32-1668

32-1668. Nurse licensure compact

This state enacts the nurse licensure compact dated November 6, 1998 as follows:

ARTICLE I

Findings and Declaration of Purpose

A. The party states find that:

1. The health and safety of the public are affected by the degree of compliance
with and the effectiveness of enforcement activities related to state nurse licensure
laws;

2. Violations of nurse licensure and other laws regulating the practice of nursing
may result in injury or harm to the public;

3. The expanded mobility of nurses and the use of advanced communication
technologies as part of our nation's healthcare delivery system require greater
coordination and cooperation among states in the areas of nurse licensure and regulation;

4. New practice modalities and technology make compliance with individual state
nurse licensure laws difficult and complex;

5. The current system of duplicative licensure for nurses practicing in multiple
states is cumbersome and redundant to both nurses and states.

B. The general purposes of this compact are to:

1. Facilitate the states' responsibility to protect the public's health and safety;

2. Ensure and encourage the cooperation of party states in the areas of nurse
licensure and regulation;

3. Facilitate the exchange of information between party states in the areas of
nurse regulation, investigation and adverse actions;

4. Promote compliance with the laws governing the practice of nursing in each
jurisdiction;

5. Invest all party states with the authority to hold a 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.

article ii

Definitions

As used in this compact:

A. "Adverse action" means a home or remote state action.

B. "Alternative program" means a voluntary, non-disciplinary monitoring program
approved by a nurse licensing board.

C. "Coordinated licensure information system" means an integrated process for
collecting, storing, and sharing information on nurse licensure and enforcement
activities related to nurse licensure laws, which is administered by a non-profit
organization composed of and controlled by state nurse licensing boards.

D. "Current significant investigative information" means:

1. Investigative information that a licensing board, after a preliminary inquiry
that includes notification and an opportunity for the 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; or

2. Investigative information that indicates that the nurse represents an immediate
threat to public health and safety regardless of whether the nurse has been notified and
had an opportunity to respond.

E. "Home state" means the party state which is the nurse's primary state of
residence.

F. "Home state action" means any administrative, civil, equitable or criminal
action permitted by the home state's laws which are imposed on a nurse by the home
state's licensing board or other authority including actions against an individual's
license such as: revocation, suspension, probation or any other action which affects a
nurse's authorization to practice.

G. "Licensing board" means a party state's regulatory body responsible for issuing
nurse licenses.

H. "Multistate licensure privilege" means current, official authority from a remote
state permitting the practice of nursing as either a registered nurse or a licensed
practical/vocational nurse in such party state. All party states have the authority, in
accordance with existing state due process law, to take actions against the nurse's
privilege such as: revocation, suspension, probation or any other action which affects a
nurse's authorization to practice.

I. "Nurse" means a registered nurse or licensed practical/vocational nurse, as
those terms are defined by each party's state practice laws.

J. "Party state" means any state that has adopted this compact.

K. "Remote state" means a party state, other than the home state:

1. Where the patient is located at the time nursing care is provided, or,

2. In the case of the practice of nursing not involving a patient, in such party
state where the recipient of nursing practice is located.

l. "Remote state action" means:

1. Any administrative, civil, equitable or criminal action permitted by a remote
state's laws which are imposed on a nurse by the remote state's licensing board or other
authority including actions against an individual's multistate licensure privilege to
practice in the remote state, and

2. Cease and desist and other injunctive or equitable orders issued by remote
states or the licensing boards thereof.

M. "State" means a state, territory, or possession of the United States, the
District of Columbia or the Commonwealth of Puerto Rico.

N. "State practice laws" means those individual party's state laws and regulations
that govern the practice of nursing, define the scope of nursing practice, and create the
methods and grounds for imposing discipline. "State practice laws" does not include the
initial qualifications for licensure or requirements necessary to obtain and retain a
license, except for qualifications or requirements of the home state.

article III

General Provisions and Jurisdiction

A. A license to practice registered nursing issued by a home state to a resident in
that state will be recognized by each party state as authorizing a multistate licensure
privilege to practice as a registered nurse in such party state. A license to practice
licensed practical/vocational nursing issued by a home state to a resident in that state
will be recognized by each party state as authorizing a multistate licensure privilege to
practice as a licensed practical/vocational nurse in such party state. In order to obtain
or retain a license, an applicant must meet the home state's qualifications for licensure
and license renewal as well as all other applicable state laws.

B. Party states may, in accordance with state due process laws, limit or revoke the
multistate licensure privilege of any nurse to practice in their state and may take any
other actions under their applicable state laws necessary to protect the health and
safety of their citizens. If a party state takes such action, it 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.

