State Law and Regulation

The essential documents from the profession serve as the foundation for legislation and regulatory policy-making that help assure the public’s safety.

APRN practice is typically defined by the Nurse Practice Act and governed by the Board of Nursing, but other laws and regulations may impact practice, and other boards may play a role. For instance, in some states nurse-midwives are regulated by a Board of Midwifery or public health. In addition, in some states, the CNS category is not identified in the Nurse Practice Act, which means the CNS is held to the same scope of practice as any registered nurse within the state. The scope of practice for CRNAs is fairly standard, but is not evident in statute in all states.

Interpretation of specific acts, not evident conclusively in the Nurse Practice Act is provided by the regulatory body in the form of an opinion. For example, Who may perform micro-dermabrasion, under what circumstances? What are the parameters for participation in a radiologic procedure? Can an APRN administer IV anesthetics for intractable pain?

Given the variation between APRNs and related state statutes, rules and regulations, it is essential that APRNs have a clear understanding of how their scope of practice is defined by those laws and regulations, as well as any opinions promulgated by the state regulatory agency. A listing of Boards of Nursing and other resources are listed below.

State Law and Regulation Resources

In addition to the listing of Boards of Nursing, the following resources might be helpful:

• Representatives from six leading organizations whose members are health care regulatory licensing boards, including NCSBN, have created a practical document designed to assist legislators and regulatory bodies with making decisions about changes to health care professions’ scopes of practice.
• The AANA State Government Affairs Division publishes summaries of state legislative and regulatory requirements
• ACNM publishes a series of state fact sheets as well as Summaries of State Laws and Regulations Affecting CNMs/CMs.
• The Citizen Advocacy Center, an organization devoted to assisting public members of regulatory bodies, has developed a series of excellent resources on scope of practice for consumers: a white paper, a toolkit, and a series of FAQs.
• In 2010, AARP updated their policy statement on APRNs to reflect their concern that "statutory and regulatory barriers at state and federal levels prevent many nurses from practicing to the full extent of their licensure."