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MASSACHUSETTS NURSE NEWSLETTER ::
November/December 2007
Interstate licensure of nurses
Important information about proposed Compact legislation
By Mary Crotty, RN
The MNA is strongly opposed to a bill,
S.1288, which would require Massachusetts
to change its model of nursing licensure and
become a “Compact” state.
“Compact” refers to an agreement by a
number of states to a common professional
license for nurses. Compact is fraught with
potential to endanger patients and to increase
red tape and the chances of data security problems
for nurses.
Compact is being promoted by the National
Council of State Boards of Nursing (NCSBN)—
which is seen as the “mother board” for state
boards of registration in nursing, although
NCSBN is actually not a regulatory entity itself.
It is more akin to a trade association.
The subject is complex. Unfortunately
NCSBN has been simplistically promoting
Compact as a “driver’s license” for nurses:
just zoom across state lines with your license
and never worry about passing another state
board.
This is NOT true, however. The reality under
Compact is that you still would need to change
your licensure if you move out-of-state—even
if you don’t change jobs. Your nursing license
becomes dictated by where you live rather than
where you work.
Following the announcement in early
October that the commonwealth accidentally
distributed confidential licensure information—
including social security numbers—to
people who should not have received it, MNA’s
concern about broadening the legally permissible
scope of data sharing (i.e. of nurse
licensure information), which Compact
would require, is now of even greater concern.
The Massachusetts Division of Professional
Licensure has launched an internal probe
and announced plans to review its protocols
after data for about 450,000 licensed professionals,
including nurses, were inadvertently
released on computer discs mailed out to
agencies across Massachusetts as well as to
New Hampshire, Pennsylvania and California.
Under Compact, licensure data that
should be guarded under top-level security
would be shared among all Compact states
and the potential for security breaches would
be magnified enormously.
The primary reasons why Compact is a bad idea for both nurses and
patients are described below. If you would like more detailed information,
please contact Mary Crotty at MNA, at 781.830.5743 or via e-mail
at mcrotty@mnarn.org.
Nine reasons nurses oppose compact
Interstate licensure of nurses, as proposed under legislation (S.1288, An
Act Adopting the Nurse Licensure Compact), is a new model of licensing
registered nurses that allows a nurse licensed in one state to cross state
borders and practice in any other state that has adopted similar legislation
allowing mutual recognition of nurse licensure. Referred to as “Compact,”
interstate licensure is a bad idea that promises to adversely weaken public safety
by decreasing our state’s ability to adequately regulate the practice of nursing.
Compact is an attempt to fix a non-existent problem. Moreover it has the
potential to cause new problems.
- Who really benefits from Compact? The big beneficiaries—and the biggest
proponents of Compact—are insurance companies and multistate
hospital corporations that want to facilitate telehealth. Telehealth saves
the insurance industry money on preventative care by having a nurse on
the telephone rather than providing direct care. In addition, Telehealth
benefits multistate hospital corporations because it allows hospitals the
ability to move nurses across state lines.
- How easy is it to get a license in another state? Proponents claim that
Compact will allow nurses to move their practice easily from state to
state. They claim this will make it easier to bring more nurses into Massachusetts.
However, a nurse can currently get a temporary license to
practice nursing in Massachusetts within 48-72 hours. How much easier
could it be? Again, this is a solution in search of a problem.
- What are the patient protection concerns about Compact? Shifting the
license requirements from state of practice to state of residency doesn’t
make common sense. Furthermore, licensure in the state of practice
rather than the state of residence is more logical for complainants and
more conducive to investigatory procedures. Follow-up investigations
of negligence, incompetence or fraud are very difficult for respondents
located across the country.
- Will Massachusetts lose its ability to require its licensed nurses to
have up-to-date nursing education? Yes. Approximately half the states
in the country, unlike Massachusetts, do not require continuing education
(CE) for nurses. In 1994, the board of nursing in Colorado, a
new Compact state, removed CE as criteria for renewal of licensure.
Closer to home, Maine does not require continuing education credits.
The practice of medicine is changing all of the time. Do we really want
nurses practicing here who aren’t required to continue their education
or update their skills in any way?
- Will the Commonwealth lose revenue from implementing
Compact? The National Council of State Boards of
Nursing (NCSBN) acknowledges that there will be a cost
to any state joining Compact. The Virginia Board of Nursing
conducted a financial analysis which estimated that
Virginia would lose $250,000 annually in license fees from
out-of-state nurses because of its proximity to nurses living
in a multistate area. This is similar to Massachusetts, with
its proximity to other states. We estimate that the Massachusetts
Board of Registration in Nursing’s loss of revenue
would be between $250,000 to $300,000 annually, or 15-18
percent of its budget.
- What is the impact of Compact on disciplinary issues
for nurses? Nurses will be subject to disciplinary action
in multiple states. Compact requires immediate posting
to all Compact member boards of what they describe as
“significant investigatory information” about a nurse. This
amounts to sharing concerns about alleged practice issues,
prior to formal investigation, hearing or final action. The
licensee would incur costs related to investigation and legal
representation in multiple states, and under Compact she/
he will also be responsible for the costs of the investigation
incurred by each state. The nurse would then have to work
to remove any inaccurate or unsubstantiated information
from their record in multiple states. Anyone who has tried
to remove information from their credit report knows how
difficult this can be. Imagine trying to do it in multiple
states simultaneously!
- Could nurses who speak up for their rights be hurt by
Compact? Yes! Nurses who speak up for their patients and/or
their own labor rights are often targeted by management for
retaliatory disciplinary action. Compact would allow such
intimidation on a much wider scale. Employers under Compact
can block a nurse from working in any other Compact
state by posting “significant investigatory information” on
her/his record.
- Will there be an increased cost to nurses for liability coverage
under Compact? It seems very likely that the increased
exposure to multi-state discipline will result in an increase
in the cost of liability premiums. One of the major insurers,
the Nurses Service Organization (NSO), raised this question
as the cover story of its recent newsletter.
- Are Advanced Practice Nurses (APRNs) included in Compact? What about physicians? No. A Compact arrangement
for APRNs is not considered feasible. And the medical profession
is simply ignoring any attempts to come up with a
physician-equivalent of the nursing Compact. In fact the
National Federation of State Medical Boards seems to be
moving in the opposite direction. If this isn’t a good idea
for Advanced Practice Nurses and physicians, why is it a
good idea for registered nurses?
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