The Kentucky Nurse Practice Act, found in KRS Chapter 314, is the state law that governs who can practice nursing in Kentucky, what each license level is allowed to do, and how the Kentucky Board of Nursing (KBN) disciplines nurses who break the rules. It applies to registered nurses, licensed practical nurses, and advanced practice registered nurses, and it reaches into licensing, continuing education, prescribing, mandatory reporting, and unlawful practice.
Who Needs a Kentucky License
Every nurse practicing in Kentucky must hold a license from the KBN. RNs apply under KRS 314.041 and LPNs under KRS 314.051. Both routes require graduating from a KBN-approved nursing program with classroom and clinical components, then passing the NCLEX-RN or NCLEX-PN.1Kentucky Board of Nursing. Examination
The KBN application fee is $125 and the NCLEX fee paid to Pearson VUE is $200. Both are nonrefundable. If you fail the NCLEX, you must wait at least 45 days before retesting, and after two unsuccessful attempts on the same application you’ll need to submit a new retest application.1Kentucky Board of Nursing. Examination
KRS 314.103 requires a fingerprint-based criminal background check for every applicant. You must disclose felony convictions, and the KBN weighs the nature of the offense, how long ago it occurred, and evidence of rehabilitation when deciding whether to grant a license.
Endorsement and the Nurse Licensure Compact
A nurse already licensed in another state can apply for Kentucky licensure by endorsement instead of retesting. You verify the existing license, show you meet Kentucky’s education and exam standards, and pass the same background check.
Kentucky is a member of the Nurse Licensure Compact, so a nurse holding a valid multistate license from another compact state can practice in Kentucky on that license without a separate Kentucky credential.2Kentucky Legislative Research Commission. Kentucky Revised Statutes 314.475 – Nurse Licensure Compact The multistate privilege only works while you remain a resident of the state that issued the license. If you make Kentucky your primary residence, you must apply for a Kentucky multistate license within 60 days, and your prior home state license will be deactivated.3NCSBN. Interstate Commission of Nurse Licensure Compact Administrators Adopts New Residency Rule
What Each License Level Can Do
KRS Chapter 314 draws clear lines between RN, LPN, and APRN practice. Practicing outside your authorized scope is grounds for discipline and can expose you to civil liability.
Registered nurses assess patients, develop and implement care plans, administer medications, and delegate appropriate tasks to LPNs and unlicensed assistive personnel. LPNs provide direct patient care under the supervision of an RN or physician, but they cannot independently assess, diagnose, or create treatment plans.
Delegation is where the RN scope carries the most weight. When assigning a task to unlicensed personnel, the RN should consider whether the task requires nursing judgment, whether the results are predictable, and whether the person receiving the task has the training to perform it safely. Tasks that call for repeated clinical assessment or complex decision-making generally shouldn’t be delegated, and the RN remains accountable for the outcome no matter who carries it out.
APRNs work under an expanded scope that includes diagnosing conditions, ordering diagnostic tests, and prescribing medications. Prescribing brings its own set of requirements.
APRN Prescriptive Authority
Before an APRN can prescribe in Kentucky, they must enter into a collaborative agreement with a licensed Kentucky physician in the same or a similar specialty. Non-controlled and legend medications require a Collaborative Agreement for Prescriptive Authority for Non-Scheduled substances (CAPA-NS). Controlled substances require a separate agreement (CAPA-CS).4Kentucky Board of Nursing. APRN Prescriptive Authority
Controlled substance prescribing carries added obligations. Beyond the CAPA-CS, you must hold a DEA registration, maintain a KASPER master account, and upload verification of both to the KBN portal. In your first year of prescribing, you and your collaborating physician must meet at least quarterly to review KASPER reports. In years two through four, those meetings shift to twice a year. Both parties keep written records of each meeting for one year past the CAPA-CS expiration.4Kentucky Board of Nursing. APRN Prescriptive Authority
After four years of prescribing controlled substances under a CAPA-CS with a Kentucky physician, an APRN can apply through the KBN portal for an exemption from the collaborative agreement requirement. The exemption isn’t automatic. You must confirm your DEA registration and KASPER account are current, pay the fee, and be in good standing. APRNs coming into Kentucky by endorsement who have prescribed controlled substances in another state for at least four years may also qualify.4Kentucky Board of Nursing. APRN Prescriptive Authority
Federal law requires any practitioner who prescribes controlled substances to hold a DEA registration. APRNs register on DEA Form 224 for an $888 fee covering three years.5eCFR. Part 1301 – Registration of Manufacturers, Distributors, and Dispensers of Controlled Substances APRNs employed by a hospital or clinic may prescribe under the institution’s DEA registration if the institution authorizes it and assigns a unique internal code. The CAPA-CS requirements still apply either way.
