WEBVTT 00:00:00.260 --> 00:00:00.730 position:50% align:middle - [Jim] All right. 00:00:00.730 --> 00:00:03.040 position:50% align:middle Well, thank you for joining us, Mr. Knight. 00:00:03.040 --> 00:00:04.720 position:50% align:middle Good afternoon. 00:00:04.720 --> 00:00:07.640 position:50% align:middle And we're going to go ahead and get started, if you're ready. 00:00:07.640 --> 00:00:09.360 position:50% align:middle - [Fred] I'm ready. 00:00:09.360 --> 00:00:11.150 position:50% align:middle - Okay. 00:00:11.150 --> 00:00:13.727 position:50% align:middle So in this Fireside Chat, 00:00:13.728 --> 00:00:17.106 position:50% align:middle we'd like to talk about the Nurse Licensure Compact 00:00:17.107 --> 00:00:22.778 position:50% align:middle and specifically about some of the requirements 00:00:22.779 --> 00:00:26.949 position:50% align:middle which lead to eligibility for a multi-state license, 00:00:26.949 --> 00:00:33.660 position:50% align:middle things that would make a nurse ineligible for a multi-state license, 00:00:33.662 --> 00:00:37.918 position:50% align:middle which we might call a disqualifier to a multi-state license 00:00:37.919 --> 00:00:43.215 position:50% align:middle as well as a little bit about the discipline process, 00:00:43.216 --> 00:00:47.511 position:50% align:middle which is something you're very familiar with in your former role 00:00:47.512 --> 00:00:51.891 position:50% align:middle with the Arkansas Board of Nursing and as an attorney. 00:00:51.892 --> 00:00:57.890 position:50% align:middle So, let me go ahead and get started with a few questions that we've prepared for you. 00:00:57.892 --> 00:01:03.768 position:50% align:middle And we appreciate your candid responses. 00:01:03.768 --> 00:01:09.200 position:50% align:middle One of the hallmarks of a multi-state license in the Nurse Licensure Compact, 00:01:09.201 --> 00:01:11.035 position:50% align:middle the current nurse compact, 00:01:11.036 --> 00:01:16.916 position:50% align:middle is that it has statutory uniform licensure requirements, 00:01:16.917 --> 00:01:20.681 position:50% align:middle and these exist across all Compact states. 00:01:21.799 --> 00:01:27.448 position:50% align:middle Can you describe just what this means in a layperson's terms? 00:01:27.448 --> 00:01:33.108 position:50% align:middle What do we mean by statutory reform license requirements? 00:01:33.108 --> 00:01:39.313 position:50% align:middle - There's a lot of different ways to look at it and the uniqueness of it, 00:01:39.314 --> 00:01:42.454 position:50% align:middle but I think sometimes, first, you need to stop and think, 00:01:42.456 --> 00:01:46.045 position:50% align:middle "We have 50 state boards of nursing. We have U.S. territories." 00:01:55.245 --> 00:01:56.511 position:50% align:middle - Fred, one moment. 00:01:56.511 --> 00:01:58.381 position:50% align:middle I believe you were muted somehow. 00:01:59.688 --> 00:02:01.278 position:50% align:middle - Is that better? 00:02:01.280 --> 00:02:02.637 position:50% align:middle - Yes, you're back now. 00:02:02.639 --> 00:02:06.219 position:50% align:middle - Okay. Sorry about that. - Somehow you accidentally got muted. 00:02:06.219 --> 00:02:07.262 position:50% align:middle Okay. 00:02:07.264 --> 00:02:10.515 position:50% align:middle - Well, it may be operator's fault. 00:02:12.699 --> 00:02:14.640 position:50% align:middle As I was saying, you know, 00:02:14.641 --> 00:02:19.144 position:50% align:middle one of the unique things about the interstate compact 00:02:19.145 --> 00:02:23.232 position:50% align:middle is, one thing we have 50 states, we have U.S. territories. 00:02:23.233 --> 00:02:25.499 position:50% align:middle They all have a state board of nursing. 00:02:27.068 --> 00:02:30.614 position:50% align:middle And all of these various state boards of nursing 00:02:30.615 --> 00:02:35.828 position:50% align:middle have similar attributes, that's evolved over many, many years. 00:02:35.829 --> 00:02:44.399 position:50% align:middle I mean, we've had boards of nursing that have had statutory authority for over a hundred years. 00:02:44.411 --> 00:02:48.231 position:50% align:middle And one thing that's happened, they have a lot of similarities, 00:02:48.231 --> 00:02:51.725 position:50% align:middle but they are not exactly alike. 00:02:51.727 --> 00:02:53.621 position:50% align:middle And we're always talking about that. 00:02:53.621 --> 00:02:58.191 position:50% align:middle You know, when you're in a meeting, whether it's annual, mid-year, or special meetings, 00:02:58.191 --> 00:03:01.061 position:50% align:middle "Well, this is how we do it in our state." 00:03:01.062 --> 00:03:04.818 position:50% align:middle Or an issue will come up, "Oh, no, we do it this way in our state." 00:03:04.820 --> 00:03:09.756 position:50% align:middle So they address the issues, but they address them in different ways. 00:03:09.758 --> 00:03:16.285 position:50% align:middle The unique thing about this compact is that the ULRs, 00:03:16.286 --> 00:03:18.621 position:50% align:middle Uniform Licensure Requirements, 00:03:18.622 --> 00:03:24.852 position:50% align:middle I think we were probably the first licensing board in the history of the United States to do this, 00:03:24.853 --> 00:03:27.318 position:50% align:middle but they created a compact. 00:03:27.320 --> 00:03:32.968 position:50% align:middle And if you look at Article 3C, it's a good start place, 1 through 11. 00:03:32.969 --> 00:03:36.930 position:50% align:middle They created 11 requirements, 00:03:36.931 --> 00:03:43.354 position:50% align:middle 11 minimum requirements to have this multi-state license. 00:03:43.355 --> 00:03:45.439 position:50% align:middle And the beauty of it is 00:03:45.440 --> 00:03:50.986 position:50% align:middle these 11 requirements are something they all agreed to, 00:03:50.987 --> 00:03:53.030 position:50% align:middle and they are identical. 00:03:53.031 --> 00:03:57.701 position:50% align:middle And it's not one of those things of, "This is how we do it in our state," 00:03:57.702 --> 00:04:00.496 position:50% align:middle it's, "If you join the Compact, 00:04:00.497 --> 00:04:05.959 position:50% align:middle every party state has agreed to do it exactly the same 00:04:05.960 --> 00:04:09.041 position:50% align:middle and to meet these requirements exactly the same." 00:04:09.043 --> 00:04:18.113 position:50% align:middle So if you think of it as a board game, we've all agreed to play by the exact same rules. 00:04:18.113 --> 00:04:24.643 position:50% align:middle And I think that is a great thing for a variety of reasons. 00:04:24.643 --> 00:04:29.363 position:50% align:middle And if you need to jump in, Jim, and ask me another question, that's fine. 00:04:29.363 --> 00:04:35.239 position:50% align:middle But I think one of the great things about this, from a layperson's standpoint, 00:04:35.240 --> 00:04:36.240 position:50% align:middle what does it do? 00:04:36.241 --> 00:04:39.076 position:50% align:middle Well, it brings you consistency 00:04:39.077 --> 00:04:44.331 position:50% align:middle and continuity between these boards in how they're handling issues, 00:04:44.332 --> 00:04:47.960 position:50% align:middle how they're sharing information, and how they work together. 00:04:47.961 --> 00:04:53.924 position:50% align:middle And I think anytime you have this kind of consistency amongst the boards, 00:04:53.925 --> 00:04:56.301 position:50% align:middle I think the boards operate better, 00:04:56.302 --> 00:05:00.343 position:50% align:middle I think we do better at protecting the public. 00:05:00.345 --> 00:05:01.890 position:50% align:middle And believe it or not, 00:05:01.891 --> 00:05:05.686 position:50% align:middle I think it's an asset to the practicing nurses out there. 00:05:05.702 --> 00:05:12.121 position:50% align:middle It encourages and it simplifies the communications between the states. 00:05:13.693 --> 00:05:16.196 position:50% align:middle It helps the states to work together, 00:05:16.197 --> 00:05:24.913 position:50% align:middle and it's just, overall, it really assists the states in getting the job done, 00:05:24.914 --> 00:05:28.375 position:50% align:middle the job that they were set up and created to do. 00:05:28.376 --> 00:05:35.674 position:50% align:middle And I think you cut out a lot of wasted time between the various boards. 00:05:35.675 --> 00:05:38.503 position:50% align:middle - Sure. Fred, thank you. 00:05:38.503 --> 00:05:43.807 position:50% align:middle When you were talking about, "They all agreed to these terms in the Compact," 00:05:43.808 --> 00:05:48.101 position:50% align:middle I'm assuming you're referring to all the various states, right? 00:05:48.103 --> 00:05:49.223 position:50% align:middle - Yes. 00:05:49.223 --> 00:05:53.484 position:50% align:middle It's my understanding when the states were working on the Compact, 00:05:53.485 --> 00:05:57.654 position:50% align:middle I think initially it was called the Enhanced Compact, 00:05:57.655 --> 00:06:00.449 position:50% align:middle and there were a lot of meetings. 00:06:00.450 --> 00:06:03.744 position:50% align:middle We all know about the walk-in-the-wood meeting, 00:06:03.745 --> 00:06:05.996 position:50% align:middle but there were a variety of meetings. 00:06:05.997 --> 00:06:08.207 position:50% align:middle There were subgroups working on this. 00:06:08.208 --> 00:06:11.919 position:50% align:middle And everybody had an opportunity at that time to say, 00:06:11.920 --> 00:06:13.629 position:50% align:middle "This is my concern." 00:06:13.630 --> 00:06:17.216 position:50% align:middle Or, "This is something I think that's important for the Compact." 00:06:17.882 --> 00:06:22.513 position:50% align:middle So they spent a couple of years, as I understand it, 00:06:22.514 --> 00:06:24.848 position:50% align:middle working through all of these issues. 