Remote nursing and practicing in multiple states. What licensure do I really need?

Agree with Lunah. If you are not providing patient care, then it's unlikely you need to be licensed in multiple states. In fact, is licensure REQUIRED to do what you're doing (not referring to what the company's stated job requirements are, but legally)? Typically, chart reviews don't REQUIRE licensure, simply the expertise that generally comes with licensure.

Lunah said:

Clarify with your employer if your role is considered "patient facing" or not. But really, I would bet your role is not patient facing and you probably only need a license in your state of residence. You could also run this past the Texas BON. 

Thank you Lunah! This is reassuring.  

klone said:

Agree with Lunah. If you are not providing patient care, then it's unlikely you need to be licensed in multiple states. In fact, is licensure REQUIRED to do what you're doing (not referring to what the company's stated job requirements are, but legally)? Typically, chart reviews don't REQUIRE licensure, simply the expertise that generally comes with licensure.

That's a good question! I hadn't though about it that way.

In my assessments I'm denoting that I have reviewed the available diagnosis, medications, comorbidities, adherence to treatment, side effects, and any possible barriers to treatment. I do this through chart review at set time points during treatment, and I don't speak to patients to get the information. If I find any major red flags then I escalate it to a provider to review. If not then I submit the assessment not to the chart saying that everything has been reviewed and and stating that continued treatment is at the discretion of the MD.

Another concern I have is that I'm acting outside my scope when I say continued treatment is appropriate in my assessment note, as it's my understanding that as an RN I'm not allowed to make any treatment recommendations. Hence I explicitly state in the note that treatment is up the MD and I am not making any treatment recommendations. Do you think this is crossing the line of my scope? I'm worried that even with the disclaimer it would seem like I'm making treatment decisions.

No it's your personal assessment that you were hired to make based on The information you have been provided. You were hired by a company that sought your knowledge base not necessarily skill set. 
If your audit results affects any individual in any monetary way rather that be insurance coverage or billing etc. then you should obtain the consent of the persons chart  and/or the poa as what you are reviewing may be omitting some Information you would need to make a fair accurate and  thorough review and assessment. If you have the consent then no there is nothing illegal going on. Because you are not providing hands on care and you are working for a company that needs you for administrative services only. If you are working as more of a legal nurse consultant more or less finding a defense to claims against the company possibly having one too many outcomes  that are unfavorable then for me, it would become a moral  issue and is fighting against a individual who received poor care being somehow twisted into its the patients fault due to non compliance of a treatment plan if the company you are working for  is in charge of the patients overall well being? You might be helping the bad guys stay bad and not even know it. 
what is the purpose of you doing these types of audits? 

Lunah said:

Definitely run this by your management - they should be able to speak to the particulars of your role. However, in appeals we could always refer to clinical guidelines or standards of care where treatments were concerned.

That's a good suggestion! These assessments I'm doing are specifically because a certain accreditation body requires them to be done/documented at certain timepoints. Generally speaking, the assessments are confirming that there no obvious safety issues or barriers to treatment. I'm thinking in my case using the clinical guidelines/standards of care would not be necessary since I'm not actually looking at the particulars of the treatment itself.

Abkr80 said:

No it's your personal assessment that you were hired to make based on The information you have been provided. You were hired by a company that sought your knowledge base not necessarily skill set. 
If your audit results affects any individual in any monetary way rather that be insurance coverage or billing etc. then you should obtain the consent of the persons chart  and/or the poa as what you are reviewing may be omitting some Information you would need to make a fair accurate and  thorough review and assessment. If you have the consent then no there is nothing illegal going on. Because you are not providing hands on care and you are working for a company that needs you for administrative services only. If you are working as more of a legal nurse consultant more or less finding a defense to claims against the company possibly having one too many outcomes  that are unfavorable then for me, it would become a moral  issue and is fighting against a individual who received poor care being somehow twisted into its the patients fault due to non compliance of a treatment plan if the company you are working for  is in charge of the patients overall well being? You might be helping the bad guys stay bad and not even know it. 
what is the purpose of you doing these types of audits? 

The assessments/audits are specifically because a certain accreditation body requires them to be done/documented at certain timepoints. The company I work for would likely not be doing them, if not to just keep this accreditation since they are not a part of the normal workflow. Likewise, nothing I do is billable or affects coverage. The assessments are also based on retrospective review of the available medical records so anything I reference (side effects, missed doses) is dated and already exists in the patient chart in some prior note.