43-12.5-01. Advanced practice registered nurse licensure compact

43-12.5-01. Advanced practice registered nurse licensure compact

ARTICLE I - FINDINGS AND DECLARATION OF PURPOSE

1. The party states find that:

a. The health and safety of the public are affected by the degree of compliance with

advanced practice registered nurse licensure requirements and the effectiveness

of enforcement activities related to state advanced practice registered nurse

licensure laws;

b. Violations of advanced practice registered nurse licensure and other laws

regulating the practice of nursing may result in injury or harm to the public;

c. The expanded mobility of advanced practice registered nurses and the use of

advanced communication and intervention technologies as part of our nation's

health care delivery system require greater coordination and cooperation among

states in the areas of advanced practice registered nurse licensure and

regulation;

d. New practice modalities and technology make compliance with individual state

advanced practice registered nurse licensure laws difficult and complex;

e. The current system of duplicative advanced practice registered nurse licensure

for advanced practice registered nurses practicing in multiple states is

cumbersome and redundant for health care delivery systems, payors, state

licensing boards, regulators, and advanced practice registered nurses; and

f. Uniformity of advanced practice registered nurse licensure requirements

throughout the states promotes public safety and public health benefits as well as

providing a mechanism to increase access to care.

2. The general purposes of this compact are to:

a. Facilitate the states' responsibility to protect the public's health and safety;

b. Ensure and encourage the cooperation of party states in the areas of advanced

practice registered nurse licensure and regulation, including promotion of uniform

licensure requirements;

c. Facilitate the exchange of information between party states in the areas of

advanced practice registered nurse regulation, investigation, and adverse

actions;

d. Promote compliance with the laws governing advanced practice registered nurse

practice in each jurisdiction;

e. Invest all party states with the authority to hold an advanced practice registered

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 privileges to practice;

f. Decrease redundancies in the consideration and issuance of advanced practice

registered nurse licenses; and

g. Provide opportunities for interstate practice by advanced practice registered

nurses who meet uniform licensure requirements.

ARTICLE II - DEFINITIONS

As used in this compact:

1. "Advanced practice registered nurse" means a registered nurse who has gained

additional specialized knowledge, skills, and experience through a program of study

recognized or defined by the Interstate Commission of Advanced Practice Registered

Nurse Compact Administrators ("commission"), and who is licensed to perform

advanced nursing practice. An advanced practice registered nurse is licensed in an

advanced practice registered nurse role that is congruent with an advanced practice

registered nurse educational program, certification, and commission rules.

2. "Advanced practice registered nurse licensure" means the regulatory mechanism used

by a party state to grant legal authority to practice as an advanced practice registered

nurse.

3. "Advanced practice registered nurse uniform licensure requirements" means the

minimum uniform licensure, education, and examination requirements set forth in

subsection 2 of article III.

4. "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 an

advanced practice registered nurse, including actions against an individual's license or

rements" means the

minimum uniform licensure, education, and examination requirements set forth in

subsection 2 of article III.

4. "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 an

advanced practice registered 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 an advanced practice registered nurse's authorization to practice,

including the issuance of a cease and desist action.

5. "Alternative program" means a non-disciplinary monitoring program approved by a

licensing board.

6. "Coordinated licensure information system" means an integrated process for

collecting, storing, and sharing information on advanced practice registered nurse

licensure and enforcement activities related to advanced practice registered nurse

licensure laws which is administered by a nonprofit organization composed of and

controlled by licensing boards.

7. "Current significant investigatory information" means:

a. Investigative information that a licensing board, after a preliminary inquiry that

includes notification and an opportunity for the advanced practice registered

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; or

b. Investigative information that indicates that the advanced practice registered

nurse represents an immediate threat to public health and safety regardless of

whether the advanced practice registered nurse has been notified and had an

opportunity to respond.

8. "Encumbrance" means a revocation or suspension of, or any limitation on, the full and

unrestricted practice of nursing imposed by a licensing board in connection with a

disciplinary proceeding.

9. "Home state" means the party state that is the advanced practice registered nurse's

primary state of residence.

10. "Licensing board" means a party state's regulatory body responsible for regulating the

practice of advanced practice registered nursing.

11. "Multistate license" means an advanced practice registered nurse license to practice

as an advanced practice registered nurse issued by a home state licensing board

which authorizes the advanced practice registered nurse to practice as an advanced

practice registered nurse in all party states under a multistate licensure privilege, in the

same role and population focus as the advanced practice registered nurse is licensed

in the home state.

