NCSBN Delegates Approve Mutual Recognition Model for Nursing Regulation


Nurses may soon be able to practice anywhere in the U.S. without obtaining multiple state licensure if states adopt the regulatory model endorsed by the National Council of State Boards of Nursing (NCSBN). In a December 1997 special session of NCSBN's Delegate Assembly, nursing boards approved proposed language for an interstate compact supporting a mutual recognition model for nursing regulation. Fifty-seven of the 61 U.S. boards of nursing attended.

In this mutual recognition model, nurses licensed by their home state can practice freely in other states, providing they observe each state's unique practice laws. To achieve mutual recognition, states have to enter into an interstate compact, an agreement between two or more states to solve a problem of mutual concern. Whether or not occurs ultimately rests with state legislatures, who will be encouraged by delegates to implement the compact no earlier than January 1, 2000.

"Boards of nursing should be commended for their foresight in progressing further toward mutual recognition," said Tom Neumann, NCSBN President. "Enactment of this language for nursing regulation will reduce many of the real or perceived barriers to health care delivery while continuing to protect the public health, safety and welfare."

The task force that drafted the mutual recognition model identified telenursing as a major force driving regulatory reform. Increasingly, health care providers are using computers, video conferencing and other technologies to link nurses with distant patients. An even more common form of telenursing, telephone triage, allows nurses to obtain information and advise patients by phone, which reduces the need for hospitalization.

While consumers may welcome these additional health delivery options, nursing activities that cross state lines create headaches for boards charged with regulating the practice of nursing in their states. The proposed model would simplify the regulation of interstate practice in several ways:

Key to the proposed model's success is the development of a central licensure database. The database would contain all the information necessary to verify a nurse's credentials and track disciplinary actions in every state in which he or she practices. NCSBN expects such a database to be fully operational before the year 2000.

The American Nurses Association, a Washington D.C.-based organization, is currently developing its own policy on multi-state licensure for regulated nurses. Winnie Carson, ANA Nurse Practice Counsel, says while she doesn't object to NCSBN's model per se, she does not feel the nursing profession should move so quickly.

The 1997 ANA House of Delegates issued the following statement: "Any changes in the current system of regulation should be addressed in a coherent manner including the issue of states rights balanced with federal regulation. Many of the same questions and concerns regarding authorization to practice are raised regardless of whether one is discussing new technologies such as telehealth, Internet health or interstate mobility."

If state legislatures adopt the proposed model, state boards will have several cost issues to resolve. Boards would need to compensate for the loss of revenue from duplicate license fees (initial, renewal, etc.). Further, boards would be expected to help build and maintain the central licensure database.

NCSBN's Delegate Assembly will meet again on August 3-8, 1998, in Albuquerque, New Mexico, to develop addtional strategies for implementation of the mutual recognition model. NCSBN will report on the projected cost to state boards at that time.

For more information, visit NCSBN's web site at Additional information on ANA's position can be obtained at