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FLORIDA NURSING LAWS AND RULES

DANA BARTLETT, RN, BSN, MSN, MA, CSPI

Dana Bartlett is a professional nurse and author. His clinical experience includes 16 years of ICU and ER experience and over 27 years as a poison control center information specialist. Dana has published numerous CE and journal articles, written NCLEX material, textbook chapters, and more than 100 online CE articles, and done editing and reviewing for publishers such as Elsevier, Lippincott, and Thieme. He has written widely on the subject of toxicology and was a contributing editor, toxicology section, for Critical Care Nurse journal. He is currently employed at the Connecticut Poison Control Center. He lives in Wappingers Falls, NY.

ABSTRACT

Florida Nurse Practice Act sets standards for the scope of nursing practice within a wide spectrum of care. The expected levels of professional standards and continuing competency, and the requirements of continuing education necessary to maintain a nursing license in the state of Florida are discussed. Additionally, licensing requirements and regulatory processes are outlined for nurses at various levels of training and skills.

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Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. Continuing Education Credit Designation This educational activity is credited for 2 hours at completion of the activity. Statement of Learning Need Nurses at all levels of training are required to know changes to the Florida nurse practice act that regulates nursing practice and everyday practice. Course Purpose To inform nurses to practice within the scope of nursing as outlined in the Florida Nurse Practice Act. Target Audience Advanced Practice Registered Nurses, Registered Nurses, and other Interdisciplinary Health Team Members. Disclosures Dana Bartlett, RN, BSN, MSN, MA, CSPI, William Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures. There is no commercial support.

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Self-Assessment of Knowledge Pre-Test:

1. The Florida Nurse Practice Act provide definitions about

a. the practice of nursing. b. the nursing licensure process. c. how nurses should be educated. d. All of the above

2. Nursing behavior or actions are covered in the Florida Nurse

Practice Act in terms of

a. specific practice guidelines. b. how the discipline process is applied. c. legal advice for nurses. d. instructions for performing specific nursing care.

3. Administrative codes in the Florida Nurse Practice Act are

a. rules and regulations formulated by government agencies. b. professional guidelines outlined by nursing agencies. c. not applicable to nursing education standards. d. developed by healthcare facilities.

4. True or False: Denial and/or suspension of a nursing license

because of impairment involves professional discipline but does not involve criminal penalties.

a. True b. False

5. A licensee is required to take 26 hours (instead of the usual 24

hours) of continuing education during a renewal period when a course in _________________ is required.

a. Human Trafficking b. Prevention of Medical Errors c. Domestic Violence d. HIV/AIDS

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Introduction

Specific laws, rules, and regulations govern the profession of nursing in the state of Florida. Some of these are particular to the profession of nursing while others are more general in nature and pertain to nursing as well as to other professions and/or occupations. But in either case, whether a regulation is only concerned with the profession of nursing or it is more general in scope, nurses practicing in the state of Florida must comply with the requirements and restrictions that have been developed by the Florida Board of Nursing and the state of Florida. These administrative, ethical, and legal requirements and restrictions are not intended to be technical guidelines. They are not specific standards of care. They provide definitions about what nursing is, what nurses may do and what they may not do, how they should be educated, the licensure process, and what behavior or actions are considered unethical, unprofessional, and illegal and the discipline process that is applied to nurses who violate ethical and professional standards.

The information in this course has been developed from two sources: 1) Florida State Statutes, 2016 Title XXXII: Regulation of the Professions and Occupations. Chapter 464: Nursing. Part I Nurse Practice Act; Part II Certified Nursing Assistants, and 2) the rules of The Board of Nursing, Chapter 64B9 of the Florida Administrative Code. There is considerable overlap between the two, but they are not identical. In the text, the use of the term Chapter refers to the Nurse Practice Act.

The Florida Nurse Practice Act

The Florida Nurse Practice Act is in the Florida State Statutes, Title XXXII: Regulation of Professions and Occupations. It is Chapter 464, Nursing: Nurse Practice Act, sections 464.001-464.027.1

Part 464:002 - Purpose of the Nurse Practice Act states: “The sole

legislative purpose in enacting this part is to ensure that every nurse practicing in this state meets minimum requirements for safe practice.”1

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The Nurse Practice Act provides basic information, relevant to the state of Florida, on the state’s definition of what nursing is, the basic duties and responsibilities of each type of nursing professional, how nurses should be educated and trained, how they should be licensed, how they should be certified, continuing education requirements, and the disciplinary process as it pertains to nurses. The Nurse Practice Act Part 464:002 - Purpose of the Nurse Practice Act also states: ”It is the legislative intent that nurses who fall below minimum competency or who otherwise present a danger to the public shall be prohibited from practicing in this state.”1

The Nurse Practice Act is not a technical document that provides

instructions and standards for performing specific nursing actions. The Nurse Practice Act offers a general overview of the laws, rules, and regulations that pertain to nursing and nursing practice in the state of Florida in the following areas:

● The nature and scope of nursing practice ● Nursing education ● Definitions, i.e., approved program, nursing diagnosis, nursing

treatment ● Licensing and certification information ● Legal and disciplinary issues: The Nurse Practice Act lists specific

violations and laws that pertain to nursing and nurses in the state of Florida

● Sexual misconduct ● Certified Nursing Assistants ● Administrative Policies

There are specifics regarding the nature and scope of nursing practices

for each of the recognized areas of practice, e.g., A.P.R.N.s, graduate nurses, but the Nurse Practice Act gives primarily broad definitions of what nursing professionals can and cannot do. The Nurse Practice Act also notes that an individual nurse can practice within the constraints of the Nurse Practice Act, but also within the constraints of that individual’s education, experience, and the rules and regulations of a specific health care facility.1

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Two examples of how nursing is defined in the Nurse Practice Act are provided here. These are from Chapter 464, Part 1, Section 464.003: Definitions. “Practice of professional nursing means the performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to:

(a) The observation, assessment, nursing diagnosis, planning,

intervention, and evaluation of care; health teaching and counseling of the ill, injured, or infirm; and the promotion of wellness, maintenance of health, and prevention of illness of others.

(b) The administration of medications and treatments as prescribed or authorized by a duly licensed practitioner authorized by the laws of this state to prescribe such medications and treatments.