00:06:24.849 --> 00:06:29.812 position:50% align:middle And ultimately, they came up, as far as the ULRs are concerned, 00:06:29.813 --> 00:06:32.314 position:50% align:middle with the 11 that we have today. 00:06:32.315 --> 00:06:35.776 position:50% align:middle And of course, one of the most important of the 11 that we never stop 00:06:35.777 --> 00:06:41.031 position:50% align:middle and think about sometimes is the very first one. 00:06:41.032 --> 00:06:44.785 position:50% align:middle And that is you continue to follow 00:06:44.786 --> 00:06:51.667 position:50% align:middle all of your other state licensure requirements plus these, 00:06:51.668 --> 00:06:53.293 position:50% align:middle if that makes any sense. 00:06:53.294 --> 00:06:57.130 position:50% align:middle And that, I think that was important to all the states. 00:06:57.131 --> 00:07:01.454 position:50% align:middle - So you're saying for an applicant in a Compact state, 00:07:01.455 --> 00:07:05.889 position:50% align:middle they not only need to meet the Uniform License Requirements 00:07:05.890 --> 00:07:08.559 position:50% align:middle that the Compact requires, 00:07:08.560 --> 00:07:13.313 position:50% align:middle but they also have to meet that state's requirements for licensure? 00:07:13.314 --> 00:07:14.648 position:50% align:middle - Absolutely. 00:07:14.649 --> 00:07:19.736 position:50% align:middle Every nurse making initial licensure request 00:07:19.737 --> 00:07:24.199 position:50% align:middle or endorsing in has to meet the home state's requirements, 00:07:24.200 --> 00:07:27.953 position:50% align:middle and if they want that multi-state license, 00:07:27.954 --> 00:07:32.332 position:50% align:middle they've got to meet Uniform Licensure Requirements set out in Article three. 00:07:32.333 --> 00:07:33.500 position:50% align:middle - I see. 00:07:33.501 --> 00:07:38.755 position:50% align:middle So it sounds like this Compact brings about some uniformity 00:07:38.756 --> 00:07:45.053 position:50% align:middle when it comes to license requirements to obtain a multi-state license. 00:07:45.054 --> 00:07:47.472 position:50% align:middle What do you think are some of the...? 00:07:49.515 --> 00:07:54.271 position:50% align:middle You talked about states, each state doing their own thing, 00:07:54.272 --> 00:07:56.648 position:50% align:middle having their own requirements. 00:07:56.649 --> 00:08:01.320 position:50% align:middle What are some of the key differences from states that 00:08:01.321 --> 00:08:05.657 position:50% align:middle if they had to come to an agreement on common requirements, 00:08:05.658 --> 00:08:07.576 position:50% align:middle what are some of the outliers? 00:08:07.577 --> 00:08:12.289 position:50% align:middle What are some of the things that differed between states that they had to, 00:08:12.290 --> 00:08:18.545 position:50% align:middle you know, accept for better or for worse a common term? 00:08:18.546 --> 00:08:22.507 position:50% align:middle - Well, right off the bat, there were a variety of things, 00:08:22.508 --> 00:08:24.801 position:50% align:middle but right off the bat, criminal background checks. 00:08:24.802 --> 00:08:29.431 position:50% align:middle I mean, if you go back 18, 19, 20 years ago, 00:08:29.432 --> 00:08:33.852 position:50% align:middle virtually no states were requiring criminal background checks. 00:08:33.853 --> 00:08:40.275 position:50% align:middle That was sort of the initial incubation period of when started looking at it. 00:08:40.276 --> 00:08:45.447 position:50% align:middle And so if you're going to join this and you're going to provide for your nurses 00:08:45.448 --> 00:08:48.909 position:50% align:middle to have the opportunity to have a multi-state license, 00:08:48.910 --> 00:08:51.344 position:50% align:middle they're going to have to do a criminal background check. 00:08:51.345 --> 00:08:54.456 position:50% align:middle So that was something new for them. 00:08:54.457 --> 00:09:01.254 position:50% align:middle We all had English proficiency requirements and foreign education requirements, 00:09:01.255 --> 00:09:05.258 position:50% align:middle but one of the things, if you were going to join the Compact, 00:09:05.259 --> 00:09:09.846 position:50% align:middle these things have to have an independent verification process. 00:09:09.847 --> 00:09:14.101 position:50% align:middle And I think most states were probably doing that already, 00:09:14.102 --> 00:09:16.895 position:50% align:middle but there were some states that were not. 00:09:18.412 --> 00:09:27.906 position:50% align:middle Other things that was agreed to in this was how to handle that initial licensure process. 00:09:27.907 --> 00:09:32.202 position:50% align:middle And especially, looking at criminal background checks. 00:09:32.203 --> 00:09:36.707 position:50% align:middle You had states that were licensing nurses. 00:09:36.708 --> 00:09:40.794 position:50% align:middle Obviously, some of them were not doing criminal background checks. 00:09:40.795 --> 00:09:43.016 position:50% align:middle They might ask the question, 00:09:43.017 --> 00:09:47.050 position:50% align:middle "Have you ever committed a crime with a felony misdemeanor?" 00:09:47.051 --> 00:09:48.927 position:50% align:middle They worded them different ways, 00:09:48.928 --> 00:09:50.595 position:50% align:middle but they didn't do anything to back it up 00:09:50.596 --> 00:09:55.225 position:50% align:middle to see if the nurse was actually being candid on their application. 00:09:55.226 --> 00:09:58.311 position:50% align:middle So with felonies and misdemeanors, 00:09:58.312 --> 00:10:02.858 position:50% align:middle especially misdemeanors related to the practice of nursing, 00:10:02.859 --> 00:10:06.069 position:50% align:middle the states are uniform on that now. 00:10:06.070 --> 00:10:07.571 position:50% align:middle They have to ask that question. 00:10:07.572 --> 00:10:09.197 position:50% align:middle They have to know what's going on. 00:10:09.198 --> 00:10:14.292 position:50% align:middle And that criminal background check gives them the type of information they need. 00:10:16.036 --> 00:10:21.209 position:50% align:middle - So, even though each state is charged with protecting the public, 00:10:21.210 --> 00:10:24.880 position:50% align:middle and each state had their own requirements, 00:10:24.881 --> 00:10:27.299 position:50% align:middle as they enter the Compact, 00:10:27.300 --> 00:10:31.762 position:50% align:middle they were able to agree on uniform requirements 00:10:31.763 --> 00:10:37.934 position:50% align:middle without risking any of the public protection element. 00:10:37.935 --> 00:10:39.311 position:50% align:middle So, in other words, 00:10:39.312 --> 00:10:42.689 position:50% align:middle there's still that high level of public protection 00:10:42.690 --> 00:10:46.902 position:50% align:middle even though all states are agreeing to the same requirements. 00:10:46.903 --> 00:10:48.403 position:50% align:middle - Exactly. 00:10:48.404 --> 00:10:55.772 position:50% align:middle And I would make the argument because this mandates a criminal background check for the first time. 00:10:57.703 --> 00:11:01.708 position:50% align:middle When states were not requiring that, or many states were not. 00:11:01.709 --> 00:11:05.629 position:50% align:middle The public is better protected than it ever has been 00:11:05.630 --> 00:11:09.341 position:50% align:middle for the states that are currently in the Compact because of that. 00:11:09.342 --> 00:11:14.888 position:50% align:middle And the ability to share information because prior to this Compact, 00:11:14.889 --> 00:11:19.351 position:50% align:middle and you move out of just...there are other requirements that they've all agreed to. 00:11:19.352 --> 00:11:23.730 position:50% align:middle They're not all contained in the Uniform Licensure Requirements. 00:11:23.731 --> 00:11:26.399 position:50% align:middle But doing that criminal background check, 00:11:26.400 --> 00:11:32.114 position:50% align:middle having the ability to share with other boards information you've discovered, 00:11:32.115 --> 00:11:36.785 position:50% align:middle can set up protections for the public probably better 00:11:36.786 --> 00:11:39.204 position:50% align:middle than in the history of nursing in this country. 00:11:40.121 --> 00:11:44.835 position:50% align:middle - That's a very big statement and big for public protection. 00:11:44.836 --> 00:11:49.422 position:50% align:middle My next question pertains to residency. 00:11:49.423 --> 00:11:54.886 position:50% align:middle Since the multi-state license is only available in Compact states, 00:11:54.887 --> 00:11:59.349 position:50% align:middle and it's only available to residents of a Compact state, 00:11:59.350 --> 00:12:03.520 position:50% align:middle what are some of the ways that the state board of nursing 00:12:03.521 --> 00:12:09.276 position:50% align:middle can actually know or determine whether an applicant is a resident or not? 00:12:10.734 --> 00:12:16.283 position:50% align:middle - Well, obviously, the very first thing, and I actually think the most important thing, 00:12:16.284 --> 00:12:20.203 position:50% align:middle strangely enough, is on your applications, 00:12:20.204 --> 00:12:22.789 position:50% align:middle whether it's first-time licensure 00:12:22.790 --> 00:12:27.919 position:50% align:middle or your endorsement applications or your renewal applications, 00:12:27.920 --> 00:12:30.589 position:50% align:middle maybe not quite as much, but yes, 00:12:30.590 --> 00:12:36.469 position:50% align:middle still on your renewal applications, is that you have a specific questionnaire, 00:12:36.470 --> 00:12:42.017 position:50% align:middle short and clean, concise, making, asking, 00:12:42.018 --> 00:12:44.519 position:50% align:middle requesting, whatever you want to call it, 00:12:44.520 --> 00:12:49.983 position:50% align:middle that nurse to declare what their primary state of residence is. 00:12:49.984 --> 00:12:56.781 position:50% align:middle And I think when that's on that application, and it has to be for you to know, 00:12:56.782 --> 00:13:02.162 position:50% align:middle the burden of being honest, and maybe we don't think of honesty as a burden, 00:13:02.163 --> 00:13:05.498 position:50% align:middle but maybe if you're trying to cover something up, a lot of times, 00:13:05.499 --> 00:13:09.544 position:50% align:middle I think when you're filling out an application for licensure, 00:13:09.545 --> 00:13:12.547 position:50% align:middle maybe if you've been thinking about not being honest, 00:13:12.548 --> 00:13:17.844 position:50% align:middle when you're going to sign that and you're doing the attestation at the end of it, 00:13:17.845 --> 00:13:22.849 position:50% align:middle I think it makes you think long and hard about being honest on that application 00:13:22.850 --> 00:13:25.435 position:50% align:middle about your primary state of residence. 