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APRN practice is typically defined by the Nurse Practice Act and governed by the Board of Nursing, but other laws and regulations may impact practice, and other boards may play a role. For instance, in some states nurse-midwives are regulated by a Board of Midwifery or public health. In addition, in some states, the CNS category is not identified in the Nurse Practice Act, which means the CNS is held to the same scope of practice as any registered nurse within the state. The scope of practice for CRNAs is fairly standard, but is not evident in statute in all states. Interpretation of specific acts, not evident conclusively in the Nurse Practice Act is provided by the regulatory body in the form of an opinion. For example, Who may perform micro-dermabrasion, under what circumstances? What are the parameters for participation in a radiologic procedure? Can an APRN administer IV anesthetics for intractable pain? Given the variation between APRNs and related state statutes, rules and regulations, it is essential that APRNs have a clear understanding of how their scope of practice is defined by those laws and regulations, as well as any opinions promulgated by the state regulatory agency. A listing of Boards of Nursing and other resources are listed below. Please see the additional considerations for the APRN scope of practice: Scope and Standards of Practice State Law and Regulation Resources In addition to the listing of Boards of Nursing, the following resources might be helpful:
Some states provide state-specific resources on determining scope of practice: A state board of nursing is the state-specific licensing and regulatory body that sets the standards for safe nursing care, decides the scope of practice for nurses within its jurisdiction, issues licenses to qualified candidates, and handles any disciplinary actions for nursing practice violations. All 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands have boards of nursing that collectively represent the member organizations that make up the National Council of State Boards of Nursing (NCSBN). The NCSBN administers the National Council Licensure Examinations that all state boards require as part of the licensing process:
California, Louisiana, and West Virginia each have two boards, one for Registered Nurses (RNs) and one for LPNs or LVNs. One state, Nebraska, has a separate board for advanced practice registered nurses (APRNs). It’s the role of these boards to determine how advanced practice registered nursing is defined in each state. How State Nursing Licensure WorksAs a nurse or prospective nurse, you probably already have a basic idea of how the licensing process goes. You put in the years it takes to get the required combination of education, experience, and put all the documentation together to prove it. You take and pass the required test for your level of licensure. You probably go through a background check and you fill out an application form that seems like it’s the size of a short novel. Then you bundle it all up and send it off to the board. In a couple of weeks, they let you know if you forgot to dot any i’s, neglected to submit something, or if your tests scores didn’t come through… or if everything looked good and your license is on the way. But what happens on the other side of that process? Well, the staff isn’t just sitting around joking about applicants who don’t make the cut. Instead, they:
And that’s just the licensing function. Before you even get that far, you might have contacted them with questions and gotten the answers you needed. After licensure, they also follow up on renewals. The board is also responsible for investigating and deciding allegations of misconduct. It’s a big job, and it makes the profession of nursing the most trusted job in America, year after year. What Is the Function and Role of Your State Board of Nursing?Even though all state boards maintain similar licensing standards and voluntarily align themselves under the NCSBN, you might be surprised to learn that there are no national rules for licensing and regulating the practice of nursing. Each state is responsible for passing their own laws, often called Nursing Practice Acts (NPAs), that establish their own regulations for nurses. The District of Columbia and each U.S. Overseas Territory also has its own nursing board.
The legal language in the NPA lays out the requirements for licensure and defines the scope of nursing practice. But a lot of the details aren’t hammered out. Instead, the Acts create nursing boards of between 10 and 17 members, usually a mixture of registered, practical, and advanced practice nurses together with members of the public. The boards then put the NPA into practice by setting specific administrative rules and regulations that further define the qualifications for licensure and the scope of practice. Board rules must be consistent with the NPA and can’t supersede NPA mandates. The board members themselves don’t handle most of the actual work of the board. Instead, they make the big decisions while professional staff handle the paperwork, investigations, and communications required. Depending on the state, nursing boards may be called commissions, examiners, or registration agencies, but despite the names they all have the same regulatory job. All boards of nursing are responsible for evaluating applications for nurse licensure, issuing and renewing nursing licenses, and taking disciplinary actions when needed. Other responsibilities that a board of nursing might take on, depending on the state, include:
