Chapter 441

441.51(1) (1) Article I — Findings and declaration of purpose.

441.51(1)(a) (a) The party states find all of the following:

441.51(1)(a)1. 1. That the health and safety of the public are affected by the degree of compliance with and the effectiveness of enforcement activities related to state nurse licensure laws.

441.51(1)(a)2. 2. That violations of nurse licensure and other laws regulating the practice of nursing may result in injury or harm to the public.

441.51(1)(a)3. 3. That the expanded mobility of nurses 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 nurse licensure and regulation.

441.51(1)(a)4. 4. That new practice modalities and technology make compliance with individual state nurse licensure laws difficult and complex.

441.51(1)(a)5. 5. That the current system of duplicative licensure for nurses practicing in multiple states is cumbersome and redundant for both nurses and states.

441.51(1)(a)6. 6. That uniformity of nurse licensure requirements throughout the states promotes public safety and public health benefits.

441.51(1)(b) (b) The general purposes of this compact are as follows:

441.51(1)(b)1. 1. To facilitate the states’ responsibility to protect the public’s health and safety.

441.51(1)(b)2. 2. To ensure and encourage the cooperation of party states in the areas of nurse licensure and regulation.

441.51(1)(b)3. 3. To facilitate the exchange of information between party states in the areas of nurse regulation, investigation, and adverse actions.

441.51(1)(b)4. 4. To promote compliance with the laws governing the practice of nursing in each jurisdiction.

441.51(1)(b)5. 5. To invest all party states with the authority to hold a nurse 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.

441.51(1)(b)6. 6. To decrease redundancies in the consideration and issuance of nurse licenses.

441.51(1)(b)7. 7. To provide opportunities for interstate practice by nurses who meet uniform licensure requirements.

441.51(2) (2) Article II — Definitions. As used in this compact:

441.51(2)(a) (a) “Adverse action” means any administrative, civil, equitable, or criminal action permitted by a state’s laws which is imposed by a licensing board or other authority against a nurse, including actions against an individual’s license or multistate licensure privilege such as revocation, suspension, probation, monitoring of the licensee, limitation on the licensee’s practice, or any other encumbrance on licensure affecting a nurse’s authorization to practice, including issuance of a cease and desist action.

441.51(2)(b) (b) “Alternative program” means a nondisciplinary monitoring program approved by a licensing board.

441.51(2)(c) (c) “Coordinated licensure information system” means an integrated process for collecting, storing, and sharing information on nurse licensure and enforcement activities related to nurse licensure laws that is administered by a nonprofit organization composed of and controlled by licensing boards.

441.51(2)(d) (d) “Current significant investigative information” means any of the following:

441.51(2)(d)1. 1. Investigative information that a licensing board, after a preliminary inquiry that includes notification and an opportunity for the nurse 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.

441.51(2)(d)2. 2. Investigative information that indicates that the nurse represents an immediate threat to public health and safety regardless of whether the nurse has been notified and had an opportunity to respond.

441.51(2)(e) (e) “Encumbrance” means a revocation or suspension of, or any limitation on, the full and unrestricted practice of nursing imposed by a licensing board.

441.51(2)(f) (f) “Home state” means the party state which is the nurse’s primary state of residence.

441.51(2)(g) (g) “Licensing board” means a party state’s regulatory body responsible for issuing nurse licenses.

441.51(2)(h) (h) “Multistate license” means a license to practice as a registered or a licensed practical/vocational nurse issued by a home state licensing board that authorizes the licensed nurse to practice in all party states under a multistate licensure privilege.

441.51(2)(i) (i) “Multistate licensure privilege” means a legal authorization associated with a multistate license permitting the practice of nursing as either a registered nurse or licensed practical/vocational nurse in a remote state.

441.51(2)(j) (j) “Nurse” means registered nurse or licensed practical/vocational nurse, as those terms are defined by each party state’s practice laws.

441.51(2)(k) (k) “Party state” means any state that has adopted this compact.

441.51(2)(L) (L) “Remote state” means a party state, other than the home state.

441.51(2)(m) (m) “Single-state license” means a nurse license issued by a party state that authorizes practice only within the issuing state and does not include a multistate licensure privilege to practice in any other party state.

441.51(2)(n) (n) “State” means a state, territory, or possession of the United States and the District of Columbia.

441.51(2)(o) (o) “State practice laws” means a party state’s laws, rules, and regulations that govern the practice of nursing, define the scope of nursing practice, and create the methods and grounds for imposing discipline. “State practice laws” does not include requirements necessary to obtain and retain a license, except for qualifications or requirements of the home state.

441.51(3) (3) Article III — General provisions and jurisdiction.

