Licensure regulates both the Practice of the Profession an

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Allied Health Professions and Licensure Efforts
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Can We Go for One National License?

• NO
• Why Not?
• Feds dont want it
• States want to keep it
• Decades of precedent

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Licensure is to Protect the Health and Safety of
the Citizensof the State

• Licensure regulates both the Practice of the
  Profession and those who render those defined
  services
• Must Define Parameters within the Scope of
  Practice section
• Then must set standards/requirements for those
  who will provide that scope of practice

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Regulating the Practice

• Professions scope of practice can vary state to
  state.
• Meet the needs of the citizens what you cant do
  in CA you could do in Alaska
• States, not the feds, set the parameters what can
  and cannot be done

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Regulating the Practitioners

• Process applications -is it filled out right?
• Issue and renew licenses have they met the CEs
  requirements, etc? Is that course really
  acceptable for a CE credit?
• Disciplinary complaints must investigate
• Provide procedural rights for practitioner with
  disciplinary action taken
• Collect the fees (States want the )

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Nurse Compact

• Comes close to national license for nurses-sort
  of.
• License issued in nurses resident state can work
  off of license issued in one state in those
  states participating in Nurse Compact
• Advocated by National Council of State Boards of
  Nursing

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Nurses Participating in NC Must

• Adhere to all state laws where practicing
• between states in relation to licensure /
• re-registration requirements, such
• as mandatory continuing education,
• criminal background checks, disciplinary
• causes of action, and evidentiary
• standards

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• Since 1997 -21 states participate in Nurse
  Compact
• Requires each state legislature to enact and
  change current laws- Not very eager
• American Nurses Association agrees to disagree
  with details of the complicated NC process

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State by State EffortWhat Do You Need to Have in
Place?

• Professional Infrastructure
• Strong State Association
• Strong (Central) National Association

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Professional Infrastructure

• Are there enough practitioners to make a state by
  state case?
• Is there a rationale for patient safety
• Licensure is NOT for professional enhancement
  or job security
• States want to license professions not
  occupations or disciplines

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• Profession nationwide accredited
  education/training programs
• Are they educated the same curricula the same?
• Are there enough schools across the country?

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• Consistent and valid competency test
• Are they all tested on the same content?
• States will use the professional competency test
  as state licensure exam
• Cost of developing a state based test is 50K

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Strong State Society

• Will lead the legislative effort
• Accept the fact it may take several years
• Does the state society have the people, time, and
  money?
• Leaders in the state will be the face of the
  profession to the legislators
• Will have to convince rank and file to support
  licensure efforts

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• Need to have the support from other key licensed
  professions
• Physicians are crucial, so are nurses
• Already a powerful, influential factor in state
  health policy
• Have legislators/policy makers ears

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• State hospital associations traditionally oppose
  licensing professions
• Argument it will cost more money
• No proven evidence to that, but has impact anyway
• Therefore need other professions (docs) support
  to offset

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• Most state societies are volunteer
• Lobbying is not their profession
• Licensure effort takes time
• Many states if the can afford it hire state a
  lobbyist to spearhead effort
• Still need cohort of state leaders to carry it
  through- Govt/Leg Affairs Cmte.
• What are the financial resources of the state
  society?

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Communication System

• Must have a good communication system in place
• Need to let members and supporters know what is
  happening and when to make contact with their
  legislators
• Need to communicate with legislators
• Internet vastly makes this easier

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Strong National Association

• Act as ringmaster/cheerleader
• May act as financier
• Develop a Model Practice Act, should use as a
  template in every state
• Key to that consistent scope of practice
• Clearinghouse for support documents
• Advice on what worked elsewhere

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Model Licensure Language will change over time

• Each state is unique
• Services provided may differ to some extent in
  different states
• Interested parties are different with different
  agendas
• Compromises will be made

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State By State Licensure Takes Time

• Scope of Practice will evolve
• RTs licensed in the 1980s no smoking cessation,
  telecommunications, Dx. Mgt.
• More focus on alternate site care
• patients leave hospital sicker and quicker
• New disciplines emerge, overlap of practice

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Respiratory Therapy Experience

• Model Practice Act developed as template
• Licensure first began in early 80s
• Currently there are 48 states, DC and PR that are
  licensed.
• Hawaii and Alaska not yet licensed
• Last state to gain licensure was Alabama-2004

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• Similarities among states
• Licensure requirements graduates of accredited
  schools of RT
• Take the national credentialing exam used as
  state licensure exam
• Majority (but not all) of scope of practice is
  the same

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Examples of Political Compromise

• Under Medical Direction
• Supervision only by a Doc
• Supervision Doc, Nurse Practitioner, Physician
  Assistant (LA revised 2007)
• Continuing ed
• 3 states none required (UT, CO, WI)
• 24 biennially in Al, 12 biennially in RI

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Compromise

• Scope of practice issues
• ECMO No way in NJ, absolutely in TX
• Protocols Can do in most states, only in an
  emergency in OH

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Compromise

• 18 RC Boards are under Board of Medicine
• Most fully independent RC Licensure Bds.
• Some are Advisory Councils rarely meet, paid
  state staff administers and addresses issues (WA)

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Regulatory Agencies

• Depending on the state, some state licensure
  boards have sweeping authority to creatively
  interpret the law
• Others extremely restrained in what they can do
• Just the nature of the state government psyche

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The way a state licenses

• States like to follow similar formula
• What did they do for other allied health
  professions in the state?
• License renewal annual/biennial?
• Most now all follow same disciplinary criteria
  (liability reasons)
• States make revisions that affect all licensure
  boards

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• Once licensure is gained must be tended to
  new/revised regulations
• Advise state societies to fight the urge to tweak
  the law, can be a Pandoras box

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Licensure Like a Chess Game

• Get all the pieces on the board before you make
  your first move
• And have patience