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1 H.99
2 Introduced by Representative Houghton of Essex
3 Referred to Committee on
4 Date:
5 Subject: Professions and occupations; nursing; Nurse Licensure Compact
6 Statement of purpose of bill as introduced: This bill proposes that the State
7 adopt and enter into the interstate Nurse Licensure Compact.
8 An act relating to relating to Vermont’s adoption of the interstate Nurse
9 Licensure Compact
10 It is hereby enacted by the General Assembly of the State of Vermont:
11 Sec. 1. 26 V.S.A. chapter 28, subchapter 5 is added to read:
12 Subchapter 5. Nurse Licensure Compact
13 § 1647. NURSE LICENSURE COMPACT; ADOPTION
14 This subchapter is the Vermont adoption of the Nurse Licensure Compact
15 as amended by the National Council of State Boards of Nursing. The form,
16 format, and text of the Compact have been conformed to the conventions of the
17 Vermont Statutes Annotated. It is the intent of the General Assembly that this
18 subchapter be interpreted as substantively the same as the Nurse Licensure
19 Compact that is enacted by other Compact party states.
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1 § 1647a. FINDINGS AND DECLARATION OF PURPOSE
2 (a) The party states find that:
3 (1) The health and safety of the public are affected by the degree of
4 compliance with and the effectiveness of enforcement activities related to state
5 nurse licensure laws.
6 (2) Violations of nurse licensure and other laws regulating the practice
7 of nursing may result in injury or harm to the public.
8 (3) The expanded mobility of nurses and the use of advanced
9 communication technologies as part of our nation’s health care delivery system
10 require greater coordination and cooperation among states in the areas of nurse
11 licensure and regulation.
12 (4) New practice modalities and technology make compliance with
13 individual state nurse licensure laws difficult and complex.
14 (5) The current system of duplicative licensure for nurses practicing in
15 multiple states is cumbersome and redundant for both nurses and states.
16 (6) Uniformity of nurse licensure requirements throughout the states
17 promotes public safety and public health benefits.
18 (b) The general purposes of this Compact are to:
19 (1) facilitate the states’ responsibility to protect the public’s health and
20 safety;
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1 (2) ensure and encourage the cooperation of party states in the areas of
2 nurse licensure and regulation;
3 (3) facilitate the exchange of information between party states in the
4 areas of nurse regulation, investigation, and adverse actions;
5 (4) promote compliance with the laws governing the practice of nursing
6 in each jurisdiction;
7 (5) invest all party states with the authority to hold a nurse accountable
8 for meeting all state practice laws in the state in which the patient is located at
9 the time care is rendered through the mutual recognition of party state licenses;
10 (6) decrease redundancies in the consideration and issuance of nurse
11 licenses; and
12 (7) provide opportunities for interstate practice by nurses who meet
13 uniform licensure requirements.
14 § 1647b. DEFINITIONS
15 As used in this subchapter:
16 (1) “Adverse action” means any administrative, civil, equitable, or
17 criminal action permitted by a state’s laws that is imposed by a licensing board
18 or other authority against a nurse, including actions against an individual’s
19 license or multistate licensure privilege, such as revocation, suspension,
20 probation, monitoring of the licensee, limitation on the licensee’s practice, or VT LEG #352223 v.1
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1 any other encumbrance on licensure affecting a nurse’s authorization to
2 practice, including issuance of a cease and desist action.
3 (2) “Alternative program” means a nondisciplinary monitoring program
4 approved by a licensing board.
5 (3) “Commission” means the Interstate Commission of Nurse Licensure
6 Compact Administrators.
7 (4) “Coordinated licensure information system” means an integrated
8 process for collecting, storing, and sharing information on nurse licensure and
9 enforcement activities related to nurse licensure laws that is administered by a
10 nonprofit organization composed of and controlled by licensing boards.
11 (5) “Current significant investigative information” means:
12 (A) investigative information that a licensing board, after a
13 preliminary inquiry that includes notification and an opportunity for the nurse
14 to respond, if required by state law, has reason to believe is not groundless and,
15 if proved true, would indicate more than a minor infraction; or
16 (B) investigative information that indicates that the nurse represents
17 an immediate threat to public health and safety regardless of whether the nurse
18 has been notified and had an opportunity to respond.
