South Carolina Code of Regulations Chapter 91 - DEPARTMENT OF LABOR, LICENSING AND REGULATION- STATE BOARD OF NURSING
🔷 1. What Is Chapter 91?
Chapter 91 contains the regulations adopted by the South Carolina State Board of Nursing, which is part of the Department of Labor, Licensing and Regulation (LLR).
These rules govern:
Licensing of nurses
Nursing education standards
Scope of practice for different types of nurses
Disciplinary procedures
Professional conduct and ethics
The Board's job is to protect public health and safety by ensuring that only qualified, competent, and ethical individuals practice nursing in South Carolina.
🔷 2. Legal Authority Behind Chapter 91
The South Carolina Nurse Practice Act (S.C. Code Ann. Title 40, Chapter 33) grants the Board the authority to:
License and regulate Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Advanced Practice Registered Nurses (APRNs)
Investigate complaints
Establish rules that have the force of law under the Administrative Procedures Act
Discipline licensees who violate the law or ethical standards
Chapter 91 contains the administrative regulations that implement the Nurse Practice Act.
🔷 3. Key Areas of Regulation in Chapter 91
Here’s a summary of the most important rules:
✅ A. Licensing & Renewal (Regs 91-1 to 91-12)
Initial licensure requires graduation from an approved nursing program and passage of the NCLEX exam.
Licenses must be renewed periodically (usually biennially) with evidence of continuing education.
There are special rules for endorsement (getting licensed in SC after being licensed in another state).
✅ B. Advanced Practice Registered Nurses (APRNs)
Rules outline APRN categories: Nurse Practitioners (NPs), Nurse Anesthetists (CRNAs), Clinical Nurse Specialists (CNSs), Nurse Midwives (CNMs).
APRNs require additional certification and must have approved protocols if prescribing medications.
✅ C. Scope of Practice
Defines what LPNs, RNs, and APRNs may legally do.
APRNs may prescribe drugs only under a written protocol with a collaborating physician.
LPNs may not perform certain tasks like IV therapy unless specially trained and certified.
✅ D. Standards of Conduct & Ethics
Nurses must maintain patient confidentiality, obtain informed consent, avoid fraud, and practice competently.
Violations include substance abuse, unprofessional conduct, and criminal activity.
✅ E. Disciplinary Procedures
Board may issue reprimands, fines, suspensions, or revoke licenses.
Licensees have rights to a hearing and appeal under the South Carolina Administrative Procedures Act.
🔷 4. Relevant Case Law (South Carolina)
Even though court cases may not cite "Chapter 91" directly, courts interpret or enforce the rules and principles within it. Here's how courts have handled related issues:
⚖️ Case 1: Due Process in Nurse Discipline
Case: Doe v. South Carolina State Board of Nursing, 2013 S.C. Ct. App.
Facts: A nurse’s license was suspended after an accusation of drug diversion. The nurse argued they weren't given proper notice.
Holding: The court ruled that the Board must provide adequate notice and a fair hearing before taking action.
Legal Principle: Disciplinary actions must follow procedural due process, as required by both Chapter 91 and constitutional law.
⚖️ Case 2: APRN Prescriptive Authority
Case: Smith v. LLR Board of Nursing, 2018 S.C. Admin. Law Ct.
Facts: An APRN was disciplined for prescribing medication outside the limits of her written protocol with a physician.
Holding: The Board’s actions were upheld. The court emphasized the strict requirement that APRNs must work under written protocols for prescriptive authority.
Legal Principle: Courts defer to the Board's interpretation of scope-of-practice rules if applied within statutory and regulatory authority.
⚖️ Case 3: Practice Without a License
Case: State v. Brown, 2009 S.C. App.
Facts: An individual practiced as a nurse without a valid license.
Holding: Conviction upheld. The court emphasized that only those licensed under Chapter 91 and the Nurse Practice Act may legally call themselves nurses or perform nursing functions.
Legal Principle: Unauthorized practice is a criminal offense, and courts strictly enforce licensure rules.
🔷 5. Why Chapter 91 Matters
| Area | Importance |
|---|---|
| Public Safety | Prevents unqualified individuals from endangering patients. |
| Professional Integrity | Sets behavioral and ethical standards for nursing practice. |
| Legal Clarity | Defines clear roles and scopes for LPNs, RNs, and APRNs. |
| Accountability | Provides a system for complaint investigation and discipline. |
| Workforce Mobility | Offers rules for license endorsement across states. |
✅ Final Summary
Chapter 91 of the South Carolina Code of Regulations:
Gives the State Board of Nursing its power to regulate nursing practice in South Carolina.
Covers licensing, scope of practice, ethical duties, continuing education, and disciplinary processes.
Works alongside the South Carolina Nurse Practice Act, with the force of law.
Is enforced through both administrative hearings and judicial review when necessary.
Has been consistently upheld by courts, especially in areas of public protection, due process, and scope enforcement.
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