S-0463.1
SENATE BILL 5247
State of Washington 67th Legislature 2021 Regular Session
By Senators Padden, Rivers, Gildon, Muzzall, Wagoner, and Warnick
Read first time 01/18/21. Referred to Committee on Health & Long
Term Care.
1 AN ACT Relating to the multistate nurse licensure compact;
2 amending RCW 18.79.030 and 18.130.040; reenacting and amending RCW
3 18.130.040; adding new sections to chapter 18.79 RCW; adding a new
4 chapter to Title 18 RCW; providing an effective date; and providing
5 an expiration date.
6 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
7 NEW SECTION. Sec. 1. This act shall be known and cited as the
8 interstate nurse licensure compact of 2021.
9 NEW SECTION. Sec. 2. (1) The legislature finds that:
10 (a) The health and safety of the public are affected by the
11 degree of compliance with and the effectiveness of enforcement
12 activities related to state nurse licensure laws;
13 (b) Violations of nurse licensure and other laws regulating the
14 practice of nursing may result in injury or harm to the public;
15 (c) The expanded mobility of nurses and the use of advanced
16 communication technologies as part of our nation's health care
17 delivery system require greater coordination and cooperation among
18 states in the areas of nurse licensure and regulation;
19 (d) New practice modalities and technology make compliance with
20 individual state nurse licensure laws difficult and complex;
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 1 (e) The current system of duplicative licensure for nurses
2 practicing in multiple states is cumbersome and redundant for both
3 nurses and states; and
4 (f) Uniformity of nurse licensure requirements throughout the
5 states promotes public safety and public health benefits.
6 (2) The general purposes of this compact are to:
7 (a) Facilitate the states' responsibility to protect the public's
8 health and safety;
9 (b) Ensure and encourage the cooperation of party states in the
10 areas of nurse licensure and regulation;
11 (c) Facilitate the exchange of information between party states
12 in the areas of nurse regulation, investigation, and adverse actions;
13 (d) Promote compliance with the laws governing the practice of
14 nursing in each jurisdiction;
15 (e) Invest all party states with the authority to hold a nurse
16 accountable for meeting all state practice laws in the state in which
17 the patient is located at the time care is rendered through the
18 mutual recognition of party state licenses;
19 (f) Decrease redundancies in the consideration and issuance of
20 nurse licenses; and
21 (g) Provide opportunities for interstate practice by nurses who
22 meet uniform licensure requirements.
23 NEW SECTION. Sec. 3. The definitions in this section apply
24 throughout this chapter unless the context clearly requires
25 otherwise.
26 (1) "Adverse action" means any administrative, civil, equitable,
27 or criminal action permitted by a state's laws which is imposed by a
28 licensing board or other authority against a nurse, including actions
29 against an individual's license or multistate licensure privilege
30 such as revocation, suspension, probation, monitoring of the
31 licensee, limitation on the licensee's practice, or any other
32 encumbrance on licensure affecting a nurse's authorization to
33 practice, including issuance of a cease and desist action.
34 (2) "Alternative program" means a nondisciplinary monitoring
35 program approved by a licensing board.
36 (3) "Coordinated licensure information system" means an
37 integrated process for collecting, storing, and sharing information
38 on nurse licensure and enforcement activities related to nurse
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 1 licensure laws that is administered by a nonprofit organization
2 composed of and controlled by licensing boards.
3 (4) "Current significant investigative information" means:
4 (a) Investigative information that a licensing board, after a
5 preliminary inquiry that includes notification and an opportunity for
6 the nurse to respond, if required by state law, has reason to believe
7 is not groundless and, if proved true, would indicate more than a
8 minor infraction; or
9 (b) Investigative information that indicates that the nurse
10 represents an immediate threat to public health and safety regardless
11 of whether the nurse has been notified and had an opportunity to
12 respond.
13 (5) "Encumbrance" means a revocation or suspension of, or any
14 limitation on, the full and unrestricted practice of nursing imposed
15 by a licensing board.
16 (6) "Home state" means the party state which is the nurse's
17 primary state of residence.
18 (7) "Interstate commission" means the interstate commission of
19 nurse licensure compact administrators.
20 (8) "Licensing board" means a party state's regulatory body
21 responsible for issuing nurse licenses.
22 (9) "Multistate license" means a license to practice as a
23 registered or a licensed practical nurse or vocational nurse issued
24 by a home state licensing board that authorizes the licensed nurse to
25 practice in all party states under a multistate licensure privilege.
26 (10) "Multistate licensure privilege" means a legal authorization
27 associated with a multistate license permitting the practice of
28 nursing as either a registered nurse, or licensed practical or
29 vocational nurse, in a remote state.
