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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Nursing practice act.

Annie P. Boehning ; Lisa M. Haddad .

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Last Update: July 17, 2023 .

Definition/Introduction

Every state and territory in the US set laws to govern the practice of nursing. These laws are defined in the Nursing Practice Act (NPA). The NPA is then interpreted into regulations by each state and territorial nursing board with the authority to regulate the practice of nursing care and the power to enforce the laws. Fifty states, District of Columbia and 4 United States (US) territories, have state boards of nursing (BON) that are responsible for regulating their individual NPA. [1] The boards enforce these laws as defined by their respective state or territorial legislative bodies. The legislative body gives the board of nursing the power to discipline nurses who violate the nursing laws and regulations. [2] Only the BON has the power to discipline a nurse who may pose a danger to the public.

Most states and territories have one nursing board regulating all levels of nursing, including PN/VN (practical nurse /vocational nurse), RN (Registered Nurse), and APN (Advanced Practice Nurse) practice (www.ncsbn.org). Some states, such as California, Nebraska, West Virginia, and Louisiana, have separate state boards for PN/VN, RN, or APN practice. These boards are all members of the National Council State Boards of Nursing (www.ncsbn.org). The National Council of State Boards of Nursing (NCSBN) promotes evidence-based regulatory excellence for patient safety in nursing care and public protection. The NCSBN has supported the Nurse Licensure Compact with 34 state boards of nursing, recognizing a single nursing license to practice in multiple states. [3] However, nurses are held accountable to the specific state NPA at the location of nursing practice.

Issues of Concern

According to the NCSBN, public health, welfare, and safety of the public are protected by nursing regulation, which is found in the NPA. [3] The NPA is the enacted regulations with full force and effect of law. Each state or territory has its own version of NPA, and they vary geographically at state lines. In general, the NPA provides guiding principles for the scope of nursing regulation to include: defining phrases and terms for the intent of the law, defining the composition of the board members, defining nursing school educational program standards, defining the scope of nursing practice, overseeing licensure processes, protecting titles and providing grounds for disciplinary actions for violations.[Russel KA]

Definitions

The NPA is the law for governing nursing practice in each state and is used for guidance to action. Therefore, the NPA has terms and phrases clearly defined for the state boards of nursing to use for enforcement. There are terms that are established for understanding among legislators and citizens.[Russel KA] For example, the California Board of Registered Nursing defines “Nurse Practitioner” as an individual with a registered nurse license that has advanced nursing education, has acquired additional educational preparation and skills, meets the certification requirements to manage health-illness needs.

Authority of the BON

The BON has the authority and power to regulate nursing practice utilizing the language stipulated in the NPA. It is also the responsibility of the BON to protect the US citizens’ health, safety, and welfare against substandard nursing care. Memberships in the BON are generally appointed by the governor or senators with the recommendations from various professional organizations within the state or territory.[Russel KA] The BON members may include nurses, doctors, attorneys, and public members. The BON office may include nurses, attorneys, and administrative staff, who have investigative duties, and are not members of the BON. The BON’s duties generally include:

Making, amending and enforcing regulations
Setting standards in nursing education
Setting licensure fees
Ensuring criminal background check
Providing license to applicants
Ensuring nurses are updated with continuing education
Collecting and analyzing nursing workforce data
Carrying out disciplinary processes

Educational Program Standards

Nursing regulation requires agencies, such as hospitals, health clinics, and nursing schools, to work together to ensure patient safety and education of nurses is accomplished, which serves the best interests of the principle of public protection. Standards on prelicensure nursing education and clinical learning experiences are defined in the NPA and used for accreditation purposes to evaluate the nursing educational programs. Language may include curriculum specifics, faculty qualifications, and data collection of success in the nursing board examination. [4]

Standards and Scope of Nursing Practice

Nursing regulation through NPA is a state-initiated effort. The regulations are to provide standardization for laws regulating the nursing practice. NPAs emphasizes the accountability of all nurses for not only providing but improving safe client care. NPA provides nursing practice standards and a code of conduct for the continued privilege to practice nursing. Clear definitions of nursing scope of practice are detailed in the NPA and aligned with the nursing process of developing a plan of care for patient advocacy. Furthermore, the scope of practice is inclusive of safe nursing practice appropriate for the level of training and orientation. [5]

Types of Licenses and Titles

The NPA exists to regulate and protect the public from practitioners who are a risk to the health, safety, and welfare of the citizens within its state board jurisdiction. This protection principle is accomplished by assessing competence at initial licensure and throughout the career of the nurse. Licensure requirements are set at initial licensure as well as for licensure renewal. Licenses and titles are defined and protected by the NPA for usage in the public. They are privileged and granted by the BON after meeting the requirements of graduating from accredited nursing educational programs, passing professional board examinations, background checks, and paying applicable fees.

