December 8, 2005, Introduced by Reps. Stakoe, Baxter, Hildenbrand, Vander Veen, Garfield, Pastor, Shaffer, Elsenheimer, Sheltrown, Amos, Wenke, David Law, Jones, Booher, Hansen, Green, Proos, Emmons, Nitz, Casperson, Gosselin, Hune, Kolb, Farrah, Huizenga, Wojno, Polidori, Byrnes, Accavitti, Lipsey, Taub, Stahl, Gaffney, Whitmer, Caswell, Mortimer, Rocca, Hoogendyk, Acciavatti, LaJoy and Marleau and referred to the Committee on Health Policy.
A bill entering into the nurse licensure compact.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
NURSE LICENSURE COMPACT
ARTICLE I. FINDINGS AND PURPOSES
The party states find that:
a. 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.
b. Violations of nurse licensure and other laws regulating the
practice of nursing may result in injury or harm to the public.
c. The expanded mobility of 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 nurse licensure and regulation.
d. New practice modalities and technology make compliance with
individual state nurse licensure laws difficult and complex.
e. The current system of duplicative licensure for nurses
practicing in multiple states is cumbersome and redundant to both
nurses and states.
The general purposes of this compact are to:
a. Facilitate the states' responsibility to protect the
public's health and safety.
b. Ensure and encourage the cooperation of party states in the
areas of nurse licensure and regulation.
c. Facilitate the exchange of information between party states
in the areas of nurse regulation, investigation, and adverse
actions.
d. Promote compliance with the laws governing the practice of
nursing in each jurisdiction.
e. 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, nondisciplinary
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 nonprofit organization
composed of and controlled by state nurse licensing boards.
d. "Current significant investigative information" means
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 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 nurse in a 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
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, where the patient is located at the time nursing care is
provided, or, in the case of the practice of nursing not involving
a patient, in a party state where the recipient of nursing practice
is located.
l. "Remote state action" means 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
cease and desist and other injunctive or equitable orders issued by
remote states or the licensing boards of the remote states.
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.
o. "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 a party state. A license to practice
licensed practical 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
nurse in a 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 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 the
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 nonparty state to a party state, and obtains
a license from the new home state, the individual state license
issued by the nonparty state is not affected and will remain in
full force if so provided by the laws of the nonparty state.
3. Moving from a party state to a nonparty 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, and shall promptly report the conclusions of
the 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 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 that
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 participation shall remain
nonpublic 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 the other
party state.
ARTICLE VI. ADDITIONAL AUTHORITIES
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, or
the production of evidence from another party state, or both, 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, or both, is located.
c. Issue cease and desist orders to limit or revoke a nurse's
authority to practice in his or her 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 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 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
states' licensing board from the coordinated licensure information
system may 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.
ARTICLE VIII. COMPACT ADMINISTRATION AND INTERCHANGE OF INFORMATION
a. The head of the nurse licensing board of each party state,
or his or her designee, shall be the administrator of this compact
for his or 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 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 a 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. 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 nonparty 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 of this 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 thereof to any government, agency, person, or
circumstance is held invalid, the validity of the remainder of this
compact and the applicability of this compact to any government,
agency, person, or circumstance shall not be affected. If this
compact shall be held contrary to the constitution of any state
party to this 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. 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
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.