(c) The supervision and teaching of other personnel in the theory and performance of any of the acts described in this subsection.”1

Practice of practical nursing means the performance of selected acts, including the administration of treatments and medications, in the care of the ill, injured, or infirm; the promotion of wellness, maintenance of health, and prevention of illness of others under the direction of a registered nurse, a licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed dentist; and the teaching of general principles of health and wellness to the public and to students other than nursing students. A practical nurse is responsible and accountable for making decisions that are based upon the individual’s educational preparation and experience in nursing.”1 The Nurse Practice Act is available online at several links, such as: http://www.doh.state.fl.us/mqa/nursing/info_PracticeAct.pdf.

The Rules of the Board of Nursing

Administrative codes are rules and regulations formulated by government agencies. The rules applicable to nursing are formulated by the Florida Board of Nursing. “The Florida Board of Nursing licenses, monitors, disciplines, educates and, when appropriate, rehabilitates its licensees to

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assure their fitness and competence in providing health care services for the people of Florida.”3 This section covers the Florida State Department of Health Administrative Code as it pertains to the practice of nursing. Florida Administrative Code 64B9

The Florida Administrative Code 64B9, administered by the Department of Health, contains rules and regulations that apply to the profession of nursing.2

There are 16 sections in Administrative Code 64B9.2 They are found in

sections 1-9 and 11-17 (there is no section 10).2 Rule 64B9-17, Role of the Registered Nurse in Conscious Sedation, has not been finalized so there is no active link for this rule.2 Some but not all of the information in Administrative Code 64B9 is duplicated in the Florida Nurse Practice Act.1,2

The 16 sections of 64B9 of the Florida Administrative Code are listed as follows:2

1. Organization- Rule 64B9-1 2. Nursing Programs- Rule 64B9-2 3. Requirements for Licensure- Rule 64B9-3 4. Administrative Policies Pertaining to Certification of Advanced

Registered Nurse Practitioners- Rule 64B9-4 5. Continuing Education Requirements- Rule 64B9-5 6. Inactive Status and Reactivation of Inactive License- Rule 64B9-6 7. Fees- Rule 64B9-7 8. Hearings, Proceedings, Conferences, Discipline- Rule 64B9-8 9. Impaired Nurse Program- Rule 64B9-9 10. Maintenance of Medical Records- Rule 64B9-11 11. Administration of Intravenous Therapy by Licensed Practical

Nurses- Rule 64B9-12 12. Home Hemodialysis Treatments- Rule 64B9-13 13. Delegation to Unlicensed Assistive Personnel- Rule 64B9-14 14. Certified Nursing Assistants- Rule 64B9-15

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15. LPN Supervision in Nursing Home Facilities- Rule 64B9-16 16. Role of the Registered Nurse in Conscious Sedation-Rule 64B9-17:

this rule is in process of development The information contained in the different sections of Code 64B9 is relatively specific, as these examples from scope of LPN practice and IV therapy illustrate. 64B9-12.004: Authority for the LPN to Administer Limited Forms of Intravenous Therapy 64B9-12.002 Definitions. 1) “Administration of Intravenous Therapy” is the therapeutic infusion and/or

injection of substances through the venous peripheral system, consisting of activity which includes: observing, initiating, monitoring, discontinuing, maintaining, regulating, adjusting, documenting, planning, intervening and evaluating.2

2) “Under the direction of a registered professional nurse” means that the

registered professional nurse has delegated intravenous therapy functions to a qualified licensed practical nurse. The registered professional nurse does not in all instances have to be on the premises in order for the licensed practical nurse to perform the delegated functions.2

3) “Direct supervision” means on the premises and immediately physically

available.2 64B9-12.003 Aspects of Intravenous Therapy Outside the Scope of Practice of the LPN 1) Aspects of intravenous therapy which are outside the scope of practice of

the licensed practical nurse unless under the direct supervision of the registered professional nurse or physician and which shall not be performed or initiated by licensed practical nurses without direct

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supervision include the following:2

a) Initiation of blood and blood products; b) Initiation or administration of cancer chemotherapy; c) Initiation of plasma expanders; d) Initiation or administration of investigational drugs; e) Mixing IV solution; f) IV pushes, except heparin flushes and saline flushes.

2) Although this rule limits the scope of licensed practical nurse practice, it is

appropriate for licensed practical nurses to care for patients receiving such therapy.

64B9-12.004 Authority for the LPN to Administer Limited Forms of Intravenous Therapy 1) With the exception of those aspects of intravenous therapy deemed outside

the scope of practice of the licensed practical nurse by Rule 64B9-12.003, F.A.C., above, and subject to the approval of the institution at which the licensed practical nurse is employed, any licensed practical nurse who meets the competency knowledge requirements of Rule 64B9-12.005, F.A.C., below, is authorized to administer intravenous therapy under the direction of a registered professional nurse.2

2) Individuals who have completed a Board approved prelicensure practical

nursing education program, professional nursing students who qualify as graduate practical nurses, or licensed practical nurses who have not completed the specified course under Rule 64B9-12.005, F.A.C., may engage in a limited scope of intravenous therapy under the direction of a registered nurse, physician or dentist. This scope includes:2

a) Perform calculation and adjust flow rate; b) Observe and report subjective and objective signs of adverse reactions to IV administration; c) Inspect insertion site, change dressing, and remove intravenous needle

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or catheter from peripheral veins; d) Hanging bags or bottles of hydrating fluid.

Administrative Code 64B9 can be viewed at the following weblink: https://www.flrules.org/gateway/Organization.asp?OrgNo=64B9.

Throughout this course there will be notations such as 64B9-8.005: Unprofessional conduct or 464.015: Titles, Abbreviations, Restrictions, Penalties. Any reference containing 64B9, indicates that the information is from the Florida Administrative Code; any reference containing464 indicates it is from the Nurse Practice Act.