30 (11) "Nurse" means registered nurse, or licensed practical or
31 vocational nurse, as those terms are defined by each party state's
32 practice laws.
33 (12) "Party state" means any state that has adopted this compact.
34 (13) "Remote state" means a party state, other than the home
35 state.
36 (14) "Single-state license" means a nurse license issued by a
37 party state that authorizes practice only within the issuing state
38 and does not include a multistate licensure privilege to practice in
39 any other party state.
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1 (15) "State" means a state, territory, or possession of the
2 United States or the District of Columbia.
3 (16) "State practice laws" means a party state's laws, rules, and
4 regulations that govern the practice of nursing, define the scope of
5 nursing practice, and create the methods and grounds for imposing
6 discipline. State practice laws do not include requirements necessary
7 to obtain and retain a license, except for qualifications or
8 requirements of the home state.
9 NEW SECTION. Sec. 4. (1) A multistate license to practice
10 registered or licensed practical or vocational nursing issued by a
11 home state to a resident in that state will be recognized by each
12 party state as authorizing a nurse to practice as a registered nurse,
13 or licensed practical or vocational nurse, under a multistate
14 licensure privilege, in each party state.
15 (2) A state must implement procedures for considering the
16 criminal history records of applicants for initial multistate license
17 or licensure by endorsement. Such procedures shall include the
18 submission of fingerprints or other biometric-based information by
19 applicants for the purpose of obtaining an applicant's criminal
20 history record information from the federal bureau of investigation
21 and the agency responsible for retaining that state's criminal
22 records.
23 (3) Each party state shall require the following for an applicant
24 to obtain or retain a multistate license in the home state:
25 (a) Meets the home state's qualifications for licensure or
26 renewal of licensure, as well as all other applicable state laws;
27 (b)(i) Has graduated or is eligible to graduate from a licensing
28 board-approved registered nurse, or licensed practical or vocational
29 nurse, prelicensure education program; or
30 (ii) Has graduated from a foreign registered nurse, or licensed
31 practical or vocational nurse, prelicensure education program that
32 (A) has been approved by the authorized accrediting body in the
33 applicable country and (B) has been verified by an independent
34 credentials review agency to be comparable to a licensing board-
35 approved prelicensure education program;
36 (c) Has, if a graduate of a foreign prelicensure education
37 program not taught in English or if English is not the individual's
38 native language, successfully passed an English proficiency
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 1 examination that includes the components of reading, speaking,
2 writing, and listening;
3 (d) Has successfully passed an NCLEX-RN® or NCLEX-PN® examination
4 or recognized predecessor, as applicable;
5 (e) Is eligible for or holds an active, unencumbered license;
6 (f) Has submitted, in connection with an application for initial
7 licensure or licensure by endorsement, fingerprints or other
8 biometric data for the purpose of obtaining criminal history record
9 information from the federal bureau of investigation and the agency
10 responsible for retaining that state's criminal records;
11 (g) Has not been convicted or found guilty, or has entered into
12 an agreed disposition, of a felony offense under applicable state or
13 federal criminal law;
14 (h) Has not been convicted or found guilty, or has entered into
15 an agreed disposition, of a misdemeanor offense related to the
16 practice of nursing as determined on a case-by-case basis;
17 (i) Is not currently enrolled in an alternative program;
18 (j) Is subject to self-disclosure requirements regarding current
19 participation in an alternative program; and
20 (k) Has a valid United States social security number.
21 (4) All party states shall be authorized, in accordance with
22 existing state due process law, to take adverse action against a
23 nurse's multistate licensure privilege such as revocation,
24 suspension, probation, or any other action that affects a nurse's
25 authorization to practice under a multistate licensure privilege,
26 including cease and desist actions. If a party state takes such
27 action, it shall promptly notify the administrator of the coordinated
28 licensure information system. The administrator of the coordinated
29 licensure information system shall promptly notify the home state of
30 any such actions by remote states.
31 (5) A nurse practicing in a party state must comply with the
32 state practice laws of the state in which the client is located at
33 the time service is provided. The practice of nursing is not limited
34 to patient care, but shall include all nursing practice as defined by
35 the state practice laws of the party state in which the client is
36 located. The practice of nursing in a party state under a multistate
37 licensure privilege will subject a nurse to the jurisdiction of the
38 licensing board, the courts, and the laws of the party state in which
39 the client is located at the time service is provided.
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 1 (6) Individuals not residing in a party state shall continue to
2 be able to apply for a party state's single-state license as provided
3 under the laws of each party state. However, the single-state license
4 granted to these individuals will not be recognized as granting the
5 privilege to practice nursing in any other party state. Nothing in
6 this compact shall affect the requirements established by a party
7 state for the issuance of a single-state license.
