The Enhanced Nurse Licensure Compact: The Licensure Solution for Interstate Nursing Practice in the US
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 Each party state is a signatory to the same contract. For that reason, there is a need for substantive sameness. 2
What is the Nurse Licensure Compact? The NLC is an interstate compact. It authorizes a nurse holding one multistate license in the primary state of residence to practice (physically or via telehealth) in any compact state. 3
Why Would a Nurse Need More than One License? A nurse must have the authority to practice in the state where the pt is located at the time service is provided. As the organizations representing state licensing boards that regulate the practice of medicine, pharmacy and nursing, (we) affirm that in a consumer protection model, health care practice occurs where the recipient of healthcare services is located. Source: The Tri-Regulator Collaborative Position Statement on Practice Location for Consumer Protection 4
Two Distinct Compacts Original NLC is the compact that began in 2000 25 member states Enhanced NLC (enlc) Updated version adopted 2015. Will replace the original NLC. States started to join in 2016. Became effective July 20, 2017 when the 26 th state enacted. 5
Original NLC Current Status 6
Original NLC -- Starting Jan 19, 2018 NOTE: These four states will introduce enlc legislation in 2018 (WI in Sept 2017). 7
The Impact of the 4 States Remaining in the Original NLC Upon Employers/Nurses in Those 4 States Employers in the four states that remain in the original NLC that have nurses practicing in the 21 original NLC states that joined the enlc will be impacted. As of January 19, 2018, those nurses in the 4 states holding an original NLC multistate license won t have the authority to practice in enlc states without applying for a single state license in each of those states. 8
Impact (Continued) As of January 19, 2018, the original NLC multistate license held by nurses in those 4 states will be valid in only those 4 states. Should an employer in the remaining 4 original NLC states rely upon the nursing workforce from the 21 original NLC states that joined the enlc, as of January 19, 2018, those nurses in enlc states with an enlc multistate license won t have the authority to practice in those four states without applying for a single state license. 9
Impact (Continued) The original NLC is anticipated to cease in the next two years as its member states dwindle to less than two. At that point, nurses in the 4 remaining original NLC states will have no multistate license. 10
Effective Date Effective date is whenever the 26 th state enacts the enlc. This happened on July 20, 2017. For states that enact the enlc, in law, this date triggers the six month notice of withdrawal of states from the original NLC. On this date, the compact agency is created. This is not the date that enlc licenses are issued or that nurses may practice in enlc states. 11
Implementation Date Implementation date (Jan 19, 2018) is when: The enlc becomes operational; i.e., nurses can practice in enlc states, boards of nursing will accept and process applications for the enlc multistate license. Since we know that 6 months after July 20, 2017, 21 states will have withdrawn from the original NLC, the implementation date must necessarily be no more than 6 months after July 20, 2017. Six months later is Jan 19, 2018. If it was any later, millions of nurses would no longer hold multistate licenses and practice would be severely curtailed. It must be a seamless transition to avoid practice interruption. 12
2016: Where are We Today with the enlc? 10 states enacted enlc 2017: 16 states enacted enlc (AR, DE, GA, IA, KY, MD, ME, MS, MT, NC, NE, ND, SC, UT, TX, WV) 2 states currently pending (MA, NJ) 13
Enhanced NLC Current Status A graphic view of the information in the preceding slide 14
The Goal: A Compact Nation One Multistate License Valid for Practice in All Jurisdictions 15
What s Different in the enhanced NLC? 16
11 Uniform Licensure Requirements To receive a multistate license, a nurse must: 1) Meet the home state s qualifications 2) Graduate from qualifying education program (or graduated from a foreign program verified by independent credentials review agency) 3) Pass the NCLEX-RN or NCLEX-PN exam (or predecessor) 17
Uniform Licensure Requirements (Continued) To receive a multistate license, a nurse must: 4) Have no active discipline on a license 5) Submit to a federal criminal background check 6) Not be currently enrolled in an alternative program 7) Have a valid U.S. Social Security number 18
Uniform Licensure Requirements (Continued) To receive a multistate license, a nurse must: 8) Self-disclose participation in an alternative program 9) Have no misdemeanors related to practice of nursing 10) Passed English proficiency exam if foreign grad 11) Have no prior state or federal felony convictions NOTE: A nurse who does not meet a requirement may receive a single state license. 19
Prevalence of Criminal Background Checks (CBCs) Map shows 12 states without a CBC requirement. Maine and Montana will have CBC requirements in the enlc. That leaves 10 states without. 20
Grandfathering Nurses in original NLC states (that enacted the enlc) holding a multistate license on the July 20, 2017 effective date will be grandfathered into the enlc. They won t have to meet the requirements for an enlc multistate license. Nurses issued a multistate license after July 20, 2017 will be required to meet the enlc multistate license requirements. 21
Rulemaking Rules adopted directly by the Commission NOTE: Rules are limited to the implementation and operations of the compact and multistate licensure. No requirement that rules be or adopted by individual states 22
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Other Interstate Licensure Compacts for Healthcare Professions: Insight into the Future of Licensure Compacts in Progress 1) Nursing (RN/LPN) 2) Nursing (APRN) 3) Physicians 4) Physical Therapists 5) Emergency Medical Technicians 6) Psychologists Compacts Under Development or Being Considered 1) Occupational Therapists 2) Speech Pathologists 3) Audiologists 4) Nutritionists 5) Dieticians 6) Physician Assistants 7) Social Workers 8) Athletic Trainers 24