Transcript Presentation Title

Nurse Licensure Compact
Lessons Learned
Joey Ridenour
Arizona State Board of Nursing
Marcia Hobbs
Board Member/Kentucky Board of Nursing
Joan Bouchard
Oregon Board of Nursing
Factors influencing a new look at
regulation developed early 1900’s
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Expedient access to qualified nurses is needed &
expected by the public – especially during natural
disasters such a Katrina. Texas Board of Nursing
processed 400-500 applications in 3-4 days; Florida
Board processed approximately 200 for Charlie.
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Expedient authorization to practice is expected by
employers & nurses
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Having to demonstrate the same licensure
qualifications to multiple states for comparable
authority to practice is cumbersome, inefficient and
not cost effective
State Based Regulatory Challenges
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New practice modalities & technology created
issues of compliance with state licensure laws
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Practice is not bound by state lines when call
centers & triage systems render care whereby
some nurses hold 20 or more licenses
Policy Goal
Simplify governmental processes
and remove regulatory barriers
to increase access to safe
nursing care.
Models Considered
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Reciprocity
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Fast endorsement
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Corporate credentialing (institutional
licensure)
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Canadian Models
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Limited License for Telehealth
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Mutual Recognition
Mutual Recognition
A state based license,
nationally recognized
& locally enforced.
Different Terms –Same Concept
Mutual
Recognition
Multistate Licensure
Interstate Practice
What is the Mutual Recognition
Model?
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Nurse Licensure Compact (NLC) is one of approximately
200 current compacts.
Nurse Licensure Allows a Nurse to have One License in
State of Residency & practice physically or electronically
in other compact or party states
Nurse is subject to each state’s practice laws & discipline
Concept is not new – thousands of nurses working in
federal facilities practice on the basis of being licensed in
one state.
Lesson: Nurses do not always want to “give up” the first
state of licensure & need advance notice regarding the
change .
What is an interstate compact?

Agreement between two or more states established for
the purpose of remedying a particular problem or
multistate concern. (Black’s Law Dictionary)
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NLC allows states to regulate cross border issues in a
manner that preserves the national interests without
federal intervention or preemption.
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NLC may be amended by all party states agreeing to &
then changing individual state laws