12. "Multistate licensure privilege" means a legal authorization associated with an

advanced practice registered nurse multistate license which permits an advanced

practice registered nurse to practice as an advanced practice registered nurse in a

remote state, in the same role and population focus as the advanced practice

registered nurse is licensed in the home state.

13. "Noncontrolled prescription drug" means a device or drug that is not a controlled

substance and is prohibited under state or federal law from being dispensed without a

prescription. The term includes a device or drug that bears or is required to bear the

legend "caution: federal law prohibits dispensing without prescription" or "prescription

only" or other legend that complies with federal law.

14. "Party state" means any state that has adopted this compact.

15. "Population focus" means one of the six population foci of family or individual across

the lifespan, adult-gerontology, pediatrics, neonatal, women's health or gender-related,

and psychiatric mental health.

16. "Prescriptive authority" means the legal authority to prescribe medications and devices

as defined by party state laws.

17. "Remote state" means a party state that is not the home state.

opulation focus" means one of the six population foci of family or individual across

the lifespan, adult-gerontology, pediatrics, neonatal, women's health or gender-related,

and psychiatric mental health.

16. "Prescriptive authority" means the legal authority to prescribe medications and devices

as defined by party state laws.

17. "Remote state" means a party state that is not the home state.

18. "Role" means one of the four recognized roles of certified registered nurse

anesthetists, certified nurse midwives, clinical nurse specialists, and certified nurse

practitioners.

19. "Single-state license" means an advanced practice registered nurse license issued by

a party state which authorizes practice only within the issuing state and does not

include a multistate licensure privilege to practice in any other party state.

20. "State" means a state, territory, or possession of the United States and the District of

Columbia.

21. "State practice laws" means a party state's laws, rules, and regulations that govern

advanced practice registered nurse practice, define the scope of advanced nursing

practice, and create the methods and grounds for imposing discipline except that

prescriptive authority must be treated in accordance with subsections 6 and 7 of

article III. State practice laws do not include:

a. A party state's laws, rules, and regulations requiring supervision or collaboration

with a health care professional, except for laws, rules, and regulations regarding

prescribing controlled substances; and

b. The requirements necessary to obtain and retain an advanced practice registered

nurse license, except for qualifications or requirements of the home state.

ARTICLE III - GENERAL PROVISIONS AND JURISDICTION

1. A state must implement procedures for considering the criminal history records of

applicants for initial advanced practice registered nurse licensure or advanced practice

registered nurse licensure by endorsement. Such procedures must include the

submission of fingerprints or other biometric-based information by advanced practice

registered nurse 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.

2. Each party state shall require an applicant to satisfy the following advanced practice

registered nurse uniform licensure requirements to obtain or retain a multistate license

in the home state:

a. Meets the home state's qualifications for licensure or renewal of licensure, as well

as, all other applicable state laws;

b. (1) Has completed an accredited graduate-level education program that

prepares the applicant for one of the four recognized roles and population

foci; or

(2) Has completed a foreign advanced practice registered nurse education

program for one of the four recognized roles and population foci that:

(a) Has been approved by the authorized accrediting body in the

applicable country; and

aws;

b. (1) Has completed an accredited graduate-level education program that

prepares the applicant for one of the four recognized roles and population

foci; or

(2) Has completed a foreign advanced practice registered nurse education

program for one of the four recognized roles and population foci that:

(a) Has been approved by the authorized accrediting body in the

applicable country; and

(b) Has been verified by an independent credentials review agency to be

comparable to a licensing board-approved advanced practice

registered nurse education program;

c. Has, if a graduate of a foreign advanced practice registered nurse 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;

d. Has successfully passed a national certification examination that measures

advanced practice registered nurse, role and population-focused competencies

and maintains continued competence as evidenced by recertification in the role

and population focus through the national certification program;

e. Holds an active, unencumbered license as a registered nurse and an active,

unencumbered authorization to practice as an advanced practice registered

nurse;

f. Has successfully passed an NCLEX-RN® examination or recognized

predecessor, as applicable;

g. Has practiced for at least two thousand eighty hours as an advanced practice

registered nurse in a role and population focus congruent with the applicant's

education and training. For purposes of this section, practice must not include

hours obtained as part of enrollment in an advanced practice registered nurse

education program;

h. 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 or, if applicable, foreign country's

criminal records;

i. Has not been convicted or found guilty or, has entered into an agreed disposition

of a felony offense under applicable state, federal, or foreign criminal law;

j. 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 by

factors set forth in rules adopted by the commission;

k. Is not currently enrolled in an alternative program;

l. Is subject to self-disclosure requirements regarding current participation in an

alternative program; and

m. Has a valid United States social security number.

