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Where is Nursing in Alabama Headed?

The Alabama Center for Nursing (a division of the Alabama Board of Nursing) warns of a shortage of nurses in Alabama that is going to get much worse in the next few years. Older nurses are retiring in higher numbers just as the overall population ages and requires even more nurses to handle the workload. These facts are well known and have become predictable.

Scope of practice

The Alabama Board of Nursing continues to add to the responsibilities and duties that LPNs can legally perform. This will probably increase, with more specific procedures added, both by way of Declaratory Rulings for individual institutions and general changes to the Administrative Code. As it stands now, there is no definitive list of tasks that nurses of any education level can perform, and the ABN website states: “The Alabama Nurse Practice Act and the Alabama Board of Nursing’s Administrative Code are written broadly so that they can apply to nursing practice in any setting.”

Pressure to have healthcare available in an environment short of nurses will probably lead to an expansion of allowed activities for nurses at all levels.

Organizational structure

Changes in the flow of authority have occurred and will continue to do so. Scarcity will require an even more pyramid shaped structure with fewer hands-on tasks being performed by more highly-trained (and harder to hire) RN’s and broader distribution of authority.

This is similar to the declaration of death by an LPN with a doctor’s telephonic communication without an actual physical exam by the doctor. Such delegation of authority for nursing functions currently extends to unlicensed personnel if the tasks do not require using independent nursing judgment. This leaves open a large territory subject to interpretation that will likely be leveraged. The Alabama Board of Nursing will be pressured to lift restrictions and will have to walk a narrow path between less than ideal care and no care at all.


Shortages in nursing staff will continue the trend of larger patient loads and increase the chances of error. It’s unlikely that patients will become less litigious. More errors will result in more suits and malpractice claims. Nurses should have their own policies to protect them, above and beyond any institutional malpractice insurance.

Shifts in treatment

It’s hard to imagine patients getting discharged earlier, but there may be some room to maneuver. Home care will probably remain an attractive option for insurance companies and understaffed hospitals. Nurses will probably take on an even larger role as gatekeepers and valued consultants. The bottleneck for nursing overall is the length of time required to educate and turn out a working nurse. Salaries may rise enough that home-care workers as adjunct ‘nursing staff’ may become a viable career option with minimal formal education and quick on-the-job training. It remains to be seen how permissive the Board of Nursing will be when it is no longer possible to meet the patient care load with nursing resources evaporating nationwide.

Our attorneys at Kreps Law Firm, LLC stand ready, willing, and able to help you and defend your Alabama Board of Nursing matter and your criminal charges, if any have been filed. You should not attempt to navigate the administrative hearing process without an attorney. Our initial consultation is confidential and free. Don’t wait! Call us today to discuss your Alabama Board of Nursing matter (866) 348-2889.

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