Nurse Practice Act (NPA)
The purpose of the NPA is to protect the public by assuring safe and competent nurses. Only licensed nurses have the legal, formal authority to practice nursing and to delegate nursing care. The NPA defines nursing practice and is the legal foundation for the practice of nursing in Massachusetts. There are clarifying definitions for the practice of registered nurses and the practice of licensed practical nurses issued in the form of regulation and promulgated by the Massachusetts Board of Registration in Nursing. These definitions are written in broad language that allows for evolving changes in nursing practice. It is important that each nurse understand the legal definition of the practice of nursing since it forms the basis for individual nursing practice in the Commonwealth of Massachusetts.
When a license is issued, the nurse accepts the responsibility and accountability to be a safe, competent practitioner. The nurse must have a clear understanding of his/her own competencies and communicate them to coworkers and supervisors.
The authority of the NPA is specific to the practice of the individual nurse. (Mass General Law (MGL ) and Chapter 112 §74-81C). The NPA authorizes the Board to regulate nursing practice and education (MGL) but does not extend that authority to employment practices, staffing patterns, or employer/employee issues.
Regulations-Code of Massachusetts Regulations (CMR)
Specifics related to the legal practice of nursing are determined by the Board of Registration in Nursing (BORN), and communicated through regulations and advisory rulings. Regulations explain the law and provide a process for implementation. Regulations hold the force of law. Nurses must be familiar and comply with all of the regulations promulgated by the Board. There are several regulations that are specific to nursing practice and provide guidance when accepting, rejecting and delegating a work assignment.
Standards of Practice (244 CMR 2:02 9:02 )(Board of Registration in Nursing)
The Standards of Practice describe nursing competence as:
- understanding policies and procedures of the employing institution
- assuring that delegation of a nursing act to a licensed or unlicensed person can be done safely
- remaining knowledgeable about current nursing procedures
- obtaining the necessary training before accepting a nursing responsibility that one does not have the knowledge to implement.
Delegation of Nursing Functions
The Massachusetts Board of Nursing regulation governing Delegation of Nursing Functions (244 CMR: 3.05) gives nurses the authority to delegate certain nursing activities to unlicensed individuals. However, the regulations specify that the nurse will determine the degree of oversight required after an evaluation of appropriate factors [244 CMR: 3.05(3)] and the activities to be delegated [244 CMR: 3.05(4)]. The delegating registered nurse shall bear full and ultimate responsibility for delegation of nursing practice activities [244 CMR: 3.02] Working beyond competencies or failure to maintain generally accepted standards of practice places the nurse at risk for disciplinary action by the Board. The Board is authorized to take action against nurses who fail to perform in a manner that ensures safe nursing practice. [MGL Chapter 112, § 61] Behavior and activities that could be the basis of disciplinary action by the Board include but are not limited to:
- Practicing beyond the scope permitted by the NPA [244 CMR: 9.00]
- Accepting a work assignment that the nurse is not competent to perform and/or failing to perform it competently.
- Failing to exercise oversight over individuals to whom the nurse has delegated nursing functions [244 CMR: 3.05(3)].
- Abandoning or neglecting a patient. [244 CMR: 9.03(15)]
Failure to report patient abuse; practice of nursing while impaired by substance abuse; diversion of controlled substances by licensed nurse. [244 CMR: 9.03(26)]
Following an investigation of a complaint against a nurse’s practice, the board is empowered to take action. (see glossary for BORN definition of complaints) Each disciplinary action is reported to the National Council of State Boards of Nursing where it is available for review by regulation to all member boards; such listings are also sent to employers of nurses in the Commonwealth of Massachusetts.
The Board issues advisory rulings and opinions to define or clarify the scope of nursing practice. The Board acts on an individual’s request and the ruling is specific to the circumstances as described in the request. Rulings are based on an extensive study of the situation. Following review of the information that has been gathered, the Board determines that a specific activity or procedure is within the scope of practice of the nurse, not within the scope of practice, or within the designated nurse’s scope if certain conditions are met. Any rulings that set conditions may require specialized training and education, site requirements, and/or supervision requirements. Nurses should be knowledgeable about these rulings because they may be helpful in making a decision about accepting or rejecting a request to perform nursing activities.