3. An advanced practice registered nurse issued a multistate license must be licensed in

an approved role and at least one approved population focus.

4. An advanced practice registered nurse multistate license issued by a home state to a

resident in that state will be recognized by each party state as authorizing the

advanced practice registered nurse to practice as an advanced practice registered

nurse in each party state, under a multistate licensure privilege, in the same role and

population focus as the advanced practice registered nurse is licensed in the home

state.

5. Nothing in this compact shall affect the requirements established by a party state for

the issuance of a single-state license, except that an individual may apply for a single-

state license, instead of a multistate license, even if otherwise qualified for the

multistate license. However, the failure of such an individual to affirmatively opt for a

single-state license may result in the issuance of a multistate license.

6. Issuance of an advanced practice registered nurse multistate license must include

prescriptive authority for noncontrolled prescription drugs.

7. For each state in which an advanced practice registered nurse seeks authority to

he

multistate license. However, the failure of such an individual to affirmatively opt for a

single-state license may result in the issuance of a multistate license.

6. Issuance of an advanced practice registered nurse multistate license must include

prescriptive authority for noncontrolled prescription drugs.

7. For each state in which an advanced practice registered nurse seeks authority to

prescribe controlled substances, the advanced practice registered nurse shall satisfy

all requirements imposed by such state in granting and renewing such authority.

8. An advanced practice registered nurse issued a multistate license may assume

responsibility and accountability for patient care independent of any supervisory or

collaborative relationship. This authority may be exercised in the home state and in

any remote state in which the advanced practice registered nurse exercises a

multistate licensure privilege.

9. All party states are authorized, in accordance with state due process laws, to take

adverse action against an advanced practice registered nurse's multistate licensure

privilege such as revocation, suspension, probation, or any other action that affects an

advanced practice registered nurse's authorization to practice under a multistate

licensure privilege, including cease and desist actions. If a party state takes such

action, it promptly shall notify the administrator of the coordinated licensure information

system. The administrator of the coordinated licensure information system promptly

shall notify the home state of any such actions by remote states.

10. Except as otherwise expressly provided in this compact, an advanced practice

registered nurse practicing in a party state shall comply with the state practice laws of

the state in which the client is located at the time service is provided. Advanced

practice registered nurse practice is not limited to patient care, but includes all

advanced nursing practice as defined by the state practice laws of the party state in

which the client is located. Advanced practice registered nurse practice in a party state

under a multistate licensure privilege subjects the advanced practice registered 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.

11. Except as otherwise expressly provided in this compact, this compact does not affect

additional requirements imposed by states for advanced practice registered nursing.

However, a multistate licensure privilege to practice registered nursing granted by a

party state must be recognized by other party states as satisfying any state law

requirement for registered nurse licensure as a precondition for authorization to

practice as an advanced practice registered nurse in that state.

12. Individuals not residing in a party state shall continue to be able to apply for a party

state's single-state advanced practice registered nurse 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 as an advanced practice

registered nurse in any other party state.

ARTICLE IV - APPLICATIONS FOR ADVANCED PRACTICE REGISTERED NURSE

LICENSURE IN A PARTY STATE

1. Upon application for an advanced practice registered nurse 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

licensed practical/vocational nursing license, a registered nursing license, or an

advanced practice registered nurse 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

ation system, whether the applicant has ever held or is the holder of a

licensed practical/vocational nursing license, a registered nursing license, or an

advanced practice registered nurse 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.

2. An advanced practice registered nurse may hold a multistate advanced practice

registered nurse license, issued by the home state, in only one party state at a time.

3. If an advanced practice registered nurse changes primary state of residence by

moving between two party states, the advanced practice registered nurse shall apply

for advanced practice registered nurse licensure in the new home state, and the

multistate license issued by the prior home state must be deactivated in accordance

with applicable commission rules.

a. The advanced practice registered nurse may apply for licensure in advance of a

change in primary state of residence.

b. A multistate advanced practice registered nurse license may not be issued by the

new home state until the advanced practice registered 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 advanced practice

registered nurse license from the new home state.

4. If an advanced practice registered nurse changes primary state of residence by

moving from a party state to a nonparty state, the advanced practice registered nurse

multistate license issued by the prior home state converts to a single-state license,

valid only in the former home state.

ARTICLE V - ADDITIONAL AUTHORITIES INVESTED IN PARTY STATE LICENSING

BOARDS

1. In addition to the other powers conferred by state law, a licensing board may:

a. Take adverse action against an advanced practice registered nurse's multistate

licensure privilege to practice within that party state.

