CHAPTER 305. NCSBN ADVANCED PRACTICE REGISTERED NURSE COMPACT
OCCUPATIONS CODE
TITLE 3. HEALTH PROFESSIONS
SUBTITLE E. REGULATION OF NURSING
CHAPTER 305. NCSBN ADVANCED PRACTICE REGISTERED NURSE COMPACT
For contingent expiration of this chapter, see Section 305.003.
Sec. 305.001. NCSBN ADVANCED PRACTICE REGISTERED NURSE COMPACT.
The NCSBN Advanced Practice Registered Nurse Compact is enacted
and entered into with all other jurisdictions that legally join
in the compact, which is as follows:
NCSBN ADVANCED PRACTICE REGISTERED NURSE COMPACT
ARTICLE 1. FINDINGS AND DECLARATION OF PURPOSE
(a) The party states find that:
(1) the health and safety of the public are affected by the
degree of compliance with APRN licensure/authority to practice
requirements and the effectiveness of enforcement activities
related to state APRN licensure/authority to practice laws;
(2) violations of APRN licensure/authority to practice and other
laws regulating the practice of nursing may result in injury or
harm to the public;
(3) the expanded mobility of APRNs and the use of advanced
communication technologies as part of our nation's health care
delivery system require greater coordination and cooperation
among states in the areas of APRN licensure/authority to practice
and regulation;
(4) new practice modalities and technology make compliance with
individual state APRN licensure/authority to practice laws
difficult and complex;
(5) the current system of duplicative APRN licensure/authority
to practice for APRNs practicing in multiple states is cumbersome
and redundant to both APRNs and states;
(6) uniformity of APRN requirements throughout the states
promotes public safety and public health benefits; and
(7) access to APRN services increases the public's access to
health care, particularly in rural and underserved areas.
(b) The general purposes of this compact are to:
(1) facilitate the states' responsibilities to protect the
public's health and safety;
(2) ensure and encourage the cooperation of party states in the
areas of APRN licensure/authority to practice and regulation,
including promotion of uniform licensure requirements;
(3) facilitate the exchange of information between party states
in the areas of APRN regulation, investigation, and adverse
actions;
(4) promote compliance with the laws governing APRN practice in
each jurisdiction; and
(5) invest all party states with the authority to hold an APRN
accountable for meeting all state practice laws in the state in
which the patient is located at the time care is rendered through
the mutual recognition of party state licenses.
ARTICLE 2. DEFINITIONS
(a) "Advanced practice registered nurse" or "APRN" means a nurse
anesthetist, nurse practitioner, nurse midwife, or clinical nurse
specialist to the extent a party state licenses or grants
authority to practice in that APRN role and title.
(b) "Adverse action" means a home or remote state disciplinary
action.
(c) "Alternative program" means a voluntary, non-disciplinary
monitoring program approved by a licensing board.
(d) "APRN licensure/authority to practice" means the regulatory
mechanism used by a party state to grant legal authority to
practice as an APRN.
(e) "APRN uniform licensure/authority to practice requirements"
means those minimum uniform licensure, education, and examination
requirements as agreed to by the compact administrators and
adopted by licensing boards for the recognized APRN role and
title.
(f) "Coordinated licensure information system" means an
integrated process for collecting, storing, and sharing
information on APRN licensure/authority to practice and
enforcement activities related to APRN licensure/authority to
practice laws, which is administered by a nonprofit organization
composed of and controlled by state licensing boards.
(g) "Current significant investigative information" means:
(1) investigative information that a licensing board, after a
preliminary inquiry that includes notification and an opportunity
for the APRN to respond if required by state law, has reason to
believe is not groundless and, if proved true, would indicate
more than a minor infraction; or
(2) investigative information that indicates that the APRN
represents an immediate threat to public health and safety
regardless of whether the APRN has been notified and had an
opportunity to respond.
(h) "Home state" means the party state that is the APRN's
primary state of residence.
