Nurse Practice Acts by State: Overview and FAQ

Over the last century, the nursing profession has grown to represent what is now the largest workforce in the healthcare industry. With the continuous expansion of nursing roles and duties, state laws have become fundamental in regulating practice standards. In particular, Nurse Practice Acts (by state enactment) are pivotal in the effort to protect patient safety and hold nurses accountable for their work.

Whether you’re a facility administrator or nursing professional, understanding your state’s Nurse Practice Act is a necessary part of delivering high quality care. We’ll provide an overview of what Nurse Practice Acts are and answer frequently asked questions about how these laws govern the nursing profession.

The Nurse Practice Act: History and Overview

Prior to the late 19th century, there were no nursing practice laws in place. Nurses didn’t receive any formal education and provided care in unregulated settings, such as people’s homes. However, the demand for care during the Civil War paved the way for nursing to become a recognized profession, with formal schools and roles being established in the following decades.

Identifying a need to regulate these developments, North Carolina, New York, New Jersey, and Virginia became the first states to pass a Nurse Practice Act in the early 1900s. Over the next few years, this guided the enactment of Nurse Practice Acts by state governments across the country, which more clearly defined nursing roles and duties. Today, these acts continue to serve as regulatory guidelines for nurses of all levels.

Nurse Practice Acts: FAQ

Now that you understand the history of these laws, you may be wondering how they continue to shape standards of care. Below we’ll answer some of the most frequently asked questions about Nurse Practice Acts to help you understand what they are and how they’re applied.

What Are Nurse Practice Acts?

These are state-by-state laws that govern everything related to nursing practice. Each state has a Board of Nursing that’s responsible for setting and enforcing these laws, which hold nursing professionals accountable for delivering quality care. They serve as statewide guides that nursing professionals must become familiar with in order to practice at the highest standards.

What Are the Components of the Nurse Practice Act?

While the exact provisions of Nurse Practice Acts differ by state, each state is required to define the following components:

• Phrases and terms for the intent of the law: The language and definitions used to convey the goals of the Nurse Practice Act.
• Composition of the board members: The roles, qualifications, and appointment processes for board members who set and enforce provisions in the Nurse Practice Act.
• Educational program standards: The standards that nursing schools must meet to ensure the quality of education provided to nurses in training.
• The scope of nursing practice: The range of duties and responsibilities that nurses are authorized to perform within their roles.
• Licensure processes: The steps that nursing professionals must follow to be legally permitted to practice within the state.
• Disciplinary actions for violations: The penalties that nurses may face for violating nursing laws and regulations.

What Is the Purpose of Nurse Practice Acts?

Nurse Practice Acts hold all nurses to a professional standard, which helps prevent patients from being harmed due to misconduct or malpractice. Essentially, these acts provide a legal framework for what nurses can and cannot do, ensuring that they have the qualifications and competence needed to deliver safe care.

What Are the Consequences of Violating the Nurse Practice Act?

The penalties for violating the Nurse Practice Act range in severity and depend on each state’s individual laws. However, these penalties may include license suspension, fines, practice restrictions, or educational remediation. Typically, state boards that receive complaints about nurses will conduct investigations and enforce penalties on a case-by-case basis.

Why Does Each State Have its Own Nurse Practice Act?

According to federal laws, each state has the autonomy to independently regulate nursing practice standards. As the structure of healthcare services varies greatly from state to state, this gives nursing boards flexibility to shape nursing care in a way that meets state-specific needs.

However, states can also enter what’s called the Nurse Licensure Compact (NLC). This compact allows nurses in participating states to practice outside of their home states without obtaining additional licensure. If a nurse faces disciplinary action, they may be penalized according to both their home state and the rules of the state they’re practicing in. Currently, 41 states are part of the NLC.

Can Nurse Practice Acts Be Updated?

The nursing profession is constantly changing based on new evidence-based standards, federal regulations, and technologies. Nurse Practice Acts can be amended through a legislative process involving various nursing organizations and regulatory bodies to reflect advancements in the industry. You can stay informed about changes to your state’s Nurse Practice Act by regularly checking the website of your Board of Nursing (BON).

Nurse Practice Acts by State

Now that we’ve covered what Nurse Practice Acts are and why they’re important, you’ll likely be seeking ways to keep up with your state-specific laws and regulations. The following table provides links to each state’s Board of Nursing, Nurse Practice Act, and information on their participation with the NLC, along with helpful state guides that provide resources and an overview for each state’s nursing practice laws.