(1) Only the home state may take adverse action against an advanced practice

registered nurse's license issued by the home state.

(2) For purposes of taking adverse action, the home state licensing board shall

give the same priority and effect to reported conduct that occurred outside of

the home 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.

b. Issue cease and desist orders or impose an encumbrance on an advanced

practice registered nurse's authority to practice within that party state.

c. Complete any pending investigations of an advanced practice registered nurse

who changes primary state of residence during the course of such investigations.

The licensing board also may take any appropriate action and promptly shall

report the conclusions of such investigations to the administrator of the

coordinated licensure information system. The administrator of the coordinated

licensure information system promptly shall notify the new home state of any

such actions.

d. Issue subpoenas for both hearings and investigations which require the

attendance and testimony of witnesses, as well as, the production of evidence.

Subpoenas issued by a party state licensing board for the attendance and

testimony of witnesses and the production of evidence from another party state

must be enforced in the latter state by any court of competent jurisdiction,

according to that court's practice and procedure in considering subpoenas issued

in its own proceedings. The issuing licensing board shall pay any witness fees,

travel expenses, mileage, and other fees required by the service statutes of the

state in which the witnesses and evidence are located.

m another party state

must be enforced in the latter state by any court of competent jurisdiction,

according to that court's practice and procedure in considering subpoenas issued

in its own proceedings. The issuing licensing board shall pay any witness fees,

travel expenses, mileage, and other fees required by the service statutes of the

state in which the witnesses and evidence are located.

e. Obtain and submit, for an advanced practice registered nurse licensure applicant,

fingerprints 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.

f. If otherwise permitted by state law, recover from the affected advanced practice

registered nurse the costs of investigations and disposition of cases resulting

from any adverse action taken against that advanced practice registered nurse.

g. Take adverse action based on the factual findings of another party state, if the

licensing board follows its own procedures for taking such adverse action.

2. If adverse action is taken by a home state against an advanced practice registered

nurse's multistate licensure, the privilege to practice in all other party states under a

multistate licensure privilege must be deactivated until all encumbrances have been

removed from the advanced practice registered nurse's multistate license. All home

state disciplinary orders that impose adverse action against an advanced practice

registered nurse's multistate license must include a statement that the advanced

practice registered nurse's multistate licensure privilege is deactivated in all party

states during the pendency of the order.

3. This compact does not 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 advanced practice registered nurse for the duration of the advanced practice

registered nurse's participation in an alternative program.

ARTICLE VI - COORDINATED LICENSURE INFORMATION SYSTEM AND EXCHANGE

INFORMATION

1. All party states shall participate in a coordinated licensure information system of all

advanced practice registered nurses, licensed registered nurses, and licensed

practical/vocational nurses. This system includes information on the licensure and

disciplinary history of each advanced practice registered nurse, as submitted by party

states, to assist in the coordinated administration of advanced practice registered

nurse licensure and enforcement efforts.

2. 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.

3. All licensing boards promptly shall 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 advanced practice registered

nurse participation in alternative programs known to the licensing board regardless of

whether such participation is deemed nonpublic and confidential under state law.

4. 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.

5. Any personally identifiable information obtained from the coordinated licensure

information system by a party state licensing board may not be shared with nonparty

rmation 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.

5. Any personally identifiable information obtained from the coordinated licensure

information system by a party state licensing board 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.

6. Any information contributed to the coordinated licensure information system which is

subsequently required to be expunged by the laws of the party state contributing the

information must be removed from the coordinated licensure information system.

7. The compact administrator of each party state shall furnish a uniform data set to the

compact administrator of each other party state, which must include, at a minimum:

a. Identifying information;

b. Licensure data;

c. Information related to alternative program participation information; and

d. Other information that may facilitate the administration of this compact, as

determined by commission rules.

8. The compact administrator of a party state shall provide all investigative documents

and information requested by another party state.

ARTICLE VII - ESTABLISHMENT OF THE INTERSTATE COMMISSION OF ADVANCED

PRACTICE REGISTERED NURSE COMPACT ADMINISTRATORS

1. The party states hereby create and establish a joint public agency known as the

interstate commission of advanced practice registered nurse compact administrators.

a. The commission is an instrumentality of the party states.

b. Venue is proper, and judicial proceedings by or against the commission must be

brought solely and exclusively, in a court of competent jurisdiction where the

principal office of the commission is located. The commission may waive venue

and jurisdictional defenses to the extent it adopts or consents to participate in

alternative dispute resolution proceedings.

c. This compact may not be construed to be a waiver of sovereign immunity.

