Assuming the NH Board of Nursing's implementation efforts go smoothly, effective January 1, 2006, New Hampshire will be a participating member of the interstate Nurse Licensure Compact.
The creation of multi-state health care delivery systems and the increasing use of nurses for telephone triage and other "tele-nursing" functions crossing state lines have demonstrated the limitations of the current state-by-state nurse licensure system. Under the current system, a nurse is licensed in the state where he or she practices and cannot serve patients across the state border without seeking endorsement in the neighboring state, paying a fee, and receiving a second license in that state. The Nurse Licensure Compact is designed to reduce duplicative licensure requirements, enhance information sharing among the state nursing boards, and establish mechanisms for disciplinary actions in connection with interstate nursing.
An interstate compact is created when two or more states enact identical laws dealing with a particular subject matter. Utah was the first state to adopt the Nurse Licensure Compact in 1998. Since then at least 17 additional states have joined. In the 2004 legislative session, the New Hampshire legislature adopted Senate Bill 153, paving the way for New Hampshire to become a member of the Compact. Problems with the 2004 legislation surfaced when the Compact refused to permit NH to join because New Hampshire's enacting legislation was not identical to that of the other Compact states. The New Hampshire legislation required nurses licensed in Compact states to undergo a NH criminal background check before their licenses would be honored. In the 2005 session, the New Hampshire legislature enacted Senate Bill 170, which (among other things) dropped the criminal background check requirement, paving the way for New Hampshire's admission to the Compact.
Here is a brief summary of the Nurse Licensure Compact and some additional changes to the New Hampshire Nurse Practice Act brought about by the passage of Senate Bill 170:
Nurse Licensure Compact
The Compact has been codified as a part of the New Hampshire Nurse Practice Act and can be found at New Hampshire RSA 326-B:46. The Compact provides for reciprocity of licensure and disciplinary findings amongst the various states that are members of the Compact. Currently, member states include: Arizona, Arkansas, Delaware, Idaho, Iowa, Maine, Maryland, Mississippi, Nebraska, New Mexico, North Carolina, North Dakota, South Dakota, Tennessee, Texas, Utah, Virginia, and Wisconsin. Implementation of the Compact is pending in New Hampshire and New Jersey. The New Hampshire Board of Nursing anticipates that New Hampshire will be ready for full implementation by January 1, 2006.
Under the Compact, a nurse who is licensed in a Compact state may practice nursing in all other party states without having to obtain a license in each state. The nurse only receives one license — from the state in which he or she resides (the "Residency State"). By virtue of the Compact, every other Compact state must grant the nurse the privilege to practice in its state as long as the nurse's license in the Residency State is in good standing.
A nurse licensed in a Compact state must still comply with the laws and regulations of the state in which he or she is practicing. For example, a nurse whose Residency State is Utah must still comply with the New Hampshire Nurse Practice Act and the regulations of the New Hampshire Board of Nursing if he or she is practicing in New Hampshire, and it is up to each individual nurse to inform him or herself of the rules and regulations of the state in which he or she is practicing.
Discipline
Both the Residency State and the state where the patient is located at the time a violation occurs may take disciplinary action. Complaints received in a non-Residency State about violations of that state's laws or rules will be processed in the state in which the violation is alleged to have occurred. Any action taken by the non-Residency State board of nursing will be reported back to the Residency State, and a computerized database enables all Compact states to share licensure and discipline information. Because of the adoption of the Compact, RSA 326-B:38, XIV was amended to provide that sanctions for discipline in another Compact state cannot be challenged in New Hampshire. Additionally, if New Hampshire chooses to impose its own, additional sanctions for the same conduct it must provide the nurse in question with adequate notice and an opportunity for a hearing.
The revised Nurse Practice Act also broadens the Board of Nursing's authority to subpoena records to include, in addition to health care records, employment records and academic records. And under the new version of RSA 326-B:30, a nurse now has an affirmative duty to report to the Board any acts or omissions that constitute grounds for disciplinary action.
Scope of Practice
The amended Nurse Practice Act (sections 326-B:11 through 326-B:14) outlines very specifically the professional responsibilities that accompany each level of nursing, from the Advanced Registered Nurse Practitioner through the Licensed Nursing Assistant. The Act now clearly states tasks that may and may not be performed under each type of license, creating a hierarchy of authority and responsibility. In addition, Section 326-B:28 now authorizes Registered Nurses and Licensed Practical Nurses to delegate nursing tasks in certain situations and under the rules of the Board.
Conclusion
Backers of the Nurse Licensure Compact hope that it will improve access to skilled nursing care by providing greater mobility for nurses. In addition, the adoption of the Compact should clarify the authority of nurses to practice "tele-nursing" across state lines and should ease restrictions on nurses practicing in multi-state healthcare delivery systems. Hopefully, as the Compact is adopted in more states, it will also provide improved access to licensed nurses during a disaster or other time of great need for nursing services. Finally, improved information sharing among the Compact states should offer better protection to the public by enabling the state boards of nursing to better track unsafe providers and to better monitor patterns of behavior.
This article is intended to serve as a summary of the issues outlined herein. While it may include some general guidance, it is not intended as, nor is it a substitute for, legal advice. Your receipt of Good Company or any of its individual articles does not create an attorney-client relationship between you and Sheehan Phinney Bass + Green or the Sheehan Phinney Capitol Group. The opinions expressed in Good Company are those of the authors of the specific articles.
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