1. Nurse Licensure Compact Council on Licensure, Enforcement & Regulation September 11, 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 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
First world series in 1903, Wright brothers took flight, Ford motor company was founded, telephone has been around for 27 years, computer was still a vision for 45 years later or 1946

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 – 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

6. Technological Factors (continued)
Technological Advances
Computers & Interactive Video
Cell Phones
Conferencing
Video/Tele
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 Pro’s/Con’s 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. Simplify Governmental Processes
Three Policy Goals:
Increase access to safe nursing care
Simplify Governmental Processes
Remove Regulatory Barriers

11. Nationally Recognized
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
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

15. 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

16. Key Points of the Interstate Compact
Each State Enacts IDENTICAL Compact
Mutual Recognition of those who enact the legislation
Example - Driver’s License Model
An interstate compact is a contract or agreement between two or more states established for the purpose of remedying a particular problem of multistate concern.
Implementation requires enactment of an identical compact by each state legislature. So the only states that can mutually recognize each other's licenses are those that enact the legislation to do so.
There are a number of interstate compacts out there. One in particular that we are all familiar with is the driver's license compact. The reason you can use your driver's license to drive your car from one state to another and that license is legal in the other state is that there is in place a driver's license compact that allows it. Each state sets it's own requirements for what you have to do to get a driver's license and the driver is responsible for knowing and must obey the laws in the state where he or she is driving. If you break the law, you are charged in the state where the incident occurred.

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. Jurisdiction 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

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 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

24. Enacted Compact States: 24 www.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

25. 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

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 State Law
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: http://www.ncsbn.org
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….