In each state of the United States, there is a specific Nurse Practice Act that addresses the scope and standard of practice of nurses. Each state has a Board of Registered Nurses that governs the Nurse Practice Act, they set up rules and regulations. When these rules and regulations become established its as if they are law. (Green, 2018)

In my great state of California, the Board of Registered Nurses (BRN) consists of nine members, four members are from the general public and five are registered nurses. The five nurses have a diverse background: patient care, nursing administration, nursing education and there is one advanced practice nurse. The California BRN is responsible for implementation and enforcement of the Nursing Practice Act: the laws related to nursing education, licensure, practice, and discipline. This is designed primarily to protect the patient, not the nurse. The BRN protects patients by setting educational standards, approving California nursing programs and evaluating licensure applicants.

This has had a direct impact on the environment I work in and my practice as a nurse. The Conscious Sedation Section 2725(b)(2) of the Nursing Practice Act of California stipulates the RN providing conscious sedation will have no other role.(Conscious Sedation, 1995) In the Cathlab environment at my hospital, prior to this NPA, the RN providing conscious sedation was also the circulator in the room. The RN was expected to administer Versed and Fentanyl to sedate patients while retrieving supplies and performing other duties: sponge accounting and point of care testing. As a result of this NPA and its impact on patient safety, there are now two RN’s present in the Cathlab during procedures when conscious sedation is utilized. It also changed the matrix of the call team. There are now four people on call for emergencies, two of the call team members are RN’s. As someone who has worked in emergent situations as the only RN, I can say this is a HUGE improvement for patient safety. I applaud the California BRN and this NPA, they really do have patient safety at the forefront. Sedated patients and a potential compromised airway deserve undivided attention from an RN. This is just one example of how the standard of practice in California has been positively influenced by this governing body.

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