00:13:25.436 --> 00:13:30.065 position:50% align:middle Other things, fortunately, we have a lot of guidance in the Compact. 00:13:30.066 --> 00:13:35.487 position:50% align:middle If you look at the rules, especially I believe it's Rule 4024, 00:13:35.488 --> 00:13:38.490 position:50% align:middle and Jim, you may have to correct me on that. 00:13:38.491 --> 00:13:41.534 position:50% align:middle Sometimes I get them a little confused. 00:13:41.535 --> 00:13:44.955 position:50% align:middle But we have guidelines there for the states to follow. 00:13:44.956 --> 00:13:49.501 position:50% align:middle And I think everybody's really familiar with this, so I won't spend too much time on it. 00:13:49.502 --> 00:13:51.378 position:50% align:middle But, you know, you can look at the driver's license, 00:13:51.379 --> 00:13:58.218 position:50% align:middle you can look at better registration, tax returns, military documents, W2s. 00:13:58.219 --> 00:14:00.512 position:50% align:middle And then we've got the big catchall, 00:14:00.513 --> 00:14:08.228 position:50% align:middle we allow each state to ask any additional questions that make them comfortable, 00:14:08.229 --> 00:14:12.357 position:50% align:middle that give them comfort in deciding to give this individual, 00:14:12.358 --> 00:14:15.318 position:50% align:middle not only a single-state license in all fairness, 00:14:15.319 --> 00:14:17.862 position:50% align:middle but to give them that multi-state license. 00:14:17.863 --> 00:14:25.829 position:50% align:middle And that they are doing it to a properly vetted individual who is truly a resident of their state. 00:14:25.830 --> 00:14:27.664 position:50% align:middle - So if I hear you correctly, 00:14:27.665 --> 00:14:33.295 position:50% align:middle you're saying that not only does an applicant sign a legal attestation 00:14:33.296 --> 00:14:39.009 position:50% align:middle but the Board of Nursing may ask for supplemental documents to back that up? 00:14:39.010 --> 00:14:39.901 position:50% align:middle - Absolutely. 00:14:39.902 --> 00:14:44.556 position:50% align:middle When I was in Arkansas, Jim, a lot of things we might ask about, 00:14:44.557 --> 00:14:47.267 position:50% align:middle we might ask for utility bills, 00:14:47.268 --> 00:14:52.522 position:50% align:middle you know, whether it was phone, whether it was electric, gas, 00:14:52.523 --> 00:14:54.524 position:50% align:middle whatever the case may be. 00:14:54.525 --> 00:14:59.404 position:50% align:middle I even asked sometimes when we thought we were dealing with an individual 00:14:59.405 --> 00:15:06.703 position:50% align:middle that might be manipulating us a bit, for not only their address, 00:15:06.704 --> 00:15:10.707 position:50% align:middle but the apartment manager's name and phone number. 00:15:10.708 --> 00:15:13.084 position:50% align:middle I didn't hesitate to pick up the phone and call them. 00:15:13.085 --> 00:15:14.502 position:50% align:middle And I will tell you, 00:15:14.503 --> 00:15:16.713 position:50% align:middle there were times when the apartment manager 00:15:16.714 --> 00:15:20.216 position:50% align:middle didn't have a clue as to who that individual was. 00:15:20.217 --> 00:15:22.594 position:50% align:middle - It sounds like you caught one there. 00:15:22.595 --> 00:15:24.971 position:50% align:middle - But you do occasionally catch a few. 00:15:24.972 --> 00:15:30.393 position:50% align:middle I always remind people, I always want to remind people, especially the new states, 00:15:30.394 --> 00:15:39.069 position:50% align:middle there weren't many to catch because 99% of them are honest just as nurses generally are, 00:15:39.070 --> 00:15:43.323 position:50% align:middle almost always are, they're honest about the information. 00:15:43.324 --> 00:15:51.206 position:50% align:middle - So it sounds like the bottom line is that the nurse needs to prove their state of residency 00:15:51.207 --> 00:15:54.334 position:50% align:middle to the satisfaction of the Board of Nursing, 00:15:54.335 --> 00:15:59.881 position:50% align:middle and whatever items or pieces of proof the board may require, 00:15:59.882 --> 00:16:01.883 position:50% align:middle the nurse needs to submit. 00:16:01.884 --> 00:16:03.426 position:50% align:middle Would that be accurate? 00:16:03.427 --> 00:16:05.512 position:50% align:middle - That would be accurate. 00:16:05.513 --> 00:16:07.013 position:50% align:middle And I think that's... 00:16:07.014 --> 00:16:10.266 position:50% align:middle So, an important part of the rule 00:16:10.267 --> 00:16:14.145 position:50% align:middle is that it gives states a lot of leeway 00:16:14.146 --> 00:16:17.816 position:50% align:middle as to what type of information they want to request. 00:16:17.817 --> 00:16:19.067 position:50% align:middle - Sure. 00:16:19.068 --> 00:16:24.781 position:50% align:middle And I think that's an important aspect that allows for differences among states, 00:16:24.782 --> 00:16:32.872 position:50% align:middle because ultimately, they're ensuring the residency of that individual 00:16:32.873 --> 00:16:36.459 position:50% align:middle in order to protect the public of their state. 00:16:36.460 --> 00:16:40.672 position:50% align:middle We haven't touched on this, 00:16:40.673 --> 00:16:42.340 position:50% align:middle but I would imagine 00:16:42.341 --> 00:16:46.803 position:50% align:middle that although we've been focusing on the Board of Nursing side, 00:16:46.804 --> 00:16:48.721 position:50% align:middle on the employer side, 00:16:48.722 --> 00:16:55.520 position:50% align:middle I imagine they have their own due diligence to ensure that a nurse is appropriately licensed, 00:16:55.521 --> 00:17:00.608 position:50% align:middle meaning has taken the necessary steps for renewal 00:17:00.609 --> 00:17:07.657 position:50% align:middle or changing their license in the event that they move to another Compact state. 00:17:07.658 --> 00:17:11.286 position:50% align:middle And I don't know what you can speak to that, 00:17:11.287 --> 00:17:15.457 position:50% align:middle but there's got probably some responsibility 00:17:15.458 --> 00:17:18.960 position:50% align:middle or some due diligence on the part of the employer as well. 00:17:18.961 --> 00:17:20.103 position:50% align:middle - Absolutely. 00:17:20.104 --> 00:17:26.926 position:50% align:middle The employer's due diligence is not only to them themselves, 00:17:26.927 --> 00:17:32.307 position:50% align:middle but it's to their patients and everybody involved in their facility. 00:17:32.308 --> 00:17:39.522 position:50% align:middle First of all, always remember that the Compact mandates, 00:17:39.523 --> 00:17:42.734 position:50% align:middle as a matter of law, that the individual, 00:17:42.735 --> 00:17:49.491 position:50% align:middle the individual nurse that is moving to get licensed in their new primary state of residence. 00:17:49.492 --> 00:17:56.706 position:50% align:middle It is for them to contact that Board of Nursing to get the application, probably online, 00:17:56.707 --> 00:18:01.503 position:50% align:middle to make the declaration that's the new state and start the process. 00:18:01.504 --> 00:18:05.590 position:50% align:middle Of course, as we know, it doesn't have to happen immediately. 00:18:05.591 --> 00:18:09.177 position:50% align:middle If they still have an active license in the state they're moving from, 00:18:09.178 --> 00:18:14.548 position:50% align:middle they can work on that until they get the process completed in their new state. 00:18:14.550 --> 00:18:16.140 position:50% align:middle Why it becomes very important? 00:18:16.140 --> 00:18:21.064 position:50% align:middle There's two levels of extreme importance here, 00:18:21.065 --> 00:18:23.233 position:50% align:middle in my mind, one, to the employer. 00:18:23.234 --> 00:18:28.780 position:50% align:middle It's very important for the employer to monitor this if they've got a good HR department. 00:18:28.781 --> 00:18:31.241 position:50% align:middle I think most of them do. 00:18:31.242 --> 00:18:35.950 position:50% align:middle It's not an area I'd want to work in, but a lot of people love that field. 00:18:35.952 --> 00:18:39.474 position:50% align:middle But it's important for that HR department 00:18:39.475 --> 00:18:44.712 position:50% align:middle or whomever oversees this process at the place of employment, 00:18:44.713 --> 00:18:52.220 position:50% align:middle to make sure that this nurse ultimately changes at primary state of residence. 00:18:52.221 --> 00:18:54.230 position:50% align:middle And the reason, we all know the reason. 00:18:54.232 --> 00:18:55.932 position:50% align:middle The reason is, 00:18:55.933 --> 00:19:02.689 position:50% align:middle at some point that other state's license is going to expire, and it will not be renewed. 00:19:02.690 --> 00:19:09.320 position:50% align:middle And this individual, the nurse will be working, we all know about Medicare and Medicaid billing, 00:19:09.321 --> 00:19:16.369 position:50% align:middle and if that individual is not licensed, then the employer will not be reimbursed. 