Grounds for Disciplinary Action

Within the NPA, the boards set standards to which they hold practitioners accountable for providing safe client care. These standards are based on professional, ethical, and legal standards for nursing. The NPA also ensures that any practitioner who has a complaint brought against their practice has the right to due process. Due process ensures the rights of the nurse are maintained throughout the discipline process. [6]

When a patient/family sues a nurse for substandard care (malpractice), there are elements that must be proved in a court of law: Duty (the nurse had a duty to the patient), breach of duty (the nurse breached that duty), harm or injury (some type of harm or injury must be demonstrated), and causation (that the harm or injury was caused by the nurse as a result of a failure to follow standards of care). [7] Malpractice cases in a court of law may set compensatory and punitive damages against a nurse, but only the board of nursing may discipline a nurse for substandard practice. [4]

The BON receives complaints regarding substandard care from a variety of sources (patients, healthcare professionals, including other nurses, and healthcare agencies). These complaints are investigated to determine if a nurse did provide care below the standard set by the NPA or other standards of care, such as in professional organizations or in the community. For the BON investigations, the actual injury does not need to be determined. Only that the nurse violated the standard of care. The BON determinations against the nurse for violating the standard of care result in disciplinary action (called stipulations against the license), which can include fines, supervised practice, mandatory remedial education, or suspending/revoking of license. [1] [2] [4] [6] [7]

Nurse Licensure Compact

The NPA also includes laws and rules relating to the Nurse Licensure Compact. [3] Currently, there are 34 states that have passed legislation joining the compact. This is a mechanism for nurses to practice, usually online or over telephone connections across state lines. There are specific laws and rules govern this practice. A nurse whose home state, a state in which he/she holds licensure, is a member of the compact may practice in another state who is a member of the compact, but the nurse must follow the laws and rules in the practice act in the state in which they practice. “Multistate licensure privilege” is the term used by the BON to denote the nurse licensure compact status of the nurse. If a nurse is practicing in a particular state and violates a law or rule of that state’s nursing practice act, that particular state may take action to discipline that nurse. Once a state’s board has determined if a practice violation occurred and has determined the disciplinary action to be implemented, the nurse’s home state may then decide to also discipline the nurse for the practice violation. In most circumstances, nurses under any form of disciplinary action usually lose their multistate licensure privilege. [3]

Clinical Significance

Nurses practicing in a state or territory should be familiar with the NPA. Nurses are responsible for knowing the laws affecting their practice as most boards maintain ignorance of the law is no excuse for non-compliance and substandard nursing practice. NPAs are laws and rules in the NPA designed to protect the public from unsafe practice, which may include standards of practice for all nursing levels (PN/VN, RN, or APN).

Nursing, Allied Health, and Interprofessional Team Monitoring

Public Access to BON and NPA

Since the BON is state-appointed and the NPA is the law, both the BON and NPA are available for public access. Licenses can be verified online through a state-sponsored verification system free of charge. Each state's BON has database tracking licensure as well as disciplinary actions against the nurse for public records. Federal law also requires states to report any adverse actions against a nurse to the National Practitioner Data Bank, established by Congress in 1986. This databank can be accessed by authorized entities, including hospitals, licensing boards, attorneys, licensees, and professional societies.[Russell KA]

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Disclosure: Annie Boehning declares no relevant financial relationships with ineligible companies.

Disclosure: Lisa Haddad declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Cite this Page Boehning AP, Haddad LM. Nursing Practice Act. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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About U.S. Nursing Regulatory Bodies

What are u.s. nursing regulatory bodies.

Nursing Regulatory Bodies (NRBs) are jurisdictional governmental agencies in the 50 states, the District of Columbia and four US territories that are responsible for the regulation of nursing practice.

