Okay, I've had it. Over the past few months I've spent several hundred dollars on nursing licenses for three states. Between fingerprint fees, license fees,transcript fees, notary fees and worst of all verification fees! This came to a head today when I called my original state of licensure to find out why my verification hadn't been sent out yet, even though I overnight mailed them the request with the check and the check had already cleared my bank. They told me it can take up to 14 days from when they receive the request to when they mail it out. WHY IN THE &*$& DOES IT TAKE 14 DAYS TO SEND OUT A SIMPLE *$% VERIFICATION?
An employer can simply log onto the boards website and verify a license in 5 seconds FOR FREE! They sure didn't wait 14 days to cash my check!
If one state has to honor another states drivers license, why not nursing licenses? If I remember my high school history right (another transcript that required a notarized request!!!), shouldn't this fall under the "full faith and credit" clause of the constitution? Because I'm old an cannot remember the exact wording, I googled it and found the text as follows: "Section 1. Full faith and credit shall be given in each state to the public acts, records, and judicial proceedings of every other state. And the Congress may by general laws prescribe the manner in which such acts, records, and proceedings shall be proved, and the effect thereof."
Am I alone in thinking this is ridiculous? Congress should mandate national participation in the Nurse Licensure Compact currently signed by 17 states! :angryfire :angryfire :angryfire :angryfire
Good link to know about. I looked around it to see if it contained info about Pennsylvania, didn't not see any. It could be there, I may not have found it. I would like to know about Pa. and compacts. I have never heard if Pa. has any compact states.
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from listing to the sbon presenting at the psna conventions, here is what i can recall is pasbon concerns. maybe pattyjo can remember more..
state sovereignty
interstate compacts are formal, binding contracts, entered into voluntarily by two or more states, that require consent from congress under the compact clause of the u. s. constitution. because each state surrenders some measure of sovereignty when it enters into a compact, the compact provisions likely would supersede conflicting state statue.
pa state legislature is well known for being conservative and protecting "state sovereignty". the pa sbon has had concerns regarding pa regulations on who can become a nurse and practice issues being stricter than some other states. these regulations are seen as a measure of "public protection". therefore, if pa became part of the compact they would lose some of the public protection measures.
discipline of pa licensed nurses
the sbon already spends 75% of its time on disciplinary hearings at meeting. how they handle practice issues and dicpline pa nurses may be different from a compact state. compact states have not fully discussed this issue.
[color=#aa5522]issues related to interstate practice
this article will address four specific issues related to interstate practice, namely, state sovereignty, discipline, information sharing and regulation of advanced practice registered nurses.
state sovereignty
the onset of nursing regulation in the u.s. dates back to the early 1900's. nurses advocated for a registration process as a means to establish recognition for nurses and to protect public health and welfare. the first state to enact a registration law was north carolina in 1903. new york, new jersey and virginia soon followed.
although regulating health care providers is within the powers of state governments, the state's authority is limited. the u.s. constitution establishes that
the regulatory scheme must be a "rational relationship" to a valid purpose and
the regulatory scheme must provide a person who is denied the right to practice the profession certain procedural rights.
a "rational relationship" is established when the following conditions are met (deloughery, 1991). first, the regulatory law must be intended to protect the public from licensees that are incompetent or unfit to practice. and second, regulation must be deemed to be a "reasonable means" of accomplishing the goal of public protection.
the nurse licensure compact offers a convenient way for nurses to practice in a party state (a state participating in the compact) without obtaining another nursing license. however, it remains unclear whether the model adequately protects the public, particularly when the state (as well as the public) has no means of determining in which of the 50 states a nurse is practicing at any point in time.
one public protection concern arises when nurses practicing remotely in another state are not held to the same licensure standards as those who are licensed in that state. states currently establish qualifications for licensure which may include residency restriction, education criteria or continuing education requirements. nurses licensed in a party state (a state participating in the compact) but practicing, either physically or electronically, in a remote state would be exempt from qualifications established by the remote state. additionally, in some instances a party state could take action to limit the nurse's ability to practice in a remote state, but if the home state failed to take action against the nurse's license, the nurse would be free to practice in any other party state. each of these factors infringe on the ability of the state to establish a regulatory means to protect the public, thus impacting state sovereignty.
