2015 -- S 0329

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LC001256

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

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A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS - NURSES - NURSE LICENSURE

COMPACT

     Introduced By: Senators Goodwin, and Miller

     Date Introduced: February 12, 2015

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 5-34-2 of the General Laws in Chapter 5-34 entitled "Nurses" is

hereby amended to read as follows:

     5-34-2. License and registration required to practice nursing or use title. -- It is

unlawful for any person to practice or offer to practice nursing in this state or to use any title,

sign, abbreviation, card, or device indicating authority to practice nursing unless that person is

licensed and registered under the provisions of this chapter or by the compact set forth in chapter

5-34.3.

     SECTION 2. Chapter 5-34.3 of the General Laws in Title 5 entitled "Nurse Licensure

Compact" is hereby repealed in its entirety.

     5-34.3-1 Short title. This chapter may be cited as the "Nurse Licensure Compact Act".

     5-34.3-2 The Nurse Licensure Compact. The nurse licensure compact is hereby adopted

and entered into with all other jurisdictions that legally join in the compact, which is, in form,

substantially similar to this chapter.

     5-34.3-3 Legislative findings. (a) The general assembly finds and declares that:

     (1) 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;

     (2) Violations of nurse licensure and other laws regulating the practice of nursing may

result in injury or harm to the public;

     (3) The expanded mobility of nurses and the use of advanced communication

technologies as part of our nation's healthcare delivery system require greater coordination and

cooperation among states in the areas of nurse licensure and regulations;

     (4) New practice modalities and technology make compliance with individual state nurse

licensure laws difficult and complex; and

     (5) The current system of duplicative licensure for nurses practicing in multiple states is

cumbersome and redundant to both nurses and states.

     (b) The general purposes of this compact are to:

     (1) Facilitate the states' responsibility to protect the public's health and safety;

     (2) Ensure and encourage the cooperation of party states in the areas of nurse licensure

and regulation;

     (3) Facilitate the exchange of information between party states in the areas of nurse

regulation, investigation and adverse actions;

     (4) Promote compliance with the laws governing the practice of nursing in each

jurisdiction; and

     (5) 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.

     5-34.3-4 Definitions. As used in this chapter:

     (1) "Adverse action" means a home or remote state action.

     (2) "Alternative program" means a voluntary, non-disciplinary monitoring program

approved by a nurse licensing board.

     (3) "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 non-profit organization composed of and

controlled by state nurse licensing boards.

     (4) "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 treat to public health and safety regardless of whether the nurse

has been notified and had an opportunity to respond.

     (5) "Home state" means the party state which is the nurse's primary state of residence.

     (6) "Home state action" means any administrative, civil, equitable or criminal action

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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.

     (7) "Licensing board" means a party state's regulatory body responsible for issuing nurse

licenses.

     (8) "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/vocational

nurse in such 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.

     (9) "Nurse" means a registered nurse or licensed practical/vocational nurse, as those

terms are defined by each party's state practice laws.

     (10) "Party state" means any state that has adopted this compact.

     (11) "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 such party state where the recipient of nursing practice is located.

     (12) "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 thereof.

     (13) "State" means a state, territory, or possession of the United States, the District of

Columbia.

     (14) "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. It 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. 

     5-34.3-5 Permitted activities 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 such party state. A

license to practice licensed practical/vocational 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/vocational nurse in such party state. In order to obtain or retain a

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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 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 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.

     5-34.3-6 Applications for licensure in a 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 such 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;

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     (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 non-party state to a party state, and obtains a license from the new

home state, the individual state license issued by the non-party state is not affected and will

remain in full force if so provided by the laws of the non-party state;

     (3) Moving from a party state to a non-party 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.

     5-34.3-7 Adverse actions. – In addition to the provisions described in § 5-34.3-5, the

following provisions apply:

     (1) 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.

     (2) 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(s), and shall promptly

report the conclusions of such 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 such actions.

     (3) 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.

     (4) 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

such conduct had occurred within the home state. In so doing, it shall apply its own state laws to

determine appropriate action.

     (5) 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.

     (6) 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 such participation shall

remain non-public if required by the party state's laws. Party states must require nurses who enter

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any alternative programs to agree not to practice in any other party state during the term of the

alternative program without prior authorization from such other party state. 

     5-34.3-8 Additional authorities invested in party state nurse licensing boards.–

Notwithstanding any other powers, party state nurse licensing boards shall have the authority to:

     (1) 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;

     (2) 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, and/or the production of

evidence from another party state, 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

and/or evidence are located.

     (3) Issue cease and desist orders to limit or revoke a nurse's authority to practice in their

state;

     (4) Promulgate uniform rules and regulations as provided for in subsection 5-34.3-10(c). 

     5-34.3-9 Coordinated licensure information system. (a) All party states shall participate

in a cooperative effort to create a coordinated data base of all licensed registered nurses and

licensed practical/vocational 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 non-party 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 state's licensing board

from the coordinated licensure information system may not be shared with non-party states or

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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.

     5-34.3-10 Compact administration and interchange of information. (a) The head of the

nurse licensing board, or his/her designee, of each party state shall be the administrator of this

compact for his/her state.

     (b) The compact administrator of each party 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 subsection 5-34.3-8(4).

     5-34.3-11 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.

     5-34.3-12 Entry into force, withdrawal and amendment. (a) This compact shall enter into

force and 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 no

such withdrawal shall take effect until six (6) 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 non-party

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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.

     5-34.3-13 Employers.– This compact is designed to facilitate the regulation of nurses,

and does not relieve employers from complying with statutorily imposed obligations. This

compact does not supersede existing state labor laws.

     5-34.3-14 Construction and severability.– (a) This compact shall be liberally construed so

as to effectuate the purposes thereof. 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 thereof to any government, agency, person or circumstance shall not be affected

thereby. If this compact shall be held contrary to the constitution of any state party thereto, 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 state(s) 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. 

     SECTION 3. Upon the state of Rhode Island's withdrawal from the "Nurse Licensure

Compact", the general assembly directs the department of health to develop a regional, multistate

compact for registered nurses and practical/vocational nurses licensed in the State of Rhode

Island, the State of Connecticut or the Commonwealth of Massachusetts.

     SECTION 4. This act shall take effect on July 1, 2015.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS - NURSES - NURSE LICENSURE

COMPACT

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     This act would repeal the nurse licensure compact law and directs the department of

health to develop a multistate compact for nurses licensed in Rhode Island, Connecticut and

Massachusetts.

     This act would take effect on July 1, 2015.

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