Definitions and Scope of Florida Nursing Practice

The State of Florida recognizes and defines the types of nursing professionals or nursing ancillary personnel and defines their scopes of practice: Advanced Practice Registered Nurse, Registered Nurse, Graduate Nurse or Graduate Practical Nurse, Licensed Practical Nurse, and Certified Nursing Assistant.Advanced Practice Registered Nurse.1

An Advanced Practice Registered Nurse is defined as any person who is

licensed in the state to practice professional nursing and who is licensed in advanced nursing practice including certified registered nurse anesthetists, certified nurse midwives, certified nurse practitioners, clinical nurse specialists, or psychiatric nurses. The proper abbreviations for these titles are A.P.R.N., C.R.N.A., C.N.M., C.N.P., and C.N.S. (464.015: Titles and abbreviations, restrictions, penalty).1

To practice as an A.P.R.N, a nurse must complete a post-basic education

program of at least one-year duration that will lead to a master’s degree with preparation in specialized skills, and possess a certification that has been granted by a specialty certification board. An A.P.R.N. in Florida can practice as a C.R.N.A., a C.N.M., a C.N.P., or a C.N.S. “Within the context of advanced or specialized nursing practice, the advanced practice registered nurse may perform acts of nursing diagnosis and nursing treatment of alterations of the

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health status. The advanced practice registered nurse may also perform acts of medical diagnosis and treatment, prescription, and operation as authorized within the framework of an established supervisory protocol.” ( Chapter 464, 464.003: Definitions).1

When the requirements have been fulfilled, an A.P.R.N. is allowed to: 1)

monitor and alter drug therapies, 2) order diagnostic tests, occupational therapy, and physical therapy, 3) initiate appropriate therapies for certain conditions, 4) manage selected medical problems, 5) initiate, monitor, or alter therapies for certain uncomplicated acute illnesses, 6) monitor and manage patients with stable, chronic diseases, 7) establish behavioral problems and diagnosis and make treatment recommendations, 8) perform acts of medical diagnosis, treatment, prescription, and operation if these are identified and approved by a special committee of the Board of Nursing, and 9) perform additional functions if they are identified by rule. In addition to the general functions specified in subsection (3), an advanced registered nurse practitioner may perform specific acts and functions appropriate to, and within his or her specialty, i.e., C.R.N.A., a C.N.M., a C.N.P., or a C.N.S. (Nurse Practice Act, Chapter 464, 464.012: Licensure of advanced practice registered nurses; fees; controlled substance prescribing). The list of these specialty responsibilities is quite long and they will not be listed here; interested readers should refer to the Florida Statutes and Chapter 464, Nursing, Part 1: Nurse Practice Act.1

One of the requirements for practice as an A.P.R.N. in Florida is

certification by a professional or national specialty board that meets the following requirements (64B9-4.002 Requirements for Licensure).1

1) Can attest to the competency of nurses in a clinical specialty area. 2) Requires a written examination prior to certification. 3) Requires completion of a formal program prior to eligibility of

examination. 4) Maintains a program accreditation or review mechanism that adheres to

criteria which are substantially equivalent to Florida requirements. 5) Identifies standards or scope of practice statements that are appropriate

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for the specialty.

Professional and national boards that are recognized by the state of Florida include, but are not limited to:1

(a) Council on Certification of Nurse Anesthetists, or Council on

Recertification of Nurse Anesthetists, or their predecessors. (b) American College of Nurse Midwives (c) American Nurses Association (American Nurses Credentialing Center)

Nurse Practitioner level examinations only. (d) National Certification Corporation for OB/GYN, Neonatal Nursing

Specialties (nurse practitioner level examination only). (e) National Board of Pediatric Nurse Practitioners and Associates

(Pediatric Nurse Associate/Practitioner level examinations only). (f) National Board for Certification of Hospice and Palliative Nurses. (g) American Academy of Nurse Practitioners (nurse practitioner level

examination only). (h) Oncology Nursing Certification Corporation. (i) American Association of Critical-Care Nurses (AACN Certification

Corporation) Adult Acute Care Nurse Practitioner Certification (ACNPC).

(j) Psychiatric Mental Health Nurse Practitioner Certification (family) (ANCC).

(k) Family Psychiatric and Mental Health Nurse Practitioner (ANCC). (l) Adult Psychiatric and Mental Health Nurse Practitioner (ANCC). (m) Psychiatric Adult CNS (ANCC). (n) Psychiatric Mental Health CNS-Child Adolescent (ANCC).

This list is specifically found at Rule 64B9-4.002 under Requirements for Licensure.2

Registered Nurse: Definition and Aspects of Practice

A registered nurse is defined as any person licensed in the state to practice nursing, and the title may be abbreviated as R.N. The term registered

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nurse and professional nurse are used interchangeably in the Nurse Practice Act. The scope of practice of a registered nurse in the state of Florida is defined as the “... performance of those acts requiring substantial specialized knowledge, judgment, and nursing skill based upon applied principles of psychological, biological, physical, and social sciences which shall include, but not be limited to:

1) The observation, assessment, nursing diagnosis, planning, intervention, and evaluation of care.

2) Health teaching and counseling of the ill, injured, or infirm. 3) The promotion of wellness, maintenance of health, and the prevention

of illness of others. 4) The administration of medications and treatments as prescribed by a

duly licensed practitioner authorized by the laws of this state to prescribe such medications and treatments.

5) The supervision and teaching of other personnel in the theory and performance of any of the above acts (Chapter 464, 464.003: Definitions).1

Registered nurses are not allowed to diagnose, prescribe medications or

dispense medications unless the R.N., is an A.P.R.N. (It should be noted that the term dispense is not synonymous with administer; an R.N., may administer medication ordered for a patient in the dosage and manner prescribed.) Graduate Nurse or Graduate Practical Nurse

A graduate nurse is defined as someone who is a graduate of an approved nursing program or nursing or an equivalent who has not yet taken and passed the licensure examination for which that person is eligible. The title may be abbreviated as G.N. (Chapter 464, 464.015: Titles and Abbreviations, Restrictions, Penalty).1

A graduate practical nurse is defined as someone who is a graduate of

an approved nursing program or an equivalent who has not yet taken the

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licensure examination for which that person is eligible. The title may be abbreviated as G.P.N (Chapter 464, 464.015: Titles and Abbreviations, Restrictions, Penalty). A graduate nurse or graduate practical nurse can practice nursing only if 1) the nurse has applied for the licensing examination and has been authorized by the State Board of Nursing to practice as a Graduate Nurse or Graduate Practical Nurse, and 2) the nurse is directly supervised by a registered nurse (64B9-3.003).1

Licensed Practical Nurse: Definition and Aspects of Practice

A licensed practical nurse is defined as any person who is licensed in the state to practice practical nursing; the title may be abbreviated as L.P.N. An L.P.N. is often allowed to perform many of the same duties and activities that an R.N. can do, but the L.P.N. must be under the direct supervision of an R.N., a licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed dentist. More specifically, an L.P.N. can perform selected acts, including the administration of treatments and medications, in the care of the ill, injured, or infirm, the promotion of wellness, maintenance of health, and prevention of illness of others under the direction of a registered nurse, a licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed dentist, and the teaching of general principles of health and wellness to the public and to students other than nursing students.

