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Multi-state nurse licensure compact--what and why.

History: The National Council of State Boards of Nursing (NCSBN) began deliberation regarding the creation of a nurse licensure compact in 1996. In 1997 the delegates to the NCSBN voted unanimously to endorse a mutual recognition model for nursing regulation. In l998 the delegates approved a policy to remove regulatory barriers to increase access to safe nursing care. And in 2000, the first participating states joined a compact: Maryland, Texas, Utah, and Wisconsin.

What is a mutual recognition model? This model allows a nurse to have a license in the state of primary residency and to practice in other states within the compact. Practice across state lines is allowed with other states in the compact unless the nurse is under disciplinary restrictions.

What is an interstate compact? "An interstate compact is an agreement between two or more states established for the purpose of remedying a particular problem of multistate concern" (Black's Law Dictionary).

What determines primary residency for licensure purposes? The NCSBN established the Nurse Licensure Compact Administrators (NLCA) to oversee multistate compacting. The NLCA defined primary residence in the rules and regulations. Primary residence is where an individual has voter registration, driver's license, or federal income tax returns delivered.

Why join a compact and have one license for multiple states? One license per nurse reduces the barriers to interstate practice. It improves tracking for disciplinary purposes. It is cost effective and simplifies licensing. One license reduces duplication on lists of licensed nurses for planning and disaster preparedness. And one license facilitates interstate commerce.

How are varying scopes of nursing practice addressed? Each nurse is accountable for complying with the Nurse Practice Act in the state in which they provide patient care. All nurses are accountable for practicing under a Practice Act; this is not unique to compacting states.

How are violations of the Nurse Practice Act reported and processed? They are processed in the state of violation and the action taken would be reported to the state of residency. If a violation occurs in the state of residency, all states in the compact are notified of the violation and the action taken. The NCSBN has established a licensure information system called Nursys to enable the sharing of information. This information is available to all state's Boards of Nursing.

Does compacting affect collective bargaining rights? Compacting does not impact the statutory authority at the federal or state level for collective bargaining. However, to the extent an individual state believes that the compact might facilitate strike-breaking, language in the legislation can be included to explicitly state that the compact does not supersede state labor laws.

How are compacts implemented? For a state to join a compact, state legislators must enact the interstate compact into state law or regulation.

Will compacting affect Montana's current Nurse Practice Act? Compacting does not change the Nurse Practice Act in any way. It gives additional authority for granting practice privileges, taking disciplinary actions, and sharing information with other compacted states.

Why should Montana support compacting? Compacting will clarify the authority to practice for many nurses currently engaged in telenursing or interstate practice. It will allow greater mobility for nurses. It will improve access to licensed nurses during a disaster or other time of great need for qualified nursing services. It will improve access to nursing care. And it will enhance the discipline and information sharing among participating compact states. Note: At this time, APRN practice is not included in compacting.

What about Montana Compacting? This is a timely topic as the Board of Nursing is discussing compacting.

Compiled by Barb Prescott DNP, FNP, RNC

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Author:Prescott, Barb
Publication:The Pulse
Geographic Code:1USA
Date:Apr 1, 2006
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