2. Membership, voting, and meetings.

a. Each party state must have and be limited to one administrator. The head of the

state licensing board or designee is the administrator of this compact for each

party state. Any administrator may be removed or suspended from office as

provided by the law of the state from which the administrator is appointed. Any

vacancy occurring in the commission must be filled in accordance with the laws of

the party state in which the vacancy exists.

b. Each administrator is entitled to one vote with regard to the promulgation of rules

and creation of bylaws and otherwise must have an opportunity to participate in

the business and affairs of the commission. An administrator shall vote in person

or by such other means as provided in the bylaws. The bylaws may provide for an

administrator's participation in meetings by telephone or other means of

communication.

c. The commission shall meet at least once during each calendar year. Additional

meetings must be held as set forth in the bylaws or rules of the commission.

d. All meetings are open to the public, and public notice of meetings must be given

in the same manner as required under the rulemaking provisions in article VIII.

e. The commission may convene in a closed, nonpublic meeting if the commission

must discuss:

(1) Noncompliance of a party state with its obligations under this compact;

(2) The employment, compensation, discipline, or other personnel matters,

practices, or procedures related to specific employees or other matters

related to the commission's internal personnel practices and procedures;

(3) Current, threatened, or reasonably anticipated litigation;

(4) Negotiation of contracts for the purchase or sale of goods, services, or real

estate;

ns under this compact;

(2) The employment, compensation, discipline, or other personnel matters,

practices, or procedures related to specific employees or other matters

related to the commission's internal personnel practices and procedures;

(3) Current, threatened, or reasonably anticipated litigation;

(4) Negotiation of contracts for the purchase or sale of goods, services, or real

estate;

(5) Accusing any person of a crime or formally censuring any person;

(6) Disclosure of trade secrets or commercial or financial information that is

privileged or confidential;

(7) Disclosure of information of a personal nature if disclosure would constitute

a clearly unwarranted invasion of personal privacy;

(8) Disclosure of investigatory records compiled for law enforcement purposes;

(9) Disclosure of information related to any reports prepared by or on behalf of

the commission for the purpose of investigation of compliance with this

compact; or

(10) Matters specifically exempted from disclosure by federal or state statute.

f. If a meeting, or portion of a meeting, is closed pursuant to this provision, the

commission's legal counsel or designee shall certify that the meeting may be

closed and shall reference each relevant exempting provision. The commission

shall keep minutes that fully and clearly describe all matters discussed in a

meeting and shall provide a full and accurate summary of actions taken, and the

reasons for those actions, including a description of the views expressed. All

documents considered in connection with an action must be identified in such

minutes. All minutes and documents of a closed meeting must remain under seal,

subject to release by a majority vote of the commission or order of a court of

competent jurisdiction.

3. By a majority vote of the administrators, the commission shall prescribe bylaws or

rules to govern its conduct as may be necessary or appropriate to carry out the

purposes and exercise the powers of this compact, including:

a. Establishing the fiscal year of the commission;

b. Providing reasonable standards and procedures:

(1) For the establishment and meetings of other committees; and

(2) Governing any general or specific delegation of any authority or function of

the commission;

c. Providing reasonable procedures for calling and conducting meetings of the

commission, ensuring reasonable advance notice of all meetings, and providing

an opportunity for attendance of such meetings by interested parties, with

enumerated exceptions designed to protect the public's interest, the privacy of

individuals, and proprietary information, including trade secrets. The commission

may meet in closed session only after a majority of the administrators vote to

close a meeting in whole or in part. As soon as practicable, the commission shall

make public a copy of the vote to close the meeting revealing the vote of each

administrator, with no proxy votes allowed;

d. Establishing the titles, duties, and authority and reasonable procedures for the

election of the officers of the commission;

e. Providing reasonable standards and procedures for the establishment of the

personnel policies and programs of the commission. Notwithstanding any civil

service or other similar laws of any party state, the bylaws exclusively govern the

personnel policies and programs of the commission; and

f. Providing a mechanism for winding up the operations of the commission and the

equitable disposition of any surplus funds that may exist after the termination of

this compact after the payment and reserving of all of its debts and obligations.

4. The commission shall publish its bylaws and rules, and any amendments to the bylaws

and rules, in a convenient form on the website of the commission.

5. The commission shall maintain its financial records in accordance with the bylaws.

6. The commission shall meet and take such actions as are consistent with the

is compact after the payment and reserving of all of its debts and obligations.

4. The commission shall publish its bylaws and rules, and any amendments to the bylaws

and rules, in a convenient form on the website of the commission.