More than 100 years ago, state and territorial governments established NRBs to protect the public's health and welfare by overseeing and ensuring the safe practice of nursing. NRBs achieve this mission by outlining the standards for safe nursing care and issuing licenses to practice nursing. Once a license is issued, the NRB's job continues by monitoring licensees' compliance to jurisdictional laws and taking action against the licenses of those nurses who have exhibited unsafe nursing practice.

All 59 NRBs in the U.S. are members of NCSBN.

The Nurse Practice Act

Each jurisdiction has a law called the Nurse Practice Act, which is enforced by each NRB. Nurses must comply with the law and related rules in order to maintain their licenses. The law describes:

Qualifications for licensure
Nursing titles that are allowed to be used
Scope of practice (what the nurse is allowed to do)
Actions that can or will happen if the nurse does not follow the nursing law

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Nursing and the Law: What Are the Rules?

chapter 12 Nursing and the Law What Are the Rules? Objectives On completing this chapter, you will be able to do the following: 1. Discuss the content of your state’s Nurse Practice Act. 2. Describe the responsibilities of your state’s board of nursing (or nursing regulatory board). 3. Explain the limits of nursing licensure within your state. 4. Define the nursing standard of care. 5. Differentiate between common law and statutory law. 6. Explain the difference between criminal and civil action. 7. Discuss the difference between intentional and unintentional torts. 8. List the four elements needed for negligence. 9. Review the steps for bringing legal action. 10. Differentiate between practical/vocational nursing student (SPN/SVN) and instructor liability in preventing a lawsuit. 11. Summarize the American Hospital Association’s publication The Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities . 12. Describe the major focus of the Health Insurance Portability and Accountability Act. 13. Discuss the differences among general consent, informed consent, and authorized consent. 14. Differentiate between the living will and durable power of attorney. 15. Explain the difference between physician-assisted suicide and euthanasia. 16. Discuss the difference between a multistate compact and a border agreement. 17. Explain how you would legally deal with two difficult situations that might occur in a clinical setting. Key Terms accountability (ă-kŏwn-tă-BĬL-ĭ-tē, p. 138) advance directives (ăd-VĂNS dĭ-RĚCT-ĭvs p. 143) assault (ă-SŎLT, p. 134) authorized consent (ĂW-thŏr-izd kŏn-SĚNT, p. 143) basic patient situation (p. 130) battery (BĂT-ĕr-ē, p. 134) border recognition agreement (BŎR-dĕr rĕk-og-NĬ-shŭn, p. 132) breach of duty (brēch, p. 136) civil action (sĭ-vŭl ĂK-shŭn, p. 134) common law (KŎM-mŏn, p. 133) complex nursing situation (KŎM-plĕks NŬR-sēng sĭt-u-Ā-shŭn, p. 130) confidentiality (kŏn-fĭ-dĕn-chē-ĂL-ĭ-tē, p. 139) criminal action (KRĬM-ĭn-ăl ĂK-shŭn, p. 133) damages (DĂM- ăj-ĕs, p. 136) defamation (dĕf- ă-MĀ-shŭn, p. 134) delegated medical act (dĕl-ĕ-GĀ-tĕd, p. 130) depositions (dĕp-ō-ZĬSH-ŏn, p. 137) direct supervision (dĭ-RĚCT soo-pŭr-VĬ-shŭn, p. 130) do-not-resuscitate (DNR) (rĭ-SŬS-ĭ-tāt, p. 144) durable medical power of attorney (p. 144) duty (DOO-tē, p. 134) end-of-life principles (EOL) (p. 146) euthanasia (ū-thă -NĀ-zhē-ă, p. 144) felony (FĚL-ō-nē, p. 134) general (implied) consent (JĚN-ĕr-ăl kŏn-SĚNT, p. 142) general supervision (JĚN-ĕr-ăl soo-pŭr-VĬ-shŭn, p. 130) Good Samaritan Act (p. 146) Health Insurance Portability and Accountability Act (HIPAA) (p. 140) informed consent (ĭn-FŎRMD kŏn-SĚNT, p. 133) institutional liability (ĭn-stĭ-TOO-shŭn-ăl lī-ă-BĬL-ĭ-tē, p. 138) intentional tort (ĭn-TĚN-shŭn-ăl tŏrts, p. 134) interstate endorsement (ĭn-tĕr-STĀT ĭn-DŎRS-mĕnt, p. 132) law (p. 130) liability (lī-ă-BĬL-ĭ-tē, p. 136) libel (LĪ-bĕl, p. 135) living will (lĭ-VĬNG wĭl, p. 143) malpractice (professional negligence) (măl-PRĂK-tĭs, p. 136) misdemeanor (mĭs-dĭ-MĒ-nŏr, p. 133) multistate licensure (Nurse Licensure Compact) (LĪ-sĕn-shŭr, p. 132) negligence (NĚG-lĭ-jĕns, p. 135) Nurse Practice Act (nŭrs PRĂK-tĭs ăkt, p. 130) nursing standard of care (NURS-ĭng STĂN-dĕrd, p. 133) Oregon Death With Dignity Act (p. 145) patient competency (PĀ-shĕnt KŎM-pĕ-tĕn-sē, p. 142) Patient Self-Determination Act (PSDA) (p. 143) personal liability (PĚR-sŭn-ăl lī-ă-BĬL-ĭ-tē, p. 137) physician-assisted suicide (PAS) (fĭ-ZĬ-shŭn ă-SĬS-tĕd SOO-ĭ-sīd, p. 144) preponderance (prĭ-PŎN-dĕr-ănts, p. 134) proximate cause (PRŎKS-ĭ-mĕt căws, p. 136) slander (SLĂN-dĕr, p. 135) statutory law (STĂ-chū-TŏR-ē, p. 133) The Joint Commission (TJC) (p. 133) The Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities (p. 140) unintentional tort (ŭn-ĭn-TĚN-shŭn-ăl tŏrts p. 134) vicarious liability (vĭ-KĂR-ē-ŭs, p. 137) Keep in Mind Ethics and law drive the practice of nursing. When there is a dispute, law—the