Lesson: The legislation to enact the NLC must “mirror”
language in all party states. Legislation materially
different has resulted in states not be able to join the
NLC.
What is meant by the multistate
licensure privilege?
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Multistate licensure privilege means the
authority to practice in any compact party
state.
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Lesson: Human Resource staff need non
technical explanations of the compact
requirements. Does not take away the
responsibility that employers must validate
the nurse is licensed in the home state
declared by the applicant.
What determines primary state of
residence?
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NLC defines primary or home state in the
compact rules & regulations.
Sources to verify a nurse’s primary residence
may include: driver’s license, federal income
tax return or voter registration.
Lesson: Nurse’s accepting employment in a
party state (not declaring a new primary state)
many times complete the new application &
pay the fee. An adjustment period may be
needed where fees are refundable.
Why was residency (not practice
location) determine the jurisdiction?
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The policy decision was made specifically to enhance
public protection while retaining state based authority
and reducing the administrative burden
Determining the state of practice would have been
difficult in an era of multiple employers, at multiples
sites across state lines & through telenursing
Tracking a nurse in the event of a complaint is better
accomplished through residence that the employment
link
Lesson: The traditional nurse licensure system was
built upon state of practice starting in 1903 & takes time
for the link to now be state of residence.
Why is an individual in the NLC
limited to one license?
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Reduces the barriers to interstate practice
Improves tracking for disciplinary purposes
Promotes cost effectiveness & simplicity for the
licensee
Acts as an unduplicated listing of nurses for planning
for disaster preparedness
Lesson: The message needs to be framed in many
different ways for nurses, employers, recruiters: One
license per each license type – RN or LPN/LVN- and no
more is permitted by the state of residency.
Does the NLC reduce the state’s
licensure requirements?
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Under the NLC, states continue to have complete
authority in determining licensure requirements &
disciplinary actions based on the state’s Nurse
Practice Act
The Nurse Licensure Compact Administrators have
carefully studied the various state licensing
requirements & agreed upon core requirements that
all party states are to enact
Lesson: The NLCA will at some future point also
need to consider core requirements for discipline
based on evidence on “best practices” that protect
the public from unsafe practitioners.
How does the NLC address
varying scopes of practice?
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The nurse is held accountable for complying
with the state laws/regulations at the time
patient care is rendered.
Accountability is similar to driver’s license
model (driver’s license compact) where one
must obey the laws while driving in that state
Lesson: All nurses need to know the state’s
scope of practice as this is not unique to the
NLC.
Does the NLC affect the primary
state’s authority to discipline?
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The NLC actually enhances the state’s ability
to discipline through exchange of disciplinary
investigations & information to better
determine the appropriate course of action in
disciplinary cases.
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Lesson: Consider assigning specific
investigative staff to the NLC complaint cases
to gain experience in learning how to expedite
& share case information.
How are disciplinary violations
reported in the NLC?
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Complaints in a nonresident compact state are processed
and reported to the home state.
The party state may issue a cease & desist order for the
nurse & the home state may take disciplinary action against
the license.
Some party states choose to investigate the complaint in
the state the incident occurred and transfer the information
to the home state so the information is taken only once.
Lesson: NCSBN/NLC is planning to host an investigator
conference to provide networking to explore how to
improve the investigative processes.
Licensure/Discipline Information -NURSYS®
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A comprehensive information system with
data on all nurses
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Historically used for discipline &
verification
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Complete system
activated 1/1/2000
How is the NLC administered?
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A separate body composed of participating
state board administrators in charge of the
state’s compact operations is called the
Nurse Licensure Compact Administrators
(NLCA)
Lesson: Need to anticipate & include current
NLCA fee of $2,000 year in budgeting process.
Are Advanced Practice Registered
Nurses included in the NLC?
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APRN’s have a separate APRN Compact model
legislation and implementation guidelines. APRN’s
were not included in the NLC because of the wide
variability in the regulation of advanced practice
that needed to be considered.
A state must be operational under the NLC before
entering the APRN Compact.
Lesson: Need to consider an RN application
process that allows for recognition of RN License
in party state for APRN compact licensure.
APRN Compact Implemented
Two States
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Utah & Iowa
State Law
APRN Compact
ARNP Compact Challenges
 Less Uniformity
 Categories vary
 Many titles
 Prescriptive Authority Varies
 Relationship with Medicine Varies
APRN Compact Provisions
 Scope of Practice – Consistent with the
State where Practicing
 State Based Prescriptive Authority
Required for
 Controlled Substances Certificate
 DEA numbers
How is the NLC implemented?
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In order for a state to join the NLC, state legislators
must enact the interstate compact into state law or
regulation. NCSBN drafted an outline entitled
Strategies for Implementation of the Mutual
Recognition Model of Nursing Regulation in 1997.
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Lesson: The legislative champion for the NLC may
need to be reminded that the legislation must be
identical or mirror the legislation in the other states or
the compact will may not be recognized by the party
states.
Lessons Learned
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Cross- state licensure is a broader issue than
issues related to nursing.
Legislative negotiations for the NLC often run
an arduous & long course.
Study of time frame for enacting 65 compacts
in 1960’s was approximately 5 years.
The very purpose of the NLC is to provide for
allocation of governing authority between
states which does not allow for individualism
in passing dissimilar enactments.
Enacted Compact States
www.ncsbn.org
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Arizona
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New Mexico
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Arkansas
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North Carolina
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Delaware
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North Dakota
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Idaho
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South Dakota
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Iowa
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Tennessee
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Maine
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Texas
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Maryland
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Utah
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Mississippi
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Virginia
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Nebraska
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Wisconsin
Status of Additional States
Awaiting Implementation
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New Jersey
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New Hampshire (Revised Language Signed)
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South Carolina (Signed 5/26/2005)
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Will address revising compact language 2006:
Indiana
Nurse Licensure Compact Implementation
The following tables and map indicate which states have enacted the RN and LPN/VN Nurse Licensure Compact. Please note that although New
Jersey and New Hampshire have enacted the Nurse Licensure Compact, these states have not yet implemented the compact. On April 25, 2005, the
states of Iowa and Utah agreed to mutually recognize APRN licenses. No date has been set for the implementation of the APRN Compact.
Last Updated: [ August 11, 2005]
Nurse Licensure Compact Map
NLC Supporters
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American Organization of Nurse
Executives (AONE)
ATA & Red Cross (formal letters pending)
Staffing & Travel Nurse agencies/registries
Occupational Health Nurses
Nephrology Nurses
Telehealth Community
Citizen Advocacy Center (CAC)
State hospital associations
NLC Non Supporters
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ANA & some state nursing associations
Unions
Compact Information
website:
http://www.ncsbn.org
Nurse Licensure Compact (section)
[email protected] or 312.525.3665
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