5. The commission shall maintain its financial records in accordance with the bylaws.

6. The commission shall meet and take such actions as are consistent with the

provisions of this compact and the bylaws.

7. The commission may:

a. Promulgate uniform rules to facilitate and coordinate implementation and

administration of this compact. The rules have the force and effect of law and are

binding in all party states;

b. Bring and prosecute legal proceedings or actions in the name of the commission.

However, the standing of any licensing board to sue or be sued under applicable

law may not be affected;

c. Purchase and maintain insurance and bonds;

d. Borrow, accept, or contract for services of personnel, including employees of a

party state or nonprofit organizations;

e. Cooperate with other organizations that administer state compacts related to the

regulation of nursing, including sharing administrative or staff expenses, office

space, or other resources;

f. Hire employees, elect or appoint officers, fix compensation, define duties, grant

such individuals appropriate authority to carry out the purposes of this compact,

and to establish the commission's personnel policies and programs relating to

conflicts of interest, qualifications of personnel, and other related personnel

matters;

g. Accept any and all appropriate donations, grants, and gifts of money, equipment,

supplies, materials, and services, and to receive, utilize, and dispose of the same.

However, at all times the commission shall strive to avoid any appearance of

impropriety or conflict of interest;

h. Lease, purchase, accept appropriate gifts or donations of, or otherwise to own,

hold, improve, or use, any property, whether real, personal, or mixed. However, at

all times the commission shall strive to avoid any appearance of impropriety;

i. Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose

of any property, whether real, personal, or mixed;

j. Establish a budget and make expenditures;

k. Borrow money;

l. Appoint committees, including advisory committees comprised of administrators,

state nursing regulators, state legislators, or their representatives, and consumer

representatives, and other such interested persons;

m. Issue advisory opinions;

n. Provide and receive information from, and to cooperate with, law enforcement

agencies;

o. Adopt and use an official seal; and

p. Perform such other functions as may be necessary or appropriate to achieve the

purposes of this compact consistent with the state regulation of advanced

practice registered nurse licensure and practice.

8. Financing of the commission.

a. The commission shall pay, or provide for the payment of, the reasonable

expenses of its establishment, organization, and ongoing activities.

b. The commission may also levy on and collect an annual assessment from each

party state to cover the cost of its operations, activities, and staff in its annual

budget as approved each year. The aggregate annual assessment amount, if

any, must be allocated based upon a formula to be determined by the

commission, which shall promulgate a rule that is binding upon all party states.

c. The commission may not incur obligations of any kind before securing the funds

adequate to meet the same, nor may the commission pledge the credit of any of

the party states, except by, and with the authority of, such party state.

d. The commission shall keep accurate accounts of all receipts and disbursements.

The receipts and disbursements of the commission are subject to the audit and

accounting procedures established under its bylaws. However, all receipts and

funds

adequate to meet the same, nor may the commission pledge the credit of any of

the party states, except by, and with the authority of, such party state.

d. The commission shall keep accurate accounts of all receipts and disbursements.

The receipts and disbursements of the commission are subject to the audit and

accounting procedures established under its bylaws. However, all receipts and

disbursements of funds handled by the commission must be audited yearly by a

certified or licensed public accountant, and the report of the audit must be

included in and become part of the annual report of the commission.

9. Qualified immunity, defense, and indemnification.

a. The administrators, officers, executive director, employees, and representatives

of the commission are immune from suit and liability, either personally or in their

official capacity, for any claim for damage to or loss of property or personal injury

or other civil liability caused by or arising out of any actual or alleged act, error, or

omission that occurred, or that the person against which the claim is made had a

reasonable basis for believing occurred, within the scope of commission

employment, duties, or responsibilities. However, this subdivision may not be

construed to protect any such person from suit or liability for any damage, loss,

injury, or liability caused by the intentional, willful, or wanton misconduct of that

person.

b. The commission shall defend any administrator, officer, executive director,

employee, or representative of the commission in any civil action seeking to

impose liability arising out of any actual or alleged act, error, or omission that

occurred within the scope of commission employment, duties, or responsibilities,

or that the person against which the claim is made had a reasonable basis for

believing occurred within the scope of commission employment, duties, or

responsibilities, provided that nothing herein may be construed to prohibit that

person from retaining that person's own counsel and the actual or alleged act,

error, or omission may not result from that person's intentional, willful, or wanton

misconduct.

c. The commission shall indemnify and hold harmless any administrator, officer,

executive director, employee, or representative of the commission for the amount

of any settlement or judgment obtained against that person arising out of any

actual or alleged act, error, or omission that occurred within the scope of

commission employment, duties, or responsibilities, or that such person had a

reasonable basis for believing occurred within the scope of commission

employment, duties, or responsibilities, if the actual or alleged act, error, or

omission did not result from the intentional, willful, or wanton misconduct of that

person.

