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Ridenour & Santa Anna, 2012, p. 504). Once enacted, rules and regulations have the full force and effect of law. Although the specificity of NPAs varies among states, all NPAs include: ⦁ definitions ⦁ authority, power, and composition of a BON ⦁ educational program standards ⦁ standards and scope of nursing practice ⦁ types of titles and licenses ⦁ protection of titles ⦁ requirements for licensure ⦁ grounds for disciplinary action, other violations, and possible remedies. Definitions For the intent of a law to be useful to legislators and citizens, terms or phrases used in statutes must be clear and unambiguous. Of course, a law does not need to define terms that are commonly understood. However, definitions are often included in laws to avoid uncertainty about the meaning of words. For example, encumbered, reinstatement, and reactivation are often defined in NPAs. An encumbered license is defined as a license with current discipline, conditions, or restrictions. Reinstatement is different from reactivation in that the former refers to reissuance of a license following disciplinary action, whereas the latter is a reissuance not related to disciplinary action (NCSBN, 2012a). Authority, Power, and Composition of a BON The NPA gives authority to regulate the practice of nursing and the enforcement of law to an administrative agency or BON that is charged with maintaining the balance between the rights of the nurse to practice nursing and the responsibility to protect the public health, safety, and welfare of its citizens (Brous, 2012, p. 508). The membership and qualifications of the BON, usually composed of registered nurses (RNs), licensed practical/vocational nurses (LPN/VNs), advanced practice nurses, and members representing the public, are specified by the NPA. Specifics regarding terms of office, meetings, and election of officers are also included. How the membership of the BON is constituted depends on state statute. Some states give the governor authority to appoint members to the BON after reviewing suggestions from professional nursing organizations. Other states require nominations from professional organizations with appointment by the director or head of the regulatory agency. In North Carolina, members of the BON are elected by the general public. In still other states, the legislature appoints public members (Brent, 2012, p. 2). The BON typically hires an executive officer, who has the authority to staff the office with nurses, attorneys, investigators, and administrative staff. Typically, the powers and duties of BONs include: ⦁ hiring BON employees ⦁ making, adopting, amending, repealing, and enforcing rules ⦁ setting nursing education standards ⦁ setting fees for licensure ⦁ performing criminal background checks ⦁ licensing qualified applicants ⦁ maintaining database of licensees ⦁ ensuring continuing competence ⦁ developing nursing standards of practice ⦁ collecting and analyzing data ⦁ implementing discipline process ⦁ regulating unlicensed assistive personnel. Educational Program Standards The BON must set standards for prelicensure nursing educational programs and clinical learning experiences and approve such programs that meet requirements of the NPA. These standards are reflected in the rules that accompany the NPA. The standards for prelicensure programs include accreditation, curriculum specifics, administrator and faculty qualifications, continuing ap- 38 Journal of Nursing Regulation proval, and approval of new, or withdrawal of approved, nursing education programs. Specific curriculum rules often include necessary standards of evidence-based clinical judgment; skill in clinical management; biologic, physical, social, and behavioral science requirements; professional responsibilities; legal and ethical issues; patient safety; and best practices of nursing. Standards and Scope of Nursing Practice One’s nursing care is both directed and measured by the NPA and rules. The standards and scope of nursing practice within an NPA are aligned with the nursing process. For example, comprehensive nursing assessment based on biologic, psychological, and social aspects of the patient’s condition; collaboration with the health care team; patient-centered health care plans, including goals and nursing interventions, can all be language within the NPA. Further standards include decision making and critical thinking in the execution of independent nursing strategies, provision of care as ordered or prescribed by authorized health care providers, evaluation of interventions, development of teaching plans, delegation of nursing intervention, and advocacy for the patient. Rules are often more specific than the act. The NPA may require safe practice, whereas the rules may specify a plan for safe practice, requiring orientation and training for competence when encountering new equipment and technology or unfamiliar care situations; communication and consultation with other health team members regarding patient concerns and special needs, status, or changes; response or lack of response to interventions; and significant changes in patient condition (NCSBN, 2012a, 2012b). The NPA typically identifies delegating and assigning nursing interventions to implement the plan of care as within an RN’s scope of practice (NCSBN, 2012a). The rules, however,
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