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Letter to the Editor

Legislative and Policy Issues Related to Interstate Practice: NAPNAP Letter

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Citation: Glazer, G. (May 4, 1999). Legislative Column: "Legislative and Policy Issues Related to Interstate Practice: NAPNAP Letter." Online Journal of Issues in Nursing. Available: 

April 8, 1998
The Honorable Mark Barnett
Attorney General of South Dakota
Office of the Attorney General
500 East Capitol
Pierre, SD 57501-5070

Dear Attorney General Barnett:

On behalf of the National Association of Pediatric Nurse Associates and Practitioners (NAPNAP), representing over 5,500 pediatric nurse practitioners (PNPs). I want to share with you our organization’s grave concerns with a proposed multistate licensure compact for registered nurses (RNs) and licensed practical nurses (LPNs) which may soon come before your state legislature. We ask you to seriously consider the negative impact of this legislation and join us in opposing it.

Founded in 1973, NAPNAP is the largest nursing organization dedicated solely to improving the quality of health care for children from birth to the age of 21. PNPs are registered nurses with advanced education and training who provide health care services in all 50 states. The PNP has completed a program of nurse practitioner (NP) preparation usually offered in Schools of Nursing as part of the Masters in Nursing Degree Program.

Facilitating the elimination of barriers which impede the continuity of high quality patient care is a reasonable goal which NAPNAP supports; however, the proposed multistate nurse licensure compact does little to accomplish this and may ultimately create additional barriers and regulatory hurdles to meeting the needs of our patients–your constituents. Further, there is a potential harm to the public health as the compact would create a "lowest common denominator" of state licensure standards. This phenomenon would result from provisions in the compact which require party states to unconditionally accept nurses’ licenses from other states regardless of whether those states require equally rigorous licensure standards.

The National Council of State Boards of Nursing (NCSBN), the umbrella organization for all state and territorial nursing boards, approved language for a multistate licensure compact for RNs and LPNs in December 1997. The NCSBN asserts that the Compact will not affect advanced practice nurses such as PNPs; however, a PNPs additional recognition is based on RN licensure. Changes in the fundamental structure of granting RN/LPN licenses carry implications for the additional licensure requirements of advanced practice for which we afford the highest level of scrutiny, and in this instance, are extremely concerned about the ramifications of such change.

On its face, the Compact appears benign; however, it gives unprecedented new authority to state boards of nursing and the NCSBN–a private entity. In short, the compact would require that the nurse hold licensure in his/her state of residence, rather than the state where the nurse works and/or practices; requires that states party to the compact recognize the license and licensure renewal protocols of the home state; but asserts that the nurse must comply with the practice act of the state in which the patient is located.

The power this Compact would delegate to state boards of nursing is unparalleled and unwise. It establishes a state board’s authority to subpoena nurses within and across state lines; provides boards of nursing the latitude to require that information such as OSHA, and tax violations be reported to the NCSBN data bank by state agencies; allows unlimited and unrestricted sharing of personal information about nurses without the individual nurse having either the right to review or verify the existence and/or transfer of their information.

This last item strikes at the heart of a contentious and unresolved debate at the state and federal level regarding privacy laws to protect personal information. Antiquated federal privacy laws and a patchwork of state laws are insufficient to protect the confidentiality of patient and provider information that can be shared in many states through this vehicle. Further, the compact is devoid of protections which preclude the sale of database information to entities with a financial interest in exploiting this sensitive and personal information such as pharmaceutical companies and insurers. Knowledge of these privacy loopholes may promulgate diminishing consumer confidence in emerging technology, trust in the provider-patient relationship, and hinder rather than help facilitate the telehealth practices that can improve quality of care and reduce medical expenditures.

Finally, the Compact’s language obscures the definition of nursing by assuming that there can be "the practice of nursing not involving a patient." Noteworthy is that the NCSBN indicated early in the development of the compact that this agreement was intended to facilitate telehealth or telenursing. We believe it does little to advance telenursing, sidesteps efforts by states to protect the quality of care and raises numerous enforcement and compliance questions.

We implore you to closely examine the implications of the compact on your state licensure laws and regulations. NAPNAP is opposed to passage of the compact in all states, questions the wisdom of delegating compact authority to an unregulated private entity, and invites discussion of other mechanisms to lower the barriers to interstate practice. To provide some background on the issue and the problems that NAPNAP has identified, I have enclosed a copy of the compact and legal analysis prepared by our counsel. Upon reviewing our materials, please do not hesitate to call our Washington Representatives Deb Hardy Havens or Marian Lowe at (202) 544-1880 if you have any additional questions or would like further information.


Patricia Franklin, RN, MSN, CPNP

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© 1999 Online Journal of Issues in Nursing
Article published May 4, 1999