discipline
the constitution guarantees that certain procedural rights be provided to persons denied the right to practice their profession. generally the compact allows any party state (a state participating in the compact) to take action against the multistate licensure privileges of any nurse practicing in that state, meaning that a state can withdraw this privilege to practice in that state. however, only the home state many take action against the license itself (i.e., revocation or suspension). hence a nurse may experience two disciplinary processes, one related to the multistate licensure privileges and a second related to privileges in the home state. it is important to ensure due process and to avoid unfair burdens on nurses attempting to defend their ability to practice safely. the right of the individual nurse to a fair hearing of any disciplinary action must be preserved without the nurse incurring unreasonable or unfair burdens, such as financial costs, in pursuing this right.
information sharing
another component of the nurse licensure compact is the establishment of a coordinated licensure information system (clis) to be operated by a nonprofit organization comprised of state boards of nursing. this data bank would contain personal information, licensure information and disciplinary information.
currently, the ncsbn maintains a disciplinary data base. although states may choose whether or not to report adverse actions taken against nurses, a number of states do contribute disciplinary information to the data bank. the benefit of such a mechanism is the sharing of information between state boards of nursing. thus nurses who are disciplined in one state cannot easily relocate to another state to practice.
[color=#aa5522]while the disciplinary data base has great merit, concerns related to the privacy and confidentiality of information held by a new data system remain.
while the disciplinary data base has great merit, concerns related to the privacy and confidentiality of information held by a new data system remain. since there is a trend to make licensure information more publicly accessible, nurses should be interested in the data elements contained in the clis and what entities, other than state boards of nursing, would be entitled to access clis data. as with all information date bases, nurses deserve some assurances regarding the range of information that will be available through the clis, and to whom it will be available, particularly since personal information such as home address and telephone number will be contained within the data base. an ana house of delegates backgrounder report (1998b) noted that the rapid explosion of communication technologies has already posed a significant challenge to a number of governmental and non-governmental bodies regarding public access to information.
regulation of advanced practice registered nurses
finally, many questions remain as to the effect of the compact on advanced practice nursing. currently, the compact provides multistate recognition for the practice of rns and lpns only, not advanced practice registered nurses (aprns), who are educated and certified at a more advanced level than are rns and lpns. although aprns are not included in the compact at this time, the ncsbn is currently developing a separate compact to address aprn practice.
perhaps, however, a better approach to resolving the diverse education and certification requirements for apns are uniform licensure requirements. as minarik (1999) states, "rather than adopting the complex approach of interstate compacts for the regulation of advanced practice, nursing should seize the opportunity to promote a uniform acts model of licensure for apns" (p. 93). uniform acts are not contractual agreements between states, but rather guides for states that wish to enact individual legislation. such an approach maintains state sovereignty while addressing the education, certification and scope of practice issues that currently vary from state to state for aprns.
thanks for posting those NRSkaren. I think those points are much stronger arguments for a national standard of entrance and practice, than against reciprocity. After all, in America, are we not all equal? Why should our government allow a person living in Topeka to recieve a lower, or higher standard of nursing care, than a person in Phoenix?
Also, a national database ( just add the info to the currently existing NCIC criminal and warrant databse) can access CURRENT information on any person in about 20 seconds using the social security or DL numbers. This is how the cop who pulls you over in Pittsburgh can arrest you for the speeding ticket you forgot to pay last year in Fresno.
"You must be the change you wish to see in the world" -Mahatma Gandhi
If you think it is messed up now, just let the Feds get a hold of it!! Ever have a problem with the IRS? The VA? I understand the desire. As someone who has been licensed in several states, I have been "challenged" at times with certain states. But the Federal Government can REALLY present "challenges". Just my thoughts! Watch what you wish for. The states will not want to give up the control or revenue. If your license costs too much now, just wait until the Feds put their fees on it too.
A national registry with a national license would be logical.
As someone mentioned, it IS mostly all about the money.
If one license worked for all states...there would be a decrease in revenue from ....verifications and new registrations.
Another issue is the variation in CEUs to renew registration and other state specific requirements for registration(eg. Washington requires a HIV nursing course...NY state requires infection control course etc)
From a NP perspective: even the DEA license has to be reapplied for since it is state-specific.
Not all states require that NPs be nationally certified...there are different precribing privileges and
different CEU requirements.
One standard for education, certification, prescriptive authority and CEUs would be helpful.
I have been registered/am registered in 4 jurisdictions so if I went to a fifth jurisdiction...I would require 4 verifications....it is a lot of paperwork, money and
a huge headache. That is why I wrote NCLEX-RN in my state of licensure even though I was warned that if I failed I would lose my RN license(by endorsement) and my NP
license too. I didn't want to write it in another state and have even more jurisdictions to coordinate!!!
