Nursing license in Puerto Rico: categories and board exam

It is not one license: there are five different categories

In Puerto Rico nursing is governed by **Act 254-2015, the «Act to Regulate the Practice of Nursing in Puerto Rico»**, which repealed the old Act 9 of 1987 and created a new Board of Nurse Examiners.

The first thing to understand before enrolling anywhere: the statute does not speak of «the nursing license». Its **Article 2(e)** defines **categories**, each with its own academic preparation, its own license and its own scope of practice. From least to most preparation:

The difference between them is not about prestige: it is about **what you may legally do** and **who has to be supervising you**. Picking the wrong category when you enroll is the expensive mistake, because the degree you study is what sets the license you can aspire to.

• **Practical nurse**, practical nursing diploma from an authorized institution. Art. 2(g).
• **Associate nurse**, associate degree in nursing. Art. 2(f).
• **Generalist nurse**, bachelor's degree in nursing. Art. 2(e)(3).
• **Specialist nurse**, generalist license plus a specialty. Art. 2(e)(2).
• **Advanced practice nurse**, master's or doctorate with core courses in advanced pathophysiology, physical assessment and pharmacology. Art. 2(e)(1).

Who supervises whom, per the statute

This is the part almost nobody explains and the one that decides your day-to-day on the floor. The statute sets limits in both directions: downward it says whom you may direct, upward it says whose boss you may not be.

The fine detail of functions is set by the Board in its Regulation, which the statute references under every category. What lives in the statute itself is the skeleton, and the skeleton is this:

• **The practical nurse may work only under the direction** of advanced practice, specialist, generalist or associate nurses, or of physicians and dentists authorized to practice. Art. 2(g).
• **The associate nurse shall refrain** from supervisory and senior roles in administration, education and nursing services, and works by contract only under the direction of generalists, specialists or advanced practice nurses. Art. 2(f).
• **The generalist directs** the care given by the associate and practical categories, and **may delegate** parts of the care plan. Art. 2(e)(3).
• **The generalist shall refrain from supervising or directing** nurses holding a master's or doctorate in nursing. It is written that way, in the statute itself. Art. 2(e)(3), item 7.
• **Generalists, specialists and advanced practice nurses may function independently** and hold private practice by contract with agencies or individuals. Arts. 2(e)(1), 2(e)(2) and 2(e)(3).

What the Board requires to admit you to the exam

**Article 14** is the one that sets the list. To apply for a license you must submit to the Board:

Once the Board admits you to the exam, you pay the fee the Board sets **by category** (the amount is set by regulation, not by the statute) and you sit the board exam matching that category.

Two details that save time. The **criminal record certificate is part of the initial file**, not something requested later; start it early. And that same Article 14 says the **Board recognizes NCLEX-RN and NCLEX-LPN** from the National Council of State Boards of Nursing as acceptable standardized tests **for endorsement** in the corresponding categories.

• **Official certification** that you completed the requirements of a nursing program from an institution authorized or recognized by Puerto Rico's Council on Education or by federal accrediting agencies and by the Board, matching your level of preparation.
• **Criminal record certificate.**
• **Any other documents** the Board deems appropriate to require.

The provisional license: one year, four attempts, once only

This is the mechanism most people use and fewest people understand. **Article 17** describes it in full and is worth reading slowly, because it has four rules with teeth.

**Who is entitled:** anyone admitted **for the first time** to the exam in the **practical, associate and generalist** categories. It does not appear for the specialist or advanced practice categories.

**How long it lasts:** it is issued **for one year only**. Within that year you are obligated to sit the exam **up to four attempts**.

**The trap in the attempts:** if the exam is offered and you do not show up, **that counts as one of the four**. Not showing up is not neutral.

**How you work under it:** every nurse with a provisional license works **under the direct supervision of a generalist nurse holding a permanent license**. It is not a license to practice on your own.

**And it is once in a lifetime:** whoever applies for the exam for the first time is entitled to the provisional license **that one time only**, even if they later apply for a board exam in a different category. If you switch categories later, no provisional license covers you.

You may sit the exam as often as needed, but from the fifth it changes

There is a widespread fear that the board exam «closes» after a certain number of failures. **Article 16, item 8** says otherwise: the candidate **may sit the exams indefinitely**.

What does change is the requirement. **Upon failing the fifth attempt**, on the next exam application and every one after, you must submit to the Board **evidence of having attended and passed a board-exam review course** at a professional organization previously approved by the Board. The Board **may also require re-education** in certain competencies, theoretical or practical, based on the results of those five attempts.

Do not confuse this with the provisional license: the four attempts in Article 17 are the ones that fit **within the provisional license year**. Once those four are spent without passing, the provisional license **is automatically cancelled**, but the right to keep sitting the exam does not end there.

