To our members & followers from Dr. Elaine Crain on behalf of MAAPC’s Board of Directors: APRN Compact Licensure
Things are afoot in Maryland and across the nation that directly affect the day-to-day practice of nurse practitioners (NP), clinical nurse specialists (CNS), nurse midwives (CNM), and nurse anesthetists (CRNA).
The Board of MAAPC wants our APRN colleagues to have the facts as we move through the next few weeks in the General Assembly and support Senate Bill 154 Advanced Practice Registered Nurse Compact.
This bill has been introduced by Senator Addie Eckardt, a friend and champion of all nurses in the MD legislature and a psychiatric CNS herself. MAAPC has worked closely with Senator Eckardt since our inception as the Maryland Coalition of Nurse Practitioners (MCNP) and has found her to be a passionate, strong advocate for Maryland nursing practice.
Senator Eckardt is the sponsor of MAAPC & CBANACNS’s Senate Bill 513 Clinical Nurse Specialists - Prescribing Authority; is supporting the CRNA’s bill Senate Bill 312 Nurse Anesthetists - Drug Authority and Collaboration and introduced SB154 as a companion bill to these important pieces of legislation.
Why does MAAPC’s Board support this legislation? Here a few of our thoughts:
- A quick review/Compact 101*
- A statutory agreement between two or more states established for the purpose of remedying a particular problem of multistate concern.
- Each party state is a signatory to the same contract. For that reason, there is a need for “substantive sameness.”
- The APRN Compact follows the Mutual Recognition Model of Licensure—developed based on the Drivers’ License Compact
- It shares the same concept of one multistate license issued in the Primary State of Residence (PSOR) and accepted in all member states, just like the Driver’s License Compact.
- Maryland is surrounded by 5 other states. It makes geographical sense to support an APRN compact license.
- Telehealth, love it, hate it, it is here to stay and an APRN compact license will make it easier to integrate into practice. Currently, if a patient leaves Maryland, they also must leave the Maryland APN’s care and that is a difficult concept to understand for a patient who only moved a few miles to VA, WV, DC, PA, or DE.
- Compact licensure is a great attempt to decrease the bureaucracy of the professional licensure. It has become costly and complicated to hold a license in more than one state and to follow different states’ advanced practice policies, CEU requirements and telehealth laws to deliver healthcare to our patients.
- The Compact requires that the Board's director or designee be represented on the council (VII. b. 1. on page 11). MAAPC will ask the Maryland Board of Nursing to designate an APRN Board member to represent us and make the Director a fall back. Both can attend the meetings but will have only one vote.
- And importantly, neither Senate Bill 154 nor the Compact require an APRN to apply for a compact license.
What are some of the objections?
There is objection to the inclusion of a 2080 clinical hour prerequisite for a multistate APRN license as it may imply that graduate APRNs are not prepared for “safe entry to practice.”
- If the argument is brought forward by any group or association, there is a plethora of research that shows APRN practice is safe and effective. This is an old, weary argument, but it does have lasting power. Luckily also easy to disprove.
- 2080 hours equates to one full time year. MAAPC’s Board does not think this an onerous requirement as APRNs will not pay more than one license fee nor take more CEU hours for every state where our patients live or travel to for vacation or work.
- This requirement would only effect new graduates who represent 6-8% of Maryland APRNs.
Confusion surrounds the statement that an APRN multistate license includes prescriptive authority for non-controlled prescription drugs. An APRN shall satisfy all requirements imposed by the state for each state in which an APRN seeks authority to prescribe controlled substances.
- The Compact does not prohibit an APRN from prescribing controlled substances, it merely follows existing protocols.
- 25 states require a second license to prescribe controlled substance (https://www.deadiversion.usdoj.gov/drugreg/reg_apps/pract_state_lic_require.htm)
- Practitioners need to obtain a separate DEA registration in each state where they plan to administer, dispense, or prescribe controlled substances (https://www.medscape.com/viewarticle/736702)
Benefits to APRNs*
- Reduces barriers to APRN services both in person and remotely.
- Expands the utilization of telehealth without unnecessary regulatory barriers.
- Increased mobility for APRNs during pandemic surges and disasters.
- Expands options for possible clinical sites and preceptors for APRN students.
No one has offered another viable plan for APRN compact licensure to date. We believe this plan is workable based on our research. The questions are - if not now? When? If not this? What? Maryland APRNs and their patients should not have to wait another 10 years to provide or receive care in the new healthcare paradigm.
The COVID pandemic has shown the weakness in the healthcare system, MAAPC’s Board believes we must be in the forefront of this issue to continue to offer excellent care to our patients, and to ensure our profession can remain relevant in a fast changing and more mobile world.
Thank you for your consideration and time,
MAAPC’s Board of Directors
President Marie Tarleton, MSN, FNP Lorraine Diana, MSN, CRNP
Treasurer Sabrina Sepulveda, MSN, PMH Beth Baldwin. MSN, PNP
Secretary Angel Hannah, MSN, FNP Angela Borger, DNP, FNP
Past President Elaine M Crain, DNP, FNP Michele Williams, DNP, CRNP
*APRN Compact PowerPoint. Nov 2021. Michelle Buck MS, APRN, CNS APRN Senior Policy Advisor NCSBN & Nicole Livanos JD, MPP Associate Director Legislative Affairs NCSBN