APRN COMPACT: Past, Present, and Future

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APRN COMPACT Past, Present, and Future
Laura Poe, MS, RN Chair, NLCA
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1903

• World Series had begun

• Wright Brothers took flight

• Ford Motor Company was founded

• Telephone had been in existence for 27 years

• Computer would not be invented for another 43
  years (1946)

• NC passed the first Nurse Practice Act in U.S.

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Much has changed . . . except regulation
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Objectives

• Review the history of mutual recognition.
• List the components of the model APRN compact.
• Discuss issues of concern.

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Telenursing Differs from Other Telepractice

• Physician consultation generally involves a
  licensed practitioner in each state

• Telenursing generally involves the nurse being in
  direct contact with the patient frequently in
  the patients home

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RegulatoryIssues
?

• States right or Interstate Commerce 200
  years of case law ruled that states have
  the right to protect consumers.
• Where does practice occur location of provider
  or patient?
• Does practice by electronic means constitute the
  practice of nursing?

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NCSBNs Definition of Telenursing

• The practice of nursing over distance using
  electronic means

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Vision Statement

• A state nursing license recognized nationally
  and enforced locally

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Solution MUTUAL RECOGNITION

• MSR Task Force
• Surveys, interviews, conferences
• Best model to protect public decrease barriers

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History of Mutual Recognition

• 1994 1997 NCSBN task forces studied
  regulatory models and telehealth.
• 1997 NCSBN Delegate Assembly endorsed mutual
  recognition model for nursing regulation for
  RN/LPN and APRN at a later date.
• 1997 Special session of NCSBN Delegate Assembly
  approved model RN/LPN compact language.

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History (continued)

• 1998 Utah became the first state to adopt the
  RN/LPN compact.
• 2000 The RN/LPN compact becomes effective among
  Utah, Maryland, Arkansas, Texas RN, Texas VN, and
  North Carolina.
• 2001 2003 APRN Compact Development
  Subcommittee charged with developing model
  language.

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History (continued)

• 2002 NCSBN Delegate Assembly approved the model
  APRN compact language.
• 2004 Utah became the first state to adopt the
  APRN compact.

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Basic Concepts of Mutual Recognition

• Allows nurse to have one license in state of
  residence and practice in party states
• Nurse is subject to each states practice laws
  and discipline
• Practice allowed physically or electronically
• Each state must enter into
  interstate compact

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Interstate Compact

• Agreement between 2 or more states to remedy a
  problem of multistate concern
• Each state enacts a compact via legislation
• Mutual recognition of those who enact the
  legislation
• Example - Drivers License Model

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General Purposes of the Compact

• Facilitate the states responsibility to protect
  the publics health and safety
• Ensure and encourage the cooperation of party
  states
• Facilitate the exchange of information
  between party states

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Purposes of the Compact (continued)

• Promote compliance with the laws governing the
  practice of nursing in each jurisdiction
• Invest all party states with the authority to
  hold a nurse accountable

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Model APRN Compact Addresses

• General Provisions and Definitions
• Jurisdiction
• Discipline
• Information Sharing
• Compact Administration

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1. General Provisions Definitions

• APRN means a CRNA, NP, CNM, or CNS to the extent
  a party state licenses or grants authority to
  practice in that APRN role and title.
• APRN Licensure/Authority to Practice means
  the regulatory mechanism used by a party
  state to grant legal authority to
  practice as an APRN.

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General Provisions (continued)

• APRN Uniform Licensure/Authority to Practice
  Requirements means those agreed upon minimum
  uniform licensure, education, and examination
  requirements adopted by licensing boards for the
  recognized APRN role and title.

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General Provisions (continued)

• State Practice Laws means a party states laws
  and regulations that govern APRN practice, define
  the scope of advanced nursing practice
  including prescriptive authority and create the
  methods and grounds for imposing discipline.
• State Practice Laws does not include the
  requirements to obtain or retain
  licensure/authority.

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General Provisions (continued)

• All APRN compact party states must participate in
  the RN/LPN compact (Nurse Licensure Compact).
• A state may not enter into the APRN compact until
  it adopts at a minimum the APRN Uniform
  Licensure/Authority to Practice Requirements.

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General Provisions (continued)

• The APRN multistate advanced practice privilege
  does not include prescriptive authority. A state
  may grant prescriptive authority on the basis of
  a multistate advanced practice privilege to the
  extent permitted by state laws.

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2. Jurisdiction

• APRN is licensed in the state of
  residence home state.
• APRN may only have one compact license.
• APRN is granted the privilege (via the compact)
  to practice in other party states (remote states)
  under the same role and title as authorized in
  the home state, provided the remote state
  recognizes that role and title.

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Jurisdiction (continued)

• An APRN practicing in a party state must comply
  with the state practice laws of the state in
  which the patient is located at the time care is
  provided.

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3. Discipline

• The home state or remote state may take
  disciplinary action.
• Only the home state can take action on the
  license.
• The remote state (where the violation
  occurred) may take action allowed by the
  state.
• Any party state can deny authority to
  practice.

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4. Information Sharing NURSYS

• A comprehensive information system containing
  data on all nurses
• Coordinates existing and future nurse databases
• Used to verify nursing
• licenses

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5. Compact Administration

• Authorizes the formation of Compact
  Administrators Group.
• Authorizes the development of rules and
  regulations to administer the Compact.

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Benefits of an APRN Compact

• Promotes adoption of Uniform APRN
  Licensure/Authority to Practice Requirements.
• Promotes standardization of scope of practice
  prescriptive practice.

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Benefits (continued)

• Increases practice site opportunities.
• Decreases costs to the APRN.
• Provides consistency with todays practice
  environment.
• Promotes public protection grants jurisdiction
  to a board over all APRNs practicing in its
  state.

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Issues of Concern

• A limited number of states eligible to enter into
  an APRN compact
• Differing implementation dates for uniform
  requirements
• Prescriptive practice collaborative/supervisory
  relationships

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Impact of Mutual Recognition

• Nurses
• Public
• Health Care Institutions
• Government
• Revenue

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How Can You Stay Informed?

• National Council of State Boards of Nursing
  www.ncsbn.org