00:19:16.370 --> 00:19:20.331 position:50% align:middle And it's not a matter of just not being reimbursed. 00:19:20.332 --> 00:19:26.546 position:50% align:middle Let me tell you, the government will go after them for prior reimbursement. 00:19:26.547 --> 00:19:31.301 position:50% align:middle And I dealt with that a few times in Arkansas. 00:19:31.302 --> 00:19:33.386 position:50% align:middle And it can be costly. 00:19:33.387 --> 00:19:42.103 position:50% align:middle And I had one case, I won't mention the hospital, but the settlement was over $150,000. 00:19:42.104 --> 00:19:45.315 position:50% align:middle I don't think there was any ill intent. 00:19:45.316 --> 00:19:49.193 position:50% align:middle It was just a failure to do what you should have done. 00:19:49.194 --> 00:19:57.035 position:50% align:middle There's another person that is extremely at risk of working and letting that license lapse, 00:19:57.036 --> 00:19:59.640 position:50% align:middle and that's the nurse themselves. 00:19:59.642 --> 00:20:04.834 position:50% align:middle Because here's what happens, that license lapse, 00:20:04.835 --> 00:20:09.631 position:50% align:middle they're working without a license in the new home state, guess what? 00:20:09.632 --> 00:20:15.920 position:50% align:middle Read the boilerplate language in your malpractice insurance policies. 00:20:15.922 --> 00:20:21.372 position:50% align:middle Whether the nurse carries one or whether they're working under the umbrella policy of the employer, 00:20:21.372 --> 00:20:24.442 position:50% align:middle I'm going to tell you right now, if they're not licensed, 00:20:24.442 --> 00:20:26.782 position:50% align:middle they don't have to pay malpractice. 00:20:26.782 --> 00:20:33.047 position:50% align:middle That's not only costly to the employer, that can be financially devastating to the nurse. 00:20:33.047 --> 00:20:36.366 position:50% align:middle So both of them have a great deal, 00:20:36.367 --> 00:20:43.831 position:50% align:middle or they're at tremendous risks if they don't mandate this and follow this. 00:20:43.832 --> 00:20:50.505 position:50% align:middle - Well, it sounds like a lot of serious consequences to not being appropriately licensed 00:20:50.506 --> 00:20:53.225 position:50% align:middle or to practicing unlicensed. 00:20:53.227 --> 00:20:58.054 position:50% align:middle But I think this is a perfect segue to my next question, which is, 00:20:58.055 --> 00:21:05.770 position:50% align:middle since the NLC is based on the same model of licensure as the driver's license, 00:21:05.771 --> 00:21:08.981 position:50% align:middle which also happens to be a Compact, 00:21:08.982 --> 00:21:15.279 position:50% align:middle how does moving and changing the primary state of residence for legal purposes 00:21:15.280 --> 00:21:18.324 position:50% align:middle impact a multi-state license holder? 00:21:18.325 --> 00:21:24.204 position:50% align:middle And I think that, you know, there's some common misunderstandings in this area. 00:21:24.206 --> 00:21:33.756 position:50% align:middle How is this similar or different to the requirements for a driver's license when someone is moving? 00:21:33.757 --> 00:21:40.263 position:50% align:middle - Well, in the simplest of forms, they're quite similar. 00:21:40.264 --> 00:21:47.854 position:50% align:middle If you just keep it at the very basic level, there's not a lot of difference. 00:21:47.855 --> 00:21:50.064 position:50% align:middle If we move to a new state, 00:21:50.065 --> 00:21:54.444 position:50% align:middle we're required if we're going to operate a motor vehicle, 00:21:54.445 --> 00:22:01.659 position:50% align:middle we are required to get a new license in that state in a certain period of time. 00:22:01.660 --> 00:22:03.993 position:50% align:middle And there's a reason for that. 00:22:03.995 --> 00:22:10.065 position:50% align:middle And that time varies from jurisdiction to jurisdiction. 00:22:10.065 --> 00:22:16.764 position:50% align:middle Also, it's the same if you're moving from state to state and you're a nurse. 00:22:16.766 --> 00:22:19.495 position:50% align:middle You have a period of time. 00:22:19.495 --> 00:22:25.275 position:50% align:middle Although we do not set a date specific to have it completed. 00:22:25.275 --> 00:22:30.906 position:50% align:middle I think everyone can agree it must, at the bare minimum, 00:22:30.906 --> 00:22:37.320 position:50% align:middle be completed before their prior home state's license lapses. 00:22:37.321 --> 00:22:39.071 position:50% align:middle There could be an exception. 00:22:39.072 --> 00:22:43.493 position:50% align:middle I mean, if you've moved and your license is lapsing in four days, 00:22:43.494 --> 00:22:47.413 position:50% align:middle then it's a possibility that nurse may have to renew down there 00:22:47.414 --> 00:22:51.125 position:50% align:middle or in their previous state until they can get this process completed. 00:22:51.126 --> 00:22:56.724 position:50% align:middle Unless you are from a state that works in record speed and can complete that process. 00:22:56.726 --> 00:23:00.570 position:50% align:middle But I don't think in a short period of time that's probably going to happen. 00:23:00.570 --> 00:23:04.640 position:50% align:middle So the requirement to get that new license is the same. 00:23:04.640 --> 00:23:10.311 position:50% align:middle I will say this, and this may surprise some of the viewers today, 00:23:10.312 --> 00:23:14.899 position:50% align:middle you know, we worry, we're pretty flexible with nurses 00:23:14.900 --> 00:23:18.820 position:50% align:middle on how much time they have to get it done. 00:23:18.821 --> 00:23:23.783 position:50% align:middle But I'll tell you, you go pull that driver's license compact up, 00:23:23.784 --> 00:23:32.458 position:50% align:middle and you start looking at the 44 or 45 states that are in that compact, 00:23:32.459 --> 00:23:36.212 position:50% align:middle strangely, there's about 5 that are not in it. 00:23:36.213 --> 00:23:39.340 position:50% align:middle But you look at that, every single one of those states, 00:23:39.341 --> 00:23:41.717 position:50% align:middle I think I'm correct in saying this, 00:23:41.718 --> 00:23:47.890 position:50% align:middle mandates a time specific to get that new driver's license. 00:23:47.891 --> 00:23:51.940 position:50% align:middle And they generally, I said generally, run, 00:23:51.941 --> 00:23:57.483 position:50% align:middle I think from anywhere from about 20 to 30 days, up to, 00:23:57.484 --> 00:24:01.070 position:50% align:middle I believe, the maximum time might be 3 months. 00:24:01.071 --> 00:24:04.115 position:50% align:middle And I may be wrong about that, so tell me. 00:24:04.116 --> 00:24:09.453 position:50% align:middle But it's a narrow window of opportunity to get in there and get it done. 00:24:09.454 --> 00:24:12.290 position:50% align:middle And I think that's public protection. 00:24:12.291 --> 00:24:14.166 position:50% align:middle They're wanting to know who's in their state, 00:24:14.167 --> 00:24:20.368 position:50% align:middle they're wanting to make sure that you're carrying driver's insurance. 00:24:20.370 --> 00:24:23.520 position:50% align:middle Another that's very much a public protectant. 00:24:23.520 --> 00:24:26.178 position:50% align:middle So the two are a lot alike in that area. 00:24:26.179 --> 00:24:27.930 position:50% align:middle - Okay. 00:24:27.931 --> 00:24:30.766 position:50% align:middle Well, I think that it sounds to me 00:24:30.767 --> 00:24:36.981 position:50% align:middle like the key trigger to the need to obtain a new license 00:24:36.982 --> 00:24:41.944 position:50% align:middle is changing your primary state of residency for legal purposes. 00:24:41.945 --> 00:24:46.616 position:50% align:middle Meaning, if I'm a nurse in Arizona and I moved to Maryland, 00:24:46.617 --> 00:24:49.744 position:50% align:middle that's my new state of residency. 00:24:49.745 --> 00:24:53.740 position:50% align:middle Obviously, other things are irrelevant, 00:24:53.741 --> 00:24:58.127 position:50% align:middle whether I found the perfect house to buy or whatever. 00:24:58.128 --> 00:25:02.715 position:50% align:middle I'm there for the foreseeable future as a permanent move. 00:25:02.716 --> 00:25:07.011 position:50% align:middle I should go ahead and get a new nursing license. 00:25:07.012 --> 00:25:13.768 position:50% align:middle - And, Jim, this is not just unique to your nursing license or your driver's license, 00:25:13.769 --> 00:25:18.940 position:50% align:middle this involves a lot of legal issues that impacts us. 00:25:18.941 --> 00:25:23.069 position:50% align:middle If I'm living in a condo or an apartment in Arkansas 00:25:23.070 --> 00:25:28.199 position:50% align:middle and I have insurance on the interior of it and all of my belongings, 00:25:28.200 --> 00:25:33.371 position:50% align:middle and I pick up next week, and let's say I move to Miami, 00:25:33.372 --> 00:25:36.290 position:50% align:middle that insurance policy is not going to be the same. 00:25:36.291 --> 00:25:38.626 position:50% align:middle I can assure you right now, 00:25:38.627 --> 00:25:44.924 position:50% align:middle when insurance, flood insurance in Miami is radically different, 00:25:44.925 --> 00:25:50.275 position:50% align:middle and unfortunately, radically more expensive than it is in Little Rock, Arkansas. 