The Maryland Nurse Practice Act, found in Title 8 of the Health Occupations Article, is the statute that governs every registered nurse, licensed practical nurse, and advanced practice registered nurse in the state. It sets who can be licensed, what each type of nurse is allowed to do, how licenses are renewed, and what the Maryland Board of Nursing can do when a nurse violates the rules. If you hold a Maryland nursing license or want one, this is the law that controls your career.
Getting Licensed in Maryland
There are two main routes to a Maryland nursing license: examination and endorsement.
The examination route is for new graduates. RN candidates need a diploma or degree from a Board-approved registered nursing program. LPN candidates need a high school diploma or equivalent plus completion of a Board-approved practical nursing program.1Legal Information Institute (LII) / Cornell Law School. Maryland Code Regs. 10.27.01.05 – Qualifications of Applicants After that comes the NCLEX, the national licensing exam.
Before you apply, you must complete a criminal history records check through the Criminal Justice Information System. Fingerprinting is done through CJIS, and the fee is paid there, separately from the Board’s application fee. Once your fingerprints are taken, you have 48 hours to submit your application to the Board.2Maryland Department of Health. NCLEX-RN Application Instructions Miss that window and you start over.
Fees changed on July 1, 2025. The examination fee is now $187 for both RN and LPN candidates, and a temporary license is $70.3Maryland Department of Health. 2025 Nurse Fee Schedule Update All fees are nonrefundable and nontransferable.
If you are already licensed in another state, you can apply by endorsement instead of retaking the NCLEX. The steps have to happen in order:
- Confirm your nursing program is on the Board’s approved list. If it is not, your program’s dean or director must complete an assessment tool so the Board can evaluate equivalency.
- Have official nursing school transcripts emailed to the Board directly from a digital credentialing service. The Board will not accept transcripts sent by the applicant.
- Complete CJIS fingerprinting and submit the application within 48 hours.
- Have your original state of licensure verified through Nursys.
- Submit a digital passport-style photograph, your CJIS tracking number, and proof of an active license elsewhere.4Maryland Department of Health. Licensure by Endorsement
Nurses who trained outside the United States have added steps, including a transcript evaluation through TruMerit (formerly CGFNS) and an English proficiency exam such as the TOEFL, IELTS, or PTE. The endorsement fee under the current schedule is $230.
The Board publicly lists nursing programs whose education it will not accept. Graduates of those programs cannot be licensed in Maryland regardless of the route.5Maryland Department of Health. Un-Approved Out of State Nursing Education Programs
Multistate Practice Under the Compact
Maryland has been part of the enhanced Nurse Licensure Compact since January 19, 2018.6Maryland Department of Health. Nurse Licensure Compact If your home state is Maryland and you hold a multistate license, you can practice in any other compact state without applying for a separate license there. That matters for nurses near state lines, travel nurses, and anyone doing telehealth across state borders.
Maryland has to be your primary state of residence to hold the multistate credential. Acceptable proof includes a Maryland driver’s license, Maryland voter registration, or a federal tax return filed with a Maryland address. If you move permanently to another compact state, your Maryland multistate license becomes invalid and you have to license in the new state. If your home state is not a compact member, you can still get a Maryland single-state license, but it only works in Maryland.
The Compact does not override local practice law. When you treat a patient in another state, that state’s nursing regulations govern the encounter, and discipline imposed by any compact state can affect your multistate privilege everywhere.
Advanced Practice Certification
Nurse practitioners, certified nurse midwives, certified registered nurse anesthetists, and clinical nurse specialists all fall under the APRN certification track. The requirements sit on top of your RN license: you need an active Maryland RN license or a multistate RN privilege under the Compact, graduation from an accredited graduate-level APRN program, and a passing score on a national certification exam recognized by the Board. A criminal history records check is required, same as for initial RN and LPN licensure.7New York Codes, Rules and Regulations. Maryland Health Occupations Code 8-302.1
There is one requirement for new nurse practitioners that surprises people. If you have never held nurse practitioner certification from any board of nursing, your application must name a mentor who will consult and collaborate with you for 18 months starting from the date the Board receives your application. This is a transitional requirement, not a permanent collaborative agreement. After the 18 months, you practice in accordance with the standards of the American Association of Nurse Practitioners or another national certifying body recognized by the Board.
APRNs who prescribe controlled substances also need a separate DEA registration with its own application and renewal cycle, handled by the federal Drug Enforcement Administration rather than the state Board.
What the Act Requires You to Do in Practice
The Act defines separate scopes for RNs and LPNs. RNs handle assessment, care planning, and delegation. LPNs work under direction within a narrower range of tasks. Practicing outside your scope is a legal violation, not just an employer issue. When you delegate to unlicensed personnel, you stay responsible for making sure the person is trained and the task is appropriate for delegation.
