152E.3 - FORM OF ADVANCED PRACTICE REGISTERED NURSE COMPACT.
152E.3 FORM OF ADVANCED PRACTICE REGISTERED NURSE
COMPACT.
The advanced practice registered nurse compact is entered into and
enacted into law with all jurisdictions legally joining therein, in
the form substantially as follows:
1. Article I -- Findings and declaration of purpose.
a. The party states find all of the following:
(1) The health and safety of the public are affected by the
degree of compliance with advanced practice registered nurse
licensure and practice requirements and the effectiveness of
enforcement activities related to state advanced practice registered
nurse license or authority to practice laws.
(2) Violations of advanced practice registered nurse licensure
and practice and other laws regulating the practice of nursing may
result in injury or harm to the public.
(3) The expanded mobility of advanced practice registered nurses
and the use of advanced communication technologies as part of our
nation's health care delivery system require greater coordination and
cooperation among states in the areas of advanced practice registered
nurse licensure and practice requirements.
(4) New practice modalities and technology make compliance with
individual state advanced practice registered nurse licensure and
practice requirements difficult and complex.
(5) The current system of duplicative advanced practice
registered nurse licensure and practice requirements for advanced
practice registered nurses practicing in multiple states is
cumbersome and redundant to both advanced practice registered nurses
and states.
(6) Uniformity of advanced practice registered nurse requirements
throughout the states promotes public safety and public health
benefits.
(7) Access to advanced practice registered nurse services
increases the public's access to health care, particularly in rural
and underserved areas.
b. The general purposes of this compact are to:
(1) Facilitate the states' responsibilities to protect the
public's health and safety.
(2) Ensure and encourage the cooperation of party states in the
areas of advanced practice registered nurse licensure and practice
requirements including promotion of uniform licensure requirements.
(3) Facilitate the exchange of information between party states
in the areas of advanced practice registered nurse regulation,
investigation, and adverse actions.
(4) Promote compliance with the laws governing advanced practice
registered nurse practice in each jurisdiction.
(5) Invest all party states with the authority to hold an
advanced practice registered nurse accountable for meeting all state
practice laws in the state in which the patient is located at the
time care is rendered through the mutual recognition of party state
licenses.
2. Article II -- Definitions. As used in this compact:
a. "Advanced practice registered nurse" means a nurse
anesthetist, nurse practitioner, nurse midwife, or clinical nurse
specialist to the extent a party state licenses or grants authority
to practice in that advanced practice registered nurse role and
title.
b. "Advanced practice registered nurse licensure and practice
requirements" means the regulatory mechanism used by a party state
to grant legal authority to practice as an advanced practice
registered nurse.
c. "Advanced practice registered nurse uniform license or
authority to practice requirements" means those minimum uniform
licensure, education, and examination requirements as agreed to by
the compact administrators and adopted by licensing boards for the
recognized advanced practice registered nurse role and title.
d. "Adverse action" means a home or remote state action.
e. "Alternative program" means a voluntary, nondisciplinary
monitoring program approved by a nurse licensing board.
f. "Coordinated licensure information system" means an
integrated process for collecting, storing, and sharing information
on advanced practice registered nurse licensure or authority to
practice and enforcement activities related to advanced practice
registered nurse license or authority to practice laws, which is
administered by a nonprofit organization composed of and controlled
by state licensing boards.
g. "Current significant investigative information" means
either of the following:
(1) Investigative information that a licensing board, after a
preliminary inquiry that includes notification and an opportunity for
the advanced practice registered nurse to respond if required by
state law, has reason to believe is not groundless and, if proved
true, would indicate more than a minor infraction.
(2) Investigative information that indicates that the advanced
practice registered nurse represents an immediate threat to public
health and safety regardless of whether the advanced practice
registered nurse has been notified and had an opportunity to respond.
h. "Home state" means the party state that is the advanced
practice registered nurse's primary state of residence.
i. "Home state action" means any administrative, civil,
equitable, criminal, or other action permitted by the home state's
laws which is imposed on an advanced practice registered nurse by the
home state's licensing board or other authority, including actions
against an individual's license or authority to practice such as
revocation, suspension, probation, or any other action which affects
an advanced practice registered nurse's authorization to practice.
j. "Licensing board" means a party state's regulatory body
responsible for advanced practice registered nurse licensure or
authority to practice.
k. "Multistate advanced practice privilege" means current
authority from a remote state permitting an advanced practice
registered nurse to practice in that state in the same role and title
as the advanced practice registered nurse is licensed or authorized
to practice in the home state to the extent that the remote state
laws recognize such advanced practice registered nurse role and
title. A party state has the authority, in accordance with existing
state due process laws, to take action against the advanced practice
registered nurse's privilege, including revocation, suspension,
probation, or any other action that affects an advanced practice
registered nurse's multistate privilege to practice.
l. "Party state" means any state that has adopted this
compact.
m. "Prescriptive authority" means the legal authority to
prescribe medications and devices as defined by party state laws.
n. "Remote state" means a party state, other than the home
state, where either of the following applies:
(1) Where the patient is located at the time advanced practice
registered nurse care is provided.
