Scope of practice in Florida: what MAs, LPNs, APRNs and PAs may do

What is the LPN scope of practice in Florida?

Section 464.003(18) defines the practice of practical nursing as “the performance of selected acts, including the administration of treatments and medications, in the care of the ill, injured, or infirm”; “the promotion of wellness, maintenance of health, and prevention of illness of others under the direction of a registered nurse, a licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed dentist”; and teaching general principles of health and wellness. A practical nurse “is responsible and accountable for making decisions that are based upon the individual’s educational preparation and experience in nursing.”

How does practical nurse scope of practice differ from RN scope?

Professional nursing includes “The observation, assessment, nursing diagnosis, planning, intervention, and evaluation of care,” giving medications and treatments “as prescribed or authorized by a duly licensed practitioner,” and “The supervision and teaching of other personnel” (s. 464.003(19)).

Under Rule 64B9-14.003, neither an RN nor an LPN may delegate to aides anything outside their own scope; “The initial nursing assessment or any subsequent assessments”; nursing diagnosis or interpreting assessments; setting care goals and the plan of care; evaluating progress against the plan; or a task the aide has not shown competence in. A delegation must state the task, expected outcome, limits of authority, time frame and supervision, and “total nursing care responsibility remains with the qualified nurse” (Rule 64B9-14.002(3)–(4)).

What is the licensed practical nurse scope of practice for IV therapy?

An LPN needs two things before giving IV therapy (Rule 64B9-12.005):

• a post-graduation course of “not less than a thirty (30) hour” length from a Board-approved continuing education provider;
• supervised clinical practice, verified by “a signed statement of a licensed registered nurse.” Central and PICC lines add at least four hours of instruction and an RN’s proficiency statement kept in the personnel file.

Even then, unless under the direct supervision of a registered nurse or other health care practitioner, an IV-certified LPN may not initiate blood or blood products, initiate or administer cancer chemotherapy, initiate plasma expanders, or initiate or administer investigational drugs (Rule 64B9-12.003). Without the course, an LPN may only adjust flow rates, observe and report adverse reactions, inspect the site, change the dressing, remove a peripheral needle or catheter and hang hydrating fluids (Rule 64B9-12.004(2)).

What is the medical assistant (MA or CMA) scope of practice in Florida?

Florida has no medical assistant license; s. 458.3485 lists the duties:

“Under the direct supervision and responsibility of a licensed physician, a medical assistant may undertake the following duties:”

• vital signs, aseptic procedures, preparing patients, “venipunctures and nonintravenous injections,” and reporting signs or symptoms;
• first aid, assisting with examinations or treatments, operating office medical equipment, and basic laboratory procedures;
• collecting routine laboratory specimens and giving medication, each “as directed by the physician”;
• office work, including general administrative duties, and dialysis procedures, including home dialysis.

Intravenous injections are not on the list. Section 458.347(4)(j) says “A physician assistant may supervise medical assistants as defined in this chapter.” Whether an APRN may supervise medical assistants is a question for your healthcare attorney. The “certified medical assistant” (CMA) designation takes certification from a program accredited by the National Commission for Certifying Agencies, a national or state medical association, or an entity the board approves (s. 458.3485(3)).

What is the nurse practitioner scope of practice in Florida?

Florida’s APRNs are certified nurse midwives, certified nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists and psychiatric nurses (s. 464.003(3)). The default is a protocol: an APRN works “within the framework of an established protocol that must be maintained on site” at each practice location (s. 464.012(3)). Within it, an APRN may prescribe, dispense, administer or order any drug (a controlled substance only with a master’s or doctoral degree in a clinical nursing specialty), initiate appropriate therapies, and order diagnostic tests and physical and occupational therapy. A certified nurse practitioner may also manage selected medical problems, initiate, monitor or alter therapies for certain uncomplicated acute illnesses, monitor and manage patients with stable chronic diseases, and “Establish behavioral problems and diagnosis and make treatment recommendations” (s. 464.012(4)(a)).

The exception is autonomous practice, defined as practice not subject to “supervision by a physician or a supervisory protocol” (s. 464.003(5)); see the last question below. Billing: NP and PA credentialing.

How does a physician assistant’s role compare with nurse practitioners scope of practice?

A PA works by delegation, not protocol. Supervision means “responsible supervision and control,” with the physician’s “easy availability or physical presence,” and easy availability “includes the ability to communicate by way of telecommunication” (s. 458.347(1)(g)). The physician may delegate only tasks within the physician’s own scope, the PA may work in any setting within it, and every task the PA performs must be documented in the medical record (Rule 64B8-30.012(1), (3)). One physician may supervise no more than 10 PAs at a time (s. 458.347(3)).

PAs prescribe only by delegation, after the physician notifies DOH on its form. Schedule II is limited to a 7-day supply, or 14 days for psychiatric mental health drugs for patients under 18, and then only under a pediatrician, family practice or internal medicine physician or psychiatrist (s. 458.347(4)(e)–(f)).

For APRNs and PAs at an office other than the physician’s primary practice location, without a supervising physician on site, a primary care physician may supervise no more than four such offices, a specialist two, and a mainly dermatologic or aesthetic skin care practice one (within 25 miles or a contiguous county). Each office posts the hours the physician is there. For an APRN protocol, the physician also notifies the Board of Medicine within 30 days of entering into or ending it (s. 458.348(1), (3)).

Who may do what in a Florida practice, role by role?

Source: the statutes and rules cited above, read Oct 20, 2026.

How does Medicare’s incident-to rule treat state scope of practice?

Medicare covers staff work incident to a practitioner’s services when “auxiliary personnel” furnish it and meet “any applicable requirements to provide incident to services, including licensure, imposed by the State.” Supervision must generally be direct (general for behavioral health services), and only the supervising practitioner may bill (42 CFR 410.26(a)(1), (b)(5)). How each text words “direct supervision”:

• Medicare: the practitioner is “present in the office suite and immediately available,” or, for most services, available by real-time audio and video (42 CFR 410.32(b)(3)(ii)).
• Nursing delegation: the supervisor “is on the premises but not necessarily immediately physically present” (Rule 64B9-14.001(10)).
• Basic X-ray machine operators: supervision that “requires the physical presence of the licensed practitioner” (s. 468.301(7)).
• Medical assistants: s. 458.3485 uses “direct supervision” without defining it. What it requires in your office is a question for your healthcare attorney.

What you can do today

1. Map every task. List each MA’s, LPN’s, RN’s, PA’s and APRN’s weekly tasks, check them against the table, and take unclear ones to your healthcare attorney.
2. Fill the IV files. For each LPN who starts IV lines: the course certificate and the RN’s signed competency statement (Rule 64B9-12.005).
3. Check protocols. Confirm each APRN’s protocol is on site and its Board of Medicine notice was filed (ss. 464.012(3), 458.348(1)).
4. Count offices. Check each supervising physician’s other offices against the 4, 2 or 1 limit, and post the hours in each (s. 458.348(3)).
5. Verify at hiring. Check licenses on MQA License Verification (how to verify a Florida license), and ask anyone who takes X-rays for the DOH certificate.

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