A Guide to Your Nurse Practice Act

Nursing professionals have a wide range of valuable resources to help them in their jobs, such as organizational policies and procedures and databases of clinical practice guidelines. Many nursing professionals use these on a regular basis to help them deliver quality care. But they tend to overlook one essential practice resource — the nurse practice act (NPA). As the name implies, a state’s or jurisdiction’s NPA provides guidance for practice; adhering to the provisions of the act makes the nurse less vulnerable to legal action. Here’s what you need to know about NPAs.


About Boards of Nursing

One of the first things to understand about an NPA is it includes the creation of a Board of Nursing (BON) for enforcement of the Act. The BON’s main purpose is to protect the public, although another consideration is the rights of nursing professionals. According to the National Council of State Boards of Nursing (NCSBN), the BON can create rules and regulations that clarify what’s in the act but are consistent with it and do not go beyond it. BON members are elected or appointed to their position. Members typically include registered nurses, licensed practical/vocational nurses, advanced practice registered nurses, and consumers.

NPA basics

Each state and territory of the United States has an NPA, which is a law passed by a legislative body. An NPA outlines what is required to practice as a nurse and the types of activities various nursing professionals can engage in. NPAs generally have several common components:

  • Definitions. Terminology needs to be clear so the information in an NPA is interpreted correctly. An example of a definition is unencumbered license — a license that doesn’t have any restrictions or current discipline issues.  
  • Authority, power, and composition of a BON. The Board of Nursing (BON) is responsible for enforcing the NPA and protecting the public (see sidebar).
  • Educational program standards. These standards, which include items such as faculty qualifications, are for schools of nursing. 
  • Standards and scope of nursing practice. This is a vital section of the NPA for practicing nursing professionals. It outlines expectations for practice and includes information about proper delegation.  
  • Titles and licenses. This section details requirements (such as graduation from an approved education program and passing an examination) needed to use a particular title such as RN. 
  • Grounds for disciplinary action, other violations, and possible remedies. The BON is responsible for investigating issues such as misuse of controlled substances and significant errors in care, and for taking appropriate action, based on what is permitted under the NPA. 


Following the NPA

You are responsible for following the NPA in the states and jurisdictions where you are licensed. Failure to do so leaves you open to legal action. For example, if you delegate incorrectly and the patient suffers harm, you could be named in a lawsuit. You would have little defense if you did not follow the NPA’s guidelines for delegation.
Consider the NPA as a helpful resource. For instance, if your organization asks you to take on a task that is outside the scope of practice defined in the NPA, you have a valid reason for declining to perform the task. If you are unsure whether a task is covered, consult the BON for the relevant state or jurisdiction. You can easily access BON contact information via the National Council of State Boards of Nursing (NCSBN): https://www.ncsbn.org/sites/ncsbn/membership/us-members/contact-bon.page.
Of course, to follow the NPA, you must know what is in it. You can easily find the NPA(s) for where you practice through the “Find Your Nurse Practice Act” page on the NCSBN’s website (https://www.ncsbn.org/policy-gov/npa-toolkit/npa.page). Simply use the drop-down menu to select your location.
It can be challenging to read a legislative act, so many states have created self-study education programs on their NPAs. You can find a list at the International Center for Regulatory Scholarship (ICRS) Connections Catalog: https://catalog.icrsncsbn.org/browse/public/continuing-ed/npa/.


A valuable resource

Following the NPA helps reduce your risk of legal action. Be sure to read newsletters and other correspondence from the BONs where you practice for any clarifications related to the NPA. It’s also a good idea to revisit the NPA on an annual basis to ensure you are practicing according to the law.
By: Cynthia Saver, MS, RN, is president of CLS Development, Inc., in Columbia, Md.

NCSBN. What every nurse needs to know about state and territorial boards of nursing. 2018. https://www.ncsbn.org/brochures-and-posters/state-and-territorial-boards-of-nursing-what-every-nurse-needs-to-know
Russell KA. Nurse practice acts guide and govern: Update 2017. J Nurs Reg. 2017;8(3):18-23. https://www.ncsbn.org/public-files/2017_NPA_Guide_and_govern.pdf

The information offered within this article reflects general principles only and does not constitute legal advice by Nurses Service Organization (NSO) or establish appropriate or acceptable standards of professional conduct. Readers should consult with an attorney if they have specific concerns. Neither Affinity Insurance Services, Inc. nor NSO assumes any liability for how this information is applied in practice or for the accuracy of this information. Please note that Internet hyperlinks cited herein are active as of the date of publication but may be subject to change or discontinuation.
This risk management information was provided by Nurses Service Organization (NSO), the nation's largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. The individual professional liability insurance policy administered through NSO is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to service@nso.com or call 1-800-247-1500. www.nso.com.


#board of nursing #nurse practice act #Scope of Practice

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Frequently Asked Questions

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What kinds of activities might trigger a disciplinary action by a licensing board or regulatory agency? 

The fact is anyone can file a complaint against you with the state board for any reason—even your own employer—and it doesn’t have to be solely connected to your professional duties. All complaints need to be taken seriously, no matter how trivial or unfounded they may appear. 

How does a shared limit policy work?

A shared limit policy is issued in the name of your professional business or company. The policy provides professional liability insurance coverage for the business entity named on the certificate of insurance and any of the employees of the business entity, provided they are a ratable profession within our program. Coverage is also provided for locum tenens professionals with whom the business entity has contracted for services the locum tenens performs for the business entity.

The business, and all eligible employees and sub-contractors you regularly employ, will be considered when determining your practice’s premium calculation and share the same coverage limits you select for the business.

We have a shared limit policy. Are employees covered if they practice outside our office?

The policy covers your employees outside the office as long as they are performing covered professional services on behalf of your business.

If your employees are moonlighting, either for pay or as a volunteer, they should carry an individual professional liability insurance policy to cover those services. Otherwise, they might not be covered for claims that arise out of these activities.

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