441.51(3)(a) (a) A multistate license to practice registered or licensed practical/vocational nursing issued by a home state to a resident in that state will be recognized by each party state as authorizing a nurse to practice as a registered nurse or as a licensed practical/vocational nurse, under a multistate licensure privilege, in each party state.

441.51(3)(b) (b) A state must implement procedures for considering the criminal history records of applicants for initial multistate license or licensure by endorsement. Such procedures shall include the submission of fingerprints or other biometric-based information by applicants for the purpose of obtaining an applicant’s criminal history record information from the federal bureau of investigation and the agency responsible for retaining that state’s criminal records.

441.51(3)(c) (c) Each party state shall require all of the following for an applicant to obtain or retain a multistate license in the home state:

441.51(3)(c)1. 1. Meets the home state’s qualifications for licensure or renewal of licensure, as well as, all other applicable state laws.

441.51(3)(c)2. 2. Satisfies one of the following:

441.51(3)(c)2.a. a. Has graduated or is eligible to graduate from a licensing board-approved registered nurse or licensed practical/vocational nurse prelicensure education program.

441.51(3)(c)2.b. b. Has graduated from a foreign registered nurse or licensed practical/vocational nurse prelicensure education program that has been approved by the authorized accrediting body in the applicable country and has been verified by an independent credentials review agency to be comparable to a licensing board-approved prelicensure education program.

441.51(3)(c)3. 3. Has, if a graduate of a foreign prelicensure education program not taught in English or if English is not the individual’s native language, successfully passed an English proficiency examination that includes the components of reading, speaking, writing, and listening.

441.51(3)(c)4. 4. Has successfully passed an NCLEX-RN or NCLEX-PN Examination or recognized predecessor, as applicable.

441.51(3)(c)5. 5. Is eligible for or holds an active, unencumbered license.

441.51(3)(c)6. 6. Has submitted, in connection with an application for initial licensure or licensure by endorsement, fingerprints or other biometric data for the purpose of obtaining criminal history record information from the federal bureau of investigation and the agency responsible for retaining that state’s criminal records.

441.51(3)(c)7. 7. Has not been convicted or found guilty, or has entered into an agreed disposition, of a felony offense under applicable state or federal criminal law.

441.51(3)(c)8. 8. Has not been convicted or found guilty, or has entered into an agreed disposition, of a misdemeanor offense related to the practice of nursing as determined on a case-by-case basis.

441.51(3)(c)9. 9. Is not currently enrolled in an alternative program.

441.51(3)(c)10. 10. Is subject to self-disclosure requirements regarding current participation in an alternative program.

441.51(3)(c)11. 11. Has a valid United States social security number.

441.51(3)(d) (d) All party states shall be authorized, in accordance with existing state due process law, to take adverse action against a nurse’s multistate licensure privilege such as revocation, suspension, probation or any other action that affects a nurse’s authorization to practice under a multistate licensure privilege, including cease and desist actions. If a party state takes such action, it 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.

441.51(3)(e) (e) A nurse practicing in a party state must comply with the state practice laws of the state in which the client is located at the time service is provided. The practice of nursing is not limited to patient care, but shall include all nursing practice as defined by the state practice laws of the party state in which the client is located. The practice of nursing in a party state under a multistate licensure privilege will subject a nurse to the jurisdiction of the licensing board, the courts, and the laws of the party state in which the client is located at the time service is provided.

441.51(3)(f) (f) Individuals not residing in a party state shall continue to be able to apply for a party state’s single-state license as provided under the laws of each party state. However, the single-state license granted to these individuals will not be recognized as granting the privilege to practice nursing in any other party state. Nothing in this compact shall affect the requirements established by a party state for the issuance of a single-state license.

441.51(3)(g) (g) Any nurse holding a home state multistate license, on the effective date of this compact, may retain and renew the multistate license issued by the nurse’s then-current home state, provided that:

441.51(3)(g)1. 1. A nurse, who changes primary state of residence after this compact’s effective date, must meet all applicable requirements under par. (c) to obtain a multistate license from a new home state.

441.51(3)(g)2. 2. A nurse who fails to satisfy the multistate licensure requirements in par. (c) due to a disqualifying event occurring after this compact’s effective date shall be ineligible to retain or renew a multistate license, and the nurse’s multistate license shall be revoked or deactivated in accordance with applicable rules adopted by the interstate commission of nurse licensure compact administrators (“commission”).

441.51(4) (4) Article IV — Applications for licensure in a party state.