Nurse Practice Act in your state—is the final authority. According to Elizabeth Johnson, a lead instructor at Northeast Wisconsin Technical Institute, “No employer/health care agency can give you permission to do something that your license/state’s Nurse Practice Act does not allow you to do.” Ethics in nursing deals with rules of conduct—what is right and what you should do in a particular situation. Ethical values, in turn, are the basis of nursing law. Law has to do with regulations that control the practice of nursing. Your state’s Nurse Practice Act, discussed following, is your legal guideline in nursing. Knowledge of your state’s Nurse Practice Act will be valuable to you in making nursing decisions. Such knowledge also will help you to protect yourself against acts and decisions that could involve you in lawsuits and criminal prosecution. Nurse practice act The state Nurse Practice Act defines nursing practice and establishes standards for nurses in your state. Ignorance of your state’s Nurse Practice Act is never a valid defense against any legal proceeding regarding your license. Basic terminology Basic terminology in a Nurse Practice Act remains standard in many states. As you study the scope of practice for licensed (or trained) practical/vocational nurses (LPNs/LVNs) in your state, an understanding of the following terms is necessary. • Basic nursing care. Nursing care that can be performed safely by the LPN/LVN, based on knowledge and skills gained during the educational program. Modifications of care are unnecessary, and patient response is predictable. • Basic patient situation. The patient’s clinical condition is predictable. Medical and nursing orders are not changing continuously. These orders do not contain complex modifications. The patient’s clinical condition requires only basic nursing care. The professional nurse assesses whether the situation is a basic patient situation . • Complex nursing situation. The patient’s clinical condition is not predictable. Medical orders or nursing interventions are likely to involve continuous changes or complex modifications. Nursing care expectations are beyond those learned by the LPN/LVN during the educational program. The professional nurse assesses whether the situation is a complex nursing situation . • Delegated medical act. During a delegated medical act , a physician’s order is given to a registered nurse (RN), an LPN, or an LVN by a physician, dentist, or podiatrist. • Delegated nursing act. In a delegated nursing act, an RN gives nursing orders to an RN, LPN, or LVN. • Direct supervision. With direct supervision , the supervisor is continuously present to coordinate, direct, or inspect nursing care. The supervisor is in the building. • General supervision. Under general supervision , a supervisor regularly coordinates, directs, or inspects nursing care and is within reach either in the building or by telephone. Content of nurse practice acts The Nurse Practice Act of each state commonly includes the following content: • Definition of nursing • Definition of LPN/LVN • Use of the title of LPN or LVN • Scope of practice • Elements of unprofessional conduct • Functions of the state’s board of nursing Try This Get Familiar with Your Scope of Practice in the State’s Nurse Practice Act Obtain a copy of your state’s Nurse Practice Act (or occupational title act). What does it state about the following topics? 1. Definition of licensed practical/vocational nursing in your state 2. Use of the titles licensed practical nurse and licensed vocational nurse 3. Specific functions of the LPN/LVN 4. Elements of unprofessional conduct State board of nursing All states and provinces have examining councils that provide nursing examinations for licensure and review complaints that can lead to revocation of a license. Functions of the board State boards of nursing (sometimes called nurse regulatory boards) have committees or councils that decide whether specific activities are within the scope of LPN/LVN practice in their state. An activity that is legal in one state may not be legal in another state. See Box 12-1 for common board of nursing functions. Box 12-1 Common Board of Nursing Functions • Licensing and certifying nurses • Setting fees • Establishing standards for educational programs • Determining duration and renewal of licenses (some boards require continuing education credits for renewal of license) • Maintaining inactive status lists • Carrying out disciplinary action for violators • Developing programs for impaired nurses • Suspending and revoking licenses and dealing with the appeal process Some state nursing boards have developed a website and may offer a variety of services (e.g., license renewal, application for licensure by examination, verification of licensure status of a state nurse, change of address/phone number/email address, downloadable forms, links to continuing education courses, the state’s Nurse Practice Act). It is important as a