Once a year the hospital would have an outside audit at each nursing station. Check utility rooms, pulling charts to see if notes were present. (nursing notes) cleanliness etc. But each hospital has their own policy's for everything up to and including how to give a patient a medication....this can vary from hospital to hospital...Includes what a N A can do, what an LPN can do, and what is the responsibility of RN’s are....Each floor would have a policy book and it was about 4 inches high....But like most things in the government, they were given a weeks notice that an inspector would be spending a day or two at the hospital...Every department went through the inspection... Pharmacy, kitchen, housekeeeping etc...
State boards were responsible to test for being licenced or registered in your choosen occupation..