21.8003.01000
Sixty-seventh
Legislative Assembly HOUSE BILL NO. 1044
of North Dakota
Introduced by
Human Services Committee
(At the request of the State Board of Nursing)
1 A BILL for an Act to amend and reenact section 43-12.5-01 of the North Dakota Century Code,
2 relating to the advanced practice registered nurse licensure compact.
3 BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
4 SECTION 1. AMENDMENT. Section 43-12.5-01 of the North Dakota Century Code is
5 amended and reenacted as follows:
6 43-12.5-01. AdvanceAdvanced practice registered nurse licensure companycompact.
7 ARTICLE I - FINDINGS AND DECLARATION OF PURPOSE
8 1. The party states find that:
9 a. The health and safety of the public are affected by the degree of compliance with
10 advanced practice registered nurse licensure requirements and the effectiveness
11 of enforcement activities related to state advanced practice registered nurse
12 licensure laws;
13 b. Violations of advanced practice registered nurse licensure and other laws
14 regulating the practice of nursing may result in injury or harm to the public;
15 c. The expanded mobility of advanced practice registered nurses and the use of
16 advanced communication and intervention technologies as part of our nation's
17 health care delivery system require greater coordination and cooperation among
18 states in the areas of advanced practice registered nurse licensure and
19 regulation;
20 d. New practice modalities and technology make compliance with individual state
21 advanced practice registered nurse licensure laws difficult and complex;
22 e. The current system of duplicative advanced practice registered nurse licensure
23 for advanced practice registered nurses practicing in multiple states is
24 cumbersome and redundant for bothhealth care delivery systems, payors, state
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1 licensing boards, regulators, and advanced practice registered nurses and states;
2 and
3 f. Uniformity of advanced practice registered nurse licensure requirements
4 throughout the states promotes public safety and public health benefits as well as
5 providing a mechanism to increase access to care.
6 2. The general purposes of this compact are to:
7 a. Facilitate the states' responsibility to protect the public's health and safety;
8 b. Ensure and encourage the cooperation of party states in the areas of advanced
9 practice registered nurse licensure and regulation, including promotion of uniform
10 licensure requirements;
11 c. Facilitate the exchange of information between party states in the areas of
12 advanced practice registered nurse regulation, investigation, and adverse
13 actions;
14 d. Promote compliance with the laws governing advanced practice registered nurse
15 practice in each jurisdiction;
16 e. Invest all party states with the authority to hold an advanced practice registered
17 nurse accountable for meeting all state practice laws in the state in which the
18 patient is located at the time care is rendered through the mutual recognition of
19 party state licensesprivileges to practice;
20 f. Decrease redundancies in the consideration and issuance of advanced practice
21 registered nurse licenses; and
22 g. Provide opportunities for interstate practice by advanced practice registered
23 nurses who meet uniform licensure requirements.
24 ARTICLE II - DEFINITIONS
25 As used in this compact:
26 1. "Advanced practice registered nurse" means a registered nurse who has gained
27 additional specialized knowledge, skills, and experience through a program of study
28 recognized or defined by the Interstate Commission of Advanced Practice Registered
29 Nurse Compact Administrators ("commission"), and who is licensed to perform
30 advanced nursing practice. An advanced practice registered nurse is licensed in an
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1 advanced practice registered nurse role that is congruent with an advanced practice
2 registered nurse educational program, certification, and commission rules.
3 2. "Advanced practice registered nurse licensure" means the regulatory mechanism used
4 by a party state to grant legal authority to practice as an advanced practice registered
5 nurse.
6 3. "Advanced practice registered nurse uniform licensure requirements" means the
7 minimum uniform licensure, education, and examination requirements as adopted by
8 the commissionset forth in subsection 2 of article III.
9 4. "Adverse action" means any administrative, civil, equitable, or criminal action
10 permitted by a state's laws which is imposed by a licensing board or other authority
11 against an advanced practice registered nurse, including actions against an
12 individual's license or multistate licensure privilege such as revocation, suspension,
13 probation, monitoring of the licensee, limitation on the licensee's practice, or any other
14 encumbrance on licensure affecting an advanced practice registered nurse's
15 authorization to practice, including the issuance of a cease and desist action.
