself or herself from incompetent providers. The accepted student must then meet the stringent academic rigors of a challenging curriculum, followed by successful completion of state board examinations before being initially licensed to practice. The surrender process, sometimes referred to as “Discipline by Consent,” is an application that the BON may or may not accept. As for regulating nursing, and or any other healthcare profession, the federal government already has vast powers, but they are used via funding. Nursing licenses Learn how to check, apply for, or renew a nursing license and learn about Advanced Practice Registered Nursing (APRN) authorization, prescriptive authority, and Mandatory Continuing Education for nurses. Outcome-oriented discipline results in inconsistency from one licensee to another for the same infraction.

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