The more states you register with, the more it costs you to register for another new state( you require verifications from every state you have ever held a license with).
I think this is where the compact is going. There was disagreement and so those states that were willing to comply are joined, I believe 11 states now? It's getting there. I understand completely. I have a friend who is a traveling nurse, she told me that how things are done in some places would never happen in others. I think that is a symptom of what the problems are. Each facility does have it's own set of rules as does each state? It's going to happen due to the shortage that is going to get worse.
Sounds like a wonderful idea. Unfortunatly, the laws pertaining to our practice are governed by each individual state and this will not change. What they could do is give us reciprocity. The problem with that lies within the fact that if a nurse has a licensed revoked in one state, could go to another state, start working before anyone knew that they really didn't have a license anymore.
I am sure when and if your license is revoked in one state, your record is public and the other state can access it. Also, I would not mind if each state did criminal checks and finger prints to curtail such problems. If we all write the same NCLEX for all states, why is the license not the same? I would go for a universal license. Globally, most countries have a universal license and there is mechanism for background and criminal record checks.
I think with the nursing shortage the way that it is, it would be very beneficial to all. The need to have our nursing lincense reciprocated is long overdue. I believe that it would solve the bad nursing care some people are receiving because of the understaffing of nurses. What do we have to do to get this done? I will be glad to help in any way that I can.
May be from the start of this discussion there was a misrepresentation of terms when the originator used "Federalize". Automatically, it goes to the mind of the reader that this will involve federal Gvt. My understanding is that there is need to universalize/nationalize licensure just as it is nationally recognized to take the same NCLEX. In other words, once you pass the NCLEX, then you have a license that you can use in any state in the USA. But for practice purposes you are mandated by the state in which you perform your dities. I believe that for one to sit for the NCLEX one has to meet certain criteria and by the same token, those criteria seem to be universal. Therefore your basic license should be recognized by all states. For example the NCSBN should run the licensure and the states will then mandate the practice formula as per their needs and the nurses could pay annually or so for continuation of certification to practise in the state. The state boards will still have the powers to set standards, discipline etc (at a cost of course) and all information is logged into the national database... the good and the bad that nurses do and will be public information. That way there is no way a revoked license or one under investigation can be used in another state; it will be easily detected. I believe in this case then nurses will be able to work where and when they are needed and also they can choose to work where they are satisfied eg close to home (or away), relocate to a fiance/spouse or go to warm or cold weather. Performance would increase and quality of care improved.
A long shot but my opinion.
Just to add another advantage: International nurses that are currently helping to curtail the shortage will be able to move to those areas of need without the hussles. Imagine how difficult it is for a foreigner to follow all those verifications with the need to get transcripts from some far away lands some of which have very limited mail capacity. May be it is time for nurses to really look into their own welfare square in the eye considering the shrinking size of the global village
Sounds like a great idea to me. With all the technology we should be able to be in one data bank. Easier way to keep track of "problem nurses" too. And what the heck is up with Homeland Security and their Visa screen???? I have been credentialed through Michigan and taken the Neclex with Michigan and now I am being asked to prove my schooling in ontario was up to standard? Did they not already do that before I was granted permission to sit for Michigan Boards. Geeeshhh why make it so hard for people when there is such a nursing shortage?:angryfire
Sounds like a great idea to me. With all the technology we should be able to be in one data bank. Easier way to keep track of "problem nurses" too. And what the heck is up with Homeland Security and their Visa screen???? I have been credentialed through Michigan and taken the Neclex with Michigan and now I am being asked to prove my schooling in ontario was up to standard? Did they not already do that before I was granted permission to sit for Michigan Boards. Geeeshhh why make it so hard for people when there is such a nursing shortage?:angryfire
My professor once said, regarding the way nurses manage their affairs, " nurses eat their young". In other words our difficulties are self made. It is us as nurses who should be in charge of the regulations governing our own practice. Therefore this forum is the very instrument that will influence this much needed change. Am I wrong to think that BONs are headed by nurses, including the NCSBN? If that's the case then we have to turn back to ourselves and ask, "Why are we suffering for /with something that can be modefied to help us and those client we save? Wake up nurses. Noone will help you but you. In the history of Councils/boards of nursing worldwide, no government/legislator ever wanted nurses to be autonomous, but we fought it out and got it. Only to thwart ourselves with a lot of restricting rules.
oramar
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