Care has to meet current evidence-based standards. Meeting the bar that existed when you graduated is not enough; the Board expects ongoing self-assessment and further training when you know your competence in a particular area is thin.
Documentation and communication generate more complaints than almost anything else. You have to chart accurately, report changes in a patient’s condition promptly, and obtain informed consent before procedures. Failing to document a medication error or a shift in vital signs is the type of lapse that reaches the Board. Patient confidentiality is treated the same way, reinforcing federal privacy law, and unauthorized disclosure of health information is a disciplinary matter.
The Act also draws a hard line between nursing and the practice of medicine. Diagnosing conditions, prescribing without prescriptive authority, or performing procedures reserved for physicians can bring both Board discipline and criminal exposure for practicing medicine without a license. This is where most scope complaints come from, especially in high-acuity settings.
Patient Abandonment
Abandonment happens when a nurse who has accepted responsibility for a patient walks away without ensuring another qualified provider takes over. Resigning from a job is not abandonment. Leaving patients already in your care mid-shift is. The Board can suspend a license for it.
How the Board Disciplines Nurses
The Board opens investigations based on complaints from employers, patients, other nurses, or law enforcement, and it can also act on what it finds during audits or in reports from other state boards. Grounds for discipline under Health Occupations § 8-316 include fraud in obtaining a license, incompetence, negligence, substance abuse, patient abuse, conviction of a felony or a crime involving moral turpitude, and practicing beyond the authorized scope.8Maryland General Assembly. Maryland Health Occupations Code Title 8 Section 8-316 – Denials, Reprimands, Probations, Suspensions, and Revocations
The Board can deny, suspend, or revoke a license, issue a reprimand, or place a licensee on probation. It can also impose fines of up to $5,000 per violation. The regulatory schedule breaks fines down by conduct:
- Probation violations: $100 per violation.
- Fraud, out-of-state discipline, or felony conviction: $1,000 to $5,000.
- Willful scope-of-practice violations with actual harm: $500 to $5,000.
- Negligent scope-of-practice violations with potential harm only: $500 to $2,000.
- Patient abuse without harm: up to $1,000 per violation.
- Patient abuse with harm: up to $5,000 per violation.
- Repeat offenses: double the applicable range, capped at $5,000.9Library of Maryland. COMAR 10.27.18.04 – Imposition of Penalties on Licensees
Hearings and Appeals
Before the Board can suspend or revoke a license, it has to hold a formal hearing. Notice goes out by certified mail to your last known address at least 30 days in advance. You can respond to the allegations, present evidence, and have an attorney represent you.10Maryland Board of Nursing. Frequently Asked Questions – Discipline If the Board rules against you, you can seek judicial review by petitioning the Circuit Court. Maryland case law requires that petition to be filed promptly after the final order; nurses who wait can lose the right to appeal. The court reviews the administrative record and can affirm, reverse, or remand.
Alternative to Discipline for Substance Use
Nurses dealing with a substance use disorder can enter an alternative-to-discipline pathway. The program removes the nurse from practice during treatment, requires demonstrated sobriety, and stays confidential. A nurse who completes it can keep their license without a public disciplinary record.
Renewing Your License
Maryland licenses renew every two years. You need 30 continuing education units during the two-year period immediately before your renewal date, taken through Board-approved providers on topics relevant to your practice.11Maryland Division of State Documents. COMAR 10.27.01.13 – Renewal of License The Board audits at random, so keep your completion certificates.
Failing an audit is not a paperwork nuisance. If you cannot document the 30 CEUs, the Board can move your license to inactive status or open a disciplinary case. You cannot backfill the credits after the fact; the regulation requires them to have been earned within the two years before you applied to renew.
Renewal fees under the schedule effective July 1, 2025:
- Active RN renewal: $191, which includes a $26 Maryland Health Care Commission assessment.
- Active LPN renewal: $165.
- Volunteer RN or LPN renewal: $73.
- Inactive RN or LPN renewal: $60.
The MHCC assessment applies only to active-status RNs and changes annually. LPNs, certified nursing assistants, and medication technicians do not pay it.12Maryland Department of Health. Schedule of Fees Converting an inactive license back to active means paying the difference between the active and inactive fees, plus the MHCC fee for RNs.3Maryland Department of Health. 2025 Nurse Fee Schedule Update
Letting a license lapse entirely is worse than letting it go inactive. Reinstating an expired license means meeting current Board requirements, which may include additional education or re-examination depending on how long the license has been expired, and the reinstatement fee is separate from the standard renewal fee. Wait too long and reinstatement is no longer an option; you would have to apply from scratch as a new licensee.