And if you already hold an associate-degree license and want the generalist one, **item 11 of that same Article 16** says how: submit evidence of having completed a **bachelor's degree in nursing** at an institution accredited by Puerto Rico's Council on Education and the Board.

If you hold a license from another state or country

**Article 15** covers anyone already authorized to practice in any U.S. state or territory, in the District of Columbia, or in a foreign country.

The general rule is that they **must sit the Board's exam or have passed the NCLEX** for the category applied for, and meet the other requirements of the statute and the regulation.

But the same article opens a door: **the Board may issue a license without examination** to someone holding a license from a U.S. state, possession or territory or from the District of Columbia **who evidences having passed the NCLEX** for the category applied for, or who comes from a state with which the Board has established **reciprocity**.

Note the difference in treatment: for a **foreign country** the statute does not mention that no-exam route. Fees are set by the Board through regulation, by category.

Advanced practice: national certification and a mandatory policy

**Article 18** provides that to practice as an advanced practice nurse you must submit written evidence of having completed the specialty studies **and pass the Board's exam**, or **instead** present evidence of having passed the national certification exam of the **ANCC**, the **AANP**, the **AANA** or another organization with national certifications recognized by Puerto Rico's Council on Higher Education or by CHEA. The Board states the specialty on the license it issues.

There is a requirement that does not show up in brochures and that can cost you your license: **Article 2(e)(1)** requires the advanced practice category to carry **adequate malpractice insurance coverage**, and **Article 13(a)(8)** makes it a crime to practice in that category **without the policy in force** with the coverage the Board sets.

For those already practicing before this statute, **Article 23** protects vested rights: the Board issues an advanced practice license **without examination** to anyone showing that, when the statute took effect, they already held national certification and a license as an anesthetist, nurse-midwife or nurse practitioner.

Every three years: the recertification people let lapse

**Article 21(a)** is short and admits no interpretation: everyone licensed to practice nursing in Puerto Rico **recertifies their license every three (3) years**, under the Board's regulation.

And there is a second, separate filing that is forgotten even more often. **Article 21(b)** requires every nurse to comply with the application to the **Health Professionals Registry of the Department of Health**, under Articles 1 et seq. of Act 11 of 1976. These are two different things: recertifying the license before the Board, and registering with the Department of Health.

Letting it lapse is not a cheap oversight. **Article 22(a)** provides a **late recertification surcharge** set by the Office for the Regulation and Certification of Health Professionals, attached to the Department of Health. But the serious part is what follows: anyone who **keeps practicing without having met the registration requirements** is deemed to be **practicing the profession illegally**, and is subject to disciplinary action including **fines of up to ten thousand (10,000) dollars per act**, license suspension for the term the Board sets, and possible **referral to the Department of Justice** for criminal proceedings.

Practicing without a license is a crime, and the employer answers too

**Article 13(a)** makes several acts a **misdemeanor**, punished with a **fine of no less than $500 and no more than $5,000**, or **imprisonment of 30 days to 6 months**, or both, at the Court's discretion. On a repeat offense the fine rises to **$1,000–$10,000** and imprisonment to 3–6 months.

Two of those acts deserve underlining, because they change the conversation with an employer:

The rest of the article covers selling or forging degrees and diplomas, using another person's documents, practicing under a false name or someone else's license, passing oneself off as a nurse without a license, and swearing falsely on an application for an exam, license, renewal or recertification. And **Article 13(c)** separately punishes anyone who circulates, sells, buys or trades exam content before it is administered: a fine of **$1,000 to $10,000**, imprisonment of 60 days to 3 months, and **immediate and permanent revocation** of the license if the convicted person is a professional licensed by the Board.

• **Practicing nursing without a valid license**, and the statute clarifies that **each day of violation counts as a separate violation**. Art. 13(a)(1).
• **Knowingly employing, aiding or inducing** an unlicensed person to practice nursing. That crime is not the employee's: it belongs to **whoever employs them**. Art. 13(a)(2).

What this statute does not cover: CNA, HHA and the three exceptions

This has to be said plainly because it is one of the most common searches: **Act 254-2015 does not create a category of «nursing assistant» (CNA) or home health aide (HHA)**. Its categories are the five above, and none of them is that. If someone offers you a CNA or HHA course promising you «the Nursing Board license», that promise does not come from this statute. We do not publish CNA or HHA requirements here because **we have not been able to verify them in an official source**, and we would rather say so than invent them.

What the statute does provide is three situations in which giving nursing assistance **is not prohibited** even without a Board license. **Article 24(a)** lists them:

In those three cases the statute also says that **holding malpractice insurance beforehand shall not be a requirement**.

• **Mass disasters or catastrophic events.**
• **Practice by nursing students** from schools or programs authorized by Puerto Rico accrediting bodies.
• **Persons authorized to practice in the United States who are employees of a federal agency, bureau or division**, while in the official performance of their duties.