Introduction
The titles of the four articles of this issue: The Regulatory Dilemma Surrounding Interstate Practice, The Mutual Recognition Model of Nursing Licensure, Multistate Licensure: Premature Policy and The Utah Experience: Adopting The Nursing Regulation Interstate Compact, illustrate differences in concept definition as each author presents her view of the same issue '” how nursing regulation needs to be reformed. The terms multistate and interstate practice have been used to describe nursing services provided by a nurse in one state to a client in another state. The Mutual Recognition Model of Nursing Licensure proposed by the National Council of State Boards of Nursing has been used interchangeably with multistate licensure in the King article. An interstate compact, a contract agreement or arrangement between 2 or more states to remedy a problem of multistate concern, is the mechanism adopted by Utah to address interstate nursing practice. Despite the confusion created by the use of multiple terms, all of the authors recognize the need to address nursing regulation due to changes in the health care delivery system, use of telecommunication technology to deliver nursing services across state lines, and the need to protect consumers of health care.
Each of the authors has been intimately involved in policy development related to nursing regulation of interstate practice. Authors were deliberately selected to represent different points of view and to provide the reader with experts' opinions about their viewpoint. It is left to you, the reader, to come to your own conclusions about regulation of interstate nursing practice.
Terri Gaffney MPA, RN, Director of State Government Relations at the American Nurses Association, focuses on regulatory issues related to telehealth in The Regulatory Dilemma Surrounding Interstate Practice. Regulatory alternatives are discussed including the Pew Health Professions Commission 1994 and 1998 recommendations, Western Governor's Association statements, Medical and Physical Therapy Organizations' proposals, the health care Financing Administration approach, and the Nurse Licensure Compact of the National Council of State Boards of Nursing (NCSBN). Four major questions and concerns related to the compact are raised. Actions of the American Nurses Association in response to the NCSBN's Nurse Licensure Compact are described. It was particularly interesting to note that the Federation of State Medical Boards and the American Medical Association disagreed on regulatory alternatives as is the case with the National Council of State Boards of Nursing and the American Nurses Association.
The Mutual Recognition Model of Nursing Licensure by Carolyn Hutcherson MS, RN, Senior Policy Advisor, and Susan Williamson MPH, RN, Director of Credentialing and Practice at the National Council of State Boards of Nursing, describes environmental issues necessitating a change in the regulation of nursing practice as well as the historical development of the NCSBN's Mutual Recognition Model of Nurse Licensure. The four major areas included in the model: jurisdiction, discipline, information sharing and administration of the compact, are explained. The authors discuss ongoing work to be done to address issues related to the model.
Susan King MS, RN, Administrator for Professional Services at the Oregon Nurses Association, believes that the mutual recognition model "proposes a solution to an as yet undefined problem which, at this time, is not widely supported by the profession" in Multistate Licensure: Premature Policy. The major concerns expressed by nurses across the country are: the standards of a state will be weakened; consumer protection is not improved with the model; state boards of nursing will be weakened; there is lack of detail about the centralized database; the ability of state nurses associations to achieve optimal standards, working conditions and compensation for nurses may be compromised; there is lack of clarity about dual disciplinary actions; the cost of mutual recognition is unknown; and any major change in nurse licensure should be made by the profession and the consumers it serves. Specific examples related to concerns are included which makes it easy for the reader to understand the issues.
The Utah Experience: Adopting the Nursing Regulation Interstate Compact by Laura Poe RN, MS, Executive Administrator of the Utah Board of Nursing, describes the reasons why Utah chose to adopt the compact language proposed by the NCSBN, and the process that followed, and advice to states who are interested in adopting the mutual recognition model of nursing regulation. Poe points out that the greatest impetus for regulatory change was the need to protect the public. The most important lesson to be learned from the Utah experience is that key stakeholders, including the Utah Board of Nursing, Utah Nurses Association, and Nursing Leadership Forum (deans and directors of the nursing education programs and the chief nursing officer from health care facilities) met early in the process to discuss the philosophy of regulation and Multistate Licensure and came to agreement on legislation prior to its introduction.
There is agreement by all authors that nursing must adapt to the changing environment by altering the system for regulating interstate practice. There is also considerable disagreement about the best way to address the issue. Some nurses have questioned the process whereby the Mutual Recognition Model of Nursing Licensure has been adopted as "the" model for nursing. Since it is apparent that consensus does not exist within the nursing profession, we should heed the words of Susan King, "What is needed now is for the profession to take a step back and engage in thoughtful consideration of the conditions which face us, what we can expect in the future and the best way to position our regulatory system to manage what we expect to happen."
It just may be possible that the National Council of State Boards of Nursing, American Nurses Association, and other nursing leaders can follow the example of the nurses in Utah and unite to adopt a model that all can support. Please become part of the dialogue and share your thoughts with us online after you have read the articles.
Article published May 31, 1999