Renewal and Continuing Education
Kentucky nursing licenses renew each year. The renewal window runs from September 15 through midnight on October 31.6Kentucky Board of Nursing. Renewal Miss the deadline and your license expires; you’ll need to go through reinstatement, which costs more and takes longer. The renewal fee is $65 for RNs and LPNs, which includes statutory contributions to the Nursing Incentive Scholarship Fund and the KARE program. APRNs pay an additional $55 per APRN designation.7Kentucky Board of Nursing. Fees for Licensure Applications and Services
Continuing education runs on its own annual cycle. Each earning period runs November 1 through October 31, and you must complete 14 contact hours of approved nursing CE during that window.8Kentucky Board of Nursing. Continuing Education Courses must come from a KBN-approved provider, another state board of nursing, or a recognized national nursing organization.9Justia Regulation. Kentucky Administrative Regulations Title 201 Chapter 20 Section 215 Holding a current national certification or completing a nursing research course for academic credit can also satisfy the requirement.
APRNs with prescriptive authority need an additional five contact hours in pharmacology each period. Two one-time courses are required before your first renewal: a domestic violence recognition course under KRS 194A.540 and an HIV/AIDS course.10Justia Law. Kentucky Revised Statutes 194A.540 – Training Courses for Mental Health Professionals and Others The KBN runs random CE audits, and you must keep your CE documentation for five years.8Kentucky Board of Nursing. Continuing Education
Mandatory Reporting Duties
Kentucky nurses carry several layers of reporting obligations, and the penalties for silence can rival the underlying conduct.
Self-Reporting Other License Actions
Under KRS 314.108, if any professional or business license you hold, from any agency in any state, becomes subject to disciplinary action, you must notify the KBN in writing within 30 days of the final order and include a certified copy plus a letter explaining the circumstances. Applicants must disclose any license ever surrendered under threat of discipline, refused, suspended, or revoked.11Kentucky Legislative Research Commission. Kentucky Revised Statutes 314.108 – Notification of Board if Any Professional or Business License is Terminated or Suspended
Employer Reporting
Under 201 KAR 20:161, employers must report to the KBN when a nurse is terminated or resigns in connection with misconduct, incompetence, or ethical violations. The rule exists so a nurse who quietly leaves one job after a serious incident cannot move to a new employer with a clean-looking record.
Abuse Reporting
KRS 620.030 requires any nurse who knows or has reasonable cause to believe a child is being abused, neglected, or is dependent to report immediately to law enforcement, the Department for Community Based Services, or the relevant prosecutor’s office, with a written follow-up within 48 hours if requested.12Kentucky Legislative Research Commission. Kentucky Revised Statutes 620.030 – Duty to Report Dependency, Neglect, Abuse, Human Trafficking, or Female Genital Mutilation KRS 209.030 requires any person, including nurses, with reasonable cause to suspect abuse, neglect, or exploitation of an adult to report to the Cabinet for Health and Family Services. Failure to report is a criminal offense. Both statutes protect good-faith reporters from retaliation.
