Nursing License Requirements and Scope of Practice in Florida

The state of Florida offers many employment opportunities for nurses. This is partly due to the popularity of the state as a retirement destination; older Americans tend to have more health issues, creating increased demand for nursing and other health-related services. Although salaries are not as high as in some other areas, the cost of living is relatively low. As of 2018, the US Bureau of Labor Statistics reports Florida employed 89,860 certified nursing assistants (CNAs) and 47,450 licensed vocational nurses (LPNs). In addition, 177,600 registered nurses (RNs) worked in Florida in 2018. This number includes the group of advanced practice registered nurses known as clinical nurse specialists (CNSs). Advanced practice nurses, who have a wider scope of practice, also included 2,180 certified registered nurse anesthetists (CRNAs), 330 certified nurse-midwives (CNMs) and 10,590 nurse practitioners (NPs).

Nursing License Requirements in Florida

Florida offers a number of different options for initial licensure; these vary according to one’s professional designation. The Florida Board of Nursing (FBN) handles initial licensure and renewals for all classes of nursing personnel. Although there are minor differences, in all cases, applicants must graduate from an accredited training program, complete fingerprinting for a criminal background check, pass specified examinations and pay examination and licensing fees. Florida is a licensure compact state. The Nursing Licensure Compact is a multi-state agreement that allows a licensed nurse to practice in multiple states without applying for a new license in each state.

Initial Licensure

CNA applicants have several options to obtain certification. In all cases, the applicant must pass the nursing assistant competency examination – both the written portion and skills-demonstration – and achieve a minimum passing score determined by the FBN. Applicants have the option of requesting an oral or Spanish exam instead of the written exam. The options are:

Complete an approved training program.
Present evidence of a high school diploma or equivalent and be at least 18 years of age.
Complete the curriculum developed by the Enterprise Florida Jobs and Education Partnership Grant.
Applicants in the latter two categories have three attempts to pass the examination. If unsuccessful, the applicant must complete an approved training program to take the examination again.

The successful applicant is placed on the Florida Nursing Assistant Registry.

To become an LPN in Florida, the applicant must have completed a Florida approved or accredited practical nursing education program and passed the NCLEX-PN examination. LPN applicants who have successfully completed a course equivalent to practical nursing education in an approved RN program with a grade of “C” or better are eligible to sit for the NCLEX-PN. The applicant has three chances to pass the examination; if unsuccessful completion of an FBN approved remedial training program is required. Fees are required for both the examination and licensure.

RN applicant requirements are the same as LPNs, except that the FBN-approved or accredited program must be in registered nursing (ADN or BSN) and the applicant must pass the NCLEX-RN examination. RN applicants also have three opportunities to pass the examination.

APRNs in Florida must hold an RN license from any US jurisdiction. Those who graduated on or after October 1, 1998, must also have a master’s degree or doctorate in nursing or a post master’s degree certification. In addition, the APRN must hold a national advanced practice certificate in his or her specialty from an approved nursing specialty board. Candidates are also required to show proof of malpractice insurance or exemption.

CRNA applicants who graduated on or after October 1, 2001, must hold a master’s degree.

Licensure Renewal

All nursing personnel in Florida are required to maintain licensure to practice. Licenses in all categories must be renewed every two years.

CNA licenses are renewed in two groups; one group renews in the even-numbered years and one in the odd-numbered years. The CNA must have performed nursing-related services within the previous 24 months for monetary compensation.

LPN licenses are renewed on odd-numbered years. The applicant must complete 24 hours of continuing education, including two hours on prevention of medical errors, two hours on laws and rules in nursing, two hours in human trafficking and two hours on recognizing human impairment in the workplace with every other renewal. The applicant must also complete two hours on domestic violence every third renewal, for a total of 26 hours of continuing education.

RNs in Florida renew their licenses on either April 30 or July 31 of the current year; the license is good for two years. RNs must complete a total of 24 hours of continuing education every 24 months. Continuing education requirements are the same as those for LPNs.

RNs with inactive licenses need only complete CE and reapply for activation.

RNs who have voluntarily relinquished their licenses or taken a null and void status must reapply for licensure and meet current requirements.

APRNs must meet all of the requirements for RNs. In addition, the APRN must provide evidence of national certification in his or her specialty. APRNs can use continuing medical education credits for up to half of their continuing education requirement. The APRN’s continuing education must include three hours on safe and effective prescribing of controlled substances. APRNs who are nationally certified are exempt from continuing education requirements except for human trafficking and safe and effective prescription of controlled substances.

LPNs and RNs who volunteer their services to medically indigent residents of Florida (those with incomes at or below 200% of the Federal Poverty Level) may be eligible for a waiver of the renewal fee and some of the continuing education hours. However, continuing education in HIV/AIDS, medical errors and domestic violence is still required.

Other Methods of Licensure

Endorsement

CNAs, LPNs, RNs, and APRNs who are licensed in other states or US territories may apply for licensure by endorsement. The CNA must be licensed in the other state, listed on the state’s registry and cannot have been found to have committed abuse, neglect or exploitation. Candidates in all categories must also have practiced nursing for two of the preceding three years.

