2007 -- S 0640 SUBSTITUTE A
A N A C T
RELATING TO BUSINESS AND PROFESSIONS - NURSES
Introduced By: Senator Maryellen Goodwin
Date Introduced: February 15, 2007
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
. or by the compact set forth in chapter
SECTION 2. Title 5 of the General Laws entitled "BUSINESSES AND
PROFESSIONS" is hereby amended by adding thereto the following chapter:
NURSE LICENSURE COMPACT
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
(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
(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
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
(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
(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
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;
(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 section 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
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
(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
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
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
(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
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
(2) The decision of a majority of the arbitrators shall be final and binding.
SECTION 3. This act shall take effect on July 1, 2008.