Update on Nurse Licensure Issues Impacting Telehealth

2007 ATA Annual MeetingKristin Hellquist, National Council of State Boards of Nursing (NCSBN)

Barriers/Challenges to Interstate Nurse Licensure

• Nurse licensure is required for practice both physically and electronically in the state or territory where the patient is located (with few exceptions)

• Nurse licensure is more alike than different, but differences in uniform core licensure requirements perpetuate barriers to interstate licensing {notably CBCs}

• Challenges to NLC from stakeholders

Nurse Licensure Compact (NLC)

• Modeled after the Drivers License Compact

• 20 states currently participating

• 2 states awaiting implementation (KY & CO)

• NLC administered by the Nurse Licensure Compact Administrators (NLCA)—NCSBN is secretariat for the NLCA

Outlook for NLC in 2007

• Legislation pending in PA, MA, RI, NV, & IN

• Legislation died this session (WY & MT)

• New Attorney General Opinion in LA (mirrors KS’ earlier opinion)

Supporters for NLC

• NLC Supporters• Emergency Nurses Association• American Organization of Nurse Executives• American Association of Occupational Health

Nurses• Citizen’s Advocacy Center• Several state nurse and hospital associations• American Nephrology Nurses Association

More Supporters for NLC

• NLC Supporters• American Telemedicine Association• Case Management Leadership Coalition• Case Management Society of America• Center for Telemedicine• Telehealth Leadership Coalition• U.S. Department of Commerce [1]•

[1] The U.S. Department of Commerce supported the NLC in speech to the American Telemedicine Association in 2003 and formally recognized NLC

2006 Gallup Research on NLC

Key positive findings• NLCA found tremendous value in belonging to the

NLC, citing increased collaboration among regulators, and as a benefit to their publics.

• Nurses overwhelmingly supported the idea of all states belonging to the NLC.

• Increasing mobility by nurses, which gives better access to nurses in times of disaster or other need.

• Many BoNs believed that the NLC sped up hiring processes and allowed for rapid licensure verification.

2006 Gallup Research on NLC

Opportunities for improvement• Improve communication regarding operations, administration and

the costs associated with joining and maintaining the NLC. • More information regarding discipline, investigations and data

sharing in the NLC. • Increase education to Board of Nursing staff, licensed nurses and

other stakeholders regarding. (A survey finding correlated to this request was that 50% of surveyed nurses erroneously thought they were part of the NLC, even though they did not reside in a NLC state).

• Information regarding Nursys (NLC coordinated nurse licensure database). Specific to duplicative records, frequency of data submissions and the number of boards participating.

Criminal Background Checks (CBCs) for Nurses

• States that conduct FBI-fingerprint based CBCs: AK, AR, AZ, CA, FL, ID, IL , LA, MO, NV, NH, NJ, NM, NC, OH, UT & WY

• States in process of implementing: MD & SD

• States pursuing the statutory authority: DC, Guam, KS

• States that do other types of CBCs: IA, KY, MA, MI, MS, WA

Nurse Licensure Portability Grant (recipient: NCSBN)

• OAT established this grant to provide support for nurse licensing boards to carry out programs for boards of nursing to cooperate, develop and implement state policies that will reduce statutory and regulatory barriers to telemedicine.

Specifics to NCSBN’s Grant Project

• Adopt Nurse Licensure Compact (NLC)• Promote Adoption of Criminal Background

Checks (CBCs) especially FBI fingerprint checks

• Increase knowledge of NLC & CBCs for boards of nursing

• Address barriers to nurse licensure portability (by exploring feasibility of sharing FBI-CBCs by boards of nursing & assessing nurse union position on NLC

Specifics to NCSBN’s Grant Project

• Develop standardized tool to evaluate the costs of implementing NLC and CBCs

• Educate and convene ‘umbrella boards’ interested in pursuing CBCs

• Award contract funds to eligible state boards of nursing to defray implementation costs of NLC and CBCs

Vision for Grant

• That all non-NLC boards of nursing explore the Nurse Licensure Compact, and the benefits it could bring to their state and nurses regarding licensure portability.

• That all states not conducting federal FBI fingerprint based CBCs on their licensure applicants consider this as a means of better protecting their publics and moving toward uniform core licensure standards in the U.S.

Work at NGA Center for Best Practices

• Health Care Practice Task Force (part of their Committee on e-health) has been looking at licensure models.

• The group has invited NCSBN, FSMB and NABP to speak about models of licensure (i.e., the NLC and single state model) and discuss initiatives to streamline licensure processes.

Work with ATA’s SIG for Nursing

• Participate with the Nursing SIG on development of a telenursing position statement.

• The practice of nursing over distance using telecommunications technology (NCSBN, 1997 Delegate Assembly).

• Nursing SIG formally supports the NLC

Contact information

• Kristin Hellquist, NCSBN at khellquist@ncsbn.org

• www.ncsbn.org (click on Nurse Licensure Compact tab)