00:25:50.285 --> 00:25:58.562 position:50% align:middle So there are a multitude of things, including our nursing licenses and my law license, 00:25:58.563 --> 00:26:02.358 position:50% align:middle that we have got to do when we make a move. 00:26:02.359 --> 00:26:09.506 position:50% align:middle And we should not treat the nursing license any less than we treat our driver's license, 00:26:09.508 --> 00:26:12.618 position:50% align:middle our insurance policies, or any other thing, 00:26:12.619 --> 00:26:18.374 position:50% align:middle we are legally required to check in with the new state and make additions to. 00:26:18.375 --> 00:26:21.335 position:50% align:middle - And I think as everyone knows 00:26:21.336 --> 00:26:25.923 position:50% align:middle the common thing that we see with any type of license is 00:26:25.924 --> 00:26:30.594 position:50% align:middle that we tend to think that we're able to wait 00:26:30.595 --> 00:26:35.725 position:50% align:middle until that one is about to expire before we take any action, 00:26:35.726 --> 00:26:38.477 position:50% align:middle even though we've just moved. 00:26:38.478 --> 00:26:39.520 position:50% align:middle - Yes. 00:26:39.521 --> 00:26:41.914 position:50% align:middle And sometimes it's because you're really busy, 00:26:41.915 --> 00:26:45.651 position:50% align:middle you have children, you have family, you have whatever. 00:26:45.652 --> 00:26:49.655 position:50% align:middle And sometimes, and this would be very applicable to me, 00:26:49.656 --> 00:26:54.076 position:50% align:middle if my former boss is listening, I'm sure she's shaking her head, 00:26:54.077 --> 00:26:56.495 position:50% align:middle it's called procrastination. 00:26:56.496 --> 00:27:00.124 position:50% align:middle I'm a notorious procrastinator. 00:27:00.125 --> 00:27:04.587 position:50% align:middle And I would fall probably in that category. 00:27:04.588 --> 00:27:08.923 position:50% align:middle Now, the only thing I might pat myself on the back with 00:27:08.924 --> 00:27:13.012 position:50% align:middle was I would be so fearful of losing my law license 00:27:13.013 --> 00:27:14.221 position:50% align:middle or messing that up. 00:27:14.222 --> 00:27:16.307 position:50% align:middle I don't think I've ever been late. 00:27:16.308 --> 00:27:21.062 position:50% align:middle Well, no, I don't think, I have never been late on renewing that license. 00:27:21.063 --> 00:27:22.813 position:50% align:middle Those things are too important. 00:27:22.814 --> 00:27:25.566 position:50% align:middle Your nursing license is too important. 00:27:25.567 --> 00:27:26.901 position:50% align:middle - Right. 00:27:26.902 --> 00:27:33.449 position:50% align:middle So, it's important to note that even though the license hasn't expired yet when you've moved, 00:27:33.450 --> 00:27:38.037 position:50% align:middle that's not a reason to not take the necessary steps to get a new license. 00:27:38.038 --> 00:27:39.413 position:50% align:middle - Absolutely. 00:27:39.414 --> 00:27:44.126 position:50% align:middle - Just whether people want to save money or whatever it might be, 00:27:44.127 --> 00:27:47.630 position:50% align:middle the triggering event is the fact that you moved, 00:27:47.631 --> 00:27:53.803 position:50% align:middle your intent is to make this your new state of residency, and nothing else matters. 00:27:53.804 --> 00:28:00.643 position:50% align:middle That now it's time to get a new nursing license, get a new driver's license, etc. 00:28:00.644 --> 00:28:03.813 position:50% align:middle Register to vote in the new state. 00:28:03.814 --> 00:28:11.195 position:50% align:middle Always the key events to becoming a resident and getting established as resident in a new state. 00:28:11.196 --> 00:28:12.113 position:50% align:middle - Yes. 00:28:12.114 --> 00:28:17.576 position:50% align:middle And I think the Compact drafters were brilliant and kind 00:28:17.577 --> 00:28:23.874 position:50% align:middle in taking into consideration the complexities of moving from one state to a new state 00:28:23.875 --> 00:28:27.086 position:50% align:middle and doing the criminal background checks or whatever required. 00:28:27.087 --> 00:28:30.381 position:50% align:middle And they, because of that, in this Compact, 00:28:30.382 --> 00:28:34.453 position:50% align:middle they specifically allow individuals to start the process early, 00:28:34.454 --> 00:28:35.898 position:50% align:middle even before they move. 00:28:35.898 --> 00:28:38.389 position:50% align:middle They can start submitting forms. 00:28:38.390 --> 00:28:41.308 position:50% align:middle They can probably start submitting criminal background checks. 00:28:41.309 --> 00:28:44.854 position:50% align:middle There's a variety of things they can do before they ever move. 00:28:44.855 --> 00:28:47.064 position:50% align:middle And that's allowed as a matter of law. 00:28:48.398 --> 00:28:49.358 position:50% align:middle - Fantastic. 00:28:49.359 --> 00:28:55.948 position:50% align:middle So we've been talking about the Uniform Licensure Requirements, but I would just like to make it clear, 00:28:55.949 --> 00:29:01.120 position:50% align:middle you mentioned there's 11 uniform requirements to get a multi-state license. 00:29:01.121 --> 00:29:08.794 position:50% align:middle If a nurse or an applicant does not meet one or more of those requirements, I mean, 00:29:08.795 --> 00:29:12.006 position:50% align:middle does this mean the nurse is out of a livelihood? 00:29:12.007 --> 00:29:13.591 position:50% align:middle - Absolutely not. 00:29:13.592 --> 00:29:23.017 position:50% align:middle That nurse, depending on the state and other state requirements, may always be eligible for that state, 00:29:23.018 --> 00:29:26.812 position:50% align:middle their home state for a single-state license. 00:29:26.813 --> 00:29:32.276 position:50% align:middle They may not be eligible for a multi-state license, but hopefully, 00:29:32.277 --> 00:29:37.323 position:50% align:middle they will meet all the other requirements that the state has for a single-state license. 00:29:37.324 --> 00:29:41.285 position:50% align:middle Ultimately, that's going to depend on the state they're in 00:29:41.286 --> 00:29:45.873 position:50% align:middle because that is going to vary a bit from state to state. 00:29:45.874 --> 00:29:50.628 position:50% align:middle And, you know, I think we've all seen this, we're all aware of it, 00:29:50.629 --> 00:29:56.926 position:50% align:middle it may be that they are not eligible for a single-state license in one state, 00:29:56.927 --> 00:30:00.638 position:50% align:middle but maybe if they're willing to move to another state, 00:30:00.639 --> 00:30:05.100 position:50% align:middle they might be eligible for a single-state license in that state. 00:30:05.101 --> 00:30:06.977 position:50% align:middle And always remember, 00:30:06.978 --> 00:30:12.983 position:50% align:middle there might be a few probably when you get into the criminal conviction issue, 00:30:12.984 --> 00:30:19.782 position:50% align:middle but there is always a possibility that when they initially get that single-state license, 00:30:19.783 --> 00:30:25.704 position:50% align:middle there may be a path down the road that they can cure 00:30:25.705 --> 00:30:31.377 position:50% align:middle whatever the issue is with the ULRs, and ultimately, 00:30:31.378 --> 00:30:34.171 position:50% align:middle be eligible for a multi-state license down the road. 00:30:34.172 --> 00:30:40.803 position:50% align:middle That will just depend on what the underlying issue is and is there a possibility for a cure. 00:30:40.804 --> 00:30:42.346 position:50% align:middle - Okay. 00:30:42.347 --> 00:30:46.267 position:50% align:middle So, you don't meet the requirements for a multi-state, 00:30:46.268 --> 00:30:49.436 position:50% align:middle you might be eligible for a single-state. 00:30:49.437 --> 00:30:53.983 position:50% align:middle And if your job requires you to be licensed in multiple states, 00:30:53.984 --> 00:31:00.531 position:50% align:middle I guess that puts you in a situation of having to apply for multiple single-state licenses. 00:31:00.532 --> 00:31:01.907 position:50% align:middle Is that correct? 00:31:01.908 --> 00:31:03.534 position:50% align:middle - That's absolutely correct. 00:31:03.535 --> 00:31:06.287 position:50% align:middle And states know how to do that. 00:31:06.288 --> 00:31:09.707 position:50% align:middle Most nurses that have been practicing, well, know how to do that 00:31:09.708 --> 00:31:12.334 position:50% align:middle because we were doing that for years. 00:31:12.335 --> 00:31:21.051 position:50% align:middle - Well, this discussion on eligibility takes me to probably one of the most important requirements 00:31:21.052 --> 00:31:25.806 position:50% align:middle for multi-state license, and that's the one that pertains to felonies. 00:31:25.807 --> 00:31:30.519 position:50% align:middle So I just would like to get some clarity on this. 00:31:30.520 --> 00:31:34.231 position:50% align:middle When an applicant has a felony conviction, 00:31:34.232 --> 00:31:39.320 position:50% align:middle my understanding is that they cannot get a multi-state license. 00:31:39.321 --> 00:31:42.990 position:50% align:middle But the question is, is there any way around this? 00:31:42.991 --> 00:31:45.284 position:50% align:middle Are there any exceptions? 00:31:45.285 --> 00:31:52.458 position:50% align:middle Anything that an applicant can do when they need a multi-state license 00:31:52.459 --> 00:31:55.377 position:50% align:middle but have a felony conviction to the record? 00:31:55.378 --> 00:31:56.920 position:50% align:middle - Well, sort of, yes. 00:31:56.921 --> 00:31:59.673 position:50% align:middle The answer, obviously, is yes here. 00:31:59.674 --> 00:32:07.056 position:50% align:middle The first rule is if you have a felony conviction, you absolutely cannot have a license. 00:32:07.057 --> 00:32:12.603 position:50% align:middle But then to every hard rule, often we will have exceptions. 00:32:12.604 --> 00:32:15.981 position:50% align:middle And this is no exception. 00:32:15.982 --> 00:32:19.026 position:50% align:middle First of all, expungements. 