A state board of nursing is the state-specific licensing and regulatory body that sets the standards for safe nursing care, decides the scope of practice for nurses within its jurisdiction, and issues licenses to qualified nurses within the state the Board presides over.
All 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands have boards of nursing that collectively form the membership of the National Council of State Boards of Nursing (NCSBN). The NCSBN administers the National Council Licensure Examinations that all states require as part of the state licensing process:
- Registered Nurses (including advanced practice RNs) – NCLEX-RN exam
- Licensed Practical or Vocational Nurses – (NCLEX-PN) exam
California, Georgia, Louisiana, and West Virginia have two boards, one for Registered Nurses (RNs) and one for LPNs or LVNs. One state, Nebraska, has a separate board for advanced practice registered nurses (APRNs).
How State Nursing Licensure Works
State legislatures pass Nursing Practice Acts (NPAs) that establish state regulation of nursing. The NPA lays out the requirements for licensure and defines the scope of nursing practice. State boards of nursing then put the NPA into practice by setting administrative rules and regulations that add details to further define the qualifications for licensure and the scope of practice. Rules must be consistent with the NPA and can’t go beyond the law. When the rules go into effect, they carry the same weight as law.
All boards of nursing are responsible for evaluating nurse licensure applications, issuing and renewing nursing licenses, and taking disciplinary actions. Other responsibilities that a board of nursing might take on, depending on the state, include:
- Authorizing the use of licensing examinations
- Approving nursing education programs that meet established criteria
- Offering advice to the legislature about determining the legal scope of nursing practice in the state
- Regulating nurse aides/nursing assistants and medication aides/assistants working in nursing home and home health care settings
State Nursing Boards and APRN Licensing
Just as every state has its requirements for RN licensing, each state also sets its own requirements for licensing of APRNs, determines the legal scope of practice of an APRN in that state, and establishes the recognized roles and titles of APRNs in the state. Generally, the board of nursing is responsible for APRN licensing, but some states also have separate laws or boards that affect APRNs.
Although the standard requirements for APRN licensure are an RN license and completion of a graduate degree program in an advanced nursing specialty, some states require extra exams (such as national certification in a specialty) or additional professional experience.
Scope of practice for APRNs also varies by state. In some states, APRNs can work independently of physicians, in other states they cannot. Some states give APRNs independent prescription-writing privileges, others don’t. The NCSBN maintains maps that show the titles used to represent APRNs in each state, the roles each state recognizes, the APRN education each state requires, the states where APRNs can practice independently, and the states where APRNs have prescriptive privileges.
The variation in state laws for APRNs and the confusion it creates for both nurses and consumers led nursing organizations to develop of the Consensus Model for APRN Regulation, which is an attempt to standardize APRN licensure requirements and scope of practice. One aspect of the model regulation is that the board of nursing would be the only regulatory body that issues licenses and oversees APRNs.
As of December 2012, only a few states have passed laws or have pending legislation that would implement the consensus model.