ARTICLE VIII - RULEMAKING

1. The commission shall exercise its rulemaking powers pursuant to the criteria set forth

in this article and the rules adopted thereunder. Rules and amendments become

binding as of the date specified in each rule or amendment and have the same force

and effect as provisions of this compact.

2. Rules or amendments to the rules must be adopted at a regular or special meeting of

the commission.

3. Before promulgation and adoption of a final rule or rules by the commission, and at

least sixty days in advance of the meeting at which the rule will be considered and

voted upon, the commission shall file a notice of proposed rulemaking:

a. On the website of the commission; and

b. On the website of each licensing board or the publication in which each state

would otherwise publish proposed rules.

4. The notice of proposed rulemaking must include:

a. The proposed time, date, and location of the meeting at which the rule will be

considered and voted upon;

b. The text of the proposed rule or amendment, and the reason for the proposed

rule;

c. A request for comments on the proposed rule from any interested person; and

blication in which each state

would otherwise publish proposed rules.

4. The notice of proposed rulemaking must include:

a. The proposed time, date, and location of the meeting at which the rule will be

considered and voted upon;

b. The text of the proposed rule or amendment, and the reason for the proposed

rule;

c. A request for comments on the proposed rule from any interested person; and

d. The manner in which interested persons may submit notice to the commission of

their intention to attend the public hearing and any written comments.

5. Before adoption of a proposed rule, the commission shall allow persons to submit

written data, facts, opinions, and arguments, which must be made available to the

public.

6. The commission shall grant an opportunity for a public hearing before it adopts a rule

or amendment.

7. The commission shall publish the place, time, and date of the scheduled public

hearing.

a. Hearings must be conducted in a manner providing each person that wishes to

comment a fair and reasonable opportunity to comment orally or in writing. All

hearings must be recorded, and a copy must be made available upon request.

b. This section may not be construed as requiring a separate hearing on each rule.

Rules may be grouped for the convenience of the commission at hearings

required by this section.

8. If no one appears at the public hearing, the commission may proceed with

promulgation of the proposed rule.

9. Following the scheduled hearing date, or by the close of business on the scheduled

hearing date if the hearing was not held, the commission shall consider all written and

oral comments received.

10. By majority vote of all administrators, the commission shall take final action on the

proposed rule and shall determine the effective date of the rule, if any, based on the

rulemaking record and the full text of the rule.

11. Upon determination that an emergency exists, the commission may consider and

adopt an emergency rule without prior notice, opportunity for comment, or hearing.

However, the usual rulemaking procedures provided in this compact and in this section

must be retroactively applied to the rule as soon as reasonably possible, in no event

later than ninety days after the effective date of the rule. For the purposes of this

provision, an emergency rule is one that must be adopted immediately in order to:

a. Meet an imminent threat to public health, safety, or welfare;

b. Prevent a loss of commission or party state funds; or

c. Meet a deadline for the promulgation of an administrative rule that is established

by federal law or rule.

12. The commission may direct revisions to a previously adopted rule or amendment for

purposes of correcting typographical errors, errors in format, errors in consistency, or

grammatical errors. Public notice of any revisions must be posted on the website of

the commission. The revision may be subject to challenge by any person for a period

of thirty days after posting. The revision may be challenged only on grounds that the

revision results in a material change to a rule. A challenge must be made in writing,

and delivered to the commission, before the end of the notice period. If no challenge is

made, the revision will take effect without further action. If the revision is challenged,

the revision may not take effect without the approval of the commission.

ARTICLE IX - OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCEMENT

1. Oversight.

a. Each party state shall enforce this compact and take all actions necessary and

appropriate to effectuate this compact's purposes and intent.

b. The commission is entitled to receive service of process in any proceeding that

may affect the powers, responsibilities, or actions of the commission, and has

standing to intervene in such a proceeding for all purposes. Failure to provide

service of process to the commission renders a judgment or order void as to the

cessary and

appropriate to effectuate this compact's purposes and intent.

b. The commission is entitled to receive service of process in any proceeding that

may affect the powers, responsibilities, or actions of the commission, and has

standing to intervene in such a proceeding for all purposes. Failure to provide

service of process to the commission renders a judgment or order void as to the

commission, this compact, or promulgated rules.

