nurse licensure compact council on licensure, enforcement & regulation september 11, 2009 joey...
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Nurse Licensure Compact
Council on Licensure, Enforcement & Regulation
September 11, 2009
Joey Ridenour RN MN FAANExecutive Director
Arizona State Board of NursingNurse Licensure Compact Administrator
Overview Evolution of Nursing Regulation Drivers of New Model of Nursing Regulation Compact Concepts Components of Nurse Licensure Compact (NLC) Compact States APRN Compact Supporters/Non Supporters of NLC Gallup Organization & Insight Research Poll Results
on the NLC June 2006
Nursing Regulation– 106 years ago
First nurse practice act in 1903:
NY, NJ, VA, NC Each State Nurse’s Association established to
pass legislation to ensure training based on standardized program
States wrote own examinations; Arizona Board Members were assigned to bring five questions to a meeting for testing purposes
State Based Standards to National Standards Over Past 100 Years
1903 2009
Factors Influencing Review of Regulation & Licensure – 21st Century
Mergers & acquisitions resulting in large,
integrated health care delivery systems
beyond state borders
Emergence of Call Centers & Telephone
Triage
On line faculty directing students providing
care
Technological Factors (continued)
Technological Advances
National Council State Boards of Nursing (NCSBN)
Definition Telenursing:
Practice of nursing over distance, using electronic means
Telenursing generally results in nurse having:
direct patient contact & directing care
NCSBN Delegate Assembly Actions
1994 – Task Force to Study Regulation
1995 - Telecommunication Task Force to Study Models
1996- Task Force Studies Pro’s/Con’s Models & Impact
1997 - August: Task Force Recommended Mutual Recognition Model
1997 – December: Special Delegate Assembly Meeting Called - Approved Model for Interstate
Compact
Models Studied & Considered
Three Policy Goals:
Mutual Recognition
Panel Legal Experts
Mutual Recognition is workable
Reflects “full faith & credit” among US states/jurisdictions
Can be implemented incrementally
Implementation could begin without uniform requirements
First Compact Adopted 1783
Compacts not new
Nurse Licensure Compact One of 200+ Compacts
(Emergency Management; Child Welfare; Water Resources; Parole)
Average Compacts Per State: 27
Mutual Recognition & Interstate Compact
Black’s Law Dictionary:
Formal agreement between 2 or more states to remedy a problem of mutual concern
Each state enacts the compact through legislation
Affords states the opportunity to develop self regulatory adaptive structure to meet challenges over time
Compact General Purposes
Facilitate State’s responsibility to protect the public’s health & safety
Ensure & encourage cooperation of party states to hold each party state and nurse accountable
Facilitate the exchange of information between states
Promote compliance with laws governing practice of nursing
Key Points of the Interstate Compact
Each State Enacts IDENTICAL Compact
Mutual Recognition of those who enact the legislation
Example - Driver’s License Model
Compacts Are Fully Enforceable Contracts
When enacted, a compact not only constitutes law but a contract which may not be amended, modified or otherwise altered without the consent of all parties
Nurse Licensure Compact Components
Why One License in Primary State of Residence?
Policy decision to enhance public protection while retaining state based authority & reducing administrative burden
Determining state of practice would be challenging in an era of multiple employers, multiple organizational sites beyond borders & through telenursing
Tracking a nurse through primary residence better accomplished than employment link
Jurisdiction
Discipline
Complaint filed where violation occurs Complaints in party state are processed &
reported to home state Significant Investigative Data entered if issues rise
to level of summary suspension Party State May Issue Cease and Desist Orders Discipline
Against license – home state Against privilege to practice – home &
party state Affect on alternative programs
Information Sharing-- NURSYS®
A comprehensive information system with
data on all nurses
Coordinates existing & future nurse
database
Used for verification & discipline
Complete system
activated 1/1/2000
Compact Administration
Authorizes the formation Nurse Licensure Compact Administrators Group (NLCA)
NLCA is separate body in charge of complying with state compact laws & rules & policies
Participation in Compact Administrator’s Meetings every other month & two face to face meetings annually
NCSBN is Secretariat for NLCA “Supra-state” Administrative Agency – neither federal
in nature or state in scope
Enacted Compact States: 24www.ncsbn.org 1.4 million nurses
Arizona
Arkansas
Colorado
Delaware
Idaho
Iowa
Kentucky
Maine
Maryland
Missouri (TBD)
Mississippi
Nebraska
New Hampshire
New Mexico
North Carolina
North Dakota
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Wisconsin
Legislation Attempted
5 States Introduced Legislation That Failed:
WY & MT, NV, IN, PA, MA
Attorney General Opinion:
Nebraska’s AG Opinion reversed
Louisiana recent opinion: cannot
delegate state rights
APRN Compact
Predicated on adoption of :
RN/LPN Compact
Legislated Uniform Core Licensure Requirements
APRN Compact Challenges
Less Uniformity Categories vary Many titles
Prescriptive Authority Differs
APRN Compact Provisions
Scope of Practice – Consistent with the State where Practicing
Prescriptive Authority Controlled Substances Certificate DEA numbers
APRN Compact States
Utah Iowa Texas
Legislated but not enacted
State Law
APRN Compact
NLC Supporters
American Organization of Nurse Executives Emergency Nurses Association Red Cross Staffing & Travel nurse agencies American Association of Occupational Health
Nurses American Nephrology Nurses Association American Telemedicine Association Citizen Advocacy Center State Hospital Associations
NLC Supporters (continued)
Case Management Leadership Coalition Case Management Society of America Center for Telemedicine Telehealth Leadership Coalition US Department of Commerce
NLC Non - Supporters
ANA Some state nursing associations Unions
June 2006 Gallup Research on Nurse Licensure Compact
NLCA positive about collaboration between states in benefiting the public
88% nurses of 800 nurses surveyed supported the NLC
50% of nurses believed their state was part of the compact even though legislation had not been passed
NLCA Major Benefits as Perceived by NLCA Administrators Gallup Research June 2006
Nurses benefited most – particularly traveling nurses
& those practicing telehealth
Nurses have greater flexibility & reduced licensure
fees practicing across state lines
Improved communication & collaboration between
states regarding disciplinary matters
Streamlined licensing procedures & decreased
regulatory barriers
Facilitated hiring process for state employers
Disadvantages Interstate Compacts
Some states experience long negotiations & arduous course before legislative process is successful
Difficult to get state legislatures to adopt compacts that adhere to the substantial sameness between states
Ceding of traditional state authority makes some states reluctant to join the compact
Compact Information
Visit NCSBN website:http://www.ncsbn.org
Nurse Licensure Compact (section)
Jim Puente, NCSBNAssociate [email protected] or 312.525.3665 NLCA Chair: Gloria Damgaard [email protected]
Summary Evolution of Nursing Regulation Drivers of New Model of Nursing Regulation Compact Concepts Components of Nurse Licensure Compact (NLC) Compact States APRN Compact Supporters/Non Supporters of NLC Gallup Organization & Insight Research Poll Results
on the NLC June 2006
QUESTIONS????
& ANSWERS….