2 questions.

1. Some institutions require countersignature, but it is not a requirement of accreditation, state or federal law. We try VERY HARD to discourage any countersignature, because it defeats the independence of our practice. Since I don't work with anesthesiologists, my surgeons DO NOT countersign any anesthesia related document.

2. I don't know what you mean by "interstate compact". Do you possibly mean "interstate commerce"? If that is what you mean, it is an important aspect of federal anti-trust laws. I believe there was one ruling in favor of CRNAs in an anti-trust action where the hospital that was involved with a conspiracy against CRNAs was considered to be engaged in interstate commerce.

I am interested to know why you are asking. These are complicated legal issues with no "one size fits all" answer. Generally speaking CRNAs have been sucessful in antitrust actions.

Yoga CRNA

Compact Licensure involves having an RN license is one and being able to work in multiple states that are in the compact realm. Not every state is a compact state and I don't think that compact licensure is applicable for advance-practice nurses. I might be wrong though.

A Texas (one of the 13 "compact states") RN license is valid in all 13 states.
Since I have a NP license it states "Valid in Texas only" on the top of the card. There is too much variability in practice (especially in prescriptive authority) between the states for advanced practice nurses to ever realize this...unless you work in a government (military, VA, PHS) setting.

When I got my NC RN license for CRNA school, they said that it voided my license in any other compact state where I might be licensed (since my NC license is valid there also). The civilian hospital that I moonlight in had heartburn with that though and made me renew for a month's worth of working before I quit and moved. I showed them my new pretty Texas license, but it is probably void?

1. What Yoga said.

2. Yes