A practical nurse is responsible and accountable for making decisions that are based upon the individual’s educational preparation and experience in nursing (Chapter 464, 464.003: Definitions).1 An L.P.N., if qualified by training and education and approved by his or her place of employment, can administer intravenous medications. There are limits to this practice, and a brief listing of these are outlined below.2

● IV therapy is defined as the therapeutic infusion and/or injection of

substances through the venous peripheral system, consisting of activity which includes observing, initiating, monitoring, discontinuing, maintaining, regulating, adjusting, documenting, planning, intervening

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and evaluating (64B9-12.002 Definitions). ● Under the direction of a registered professional nurse means that the

registered professional nurse has delegated intravenous therapy functions to a qualified licensed practical nurse. The registered professional nurse does not in all instances have to be on the premises in order for the licensed practical nurse to perform the delegated functions (64B9-12.002 Definitions).

● Direct supervision means on the premises and immediately physically

available (64B9-12.002 Definitions). ● Aspects of intravenous therapy which are outside the scope of practice

of the licensed practical nurse unless under the direct supervision of the registered professional nurse or physician and which shall not be performed or initiated by licensed practical nurses without direct supervision include the 1) Initiation of blood and blood products, 2) Initiation or administration of cancer chemotherapy, 3) Initiation of plasma expanders, 4) Initiation or administration of investigational drugs, 5) Mixing IV solutions, and 5) IV pushes, except heparin flushes and saline flushes (64B9-12.003. Aspects of Intravenous Therapy Outside the Scope of Practice of the LPN).

● It is appropriate for licensed practical nurses to care for patients

receiving such therapy (64B9-12.003. Aspects of Intravenous Therapy Outside the Scope of Practice of the LPN).

● With the exception of those aspects of intravenous therapy deemed

outside the scope of practice of the licensed practical nurse by Rule 64B9-12.003, F.A.C., above, and subject to the approval of the institution at which the licensed practical nurse is employed, any licensed practical nurse who meets the competency knowledge requirements of Rule 64B9-12.005, is authorized to administer intravenous therapy under the direction of a registered nurse. The competency knowledge requirements of Rule 64B9-12.005 are quite

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lengthy and the full text of this rule will not be covered. ● Individuals who have completed a Board approved pre-licensure

practical nursing education program, professional nursing students who qualify as graduate practical nurses, or licensed practical nurses who have not completed the specified course under Rule 64B9-12.005, may engage in a limited scope of intravenous therapy under the direction of a registered nurse, physician or dentist. This scope includes 1) Perform calculation and adjust flow rate, 2) Observe and report subjective and objective signs of adverse reactions to IV administration, 3) Inspect insertion site, change dressing, and remove intravenous needle or catheter from peripheral veins, and 4) Hanging bags or bottles of hydrating fluid.

An L.P.N. may act in a supervisory role in nursing home facilities if

certain requirements are met. These requirements are listed in two rules, 64B9-16.003 Competency and Knowledge Requirements Necessary to Qualify the LPN to Supervise in Nursing Home Facilities, and in 64B9-16.004 Delegation of Tasks Prohibited. Examples: 64B9-16.004 states: “The licensed practical nurse, under the direction of the appropriate licensed professional as defined in Section 464.003(19), F.S. shall not delegate: (1) Any activity that is outside the scope of practice of the LPN; or in which the Nurse Practice Act stipulates that the LPN must have direct supervision of a Registered Nurse in order to perform the procedure. (2) Those activities for which the licensed practical nurse, certified nursing assistant or UP has not demonstrated competence.”2

Certified Nursing Assistants

A Certified Nursing Assistant (C.N.A.) must go through an approved program, take a written exam and a clinical skills test, and can then receive certification if the examined skills and the test are successfully completed. The C.N.A. is then allowed to perform his/her duties while under the direct supervision of an R.N. or an L.P.N. or other licensed professional (64B9-15.002: Definitions).2

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Under certain circumstances, a C.N.A., may practice under the supervision of an R.N., or an L.P.N., if that person is not present but can easily be contacted when needed for consultation or advice. A Certified Nursing Assistant provides basic care to patients: a complete list of responsibilities and scope of practice of a C.N.A. can be found in Florida Administrative Code, section 64B9-15.002, Certified Nursing Assistant Authorized Duties. Examples of the duties, responsibilities, and limits of C.N.A. practice are:2

● A certified nursing assistant shall not perform any task which requires

specialized nursing knowledge, judgment, or skills (64B9-15.002, Certified Nursing Assistant Authorized Duties).

● A certified nursing assistant may receive additional training beyond that required for initial certification and upon validation of competence in the skill by a registered nurse may perform such skills as authorized by the facility (64B9-15.002, Certified Nursing Assistant Authorized Duties).

● A certified nursing assistant shall not work independently without the supervision of a registered nurse or a licensed practical nurse (64B9-15.002, Certified Nursing Assistant Authorized Duties).

● The R.N. or L.P.N. may not delegate the C.N.A. certain tasks (64B9-14.003: Delegation of Tasks Prohibited).

Nursing Laws, Rules, and Ethical Practice in Florida

Nursing is a profession and is governed by rules and ethics, and the

expression of these is typically called professional conduct. Nurses are also obviously guided and constrained by the rules of conduct and the laws of our society. Some actions or behaviors may be considered unethical and unprofessional but may not be illegal - but a nurse who participated in unethical or unprofessional behavior could be punished and/or sanctioned by the Board of Nursing. And some actions and behaviors are unethical, unprofessional, and illegal, and would be subject to punishment by the criminal justice system.

