Legal and Regulatory Foundations

In the United States, nursing law is state-based. Each state has a Nurse Practice Act that establishes the nursing regulatory framework, and the state board of nursing issues rules that explain how that law is applied. There is no single national nursing license, and an employer cannot create authority that state law does not provide. A facility policy may be more restrictive than the law, but it cannot expand the nurse's legal scope. The practical-nurse role is generally titled LPN or VN in the United States. “RPN” refers to Registered Practical Nurse in Ontario and to Registered Psychiatric Nurse in several western Canadian jurisdictions; it is not the usual US license title and should not be treated as interchangeable with LPN/VN. At the bedside, legal reasoning begins before the task begins. The experienced nurse asks, “Am I authorized to do this for this patient, in this setting, under these conditions?” A familiar procedure is not automatically a permitted procedure. A provider's request is not a substitute for a license, competence, or a state-authorized scope of practice. Legal accountability also follows...