(i) "Home state action" means any administrative, civil,
equitable, or criminal action permitted by the home state's laws
which are imposed on an APRN by the home state's licensing board
or other authority, including actions against an individual's
license/authority to practice such as: revocation, suspension,
probation, or any other action which affects an APRN's
authorization to practice.
(j) "Licensing board" means a party state's regulatory body
responsible for issuing APRN licensure/authority to practice.
(k) "Multistate advanced practice privilege" means current
authority from a remote state permitting an APRN to practice in
that state in the same role and title as the APRN is
licensed/authorized to practice in the home state to the extent
that the remote state laws recognize such APRN role and title. A
remote state has the authority, in accordance with existing state
due process laws, to take actions against the APRN's privilege,
including revocation, suspension, probation, or any other action
that affects an APRN's multistate privilege to practice.
(l) "Party state" means any state that has adopted this compact.
(m) "Prescriptive authority" means the legal authority to
prescribe medications and devices as defined by party state laws.
(n) "Remote state" means a party state, other than the home
state:
(1) where the patient is located at the time APRN care is
provided; or
(2) in the case of APRN practice not involving a patient, in
such party state where the recipient of APRN practice is located.
(o) "Remote state action" means:
(1) any administrative, civil, equitable, or criminal action
permitted by a remote state's laws which are imposed on an APRN
by the remote state's licensing board or other authority,
including actions against an individual's multistate advanced
practice privilege in the remote state; and
(2) cease and desist and other injunctive or equitable orders
issued by remote states or the licensing boards thereof.
(p) "State" means a state, territory, or possession of the
United States.
(q) "State practice laws" means a party state's laws and
regulations that govern APRN practice, define the scope of
advanced nursing practice, including prescriptive authority, and
create the methods and grounds for imposing discipline. State
practice laws do not include the requirements necessary to obtain
and retain APRN licensure/authority to practice as an APRN,
except for qualifications or requirements of the home state.
(r) "Unencumbered" means that a state has no current
disciplinary action against an APRN's license/authority to
practice.
ARTICLE 3. GENERAL PROVISIONS AND JURISDICTION
(a) All party states shall participate in the nurse licensure
compact for registered nurses and licensed practical/vocational
nurses in order to enter into the APRN compact.
(b) No state shall enter the APRN compact until the state
adopts, at a minimum, the APRN uniform licensure/authority to
practice requirements for each APRN role and title recognized by
the state seeking to enter the APRN compact.
(c) APRN licensure/authority to practice issued by a home state
to a resident in that state will be recognized by each party
state as authorizing a multistate advanced practice privilege to
the extent that the role and title are recognized by each party
state. To obtain or retain APRN licensure/authority to practice
as an APRN, an applicant must meet the home state's
qualifications for authority or renewal of authority as well as
all other applicable state laws.
(d) The APRN multistate advanced practice privilege does not
include prescriptive authority, and does not affect any
requirements imposed by states to grant to an APRN initial and
continuing prescriptive authority according to state practice
laws. However, a party state may grant prescriptive authority to
an individual on the basis of a multistate advanced practice
privilege to the extent permitted by state practice laws.
(e) A party state may, in accordance with state due process
laws, limit or revoke the multistate advanced practice privilege
in the party state and may take any other necessary actions under
the party state's applicable laws to protect the health and
safety of the party state's citizens. If a party state takes
action, the party state shall promptly notify the administrator
of the coordinated licensure information system. The
administrator of the coordinated licensure information system
shall promptly notify the home state of any such actions by
remote states.
(f) An APRN practicing in a party state must comply with the
state practice laws and licensing board rules of the state in
which the patient is located at the time care is provided. The
APRN practice includes patient care and all advanced nursing
practice defined by the party state's practice laws. The APRN
practice will subject an APRN to the jurisdiction of the
licensing board, the courts, and the laws of the party state.
