1. Allied Health Professions and Licensure Efforts

2. Can We Go for One National License? NO NO Why Not? Why Not? Feds don’t want it Feds don’t want it States want to keep it States want to keep it *Decades of precedent *Decades of precedent

3. Licensure is to Protect the Health and Safety of the Citizens of the State Licensure regulates both the Practice of the Profession and those who render those defined services Licensure regulates both the Practice of the Profession and those who render those defined services Must Define Parameters within the Scope of Practice section Must Define Parameters within the Scope of Practice section Then must set standards/requirements for those who will provide that scope of practice Then must set standards/requirements for those who will provide that scope of practice

4. Regulating the Practice Professions scope of practice can vary state to state. Professions scope of practice can vary state to state. Meet the needs of the citizens: what you can’t do in CA you could do in Alaska Meet the needs of the citizens: what you can’t do in CA you could do in Alaska States, not the feds, set the parameters what can and cannot be done States, not the feds, set the parameters what can and cannot be done

5. Regulating the Practitioners Process applications -is it filled out right? Process applications -is it filled out right? Issue and renew licenses – have they met the CEs requirements, etc? Is that course really acceptable for a CE credit? Issue and renew licenses – have they met the CEs requirements, etc? Is that course really acceptable for a CE credit? Disciplinary complaints: must investigate Disciplinary complaints: must investigate Provide procedural rights for practitioner with disciplinary action taken Provide procedural rights for practitioner with disciplinary action taken Collect the fees (States want the $$$) Collect the fees (States want the $$$)

6. Nurse Compact Comes close to national license for nurses- sort of……. Comes close to national license for nurses- sort of……. License issued in nurses resident state; can work “off” of license issued in one state in those states participating in Nurse Compact License issued in nurses resident state; can work “off” of license issued in one state in those states participating in Nurse Compact Advocated by National Council of State Boards of Nursing Advocated by National Council of State Boards of Nursing

7. Nurses Participating in NC Must Adhere to all state laws where practicing between states in relation to licensure / re-registration requirements, such as mandatory continuing education, criminal background checks, disciplinary causes of action, and evidentiary standards

8. Since 1997 -21 states participate in Nurse Compact Since 1997 -21 states participate in Nurse Compact Requires each state legislature to enact and change current laws- Not very eager Requires each state legislature to enact and change current laws- Not very eager American Nurses Association: “agrees to disagree” with details of the complicated NC process American Nurses Association: “agrees to disagree” with details of the complicated NC process

9. State by State Effort What Do You Need to Have in Place? Professional Infrastructure Professional Infrastructure Strong State Association Strong State Association Strong (Central) National Association Strong (Central) National Association

10. Professional Infrastructure Are there enough practitioners to make a state by state case? Are there enough practitioners to make a state by state case? Is there a rationale for patient safety Is there a rationale for patient safety Licensure is NOT for professional enhancement or job security Licensure is NOT for professional enhancement or job security States want to license “professions” not occupations or disciplines States want to license “professions” not occupations or disciplines

11. Profession= nationwide accredited education/training programs Profession= nationwide accredited education/training programs Are they educated the same; curricula the same? Are they educated the same; curricula the same? Are there enough schools across the country? Are there enough schools across the country?

12. Consistent and valid competency test Consistent and valid competency test Are they all tested on the same content? Are they all tested on the same content? States will use the professional competency test as state licensure exam States will use the professional competency test as state licensure exam Cost of developing a state based test is $50K Cost of developing a state based test is $50K

13. Strong State Society Will lead the legislative effort Will lead the legislative effort Accept the fact it may take several years Accept the fact it may take several years Does the state society have the people, time, and money? Does the state society have the people, time, and money? Leaders in the state will be the “face” of the profession to the legislators Leaders in the state will be the “face” of the profession to the legislators Will have to convince rank and file to support licensure efforts Will have to convince rank and file to support licensure efforts

14. Need to have the support from other key licensed professions Need to have the support from other key licensed professions Physicians are crucial, so are nurses Physicians are crucial, so are nurses Already a powerful, influential factor in state health policy Already a powerful, influential factor in state health policy Have legislators/policy makers ears Have legislators/policy makers ears

15. State hospital associations traditionally oppose licensing professions State hospital associations traditionally oppose licensing professions Argument: it will cost more money Argument: it will cost more money No proven evidence to that, but has impact anyway No proven evidence to that, but has impact anyway Therefore need other professions (docs) support to offset Therefore need other professions (docs) support to offset

16. Most state societies are volunteer Most state societies are volunteer Lobbying is not their profession Lobbying is not their profession Licensure effort takes time Licensure effort takes time Many states if the can afford it hire state a lobbyist to spearhead effort Many states if the can afford it hire state a lobbyist to spearhead effort Still need cohort of state leaders to carry it through- Gov’t/Leg Affairs Cmte. Still need cohort of state leaders to carry it through- Gov’t/Leg Affairs Cmte. What are the financial resources of the state society? What are the financial resources of the state society?