practical/vocational nurse to understand that you must limit your work to the area of nursing defined in the state’s Nurse Practice Act. In 2003, the National Association for Practical Nurse Education and Service Inc. (NAPNES) issued a professional guideline for LPNs/LVNs titled “The LPN/LVN Fulfills the Professional Responsibilities of the Practical/Vocational Nurse” (see Appendix B). This is an example of a statement from an official nursing organization, but it does not carry the weight of law. These statements are useful as guides for behavior and may be used in a court of law as a point of reference. The Nurse Practice Act in your state is always your final authority . Disciplinary responsibility of the board Each state’s Nurse Practice Act lists specific reasons for which they seek to discipline a nurse. Eight general categories of disciplinary actions can be taken against nurses. Brent (2001) lists them as “fraud and deceit; criminal activity; negligence; risk to patients because of physical or mental incapacity; violation of the Nurse Practice Act or rules; disciplinary action by another board; incompetence; unethical conduct; and drug and/or alcohol use.” See Box 12-2 for the eight categories of disciplinary action. Box 12-2 Eight Categories of Disciplinary Actions Taken Against Nurses 1. Fraud and deceit: Most often, fraud and deceit involve a person using fake means to get a nursing license (e.g., forging documents). 2. Criminal activity: This includes conviction of a felony, such as murder; or conviction for gross immorality, such as theft, fraud, personal misrepresentation, or embezzlement. 3. Negligence: The nurse does not do what a reasonable, prudent nurse would do in a similar situation. Negligence includes serious risk to the health, safety, or physical or mental health of a patient. (This may include patient injury.) 4. Violation of the Nurse Practice Act: Some states’ Nurse Practice Acts list specific violations (e.g., unprofessional conduct, such as becoming personally involved with a patient). 5. Discipline by another jurisdiction: In the past, it was difficult to find out if a nurse had been disciplined in another state. Now there are two national data banks that make it easier to track disciplinary action of LPNs/LVNs in other states. However, it is not mandatory for the disciplining authority to notify a data bank. The data banks are as follows: a. National Practitioner Data Bank (NPDB). Established by federal law, it has been in operation since 1999. It contains information on final actions when guilt of a professional violation has been established or admitted. The NPDB primarily contains disciplinary actions taken against dentists and other health practitioners, including nurses. The purpose of the data bank is to restrict the ability of incompetent professionals to move from state to state without disclosure of previous incompetence. b. The National Council of State Boards of Nursing Disciplinary Data Bank (NCSBNDB) was established in 1990. It collects disciplinary information about nurses from all state boards of nursing, and distributes it to all state boards of nursing. The state boards of nursing use this information for disciplinary and licensing purposes. Action by the Board can affect your license or certificate to practice in another state. 6. Incompetence: Examples include failure to meet generally accepted standards of nursing practice; negligence; and a nurse’s mental disability that would interfere with patient safety. 7. Unethical conduct: Examples include a breach of nurse-patient confidentiality; refusal to provide nursing care for someone because of race, creed, color, national origin, disease, or sexual orientation; violation of the ethical code for LPNs/LVNs; and failure to maintain nursing competence. 8. Alcohol and/or other drug abuse: Alcohol and other drug abuse by a nurse (e.g., diversion of drugs, often controlled substances, for personal use) is a threat to patient safety. Some nurses steal and sell diverted substances and equipment such as syringes and IV tubing, falsify patient records, and deprive patients of their medication. The number of nurses disciplined for alcohol and/or other drug abuse is increasing. Disciplinary process and action The disciplinary process is based on law and follows the rules of law. See Box 12-3 for the steps of a disciplinary process. Box 12-3 Steps for Disciplinary Action • Sworn complaint: Filed against the LPN/LVN by a person, health care agency, or professional organization. • Complaint is reviewed: The LPN/LVN receives a notice of the hearing, which will be before the state board of nursing or a state officer. Evidence of wrongdoing is presented to the nurse and board. The nurse and the nurse’s attorney (who is familiar with nursing) present witnesses. The board makes a decision on findings. • Finding of not guilty: No action is taken. • Finding of guilty of misconduct: The board may issue a public or private reprimand, such as: • Continuing education • Probation • Nonrenewal of license • Suspension of license • Revocation of license • If nurse is involved in alcohol or drug abuse, a diversion program may be an alternative. “Many states have developed Alternative to Discipline Programs for nurses with drug or alcohol dependencies that also meet certain requirements. These programs promote early intervention; support the treatment and recovery, and most important, monitoring when the nurse returns to work.” Source: the National Council of State Boards of Nursing at http://www.ncsbn.org/163.htm . Nursing licensure It is nursing licensure that defines and protects the title of LPN or LVN. Some states (e.g., Minnesota) have amended their Nurse Practice Act to include the provision that only licensed practical or registered nurses may use the professional title “nurse.” On completion of a state-approved practical/vocational nursing education program, a graduate is eligible to apply for the national licensing examination in practical/vocational nursing (NCLEX-PN® examination). While awaiting examination results, the graduate may apply for a temporary permit to practice nursing. On successful completion of the examination, the graduate receives a nursing license. If the graduate nurse fails the NCLEX-PN® examination, the temporary permit is revoked. The graduate has an opportunity to retest at a later date for an additional fee. Until successful completion of the NCLEX-PN® examination, the temporary permit remains revoked and the graduate can work only as a nursing assistant. Working in other states States have arrangements for interstate endorsements for nurses who choose to work in other states. This means that it is possible to work in another state without repeating the NCLEX-PN® examination, after you meet that state’s criteria for licensure by endorsement. Some states are involved in multistate licensure : a mutual recognition model for nursing regulation. The NCSBN adopted the Nurse Multistate Licensure Mutual Recognition Model in 1997. Utah was the first state to adopt the NCSBN compact language that took effect in 2000. The mutual recognition model allows a nurse to have one license in his or her state of residency and practice in other states, depending on each state’s Nurse Practice Act and legislation. To become law, each state must pass the law as part of their state Nurse Practice Act. As of 2012, 24 states had mutual recognition compacts. Check the Nurse Practice Act of the state in which you will be working to find out if it is a compact state. Try This Compact States and the Nurse Practice Act Obtain and read the Nurse Practice Act of a compact state by contacting that state’s board of nursing. Addresses are available online. If approved to work in a compact state, the LPN/LVN must know the contents of the NPA of the compact state. The mutual recognition model is not the same as Minnesota’s border recognition agreement (effective January 1, 2003), which allows nurses who have a license in the border states of Iowa, North Dakota, South Dakota, or Wisconsin to practice nursing in Minnesota. All of these states are compact states. The Minnesota Board of Nursing has endorsed the compact, but it has not become law because the Minnesota Nurses Association and the National Nurses United oppose it. The issue has gone before the Minnesota Legislature in 2003, 2008, 2009, 2010, and 2011. At this time, nurses who reside in Minnesota are not permitted to practice nursing in other states without obtaining a license in that state. Try This Interstate Agreement Contact the board of nursing in the state in which you will be employed. Inquire if they have multistate licensure or a border recognition agreement. If the state involved does not have such an agreement with other states, inquire what is needed for interstate endorsement. Verification of licensure Some boards of nursing are instituting online verification of nursing licensure. The board provides public information about nurses who have current licensure. The verification system enables potential employers to call and obtain a nurse’s license number, registration expiration date, and whether any board action has taken place. The service is available 24 hours a day, 7 days a week. Check your state’s board of nursing site to find out if this service is available. Employers are able to use this option to comply with requirements for written verification of a nurse’s registration by The Joint Commission (TJC) . Unlicensed assistive personnel The use of unlicensed assistive personnel (UAP) to provide patient care has grown dramatically in recent years. It is expected that the trend will continue. These unlicensed persons are trained to perform a variety of nursing tasks. Licensed nurses need to be aware of specific training that UAPs have had and facility job descriptions so they can safely make assignments. Supervision of UAPs by the RN and the LPN/LVN charge nurse in long-term care to ensure