(g) Individuals not residing in a party state may apply for APRN
licensure/authority to practice as an APRN under the laws of a
party state. However, the authority to practice granted to these
individuals will not be recognized as granting the privilege to
practice as an APRN in any other party state unless explicitly
agreed to by that party state.
ARTICLE 4. APPLICATIONS FOR APRN LICENSURE/AUTHORITY TO PRACTICE
IN A PARTY STATE
(a) Once an application for APRN licensure/authority to practice
is submitted, a party state shall ascertain, through the
coordinated licensure information system, whether:
(1) the applicant has held or is the holder of a nursing
license/authority to practice issued by another state;
(2) the applicant has had a history of previous disciplinary
action by any state;
(3) an encumbrance exists on any license/authority to practice;
and
(4) any other adverse action by any other state has been taken
against a license/authority to practice.
This information may be used in approving or denying an
application for APRN licensure/authority to practice.
(b) An APRN in a party state shall hold APRN licensure/authority
to practice in only one party state at a time, issued by the home
state.
(c) An APRN who intends to change the APRN's primary state of
residence may apply for APRN licensure/authority to practice in
the new home state in advance of such change. However, new
licensure/authority to practice will not be issued by a party
state until after an APRN provides evidence of change in primary
state of residence satisfactory to the new home state's licensing
board.
(d) When an APRN changes primary state of residence by:
(1) moving between two party states, and obtains APRN
licensure/authority to practice from the new home state, the APRN
licensure/authority to practice from the former home state is no
longer valid;
(2) moving from a nonparty state to a party state, and obtains
APRN licensure/authority to practice from the new home state, the
individual state license issued by the nonparty state is not
affected and will remain in full force if so provided by the laws
of the nonparty state; and
(3) moving from a party state to a nonparty state, the APRN
licensure/authority to practice issued by the prior home state
converts to an individual state license, valid only in the former
home state, without the multistate licensure privilege to
practice in other party states.
ARTICLE 5. ADVERSE ACTIONS
(a) The licensing board of a remote state shall promptly report
to the administrator of the coordinated licensure information
system any remote state actions, including the factual and legal
basis for such action, if known. The licensing board of a remote
state shall also promptly report any significant current
investigative information yet to result in a remote state action.
The administrator of the coordinated licensure information
system shall promptly notify the home state of any such reports.
(b) The licensing board of a party state shall have the
authority to complete any pending investigations for an APRN who
changes primary state of residence during the course of such
investigations. It shall also have the authority to take
appropriate action, and shall promptly report the conclusions of
such investigations to the administrator of the coordinated
licensure information system. The administrator of the
coordinated licensure information system shall promptly notify
the new home state of any such actions.
(c) A remote state may take adverse action affecting the
multistate advanced practice privilege to practice within that
party state. However, only the home state shall have the power
to impose adverse action against the APRN licensure/authority to
practice issued by the home state.
(d) For purposes of imposing adverse action, the licensing board
of the home state shall give the same priority and effect to
reported conduct received from a remote state as it would if such
conduct had occurred within the home state. In so doing, it
shall apply its own state laws to determine appropriate action.
(e) The home state may take adverse action based on the factual
findings of the remote state, so long as each state follows its
own procedures for imposing such adverse action.
(f) Nothing in this compact shall override a party state's
decision that participation in an alternative program may be used
in lieu of adverse action and that such participation shall
remain nonpublic if required by the party state's laws. Party
states must require APRNs who enter any alternative programs to
agree not to practice in any other party state during the term of
the alternative program without prior authorization from such
other party state.
(g) All home state licensing board disciplinary orders, agreed
or otherwise, which limit the scope of the APRN's practice or
require monitoring of the APRN as a condition of the order shall
include the requirements that the APRN will limit her or his
practice to the home state during the pendency of the order.
This requirement may allow the APRN to practice in other party
states with prior written authorization from both the home state
and party state licensing boards.
