Multistate Licensure: Who Owns Your Care?
February 3, 2000
in response to The Regulatory Dilemma Surrounding Interstate Practice by Terri Gaffney, MPA, RN (May 31, 1999)
Dear Editor:
"The Regulatory Dilemma Surrounding Interstate Practice" by Terri Gaffney, MPA, RN, brings to light the basics of the outdated, state-based model of licensure regulation versus the advances of healthcare telecommunications. The National Council of State Boards of Nursing has brought the debate on this issue center stage with the endorsement of the Interstate Compact for Mutual Recognition of State Licensure, which is not supported by the American Nurses Association. At question for most nurses is can concern for repercussions of "practicing" across state lines be remedied be by mutual recognition policies. A few states have answered yes, primarily Utah and Arkansas, and as a registered nurse utilizing pediatric telephone triage, I agree with the proposed solution.
Recently on active duty in the U.S. Air Force in Illinois, I used telephone triage to provide advice to family members residing in St. Louis, Missouri, twenty minutes away. My nursing license was from Pennsylvania. The military policy of allowing the registered nurse to be held to the standards of the individual's state of residency compliments the needs of a mobile nursing workforce, and more importantly, mobile patients. One point of dissention is that licensure based on residency does not allow the state of "practice" to determine licensure requirements; therefore, a resident nurse may have different "standards" than the non-resident. Standards of care, the fundamentals, are substantially similar across the United States.
I do not think the number of continuing education credits one state mandates versus another should slow progress. Other concerns range from the lack of confidentiality from information sharing to the speculated higher costs and burdens to the disciplinary process. The bases of these arguments are currently unfounded. Limitations can be placed on information access, there is no documentation of the impact on operational costs, and a nurse would have to face the same disciplinary actions for state of residency and state of practice cases.
With the interstate compact in place, the focus should be on how to make it a successful model for nursing practice and other professions with similar licensure debates. I agree with the author that it is rewarding to have the profession of nursing at the forefront of change, instead of remaining stagnate on policy.
Shannon L. Riedel, RN, BSN
Columbus, OH