(2) In the case of advanced practice registered nurse practice
not involving a patient, in such party state where the recipient of
advanced practice registered nurse care is located.
o. "Remote state action" means either of the following:
(1) Any administrative, civil, equitable, criminal, or other
action permitted by a remote state's laws which is imposed on an
advanced practice registered nurse by the remote state's licensing
board or other authority, including actions against an individual's
multistate advanced practice privilege in the remote state.
(2) Cease and desist and other injunctive or equitable orders
issued by remote states or the licensing boards of remote states.
p. "State" means a state, territory, or possession of the
United States, the District of Columbia, or the Commonwealth of
Puerto Rico.
q. "State practice laws" means a party state's laws and
regulations that govern advanced practice registered nurse 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 necessary to obtain and retain advanced practice
registered nurse licensure or authority to practice as an advanced
practice registered nurse, except for qualifications or requirements
of the home state.
r. "Unencumbered" means that a state has no current
disciplinary action against an advanced practice registered nurse's
license or authority to practice.
3. Article III -- General provisions and jurisdiction.
a. All party states shall participate in the nurse licensure
compact for registered nurses and licensed practical or vocational
nurses in order to enter into the advanced practice registered nurse
compact.
b. A state shall not enter the advanced practice registered
nurse compact until the state adopts, at a minimum, the advanced
practice registered nurse uniform license or authority to practice
requirements for each advanced practice registered nurse role and
title recognized by the state seeking to enter the advanced practice
registered nurse compact.
c. Advanced practice registered nurse license or authority to
practice issued by a home state to a resident in that state shall be
recognized by each party state as authorizing a multistate advanced
practice privilege to the extent that the role and title are
recognized by each party state. To obtain or retain advanced
practice registered nurse licensure and practice requirements as an
advanced practice registered nurse, an applicant must meet the home
state's qualifications for authority or renewal of authority as well
as all other applicable state laws.
d. The advanced practice registered nurse multistate advanced
practice privilege does not include prescriptive authority, and does
not affect any requirements imposed by states to grant to an advanced
practice registered nurse initial and continuing prescriptive
authority according to state practice laws. However, a party state
may grant prescriptive authority to an individual on the basis of a
multistate advanced practice privilege to the extent permitted by
state practice laws.
e. A party state may, in accordance with state due process
laws, limit or revoke the multistate advanced practice privilege in
the party state and may take any other necessary actions under the
party state's applicable laws to protect the health and safety of the
party state's citizens. If a party state takes action, the party
state shall promptly notify the administrator of the coordinated
licensure information system. The administrator of the coordinated
licensure information system shall promptly notify the home state of
any such actions by remote states.
f. An advanced practice registered nurse 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. The
advanced practice registered nurse practice includes patient care and
all advanced nursing practice defined by the party state's practice
laws. The advanced practice registered nurse practice subjects an
advanced practice registered nurse to the jurisdiction of the
licensing board, the courts, and the laws of the party state.
g. Individuals not residing in a party state may apply for an
advanced practice registered nurse license or authority to practice
as an advanced practice registered nurse under the laws of a party
state. However, the authority to practice granted to these
individuals shall not be recognized as granting the privilege to
practice as an advanced practice registered nurse in any other party
state unless explicitly agreed to by that party state.
4. Article IV -- Applications for advanced practice registered
nurse licensure or authority to practice in a party state.
a. (1) Once an application for an advanced practice
registered nurse license or authority to practice is submitted, a
party state shall ascertain, through the coordinated licensure
information system, whether the applicant has held, or is the holder
of, a nursing license or authority to practice issued by another
state, whether the applicant has had a history of previous
disciplinary action by any state, whether an encumbrance exists on
any license or authority to practice, and whether any other adverse
action by any other state has been taken against a license or
authority to practice.