16 5. "Alternative program" means a non-disciplinary monitoring program approved by a
17 licensing board.
18 6. "Coordinated licensure information system" means an integrated process for
19 collecting, storing, and sharing information on advanced practice registered nurse
20 licensure and enforcement activities related to advanced practice registered nurse
21 licensure laws which is administered by a nonprofit organization composed of and
22 controlled by licensing boards.
23 7. "Current significant investigatory information" means:
24 a. Investigative information that a licensing board, after a preliminary inquiry that
25 includes notification and an opportunity for the advanced practice registered
26 nurse to respond, if required by state law, has reason to believe is not groundless
27 and, if proved true, would indicate more than a minor infraction; or
28 b. Investigative information that indicates that the advanced practice registered
29 nurse represents an immediate threat to public health and safety regardless of
30 whether the advanced practice registered nurse has been notified and had an
31 opportunity to respond.
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1 8. "Encumbrance" means a revocation or suspension of, or any limitation on, the full and
2 unrestricted practice of nursing imposed by a licensing board in connection with a
3 disciplinary proceeding.
4 9. "Home state" means the party state that is the advanced practice registered nurse's
5 primary state of residence.
6 10. "Licensing board" means a party state's regulatory body responsible for regulating the
7 practice of advanced practice registered nursing.
8 11. "Multistate license" means an advanced practice registered nurse license to practice
9 as an advanced practice registered nurse issued by a home state licensing board
10 which authorizes the advanced practice registered nurse to practice as an advanced
11 practice registered nurse in all party states under a multistate licensure privilege, in the
12 same role and population focus as the advanced practice registered nurse is licensed
13 in the home state.
14 12. "Multistate licensure privilege" means a legal authorization associated with an
15 advanced practice registered nurse multistate license which permits an advanced
16 practice registered nurse to practice as an advanced practice registered nurse in a
17 remote state, in the same role and population focus as the advanced practice
18 registered nurse is licensed in the home state.
19 13. "Noncontrolled prescription drug" means a device or drug that is not a controlled
20 substance and is prohibited under state or federal law from being dispensed without a
21 prescription. The term includes a device or drug that bears or is required to bear the
22 legend "caution: federal law prohibits dispensing without prescription" or "prescription
23 only" or other legend that complies with federal law.
24 14. "Party state" means any state that has adopted this compact.
25 15. "Population focus" means a specific patient population that is congruent with the
26 advanced practice registered nurse educational program, certification, and
27 commission rulesone of the six population foci of family or individual across the
28 lifespan, adult-gerontology, pediatrics, neonatal, women's health or gender-related,
29 and psychiatric mental health.
30 16. "Prescriptive authority" means the legal authority to prescribe medications and devices
31 as defined by party state laws.
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1 17. "Remote state" means a party state that is not the home state.
2 18. "Role" means one of the four recognized roles of certified registered nurse
3 anesthetists, certified nurse midwives, clinical nurse specialists, and certified nurse
4 practitioners.
5 19. "Single-state license" means an advanced practice registered nurse license issued by
6 a party state which authorizes practice only within the issuing state and does not
7 include a multistate licensure privilege to practice in any other party state.
8 19.20. "State" means a state, territory, or possession of the United States and the District of
9 Columbia.
10 20.21. "State practice laws" means a party state's laws, rules, and regulations that govern
11 advanced practice registered nurse practice, define the scope of advanced nursing
12 practice, including prescriptive authority, and create the methods and grounds for
13 imposing discipline except that prescriptive authority must be treated in accordance
14 with subsections 6 and 7 of article III. State practice laws do not include the:
15 a. A party state's laws, rules, and regulations requiring supervision or collaboration
16 with a health care professional, except for laws, rules, and regulations regarding
17 prescribing controlled substances; and
18 b. The requirements necessary to obtain and retain an advanced practice registered
19 nurse license, except for qualifications or requirements of the home state.
