Many states and jurisdictions now post the most current version of their nurse practice act on the Internet. The NCSBN, whose mission is to promote regulatory excellence, maintains a database on its website (http://www.ncsbn.org/contact-bon.htm) that contains electronic contact information for state BONs for all 50 states, the District of Columbia, and four U.S. territories (Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands).
Many of the state nursing board websites include links to the current state nurse practice act. For those states that do not include links, there is contact information. Your state or territory’s state nursing board or designated regulatory agency also can help answer many of your questions concerning the practice of nursing within your jurisdiction. If you are not certain whether a website is official or up to date, call your state or territory’s state BON, and they can direct you to the most current version of their jurisdiction’s nurse practice act.
Because nurse practice acts can be written in a legal format that may be difficult to interpret, you may also want to consult the accompanying administrative rules for the NPA. Administrative rules help to further define the NPA, providing additional details. Administrative rules are very helpful in answering specific questions that you might have about your NPA.
As a licensed registered nurse (RN), it is imperative that you also become familiar with your employer’s practice policies and guidelines. For example, some employers will use more stringent guidelines concerning delegation than are dictated by the jurisdiction’s NPA. The concept of delegation is specifically addressed in each state’s NPA, a document that is always being updated and is subject to change. “All nurses have a duty to understand their NPA and to keep up with ongoing changes as this dynamic document evolves as the scope of practice expands”
Delegation: The process by which a registered nurse directs another person to perform nursing skills and activities that the person would not normally carry out while still retaining accountability for those activities.
Most states recognize the concept of delegation. Therefore, it is important for RNs to be familiar with the concept of delegation as many states’ NPAs define parameters that authorize RNs to delegate certain tasks under specific conditions. “All decisions related to delegation and assignment are based on the fundamental principles of protection of the health, safety and welfare of the public”.
The Joint Statement on Delegation developed by the ANA and the National Council of State Boards of Nursing lists the five rights of delegation that are applicable to each state’s NPA. An RN must apply professional judgment when following the five rights of delegation within his or her state or terrority’s NPA to ensure the following: the right task, under the right circumstances, to the right person, with the right directions and communication, and under the right supervision and evaluation.
As the practice of nursing continues to evolve and expand, the concept of delegation also changes. It is critically important for RNs to be able to effectively work with others, delegate, manage, and appropriately supervise within the legal parameters of a governing jurisdiction’s NPA. The nursing shortage and need for nursing services mandates that nurses understand and use delegation to meet the needs of healthcare consumers.
The topic of delegation should be covered during your employment orientation. If the topic of delegation and your employer’s policies are not discussed in your orientation, you should request copies of these policies for your review and use so that you can correctly apply this critical nursing skill.
The History of State Boards and Their Regulatory Functions
Prior to the Industrial Revolution, it was easier for persons to evaluate the quality of services that they received because communities were small and persons were well known by everyone in the community. Family members provided healthcare services and if outside services were required, the reputation of healthcare providers was well known within the community.
The first state to pass a nursing regulation law protecting the title of “nurse” was North Carolina which did so in 1903. At that time it became the responsibility of the North Carolina Board of Nursing to develop the nursing licensure examination and issue nursing licenses. In the early 1900s, states initiated the development of government-established BONs to protect the public’s health by overseeing and ensuring the safe practice of nursing.
At the turn of the century, New York, New Jersey, and Virginia developed some of the first nurse practice acts. In addition to establishing standards for safe nursing care, BONs are responsible for accrediting or approving nursing education programs. Program approval is an essential component of state licensure because it ensures that state and territorial standards are being met. This process is different from national nursing accreditation that assesses and ensures that the quality of nursing programs is maintained on a national level.
In addition to protecting the public from harm, one of the most critical functions for BONs is the issuance of licenses to practice nursing. However, once a nursing license is issued, a nursing board’s job is not complete. State and territorial nursing boards continue to monitor each nurse’s adherence to governing laws. If a nurse engages in an unsafe or unlawful practice of nursing, a BON can revoke a license. Box 3-1 provides a further description of the functions of BONs.
FUNCTIONS OF THE STATE BOARDS OF NURSING
- Issue licenses and manage renewal process
- Establish nursing practice standards
- Regulate advanced practice nursing
- Approve operation of nursing education programs
- Investigate complaints against licensed practitioners
- Hold disciplinary hearings, suspending or revoking licensure if necessary
- Promulgate all rules related to the regulation of nursing practice
Individuals who serve on a BON are typically appointed to their position, in many states by the governor. Professional organizations nominate members in other states. The process can further differ between states and territories. For example, in North Carolina, state board members are elected.
The legislature is also responsible for appointing board members in other states. Members of a BON generally report to the governor of a state or territory, both the governor and state or territorial agency, a state or territorial agency or another state or territorial official or organization. State or territorial law often determines the membership or composition of a state BON, which is usually a mix of different types of nurses with various educational backgrounds as well as healthcare consumers. Generally, BONs consist of licensed practical nurses (LPNs), RNs, advanced practice registered nurses (APRNs), and healthcare consumers.
The members of a BON convene to oversee nursing activities, including nursing education within a state, and also to take regulatory actions including discipline on nurse licenses when the nurse practice act is violated. In some states and territories, BONs also regulate certified nursing assistants (CNAs) and other healthcare professionals. Individual state nurse practice acts dictate the scope of regulatory authority and powers for individual state and territory BONs.
Each state and territory is represented by the NCSBN, a not-for-profit organization that serves as the vehicle for BONs to act together to provide regulatory excellence for public safety, health, and welfare. The membership for the NCSBN is composed of members from the BONs in the 50 states, the District of Columbia, and four U.S. territories—Guam, the Virgin Islands, American Samoa, and the Northern Mariana Islands. Four states currently maintain two separate BONs for RNs and LPNs—California, Georgia, Louisiana, and West Virginia