441.51(4)(a) (a) Upon application for a multistate license, the licensing board in the issuing party state shall ascertain, through the coordinated licensure information system, whether the applicant has ever held, or is the holder of, a license issued by any other state, whether there are any encumbrances on any license or multistate licensure privilege held by the applicant, whether any adverse action has been taken against any license or multistate licensure privilege held by the applicant, and whether the applicant is currently participating in an alternative program.

441.51(4)(b) (b) A nurse may hold a multistate license, issued by the home state, in only one party state at a time.

441.51(4)(c) (c)

441.51(4)(c)1. 1. If a nurse changes primary state of residence by moving between 2 party states, the nurse must apply for licensure in the new home state, and the multistate license issued by the prior home state will be deactivated in accordance with applicable rules adopted by the commission.

441.51(4)(c)2. 2. The nurse may apply for licensure in advance of a change in primary state of residence.

441.51(4)(c)3. 3. A multistate license shall not be issued by the new home state until the nurse provides satisfactory evidence of a change in primary state of residence to the new home state and satisfies all applicable requirements to obtain a multistate license from the new home state.

441.51(4)(d) (d) If a nurse changes primary state of residence by moving from a party state to a non-party state, the multistate license issued by the prior home state will convert to a single-state license, valid only in the former home state.

441.51(5) (5) Article V — Additional authorities invested in party state licensing boards.

441.51(5)(a) (a) In addition to the other powers conferred by state law, a licensing board shall have the authority to do any of the following:

441.51(5)(a)1. 1. Take adverse action against a nurse’s multistate licensure privilege to practice within that party state, subject to all of the following:

441.51(5)(a)1.a. a. Only the home state shall have the power to take adverse action against a nurse’s license issued by the home state.

441.51(5)(a)1.b. b. For purposes of taking adverse action, the home state licensing board 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, the home state shall apply its own state laws to determine appropriate action.

441.51(5)(a)2. 2. Issue cease and desist orders or impose an encumbrance on a nurse’s authority to practice within that party state.

441.51(5)(a)3. 3. Complete any pending investigations of a nurse who changes primary state of residence during the course of such investigations. The licensing board 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.

441.51(5)(a)4. 4. Issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses, as well as, the production of evidence. Subpoenas issued by a licensing board in a party state for the attendance and testimony of witnesses 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 in which the witnesses or evidence are located.

441.51(5)(a)5. 5. Obtain and submit, for each nurse licensure applicant, fingerprint or other biometric-based information to the federal bureau of investigation for criminal background checks, receive the results of the federal bureau of investigation record search on criminal background checks, and use the results in making licensure decisions.

441.51(5)(a)6. 6. If otherwise permitted by state law, recover from the affected nurse the costs of investigations and disposition of cases resulting from any adverse action taken against that nurse.

441.51(5)(a)7. 7. Take adverse action based on the factual findings of the remote state, provided that the licensing board follows its own procedures for taking such adverse action.

441.51(5)(b) (b) If adverse action is taken by the home state against a nurse’s multistate license, the nurse’s multistate licensure privilege to practice in all other party states shall be deactivated until all encumbrances have been removed from the multistate license. All home state disciplinary orders that impose adverse action against a nurse’s multistate license shall include a statement that the nurse’s multistate licensure privilege is deactivated in all party states during the pendency of the order.

441.51(5)(c) (c) 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. The home state licensing board shall deactivate the multistate licensure privilege under the multistate license of any nurse for the duration of the nurse’s participation in an alternative program.

441.51(6) (6) Article VI — Coordinated licensure information system and exchange of information.

441.51(6)(a) (a) All party states shall participate in a coordinated licensure information system of all licensed registered nurses and licensed practical/vocational nurses. This system will include information on the licensure and disciplinary history of each nurse, as submitted by party states, to assist in the coordination of nurse licensure and enforcement efforts.

441.51(6)(b) (b) The commission, 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.

441.51(6)(c) (c) All licensing boards shall promptly report to the coordinated licensure information system any adverse action, any current significant investigative information, denials of applications (with the reasons for such denials), and nurse participation in alternative programs known to the licensing board regardless of whether such participation is deemed nonpublic or confidential under state law.

441.51(6)(d) (d) Current significant investigative information and participation in nonpublic or confidential alternative programs shall be transmitted through the coordinated licensure information system only to party state licensing boards.

441.51(6)(e) (e) Notwithstanding any other provision of law, all party state 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.

441.51(6)(f) (f) Any personally identifiable information obtained from the coordinated licensure information system by a party state licensing board shall 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.

441.51(6)(g) (g) 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.

441.51(6)(h) (h) The compact administrator of each party state shall furnish a uniform data set to the compact administrator of each other party state, which shall include, at a minimum, all of the following:

441.51(6)(h)1. 1. Identifying information.

441.51(6)(h)2. 2. Licensure data.