ARTICLE 6. ADDITIONAL AUTHORITIES INVESTED IN PARTY STATE
LICENSING BOARDS
(a) Notwithstanding any other powers, party state licensing
boards shall have the authority to:
(1) if otherwise permitted by state law, recover from the
affected APRN the costs of investigations and disposition of
cases resulting from any adverse action taken against that APRN;
(2) issue subpoenas for both hearings and investigations, which
require the attendance and testimony of witnesses, and the
production of evidence;
(3) issue cease and desist orders to limit or revoke an APRN's
privilege or licensure/authority to practice in their state; and
(4) promulgate uniform rules and regulations as provided for in
Article 8(c).
(b) Subpoenas issued by a licensing board in a party state for
the attendance and testimony of witnesses, and/or the production
of evidence from another party state, shall be enforced in the
latter state by any court of competent jurisdiction, according to
the practice and procedure of that court applicable to subpoenas
issued in proceedings pending before it. The issuing authority
shall pay any witness fees, travel expenses, mileage, and other
fees required by the service statutes of the state where the
witnesses and/or evidence are located.
ARTICLE 7. COORDINATED LICENSURE INFORMATION SYSTEM
(a) All party states shall participate in a cooperative effort
to create a coordinated database of all APRNs. This system will
include information on the APRN licensure/authority to practice
and disciplinary history of each APRN, as contributed by party
states, to assist in the coordination of APRN licensure/authority
to practice and enforcement efforts.
(b) Notwithstanding any other provision of law, all party
states' licensing boards shall promptly report adverse actions,
actions against multistate advanced practice privileges, any
current significant investigative information yet to result in
adverse action, denials of applications, and the reasons for such
denials to the coordinated licensure information system.
(c) Current significant investigative information shall be
transmitted through the coordinated licensure information system
only to party state licensing boards.
(d) Notwithstanding any other provision of law, all party
states' licensing boards contributing information to the
coordinated licensure information system may designate
information that may not be shared with nonparty states or
disclosed to other entities or individuals without the express
permission of the contributing state.
(e) Any personally identifiable information obtained by a party
states' licensing board from the coordinated licensure
information system may not be shared with nonparty states or
disclosed to other entities or individuals except to the extent
permitted by the laws of the party state contributing the
information.
(f) Any information contributed to the coordinated licensure
information system that is subsequently required to be expunged
by the laws of the party state contributing that information
shall also be expunged from the coordinated licensure information
system.
(g) The compact administrators, acting jointly with each other
and in consultation with the administrator of the coordinated
licensure information system, shall formulate necessary and
proper procedures for the identification, collection, and
exchange of information under this compact.
ARTICLE 8. COMPACT ADMINISTRATION AND INTERCHANGE OF INFORMATION
(a) The head of the licensing board, or his/her designee, of
each party state shall be the administrator of this compact for
his/her state.
(b) The compact administrator of each party state shall furnish
to the compact administrator of each other party state any
information and documents including, but not limited to, a
uniform data set of investigations, identifying information,
licensure data, and disclosable alternative program participation
information to facilitate the administration of this compact.
(c) Compact administrators shall have the authority to develop
uniform rules to facilitate and coordinate implementation of this
compact. These uniform rules shall be adopted by party states,
under the authority invested under Article 6(a)(4).
ARTICLE 9. IMMUNITY
No party state or the officers or employees or agents of a party
state's licensing board who act in accordance with the provisions
of this compact shall be liable on account of any act or omission
in good faith while engaged in the performance of their duties
under this compact. Good faith in this article shall not include
willful misconduct, gross negligence, or recklessness.
ARTICLE 10. ENTRY INTO FORCE, WITHDRAWAL, AND AMENDMENT
(a) This compact shall enter into force and become effective as
to any state when it has been enacted into the laws of that
state. Any party state may withdraw from this compact by
enacting a statute repealing the same, but no such withdrawal
shall take effect until six months after the withdrawing state
has given notice of the withdrawal to the executive heads of all
other party states.
(b) No withdrawal shall affect the validity or applicability by
the licensing boards of states remaining party to the compact of
any report of adverse action occurring prior to the withdrawal.