19 (6) “Encumbrance” means a revocation or suspension of, or any
20 limitation on, the full and unrestricted practice of nursing imposed by a
21 licensing board.
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1 (7) “Home state” means the party state that is the nurse’s primary state
2 of residence.
3 (8) “Licensing board” means a party state’s regulatory body responsible
4 for issuing nurse licenses.
5 (9) “Multistate license” means a license to practice as a registered nurse
6 (RN) or a licensed practical or vocational nurse (LPN/VN) issued by a home
7 state licensing board that authorizes the licensed nurse to practice in all party
8 states under a multistate licensure privilege.
9 (10) “Multistate licensure privilege” means a legal authorization
10 associated with a multistate license permitting the practice of nursing as either
11 an RN or LPN/VN in a remote state.
12 (11) “Nurse” means RN or LPN/VN, as those terms are defined by each
13 party state’s practice laws.
14 (12) “Party state” means any state that has adopted this Compact.
15 (13) “Remote state” means a party state other than the home state.
16 (14) “Single-state license” means a nurse license issued by a party state
17 that authorizes practice only within the issuing state and does not include a
18 multistate licensure privilege to practice in any other party state.
19 (15) “State” means a state, territory, or possession of the United States
20 and the District of Columbia.
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1 (16) “State practice laws” means a party state’s laws, rules, and
2 regulations that govern the practice of nursing, define the scope of nursing
3 practice, and create the methods and grounds for imposing discipline. “State
4 practice laws” do not include requirements necessary to obtain and retain a
5 license, except for qualifications or requirements of the home state.
6 § 1647c. GENERAL PROVISIONS AND JURISDICTION
7 (a) A multistate license to practice registered or licensed practical or
8 vocational nursing issued by a home state to a resident in that state will be
9 recognized by each party state as authorizing a nurse to practice as an RN or
10 LPN/VN, under a multistate licensure privilege, in each party state.
11 (b) A state must implement procedures for considering the criminal history
12 records of applicants for initial multistate license or licensure by endorsement.
13 Such procedures shall include the submission of fingerprints or other
14 biometric-based information by applicants for the purpose of obtaining an
15 applicant’s criminal history record information from the Federal Bureau of
16 Investigation and the agency responsible for retaining that state’s criminal
17 records.
18 (c) Each party state shall require the following for an applicant to obtain or
19 retain a multistate license in the home state:
20 (1) meets the home state’s qualifications for licensure or renewal of
21 licensure, as well as all other applicable state laws;
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1 (2)(A) has graduated or is eligible to graduate from a licensing board-
2 approved RN or LPN/VN pre-licensure education program; or
3 (B) has graduated from a foreign RN or LPN/VN pre-licensure
4 education program that has been:
5 (i) approved by the authorized accrediting body in the applicable
6 country; and
7 (ii) verified by an independent credentials review agency to be
8 comparable to a licensing board-approved pre-licensure education program;
9 (3) has, if a graduate of a foreign pre-licensure education program not
10 taught in English or if English is not the individual’s native language,
11 successfully passed an English proficiency examination that includes the
12 components of reading, speaking, writing, and listening;
13 (4) has successfully passed an NCLEX-RN or NCLEX-PN Examination
14 or recognized predecessor, as applicable;
15 (5) is eligible for or holds an active, unencumbered license;
16 (6) has submitted, in connection with an application for initial licensure
17 or licensure by endorsement, fingerprints or other biometric data for the
18 purpose of obtaining criminal history record information from the Federal
19 Bureau of Investigation and the agency responsible for retaining that state’s
20 criminal records;
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1 (7) has not been convicted or found guilty, or has entered into an agreed
2 disposition, of a felony offense under applicable state or federal criminal law;
3 (8) has not been convicted or found guilty, or has entered into an agreed
4 disposition, of a misdemeanor offense related to the practice of nursing as
5 determined on a case-by-case basis;
6 (9) is not currently enrolled in an alternative program;
7 (10) is subject to self-disclosure requirements regarding current
8 participation in an alternative program; and
9 (11) has a valid U.S. Social Security number.