C. Every 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 rendered. In addition,
the practice of nursing is not limited to patient care, but shall include all nursing
practice as defined by the state practice laws of a party state. The practice of nursing
will subject a nurse to the jurisdiction of the nurse licensing board and the courts, as
well as the laws, in that party state.

D. This compact does not affect additional requirements imposed by states for
advanced practice registered nursing. However, a multistate licensure privilege to
practice registered nursing granted by a party state shall be recognized by other party
states as a license to practice registered nursing if one is required by state law as a
precondition for qualifying for advanced practice registered nurse authorization.

E. Individuals not residing in a party state shall continue to be able to apply for
nurse licensure as provided for under the laws of each party state. However, the license
granted to these individuals will not be recognized as granting the privilege to practice
nursing in any other party state unless explicitly agreed to by that party state.

article iv

Applications for Licensure in a Party State

A. Upon application for a license, the licensing board in a party state shall
ascertain, through the coordinated licensure information system, whether the applicant
has ever held, or is the holder of, a license issued by any other state, whether there
are any restrictions on the multistate licensure privilege, and whether any other adverse
action by any state has been taken against the license.

B. A nurse in a party state shall hold licensure in only one party state at a time,
issued by the home state.

C. A nurse who intends to change primary state of residence may apply for licensure
in the new home state in advance of such change. However, new licenses will not be issued
by a party state until after a nurse provides evidence of change in primary state of
residence satisfactory to the new home state's licensing board.

D. When a nurse changes primary state of residence by:

1. Moving between two party states, and obtains a license from the new home state,
the license from the former home state is no longer valid;

2. Moving from a non-party state to a party state, and obtains a license from the
new home state, the individual state license issued by the non-party state is not
affected and will remain in full force if so provided by the laws of the non-party state;

3. Moving from a party state to a non-party state, the license 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.

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 a nurse who changes primary state of residence during the
course of such investigations. It shall also have the authority to take appropriate
action(s), 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 licensure
privilege to practice within that party state. However, only the home state shall have
the power to impose adverse action against the license 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 licensure action and that
such participation shall remain non-public if required by the party state's laws. Party
states must require 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.

article vi

Additional Authorities Invested in Party

State Nurse Licensing Boards

Notwithstanding any other powers, party state nurse licensing boards shall have the
authority to:

A. If otherwise permitted by state law, recover from the affected nurse the costs
of investigations and disposition of cases resulting from any adverse action taken
against that 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 nurse licensing board in a party state for the attendance and testimony of
witnesses, and/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 and/or evidence are
located.

C. Issue cease and desist orders to limit or revoke a nurse's authority to practice
in their state;

D. Promulgate uniform rules and regulations as provided for in article VIII(c).

article vii

Coordinated Licensure Information System

A. All party states shall participate in a cooperative effort to create a
coordinated database of all licensed registered nurses and licensed practical/vocational
nurses. This system will include information on the licensure and disciplinary history of
each nurse, as contributed by party states, to assist in the coordination of nurse
licensure and enforcement efforts.

B. Notwithstanding any other provision of law, all party states' licensing boards
shall promptly report adverse actions, actions against multistate licensure 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 may not be shared with non-party 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 states' licensing
board from the coordinated licensure information system may not be shared with non-party
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.

ARTICLE viii

Compact Administration and Interchange of Information

A. The head of the nurse licensing board, or his/her designee, of each party state
shall be the administrator of this compact for his/her 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 (d).

article ix

Immunity

No party state or the officers or employees or agents of a party state's nurse
licensing board who acts in accordance with the provisions of this compact shall 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.

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 no such withdrawal shall 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. No withdrawal shall 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. Nothing contained in this compact shall be construed to invalidate or prevent
any nurse licensure agreement or other cooperative arrangement between a party state and
a non-party state that is made in accordance with the other provisions of this compact.

D. This compact may be amended by the party states. No amendment to this compact
shall become effective and binding upon the party states unless and until it is enacted
into the laws of all party states.

article xi

Construction and Severability

A. This compact shall be liberally construed so as to effectuate the purposes
thereof. 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 thereof to any government,
agency, person or circumstance is held invalid, the validity of the remainder of this
compact and the applicability thereof to any government, agency, person or circumstance
shall not be affected thereby. If this compact shall be held contrary to the constitution
of any state party thereto, 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. In the event party states find a need for settling disputes arising under this
compact:

1. The party states may submit the issues in dispute to an arbitration panel which
will 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(s)
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.