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Nurse Practice Act

NLC Nurse Practice Act Comparison

During the 2023 Legislative Session, the Washington State Legislature passed Substitute Senate Bill 5499: An Act Relating to the Multistate Licensure Compact, which provided the framework for Washington state to join the Nurse Licensure Compact.

One of the requirements in SSB 5499 is for the Board of Nursing to publish an annually updated summary of the key differences in each state's Nurse Practice Act.

This page provides information and resources on state Nurse Practice Acts and key elements that may vary from state to state. 

What is a Nurse Practice Act?

A Nurse Practice Act is a set of laws established by each state legislature to regulate the practice of nursing within its jurisdiction.

  • These laws establish the authority and composition of the Board of Nursing, along with legal frameworks for nursing education, licensure, scope of practice, and discipline.   

Nurse Practice Acts are a fundamental part of the overall regulatory framework for healthcare professionals. They are designed to protect patients and help ensure that nurses provide safe and competent care.

Why should I understand the Nurse Practice Act for the states I work and am licensed in?

State Nurse Practice Acts:

  • Define your ability to practice in the states you work in.
  • Set standards for competent patient care.
  • Set rules of professional and ethical conduct.

Violating elements of the Nurse Practice act in the states you work in may result in disciplinary action taken against your license.

It is recommended nurses check their home state for any changes to its Nurse Practice Act and the Nurse Practice Acts of states they are new to before beginning practice.

Key differences of Nurse Practice Acts from state to state

Nurse Practice Act elements can vary from state to state.

It's important for practicing nurses to ensure that they are providing safe and competent care as defined by the states they are licensed by or practicing in, and to avoid license discipline.

The following describes key elements that may vary from state to state along with examples:

Scope of practice

Scope of practice defines the procedures, actions, and processes that a healthcare professional is permitted to perform according to state or jurisdiction law.

It creates assurances that an individual is competent to provide safe and effective care.

According to the American Nurses Association scope of practice describes the who, what, where, why and how of nursing practice.

  • In Washington state, the Nurse Practice Act includes definitions for registered and licensed practical nursing practice.  A Decision Tree is used to assist nurses in determining the responsibilities a nurse can safely perform.
  • In the state of Wisconsin, the Nurse Practice Act includes an extensive section on standards of practice. It outlines requirements for assessment, planning, intervention, evaluation, and delegation.
  • Virginia's Nurse Practice Act does not specifically address nursing scope or practice standards. It does provide a decision-making model like Washington State.
Delegation

Delegation means transferring to a competent individual the authority to perform a selected nursing task in a selected situation.

Nurse Practice Acts generally include specific requirements to organize, manage, and supervise the practice of nursing.

It is important to realize that even though a task may be delegated the nurse still maintains responsibility for overall patient care.

  • In Washington state, the Nurse Practice Act addresses delegation of tasks by a registered nurse. It includes specific requirements for home health, hospice, community-based and in-home care settings.
  • Utah's Nurse Practice Act only addresses delegation by a “responsible caregiver” (patient spouse, parent, adult child) to an “unlicensed direct care worker” (any individual who is 18 years of age or older).
  • In the state of Colorado, Nurse Practice Act broadly defines “delegation of patient care” allowing the delegation of patient care by a licensed healthcare provider within the scope of the providers practice.
Collaboration

Collaboration is the process of working together with other healthcare professionals to provide efficient, effective patient care.

Collaboration allows healthcare professionals to assume complimentary roles and enhances access to care. 

  • In Washington state, the Nurse Practice Act does not address issues related to collaboration of care.
  • The state of Colorado's Nurse Practice Act includes “collaborating with other health care professionals in the management of health care” in its definition of the practice of registered nursing.
  • South Carolina's Nurse Practice Act includes the responsibility of engaging in collaborative care planning and collaborative communication with other healthcare providers. 
Telehealth

Telehealth is the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care and patient education.

Telehealth is becoming more common and with that more regulated.

It is important that a nurse, providing telehealth services, understand the scope of practice, regulatory requirements, and practice standards of the state in which they work and the states where patients are located.  