10 (d) All party states shall be authorized, in accordance with existing state
11 due process law, to take adverse action against a nurse’s multistate licensure
12 privilege, such as revocation, suspension, probation, or any other action that
13 affects a nurse’s authorization to practice under a multistate licensure privilege,
14 including cease and desist actions. If a party state takes such action, it shall
15 promptly notify the administrator of the coordinated licensure information
16 system. The administrator of the coordinated licensure information system
17 shall promptly notify the home state of any such actions by remote states.
18 (e) A nurse practicing in a party state must comply with the state practice
19 laws of the state in which the client is located at the time service is provided.
20 The practice of nursing is not limited to patient care, but shall include all
21 nursing practice as defined by the state practice laws of the party state in which VT LEG #352223 v.1
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1 the client is located. The practice of nursing in a party state under a multistate
2 licensure privilege will subject a nurse to the jurisdiction of the licensing
3 board, the courts, and the laws of the party state in which the client is located
4 at the time service is provided.
5 (f) Individuals not residing in a party state shall continue to be able to apply
6 for a party state’s single-state license as provided under the laws of each party
7 state. However, the single-state license granted to these individuals will not be
8 recognized as granting the privilege to practice nursing in any other party state.
9 Nothing in this Compact shall affect the requirements established by a party
10 state for the issuance of a single-state license.
11 (g) Any nurse holding a home state multistate license on the effective date
12 of this Compact may retain and renew the multistate license issued by the
13 nurse’s then-current home state, provided that:
14 (1) A nurse who changes primary state of residence after this Compact’s
15 effective date must meet all applicable requirements of subsection (c) of this
16 section to obtain a multistate license from a new home state.
17 (2) A nurse who fails to satisfy the multistate licensure requirements in
18 subsection (c) of this section due to a disqualifying event occurring after this
19 Compact’s effective date shall be ineligible to retain or renew a multistate
20 license, and the nurse’s multistate license shall be revoked or deactivated in
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1 accordance with applicable rules adopted by the Interstate Commission of
2 Nurse Licensure Compact Administrators.
3 § 1647d. APPLICATIONS FOR LICENSURE IN A PARTY STATE
4 (a) Upon application for a multistate license, the licensing board in the
5 issuing party state shall ascertain, through the coordinated licensure
6 information system, whether the applicant has ever held, or is the holder of, a
7 license issued by any other state, whether there are any encumbrances on any
8 license or multistate licensure privilege held by the applicant, whether any
9 adverse action has been taken against any license or multistate licensure
10 privilege held by the applicant, and whether the applicant is currently
11 participating in an alternative program.
12 (b) A nurse may hold a multistate license, issued by the home state, in only
13 one party state at a time.
14 (c) If a nurse changes primary state of residence by moving between two
15 party states, the nurse must apply for licensure in the new home state, and the
16 multistate license issued by the prior home state will be deactivated in
17 accordance with applicable rules adopted by the Commission.
18 (1) The nurse may apply for licensure in advance of a change in primary
19 state of residence.
20 (2) A multistate license shall not be issued by the new home state until
21 the nurse provides satisfactory evidence of a change in primary state of
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1 residence to the new home state and satisfies all applicable requirements to
2 obtain a multistate license from the new home state.
3 (d) If a nurse changes primary state of residence by moving from a party
4 state to a non-party state, the multistate license issued by the prior home state
5 will convert to a single-state license, valid only in the former home state.
6 § 1647e. ADDITIONAL AUTHORITY INVESTED IN PARTY STATE
7 LICENSING BOARDS
8 (a) In addition to the other powers conferred by state law, a licensing board
9 shall have the authority to:
10 (1) Take adverse action against a nurse’s multistate licensure privilege
11 to practice within that party state.
12 (A) Only the home state shall have the power to take adverse action
13 against a nurse’s license issued by the home state.
14 (B) For purposes of taking adverse action, the home state licensing
15 board shall give the same priority and effect to reported conduct received from
16 a remote state as it would if such conduct had occurred within the home state.
17 In so doing, the home state shall apply its own state laws to determine
18 appropriate action.
19 (2) Issue cease and desist orders or impose an encumbrance on a nurse’s
20 authority to practice within that party state.