(2) This information may be used in approving or denying an
application for an advanced practice registered nurse license or
authority to practice.
b. An advanced practice registered nurse in a party state
shall hold an advanced practice registered nurse license or authority
to practice in only one party state at a time, issued by the home
state.
c. An advanced practice registered nurse who intends to
change the nurse's primary state of residence may apply for an
advanced practice registered nurse license or authority to practice
in the new home state in advance of such change. However, a new
license or authority to practice shall not be issued by a party state
until after an advanced practice registered nurse provides evidence
of change in the nurse's primary state of residence satisfactory to
the new home state's licensing board.
d. (1) If an advanced practice registered nurse changes the
nurse's primary state of residence by moving between two party
states, and obtains an advanced practice registered nurse license or
authority to practice from the new home state, the advanced practice
registered nurse license or authority to practice from the former
home state is no longer valid.
(2) If an advanced practice registered nurse changes the nurse's
primary state of residence by moving from a nonparty state to a party
state, and obtains an advanced practice registered nurse license or
authority to practice from the new home state, the individual state
license issued by the nonparty state is not affected and shall remain
in full force if so provided by the laws of the nonparty state.
(3) If an advanced practice registered nurse changes the nurse's
primary state of residence by moving from a party state to a nonparty
state, the advanced practice registered nurse license or authority to
practice issued by the prior home state converts to an individual
state license, valid only in the former home state, without the
multistate licensure privilege to practice in other party states.
5. Article V -- Adverse actions. In addition to the general
provisions described in article III, the following provisions apply:
a. The licensing board of a remote state shall promptly
report to the administrator of the coordinated licensure information
system any remote state actions, including the factual and legal
basis for such action, if known. The licensing board of a remote
state shall also promptly report any significant current
investigative information yet to result in a remote state action.
The administrator of the coordinated licensure information system
shall promptly notify the home state of any such reports.
b. The licensing board of a party state shall have the
authority to complete any pending investigations for an advanced
practice registered nurse who changes the nurse's primary state of
residence during the course of such investigations. It shall also
have the authority to take appropriate action and shall promptly
report the conclusions of such investigations to the administrator of
the coordinated licensure information system. The administrator of
the coordinated licensure information system shall promptly notify
the new home state of any such actions.
c. A remote state may take adverse action affecting the
multistate advanced practice privilege to practice within that party
state. However, only the home state shall have the power to impose
adverse action against the advanced practice registered nurse license
or authority to practice issued by the home state.
d. For purposes of imposing adverse action, the licensing
board of the home state shall give the same priority and effect to
reported conduct received from a remote state as it would if such
conduct had occurred within the home state. In so doing, it shall
apply its own state laws to determine appropriate action.
e. The home state may take adverse action based on the
factual findings of the remote state, so long as each state follows
its own procedures for imposing such adverse action.
f. Nothing in this compact shall override a party state's
decision that participation in an alternative program may be used in
lieu of adverse action and that such participation shall remain
nonpublic if required by the party state's laws. Party states must
require advanced practice registered nurses who enter any alternative
programs to agree not to practice in any other party state during the
term of the alternative program without prior authorization from such
other party state.
g. All home state licensing board disciplinary orders, agreed
to or otherwise, which limit the scope of the advanced practice
registered nurse's practice or require monitoring of the advanced
practice registered nurse as a condition of the order shall include
the requirements that the advanced practice registered nurse will
limit the nurse's practice to the home state during the pendency of
the order. This requirement may allow the advanced practice
registered nurse to practice in other party states with prior written
authorization from both the home state and party state licensing
boards.
6. Article VI -- Additional authorities invested in party state
licensing boards. Notwithstanding any other powers, party state
licensing boards shall have the authority to do all of the following:
a. If otherwise permitted by state law, recover from the
affected advanced practice registered nurse the costs of
investigations and disposition of cases resulting from any adverse
action taken against that advanced practice registered nurse.
b. Issue subpoenas for both hearings and investigations which
require the attendance and testimony of witnesses, and the production
of evidence. Subpoenas issued by a licensing board in a party state
for the attendance and testimony of witnesses, or the production of
evidence from another party state, shall be enforced in the latter
state by any court of competent jurisdiction, according to the
practice and procedure of that court applicable to subpoenas issued
in proceedings pending before it. The issuing authority shall pay
any witness fees, travel expenses, mileage, and other fees required
by the service statutes of the state where the witnesses or evidence
is located.
c. Issue cease and desist orders to limit or revoke an
advanced practice registered nurse's privilege, license, or authority
to practice in the state.
d. Promulgate uniform rules and regulations as provided for
in article VIII, paragraph "c".