17. Communication System Must have a good communication system in place Must have a good communication system in place Need to let members and supporters know what is happening and when to make contact with their legislators Need to let members and supporters know what is happening and when to make contact with their legislators Need to communicate with legislators Need to communicate with legislators Internet vastly makes this easier Internet vastly makes this easier

18. Strong National Association Act as ringmaster/cheerleader Act as ringmaster/cheerleader May act as financier May act as financier Develop a Model Practice Act, should use as a template in every state Develop a Model Practice Act, should use as a template in every state Key to that: consistent scope of practice Key to that: consistent scope of practice Clearinghouse for support documents Clearinghouse for support documents Advice on what worked elsewhere Advice on what worked elsewhere

19. Model Licensure Language will change over time Each state is unique Each state is unique Services provided may differ to some extent in different states Services provided may differ to some extent in different states Interested parties are different with different agendas Interested parties are different with different agendas Compromises will be made Compromises will be made

20. State By State Licensure Takes Time Scope of Practice will evolve Scope of Practice will evolve RTs licensed in the 1980’s no smoking cessation, telecommunications, Dx. Mgt. RTs licensed in the 1980’s no smoking cessation, telecommunications, Dx. Mgt. More focus on alternate site care More focus on alternate site care patients leave hospital “sicker and quicker” patients leave hospital “sicker and quicker” New disciplines emerge, overlap of practice New disciplines emerge, overlap of practice

21. Respiratory Therapy Experience Model Practice Act developed as template Model Practice Act developed as template Licensure first began in early ’80s Licensure first began in early ’80s Currently there are 48 states, DC and PR that are licensed. Currently there are 48 states, DC and PR that are licensed. Hawaii and Alaska not yet licensed Hawaii and Alaska not yet licensed Last state to gain licensure was Alabama- 2004 Last state to gain licensure was Alabama- 2004

22. Similarities among states: Similarities among states: Licensure requirements: graduates of accredited schools of RT Licensure requirements: graduates of accredited schools of RT Take the national credentialing exam used as state licensure exam Take the national credentialing exam used as state licensure exam Majority (but not all) of scope of practice is the same Majority (but not all) of scope of practice is the same

23. Examples of Political Compromise Under Medical Direction Under Medical Direction Supervision: only by a Doc Supervision: only by a Doc Supervision: Doc, Nurse Practitioner, Physician Assistant (LA revised 2007) Supervision: Doc, Nurse Practitioner, Physician Assistant (LA revised 2007) Continuing ed: Continuing ed: 3 states none required (UT, CO, WI) 3 states none required (UT, CO, WI) 24 biennially in Al, 12 biennially in RI 24 biennially in Al, 12 biennially in RI

24. Compromise Scope of practice issues Scope of practice issues ECMO: No way in NJ, absolutely in TX ECMO: No way in NJ, absolutely in TX Protocols: Can do in most states, only in an emergency in OH Protocols: Can do in most states, only in an emergency in OH

25. Compromise 18 RC “Boards” are under Board of Medicine 18 RC “Boards” are under Board of Medicine Most fully independent RC Licensure Bds. Most fully independent RC Licensure Bds. Some are Advisory Councils rarely meet, paid state staff administers and addresses issues (WA) Some are Advisory Councils rarely meet, paid state staff administers and addresses issues (WA)

26. Regulatory Agencies Depending on the state, some state licensure boards have sweeping authority to “creatively” interpret the law Depending on the state, some state licensure boards have sweeping authority to “creatively” interpret the law Others extremely restrained in what they can do Others extremely restrained in what they can do Just the nature of the state government psyche Just the nature of the state government psyche

27. The way a state licenses States like to follow similar formula States like to follow similar formula What did they do for other allied health professions in the state? What did they do for other allied health professions in the state? License renewal: annual/biennial? License renewal: annual/biennial? Most now all follow same disciplinary criteria (liability reasons) Most now all follow same disciplinary criteria (liability reasons) States make revisions that affect all licensure boards States make revisions that affect all licensure boards

28. Once licensure is gained must be tended to: new/revised regulations Once licensure is gained must be tended to: new/revised regulations Advise state societies to fight the urge to tweak the law, can be a Pandora’s box Advise state societies to fight the urge to tweak the law, can be a Pandora’s box

29. Licensure Like a Chess Game Get all the pieces on the board before you make your first move Get all the pieces on the board before you make your first move And have patience And have patience