  • In Washington state, the Nurse Practice act does not address telehealth services. Guidance regarding the provision of telehealth services can be found in NCAO 25.00 Nursing Telehealth Practice.
  • The state of West Virgina's Nurse Practice Act includes extensive direction for registered nurses on the provision of telehealth services including definitions, practice requirements, interstate registration, and practitioner-patient relationship.
  • In Ohio, the Nurse practice act only authorizes advanced practice nurses to provide telehealth services.
Title protection

Title protection is generally included in Nurse Practice Acts for the use of the title of Registered Nurse (RN) and Licensed Practical Nurse/Vocational Nurse (LPN/VN).

The Nurse Practice Act protects these titles from being used by unauthorized persons and thereby protects the public.

Nurse Practice Acts may also include specific penalties for title misuse or misrepresentation.

  • In Washington state, the Nurse Practice Act makes it unlawful for persons to practice as a nurse in Washington State unless licensed under the provisions of the Nurse Practice Act.
  • South Carolina's Nurse Practice Act includes additional language regarding exceptions, abbreviations, provisions of services to patients located in another state, and the use of signs, cards, or device to indicate the person is a nurse.
  • In the state of Texas, the Nurse Practice Act requires the nurse to wear a name tag identifying yourself as a “RN” or “LVN” while providing patient care.
Continuing Competency

Continuing competency is overseen by all state Boards of Nursing to ensure that nurses maintain a level of continued competence.

The most common regulatory approach is to require minimum levels of ongoing practice experience and continuing education.

Nurse Practice Acts may direct minimum continuing education required to maintain licensure; examples include.

Washington state requires:

  • 8 continuing education hours yearly
  • 96 practice hours yearly
Ohio requires:
  • 24 continuing education hours every 2 years
    • At least one hour must be related to the statutes and rules related to nursing practice
Kentucky requires:
  • "document continuing competency during the immediate past licensure period as prescribed in regulations promulgated by the board"
  • Only continuing education hours by Board approved providers be accepted
Unprofessional conduct and duty to report

Many Nurse Practice acts define what constitutes unprofessional and unethical conduct and the nurse’s duty to report detrimental conduct of other health professionals or oneself (this may include the presence of impairing medical conditions.

It is important to realize that unprofessional conduct is often not limited to the practice setting but may include any conduct that may impugn the reputation of nursing, e.g., a DUI conviction.

Mandatory reporting requirements may be found in the Nurse Practice Act or in related statue/regulation.    

  • In Washington state, the Nurse Practice Act refers to Chapter 18.130 RCW: Uniform Disciplinary Act, regarding disciplining of licensees. Mandatory reporting regulations are found in Chapter 246-16 WAC: Standards of Professional Conduct, which includes requirements for self, other license holder, and health care institution reporting.
  • The Arizona Nurse Practice act does not include a full definition of unprofessional conduct, nor reference to mandatory reporting.
  • Delaware state's Nurse Practice Act includes requirements to report any provider who “has engaged or is engaging in conduct that would constitute grounds for disciplinary action” or “may be unable to practice with reasonable skill and safety.”  It also includes a requirement to self-report any arrest, conviction, or criminal indictment.
Alternative to discipline (substance use disorder monitoring)

Nurse Practice Acts may include authorization for the Board of Nursing to provide an alternative to discipline option for nurses with an active substance use disorder or other impairing medical or mental condition.

Alternative to discipline programs support safe nursing practice, offer access to recovery services, and retain nurses in the workforce.

Eligibility requirements and program policies vary from state to state.

  • In Washington state, the Nurse Practice Act does not include specific authorization for an alternative to discipline approach.  Authorization and program structure requirements are found in found in Chapter 18.130.175 RCW of the Uniform Disciplinary Act.
  • In Arkansas, the Nurse Practice Act includes Subchapter 8 - Alternative to Discipline Act. The Act outlines program requirements and reporting procedures.
  • Hawaii does not have a Board approved alternative to discipline program.
Practice specific laws

Nurse Practice Acts may include laws that address specific aspects of nursing care, procedures, and responsibilities. 

These provisions are designed to ensure patient safety, regulate the profession, and adapt to evolving healthcare needs. 

Specific examples:

Washington 

  • Down Syndrome - Parent Information
  • Catheterization of students
Nebraska
  • Intravenous therapy
Alaska
  • Determination of death
  • Administration of herbal or non-herbal nutritional supplements

Resources

Publications

National Council of State Boards of Nurses Resources

Washington State Resources

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