00:32:19.027 --> 00:32:23.489 position:50% align:middle If they have the ability based on the type of conviction they have, 00:32:23.490 --> 00:32:28.535 position:50% align:middle and depending on how the expungement laws are written in a particular state, 00:32:28.536 --> 00:32:37.600 position:50% align:middle they can go back before that judge or a judge and have their criminal record expunged, 00:32:37.600 --> 00:32:43.780 position:50% align:middle assuming that the definition of expungement in a particular state meets the requirements. 00:32:43.780 --> 00:32:47.690 position:50% align:middle At that point in time, they get everything expunged. 00:32:47.690 --> 00:32:50.280 position:50% align:middle They meet all of the other ULRs. 00:32:50.280 --> 00:32:53.670 position:50% align:middle They meet all of the other state requirements. 00:32:53.670 --> 00:33:00.798 position:50% align:middle And at that point, they would be eligible to a multi-state license. 00:33:00.798 --> 00:33:06.558 position:50% align:middle And this one may not be as absolute, but sealed records. 00:33:06.558 --> 00:33:14.188 position:50% align:middle Often, in many states, a sealed file works very much like an expungement. 00:33:14.188 --> 00:33:18.378 position:50% align:middle You may need to look at how the law is written in a particular state. 00:33:18.378 --> 00:33:22.940 position:50% align:middle I think most states attorneys for their boards, whether they're in-house 00:33:22.941 --> 00:33:25.509 position:50% align:middle or they're with the AG's office, 00:33:25.510 --> 00:33:29.471 position:50% align:middle they pretty much understand sealed records in their state. 00:33:29.472 --> 00:33:36.770 position:50% align:middle I hate to always rely on my experiences in Arkansas, but, you know, you talk about what you know. 00:33:36.771 --> 00:33:42.484 position:50% align:middle And in Arkansas, generally, sealed records apply to people 18 or under. 00:33:42.485 --> 00:33:45.529 position:50% align:middle There are exceptions to that too. 00:33:45.530 --> 00:33:50.451 position:50% align:middle But if they did everything they were supposed to, that record was sealed. 00:33:50.452 --> 00:33:58.083 position:50% align:middle Those individuals would generally be eligible for a multi-state license if everything else was met. 00:33:58.084 --> 00:34:06.258 position:50% align:middle This one is not quite another exception that's not quite as solid, the pardon. 00:34:06.259 --> 00:34:09.011 position:50% align:middle The power of pardon from a state. 00:34:09.012 --> 00:34:12.014 position:50% align:middle Generally, it's vested with the governor. 00:34:12.015 --> 00:34:15.767 position:50% align:middle There are a couple of minor exceptions to that, I believe. 00:34:15.768 --> 00:34:21.273 position:50% align:middle But pardons don't always clear the conviction. 00:34:21.274 --> 00:34:28.155 position:50% align:middle And in a lot of states, what a pardon does is it restores rights. 00:34:28.156 --> 00:34:32.826 position:50% align:middle It restores maybe your right to bear arms, so they can go hunting. 00:34:32.827 --> 00:34:34.661 position:50% align:middle Their right to vote. 00:34:36.662 --> 00:34:42.169 position:50% align:middle Maybe their right to have access to certain types of loans, strange enough. 00:34:42.170 --> 00:34:50.344 position:50% align:middle So what it normally does is restoring rights, but not always clearing a conviction. 00:34:50.345 --> 00:34:56.099 position:50% align:middle I come from a state that a pardon rarely clears a conviction. 00:34:56.100 --> 00:35:00.938 position:50% align:middle And I know people that have been in meetings with me before are aware that I've dealt... 00:35:00.939 --> 00:35:04.691 position:50% align:middle well, only two or three times with presidential pardons. 00:35:04.692 --> 00:35:10.614 position:50% align:middle And even in those, they did not open the way for clearing a conviction. 00:35:10.615 --> 00:35:16.620 position:50% align:middle And one president, in particular, I'm just, to this day, so surprised by it. 00:35:16.621 --> 00:35:18.330 position:50% align:middle I read the entire pardon. 00:35:18.331 --> 00:35:20.332 position:50% align:middle It was very impressive. 00:35:20.333 --> 00:35:22.292 position:50% align:middle It restored so many rights. 00:35:22.293 --> 00:35:26.129 position:50% align:middle But the very last paragraph said, 00:35:26.130 --> 00:35:31.718 position:50% align:middle "This pardon cannot be used as a clearing of criminal convictions 00:35:31.719 --> 00:35:35.889 position:50% align:middle in order to obtain licensure in your state." 00:35:35.890 --> 00:35:39.518 position:50% align:middle And I thought that is detailed and... 00:35:39.519 --> 00:35:41.228 position:50% align:middle - That cleared it up. 00:35:41.229 --> 00:35:43.105 position:50% align:middle - Cleared it up very quickly. 00:35:43.106 --> 00:35:48.694 position:50% align:middle - It sounds like the pardon may not help someone 00:35:48.695 --> 00:35:52.573 position:50% align:middle when it comes to removing a felony conviction from the record, 00:35:52.574 --> 00:35:58.370 position:50% align:middle but potentially, an expungement or a ceiling will help maybe, 00:35:58.371 --> 00:36:01.400 position:50% align:middle depending on that particular state's laws. 00:36:01.400 --> 00:36:05.600 position:50% align:middle And it really sounds like you're saying there's a lot of variance from state to state 00:36:05.600 --> 00:36:11.592 position:50% align:middle with the impact or effect of an expungement or sealing of records. 00:36:11.593 --> 00:36:12.718 position:50% align:middle - Absolutely. 00:36:12.719 --> 00:36:16.555 position:50% align:middle And another aspect of it that is of no fault of the boards. 00:36:16.556 --> 00:36:21.393 position:50% align:middle You have some states that judges are hesitant to expunge, 00:36:21.394 --> 00:36:25.564 position:50% align:middle and you have other states where expungements come fairly easy, 00:36:25.565 --> 00:36:28.025 position:50% align:middle and that's just the luck of the draw. 00:36:28.026 --> 00:36:29.484 position:50% align:middle - Yep. 00:36:29.485 --> 00:36:29.816 position:50% align:middle Yeah. 00:36:29.817 --> 00:36:38.327 position:50% align:middle I think ideally you'd hope to never have to deal with that situation of having a felony conviction. 00:36:38.328 --> 00:36:42.748 position:50% align:middle Let me move on, as time is passing quickly, 00:36:42.749 --> 00:36:45.167 position:50% align:middle to another question that I have 00:36:45.168 --> 00:36:48.045 position:50% align:middle about alternative to discipline programs. 00:36:48.046 --> 00:36:49.838 position:50% align:middle And there are a couple of, I noticed, 00:36:49.839 --> 00:36:55.469 position:50% align:middle a few of the Uniform License Requirements pertaining to alternative to discipline programs. 00:36:55.470 --> 00:37:02.017 position:50% align:middle But I do think, for our audience, it's a term that many people don't understand, 00:37:02.018 --> 00:37:08.357 position:50% align:middle especially applicants for licensure may not understand alternative to discipline program. 00:37:08.358 --> 00:37:11.026 position:50% align:middle Especially because in many states 00:37:11.027 --> 00:37:17.074 position:50% align:middle the program goes under a certain acronym type of a name for the program. 00:37:17.075 --> 00:37:23.955 position:50% align:middle And so we, in the Compact, use a generic term to pertain to all programs. 00:37:23.956 --> 00:37:29.044 position:50% align:middle But can you explain what this program is? 00:37:29.045 --> 00:37:31.588 position:50% align:middle Who typically is participating in it? 00:37:31.589 --> 00:37:36.718 position:50% align:middle And how does that relate to someone who wants a multi-state license? 00:37:36.719 --> 00:37:39.513 position:50% align:middle - Well, an alternative to discipline program, 00:37:39.514 --> 00:37:41.807 position:50% align:middle and that is sort of the catchall 00:37:41.808 --> 00:37:45.060 position:50% align:middle for the various names of the programs. 00:37:45.061 --> 00:37:53.860 position:50% align:middle It's a program that is established by the board and by the, generally, legislative approval. 00:37:53.861 --> 00:38:00.283 position:50% align:middle It's normally set out the statute and then often the details...the devil's in the details. 00:38:00.284 --> 00:38:05.789 position:50% align:middle And that's often set out in your rules, your state rules governing that program. 00:38:05.790 --> 00:38:09.835 position:50% align:middle And there's sort of two general types of programs. 00:38:09.836 --> 00:38:15.424 position:50% align:middle There are those programs that are operated somewhat in-house by the board and the board staff, 00:38:15.425 --> 00:38:22.305 position:50% align:middle or at least some of their staff run those programs and are familiar with all the participants. 00:38:22.306 --> 00:38:28.103 position:50% align:middle The other type is what I would sort of think of, although it's board-created, 00:38:28.104 --> 00:38:30.731 position:50% align:middle it's completely independent of the board. 00:38:30.732 --> 00:38:37.946 position:50% align:middle And the board and the board staff may have absolutely no knowledge of who's in those programs 00:38:37.947 --> 00:38:41.324 position:50% align:middle until they default to the individual nurse who's a participant, 00:38:41.325 --> 00:38:45.078 position:50% align:middle defaults in some form or fashion in the program. 00:38:45.079 --> 00:38:47.330 position:50% align:middle The programs are almost always, 00:38:47.331 --> 00:38:50.876 position:50% align:middle and I'm sure someone out there does something a little different 00:38:50.877 --> 00:38:53.920 position:50% align:middle or a little differently than what we did and many states do, 00:38:53.921 --> 00:38:59.593 position:50% align:middle but generally, they are covering individuals with substance abuse issues. 