CLEAR News - Winter 2000

Mutual Recognition - Nurse Licensure Comes of Age
Submitted by the National Council of State Boards of Nursing

A nurse lives in Arkansas but practices in Texas. Does she need to be licensed in both states? Not if these states have enacted the mutual recognition model of nurse licensure. In the health care environment, with its advancing technology and increasing telepractice needs, mutual recognition provides opportunities that would not have been possible even ten years ago. Mutual recognition for nursing regulation meets the needs of a changing healthcare environment by capitalizing on new practice methods and technology.

State boards of nursing have worked effectively in regulating the practice of nursing within the geographic boundaries of a particular state for nearly 100 years. However, this regulatory system was devised when interstate travel was unimaginable and communication took days and weeks, not minutes. Modern factors such as the increased mobility of nurses, advanced communication technologies and integrated health care systems that traverse state lines have substantially altered the way nursing is practiced. In response to the changing needs of the healthcare community, the National Council of State Boards of Nursing (NCSBN) in 1994 began to explore different approaches to regulation that would allow state boundaries to be more permeable while at the same time maintaining standards for protection of the public. Charged with creating a system where a state nursing license was recognized nationally and enforced locally, several models of nursing regulation were developed and analyzed and mutual recognition emerged as the preferred regulatory model.

Without the adoption of mutual recognition, nurses who provide care via video or teleconferencing or utilize a fax machine, computer or interactive television must be licensed in the state where the patient receiving the advice or care is located. Under the mutual recognition model, nurses hold a license in their state of residency and are able to practice in any state that has implemented an interstate compact, provided they follow the laws and regulations of the state in which they are practicing.

The mutual recognition model for nursing regulation is implemented via an interstate compact* that is adopted at the state level. An interstate compact for nurse licensure is an agreement among states to coordinate certain activities associated with nurse licensure. It is designed to reduce multiple licensure requirements, enhance information sharing, and establish mechanisms for disciplinary actions associated with interstate practice.

Currently, there are nine states that have implemented an interstate nurse licensure compact, with three more states due to enact a compact in 2001. According to Marcia Rachel, Executive Director of the Mississippi Board of Nursing, "It was an idea whose time had come. Implementation of the compact will improve the ability to communicate between and among boards of nursing regarding investigations, eliminate duplicative requests for documentation from nurse applicants, and utilize resources by multi-state organizations."

Although the process of moving legislation through legislative sessions can require a great deal of work, and differs by state because of various intricacies in laws and procedures, most states that have adopted the interstate compact have received little opposition from state legislatures. Polly Johnson, Executive Director of the North Carolina Board of Nursing, states, "Probably the most important part of getting our bill through the legislature was working closely with our nurses association and seeking endorsement from key trade associations as well as major medical systems in the state."

Naturally, implementing mutual recognition requires changes to the administrative process in each state. In North Carolina, the primary changes have occurred in the licensure and information systems departments. According to Johnson, "The biggest effort was in changing our data base and data fields, as well as changing our initial and renewal application forms for licensure." In Texas similar changes have occurred, with the processes in the Enforcement department also experiencing change. "In Enforcement, procedures to verify the national database, NURSYS*, for significant investigative information were added. Joint investigations were initiated on cases which crossed state lines and implementation of enforcement changes will occur over time as we have more shared cases," reports Katherine Thomas, Executive Director of the Texas Board of Nurse Examiners.

Compact administrators unanimously agree that mutual recognition is a potential model for other professions. "We believe it will work, and to the extent that other professions are regulated in a similar manner, this model seems applicable," says Thomas. Indeed, according to Myra Broadway, a member of the NCSBN Board of Directors and Executive Director of the Maine State Board of Nursing, the Board of Engineers in Maine has expressed interest in this model.

The NCSBN believes the primary goal of mutual recognition is to provide better protection for the public through improved regulation. Not only will mutual recognition increase mobility across state lines, but it also increases communication among state boards regarding discipline. The resulting enhanced communication can only mean greater safety to the public at large.

For additional information, visit the NCSBN website at

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