1. The Enhanced Nurse Licensure Compact and APRN Compact

2. What is NCSBN?  NCSBN is an independent, not-for-profit association comprised of boards of nursing from the U.S. and around the world – 59 member boards from all 50 U.S. states, D.C., & four U.S. territories – 21 associate members representing nursing regulatory bodies from four continents – North America, Europe, Australia and Asia 2

3. The Role of Boards of Nursing Boards of nursing are responsible for licensure, practice and discipline of 4.5 million nurses (RNs, LPN/VNs and APRNs) in the U.S. with active licenses. 3

4. NCSBN’s Role in the State-based Licensure System NCSBN was created in 1978 to bring boards of nursing together to act and counsel with one another and lessen the burden of government. 4

5. NCSBN is…  The leading source of data, information and research regarding nursing regulation and related issues  Provides boards of nursing, employers and the public with access to Nursys®, the only national database currently available for verification of nurse licensure and discipline for RNs, LPN/VNs and APRNs  A key partner in nursing and its regulation in the U.S. and internationally 5

6. Our Mission NCSBN provides education, service, and research through collaborative leadership to promote evidence-based regulatory excellence for patient safety and public protection. 6

7. NCSBN Achieves its Mission by:  Promoting uniformity in the regulation of nursing practice  Conducting research and analyzing data related to the licensure and discipline of nurses  Monitoring trends in public policy, nursing practice and education 7

8. History of Boards of Nursing  Nursing regulation can be traced back to New York state in 1901  Nursing has been regulated under the single- state model since then  In 1997, NCSBN’s members explored whether the single-state model of nurse licensure is the model that should be taken into the future 8

9. What is the Nurse Licensure Compact?  The NLC is an interstate compact.  It allows a nurse to have one multistate license (in primary state of residency)  This permits the nurse to practice in other member states (both physically and electronically) subject to each state’s practice laws 9

10. What is an Interstate Compact?  A statutory agreement between two or more states established for the purpose of remedying a particular problem of multistate concern  A contract between two or more party states 10

11. Mutual Recognition Model of Licensure The NLC is modeled after the driver’s license compact which follows the mutual recognition model of licensure. 11

12. Primary Concepts  Nurse is issued a multistate license in the declared primary state of residence (PSOR) known as the home state  Nurse holds only one multistate license issued by the home state  Nurse has a multistate licensure privilege in other Compact states (remote states) 12

13. Public Policy Goal Nurse Licensure Compact A State-Based LicenseNationally RecognizedLocally Enforced 13

14. NLC Benefits for Telehealth  Nurses can practice in multiple states with one license  Increases patient access to care  Enables care continuity for patients regardless of their location  Provides member states with authority to facilitate a discipline case across state lines 14

15. NLC Benefits for Nurses  Ability to practice in multiple states with one license  Reduces regulatory requirements by removing necessity for obtaining a license in each state  Clarifies a nurse’s authority to practice in multiple states via telehealth 15

16. NLC Benefits for Nursing Boards  Ability to share complaint and investigative information throughout the investigative course  Shared responsibility for patient safety not governed by geographical boundaries  Shared commitment to improving our collective ability to protect patients 16

17. More Benefits for Nursing Boards  Multiple states working together to assure patient safety  Ability to locate, isolate or limit ability to practice on Privilege to Practice  Reduces duplicative board actions  Uniform statutes, rules and policies applicable and enforceable to all compact states 17

18. NLC Participating States 18

19. Historical Perspective of the NLC  1997: Endorsed mutual recognition model at Special Delegate Assembly; Approved NLC  1999: First state passes NLC legislation  2000-2010: 24 states enact NLC  2015: Montana is 25 th state to enact NLC, effective Oct.1 19

20. Recent Drivers of Change  NLC adoption slowed  Growth in advanced practice registered nurse (APRN) practice creates need for additional compact  Affordable Care Act (ACA) has increased access to care for nation’s growing and aging population  Military/veterans’ health care challenges 20

21. Recent Drivers of Change  Telehealth services are increasingly being utilized, transforming care delivery and erasing geographic boundaries  National licensure discussions in Congress  Other health care professions developing interstate licensure compacts (medicine, physical therapy, EMS, psychology) 21

22. NCSBN’s Response to Change  2013-2014: NCSBN members convene a series of meetings to consider best possible licensure model  Decision made to revise the NLC  2014-2015: NLC is redrafted as a new compact  APRN Compact revised alongside the NLC in order to harmonize the two compacts where possible  March 2015: NCSBN members complete revisions to enhanced NLC and APRN Compact

23. And then…  May 4, 2015: NCSBN members overwhelmingly approve enhanced NLC and APRN Compact at a Special Delegate Assembly  May 2015: NCSBN Board of Directors commits staff and financial resources to advocate for state adoption of enhanced NLC and APRN Compact  January 2016: State legislatures begin to consider and adopt enhanced NLC and APRN Compact 23

24. Why Did We Pursue Enhancing the NLC?  Several states expressed concerns that they couldn’t join current NLC for various reasons  Current NLC states wanted to ensure long-term growth and viability of the NLC  Need for facilitating interstate nursing practice continues to grow 24