8 (7) Any nurse holding a home state multistate license, on the
9 effective date of this compact, may retain and renew the multistate
10 license issued by the nurse's then-current home state, provided that:
11 (a) A nurse, who changes primary state of residence after the
12 effective date of this compact, must meet all applicable requirements
13 of subsection (3) of this section to obtain a multistate license from
14 a new home state.
15 (b) A nurse who fails to satisfy the multistate licensure
16 requirements in subsection (3) of this section due to a disqualifying
17 event occurring after the effective date of this compact shall be
18 ineligible to retain or renew a multistate license, and the nurse's
19 multistate license shall be revoked or deactivated in accordance with
20 applicable rules adopted by the interstate commission.
21 NEW SECTION. Sec. 5. (1) Upon application for a multistate
22 license, the licensing board in the issuing party state shall
23 ascertain, through the coordinated licensure information system,
24 whether the applicant has ever held, or is the holder of, a license
25 issued by any other state, whether there are any encumbrances on any
26 license or multistate licensure privilege held by the applicant,
27 whether any adverse action has been taken against any license or
28 multistate licensure privilege held by the applicant, and whether the
29 applicant is currently participating in an alternative program.
30 (2) A nurse may hold a multistate license, issued by the home
31 state, in only one party state at a time.
32 (3) If a nurse changes primary state of residence by moving
33 between two party states, the nurse must apply for licensure in the
34 new home state, and the multistate license issued by the prior home
35 state will be deactivated in accordance with applicable rules adopted
36 by the interstate commission.
37 (a) The nurse may apply for licensure in advance of a change in
38 primary state of residence.
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1 (b) A multistate license shall not be issued by the new home
2 state until the nurse provides satisfactory evidence of a change in
3 primary state of residence to the new home state and satisfies all
4 applicable requirements to obtain a multistate license from the new
5 home state.
6 (4) If a nurse changes primary state of residence by moving from
7 a party state to a nonparty state, the multistate license issued by
8 the prior home state will convert to a single-state license, valid
9 only in the former home state.
10 NEW SECTION. Sec. 6. (1) In addition to the other powers
11 conferred by state law, a licensing board shall have the authority
12 to:
13 (a) Take adverse action against a nurse's multistate licensure
14 privilege to practice within that party state.
15 (i) Only the home state shall have the power to take adverse
16 action against a nurse's license issued by the home state.
17 (ii) For purposes of taking adverse action, the home state
18 licensing board shall give the same priority and effect to reported
19 conduct received from a remote state as it would if such conduct had
20 occurred within the home state. In so doing, the home state shall
21 apply its own state laws to determine appropriate action;
22 (b) Issue cease and desist orders or impose an encumbrance on a
23 nurse's authority to practice within that party state;
24 (c) Complete any pending investigations of a nurse who changes
25 primary state of residence during the course of such investigations.
26 The licensing board shall also have the authority to take appropriate
27 action and shall promptly report the conclusions of such
28 investigations to the administrator of the coordinated licensure
29 information system. The administrator of the coordinated licensure
30 information system shall promptly notify the new home state of any
31 such actions;
32 (d) Issue subpoenas for both hearings and investigations that
33 require the attendance and testimony of witnesses, as well as the
34 production of evidence. Subpoenas issued by a licensing board in a
35 party state for the attendance and testimony of witnesses or the
36 production of evidence from another party state shall be enforced in
37 the latter state by any court of competent jurisdiction, according to
38 the practice and procedure of that court applicable to subpoenas
39 issued in proceedings pending before it. The issuing authority shall
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 1 pay any witness fees, travel expenses, mileage, and other fees
2 required by the service statutes of the state in which the witnesses
3 or evidence are located;
4 (e) Obtain and submit, for each nurse licensure applicant,
5 fingerprint or other biometric-based information to the federal
6 bureau of investigation for criminal background checks, receive the
7 results of the federal bureau of investigation record search on
8 criminal background checks, and use the results in making licensure
9 decisions;
10 (f) If otherwise permitted by state law, recover from the
11 affected nurse the costs of investigations and disposition of cases
12 resulting from any adverse action taken against that nurse;
13 (g) Take adverse action based on the factual findings of the
14 remote state, provided that the licensing board follows its own
15 procedures for taking such adverse action.
16 (2) If adverse action is taken by the home state against a
17 nurse's multistate license, the nurse's multistate licensure
18 privilege to practice in all other party states shall be deactivated
19 until all encumbrances have been removed