00:38:59.594 --> 00:39:03.638 position:50% align:middle And many of them go ahead and cover mental health issues too. 00:39:03.639 --> 00:39:07.350 position:50% align:middle The two are often intertwined, as most people know that have dealt with this 00:39:07.351 --> 00:39:08.852 position:50% align:middle and worked with it. 00:39:08.853 --> 00:39:14.274 position:50% align:middle And so the goal here is to try not to punish 00:39:14.275 --> 00:39:18.945 position:50% align:middle or add to the stress and anxiety of an individual 00:39:18.946 --> 00:39:24.242 position:50% align:middle who has mental health issues and/or substance abuse issues. 00:39:24.243 --> 00:39:30.415 position:50% align:middle And it's to get those individuals into a program, get them counseling, assist them on treatment. 00:39:30.416 --> 00:39:34.044 position:50% align:middle Generally, we don't have treatment programs within the board. 00:39:34.045 --> 00:39:35.378 position:50% align:middle Some may. 00:39:35.379 --> 00:39:37.297 position:50% align:middle But it's to help them. 00:39:37.298 --> 00:39:47.307 position:50% align:middle And it's not to add another layer of stress and burdens that go hand-in-hand with "discipline." 00:39:47.308 --> 00:39:51.520 position:50% align:middle And disciplining that individual for those types of issues. 00:39:51.521 --> 00:39:53.188 position:50% align:middle I've always, always, 00:39:53.189 --> 00:39:57.984 position:50% align:middle I had a problem with disciplining someone with a mental health issue. 00:39:57.985 --> 00:39:59.861 position:50% align:middle That's a health issue. 00:39:59.862 --> 00:40:03.782 position:50% align:middle We don't discipline people with broken legs, broken arms. 00:40:03.783 --> 00:40:06.326 position:50% align:middle They've had to have stents placed in their heart. 00:40:06.327 --> 00:40:10.831 position:50% align:middle And to me, it never made sense to discipline someone with a mental health issue. 00:40:10.832 --> 00:40:18.755 position:50% align:middle So those are the programs that they're embarrassed as to what they are 00:40:18.756 --> 00:40:20.340 position:50% align:middle and what they do. 00:40:20.341 --> 00:40:29.307 position:50% align:middle I think where it gets complicated for members of the Compact of those states 00:40:29.308 --> 00:40:35.730 position:50% align:middle that have no involvement with the program until the individual has been, 00:40:35.731 --> 00:40:39.651 position:50% align:middle so to speak, booted out of the program for non-compliance. 00:40:39.652 --> 00:40:43.613 position:50% align:middle But there are processes and procedures for dealing with that. 00:40:43.614 --> 00:40:54.040 position:50% align:middle And I think that is probably Article 3, seems like, down around C-10 maybe, or 9. 00:40:54.041 --> 00:40:56.334 position:50% align:middle Maybe 9 and then 10. 00:40:56.335 --> 00:40:59.588 position:50% align:middle There is a bit of burden we place on the nurse. 00:40:59.589 --> 00:41:04.384 position:50% align:middle For the nurse that are in these programs, that the boards are not aware of, 00:41:04.385 --> 00:41:09.306 position:50% align:middle there is an obligation and a legal requirement. 00:41:09.307 --> 00:41:11.850 position:50% align:middle Remember, this is statutory. 00:41:11.851 --> 00:41:17.147 position:50% align:middle There is a legal requirement for that nurse to report to the new state, 00:41:17.148 --> 00:41:19.374 position:50% align:middle the new primary state residents 00:41:19.375 --> 00:41:27.365 position:50% align:middle that he or she is already in an alternative discipline program in the state they're coming into. 00:41:27.366 --> 00:41:32.871 position:50% align:middle And so it's very, very important you put that question on your application 00:41:32.872 --> 00:41:37.125 position:50% align:middle and ask them on any applications, "Are you currently in?" 00:41:37.126 --> 00:41:41.338 position:50% align:middle Because it's mandated that they do that. 00:41:41.339 --> 00:41:44.649 position:50% align:middle - So, Fred, I hate to interrupt, 00:41:44.650 --> 00:41:49.512 position:50% align:middle but you're saying that someone at the point of application 00:41:49.513 --> 00:41:55.060 position:50% align:middle for a multi-state license may be already in a program in another state perhaps, 00:41:55.061 --> 00:41:58.229 position:50% align:middle and as they're applying for license by endorsement, 00:41:58.230 --> 00:42:01.358 position:50% align:middle obviously, the new state needs to know that, right? 00:42:01.359 --> 00:42:02.233 position:50% align:middle - Absolutely. 00:42:02.234 --> 00:42:04.110 position:50% align:middle And that's not a rare occurrence. 00:42:04.111 --> 00:42:05.445 position:50% align:middle It happens. 00:42:05.446 --> 00:42:11.767 position:50% align:middle And what's going to happen is we all know in the Compact, if you are in an ATD, 00:42:11.768 --> 00:42:18.333 position:50% align:middle then you're not eligible while you're in that program for a multi-state license. 00:42:18.334 --> 00:42:24.881 position:50% align:middle Now, if you successfully complete the program, and again, I always fall back on this language, 00:42:24.882 --> 00:42:30.637 position:50% align:middle and you meet all the other ULR requirements and that state's other additional requirements, 00:42:30.638 --> 00:42:37.852 position:50% align:middle then it's been cured and you will, most likely, be eligible for a multi-state license at that point. 00:42:37.853 --> 00:42:42.399 position:50% align:middle But when you're transferring or moving into a new state 00:42:42.400 --> 00:42:49.906 position:50% align:middle and you're currently under an alternative discipline program in another state, 00:42:49.907 --> 00:42:53.410 position:50% align:middle it's going to be up to that new state as to whether they're going to issue 00:42:53.411 --> 00:42:57.497 position:50% align:middle a single-state license or they're going to make you wait 00:42:57.498 --> 00:43:00.583 position:50% align:middle until you've completed the process in your other state. 00:43:00.584 --> 00:43:03.211 position:50% align:middle And that's going to vary from state to state. 00:43:03.212 --> 00:43:07.799 position:50% align:middle One thing I'd like to add, for the states and the Compact, 00:43:07.800 --> 00:43:10.385 position:50% align:middle because that's really all that matters today, 00:43:10.386 --> 00:43:13.555 position:50% align:middle when you draft your contracts or your agreements 00:43:13.556 --> 00:43:18.144 position:50% align:middle or whatever you call them in your alternative to discipline programs, 00:43:18.145 --> 00:43:23.064 position:50% align:middle if you are not doing it, something you might want to think about 00:43:23.065 --> 00:43:25.734 position:50% align:middle is adding the statement in there 00:43:25.735 --> 00:43:34.325 position:50% align:middle that you shall successfully complete the alternative to discipline program. 00:43:34.326 --> 00:43:39.831 position:50% align:middle And if you don't, you are subject to discipline at that point in time. 00:43:39.832 --> 00:43:42.751 position:50% align:middle And you can word it any way you want. 00:43:42.752 --> 00:43:46.212 position:50% align:middle But I think you need to have that successful completion language in there. 00:43:47.713 --> 00:43:51.551 position:50% align:middle - Well, that seems to make sense because that's the goal of the program, right? 00:43:51.552 --> 00:43:54.012 position:50% align:middle Successful completion of the program. 00:43:54.013 --> 00:43:59.017 position:50% align:middle So, you're saying that being in a program 00:43:59.018 --> 00:44:03.897 position:50% align:middle and a multi-state license are not two things that go well together? 00:44:03.898 --> 00:44:12.978 position:50% align:middle So if someone were to enter a program subsequent to being issued a multi-state license, 00:44:13.546 --> 00:44:15.376 position:50% align:middle then they're no longer eligible? 00:44:15.376 --> 00:44:17.836 position:50% align:middle - Exactly. - Okay. 00:44:17.836 --> 00:44:18.846 position:50% align:middle - Exactly. 00:44:18.846 --> 00:44:22.082 position:50% align:middle - And then they may or may not be eligible for a single-state license. 00:44:22.083 --> 00:44:23.208 position:50% align:middle - Exactly. 00:44:23.209 --> 00:44:24.125 position:50% align:middle And you know what? 00:44:24.126 --> 00:44:30.840 position:50% align:middle I could move to a state and get a multi-state license in that state. 00:44:30.841 --> 00:44:32.884 position:50% align:middle But it's a party state. 00:44:32.885 --> 00:44:36.721 position:50% align:middle And at the moment I got it, I was completely eligible for it. 00:44:36.722 --> 00:44:43.353 position:50% align:middle And it's conceivable that I also have a license in a non-Compact state. 00:44:43.354 --> 00:44:46.956 position:50% align:middle And I get into trouble in that state 00:44:46.957 --> 00:44:52.403 position:50% align:middle and enter into an alternative to discipline program in a non-Compact state, 00:44:52.404 --> 00:44:57.117 position:50% align:middle you still can't have a multi-state license in the new state, 00:44:57.118 --> 00:45:01.871 position:50% align:middle in the primary state of residence because it covers all states. 00:45:01.872 --> 00:45:06.000 position:50% align:middle - So it sounds like the mere participation 00:45:06.001 --> 00:45:11.214 position:50% align:middle in an alternative to discipline program disqualifies you from a multi-state license? 00:45:11.215 --> 00:45:12.549 position:50% align:middle - Absolutely. 00:45:12.550 --> 00:45:18.513 position:50% align:middle And, Jim, the sole purpose of this and the foundation of this is public protection. 00:45:18.514 --> 00:45:20.390 position:50% align:middle - Got you. 00:45:20.391 --> 00:45:25.395 position:50% align:middle Fred, I'd like to switch gears just a little bit on our final question of the day, 00:45:25.396 --> 00:45:30.066 position:50% align:middle of the hour and talk about the discipline process. 