Overview

1. Nurse Licensure Compact Council on Licensure, Enforcement & RegulationSeptember 11, 2009Joey Ridenour RN MN FAANExecutive Director Arizona State Board of NursingNurse 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

4. State Based Standards to National Standards Over Past 100 Years 1903 2009

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

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 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

9. Models Studied & Considered

10. Three Policy Goals:

11. Mutual Recognition

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

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

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

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. Arizona Arkansas Colorado Delaware Idaho Iowa Kentucky Maine Maryland Missouri (TBD) Mississippi Nebraska Enacted Compact States: 24www.ncsbn.org 1.4 million nurses • 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 • 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 jpuente@ncsbn.org or 312.525.3665 NLCA Chair: Gloria Damgaard Gloria.Damgaard@state.sd.us

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….