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The overlap between unethical or unprofessional and illegal can be complicated, and the specific differences between ethical and legal - what constitutes one as opposed to another - are not discussed. Punishments for infractions are clearly outlined, but the State Board of Nursing and the criminal justice system consider many factors when deciding on punishments. These factors include the danger to the public, previous infractions, the length of time the nurse has practiced, the damage that has been caused, and any attempts by the nurse to correct or stop the behavior in question. Most of the information provided in the following sections has been gleaned from the Chapter 64B9, Hearings, Proceedings, Conferences, Discipline, Sections 64B90-8.001 to 8.014, which is available online at https://www.flrules.org/gateway/ChapterHome.asp?Chapter=64B9-8.

Information on Criminal Offenses and Denial of License is from Title XXXII: Regulation of the Professions and Occupations. Chapter 464, 464:016 Violations and Penalties (accessed at: http://floridasnursing.gov/resources/). Details about the disciplinary process is in 64B9-8.001, The Probable Cause Panel, and in 64B9-8.006, Disciplinary Guidelines, Range of Penalties, Aggravating and Mitigating Circumstances. Unprofessional Conduct

This section covers actions considered to be unprofessional conduct in the practice of nursing in Florida under Chapter 64B9, Section 64B9-8.005: Unprofessional Conduct. These actions include:2

● Inaccurate recording. ● Misappropriating drugs, supplies or equipment. ● Leaving a nursing assignment without advising licensed nursing

personnel. ● Stealing from a patient. ● Violating the integrity of a medication administration system or an

information technology system. ● Falsifying or altering of patient records or nursing progress records,

employment applications, or time records.

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● Violating the confidentiality of information or knowledge concerning a patient.

● 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 the individuals.

● Engaging in fraud, misrepresentation, or deceit in taking the licensing examination.

● Impersonating another licensed practitioner, or permitting another person to use his certificate 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 the licensee’s license, educational preparation or nursing experience.

● Using force against a patient, striking a patient, or throwing objects at a patient.

● Using abusive, threatening or foul language in front of a patient or directing such language toward a patient.

● Accepting a gift from a patient the value of which exceeds the employer’s policy regarding gifts.

● Knowingly obtaining or using or attempting to obtain or use a patient’s property with the intent to temporarily or permanently deprive the patient of the use, benefit or possession of the funds, assets or property, or to benefit someone other than the patient.

Citations

A citation is defined as a summons to appear before a court, governing body, etc. The citations and the penalties associated with them are explained in 64B9-8.003, Citations.2 The circumstances and penalties associated with citations are listed below.4

The Board designates the first instance of the following as citation

violations, which shall result in a penalty of $100.00:

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● 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 nolo contendere to, regardless of adjudication, a crime in any jurisdiction, in violation of section 456.072(1)(x), F.S.

● A first offense of failing to consult the prescription drug monitoring system as required by section 893.055(8), F.S.

The Board designates the second instance of the following as citation

violations, which shall result in a penalty of $100.00: ● Failure to report address change in violation of rule 64B9-1.013, F.A.C.,

provided the licensee was not ordered to do so in a Board disciplinary order.

● 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, F.S.

The Board designates the first instance of the following a citation

violation, which shall result in a penalty of $1,000: ● Failure of a program to perform statutory or legal obligation as found in

section 456.072(1)(k) F.S., by not complying with a request for data as required by section 464.019(10), F.S.

The Board designates the first instance of the following a citation

violation, which shall result in a penalty of $1,500: ● Providing to another individual a confidential password, access code,

keys, or other entry mechanisms, which results in a violation of, or threatens, the integrity of a medication administration system or an information technology system. In addition to the fine, the licensee will be required to complete a 2-hour continuing education course in legal aspects of nursing within 60 days of the issuance of the citation.

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The following failures to comply with Board rules associated with varied citations and fines are outlined in the Florida board of nursing rules and regulations for nursing practice.

● Failure to report address change in violation of Rule 64B9-1.013, F.A.C., provided the licensee was not ordered to do so in a Board disciplinary order.

● Failure to pay a Board ordered administrative fine by the time ordered, provided payment had been made by the time the citation issues.

● Failure to complete a Board ordered continuing education course by the time ordered, provided the course had been completed by the time the citation issues.

● Failure when requested to document full compliance with the continuing education requirements, provided that all continuing education courses had been timely completed.

● 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, F.S.

Minor Violations

Minor violations include the following (Chapter 64B9-8, Section 64B9-8.0045: Minor Violations):2

● False, deceptive or misleading advertising in violation of Section

464.018(1)(g), F.S., provided no criminal prosecution resulted. ● Issuance of a worthless bank check to the Department or to the Board in

violation of Section 464.018(1)(a), F.S., provided the licensee does not continue to practice on an inactive license or the check was not in payment of a Board ordered administrative fine; Failure to report address change in violation of Rule 64B9-1.013, F.A.C., provided the licensee was not ordered to do so in a Board disciplinary order.

● Improper use of a nursing title under Section 464.015, F.S., provided no practice issue was involved or no criminal prosecution resulted.

● Failure to report address change in violation of Rule 64B9-1.013, F.A.C.,

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provided the licensee was not ordered to do so in a Board disciplinary order; Sexual Misconduct The Nurse Practice Act’s definition of sexual misconduct. “Sexual misconduct in the practice of nursing means 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 contact between a nurse and a patient is unethical, unprofessional, and can be punishable by the Nursing Board and the criminal justice system (Chapter 464, Section 464.017: Sexual Misconduct in the Practice of Nursing). Criminal Offenses

The following acts are considered to be a felony of the third degree, punishable as provided in the Florida Statutes s. 775.082, s. 775.083, or s. 775.084. This information is from Chapter 464, 464.016: Violations and Penalties. ● Practicing advanced or specialized, professional, or practical nursing, as

defined in this part, unless holding an active license or certificate to do so. ● Using or attempting to use a license or certificate which has been

suspended or revoked. ● Knowingly employing unlicensed persons in the practice of nursing. ● Obtaining or attempting to obtain a license or certificate under this part by

misleading statements or knowing misrepresentation.

Each of the following acts constitutes a misdemeanor of the first degree, punishable as provided in Florida Statutes s. 775.082 or s. 775.083:

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● Using the name or 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 or title which implies that a person was licensed or certified as same, unless such person is duly licensed or certified.

● Knowingly concealing information relating to violations of this part.