safety of patient care is a major concern. There is concern that because of the lack of licensed nurses in an agency, duties might be delegated and/or assigned inappropriately to UAPs. It is the RNs and LPNs/LVNs who stand to lose their jobs and licenses if the care provided by UAPs does not meet the standards of safety and effectiveness. The training program for UAPs does not provide the same in-depth education and experience that programs for student nurses provide. Licensed nurses are also accountable to both their employers and their state nursing boards (see Chapter 21 ). Nursing standard of care The nursing standard of care is your guideline for good nursing care. The phrase “You are held to the nursing standard of care” has important legal implications. The standard is based on what an ordinary, prudent nurse with similar education and nursing experience would do in similar circumstances. Resources for the nursing standard of care are found in Box 12-4 . Note that unit routine (“I know you studied how to do this in nursing school, but this is how we do it here.”) is not on the list. Box 12-4 Resources for the Nursing Standard of Care • Nurse Practice Act: Identifies the minimum level of competency necessary for a person to function as an LPN or LVN in a particular state. • Nursing licensure examination (NCLEX-PN® examination): Tests for minimum competence. • Practical/vocational nursing programs: Based on guidelines provided by the board of nursing, these programs guarantee a minimum knowledge base and the clinical practice necessary to provide safe nursing care. • Curricula, textbooks, and instructors are resources for information about the standard of care. • Written policies and procedures: The agency that employs the individual provides a standard of nursing care that must be followed. It is important to read the policies of the agency to find out whether verbal directions are supported by written policies. If a question about care ever comes up in court, a lawyer will use the agency’s policy and procedure manual as one guide to expected behavior. Remember that policies and procedures do not overrule the state’s Nurse Practice Act and educational preparation. However, institutional policies may be stricter than state law. • Custom: An unwritten, usually acceptable way of giving nursing care. Expert witnesses, not coworkers, would be called to testify to “the acceptable way.” • Law: Decisions that have been arrived at in similar cases brought up before a court (judge-made law). • Statements from the NAPNES and NFLPN. See Appendixes A and B. • Nursing texts and journals. • Administrative rules of the board of nursing. Keep in Mind Accurate documentation is an important part of nursing care. In the eyes of the law, if it was not documented, it was not done. How the law affects licensed practical nurses and licensed vocational nurses Common law versus statutory law The legal system in both the United States and Canada originates from English common law. Common law is called judge-made law because it originates in the courts. Common law is one way of establishing standards of legal conduct and is useful in settling disputes. Once the judge has made a decision, this decision sets the precedent for a ruling on a case with similar facts in the future. Informed consent and a patient’s right to refuse treatment are examples of common law. Statutory law is law developed by the legislative branch of the state and the U.S. Congress of the federal government. The Nurse Practice Act, which governs the practice of nursing, is an example of a statutory law. State boards of nursing can make nursing laws as long as the items in their laws do not conflict with any federal statutes. Criminal versus civil action The two classifications of legal action are criminal action and civil action. A criminal action involves people and society as a whole. It involves relationships between individuals and the government. A criminal action is classified as follows: • Misdemeanor: A misdemeanor is the least serious charge and can result in a fine or prison sentence of no more than 1 year. This criminal act might include taking a narcotic intended for the patient’s pain relief and giving the patient another substance in its place. • Felony: A felony is a serious offense with a penalty that ranges from more than 1 year in prison to death—for example, when the nurse injects a patient with a lethal drug to hasten death or removes life support before the patient has been pronounced dead by the physician. Guilt on the part of the nurse needs to be established by producing proof beyond a reasonable doubt . Regardless of the outcome of the criminal case, when a criminal case is completed, it is possible to be sued in a civil court. A civil action protects individual rights and results in payment of money to the injured person (e.g., a back injury was sustained during a fall because spilled urine was not wiped up. This injury caused the patient