HIPAA is not a barrier here. The Privacy Rule permits disclosure of protected health information to government authorities receiving reports of child abuse and neglect and to authorities receiving reports of abuse, neglect, or domestic violence involving adults, and the “minimum necessary” limitation doesn’t apply where a disclosure is required by law.13U.S. Department of Health & Human Services. Summary of the HIPAA Privacy Rule
Discipline: How the Board Acts on Complaints
Complaints against a Kentucky nurse can come from employers, patients, other nurses, or the public. The KBN investigates under KRS 314.091. Common triggers include substance abuse, patient neglect, falsifying records, and unprofessional conduct. If evidence supports it, the Board may offer an agreed order (a negotiated resolution) or move to a formal hearing.14Justia Law. Kentucky Revised Statutes 314.091 – Reprimand, Denial, Limitation, Probation, Revocation, or Suspension of Licenses
Sanctions run from a public reprimand to permanent revocation. Between those, the Board can impose remedial education, probation with conditions, practice limitations, or a fixed-term suspension. Criminal conduct such as drug diversion or patient abuse can bring prosecution on top of Board action. The KBN publishes disciplinary actions in a public database that patients and employers can search.
If you want to challenge a final Board order, you can appeal to circuit court under KRS 13B.140. The appeal must be filed within 30 days of the final order being mailed or personally served, and you must exhaust administrative remedies with the Board first.15Kentucky Legislative Research Commission. Kentucky Revised Statutes 13B.140 – Judicial Review of Final Order
The KARE Program
Kentucky operates the Kentucky Alternative Recovery Effort (KARE), a KBN-administered monitoring program for nurses with substance use disorders. Participants sign a program agreement (a legal contract with the KBN) that sets treatment requirements, random drug screens, and regular check-ins. The minimum commitment is three years, and participants pay their own treatment, testing, and evaluation costs. Violating the agreement means termination from KARE and suspension of your license.16Kentucky Board of Nursing. Kentucky Alternative Recovery Effort (KARE) for Nurses Participant Handbook When it works, it offers a path back to practice that straight discipline wouldn’t.
Federal Consequences That Follow State Discipline
State disciplinary action doesn’t stay at the state level. Two federal systems extend the reach.
The U.S. Department of Health and Human Services Office of Inspector General maintains the List of Excluded Individuals and Entities. If you’re on it, no federal healthcare program, including Medicare and Medicaid, will pay for items or services you furnish, order, or prescribe, and employers who hire someone on the list face civil monetary penalties.17U.S. Department of Health and Human Services, Office of Inspector General. Background Information – Exclusions Some exclusions are mandatory, including convictions for Medicare or Medicaid fraud, patient abuse or neglect, healthcare-related felonies involving fraud or theft, or felonies related to illegally manufacturing or dispensing controlled substances. Others are discretionary, including misdemeanor healthcare fraud, license revocation or surrender for reasons related to professional competence, and false claims to federal programs.
The National Practitioner Data Bank (NPDB) tracks adverse actions against healthcare practitioners nationwide. When the KBN takes formal action against your license, whether revocation, suspension, reprimand, probation, or a voluntary surrender while under investigation, that action is reported to the NPDB.18eCFR. Part 60 – National Practitioner Data Bank Healthcare-related criminal convictions, malpractice payments, and federal exclusions are also reported. Hospitals and licensing boards in other states query the NPDB when credentialing, so a Kentucky action travels with you. You can submit a statement or dispute an inaccurate report, but the report remains visible to queriers during the dispute.
Practicing Without a Valid License
KRS 314.031 makes it illegal to practice nursing in Kentucky without a valid license or to use the titles “RN” or “LPN” without holding the matching credential. It’s also unlawful for an employer to knowingly hire an unlicensed nurse, and violations can bring criminal charges. If your license lapses through a missed renewal, you cannot continue practicing during the gap. Doing so carries the same legal exposure as someone who was never licensed. Reinstatement requires completing the Board’s reinstatement process and paying additional fees before you can return to practice.