Disciplinary Guidelines

Disciplinary guidelines governing nursing practice in Florida are outlined in two places: The Florida State Statutes, Title XXXII, Regulation of Professions and Occupations, Chapter 456, 456.072: Grounds for discipline; penalties; enforcement.4

The Florida State Administrative Code, Hearings, Proceedings,

Conferences, Discipline, 64B9-8.006: Disciplinary Guidelines; Range of Penalties; Aggravating and Mitigating Circumstances. The Disciplinary Guidelines list and define actions and behaviors that are subject to disciplinary action and the consequences, e.g., fines, license suspension or revocation.2

The disciplinary guidelines are lengthy and complex and will not be fully

covered here; Several examples are: ● Failing to comply with the requirements for profiling and credentialing. ● Engaging or attempting to engage in the possession, sale or distribution

of controlled substances as set forth in chapter 893, F.S. for illegitimate purposes; being unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, or chemicals or any other type of material or as a result of any mental or physical condition; testing positive for any drug, as defined in section 112.0455, F.S., on any confirmed pre-employment or employer-ordered drug screening when the practitioner does not have a lawful prescription and legitimate medical reason for using such drug; or being terminated from a treatment program for impaired practitioners for failure to comply

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without good cause with the terms of the monitoring or treatment contract, or not successfully completing a drug or alcohol treatment program.

● Failing to meet minimal standards of acceptable and prevailing nursing practice, including engaging in acts for which the licensee is not qualified by training or experience, or practicing; or offering to practice beyond the scope permitted by law or accepting and performing professional responsibilities the licensee knows, or has reason to know, the licensee is not competent to perform.

● Failing to comply with the educational course requirements. (Section 456.072(1)(e) or (s), 464.013(3)(b), F.S., or rule 64B9-5.002, F.A.C.)

● Having been found liable in a civil proceeding for knowingly filing a false report or complaint with the department against another licensee.

● Aiding, assisting, procuring, employing, or advising any unlicensed person or entity to practice a profession contrary to this chapter, the chapter regulating the profession, or the rules of the department or the board, or delegating or contracting for the performance of professional responsibilities by a person when the licensee delegating or contracting for performance of the responsibilities knows, or has reason to know, the person is not qualified by training, experience, and authorization when required to perform them.

Revocation of a License

A license to practice nursing in the state of Florida can be revoked. The actions and behaviors for which a nursing license can be revoked are listed below. More information about this topic is in the Florida Administrative Code, Department of Health, Board of Nursing, in the chapter Hearings, Proceedings, Conferences, and Discipline.1,2,4

The specific section is 64B9-8.006 Disciplinary Guidelines; Range of

Penalties; Aggravating and Mitigating Circumstances.2

● Having a license to practice nursing revoked, suspended, or otherwise

acted against, including the denial of licensure, by the licensing authority of another state, territory, or country.

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● Being convicted or found guilty of, or entering a plea of nolo contendere to, regardless of adjudication, a crime in any jurisdiction which directly relates to the practice of nursing or to the ability to practice nursing.

● Being found guilty, regardless of adjudication, of any of the following offenses: 1) A forcible felony as defined in chapter 776, 2) A violation of chapter 812, relating to theft, robbery, and related crimes, 3) A violation of chapter 817, relating to fraudulent practices, 4) A violation of chapter 800, relating to lewdness and indecent exposure, 5) A violation of chapter 784, relating to assault, battery, and culpable negligence, 6) A violation of chapter 827, relating to child abuse, 7) A violation of chapter 415, relating to protection from abuse, neglect, and exploitation, 8) A violation of chapter 39, relating to child abuse, abandonment, and neglect.

● Having been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, any offense prohibited under Florida Statute s. 435.04 or similar statute of another jurisdiction; or having committed an act which constitutes domestic violence as defined in s. 741.28.

● Making or filing a false report or record, which the licensee knows to be false, intentionally or negligently failing to file a report or records required by state or federal law, willfully impeding or obstructing such filing or inducing another person to do so; Intentionally submitting a claim, statement or bill that has been upcoded as defined in section 627.736, F.S., for a PIP claim or for services that were not rendered.

● Unprofessional conduct as defined by rule 64B9-8.005, F.A.C. (section 464.018(1)(h), F.S.).

● Engaging or attempting to engage in the possession, sale or distribution of controlled substances as set forth in chapter 893, F.S. for illegitimate purposes; being unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, or chemicals or any other type of material or as a result of any mental or physical condition; testing positive for any drug, as defined in section 112.0455, F.S., on any confirmed pre-employment or employer-ordered drug screening when the practitioner does not have a lawful prescription and legitimate medical reason for using such drug; or being terminated from a treatment program for impaired practitioners for failure to comply without good cause with the terms of the monitoring or treatment contract,

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or not successfully completing a drug or alcohol treatment program. (section 456.072(1)(z), (aa), or (hh), or 464.018(1)(i) or (j), F.S.

● Knowingly violating any provision of Chapter 456 or 464, F.S., a rule of the board or the department, or a lawful order of the board or department previously entered in a disciplinary proceeding or failing to comply with a lawfully issued subpoena of the department; or failing to perform any statutory or legal obligation placed on a licensee.

● Failing to report to the department any licensee under chapter 458, or 459, F.S., who the nurse knows has violated the grounds for disciplinary action set out in the law under which that person is licensed and who provides health care services in a facility licensed under chapter 395, F.S., or a health maintenance organization certificated under part I of chapter 641, F.S., in which the nurse also provides services.

● Failing to meet minimal standards of acceptable and prevailing nursing practice, including engaging in acts for which the licensee is not qualified by training or experience, or practicing; or offering to practice beyond the scope permitted by law or accepting and performing professional responsibilities the licensee knows, or has reason to know, the licensee is not competent to perform.

● Making misleading, deceptive or fraudulent representations in or related to the practice of the licensee’s profession or making deceptive, untrue, or fraudulent representations in or related to the practice of a profession or employing a trick or scheme in or related to the practice of a profession.

● Having been found liable in a civil proceeding for knowingly filing a false report or complaint with the department against another licensee.

