ANA Analysis and Comparison Chart
Evaluation of the American Nurses Association's 1998 House of Delegate's 14 Points on Interstate/Multistate Practice

Related to:
The National Council of State Boards of Nursing Interstate Compact Model Language The National Council of State Boards of Nursing Interstate Rules and Regulations National Council of State Boards of Nursing Optional Enabling Act Provisions & Legislation from States Included in the Interstate Compact
last updated 8/22/00



 

HOD14 Points on Interstate/Multistate Practice

 NCSBN's Nurse Licensure Compact dated 11/6/1998 & Optional Enabling Act Provisions dated 10/29/1998 NCSBN's Compact Rules and Regulations dated October 11, 1999 Interstate Compact Legislation passed as of May 10, 2000 (AR, IA, MD, NE, NC, SD, TN, TX, UT, WI)
a. Interstate practice legislation should clearly define key terms and be precisely drafted to ensure that the primary objective to be accomplished by interstate practice is achieved, i.e., asserting jurisdiction over out-of-state nurses practicing in a state; ANA requested clarification in the following areas:

ANA request: The authority for remote state action and home state action be defined.

NCSBN response: Not Included

ANA request: Clarify the role of the head of the licensing board;

NCSBN response: Each state would define the compact administrator based on the following optional Enabling Act Provisions:

The head of the nurse licensing board as used to define the compact administrator in Article VIII(a) shall mean____.

 

States defined the compact administrator as follows: SD, the Executive Director of the Board of nursing; AK the Head of the Nurse Licensing Board; and IA, the Executive Director of the Board of Nursing.
a. Continued ANA request: Clarify the difference between license and privilege;

NCSBN response: Not included

ANA request: Clarify party (non-home, non-remote state adverse action). ANA was concerned that party states could invoke any discipline or revoke a license. ANA wanted to make certain a party state could not revoke a license.

NCSBN response: Compact language changed:

Removed adverse where reference to appropriate state action.

ANA request: Define the role of the administrator of CLIS;

NCSBN response: Not Included

ANA request: Clarify the impact of the compact on state social policy laws.

NCSBN response: Not Included
 		 TX response: The Executive Director of Nurses Examiners and Board of Vocational Nurse Examiners are licensure compact administrators for the state. They are responsible for administrative matters related to RNs and LVNs....they may adopt rules necessary to implement the Interstate Compact.
  • The rule-making process to implement any interstate practice legislation should be clearly spelled out in the legislation, and proposed implementation regulations of key provisions should be developed simultaneously with any legislation;

 ANA request: Involvement in the rulemaking process.

NCSBN response: Not Included

 


 

HOD14 Points on Interstate/Multistate Practice

 NCSBN's Nurse Licensure Compact dated 11/6/1998 & Optional Enabling Act Provisions dated 10/29/1998 NCSBN's Compact Rules and Regulations dated October 11, 1999 Interstate Compact Legislation passed as of May 10, 2000 (AR, IA, MD, NE, NC, SD, TN, TX, UT, WI)
c. Clear parameters should be established related to the confidentiality of any information shared with other states as well as who shall have access to such information;

ANA request: Penalty provisions for breach of confidentiality be added.

NCSBN response: Not included

ANA request: Language added to limited information sharing to party states licensing boards.

NCSBN response: Language included

Any personally identifiable information obtained by a party state' licensing board from the coordinated licensure information system may not be shared with non-party states or disclosed to other entities or individuals except to the extent permitted by the laws of the party state contributing the information.
 
 
d. The sharing of any information related to disciplinary matters, other than final orders and emergency suspensions, should be prohibited unless there is a clear and convincing need to do so to protect the public;

ANA request: The addition of a definition of "significant current investigative information" and ensure due process for the nurse.

NCSBN response: Inclusion of the following legislative language:

A. "Current significant investigative information"means:

(1) investigative information that a licensing board, after a preliminary inquiry that includes notification and an opportunity for the nurse to respond if required by state law, has reason to believe is not groundless and, if proved true, would indicate more than a minor infraction; or

(2) investigative information that indicates that the nurse represents an immediate threat to public health and safety regardless of whether the nurse has been notified and had an opportunity to respond.