2. Default, technical assistance, and termination.

a. If the commission determines that a party state has defaulted in the performance

of its obligations or responsibilities under this compact or the promulgated rules,

the commission shall:

(1) Provide written notice to the defaulting state and other party states of the

nature of the default, the proposed means of curing the default or any other

action to be taken by the commission; and

(2) Provide remedial training and specific technical assistance regarding the

default.

b. If a state in default fails to cure the default, the defaulting state's membership in

this compact may be terminated upon an affirmative vote of a majority of the

administrators, and all rights, privileges, and benefits conferred by this compact

may be terminated on the effective date of termination. A cure of the default does

not relieve the offending state of obligations or liabilities incurred during the

period of default.

c. Termination of membership in this compact must be imposed only after all other

means of securing compliance have been exhausted. Notice of intent to suspend

or terminate must be given by the commission to the governor of the defaulting

state and to the executive officer of the defaulting state's licensing board, the

defaulting state's licensing board, and each of the party states.

d. A state whose membership in this compact has been terminated is responsible

for all assessments, obligations, and liabilities incurred through the effective date

of termination, including obligations that extend beyond the effective date of

termination.

e. The commission may not bear any costs related to a state that is found to be in

default or whose membership in this compact has been terminated, unless

agreed upon in writing between the commission and the defaulting state.

f. The defaulting state may appeal the action of the commission by petitioning the

United States district court for the District of Columbia or the federal district in

which the commission has its principal offices. The prevailing party must be

awarded all costs of such litigation, including reasonable attorneys' fees.

3. Dispute resolution.

a. Upon request by a party state, the commission shall attempt to resolve disputes

related to the compact that arise among party states and between party and

nonparty states.

b. The commission shall promulgate a rule providing for both mediation and binding

dispute resolution for disputes, as appropriate.

c. If the commission cannot resolve disputes among party states arising under this

compact:

(1) The party states may submit the issues in dispute to an arbitration panel,

which will be comprised of individuals appointed by the compact

administrator in each of the affected party states and an individual mutually

agreed upon by the compact administrators of all the party states involved in

the dispute.

commission cannot resolve disputes among party states arising under this

compact:

(1) The party states may submit the issues in dispute to an arbitration panel,

which will be comprised of individuals appointed by the compact

administrator in each of the affected party states and an individual mutually

agreed upon by the compact administrators of all the party states involved in

the dispute.

(2) The decision of a majority of the arbitrators is final and binding.

4. Enforcement.

a. The commission, in the reasonable exercise of its discretion, shall enforce the

provisions and rules of this compact.

b. By majority vote, the commission may initiate legal action in the United States

district court for the District of Columbia or the federal district in which the

commission has its principal offices against a party state that is in default to

enforce compliance with the provisions of this compact and its promulgated rules

and bylaws. The relief sought may include both injunctive relief and damages. If

judicial enforcement is necessary, the prevailing party must be awarded all costs

of such litigation, including reasonable attorneys' fees.

c. The remedies herein are not the exclusive remedies of the commission. The

commission may pursue any other remedies available under federal or state law.

ARTICLE X - EFFECTIVE DATE, WITHDRAWAL, AND AMENDMENT

1. This compact comes into limited effect at such time as this compact has been enacted

into law in seven party states for the sole purpose of establishing and convening the

commission to adopt rules relating to its operation.

2. Any state that joins this compact after the commission's initial adoption of the

advanced practice registered nurse uniform licensure requirements are subject to all

rules that have been previously adopted by the commission.

3. Any party state may withdraw from this compact by enacting a statute repealing the

same. A party state's withdrawal does not take effect until six months after enactment

of the repealing statute.

4. A party state's withdrawal or termination does not affect the continuing requirement of

the withdrawing or terminated state's licensing board to report adverse actions and

significant investigations occurring before the effective date of such withdrawal or

termination.

5. This compact may not be construed to invalidate or prevent any advanced practice

registered nurse licensure agreement or other cooperative arrangement between a

party state and a nonparty state that does not conflict with the provisions of this

compact.

6. This compact may be amended by the party states. An amendment to this compact

does not become effective and binding upon any party state until it is enacted into the

laws of all party states.

7. Representatives of nonparty states to this compact must be invited to participate in the

activities of the commission, on a nonvoting basis, before the adoption of this compact

by all states.

ARTICLE XI - CONSTRUCTION AND SEVERABILITY

This compact must be liberally construed so as to effectuate the purposes of this compact.

The provisions of this compact are 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 if 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 is not affected thereby. If this compact is held to

be contrary to the constitution of any party state, this compact remains 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.