By Dr. Jennifer Clifton, for the American Correctional Nurses Association
Modern health care delivery requires care provided by Advanced Practice Registered Nurses (APRNs) and nurses—including Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Licensed Vocational Nurses (LVNs)—be dynamic and fluid across state boundaries. Traditionally, health care professionals in the United States have been licensed by the state or jurisdiction in which they practice. This means licensure is necessitated in multiple states if their practice crosses state or territorial lines. The National Council of State Boards of Nursing has created interstate compacts for both nurses and APRNs to address this issue.
The Nursing Licensure Compact (NLC), which pertains to RN, LVN, and LPN licenses, created the first compact or multi-state nursing licenses in 2000. Currently, 31 states and territories have accepted the NLC, with eight more states pending legislation. Thus, when a nurse applies for a license in a compact state, if the nurse declared that state as their primary residence and met the licensure requirements of that state, the license they are issued is multi-state, assuming the nurse is currently in good standing with their State Board of Nursing.
The APRN Compact was adopted in August 2020, although it will not be actualized until seven states join. The term APRN encompasses a broad group of clinicians: Certified Nurse Practitioners (NPs), Certified Registered Nurse Anesthetists (CRNAs), Clinical Nurse Specialists (CNS), and Certified Nurse-Midwives (CNMs). Delaware and North Dakota were the first two states to sign the APRN compact into law in 2021. Utah recently joined these two. Maryland currently has legislation pending. The APRN compact allows APRNs to practice in another compact state who have met licensing requirements in their home state, have practiced for 2080 hours, and passed a criminal background check.
The APRN compact is not without controversy. The American Association of Nurse Practitioners, the National Association of Nurse Practitioner Faculties, the National Association of Pediatric Nurse Practitioners, and other professional organizations have publicly taken a stand against this compact because of the 2080 hour practice requirement arguing that there is no evidence that postgraduate practice hours of any length improve patient safety. “After graduation from an accredited graduate education NP program and successful passage of national certification examinations, NPs are qualified to assume the full scope of responsibilities associated with independent single and multi-state licensure. Arbitrary regulations requiring NPs to complete any number of clinical hours after graduation and national board certification create unnecessary, costly barriers to workforce development and affordable patient car”. (AANP, 2022) Indeed, in states where NPs are working toward full practice authority immediately upon graduation, this 2080 hour requirement may be used as an argument against them.
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