● Aiding, assisting, procuring, employing, or advising any unlicensed person or entity to practice a profession contrary to this chapter, the chapter regulating the profession, or the rules of the department or the board, or delegating or contracting for the performance of professional responsibilities by a person when the licensee delegating or contracting for performance of the responsibilities knows, or has reason to know, the person is not qualified by training, experience, and authorization when required to perform them.

● Exercising influence on the patient or client for the purpose of financial gain of the licensee or a third party.

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● Improperly interfering with an investigation or inspection authorized by statute, or with any disciplinary proceeding.

● Engaging or attempting to engage in sexual misconduct as defined and prohibited in section 456.063(1), F.S. (Section 456.072(1)(v), F.S.)

● Failing to report to the board, or the department if there is no board, in writing within 30 days after the licensee has been convicted or found guilty of, or entered a plea of nolo contendere to, regardless of adjudication, a crime in any jurisdiction.

● Failing to remit the sum owed to the state for an overpayment from the Medicaid program pursuant to a final order, judgment, or stipulation or settlement

● Failing to report adverse incidents occurring in planned out-of-hospital births as required by section 456.0495, F.S. (Section 456.072(1)(k), F.S.)

● Engaging in a pattern of practice when prescribing medicinal drugs or controlled substances which demonstrates a lack of reasonable skill or safety to patients. (Section 456.072(1)(gg), F.S.)

The Impaired Nurse

A license to practice nursing may be denied or an existing license suspended if a nurse is “... unable to practice nursing with reasonable skill and safety to patients by reason of ... use of alcohol, drugs, narcotics, chemicals or any type of material or as a result of any mental or physical condition.” (Chapter 464, 464:018: Disciplinary Actions).1 The disciplinary process for this infraction is explained in the Section 64B9-8.006: Disciplinary Guidelines, Range of Penalties, Aggravating and Mitigating Circumstances. Section 64B9-8.014: Continuous Sobriety also addresses this issue.2 Online resources for impaired nurses and safe nursing practice are available at http://www.ipnfl.org.

Denial or suspension of a nursing license because of impairment involves professional discipline and possibly criminal penalties, and it is a complex issue. For more information, the reader is referred to the Florida Board of Nursing, Intervention Project for Nurses. The Nurse Practice Act and Chapter 64B9 provide general information about nurse impairment. It is not

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comprehensive but it provides guidance. Maintaining Licensure

The following requirements must be met to maintain nursing licensure in Florida. These requirements are current as of 07/30/2019, and can be viewed by going to the Florida Administrative Code, Department of Health, Board of Nursing, Continuing Education Requirements: 64B9-5.002, at https://www.flrules.org/gateway/ruleno.asp?id=64B9-5.002.

Rule 64B9-5.002, subdivisions (1) and (2) read:

“(1) During each biennium, one contact hour must be earned for each calendar month of the licensure cycle. (2) The following continuing education courses are a mandatory part of the hours required in subsection (1), at the stated time periods: (a) A two hour course in prevention of medical errors each biennium; (b) A one hour course in HIV/AIDS in the first biennium only; (c) A two hour course in Florida laws and rules each biennium; (d) A two hour course in recognizing impairment in the workplace every other biennium thereafter; (e) For biennial renewal on or after January 1, 2019, a two hour course on human trafficking, and each biennium thereafter; (f) A course in domestic violence every third biennium.”2

Under Rule 64B9-5.002, all nurses licensed in Florida are required to

renew their license based on a 24-month cycle, called a “biennium.” During varied bienniums, a nurse must complete 24 hours of continuing education that must include a two hour course in prevention of medical errors, and a two hour course in Florida laws and rules. Since January 1, 2019, a two hour course on human trafficking has been added to the 24-month cycle renewal cycle.2

Other courses have varying continuing education requirements: a one

hour course in HIV/AIDS that must be completed prior to the first renewal;

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and, a two hour course recognizing impairment in the workplace is required every 4 years, (every four years).2

In addition to the 24 hours of continuing education that is required, a

two-hour course in domestic violence is required every third biennium (every six years). Since Domestic Violence is a 2-hour requirement, the licensee will have 26 hours of CE during the renewal period when Domestic Violence is taken.2

People licensed by examination within a biennium are exempt from the

continuing education requirement for that biennium. This exemption shall apply to a person who is licensed by endorsement during a biennium if such person was licensed in the original state of licensure by successful completion of an acceptable licensure examination during that biennium. A licensee who has endorsed into this State during a biennium or whose license was reactivated or reinstated during a biennium shall be required to accrue one (1) contact hour for each calendar month remaining in the biennium after licensure, reactivation, or reinstatement (however, no hours are required if the time remaining in the biennium is six months or less). This exemption or limitation shall only apply if the license is timely renewed at the end of the biennium, and does not apply if the license is suspended, revoked, or is (or becomes) inactive at the end of the biennium.

A registered nurse who also holds a current license as a licensed practical nurse may satisfy the continuing education requirement for renewal of both licenses by completing appropriate continuing education for a registered nurse. A registered nurse who also holds a current A.P.R.N., certificate may satisfy the continuing education requirement for both licenses by completing appropriate continuing education for a registered nurse, 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.

A nurse who is the spouse of a member of the Armed Forces and was caused to be absent from Florida due to the spouse’s duties with the Armed

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Forces shall be exempt from continuing education requirements. The licensee must show satisfactory proof of the absence and the spouse’s military status.

The Florida Board of Nursing requires nurses to complete the course work that is required for license renewal and to submit documentation that the required course work was done. “If the practitioner’s continuing education records are not complete, they will be prompted to enter their remaining continuing education hours before proceeding with their license renewal. If the practitioner does not have the hours to report, the license will move to a delinquent status at expiration. In order to renew a delinquent license, the practitioner will be required to complete the continuing education requirements. Additional fees may apply.” Florida Board of Nursing.

Continuing education is a requirement for nurses and if the licensee does not meet the requirements a citation can be issued and a reprimand, a fine of $250 to $500 can be applied, and a nurse may be suspended until he or she complies. For a second offense, a $500 fine and suspension until the licensee complies or a $750 fine and suspension until the licensee complies can be applied.

