Crossing State Lines : Are Interstate Licenses In Nursing's Future?

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  • H E A L T H C A R E u d t uoca e

    Melinda Mercer Ray, MSN, RN

    Crossing State Lines Are Interstate Licenses in Nursings Future?

    he National Council of State Boards of Nursing, Inc. (NCSBN), is

    actively pursuing a new model of nurse licensure for states that T could have a far-reaching impact on nursing and potentially change the mechanisms used to modify state licensing laws.

    NCSBN is a membership associa- tion supported and populated by representatives from the state boards of nursing in each state. In December 1997, the NCSBN dele- gate assembly approved a master plan for the implementation of a new model of state licensure that has come to be known as the inter- state compact for mutual recogni- tion of nurse licensure. The draft compact currently being debated in the states applies to just RN and LPNLVN licensure. The NCSBN plans to draft a separate compact for advanced practice nurse licen- sure. Basically, the compact would allow states to enter into agreements with other states to recognize nurse licensure across state lines. NCSBN calls this model as an opportunity to enhance interstate practice.

    A Trojan Horse? In considering this compact, this is the question that nursing associa- tions and state boards of nursing

    must ask: Is this compact a Trojan horse or is it the solution for the future? Currently, nursing associations and state boards of nursing vary in their support of the NCSBN proposal.

    concerns, and a number of states ready to move ahead, individual nurses should know how this com- pact could impact their state license, state licensing fees, and the licensure disciplinary system.

    Theres No Place like Home The NCSBN proposal redefines licensure by tying it to the state of primary residence. This means that if two states enter into a compact, nurses would be licensed by the state where they live, even if they work in the other state. However, because nurses practicing under the compact wouldnt be required to

    With the federal government raising concerns, and a number of states ready to move abead,

    individual nurses should know bow tbis model could impact their state license, state licensing fees,

    and tbe licensure disciplinary system.

    Recently, Congress passed report language in the 1999 appropriations bill that will not allow federal fund- ing to be used to fund implementa- tion of this model pending the reso- lution of several important issues concerning the interstate compact. With the federal government raising

    Nurses Speak out Against Interstate Compact AWHONN has taken a position in opposition to the interstate com- pact for mutual recognition of nurse licensure as proposed by NCSBN. Because of the potential impact to nurses and their practice, AWHONN is encouraging nurses to get involved in the debate in their state legislatures. To find out more about the compact, surf to these web sites for the latest in information and links:

    AWHONN Home Page:

    National Council of State Boards of Nursing, Inc.:

    register with any other state boards, those other state boards would have no way of knowing that those nurs- es were practicing in their state. And while nurses practicing in states other than their own residen- tial state wouldnt be required to register with other state boards, they would be responsible for knowing the practice act of the compact state in which they are practicing. Its important to note that if they practice in a state thats not in the compact, theyll have to pay that states licensure fee in addi- tion to the compact fee. There are estimates that the compact license could be costly-with an annual fee perhaps approaching $200 a year or every other year. Melinda Mercer Ray, MSN, RN, is director, Health Policy and Advocacy at AWHONN in Washington, DC.

    February/March 1999 A W H O N N L i f e l i n e s 21

  • Organizations that oppose the interstate compact model as pro- posed by NCSBN, such as AWHONN, argue that the state's interest in protecting the safety of its citizens could be better served through the maintenance of licen- sure based on state of practice.

    Protecting Information As part of the NCSBN's plan for implementing the interstate com- pact, NCSBN is developing a national database for nurse licen- sure. All states that participate in the interstate compact would report licensure information to this data- bank, of which NCSBN would have proprietary control.

    Information regarding individual licensees would be contained in this database, as well as information regarding disciplinary actions. Currently, it's unclear what confi- dentiality and privacy parameters would exist within this system. Discussions at the NCSBN delegate assembly in July 1998 indicated that the individual licenseethe nurse-would be charged whenever an inquiry was made-even if the nurse is unaware of the query. At this point, it's unknown what con- trol, if any, licensees would have concerning databank inquiries.

    The National Practitioner Data Bank has been established by con- gress and currently contains mal- practice report information about physicians and other health profes- sionals. Because this database was established by congress, nurses and others in the health care community can affect its development and use through the regulatory process. However, because NCSBN is a pri-

    Becoming Involved in tbe Legishtive Process.. . Nurses can play a critical role in striving to "promote excellence in nursing practice to improve the health of women and newborns" by becoming involved in the legislative process. Here are a few key points to remember: H Register to vote and be sure to vote in local, state, and federal

    elections H Send a personal letter to your legislator to let him/her know you

    are interested in health care-related issues, specifically those affecting nurses, women, and children. Ask to be placed on any mailing lists he/she may have for those areas of interest.

    H Become familiar with the issues being addressed in the legislature by being involved in your local state chapter/section and express- ing an interest in the legislative process.

    H Legislators are not experts on every issue ...y ou have an expertise in nursing and you can share that knowledge with your legislator, particularly when legislation is introduced.

    H If your legislator agrees with you and supports specific legislation, send him/her a thank you note. If he/she opposes the legislation and does not agree with you, offer to share information with him/her either by letter or in person.

    For more information on getting involved or to join AWHONN's Legislative Network, please call Melinda Mercer Ray, director, Health Policy/Advocacy at (202) 261-2405 (e-mail: or visit the Advocacy page on our Web site:

    vate entity representing regulatory members, individual nurses and nursing organizations wouldn't have the same recourse in defining the use and parameters of the pro- posed nursing databank.

    Crossing State lines Discipline of the licensee across state boundaries is an area of con- tinued discussion. NCSBN is in the process of finalizing proposed regu- lations-for this aspect of the inter- state compact. Currently, if a licensee practicing in a compact state that is not the state of resi-

    dence (remote state) is involved in an incident that leads to discipli- nary action, it is up to the state of residence to bring an action against the licensee. There continues to be discussion as to the role of the remote state.

    the home state can bring a simulta- neous action against the licensee, the licensee must bear the cost of these legal actions in both states. It's also possible that all states in the compact may participate in individual actions against the licensee. +

    If, indeed, the remote state and