Guest Author - Colleen Moore, RN
The role of the registered nurse is in the process of changing. Advances in technology, the decreasing number of RN’s in the workforce and the involvement of patients in their care are the driving force of many of these changes.
The time has come to examine the need for nurse’s to be able to practice in multiple states. There are pros and cons of both National Licensure and State Licensure.
The pros for state regulation of nursing licensure can easily be defined. Licensure is much easier to regulate on a small scale, especially disciplinary actions and fraudulence.
Individual Nurse Practice Acts gives states the ability to regulate healthcare and standards of practice. The U.S. Constitution has given the states the right to regulate public protection needs in the Tenth Amendment. Standards of practice can be changed by Nurse’s addressing their state legislator.
Ultimately, nurses are protected from substandard wages; working conditions and quality of practice by the state they are licensed. The state nursing licensure does not address the increasing need for nurses to be able to practice in multiple states, a national licensing board would.
The pros to a national based licensing board seem just as easily defined on the surface. Nurses would practice under one set of standards, which would be clearly defined by a National Nurse Practice Act.
Nurses would be able to practice in a much larger territory, either working for a travel agency, telenursing company or multi-state home health agency. Patients may have more protection from information on Internet sites claiming sponsorship from healthcare professionals.
National regulation of nursing licensure may sound like an easy solution to today’s increasing need for multi-state practice but when examined closer that may not be the case.
National based licensing for nurses would be a difficult transition. A National Nurse Practice Act would have to be established by the National Council of State Boards of Nursing, which would be a huge undertaking.
Some states would have to lower their standards of practice such as North Dakota, which requires their practicing RN’s to have a bachelors degree. It would be very difficult to have all the states agree on the same standards of practice.
Disciplinary action and infractions would have to be dealt with on a federal level. Nurses would have to lobby through the capital to change legislature versus changing standards of practice through the state. The profession and patient care could suffer if regulated on a federal level. Just look at the Medicaid system when deciding if nursing licensure should be regulated at the federal level. Interstate compacts seem like a reasonable solution.
Multi-state compacts are like a driver’s license; one would hold the license in his or her original state but could move from state to state under that license. The problem with this type of arrangement is the RN is responsible for knowing the NPA for the state he or she is currently working. If they work for a travel agency or in telenursing, it could become very difficult knowing the regulations under each Nurse Practice Act. In telemedicine, one would have to be very clear about the state, which the patient resides. NPA’s would have to be easier to read and understand.
Individual Nurse Practice Act’s do have benefits both to the nurse and the consumer. Practice standards as a rule are made at the state level. These standards by and large affect patient safety. Standards are generally tested in one state then adopted by others.
Today, consumers are very aware of their rights and if they are not they receive a copy of the Patient Bill of Rights on admission with a phone number to call with any grievances. If the standards of practice for nurses were on a national scale, it would be much harder to regulate.
Without individual NPA’s, nurses would not be guaranteed desirable working conditions, maybe subjected to substandard wages and could be held to less then desirable standards of practice.
At the present time, I believe there is not a better option then the individual state licensure. Individual state licensure and NPA’s ensure that nurses and patients will be treated fairly.
Nurse’s have a much louder voice on a state level and have the ability to make necessary changes to their practice, work conditions and wages. Disciplinary actions and fraudulent practices can be detected more rapidly.
National licensure is too broad, and the changes needed would be difficult and costly and a multistate compact puts a great deal of responsibility on the individual nurse to know each state's NPA. If a nurse is accused of any negligent act, it is unclear which state has the jurisdiction to prosecute and the nurse may be tried in two states, requiring two attorneys, which could be quite costly.
The lack of clarity of standards and regulations with a multistate compact makes me believe the best practice at the present time is state regulated licensure.