In response to a growing and changing healthcare industry, nursing roles and responsibilities must also evolve to meet clinical demands. Without rules that establish standards of care in such a dynamic environment, it can be challenging to regulate treatment quality. That's why each state is held responsible for enacting its own laws to specify rulemaking authority and govern nursing practice. In Maryland, this legislation is known as the Maryland Nurse Practice Act.
How does the nurse practice act (NPA) impact nursing professionals and the facilities where they work? Here, we summarize the specific rules outlined in the Maryland NPA, outline key laws that affect a clinician's daily practice, and provide tips for Maryland healthcare leaders looking to promote safe nursing care and regulatory compliance within their facility.
What Is the Maryland Nurse Practice Act?
LPNs, RNs, and APRNs practicing in Maryland are required to follow certain guidelines under the Maryland state nurse practice act. While most state NPA laws contain similar content regarding regulatory functioning and licensure requirements, each state works independently to develop unique nursing scopes of practice and rules for delegation. In Maryland, this legislation influences the nursing profession by:
- Establishing Maryland Board of Nursing rules and regulations.
- Outlining requirements for Maryland nursing education programs.
- Setting minimum care standards that must be met.
- Regulating the maintenance and renewal of a Maryland nursing license.
- Clarifying and setting penalties for NPA violations.
The Maryland Nursing Practice Act: Laws at a Glance
Providing safe patient care requires a thorough understanding of Maryland nursing practice laws. While most clinicians and administrators are familiarized with the NPA during nursing school or employee onboarding, many aren't aware of the intricacies of the laws or the potential penalties for violations.
To ensure you fully understand Maryland's specific nursing rules and regulations, we break down some of the key elements of the state's NPA in the table below.
| Maryland Nursing Practice Act | |
|---|---|
| Legal Authorities | Maryland Annotated Code, Health Occupations, Title 8:Sections 8.101-8.802Code of Maryland Regulations (COMAR), Title 10:Chapters01.01-27.04 |
| Maryland State Nursing Licensure Requirements | MarylandRN licensure applicantsmust qualify by either passing the NCLEX examination or getting a license endorsed from another state.Steps forNCLEX Exam Qualification:Graduate from an MD approved or accreditednursing education program.Submit anapplicationwith the appropriate fees.Complete acriminal history record check.Register for and pass theNCLEX examination.Steps forEndorsement Qualification:Graduate from a Maryland BON-approved nursing education program and submit verified transcripts.Pass theNCLEX examination.Complete a background check and Live Scanfingerprint scan.Present a valid license to practice nursing in another state.Submit a license application with the appropriate fees.Note:The board may grant atemporary RN licenseto practice for up to 90 days while their permanent license is processing and under legal review. If the applicant holds a current multistate (compact) license, they don’t require a temporary license, but instead can practice on their multistate license until their permanent license is approved.The Maryland Board of Nursing website also provides approximate timeframes for application processing and outlines the required steps torenew a nursing license. |
| Maryland Nurse Practice Act Delegation of Duties | Nursing professionalsare allowed to delegatewhen:The individual is competent to perform the act or task.The assignment doesn’t jeopardize the client’s welfare.The act is within the individual’s scope of practice.The individual has the skills, knowledge, and clinical competency to perform the act.The act is consistent with the facility’s policies and procedures.The nurse is able to instruct, direct, and evaluate the performance of the nursing task.Note:The nurse must rectify a situation where an unlicensed individual is performing the task incorrectly, or must prohibit the continued performance if the unlicensed individual is performing incompetently.Nursing professionalsare prohibited from delegatingtasks such as:Duties requiring nursing triage.Intraoperative nursing tasks (identifying emerging situations, administering medications, gathering resuscitative equipment, planning postoperative care, documenting timely records).Tasks that require a nursing assessment or diagnosis.Case management tasks.The supervision of RNs, other LPNs, or unlicensed personnel. |
| Penalties | Under COMAR10.27.18.04, the following are considered violations of the law under the Nurse Practice Act:The following offenses can be subject to penalties between $100 and $1,000:Falsifying records or other documentsPracticing nursing after failing to renew a licenseProviding professional services while under the influence of alcohol, narcotics, or another controlled substanceFailing to report suspected child abuseDiscriminating against an individual who is HIV positiveViolation of probationThe following offenses can be subject to penalties between $5,000 and $5,000:Committing licensure fraudPerforming an act where willful or actual harm resultsActing negligently with actual or potential harm to the publicKnowingly abusing a patient and causing harmRepeat offenses |
| Nurse Licensure Compact (NLC) State? | Marylandisinvolved in theNLC compact. Therefore, the Maryland Nurse Practice Act encompassesrules and guidelinesestablished by the NLC. |
Promoting Safe Nursing Practice: 3 Strategies for Facilities
By following the laws set forth in the Nurse Practice Act, Maryland healthcare facility leaders can protect their staff and ensure patients receive the best possible care. Here are three tips to keep your nursing team practicing safely and effectively.
1. Partner With a Legal Team to Develop Facility Policies
It's important to make sure your organization's policies and procedures fall in line with state nursing laws. Collaborate with a legal team when drafting these documents to help your clinicians stay compliant with state regulations. This protects your facility and its employees from accidental misconduct and subsequent monetary penalties.
2. Conduct Compliance Audits
Even if your facility's policies mandate safe and appropriate care, treatment isn't always provided within the rules and confines you've specified. Increased patient acuity and short staffing levels may pressure clinicians into practicing outside of their legal scope, putting themselves — and your organization — at risk.
The best way to prevent this from happening is through the completion of compliance audits. You can do this by:
- Rounding on clinical units.
- Performing care assessments.
- Discussing challenges and barriers to safe care with staff members.
- Distributing employee feedback tools like surveys and questionnaires.
- Reviewing task documentation in the EMR.
3. Provide an NPA Continuing Education (CE) Course
Empowering your nurses with the knowledge to safely manage their own professional practice boosts engagement and care quality. Create a Maryland Nurse Practice Act CE course that provides them with information on Maryland's nursing scope of practice, rules for delegation, and risks associated with violations of NPA law.
Looking for More Ways to Stay Compliant?
Understanding the laws outlined in the Maryland Nurse Practice Act is the first step in providing safe, appropriate nursing care. Follow along in our newsletter for our latest free practice insights on how to boost staff engagement, improve health outcomes, and maintain regulatory compliance at your facility.
Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.