7. Article VII -- Coordinated licensure information system.
a. All party states shall participate in a cooperative effort
to create a coordinated database of all advanced practice registered
nurses. This system shall include information on the advanced
practice registered nurse licensure and practice requirements and
disciplinary history of each advanced practice registered nurse, as
contributed by party states, to assist in the coordination of the
advanced practice registered nurse licensure or authority to practice
and enforcement efforts.
b. Notwithstanding any other provision of law, all party
states' licensing boards shall promptly report adverse actions,
actions against multistate advanced practice privileges, any current
significant investigative information yet to result in adverse
action, denials of applications, and the reasons for such denials, to
the coordinated licensure information system.
c. Current significant investigative information shall be
transmitted through the coordinated licensure information system only
to party state licensing boards.
d. Notwithstanding any other provision of law, all party
states' licensing boards contributing information to the coordinated
licensure information system may designate information that shall not
be shared with nonparty states or disclosed to other entities or
individuals without the express permission of the contributing state.
e. Any personally identifiable information obtained by a
party state's licensing board from the coordinated licensure
information system shall not be shared with nonparty states or
disclosed to other entities or individuals except to the extent
permitted by the laws of the party state contributing the
information.
f. Any information contributed to the coordinated licensure
information system that is subsequently required to be expunged by
the laws of the party state contributing that information shall also
be expunged from the coordinated licensure information system.
g. The compact administrators, acting jointly with each other
and in consultation with the administrator of the coordinated
licensure information system, shall formulate necessary and proper
procedures for the identification, collection, and exchange of
information under this compact.
8. Article VIII -- Compact administration and interchange of
information.
a. The head of the licensing board, or the head's designee,
of each party state shall be the administrator of this compact for
the head's state.
b. The compact administrator of each party state shall
furnish to the compact administrator of each other party state any
information and documents including but not limited to a uniform data
set of investigations, identifying information, licensure data, and
disclosable alternative program participation information to
facilitate the administration of this compact.
c. Compact administrators shall have the authority to develop
uniform rules to facilitate and coordinate implementation of this
compact. These uniform rules shall be adopted by party states, under
the authority invested under article VI, paragraph "d".
9. Article IX -- Immunity. A party state or the officers or
employees or agents of a party state's licensing board who act in
accordance with the provisions of this compact shall not be liable on
account of any act or omission in good faith while engaged in the
performance of their duties under this compact. Good faith in this
article shall not include willful misconduct, gross negligence, or
recklessness.
10. Article X -- Entry into force, withdrawal, and amendment.
a. This compact shall enter into force and become effective
as to any state when it has been enacted into the laws of that state.
Any party state may withdraw from this compact by enacting a statute
repealing the same, but such withdrawal shall not take effect until
six months after the withdrawing state has given notice of the
withdrawal to the executive heads of all other party states.
b. Withdrawal shall not affect the validity or applicability
by the licensing boards of states remaining party to the compact of
any report of adverse action occurring prior to the withdrawal.
c. This compact shall not be construed to invalidate or
prevent any advanced practice registered nurse licensure or authority
to practice agreement or other cooperative arrangement between a
party state and a nonparty state that is made in accordance with the
other provisions of this compact.
d. This compact may be amended by the party states. An
amendment to this compact shall not become effective and binding upon
the party states unless and until it is enacted into the laws of all
party states.
11. Article XI -- Construction and severability.
a. This compact shall be liberally construed so as to
effectuate the purposes of the compact. The provisions of this
compact shall be severable and if any phrase, clause, sentence, or
provision of this compact is declared to be contrary to the
constitution of any party state or of the United States, or the
applicability of the compact to any government, agency, person, or
circumstance is held invalid, the validity of the remainder of this
compact and the applicability of the compact to any government,
agency, person, or circumstance shall not be affected by that action.
If this compact shall be held contrary to the constitution of any
state which is party to the compact, the compact shall remain in full
force and effect as to the remaining party states and in full force
and effect as to the party state affected as to all severable
matters.
b. (1) In the event party states find a need for settling
disputes arising under this compact, the party states may submit the
issues in dispute to an arbitration panel which shall be comprised of
an individual appointed by the compact administrator in the home
state, an individual appointed by the compact administrator in the
remote state or states involved, and an individual mutually agreed
upon by the compact administrators of all the party states involved
in the dispute.
(2) The decision of a majority of the arbitrators shall be final
and binding. Section History: Recent Form
2005 Acts, ch 53, §9; 2007 Acts, ch 22, §38; 2008 Acts, ch 1032,
§201
Referred to in § 147.2, 147.5, 147.7, 152.6, 152.7, 152.8, 152.10,
152E.2, 272C.6