Transcript National Council of State Boards of Nursing (NCSBN) 1997

Allied Health Professions and
Licensure Efforts
Can We Go for One National
License?
 NO
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Why Not?
Feds don’t want it
States want to keep it
*Decades of precedent
Licensure is to Protect the Health and
Safety of the Citizens
of the State
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Licensure regulates both the Practice of the
Profession and those who render those defined
services
Must Define Parameters within the Scope of
Practice section
Then must set standards/requirements for those
who will provide that scope of practice
Regulating the Practice
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Professions scope of practice can vary
state to state.
Meet the needs of the citizens: what you
can’t do in CA you could do in Alaska
States, not the feds, set the parameters
what can and cannot be done
Regulating the Practitioners
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Process applications -is it filled out right?
Issue and renew licenses – have they met
the CEs requirements, etc? Is that course
really acceptable for a CE credit?
Disciplinary complaints: must investigate
Provide procedural rights for practitioner
with disciplinary action taken
Collect the fees (States want the $$$)
Nurse Compact
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Comes close to national license for nursessort of…….
License issued in nurses resident state;
can work “off” of license issued in one
state in those states participating in Nurse
Compact
Advocated by National Council of State
Boards of Nursing
Nurses Participating in NC Must
Adhere to all state laws where practicing
between states in relation to licensure /
re-registration requirements, such
as mandatory continuing education,
criminal background checks, disciplinary
causes of action, and evidentiary
standards
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Since 1997 -21 states participate in Nurse
Compact
Requires each state legislature to enact
and change current laws- Not very eager
American Nurses Association: “agrees to
disagree” with details of the complicated
NC process
State by State Effort
What Do You Need to Have in
Place?
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Professional Infrastructure
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Strong State Association
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Strong (Central) National Association
Professional Infrastructure
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Are there enough practitioners to make a
state by state case?
Is there a rationale for patient safety
Licensure is NOT for professional
enhancement or job security
States want to license “professions” not
occupations or disciplines
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Profession= nationwide accredited
education/training programs
Are they educated the same; curricula the
same?
Are there enough schools across the
country?
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Consistent and valid competency test
Are they all tested on the same content?
States will use the professional
competency test as state licensure exam
Cost of developing a state based test is
$50K
Strong State Society
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Will lead the legislative effort
Accept the fact it may take several years
Does the state society have the people,
time, and money?
Leaders in the state will be the “face” of
the profession to the legislators
Will have to convince rank and file to
support licensure efforts
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Need to have the support from other key
licensed professions
Physicians are crucial, so are nurses
Already a powerful, influential factor in
state health policy
Have legislators/policy makers ears
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State hospital associations traditionally
oppose licensing professions
Argument: it will cost more money
No proven evidence to that, but has
impact anyway
Therefore need other professions (docs)
support to offset
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Most state societies are volunteer
Lobbying is not their profession
Licensure effort takes time
Many states if the can afford it hire state a
lobbyist to spearhead effort
Still need cohort of state leaders to carry it
through- Gov’t/Leg Affairs Cmte.
What are the financial resources of the state
society?
Communication System
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Must have a good communication system
in place
Need to let members and supporters know
what is happening and when to make
contact with their legislators
Need to communicate with legislators
Internet vastly makes this easier
Strong National Association
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Act as ringmaster/cheerleader
May act as financier
Develop a Model Practice Act, should use
as a template in every state
Key to that: consistent scope of practice
Clearinghouse for support documents
Advice on what worked elsewhere
Model Licensure Language will
change over time
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Each state is unique
Services provided may differ to some
extent in different states
Interested parties are different with
different agendas
Compromises will be made
State By State Licensure Takes
Time
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Scope of Practice will evolve
RTs licensed in the 1980’s no smoking
cessation, telecommunications, Dx. Mgt.
More focus on alternate site care
patients leave hospital “sicker and
quicker”
New disciplines emerge, overlap of
practice
Respiratory Therapy Experience
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Model Practice Act developed as template
Licensure first began in early ’80s
Currently there are 48 states, DC and PR
that are licensed.
Hawaii and Alaska not yet licensed
Last state to gain licensure was Alabama2004
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Similarities among states:
Licensure requirements: graduates of
accredited schools of RT
Take the national credentialing exam used
as state licensure exam
Majority (but not all) of scope of practice
is the same
Examples of Political Compromise
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Under Medical Direction
Supervision: only by a Doc
Supervision: Doc, Nurse Practitioner, Physician
Assistant (LA revised 2007)
Continuing ed:
3 states none required (UT, CO, WI)
24 biennially in Al, 12 biennially in RI
Compromise
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Scope of practice issues
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ECMO: No way in NJ, absolutely in TX
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Protocols: Can do in most states, only in
an emergency in OH
Compromise
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18 RC “Boards” are under Board of
Medicine
Most fully independent RC Licensure Bds.
Some are Advisory Councils rarely meet,
paid state staff administers and addresses
issues (WA)
Regulatory Agencies
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Depending on the state, some state licensure
boards have sweeping authority to “creatively”
interpret the law
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Others extremely restrained in what they can do
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Just the nature of the state government psyche
The way a state licenses
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States like to follow similar formula
What did they do for other allied health
professions in the state?
License renewal: annual/biennial?
Most now all follow same disciplinary
criteria (liability reasons)
States make revisions that affect all
licensure boards
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Once licensure is gained must be tended
to: new/revised regulations
Advise state societies to fight the urge to
tweak the law, can be a Pandora’s box
Licensure Like a Chess Game
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Get all the pieces on the board before you
make your first move
And have patience