Nursing License Requirements in Indiana
Hospitals, clinics, schools, and nursing homes are just some of the possible work settings for nursing personnel in Indiana. The US Bureau of Labor Statistics reports that in 2018, 30,220 certified nursing assistants (CNAs), 15,480 licensed practical nurses (LPNs) and 67,870 registered nurses (RNs) were employed in the state. The data on the RN group includes clinical nurse specialists (CNSs), who are not counted separately. In addition, Indiana employed 5,540 advanced practice registered nurses (APRNs). This group included 4,780 nurse practitioners (NPs) and 70 certified nurse-midwives (CNMs). Although Indiana recognizes the 690 certified registered nurse anesthetists (CRNAs) who practice in the state, they are not defined as APRNs in the state administrative code.
Each nursing group must meet specific requirements to become licensed or certified in the state of Indiana. The Indiana State Board of Nursing, in collaboration with the Indiana Professional Licensing Agency, is responsible for all licensing activities. The Indiana State Department of Health maintains the Indiana Nurse Registry. Indiana is not a nursing compact state, which allows nurses educated outside the state to practice in Indiana. The application process to become a nursing compact state was submitted in 2019 but was not in effect at the time of this writing.
Certified Nurse Aides
CNA applicants in Indiana must meet both federal and state requirements. The Indiana State Department of Health oversees all nurse aide training and competency evaluation activities. Indiana does not have an age or general education requirements, but the applicant must complete a 105-hour state-approved nurse aide training program and pass both written and skill-based competency examinations. Fees are required for both tests. Applicants have three chances to pass the examinations.
Student nurses currently enrolled in a practical or registered nursing program who have completed fundamentals of nursing course with a grade of “C” or better are eligible to take the CNA examination.
A graduate nurse of either program is also eligible to sit for the examination if he or she has not taken the NCLEX.
An out-of-state CNA who holds a current certificate and is in good standing in another state may sit for the written examination; the skills test is optional.
Indiana also has a class of CNA called qualified medication aides (QMAs). These individuals must complete additional training and pass the nurse aide written competency evaluation. A QMA must work under the direct supervision of an LPN or RN. QMAs must complete six hours of medication-related training each year to maintain certification.
Licensed Practical Nurses
Indiana requires that LPN candidates for initial licensure graduate from an accredited, approved practical nursing program. Candidates who do not have a high school diploma must submit a copy of their GED scores. Candidates who have held other health career-related licenses or certification such as a CNA or EMT certification must submit copies as part of the application process. Fingerprints are required for a criminal background check. LPN candidates must pass the NCLEX-PN examination.
Foreign nursing school graduates who want to become licensed as LPNs in Indiana must submit proof of high school graduation and nursing school transcripts through the Commission on Graduates of Foreign Nursing Schools (CGFNS) Certification Program and pass the CGFNS examination. Those who have held a license in another country must also submit proof of licensure through CGFNS. Holding an RN license in another country does not qualify a candidate to become licensed as an LPN in Indiana. The application process must be completed within one year.
Those seeking RN licensure in Indiana must provide proof of graduation from an approved and accredited registered nursing program (ADN or BSN). Fingerprints are required for a criminal background check, as is a passing score on the NCLEX-RN examination.
Advanced Practice Registered Nurses
Indiana recognizes three advanced practice roles: clinical nurse specialist, nurse practitioner, and nurse-midwife. CRNAs are recognized in Indiana but not defined as advanced practitioners in the state administrative code. In all cases, the candidate must hold an RN license. With the exception of NPs, an APRN must have graduated from an approved and accredited masters or doctorate program. NPs who do not hold at least a master’s credential must be nationally certified. Although in other states an APRN or CRNA must also be certified in his or her specialty, this is not an across-the-board requirement in Indiana. CNMs must also hold a license as a limited midwife and certification from the American Midwifery Certification Board. CNMs, NPs, and CNSs who wish to prescribe must apply for prescriptive authority; they must have at least two semester hours of graduate coursework in pharmacology. Out-of-state-candidates whose qualifying pharmacology coursework was completed more than five years in the past must complete continuing education in pharmacology. Out-of-state practitioners must also provide proof of recent prescriptive experience. APRNs with prescriptive authority are required to have collaborative practice agreements with a physician. APRNs who wish to prescribe controlled substances must also have a Controlled Substances Registration (CSR) and a Federal Drug Enforcement Administration registration. A professional-quality head and shoulder photograph is required for licensure as an APRN. CRNAs are authorized to administer anesthesia but are not required to apply for prescriptive authority. They do not apply to the Indiana Professional Licensing Agency. However, they must have graduated from an approved, accredited master’s or doctoral program and hold national certification in nursing anesthesia.
