Editing RN Scope of Practice (section)

== Legal foundation ==

=== Nurse practice acts ===

Every state and territory has a nurse practice act, a statute passed by the legislature that defines nursing, establishes licensure requirements, creates the board of nursing, and grants the board authority to write and enforce rules (National Council of State Boards of Nursing [NCSBN], 2022). The nurse practice act is the legal ceiling on practice. No employer policy, provider order, or institutional custom can expand it.

Nurse practice acts typically address:

* Definitions of registered nursing, practical or vocational nursing, and advanced practice registered nursing.
* Requirements for licensure by examination and by endorsement.
* Titles and title protection, so that only a licensed person may use the title "registered nurse" or the credential "RN."
* Grounds for discipline, such as practicing beyond scope, diversion of controlled substances, patient abandonment, falsification of records, and practicing while impaired.
* Continuing competence or continuing education requirements.

=== State boards of nursing ===

The board of nursing is the regulatory agency that administers the nurse practice act. Its statutory mission is protection of the public, not advocacy for nurses. Core board functions include issuing and renewing licenses, approving nursing education programs, writing administrative rules, issuing advisory opinions or declaratory rulings on scope questions, investigating complaints, and imposing discipline ranging from a letter of concern to license revocation (NCSBN, 2022).

Boards of nursing are distinct from professional associations. The ANA and specialty organizations set voluntary professional standards and advocate for the profession; they do not license or discipline.

=== Licensure and the NCLEX ===

Entry into RN practice generally requires graduation from a board-approved nursing program, passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN), and meeting the state's background and eligibility requirements. The NCLEX-RN is developed by NCSBN and is used by all United States boards of nursing as the licensure examination for RN candidates (NCSBN, 2023).

=== Multistate licensure ===

Many states participate in the Nurse Licensure Compact, which allows a nurse whose primary state of residence is a compact state to hold one multistate license and practice, in person or by telehealth, in other compact states (NCSBN, 2022). A key study point is that the nurse practices under the laws of the state where the ''patient'' is located, not the state where the nurse lives.

=== Advanced practice is a separate scope ===

Nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives hold an additional license or recognition beyond the RN license, with a scope that may include diagnosing, ordering diagnostic tests, and prescribing. Prescriptive authority and the degree of physician involvement required vary widely by state. For licensure exam purposes, the baseline RN does not diagnose medical conditions, does not prescribe, and does not independently order diagnostic tests.