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Nurse Licensure Compact Council on Licensure, Enforcement & Regulation September 11, 2009 Joey Ridenour RN MN FAAN Executive Director Arizona State Board.

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Presentation on theme: "Nurse Licensure Compact Council on Licensure, Enforcement & Regulation September 11, 2009 Joey Ridenour RN MN FAAN Executive Director Arizona State Board."— Presentation transcript:

1 Nurse Licensure Compact Council on Licensure, Enforcement & Regulation September 11, 2009 Joey Ridenour RN MN FAAN Executive Director Arizona State Board of Nursing Nurse Licensure Compact Administrator

2 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

3 Nursing Regulation– 106 years ago First nurse practice act in 1903: NY, NJ, VA, NC Each State Nurses 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

4 State Based Standards to National Standards Over Past 100 Years Nursing Programs Nationally Accredited National Council Licensure Exam NCLEX State Boards Similar in Roles/Functions

5 Factors Influencing Review of Regulation & Licensure – 21 st 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

6 Technological Factors (continued) Technological Advances Computers & Interactive Video Cell Phones Video/Tele Conferencing Telehealth electronic diagnostic technologies & robotics

7 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

8 NCSBN Delegate Assembly Actions 1994 – Task Force to Study Regulation Telecommunication Task Force to Study Models Task Force Studies Pros/Cons Models & Impact August: Task Force Recommended Mutual Recognition Model 1997 – December: Special Delegate Assembly Meeting Called - Approved Model for Interstate Compact

9 Models Studied & Considered Mutual Recognition Fast Endorsement Reciprocity Institutional/ Corporate Credentialing Limited License for Tele health Canadian Models

10 Three Policy Goals: Increase access to safe nursing care Simplify Governmental Processes Remove Regulatory Barriers

11 Mutual Recognition State Based License Nationally Recognized Locally Enforced

12 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

13 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

14 Mutual Recognition & Interstate Compact Blacks 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

15 Compact General Purposes Facilitate States responsibility to protect the publics 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

16 Key Points of the Interstate Compact Each State Enacts IDENTICAL Compact Mutual Recognition of those who enact the legislation Example - Drivers License Model

17 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

18 Nurse Licensure Compact Components Compact Administration Discipline Information Sharing Jurisdiction

19 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

20 Connecting Concepts Nurse Declares Primary/Home State of Residence Nurse Holds One License Nurse Has Multistate Privilege to Practice Other Party States Nurse Subject to NPA in State Practicing Jurisdiction

21 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

22 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

23 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 Administrators 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

24 Enacted Compact States: 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

25 Legislation Attempted 5 States Introduced Legislation That Failed: WY & MT, NV, IN, PA, MA Attorney General Opinion: Nebraskas AG Opinion reversed Louisiana recent opinion: cannot delegate state rights

26 APRN Compact Predicated on adoption of : RN/LPN Compact Legislated Uniform Core Licensure Requirements

27 APRN Compact Challenges Less Uniformity Categories vary Many titles Prescriptive Authority Differs

28 APRN Compact Provisions Scope of Practice – Consistent with the State where Practicing Prescriptive Authority Controlled Substances Certificate DEA numbers

29 APRN Compact States Utah Iowa Texas Legislated but not enacted State Law APRN Compact

30 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

31 NLC Supporters (continued) Case Management Leadership Coalition Case Management Society of America Center for Telemedicine Telehealth Leadership Coalition US Department of Commerce

32 NLC Non - Supporters ANA Some state nursing associations Unions

33 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

34 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

35 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

36 Compact Information Visit NCSBN website: Nurse Licensure Compact (section) Jim Puente, NCSBN Associate NLCA or NLCA Chair: Gloria Damgaard

37 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

38 QUESTIONS???? & ANSWERS….


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