Nursing Practice Act

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In the United States, the nursing practice remains regulated at the state or province level, with each state having their scope and regulations of training for their nurses within their defined jurisdiction. The activities of nurses are overseen and governed by a board of nursing, a regulatory body that oversees the practice of nurses in a given state. The boards of nursing are all integrated by the National Council of State Boards of Nursing, a US-based non-profit organization comprising of Boards of Nurses in the 50 states, the District of Columbia and 4 US territories, responsible for regulating nursing practice. The primary obligation of establishing Boards of Nurses was to ensure the safety and welfare of the public health by setting standards that provide safety training of nursing services. (, 2018)

The nursing regulation acts under a specific scope that anchored in protecting the health and safety of the public. They also try to: ensure competence among all nursing practitioners, ensure accountability while administering care, providing an ethical environment amongst their practitioners and more importantly evidence-based regulation. This study will be centered on exploring the nature of this regulatory bodies and investigating their primary goals, their mission and vision also outlining their shortcomings as they try to achieve this goal.

The practice of nursing requires specialized skills and knowledge to efficiently perform as it involves the handle and care of live human beings. It is therefore very important for Nurse practice acts to be present to regulate and govern the practice of nursing. (Brooker, 2013) These laws are there to protect the public from harm and to ensure that every certified professional is prepared and competent for the job. (Parris, 2012, p. 43) The regulations related to nursing are enacted under a nursing practice act by the individual legislative bodies of each state. The bill on its own cannot create clarity on the laws and as a result, establishes a board of nursing which is responsible for developing specific regulations and provide detail to what the nursing practice act cannot outline (Hayden, 2014, p. 33). Laws created or specified by the board are to be in line with the nursing act and cannot establish laws beyond the jurisdiction of the bill. The rules undergo public review and once enacted become part of the law. (Stevens, 2013, p. 88)

This laws differ from state to state. However  the Nursing Practice Acts of each state ought to have: the jurisdiction and the composition of the board of nursing, education curriculum standards, the scope and standards of the nursing practice which outlines what is required and allowed for them to do, the various types of titles and licenses, requirements needed to attain this licenses and more importantly the grounds under which a nurse may come to disciplinary action and the possible solution in those case scenarios. (Kathleen, 2012, p. 37)

The NCSBN (National Council of State Boards of Nursing), provides a platform for uniform licensure, contained under the Uniform Licensure Requirements which documents all the procedures and prerequisites that applicants require during their licensure process. This requirement promotes safe practice of nursing assuring the public that a nurse has been fully certified to perform their duty. The NCSBN has also created a database platform for verification of nurse licensure. (, 2018) This system provides real-time notification on the nurse employees on their licensure and discipline conduct records. Some of these systems are available for public use, and they include the Nursys Services, a database for verification of nurse licensure, the Nursys Licensure QuickConfirm and also the Nursys Licensure Verification for license verification when applying for endorsement to another state.

Education program approval is critical during nurse licensure. It officially recognizes that the program, institution and resources used were sufficient as per the requirements and standards established by the boards of nursing, in that state.

Concerning education, an increase in the use of simulation in nursing education has dramatically increased over the years with the sophistication of simulation equipment. (Hayden, 2014) From research carried out by the NCSBN, the conclusion made was that there was an increased interest in the use of clinical simulation strategy (Foronda, 2013, p. 40). This triggered the NCSBN to provide additional tools that aid nursing education programs offer simulation experiences with guidelines that will intergrade evidence regarding the simulation. In 2016, the majority of the state boards related to 10 hours as the maximum number of simulations in the clinical experience. (Sportsman, 2018)

The NCSBN produces innovative materials and initiatives to support nursing boards. The practice guidelines, provide evidence-based resources that will act as regulators during the practice of nursing. This leads to the breaking down of nursing into four primary levels based on education and certification requirements (Peate, 2012, p. 19). First are nurse assistants with the title of nursing aides or Certified Nursing Assistants(CNAs). They are at the core of contact between the medical staff and patients assisting them with their daily activities such as eating and helping them dress. To become a nurse assistant one must complete state-approved education program which can found in nursing homes and technical colleges. It takes three to eight weeks to complete after which aspiring nurse aspirants must pass an exam to earn their CNA. (Flavin, 2017)

Above the certified nurse, assistants are the licensed practical nurse(LPN). They are responsible for monitoring the patients’ health such as measuring of blood pressure. They also communicate to the family members on the ongoing care that the patient is undergoing with the aim of creating assurance. To become one, an aspirant ought to obtain a practical nursing diploma found in technical schools, career colleges and will last up to a year. Upon graduation, the applicant will be required to pass the National Council Licensure Examination to receive a license showing competence to work. Additional knowledge is available where one can have an advanced level of education about a specific subject such as therapy, developmental disabilities and childbirth. (Doyle, 2018)