CNA – A CNA in Indiana must renew his or her certification every two years. There is no fee. Renewal is required to remain active on the Indiana Nurse Aide Registry.
LPN – License renewal is required every two years on 10/31 in even-numbered years. Continuing education is not required but there is a renewal fee.
RNs – License renewal is required on 10/31 of odd-numbered years. Continuing education is not required but there is a renewal fee.
APRNs – must meet the same requirements as RNs. In addition, they must maintain national certification, which does require continuing education. Those with prescriptive authority must complete 30 hours of continuing education with at least eight hours in pharmacology. For those with prescriptive authority for distribution or dispensing a controlled substance, a minimum of two hours of continuing education in the previous two years addressing the topics of opiate prescribing and opioid abuse are required for renewal.
Other Methods of Licensure
Nurses who were previously licensed in Indiana can reactivate a license by submitting a passport-style photo, proof of licensure in another state, documentation on any disciplinary actions and paying necessary fees. A similar method is used for licensure by endorsement. Applicants whose original states of licensure do not verify education for applicants must also provide official documentation of graduation from a state-accredited nursing program. Transcripts must be submitted directly to the ISBN from the school. A criminal background check is also required. Nurses licensed in multiple states or territories must submit proof of licensure in each state/territory.
Requirements for foreign-educated nurses are the same as those above. In addition, the applicant must submit an official copy of a high school diploma or equivalent and official nursing school transcripts through the Commission on Graduates of Foreign Nursing Schools (CGFNS). Canadian nurses must also provide proof that they passed one of three examinations: the National Council Licensing Examination (NCLEX), the State Board Test Pool Examination (SBTPE) or the English version of the Canadian Nurses Examination (CNATS). Applications must be completed within one year.
Criminal History Reports
Applicants for initial licensure are required to submit to a criminal background check. A conviction will not necessarily preclude licensure – it depends on such factors as the type of charges, the time that has lapsed since the conviction and whether a sentence or rehabilitation was completed by the applicant. Once licensed, nurses are required to report new criminal convictions within 90 days. Dismissed cases must also be reported. Expunged cases have been removed from the record and reporting is not required.
The ISBN, like all nursing boards, is required to protect the public from unsafe practitioners. Applicants who are applying for renewal must report whether they have been disciplined in another state, had a nursing license revoked or been convicted of, pled guilty to or offered a plea of nolo contendere to any offense, misdemeanor, or felony in any state. In addition, the board will respond to complaints against a nurse by investigating and holding an administrative hearing. Among the possible causes for disciplinary action are theft, substance abuse, malpractice, patient abandonment, abuse, murder, sexual or child abuse and other types of unethical, unprofessional or dishonorable conduct. Once the investigation is completed, the ISBN will take such actions as revoking or suspending a license. Factors the Board considers are the severity of the offense, mitigating factors and/or the completion of a rehabilitation program.
Scope of Practice
Indiana determines what each class of nursing professional may do in relation to patient care and management. CNAs have the most narrow scope of practice while APRNs have a very broad scope of practice. Nurses’ tasks include those of the group below them.
CNAs are direct bedside caregivers who must work under the direction of a licensed nurse. They perform hygiene tasks and administer such treatments as basic dressing changes, enemas, and compresses. Those who are qualified medication aides may also administer respiratory therapy and medications by all routes, including intravenously, under the direct supervision of an RN or LPN.
LPNs must also work under the supervision of a physician or registered nurse. They typically work in long-term care facilities and home care. Indiana does not have specific language defining the scope of practice for LPNs; they may perform tasks they have been trained to do and that are allowed by the organization in which they work in.
RNs are considered independent practitioners and do not need direct supervision. They are responsible for more complex tasks such as assessment, evaluation, and care planning, dialysis, and the supervision of and delegation to other members of the health care team.
APRNs, as the highest level of nursing practitioner, perform most functions once reserved for doctors, with the exception of surgery. An APRN with prescriptive authority may prescribe medications, including controlled substances. Other functions depend on the practitioner's specialty. CRNAs administer anesthesia; CNMs provide prenatal, obstetric and gynecological services and NPs provide primary care to adults and children.
Resources for more information:
- Indiana State Board of Nursing - Administrative Code
- National Association of Clinical Nurse Specialists Census
- STATUTORY/REGULATORY NURSE ANESTHETIST RECOGNITION
- Number of Certified Nurse-Midwives (CNM) / Certified Midwives (CM) by State
- Indiana Center for Nursing
- Medication Aide / Technician Categories By State