PA003 Regulation
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Walden University
NURS 6050 – Policy and Advocacy for Improving Population Health
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Differences Between a Board of Nursing and Professional Nurse Associations
A Board of Nursing (BON) serves as a state-mandated regulatory body responsible for overseeing and enforcing the legal standards that govern nursing practice. Established through state legislation—most commonly the Nurse Practice Act—the BON ensures that public safety remains the central priority in all nursing activities. This authority grants BONs the power to evaluate nursing education programs, issue and revoke licenses, investigate allegations of misconduct, and impose disciplinary actions when necessary. By performing these functions, BONs create a regulatory environment that safeguards the public and ensures that nurses practice in an ethical, competent, and accountable manner (Short & Loversidge, 2019; National Council of State Boards of Nursing, 2022).
Professional Nurse Associations vs. Board of Nursing
In contrast to the governmental and regulatory purpose of BONs, professional nurse associations exist as independent, member-supported organizations dedicated to advancing the profession rather than regulating it. These associations—such as the American Nurses Association (ANA) or specialty groups like the American Association of Critical-Care Nurses—focus on professional development, policy advocacy, continuing education, leadership building, and advancing evidence-based practice (American Nurses Association, 2021). Membership is voluntary, and participation in these organizations offers nurses opportunities to expand their expertise, influence healthcare policies, and engage with a community of peers.
State boards of nursing, however, maintain a structure that reflects their statutory responsibilities. For example, the Florida Board of Nursing (FBON) is composed of appointed members, including licensed nurses, consumer representatives, and at least one member aged 60 or older. This balance ensures that decisions reflect both professional standards and the interests of the general public (Toney-Butler & Martin, 2021).
Table 1
Comparison of Boards of Nursing and Professional Nurse Associations
| Feature | Board of Nursing (BON) | Professional Nurse Associations |
|---|---|---|
| Primary Function | Regulates nursing practice and protects public safety | Advocates for nurses, supports professional development |
| Authority | Established by state law; empowered through Nurse Practice Act | Functions as a private or non-profit entity |
| Membership | Automatic for licensed nurses; not optional | Voluntary enrollment; dues or fees required |
| Focus Areas | Licensure, discipline, scope-of-practice rules, education program oversight | Continuing education, leadership, networking, policy advocacy |
| Beneficiaries | Public consumers of healthcare | Nursing professionals |
| Examples | State Boards of Nursing (e.g., FBON) | ANA, specialty nursing associations |
Medical Necessity: A Federal Regulation of Healthcare
Medical necessity is a federally guided principle used primarily by Medicare and other insurers to determine whether specific medical services are reasonable, appropriate, and eligible for reimbursement. Medicare defines medically necessary services as those essential for diagnosing, treating, or managing a medical condition, including restoring or improving bodily function (CMS, 2021; Verhovshek, 2019). This regulatory requirement plays a crucial role in shaping clinical decision-making, influencing the services patients can access, the timing of care delivery, and the level of financial coverage available.
While medical necessity criteria promote consistency and help reduce misuse or unnecessary healthcare spending, they can also introduce barriers. Healthcare providers may face delays due to prior authorizations, extensive documentation requests, or rigid criteria that must be met before approval. These processes ensure evidence-based practice but may inadvertently contribute to treatment delays, administrative burden, and patient frustration. Nonetheless, adherence remains essential to ensure equitable, accountable, and high-quality care across federal healthcare programs.
Regulation of Registered Nurses and Advanced Practice Nurse Practitioners in Florida
The practice of Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs) in Florida is governed by the Florida Nurse Practice Act, which outlines expectations for safe, ethical, and competent care. RNs must complete an approved nursing education program and pass the NCLEX-RN to demonstrate fundamental clinical competency. Their licensure must be renewed biennially, accompanied by mandatory continuing education requirements aimed at maintaining up-to-date knowledge and professional accountability (Florida Board of Nursing, 2022).
APRNs undergo a more advanced regulatory pathway due to their expanded clinical roles. They must first hold an RN license, then obtain a graduate degree—typically a master’s or doctoral degree—from an accredited program. Additionally, APRNs must earn national board certification in their specialty area. Florida law requires APRNs who wish to practice independently to complete 3,000 hours of supervised clinical experience under a collaborative practice agreement before being eligible for autonomous practice status (Florida Board of Nursing, 2022). These layered regulatory requirements ensure that APRNs possess the advanced clinical reasoning, diagnostic skills, and specialized competencies necessary for independent and safe practice.
Impact of Advanced Practice Nurse Practitioners on Healthcare Delivery, Costs, and Access
Advanced Practice Registered Nurses (APRNs) are instrumental in improving healthcare accessibility, particularly in states such as Florida where growth in the older adult population and physician shortages heighten the need for expanded care models. APRNs deliver comprehensive care—diagnosing conditions, prescribing medications, and managing chronic diseases—thereby addressing gaps in primary care and meeting the needs of underserved and rural populations (Cleveland et al., 2019).
APRNs also contribute significantly to cost-effective healthcare delivery. Research indicates that care provided by APRNs is of comparable quality to that provided by physicians, often at a lower overall cost. Their involvement helps reduce unnecessary emergency department visits, shorten wait times, and increase preventive care uptake. These advantages are particularly important in Florida, where chronic disease prevalence and long-term care needs continue to escalate. By maximizing APRN autonomy and integrating them fully into healthcare teams, states can enhance service efficiency, reduce system-wide costs, and ensure sustained high-quality outcomes for diverse patient populations.
References
American Nurses Association. (2021). American Nurses Association. https://www.nursingworld.org/ana/
Cleveland, K., Motter, T., & Smith, Y. (2019). Affordable care: Harnessing the power of nurses. OJIN: The Online Journal of Issues in Nursing, 24(2). https://doi.org/10.3912/ojin.vol24no02man02
Centers for Medicare & Medicaid Services. (2021). CMS. https://www.cms.gov/
Florida Board of Nursing. (2022). Licensing and registration. https://floridasnursing.gov/licensing/
National Council of State Boards of Nursing. (2022). Nursing regulation. https://www.ncsbn.org/boards.htm
PA003 Regulation
Short, N. M., & Loversidge, J. M. (2019). Government response: Regulation. In Health policy and politics: A nurse’s guide (6th ed., pp. 56–84). Jones & Bartlett Learning.
Toney-Butler, T. J., & Martin, R. L. (2021). Florida Nurse Practice Act laws and rules. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532859/
Verhovshek, J. V. J. (2019). Medical necessity: Why it matters, ways to demonstrate it. AAPC Knowledge Center. https://www.aapc.com/blog/46500-medical-necessity-why-it-matters-ways-to-demonstrate-it/