25. What Does it Take to Join?  A state must enact the enhanced NLC model language into law  A state must have the ability to conduct a federal criminal background check of a nurse upon initial licensure or licensure by endorsement 25

26. Key New Provisions in the Enhanced Nurse Licensure Compact 26

27. What’s New?  Uniform licensure requirements  Grandfathering provision  Authority to obtain and submit criminal background checks (CBCs)  Prompt reporting to Nursys® of participation in alternative to discipline programs 27

28. What’s New? 28  Establishes Interstate Commission  Provides for rulemaking by the Commission  Improves dispute resolution and termination if necessary

29. Uniform Licensure Requirements To receive a multistate license, a nurse must:  Meet the home state’s qualifications  Graduate from qualifying education program  Pass the NCLEX-RN® or NCLEX-PN® exam (or predecessor) 29

30. Uniform Licensure Requirements To receive a multistate license, a nurse must:  Have no active discipline on a license  Submit to a criminal background check and have no prior state or federal felony convictions  Not be currently enrolled in an alternative program  Have a valid U.S. Social Security number 30

31. Grandfathering  A nurse holding a home state multistate license on the compact’s effective date may retain and renew the license provided that:  A nurse who changes primary state of residence after the enhanced NLC’s effective date must meet requirements to obtain a multistate license from a new home state (Article III (c))  A nurse who fails to satisfy the requirements in Article III (c) due to a disqualifying event occurring after the compact’s effective date is ineligible to retain or renew a multistate license 31

32. Effective Date  A state must pass the enhanced NLC legislation to join the compact  Does not become effective until the earlier of enactment by 26 states or Dec. 31, 2018  Example 1 – If 26 states join by Jan. 1, 2017, the enhanced NLC becomes effective  Example 2 – If only 20 states have joined by Dec. 31, 2018, the enhanced NLC still becomes effective  Multistate licenses issued under the current NLC will still be recognized by party states in the enhanced NLC for six months after that compact’s effective date 32

33. Key Provisions Common in Both Compacts 33

34. Authorities of Party State Licensing Boards  Submit applicant fingerprints to FBI and obtain FBI criminal background checks for licensure  Required to deactivate multistate licensure privileges when license is encumbered or participant is in alternative to discipline program 34

35. Interstate Commission  Governing body that is also a public agency  This term is commonly used by other interstate compact governing bodies  Comparable to the current compact’s Nurse Licensure Compact Administrators (NLCA) 35

36. Rulemaking  Rules adopted directly by the Commission  Legally binding in all party states  No requirement that rules be ratified or adopted by individual states  Such rulemaking authority is permitted and exercised by other current interstate compacts that have been enacted in all 50 states 36

37. More on Rulemaking  The procedural requirements include: 37  Notice to the public of proposed and adopted rules  Opportunity for comment  Opportunity for public hearing  Consideration and voting upon proposed rules  Responding to comments received

38.  Procedures followed in the event of noncompliance with the compact:  Technical assistance to address noncompliance  Dispute resolution processes  Termination from the compact if compliance has not been successful Oversight, Dispute Resolution and Enforcement 38

39. The APRN Compact 39

40. Historical Perspective of the APRN Compact  2002: NCSBN Adoption of APRN Compact  2006: Collaboration Between NCSBN and APRN Consensus Workgroup  2007: Joint Dialogue Group Formed  2008: Adoption of Consensus Model for APRN Regulation  2012 – 2014: Revision Workgroup meetings and involvement of stakeholders 40

41. Overview of the APRN Compact  Available to all four roles of APRNs  Certified Registered Nurse Anesthetist (CRNA)  Certified Nurse-Midwife (CNM)  Clinical Nurse Specialist (CNS)  Certified Nurse Practitioner (CNP)  Mutual recognition model of licensure like NLC  Complies with all tenets of the APRN Consensus Model 41

42. APRN Compact Eligibility  Licensure as an RN and as an APRN in one of the four described roles  Graduate or post graduate education from an accredited program  Certification at advanced level from an accredited program that is maintained 42

43. Key Provisions Unique to the APRN Compact  Uniform licensure requirements in rule  Rules identify role and population foci, education, and certification requirements  Prescriptive authority for non-controlled prescription drugs  Controlled drugs approved at state/federal level  Full practice authority  No supervisory relationship or collaborative agreement with a physician  Threshold number of states to implement: 10 43

44. APRN Compact Scope of Practice  Congruent with the APRN Consensus Model  Full practice authority  No requirement for supervisory relationship or collaborative agreement with a physician  Certain APRNs have prescriptive authority for legend drugs in remote states  Dependent on an APRN’s education and practice experience  Controlled substance prescribing in accordance with DEA regulations 44

45. Making License Portability a Reality Nationwide  Voice your support to the board of nursing, the state nurses association, and legislators  Work with these organizations to identify a legislator to introduce NLC and/or APRN Compact legislation  Testify at legislative hearings and contact legislators  Join a state-based compact advocacy coalition  Ask your company or organization to endorse both compacts 45

46. Questions and Advocacy Please email nursecompact@ncsbn.org if you have questions or need any resources as you embark on your journey adopting the enhanced Nurse Licensure Compact.nursecompact@ncsbn.org 46