Key Words: Interstate practice, Interstate compact legislation, Multistate licensure
Examination of interstate nursing practice by the National Council of State Boards of Nursing (NCSBN), the American Nurses Association (ANA), specialty organizations and state legislatures has resulted from three major influences:
- the rapid growth of the telehealth/telemedicine;
- the expansion of multistate healthcare systems; and
- the increased mobility of registered nurses.
The present licensure model requires nurses to be licensed in each state in which they practice. Multistate Licensure, a system of Licensure in which one license allows a nurse to practice in multiple states, has been proposed by various groups to address the above influences. An interstate compact, a contract or agreement between 2 or more states to remedy a problem of multistate concern, has been advocated as a mechanism to address interstate nursing practice. An Interstate Compact on Nursing Licensure would be identical legislation between 2 or more states to coordinate nurse licensure activities. Changes in the licensure system will affect all 2.4 million registered nurses in the U.S. A brief look at the historical background leading up to individual state's adoption of compact legislation is instructive.
Multistate Licensure is not a new concept; it has been discussed for years. The term for the overall goal and approach of multistate licensure is the mutual recognition model for nursing regulation. However, formal policy statements and legislation are recent developments. The NCSBN elevated their 2 year discussion of multistate licensure to a policy issue by approving the concept of implementation of multistate licensure for RNs at the Delegate Assembly in August, 1997. The Nurse Multistate Licensure Mutual Recognition Model was adopted by the NCSBN. A special NCSBN Delegate Assembly met in December, 1997, and approved legislative compact language. The 1998 Delegate Assembly adopted the outcome of implementation of the Mutual Recognition Master Plan and reaffirmed the NCSBN's commitment to continue dialogue with professional and consumer groups about concerns related to compact language. Utah was the first state to adopt the NCSBN compact language and enacted S.B. 146: Nursing Regulation '” Interstate Compact. The act takes effect Jan. 1, 2000. This legislative column hyperlinks to the text of the bill since this bill will likely serve as a prototype for other states. Other states are actively involved in moving multistate licensure forward. Over 20 states attended a NCSBN legislative strategies meeting in the summer of 1998 to help states develop a process to effectively pursue multistate regulation. States expressing an interest in adopting a compact in 1999 or 2000 include: Alaska, Arkansas, Arizona, Delaware, Idaho, Iowa, Massachusetts, Maryland, Mississippi, Minnesota, Montana, Nebraska, North Carolina, New Jersey, Nevada, South Dakota, Texas, Tennessee, Wisconsin and Puerto Rico.
The ANA and National Association of Pediatric Nurse Practitioner Associates and Practitioners, (NAPNAP), separately commissioned legal memorandums related to the NCSBN Compact language. NAPNAP sent a letter detailing their "grave concerns" with the proposed NCSBN multistate licensure compact language to the governors and attorney generals in every state in April, 1998. This column hyperlinks to one such letter. The NCSBN responded to NAPNAP's letters by sending all of the governors and attorney generals a letter, hyperlinked to this column, to "set the record straight and urge you to support the adoption of the compact in your state," in May 1998.
ANA's legal analysis of the proposed NCSBN multistate licensure compact was made public in June, 1998. A summary of the legal opinion contains numerous issues. The June, 1998 ANA House of Delegates adopted a resolution dealing with interstate practice which identifies the guiding criteria needed in interstate compacts. The ANA Board of Directors subsequently developed a position statement on the nurse licensure compact in February, 1999, which addresses "grave concerns" about the current Nurse Licensure Compact. Collaboration has occurred during Fall, 1998, and Winter, 1999, between the NCSBN, ANA, specialty organizations, state boards of nursing and state nurses associations to address concerns about the interstate compact language. New language has been proposed related to:
- release of "current significant investigative information;
- deletion of immunity to a non governmental entity;
- extension of authority for states to recoup the costs of investigations and prosecutions. The authority should be sought by states that don't currently have the authority to recover costs in enabling language of the compact; and
- establishing a "compact evaluation initiative."
Despite these language changes, there is still lack of consensus about multistate licensure and compact language.
All of the original documents can be accessed at this website by clicking on the name of the document, so that the reader can make a personal judgment about policy and legislative issues. It should be apparent that there is a wide diversity of opinion about the Nurse Licensure Compact within nursing. Equally important to recognize is that the lack of unity within nursing has been shared with policy makers. Although all nurses will never agree on everything related to compact language, it would be in the best interest of nursing for nurses to work out their differences privately and then present policymakers with a unified plan.
Greer Glazer, PhD, RN, FAAN
Director, Parent Child Nursing
College of Nursing
Kent State University
Kent, OH 44202
E-mail Address: GGlazer@kent.edu
Dr. Glazer is Professor and Director of Parent Child Nursing at Kent State University College of Nursing. Besides her many research activities in the field of women's health and stress, Dr. Glazer is chairman of the Ohio Nurses' Association Government Affairs Committee, a combination legislation committee and PAC. She is currently the legislative liaison to congressman Steve LaTourette and has previously been on health care committees at the state and national level. Locally she serves on the Board of the Cuyahoga County (Ohio) Children's Trust Fund and recently completed four years on the Health Care Committee allocation panel for United Way in Cuyahoga County.
Article published May 4, 1999