20 ARTICLE III - GENERAL PROVISIONS AND JURISDICTION
21 1. A state must implement procedures for considering the criminal history records of
22 applicants for initial advanced practice registered nurse licensure or advanced practice
23 registered nurse licensure by endorsement. Such procedures must include the
24 submission of fingerprints or other biometric-based information by advanced practice
25 registered nurse applicants for the purpose of obtaining an applicant's criminal history
26 record information from the federal bureau of investigation and the agency responsible
27 for retaining that state's criminal records.
28 2. By rule, the commission shall adopt the advanced practice registered nurse uniform
29 licensure requirements. The uniform licensure requirements must provide the
30 minimum requirements for advanced practice registered nurse multistate licensure in
31 party states, if the commission may adopt rules whereby an advanced practice
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1 registered nurse, with an unencumbered license on the effective date of this compact,
2 may obtain, by endorsementEach party state shall require an applicant to satisfy the
3 following advanced practice registered nurse uniform licensure requirements to obtain
4 or otherwise, and retain a multistate license in a partythe home state.
5 3. In order to obtain or retain a multistate license, an advanced practice registered nurse
6 shall meet, in addition to the uniform licensure requirements,:
7 a. Meets the home state's qualifications for licensure or renewal of licensure, as well
8 as, all other applicable home state laws.
9 4. By rule, the commission shall identify the approved advanced practice registered
10 nurse roles and population foci for licensure as an advanced practice registered
11 nurse.;
12 b. (1) Has completed an accredited graduate-level education program that
13 prepares the applicant for one of the four recognized roles and population
14 foci; or
15 (2) Has completed a foreign advanced practice registered nurse education
16 program for one of the four recognized roles and population foci that:
17 (a) Has been approved by the authorized accrediting body in the
18 applicable country; and
19 (b) Has been verified by an independent credentials review agency to be
20 comparable to a licensing board-approved advanced practice
21 registered nurse education program;
22 c. Has, if a graduate of a foreign advanced practice registered nurse program not
23 taught in English or if English is not the individual's native language, successfully
24 passed an English proficiency examination that includes the components of
25 reading, speaking, writing, and listening;
26 d. Has successfully passed a national certification examination that measures
27 advanced practice registered nurse, role and population-focused competencies
28 and maintains continued competence as evidenced by recertification in the role
29 and population focus through the national certification program;
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1 e. Holds an active, unencumbered license as a registered nurse and an active,
2 unencumbered authorization to practice as an advanced practice registered
3 nurse;
4 f. Has successfully passed an NCLEX-RN® examination or recognized
5 predecessor, as applicable;
6 g. Has practiced for at least two thousand eighty hours as an advanced practice
7 registered nurse in a role and population focus congruent with the applicant's
8 education and training. For purposes of this section, practice must not include
9 hours obtained as part of enrollment in an advanced practice registered nurse
10 education program;
11 h. Has submitted, in connection with an application for initial licensure or licensure
12 by endorsement, fingerprints or other biometric data for the purpose of obtaining
13 criminal history record information from the federal bureau of investigation and
14 the agency responsible for retaining that state or, if applicable, foreign country's
15 criminal records;
16 i. Has not been convicted or found guilty or, has entered into an agreed disposition
17 of a felony offense under applicable state, federal, or foreign criminal law;
18 j. Has not been convicted or found guilty or has entered into an agreed disposition,
19 of a misdemeanor offense related to the practice of nursing as determined by
20 factors set forth in rules adopted by the commission;
21 k. Is not currently enrolled in an alternative program;
22 l. Is subject to self-disclosure requirements regarding current participation in an
23 alternative program; and
24 m. Has a valid United States social security number.
25 3. An advanced practice registered nurse issued a multistate license must be licensed in
26 an approved advanced practice registered nurse role and at least one approved
27 population focus.
28 5.4. An advanced practice registered nurse multistate license issued by a home state to a
29 resident in that state will be recognized by each party state as authorizing the
30 advanced practice registered nurse to practice as an advanced practice registered
31 nurse in each party state, under a multistate licensure p