It should be noted here that the American Nurses Association (ANA) has issued a statement: Call for Action: Nurses Lead and Transform Palliative Care. This statement has several parts and one is a recommendation that continuing education in palliative care be a requirement for license renewal by encouraging state boards of nursing with continuing education re-licensure requirements to mandate inclusion of palliative care content. At the time of this writing, the state of Florida does not require that nurses have continuing education in palliative care as a requirement for re-licensure. Application and Fees

License renewal requires filling out a renewal application (by mail or on-line) and paying a renewal fee. Information on the renewal process can be found on the Florida Board of Nursing website using this link: http://www.floridasnursing.gov/renewals/.

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Summary

Specific laws, rules, and regulations govern the profession of nursing in the state of Florida. Some of these are particular to the profession of nursing while others are more general in nature and pertain to nursing and as well as to other professions and/or occupations. But in either case, whether a particular regulation is only concerned with the profession of nursing or it is more general in scope, nurses practicing in the state of Florida must comply with the requirements and restrictions that have been developed by the state and by the Nursing Board.

The Florida State Statutes, 2016Title XXXII: Regulation of the Professions and Occupations. Chapter 464: Nursing. Part I Nurse Practice Act; Part II Certified Nursing Assistants, and the rules of The Board of Nursing, Chapter 64B9 of the Florida Administrative Code were the primary references for the material in this course. The Florida Board of Nursing also provides online resources for licensees that define nursing practice, education requirements, licensure process, and discipline process for unethical, unprofessional, and illegal conduct by nursing licensees.

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Self-Assessment of Knowledge Post-Test: Please take time to help NurseCe4Less.com course planners evaluate the nursing knowledge needs met by completing the self-assessment of Knowledge Questions after reading the article, and providing feedback in the online course evaluation. Completing the study questions is optional and is NOT a course requirement. 1. The Florida Nurse Practice Act provide definitions about

a. the practice of nursing. b. the nursing licensure process. c. how nurses should be educated. d. All of the above

2. Nursing behavior or actions are covered in the Florida Nurse

Practice Act in terms of

a. specific practice guidelines. b. how the discipline process is applied. c. legal advice for nurses. d. instructions for performing specific nursing care.

3. Administrative codes in the Florida Nurse Practice Act are

a. rules and regulations formulated by government agencies. b. professional guidelines outlined by nursing agencies. c. not applicable to nursing education programs. d. developed by healthcare facilities.

4. True or False: Denial and/or suspension of a nursing license

because of impairment involves professional discipline but does not involve criminal penalties.

a. True b. False

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5. A licensee is required to take 26 hours (instead of the usual 24 hours) of continuing education during a renewal period when a course in _________________ is required.

a. Human Trafficking b. Prevention of Medical Errors c. Domestic Violence d. HIV/AIDS

6. An Advanced Registered Nurse Practitioner is allowed to

a. monitor and alter drug therapies. b. initiate, monitor, or alter therapies for any acute illness. c. perform any medical diagnosis, treatment, prescription, and

operation. d. monitor and manage patients with unstable chronic diseases.

7. A Graduate Nurse/Graduate Practical Nurse may practice nursing

a. as soon as he or she has graduated from an approved program. b. as soon as he or she passes the licensing examination. c. if, among other requirements, he or she is directly supervised by a

Registered Nurse. d. before he or she graduates so long as he or she is supervised.

8. True or False: Registered Nurses are not allowed to administer

medications unless the R.N., is an A.P.R.N.

a. True b. False

9. A Certified Nursing Assistant (C.N.A.) who is practicing under the

supervision of an R.N./L.P.N., even if the supervising person is not present so long as

a. the R.N./L.P.N., left written instructions. b. a physician has determined that the C.N.A., has sufficient

experience. c. the patient approves. d. the R.N./L.P.N., can be easily contacted for consultation or advice.

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10. A citation can be issued and a fine of $100 can be levied if a nurse has committed any of the following acts a second time:

a. Stealing from a patient. b. Failure to report address change. c. Falsifying or altering of patient records. d. Violating the confidentiality of a patient.

11. Which of the following acts are considered to be a felony of the

third degree?

a. False, deceptive or misleading advertising. b. Falsifying or altering of patient records. c. Failure to report address change to the Board. d. Knowingly employing unlicensed persons in the practice of nursing.

12. The Nurse Practice Act allows an individual nurse to practice

within

a. the constraints of the Nurse Practice Act. b. the constraints of that individual’s education and experience. c. the rules and regulations of a specific health care facility. d. All of the above

13. Nurses are required to take courses on the following subjects,

EXCEPT

a. palliative care. b. HIV/AIDS. c. impairment in the workplace. d. the prevention of medical errors.

14. True or False: An L.P.N. may act in a supervisory role in nursing

home facilities if certain requirements are met.

a. True b. False

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15. In order to become a certified A.P.R.N., in Florida, a nurse

a. is only required to pass a written examination. b. only needs a basic nursing education to take an A.P.R.N.,

examination. c. must complete a formal program prior to eligibility of examination. d. None of the above

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Reference Section

1. Florida State Statutes, 2019 Title XXXII: Regulation of the Professions and Occupations. Chapter 464: Nursing. Part I Nurse Practice Act; Part II Certified Nursing Assistants. Retrieved on May 7, 2020 at http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0464/0464.html

2. Florida Administrative Code & Florida Administrative Register, Division 64B9. Board of Nursing. Retrieved on May 7, 2020 at https://www.flrules.org/gateway/Organization.asp?OrgNo=64B9

3. Florida Board of Nursing. https://floridasnursing.gov 4. Florida State Statutes, 2019 Title XXXII: Regulation of the Professions

and Occupations. Chapter 456: Health Professions and Occupations: General Provisions. Retrieved on May 7, 2020 at http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0456/0456.html

The information presented in this course is intended solely for the use of healthcare professionals taking this course, for credit, from NurseCe4Less.com. The information is designed to assist healthcare professionals, including nurses, in addressing issues associated with healthcare. The information provided in this course is general in nature, and is not designed to address any specific situation. This publication in no way absolves facilities of their responsibility for the appropriate orientation of healthcare professionals. Hospitals or other organizations using this publication as a part of their own orientation processes should review the contents of this publication to ensure accuracy and compliance before using this publication. Hospitals and facilities that use this publication agree to defend and indemnify, and shall hold NurseCe4Less.com, including its parent(s), subsidiaries, affiliates, officers/directors, and employees from liability resulting from the use of this publication. The contents of this publication may not be reproduced without written permission from NurseCe4Less.com.