additional treatment time, including physical therapy, pain, suffering, and loss of time from work). A civil action involves a relationship between individuals and the violation of those rights. A tort is a civil wrong. The two kinds of torts are intentional and unintentional, which are described as follows: • Intentional: An intentional tort is intended to cause harm to the patient (e.g., threat or actual physical harm). • Unintentional: An unintentional tort did not mean to harm the patient. “I did not mean to hurt the patient” is no defense when you did not use the “Rule of 5” and gave the patient an incorrect medication, which caused injury. Guilt on the part of the nurse can be established by a preponderance (majority) of the evidence. Table 12-1 provides a comparison of criminal and civil law. Table 12-1 Comparison of Two Basic Classifications of Law CIVIL LAW CRIMINAL LAW Who law generally applies to Relationships between private individuals and infringements on individual rights Relationships between individuals and the government (state) Society as a whole Sources of law U.S. Constitution, state and federal legislatures U.S. Constitution, state and federal legislatures Punishment for breaking law Payment of a monetary compensation Death, imprisonment, fines, restrictions How guilt is established Proof by a preponderance of the evidence Proof beyond a reasonable doubt Examples of nursing liability Contract Tort Unintentional Intentional Negligence Murder, rape, larceny, homicide, manslaughter, assault and battery, embezzlement Felony/misdemeanor Basic sources of law: Common law—judge-made law . A trial judge’s ruling lays down a legal principle and sets a precedent. These principles are used to decide future cases. This type of law is continually adapted and expanded. Statutory law—formal legislative enactment. Law passed by Congress or enacted by state government. May be amended, repealed, or expanded by the legislature. The Nurse Practice Act is an example of statutory law. Intentional torts Tort law is based on the premise that in the course of relationships with one another there is a general duty to avoid injuring one another. A tort is a wrong or injury done to someone that violates his or her rights. Intentional torts require a specific state of mind—that is, that the nurse intended to do the wrongful act. Assault and battery, false imprisonment and use of restraints, defamation that includes both libel and slander (discussed later), and physical and emotional abuse are examples of intentional torts. Not all insurance companies cover intentional torts in their malpractice insurance policies, so you should check your policy. Assault and Battery Assault is an unjustified attempt or threat to touch someone. Battery means to cause physical harm to someone. When a patient refuses a treatment or medication, forcing the patient to take medication could result in an assault and battery charge against you. The patient gives implied consent (permission) for certain routine treatments when entering the institution. Patients retain the right to refuse any treatment verbally and may leave the institution when they choose, unless they are there for court-ordered treatment. Nurses can also protect themselves from assault by a patient but can use only as much force as is considered reasonable for self-protection. Treating a patient without consent is battery even if the treatment is medically beneficial. A physician might go to the court to attempt to get a court order to allow a blood transfusion for someone who opposes it on religious grounds. If the patient is fully competent, is not pregnant, and has no children, the court is likely to rule for the patient even if a blood transfusion would save his or her life. When faced with a similar situation, the practical/vocational nurse respects the patient’s belief system and notifies the supervisor for further advice or interpretation. False Imprisonment and Use of Restraints False imprisonment is keeping someone detained against his or her will. It can include the use of restraints or seclusion in a room without cause and without a physician’s order. Restraint by verbal threats of physical harm is also included in this category. Chemical restraint (with medication) is defined as administering a PRN medication with a sedating side effect every 4 hours to keep the patient tired and in his or her room. In this situation,the intent is to keep the patient quiet and out of the way. The intended use of the medication has been circumvented to meet the nurse’s need. Defamation Defamation means damage to someone’s reputation through false communication or communication without their permission. Libel and slander are included in this category and are described as follows: • Libel is defamation through written communication or pictures. • Slander is defamation by verbalizing untrue or private information (gossip) to a third party.

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