Discussion 2: Multistate Regulation
Regulation refers to the implementation of rules, as established by law by a regulatory body; in nursing state practice acts are implemented by respective state boards of nursing (Loversidge, 2021). The Nurse Licensure Compact (NLC) as adopted by the National council of State Boards of Nursing (NCSBN) is the present framework for multi-state regulation of the nursing profession. The NLC allows nurses to be licensed in one home state while concurrently having the flexibility to practice in any other state whose legislature and Board of Nursing has passed and implemented the compact (NCSBN, 1998). The NLC was originally adopted in 1997 and received a comprehensive update in 2015 that included addition of an APRN compact model (NCSBN, 2017). Currently, 38 states have at least partial implementation of the NLC for RNs (NCSBN, 2021a), but only North Dakota and Delaware have adopted APRN compact legislation (NCSBN, 2021b).
There are numerous advantages of implementation of multistate regulation for APRNs for both patients and practitioners. First, APRN compact legislation allows APRNs to practice unencumbered among member states while allowing states to retain full autonomy and authority of their respective nurse practice acts (NCSBN, 2021c). This is advantageous to APRNs, ensuring portability of licensure and certification. Compact legislation also eliminates redundant regulatory processes and unnecessary fees. Ensuring portability of licensure for APRNS allows them to fulfill their original purpose; to meet the increased demand for healthcare in the face of a shortage of physicians (Loversidge, 2021). As remote delivery of health services becomes more common, the ability for practitioners to work across state lines using telehealth will become a significant benefit for all parties (Oyeleye, 2019). Fluid, regional needs for healthcare are best met by a highly mobile workforce.
APRNs with the flexibility to practice across state lines poses a boon for healthcare consumers by providing increased access to primary care services. In addition, multi state regulation may enhance disaster preparedness response in emergent conditions by eliminating regulatory barriers to practice (NCSBN, 2021c). While redundant regulatory barriers are removed, the APRN compact model actually facilitates public protection in cases of adverse actions and events, by facilitating interstate investigations and sharing of information (NCSBN, 2021c).
One potential disadvantage of Compact licensure for APRNs is the reality that increased privileges carry increased risk. A practitioner who is being investigated or disciplined in one compact state would be unable to practice in any compact state until the issue was resolved (Oyeleye, 2019). Another potential disadvantage to healthcare consumers would be the potential for practitioners to have less continuing education. If a practitioner from a home state with scant requirements for continuing education were in a state with more robust requirements, the compact license would allow them to practice without meeting the requirements (OPPAGA, 2006). Similarly, background check requirements may not be met by providers who have a home state with less stringent requirements (OPPAGA, 2006). These problems do create an healthcare system where there is potential for patients to not receive care from practitioners who have met the full requirements of practice in their state.
Ultimately, it appears that for both patients and NPs, multistate licensure would be a net positive. Widespread adoption of the APRN compact model would enable greater flexibility of NPs to practice in person and through telehealth to meet the burgeoning needs of underserved populations. Though the argument can be made that patients in states with more stringent requirements may be short-changed with less prepared providers, it is hard to argue that a provider who does meet the appropriate requirements in one state is unfit for practice in another. In fact, the NCSBN has already proposed a consensus model for APRN licensure that would negate this issue entirely (NCSBN, 2008). The enhanced portability of credentials and licensure that a multi state regulatory model would provide for APRNs would be a major benefit to the profession, and ought to be an active legislative priority for all APRNs and students. The NCSBN and FNA both provide avenues to become involved in legislative advocacy to remove unnecessary hindrances and barriers to practice for NPs across state borders.
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