Programs with no FBN Approval

Graduates of Accreditation Commission for Education in Nursing (ACEN), Commission on Collegiate Nursing Education (CCNE) accredited nursing programs or a military nursing education program issued an NCLEX code by the National Council of State Boards of Nursing may apply for licensure in Florida.

Graduates of programs from areas like Puerto Rico or an international nursing program that the FBN determines to be the equivalent of an NCSBN-approved program may apply for licensure in Florida.

RNs who took the Canadian Nurses Association Testing Service (CNATS) prior to August 8, 1995, must take the NCLEX-RN examination to become licensed in Florida. Those RNs who took the CNATS prior to that date may be eligible for endorsement without examination is scores were in an acceptable range.

Canadian LPNs must take the NCLEX-PN examination to become licensed in Florida.

Military veterans who complete programs to become a hospital corpsman, technician or equivalent do not meet the requirements for any nursing license in Florida. Additional testing and NCLEX examination are required.

Criminal History Reports

Prior to applying for a Florida nursing license in any category, the applicant must submit to Livescan fingerprinting to allow the Florida Department of Law Enforcement to conduct a search for any Florida and national criminal history records that may pertain to the applicant. The applicant must also report all convictions, guilty pleas and nolo contendere pleas except for minor traffic violations not related to the use of drugs or alcohol. Misdemeanors, felonies, driving while intoxicated (DWI) and driving under the influence (DUI) must be reported. Crimes must be reported whether or not the applicant received a suspended imposition of sentence. Prior or current disciplinary action against any professional license must also be reported by the applicant regardless of where it occurred. Each application is evaluated on a case-by-case basis. The FBN will consider the nature and severity of the offense, how recently the offense occurred and whether the applicant completed his or her sentence or a rehabilitation program. The burden of proof lies with the applicant, not the FBN. The Florida Statute sections 464.018, 435.04(2) and 408.809 list offenses that can result in denial of a nursing license in Florida. Among the offenses are robbery, child abuse, domestic violence, possession of a controlled substance, assault, battery, sexual battery, Medicare fraud, identify theft and forgery.

Disciplinary Actions

The FBN is responsible to protect the public and assure that all members of the nursing profession practice safely. To that end, the FBN may respond to complaints and conduct disciplinary hearings as appropriate. Grounds for disciplinary action typically focus on the ability of nursing personnel to practice safely, ethical behavior, the scope of practice, misrepresentation or fraud, and substance abuse. Failure to comply with continuing education requirements may also trigger disciplinary action. If a licensee has knowledge of but fails to report another individual who is unable to practice safely by reason of illness, a physical or mental condition or substance abuse, the individual who fails to report may also be disciplined. Once the FBN has conducted an investigation, it will hold an administrative hearing and then make a determination as to any disciplinary action. Disciplinary action may result in the suspension or permanent revocation of a license. In some cases, a licensee who has satisfactorily completed a rehabilitation program may be allowed to practice again, although restrictions such as not prescribing or handling controlled substances may be imposed by the FBN.

Scope of Practice

A CNA in Florida has a limited scope of practice and must perform all of his or her duties under the supervision of an LPN or RN. Typical tasks allotted to the CNA include hygiene activities such as bathing, shampooing a patients hair or brushing a patient’s teeth. The CNA may assist a patient to maintain mobility, turn the patient as necessary or assist with toileting. CNAs can collect specimens, apply previously fitted and adjusted orthotic devices or anti-embolism stockings, and gather data by measuring blood pressure, pulse or respirations. CNAs cannot administer medications in Florida except with additional training and when working in day programs for the developmentally disabled.

LPNs in Florida are authorized to perform all tasks at the CNA level. In addition, the LPN can administer medications orally, topically and by inhalation or injection. LPNs who have completed additional training may administer intravenous therapy with exceptions. The LPN may not administer blood or blood products, plasma expanders, chemotherapy, investigational products or IV push medications, or mix IV solutions. LPNs must work under the supervision of an RN or physician.

RNs perform all of the tasks or a CNA or LPN. However, the RN is also responsible for higher-level functions that include more advanced knowledge, critical thinking skills and knowledge of the nursing process. Among these are care planning and evaluation, delegation of appropriate tasks, care coordination and collaboration with other members of the health care team. RNs can also perform the intravenous therapy functions denied to the LPN. RNs who have completed additional training and are certified in perioperative nursing may also act as first assistants (RNFAs) to surgeon in the operating room.

APRNs in Florida provide physician-level services such as diagnosing and treating medical conditions, prescribing medications and medical devices, or ordering laboratory and diagnostic tests. The APRN must function under a set of written protocols at his or her place of employment. The APRN must have a designated supervising physician. APRNs provide a variety of services: NPs provide primary care, APRNs provide anesthesia and pain management and CNMs provide gynecological and obstetric services.