(c) Nothing contained in this compact shall be construed to
invalidate or prevent any APRN licensure/authority to practice
agreement or other cooperative arrangement between a party state
and a nonparty state that is made in accordance with the other
provisions of this compact.
(d) This compact may be amended by the party states. No
amendment to this compact shall become effective and binding upon
the party states unless and until it is enacted into the laws of
all party states.
ARTICLE 11. CONSTRUCTION AND SEVERABILITY
(a) This compact shall be liberally construed so as to
effectuate the purposes thereof. The provisions of this compact
shall be severable and if any phrase, clause, sentence, or
provision of this compact is declared to be contrary to the
constitution of any party state or of the United States or the
applicability thereof to any government, agency, person, or
circumstance is held invalid, the validity of the remainder of
this compact and the applicability thereof to any government,
agency, person, or circumstance shall not be affected thereby.
If this compact shall be held contrary to the constitution of any
state party thereto, the compact shall remain in full force and
effect as to the remaining party states and in full force and
effect as to the party state affected as to all severable
matters.
(b) In the event party states find a need for settling disputes
arising under this compact:
(1) the party states may submit the issues in dispute to an
arbitration panel which will be composed of an individual
appointed by the compact administrator in the home state, an
individual appointed by the compact administrator in the remote
state involved, and an individual mutually agreed upon by the
compact administrators of all the party states involved in the
dispute; and
(2) the decision of a majority of the arbitrators shall be final
and binding.
Added by Acts 2007, 80th Leg., R.S., Ch.
889, Sec. 30, eff. September 1, 2007.
Sec. 305.002. BOARD AUTHORITY. Notwithstanding any provision of
this chapter, the Texas Board of Nursing may establish criteria
for recognizing advanced practice registered nurses under the
NCSBN APRN Compact.
Added by Acts 2007, 80th Leg., R.S., Ch.
889, Sec. 30, eff. September 1, 2007.
Sec. 305.003. RULES; EXPIRATION OF CHAPTER. (a) The Texas
Board of Nursing may adopt rules necessary to implement this
chapter.
(b) If the board does not adopt rules to implement the compact
under this chapter before December 31, 2011, the board may not
implement the NCSBN APRN Compact and this chapter expires
December 31, 2011.
Added by Acts 2007, 80th Leg., R.S., Ch.
889, Sec. 30, eff. September 1, 2007.
Sec. 305.004. APPLICABILITY OF CHAPTER. If a provision of this
chapter or another state's law under the NCSBN APRN Compact
conflicts with the laws of this state, the laws of this state
prevail.
Added by Acts 2007, 80th Leg., R.S., Ch.
889, Sec. 30, eff. September 1, 2007.
Sec. 305.005. RIGHTS AND OBLIGATIONS. (a) Unless the context
indicates otherwise, or doing so would be inconsistent with the
NCSBN APRN Compact, nurses practicing in this state under a
license issued by a state that is a party to the NCSBN APRN
Compact have the same rights and obligations as imposed by the
laws of this state on license holders of the Texas Board of
Nursing.
(b) The Texas Board of Nursing has the authority to determine
whether a right or obligation imposed on license holders applies
to nurses practicing in this state under a license issued by a
state that is a party to the NCSBN APRN Compact unless that
determination is inconsistent with the NCSBN APRN Compact.
Added by Acts 2007, 80th Leg., R.S., Ch.
889, Sec. 30, eff. September 1, 2007.
Sec. 305.006. ENFORCEMENT. The Texas Board of Nursing is the
state agency responsible for taking action against nurses
practicing in this state under a license issued by a state that
is a party to the NCSBN APRN Compact as authorized by the NCSBN
APRN Compact. The action shall be taken in accordance with the
same procedures for taking action against nurses licensed by this
state.
Added by Acts 2007, 80th Leg., R.S., Ch.
889, Sec. 30, eff. September 1, 2007.