ANA agreed with NCSBN that this provision should not restrict access to information that is currently shared or available to state boards of nursing.

ANA request: Regulations are clear that information is to be shared between boards of nursing only.

NCSBN response: Inclusion of regulatory language: The Public shall have access to nurse licensure information limited to: (a) the nurse's name, (b) jurisdiction(s) of licensure, (c) licensure expiration date(s), (d) licensure classification(s) and status(es), (e)public emergency and final disciplinary actions, as defined by contributing state authority, and (f) the status of multistate licensure privileges.

Non-party state Boards shall have access to all information System data contributed by the party states and other information as limited by contributing party state authority. Party state Boards shall have access to all information System data contributed by the party states and other information as limited by contributing non-party state authority.

 

e. The process for selecting an entity to conduct data collection or provide other services related to implementation of interstate practice shall be open and competitive;

ANA request: raised concern about delegating authority to a non-governmental entity, as well as concern related to the lack of competitive bidding.

NCSBN response did not address ANA's concern:

Definition revised:

"Coordinated licensure information system" means an integrated process for collecting, storing, and sharing information on nurse licensure and enforcement activities related to nurse licensure laws, which is administered by a non-profit organization composed of and controlled by state nurse licensing boards.


 
 

HOD14 Points on Interstate/Multistate Practice

 NCSBN's Nurse Licensure Compact dated 11/6/1998 & Optional Enabling Act Provisions dated 10/29/1998 NCSBN's Compact Rules and Regulations dated October 11, 1999 Interstate Compact Legislation passed as of May 10, 2000 (AR, IA, MD, NE, NC, SD, TN, TX, UT, WI)
f. Before any immunity from liability is extended to non-governmental entities, there should be careful scrutiny to ensure those entities are appropriately accountable for their actions; ANA raised concern of immunity for a non-governmental entity.

NCSBN response: Language revised:

No party state or the officers or employees or agents of a party state's nurse licensing board who acts in accordance with the provisions of this compact shall be liable on account of any act or omission in good faith while engaged in the performance of their duties under this compact. Good faith in this article shall not include willful misconduct, gross negligence, or recklessness.


 		 NE: No party state.....shall be liable except as provided in the state tort claims act.
g. Mechanisms should be established to ensure that the process used by any entity collecting data be reconciled with state law and procedures regarding collecting, maintaining and distributing licensure and disciplinary information;

ANA requested the compact be revised to clarify the sharing of information specifically related to discipline that is not already available to the public and any other related data that is collected be limited to between boards of nursing.

NCSBN response: Language added:

Current significant investigative information shall be transmitted through the CLIS only to party state licensing boards.

Any personally identifiable information obtained by a party states' licensing board from the CLIS may not be shared with non-party states or disclosed to other entities or individuals except to the extent permitted by the laws of the party state contributing the information... shall also be expunged from the CLIS.

 

 

h. The right of individual nurses to a fair hearing of any disciplinary matter must be protected; and, no unfair or undue burden, financial or otherwise, should be placed on a nurse's exercising his/her right to a fair hearing;

ANA request: a section on the Rights of the Nurse be included that would provide the nurse with the right of notice, of appeal, to review information contained in the data base, and to have information expunged.

NCSBN response: Language was added in several sections to clarify that the compact would be implemented in accordance with state due process laws. ANA was concerned that state due process laws are not as extensive as ANA would like, for example see NC Compact language.

 ANA and NCSBN agreed in principle that state administrative procedure acts would apply to disciplinary processes. There still may be a question as to whether this language would appear in the compact, itself or in the regulations.

ANA request: would like this language to be added to the compact and would also want to see language in the compact providing for notice and other specific requirements for a fair hearing.

NCSBN response: Not addressed except for reviewing information in the data base:

In an event a licensee asserts that any data relating to him or her is inaccurate, the burden of proof shall be upon the licensee to provide evidence that substantiates such claim.

 NC: If a licensing board finds current significant investigative information as defined in section.....the licensing board shall, after giving the licensee notice and an opportunity to respond if required by state law, conduct a hearing and decide what adverse action, if any, should be taken against the licensee. If a licensing board finds current significant investigative information as defined in ....., the licensing board may take adverse action against the licensee without first providing the licensee notice or an opportunity to respond to the information. A hearing shall be promptly commenced and determined.

