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Position
Statement on Multi-State Licensure
BACKGROUND
In most areas of the United States of America,
access to the specialized care, education and support for the person with Spinal
Cord Impairment (SCI) is not available in the local community. The
Patient-Consumer must travel to a medical center that specializes in the
rehabilitation of this catastrophic insult. Advancements in telecommunication
technologies using: computers, telephones, interactive video and other
electronic devices, make it possible to bring personalized care to the
patient-consumer.
Currently, treatment for SCI is received at a
rehabilitation center of specialization and excellence. The SCI Patient-Consumer
is discharged home, often crossing a state line. The Registered Nurse, having
provided the patient assessment, a specialized education, the implementation of
care for altered functions and problem solving strategies is not legally
permitted to answer SCI related questions for the patient, family, or
caretakers. To be legally available to the patient with SCI, the Nurse must
possess a Nursing License in the same state, in which the patient lives. State
laws which were put into effect to protect the patient are in fact causing a
disservice to the patient by preventing them from using currently available
technological services which would increase the quality of their health care,
decrease the personal cost of care and decrease the probability of
complications.
Most State Laws have not been updated to reflect
the advancement in health care delivery. Patient-Consumers cross State Lines to
receive care. Caregivers (Nurses) should be allowed to provide on-going
consultation and care for these patients.
A solution for this problem of appropriate care
delivery is state adoption of a mutual recognition of Nursing Licenses; similar
to a Driver ’s
License. This allows the Nurse to follow patient care across State Lines. The
AASCIN understands the concerns the States, Registered Nurses and Patients with
SCI have about the model.
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The differences between the
individual State’s regulations.
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Will weaken the standards of some states?
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Will weaken the individual State Boards of
Nursing?
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Will States lose revenue and have to raise
licenser fees?
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The ability to maintain or improve
the protection of the public.
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Will a state know who is practicing within its
borders?
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The possibility of dual disciplinary
measures taken against a nurse by the state of licensure and/or the state of
practice.
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Will there be an overwhelming inability for a
nurse to defend herself in one or more states?
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Will this increase the burden of investigating
complaints against nurses?
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The maintenance of a nationally
centralized database.
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Will confidentiality be maintained as it pertains
to a centralized database?
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How will this be funded?
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The funding of the compact
administration
The States Boards of Nursing are also aware of
these and other problems associated with Nursing Licensing in multiple States.
Their professional organization, the National Counsel for State Boards of
Nursing (NCSBN) created a task force to study telehealth and licensure. They
endorsed the concept of a mutual recognition model for the regulation of
interstate licensure.
In the Mutual Recognition Model the nurse is held
accountable for the nursing practice laws and other regulations in the state
where the nurse provides the services, while not being required to obtain a
license, in states that join the compact.
The AASCIN believes each state has the right to
legislate the Scope of Nursing Practice within their borders.
The AASCIN believes that the mutual recognition
model does not circumvent the States rights but does in fact stimulate States to
review their practice.
The AASCIN believes that technologies such as the
phone, computer and interactive video should be used to supply health care
information, teaching materials and specialized nursing advice.
The AASCIN believes that technologies such as the
phone, computer and interactive video can be used to improve the quality of
health care while reducing the cost of health care by preventing complications
and unnecessary hospital admissions.
The AASCIN feels that follow-up (for continuity of
care or specialty information) via telephone, computer, and video should be
allowed regardless of the care giver’s
or patient’s state
of residence.
AASCIN supports multi-state licensure in order to
provide persons with SCI impairments access to SCI specialty nursing they might
otherwise not receive.
AASCIN supports the opportunity multi-state
licensure would provide a person with SCI to obtain education and services.
The AASCIN endorses the concept of a mutual
recognition model.
References
House Bill 1342
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Bill Text
- "Nurse
Licensure Compact",
11-06-98
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www.ncsbn.org/files/mutual/compact.asp
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"Nursing
Regulation for the New Millennium: The Mutual Recognition Model",
Carolyn Hutcherson, MS, RN and Susan H. Williamson, MPH, RN, 5-31-99,
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www.nursingworld.org/ojin/topic9/topic9_2.htm
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"The
Regulatory Dilemma Surrounding Interstate Practice",
Terri Gaffney, MPA, RN, 5-31-99,
www.nursingworld.org/ojin/topic9/topic9_1.htm
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"Position
Statement of American Nurses Association’s Board of Directors on the Nurse
Licensure Compact",
2-17-99
- NCSBN’s
FAQs,
www.ncsbn.org/files/mutual/mrfaq.asp
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- NCBSN’s
"Response to ANA House of Delegates Regarding Mutual Recognition and the
Interstate Compact", National Council Paper, 6-9-99
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www.ncsbn.org/files/mutual/ana990609.asp
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NCSBN,
"Continuum of Models for
Regulating Multistate Nursing Practice"
- "Telepractice
and Professional Licensing: A Guide for Legislators"
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www.clearhq.org/teleguide.htm.
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- "Multistate
Licensure: Premature Policy", Susan E. King, MS RN, 5-31-99,
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www.nursingworld.org/ojin/topic9/topic9_3.htm
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"1999
State Legislative Trends",
APRN, 5-17-99
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www.nursingworld.org/gova/state/hod99/aprn.htm
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"ANA
Response to Pew Commission Report"
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www.nursingworld.org/readroom/pew.htm
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"An
Overview of State Laws and Approaches to Minimize Licensure Barriers",
Linda Gobis, RN, FNP, JD
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www.telemedtoday.com/mainpages/statelaw.htm
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ANA Policy Series:
"Telehealth -- Issues for
Nursing",
10-09-96
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www.nursingworld.org/readroom/tele2.htm
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"ANA
Multistate Regulation of Nurses - Backgrounder",
June 24, 1998
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www.nursingworld.org/gova/multibg.htm
(Approved 12/2000) |