Most state nursing boards date back to the early 20th century when the nursing profession was becoming more formal and better recognized. The American Nurses Association (ANA) was established in 1896 and began lobbying lawmakers for recognition and professional standards. Lawmakers responded by passing some of the first laws regulating nursing. In 1903, North Carolina became the first state in the nation to have a registration process for nurses, paving the way for the RN designation now established in every state. And in doing so, it created the very first nursing board, a Board of Examiners which had discretion to “…issue license without examination to such applicants as shall furnish evidence of competency entirely satisfactory to them.” More boards followed, and exams became a part of the process. Eventually, licensing become mandatory in 1935 and the titles of Registered Nurse and Licensed Practice Nurse became legally protected, applying only to nurses recognized by nursing boards. How Does APRN Independent Practice Differ By State?Just as every state has its requirements for RN licensing, each state also sets its own requirements for licensing APRNs. They determine the legal scope of practice for APRNs and establish the APRN roles and titles recognized in the state. Variations in state laws for APRNs creates confusion for both nurses and patients. A coalition of nursing organizations led by the NCSBN have developed a Consensus Model for APRN Regulation to standardize both licensing requirements and the scope of practice for advanced practice nurses nationwide. NCSBN and other organizations continue to actively lobby for state legislatures to incorporate it. To date, 18 states have fully adopted the model into their laws, but most state boards of nursing have adopted at least some part of the NCSBN’s APRN Consensus Model. As of July, 2021, nursing boards in 37 states plus the District of Columbia allow APRNs to independently prescribe certain drugs. According to the American Association of Nurse Practitioners (AANP), 24 states offer full independent practice authority to diagnose and treat patients without direct physician oversight or a collaborative agreement in place. This widespread trend to adopt the consensus model strongly suggests that additional state boards of nursing will soon tailor their regulations to match this model. The COVID-19 pandemic hit the American healthcare system like a Mack truck. Hospitals were swamped with patients; infected healthcare providers had to quarantine, putting even more pressure on those who remained to deliver services. In an industry that was already running short of doctors, there was suddenly a critical need for advanced practice providers to shore up the gaps. State legislatures, insurers, and federal agencies like the Centers for Medicare and Medicaid Services scrambled to put in place emergency rule changes to allow APRNs and other providers more latitude to practice independently. Not only were the shortages of healthcare professionals during the pandemic a major driver of these policies, but so were the limitations on existing collaborative practice agreements that assumed a level of supervision that just wasn’t possible remotely.
As of July 2021, 18 different states had temporarily suspended or waived practice agreement requirements to cope with COVID-19 according to AANP. Thirteen of those suspensions remained in force. Having demonstrated in all those states and more (no exemptions were necessary in states already offering full practice authority) that they are fully capable of handling major healthcare emergencies, it’s a good bet that APRNs will have a stronger hand next time they ask state legislatures for independent practice and prescriptive authority. State-by-State Guide to Nursing Boards, APRN Acts, and Independent Practice RulesThis list is not reflective of temporary emergency authorizations put in place in response to the COVID-19 pandemic. The definitions for independent practice and prescriptive authority we use to evaluate each state reflect those of the National Council of State Boards of Nursing:
Various levels of independent practice and prescriptive authority may be allowed in certain states. For example, state law may allow advanced practice nurses to prescribe only under a collaborative agreement with a physician, but grant independent practice for everything else. These variations are also noted here. AlabamaAlabama Board of Nursing
AlaskaAlaska Board of Nursing
ArizonaArizona State Board of Nursing ArkansasArkansas State Board of Nursing
CaliforniaCalifornia Board of Registered Nursing ColoradoColorado Board of Nursing ConnecticutConnecticut Department of Public Health DelawareDelaware Board of Nursing
District of ColumbiaDC.gov Department of Health
FloridaFlorida Board of Nursing
GeorgiaGeorgia Board of Nursing HawaiiHawaii Board of Nursing IdahoState of Idaho Board of Nursing IllinoisIllinois Department of Financial & Professional Regulation – Nursing IndianaIndiana State Board of Nursing IowaIowa Board of Nursing KansasKansas State Board of Nursing
KentuckyKentucky Board of Nursing LouisianaLouisiana State Board of Nursing MaineMaine State Board of Nursing
MarylandMaryland Board of Nursing
MassachusettsMassachusetts Board of Registration in Nursing
MichiganMichigan Board of Nursing
MinnesotaMinnesota Board of Nursing MississippiMississippi Board of Nursing MissouriMissouri Board of Nursing MontanaMontana Board of Nursing NebraskaNebraska Department of Health & Human Services – Nursing
NevadaNevada State Board of Nursing New HampshireNew Hampshire Board of Nursing New JerseyNew Jersey Board of Nursing
New MexicoNew Mexico Board of Nursing New Mexico Department of Health (For CNM Licensing) New YorkNew York State Office of the Professions – Nursing New York State Office of the Professions – Midwifery North CarolinaNorth Carolina Board of Nursing
North DakotaNorth Dakota Board of Nursing OhioState of Ohio Board of Nursing OklahomaOklahoma Board of Nursing OregonOregon State Board of Nursing PennsylvaniaState Board of Nursing Board of Medicine (CNM Licensing) Rhode IslandState of Rhode Island Department of Health – Nursing South CarolinaSouth Carolina Board of Nursing South DakotaSouth Dakota Board of Nursing
TennesseeTennessee Board of Health
TexasTexas Board of Nursing
UtahUtah Board of Nursing VermontVermont Board of Nursing VirginiaVirginia Board of Nursing
WashingtonWashington State Department of Health Nursing Commission West VirginiaWest Virginia RN Board WisconsinWisconsin Board of Nursing
WyomingWyoming State Board of Nursing |