The registered nurse is the general personnel that individuals tend to interact mostly due to their extensive roles in administering patient care. They are responsible for monitoring patient symptoms, records and medical equipment that a patient. They also deliver medication to the patients and also collaborate with doctors in establishing the plan of care for the patients.  They are responsible for LPNs and CNAs who are under them. To become a registered nurse one can earn an Associate Degree in Nursing(ADN) or by making a Bachelor’s of Science in Nursing(BSN). An ADN lasts for 18-24 months while BSN in about 33months, and upon completion, there is the examination by the National Council Licensure Examination.

At the highest level, the advanced practice registered nurses(APRNs) who have earned their Masters of science in nursing (MSN). They perform all duties of an RN as well as more complex functions like referring patients to physicians and evaluating test results. They have a vast opportunity for careers ranging from being educators in nursing schools to working independently. The first procedure of becoming an APRN is to become an RN. Secondly, one has to gain acceptance into an accredited MSN program, and upon completion, issuing of an exam in the area of specialty is mandatory (, 2018).

Besides education, the NCSBN is also responsible for instilling discipline and ethical values amongst practicing nursing professional during their practice. Practicing nurses that have been found to violate various codes of conduct are subject to disciplinary measures and remedies provided. The boards of nurses are responsible for formulating these procedures, and they vary from state to state. There are various phases involved in these proceedings.

First and foremost, to note is the initial review of the complaint. Upon the submission of a claim by the member of the public or a healthcare facility, the first obligation of the board of nursing is to identify whether they have the jurisdiction to take action against that particular individual. Under the nurse's practice act, the board of nursing can only act if the allegations made against the practitioner are falling under the line of sexual misconduct, drug-related, practice-related and violation of boundaries. Issues beyond the control of the BON are employee disputes, labor issues, interpersonal quarrels, impolite behavior and also complaints against health workers that are not nurses. (, 2018)

Once the board has certified that the case presented to it is under its jurisdiction, it sets out the various proceedings to carry out investigations which vary with the seriousness of the complaints. The investigation may require additional documents, response of the accused and also conducting witness interviews. Upon the completion of the investigation, the board of nursing reviews all the investigative data and determined whether the violation alleged has occurred or not. The decision to close the case, moving to informal proceeding, suggesting an alternative program or the filling of formal charges to present evidence at a formal hearing is made at this point. At this point, the nurse subjected to these proceedings is given an opportunity to present their side of the case (, 2013)

Upon consideration of the evidence and relevant information presented with clear evidence available, the board of nursing takes emergency actions. This action takes the form of suspension of the nurse’s license to avoid further harm to the public. More to this, the board disciplinary actions may include: referral to an alternative to discipline program for nurses with mental or physical conditions such as drug dependency, public reprimand or charging of fine to the accused. To ensure the practice of safety, the NCSBN provides a set of guidelines that provide requirements that a nurse requires in order for the license to be reinstated. Through its courses on the NCSBN learning extension, nurses are educated on the essential legalities that are key for practice and remediation of licensure as per the Nursing Practice Acts. (, 2018)  

It is equally important to note that has been an increase in the demand for nurses in the United States. According to studies, there are 11.1 nurses per 1,000 people in the United States, compared to an average of 8.7 nurses per 1,000 people across the world’s most economically developed nations. However, this population is ageing and unable to keep up with the demand that grows exponentially on an annual basis. (Phil, 2017)

The significant elements that bring this demand come from the increase of ageing population with high chronic disease rates accredited to lifestyle and other socio-economic factors. On the other hand, the shortage of nurses has come into play due to a couple of reasons. First, the limited resources in nursing schools have resulted in the training of the limited number of students. Second, despite the high number of applicants to nursing schools, few can meet the standards in place for acceptance and are thus rejected. Also, there has been the shortage of educators in the nursing field which limits the capacity of the training schools. The boards of nurses under its jurisdiction should strive to develop strategies in collaboration with the state governments to address this issue without compromising the standards and safety of the public. (Grant, 2016)

            In conclusion, it has been evident that the significant scope of the Board of Nurses is to ensure the safety of every public who accesses the services of a nurse in the United States. Specific to each State they are to provide the competence of nursing professions and execute its authority over them as per the nursing act requirements. The Board of Nurses ensures: the education standards for students are at the required level. Similarly, the board sets the guidelines for issuing licenses to the qualified personnel’s, categorize nurses as per the level of skill, provide disciplinary actions to members that violate the various codes of conduct and most importantly is to define the scope and nature of the nursing practice.

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October 13, 2023

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