TX response: Upon request and payment of a reasonable fee, the board will provide a nurse licensed in the state with a copy of information regarding the nurse maintained on CLIS.

HOD14 Points on Interstate/Multistate Practice

 NCSBN's Nurse Licensure Compact dated 11/6/1998 & Optional Enabling Act Provisions dated 10/29/1998 NCSBN's Compact Rules and Regulations dated October 11, 1999 Interstate Compact Legislation passed as of May 10, 2000 (AR, IA, MD, NE, NC, SD, TN, TX, UT, WI)
h. continued ANA raised concerns about nurses paying for costs of investigations and disposition.

NCSBN response: Not addressed

The compact includes language that it is up to each state and this is addressed in model enabling language:

To facilitate cross-state enforcement efforts, the legislature finds that it is necessary for [this state] to have the power to recover from the affected nurse the costs of investigations and disposition of cases resulting from adverse actions taken by this state against that nurse.

ANA request: ANA believes that, in order to reduce the financial burden on the nurse, the regulations should contain language providing that only the remote state where the incident occurred and the home state would be able to conduct a disciplinary hearing.

NCSBN response: Not Included
 
i. Approaches to interstate advanced practice nursing should be addressed for consistency in connection with interstate practice for other RNs;

ANA request: Compact must include APRNs.

NCSBN response: Not included

 

WI legislative language: Includes APRNs. (practice act does delineate between RN's and APRN's scope of practice except for prescriptive authority privileges.)
j. Mechanisms should be in place that ensure nurses have ready and ongoing access to practice-related information, including current board of nursing policies;

ANA request: To include the following language: Upon request, each state shall provide the nurse with a copy of the state practice act, state rules and regulations, rules and administrative policies of the CLIS and narratives explaining the state's additional Licensure requirements which are applicable to nurses and the state's administrative and judicial processes.

NCSBN response: Not included
 		 TX response: Practice related information provided by the nursing board will be made available to nurses practicing in Texas via a party state, at a reasonable cost upon request.

HOD14 Points on Interstate/Multistate Practice

 NCSBN's Nurse Licensure Compact dated 11/6/1998 & Optional Enabling Act Provisions dated 10/29/1998 NCSBN's Compact Rules and Regulations dated October 11, 1999 Interstate Compact Legislation passed as of May 10, 2000 (AR, IA, MD, NE, NC, SD, TN, TX, UT, WI)
k. Mechanisms should be in place to ensure that a board of nursing knows who is practicing in its state under authority of a license granted by another state or through an interstate practice agreement;

ANA request: Each state board of nursing maintain a registry of nurses practicing remotely in their state.

NCSBN response: Not included

 

NE response: Requires the board to determine, before recognizing a home state license from another state if the qualifications are substantially equivalent to Nebraska's. The legislation does not indicate however how the state will determine who is practicing in the state.

MD response: Requires a nurse who has multistate licensing privileges to notify the MD Board of Nursing prior to starting employment as well as the identity and location of the nurse's employer.

l. The state of predominant practice should be the state of licensure; if the nurse is not practicing, the nurse should be licensed in his/her state of residence;

 ANA request: The state of licensure be changed from state of residence to state of practice.

NCSBN response: Not included

 

 

  • Employers must be held accountable for ensuring that they utilize staff who are licensed (or otherwise authorized to practice) under state law;
 ANA request: The compact clarify that it is not to be used as a substitute for employer responsibility

NCSBN response included in model enabling language:

This compact is designed to facilitate the regulation of nurses, and does not relieve employers from complying with statutorily imposed obligations.


 
 
n. Interstate practice must not be implemented in a way that allows persons to circumvent or contravene existing public policy as expressed by a state's laws or policies, including laws on the use of strikebreakers and striker replacement or initial and continuing licensure requirements.

 ANA request: The compact is not intended to contravene existing state labor laws but would not include this language in the compact.

NCSBN response: Addressed in optional model enabling language:

This compact does not supercede existing state labor laws.


 		 MD response: The nurse compact is designed to facilitate the regulation of nurses, and may not relieve employers from complying with contractual and statutorily imposed obligations and may not supercede existing state labor laws.


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