Mackenzie Bean (Twitter) Becker’s Hospital Review
Some physician and nursing groups are challenging efforts to enact a multistate licensing compact for advanced practice registered nurses.
The compact would enable APRNs with more than 2,080 hours of practice to hold one multistate license, allowing them to work in other compact part states without obtaining additional licenses. The compact states that an APRN issued a multistate license is authorized to assume responsibility for patient care independently, without any supervisory or collaborative relationship, but must still comply with the practice laws of each state where they provide care.
“This increases access to care by allowing APRNs to care for patients across state lines — both in person and electronically,” the National Council of State Boards of Nursing’s website reads. “The APRN Compact provides public protection by establishing uniformity in the way APRNs are regulated at the state level.”
The American Association of Nurse Practitioners has encouraged states to pause adoption of the compact so an improved version can be developed. The AANP said it “strongly opposes” the inclusion of practice hours as a prerequisite for a multistate license, noting APRNs are prepared to practice safely right after graduating and passing their board examination. The association is also calling for the compact to include an APRN advisory committee to address the complexity and variety of practice issues.
“In the past, the association has supported the concept of a multistate licensure compact for APRNs,” the group said. “AANP knows that ending the current patchwork of licensure and practice authorization is necessary to improve health outcomes for patients and address healthcare workforce needs. It is unfortunate, but necessary, that AANP not endorse or work toward implementing NCSBN’s revised APRN Compact.”
The American Medical Association has also pushed back on the compact, claiming it differs from other licensing compacts by preempting state scope of practice laws.
“The AMA strongly objects to the use of interstate compacts as a mechanism through which to grant independent practice to APRNs or grant prescriptive authority where such authority does not currently exist,” the organization said June 27. “Not only is this deceptive, it is the AMA’s position that this use of a licensure compact has the potential to threaten patient care and safety.”
NCSBN disagrees with the notion that the compact preempts state law. Nicole Livanos, the organization’s director of state affairs, said states that enact the compact are making a policy decision to allow multistate licensees to practice independently.
The NCSBN adopted the APRN Compact in August 2020. Seven states must enact the legislation for the APRN Compact to take effect. To date, Utah, North Dakota, South Dakota and Delaware have joined the compact. Seven states rejected the compact in 2023. Two other states introduced compact legislation this year, which both failed after passing one chamber in the state legislature.
However, Ms. Livanos said nursing support for the APRN Compact at the state level is growing steadily and significantly. South Dakota became the most recent state to join the compact in February, with all nursing organizations in the state supporting the measure. On June 23, the Wyoming Council of Advanced Practice Nurses also unanimously voted to support the compact, reversing its previous opposition.
“We think that the time for the APRN Compact isn’t now. It was actually yesterday. It was last year, the year before,” Ms. Livanos said. “We know patients deserve greater access to care from safe and quality APRN providers. And APRNs deserve access to a modern, 21st century licensure framework.”
