Introduction to State Boards of Nursing
As is true for the vast majority of professionals within and outside of the healthcare industry, governmental oversight of individual professions is driven by the need to protect the public. Healthcare professionals are among the most highly regulated due to the state’s mission of public health and safety.
Nurses, and in some states, nursing support staff (i.e., Certified Nursing Assistants), are subject to oversight by a regulatory body. Official titles of these bodies vary by state. However, the most common titles are the State Board of Nursing and the State Board of Nurse Examiners.
How are Boards of Nursing Formed and What Do They Do?
The composition of a given state’s board of nursing and how the board functions is dictated by the state’s Nurse Practice Act (NPA). In most states, the practice act applies to nursing practice in general and, therefore, applies to vocational/practical nurses, registered nurses and advanced practice nurses. The state NPA holds the force of law and provides for the following functions:
- The composition and roles of a Board of Nursing
- Establishes requirements for licensure and renewal
- Defines the scope of practice of nurses and, in some cases, nursing support personnel
What are the Qualifications of Board Members?
The numbers and qualifications of board members vary. The typical board is comprised of the following:
- Registered nurses
- Practicing nurses (variety of disciplines)
- Nursing faculty (ADN, BSN and graduate)
- Nursing administrators (variety of settings)
- Licensed Vocational/Practical Nurses (if the NPA governs vocational practice)
- Advanced Practice Nurses
- Consumer(s) of healthcare (lay public members)
Board members are either appointed by the governor or nominated and elected to their posts. Board members elect officers of the board (chair, co-chair, secretary, treasurer). Board members are also typically responsible for the selection of the board’s administrative leadership, often referred to as the Executive Director.
What is the Board of Nursing Accountable For?
Despite state-by-state variations in NPAs, boards of nursing have three broad regulatory functions:
- Setting standards of practice
- Review and evaluate initial applications for licensure
- Provide for a renewal process
- Final jurisdiction on disciplinary actions
Setting Standards for Nursing Practice
Boards of nursing have far-reaching responsibility for maintaining a standard of practice for all licensed nurses. This responsibility begins with the review and approval of all nursing education programs in the state. In doing so, the Board ensures that curriculum and course content meets minimum standard to prepare competent graduate nurses to provide safe nursing care.
The Board is also responsible for the administration of the National Council Licensure Examination (NCLEX). This includes the provision of the examination and ensuring the validity of results.
As stipulated in the NPA, the Board is responsible for identifying the types of nursing licenses issued. The list of licenses could include:
Finally and most importantly, the board is responsible for defining the scope of practice for all levels of licensees. This function provides guardrails that define the complexity of nursing care an individual nurse may provide. This includes but is not limited to prescriptive authority and level of autonomy.
Licensure Responsibility of Nursing Boards
Whether a new graduate or a practicing nurse relocating to another state, the board has the responsibility to review and approve all initial applicants for licensure within the state. This review includes:
- Ensuring graduation from an accredited nursing education program
- Criminal background checks to ensure the applicant is in good standing
- Ensuring that practicing nurses have unencumbered license(s) in previous states of residence.
At regular intervals following initial licensure, nurses are required to renew their licenses. The board is accountable for ensuring that all renewals are reviewed. This review includes:
- Unencumbered license
- Ensuring the nurse has completed required and optional continuing education credits.
Finally, the board is responsible for ensuring that it maintains a current roster of all licensees. This roster includes demographics, practice setting and area of practice.
A vital function of the board is to ensure that there is an impartial, peer-driven process for disciplinary action for licensed nurses. This board action is triggered by a formal complaint about an individual nurse’s practice. This complaint could be registered by a consumer, an employer or via self-reporting by the practicing nurse.
NPAs across the nation require a structured peer review process to be completed by employers prior to submission of a formal complaint to the board. This process includes setting and specialty-specific peer review committees that are responsible for impartial investigation of allegations.
Investigations are documented in detail. Peer review committees are asked to use the standard of what a reasonably prudent practitioner would do in similar circumstances as their standard for making decisions to report their findings to the board.
Upon receipt of a formal complaint or recommendation from a peer review committee, the board conducts its own in-depth investigation. This investigation entails formal hearings and testimony from the subject nurse and involved parties. Based on its findings, the board determines the level of discipline to be administered. Levels of discipline range from no action indicated to temporary suspension of licensure with stipulations of revocation.
It is important to note that, tangential to the disciplinary process, boards across the nation have developed peer-driven programs addressing mental illness, chemical dependency and alcoholism among nurses. These programs are focused on ensuring the public’s safety while supporting the nurses’ rehabilitation and recovery.
With the public’s safety and health as a core mission, boards of nursing serve a vital function in regulating nursing practice. Based upon NPAs, state boards of nursing provide structure and consistency in setting standards of practice, issuing and renewing licenses and ensuring impartial review of complaints and administration of disciplinary action as indicated.
It is incumbent upon each practicing nurse to stay abreast of the actions and pending actions of boards of nursing. All boards of nursing communicate their actions to licensees through online and/or paper newsletters. These communications provide nurses with information as to pending rule changes and offer the opportunity to voice opinions and participate in the election of officers. Let your voice be heard.
List of Nursing Boards in the US