00:45:30.067 --> 00:45:33.628 position:50% align:middle I hate for it to be a loaded question 00:45:33.629 --> 00:45:39.075 position:50% align:middle because I'm sure you could talk about this for half a day if given the time. 00:45:39.076 --> 00:45:41.369 position:50% align:middle But my question is, 00:45:41.369 --> 00:45:46.374 position:50% align:middle how does the discipline process work when a nurse violates the law 00:45:46.375 --> 00:45:52.463 position:50% align:middle in a Compact state that's not her home state, his or her home state? 00:45:52.464 --> 00:45:59.762 position:50% align:middle And as an example, I'm a nurse whose home state is Maryland, however, 00:45:59.763 --> 00:46:06.227 position:50% align:middle I'm practicing in another Compact state, which is Florida as a travel nurse. 00:46:06.228 --> 00:46:10.857 position:50% align:middle And while I'm in Florida, I violate the practice laws in Florida. 00:46:12.149 --> 00:46:16.613 position:50% align:middle How is that discipline process carried out, 00:46:16.614 --> 00:46:21.201 position:50% align:middle assuming that the hospital where I'm working in Florida 00:46:21.202 --> 00:46:26.247 position:50% align:middle files a complaint against me with the Florida Board of Nursing? 00:46:27.831 --> 00:46:32.253 position:50% align:middle - I think the first thing you do is you look at the complaint 00:46:32.254 --> 00:46:37.467 position:50% align:middle exactly the same as you would look at a complaint you received 00:46:37.468 --> 00:46:40.053 position:50% align:middle on a nurse who was licensed in Florida. 00:46:40.054 --> 00:46:42.805 position:50% align:middle That that was their primary state of residence. 00:46:42.806 --> 00:46:46.976 position:50% align:middle First of all, remember, the nurse's working on a privilege to practice license, 00:46:46.977 --> 00:46:50.647 position:50% align:middle that language actually appears in the Compact. 00:46:50.648 --> 00:46:59.405 position:50% align:middle We get a little lost sometimes that this privilege to practice is less than an actual license. 00:46:59.406 --> 00:47:00.448 position:50% align:middle It's different. 00:47:00.449 --> 00:47:03.701 position:50% align:middle It's not less than, it's just different. 00:47:03.702 --> 00:47:06.996 position:50% align:middle And so, Florida, of course, they get the complaint, 00:47:06.997 --> 00:47:13.428 position:50% align:middle they're going to review that complaint like they would any other complaint coming into their office. 00:47:13.428 --> 00:47:15.964 position:50% align:middle Once they've reviewed it, they make a determination 00:47:15.965 --> 00:47:22.512 position:50% align:middle whether this is something that is a violation of the Florida State Nursing Board's Practice Act. 00:47:22.513 --> 00:47:26.849 position:50% align:middle And they would start the exact same process that they would have 00:47:26.850 --> 00:47:29.727 position:50% align:middle if the individual's home state had been Florida. 00:47:29.728 --> 00:47:34.399 position:50% align:middle They would, I imagine, and I don't know the inner workings of Florida, 00:47:34.400 --> 00:47:38.778 position:50% align:middle but I know Joe knows and he probably is listening. 00:47:38.779 --> 00:47:41.072 position:50% align:middle But you would send it to your investigators. 00:47:41.073 --> 00:47:44.659 position:50% align:middle Your investigators would start the investigative process. 00:47:44.660 --> 00:47:46.202 position:50% align:middle They would contact the facility. 00:47:46.203 --> 00:47:51.082 position:50% align:middle Let's say it's a drug diversion case from a hospital. 00:47:51.083 --> 00:47:53.835 position:50% align:middle They're going to go in, they're going to look at the documentation, 00:47:53.836 --> 00:47:59.215 position:50% align:middle they're going to look at Pyxis records, they may look at video footage in the hallways, 00:47:59.216 --> 00:48:01.301 position:50% align:middle maybe in the med rooms. 00:48:01.302 --> 00:48:09.392 position:50% align:middle Whatever they do on any other case of that nature that is filed with them, 00:48:09.393 --> 00:48:11.728 position:50% align:middle they're going to treat it exactly the same way. 00:48:11.729 --> 00:48:15.398 position:50% align:middle They will then draft, put the file together. 00:48:15.399 --> 00:48:18.151 position:50% align:middle They would put together a report of what happened. 00:48:18.152 --> 00:48:22.030 position:50% align:middle They are going to attach all the relevant documents and exhibits. 00:48:22.031 --> 00:48:25.366 position:50% align:middle And Florida may take action on the privileged practice. 00:48:25.367 --> 00:48:27.910 position:50% align:middle They may take her before their board. 00:48:27.911 --> 00:48:30.288 position:50% align:middle They may issue a cease and desist. 00:48:30.289 --> 00:48:33.791 position:50% align:middle They may do an emergency hearing or summary suspension. 00:48:33.792 --> 00:48:37.503 position:50% align:middle But when they're done with all that, at that point in time, 00:48:37.504 --> 00:48:40.590 position:50% align:middle they send that file to the home state. 00:48:40.591 --> 00:48:43.134 position:50% align:middle In this case, I believe, you said Maryland. 00:48:43.135 --> 00:48:50.099 position:50% align:middle And at that point, Maryland needs to treat this case, and this is very important, 00:48:50.100 --> 00:48:53.561 position:50% align:middle just as if it had occurred in Maryland. 00:48:53.562 --> 00:48:56.356 position:50% align:middle And take the same type of action in Maryland 00:48:56.357 --> 00:49:02.612 position:50% align:middle that they would've taken if the incident had occurred there. 00:49:02.613 --> 00:49:08.659 position:50% align:middle - So, are you saying that Florida can take away this person's multi-state license? 00:49:08.660 --> 00:49:13.373 position:50% align:middle - Florida can't do anything to the underlying license. 00:49:13.374 --> 00:49:16.167 position:50% align:middle They have no jurisdiction over the license. 00:49:16.168 --> 00:49:17.543 position:50% align:middle - They cannot? 00:49:17.544 --> 00:49:18.795 position:50% align:middle - They cannot. 00:49:18.796 --> 00:49:24.258 position:50% align:middle Only Maryland can take action under this scenario against the license. 00:49:24.259 --> 00:49:26.677 position:50% align:middle But what Florida can do, 00:49:26.678 --> 00:49:33.726 position:50% align:middle they can take any action available to them against the privilege to practice license. 00:49:33.727 --> 00:49:35.895 position:50% align:middle - I see. So, in other words, 00:49:35.896 --> 00:49:39.190 position:50% align:middle that nurse's privilege to practice in Florida, 00:49:39.191 --> 00:49:43.820 position:50% align:middle that's what they're going to impact, therefore protecting the people of Florida. 00:49:43.821 --> 00:49:47.782 position:50% align:middle - That's all they can do, is restrict the privilege of practice in Florida. 00:49:47.783 --> 00:49:49.659 position:50% align:middle Let's say wanted... 00:49:49.660 --> 00:49:52.328 position:50% align:middle - I'm assuming because they didn't issue the license. 00:49:52.329 --> 00:49:53.621 position:50% align:middle - That's right. 00:49:53.622 --> 00:49:58.292 position:50% align:middle And so if they're worried about this nurse working on a privilege in North Carolina, 00:49:58.293 --> 00:50:01.437 position:50% align:middle Florida can't help them with the North Carolina privilege, 00:50:01.438 --> 00:50:04.311 position:50% align:middle that would be up to North Carolina to address. 00:50:04.313 --> 00:50:05.425 position:50% align:middle - Okay. 00:50:05.426 --> 00:50:11.013 position:50% align:middle So, you said they're going to send the report of the investigation to Maryland. 00:50:11.014 --> 00:50:13.933 position:50% align:middle Maryland can take action on the license. 00:50:13.934 --> 00:50:19.313 position:50% align:middle And I'm assuming then when they do as the state that issued the license, 00:50:19.314 --> 00:50:22.275 position:50% align:middle that then is going to protect the rest of the states? 00:50:22.276 --> 00:50:23.109 position:50% align:middle - Exactly. 00:50:23.110 --> 00:50:27.572 position:50% align:middle Because at that point, once they take action on the license, 00:50:27.573 --> 00:50:33.077 position:50% align:middle the individual will lose the multi-state licensure privilege 00:50:33.078 --> 00:50:37.373 position:50% align:middle at a minimum while they're under the order of Maryland. 00:50:37.374 --> 00:50:38.749 position:50% align:middle - I see. 00:50:38.750 --> 00:50:41.878 position:50% align:middle Assuming there's some level of encumbrance, right? 00:50:41.879 --> 00:50:43.504 position:50% align:middle - Sure, absolutely. 00:50:43.505 --> 00:50:44.755 position:50% align:middle There has to be. 00:50:44.756 --> 00:50:47.341 position:50% align:middle Whatever Maryland does, it has to rise. 00:50:47.342 --> 00:50:51.679 position:50% align:middle Once it rises to the level of an encumbrance, 00:50:51.680 --> 00:50:55.797 position:50% align:middle then at that point they're going to lose the multi-state license privilege. 00:50:55.797 --> 00:50:59.197 position:50% align:middle Fred, I just have one follow-up question to this. 00:50:59.197 --> 00:51:05.214 position:50% align:middle As this nurse, in your example, my example, diverted drugs in Florida, 00:51:05.214 --> 00:51:11.774 position:50% align:middle and then there was a complaint filed against her in Florida, him or her. 00:51:11.774 --> 00:51:18.864 position:50% align:middle If this nurse were to leave Florida immediately upon hearing about that complaint, 00:51:18.864 --> 00:51:24.964 position:50% align:middle would that relieve the duty for that remote state, whether it be Florida or any other state? 00:51:24.964 --> 00:51:29.717 position:50% align:middle Does that relieve the duty from them to investigate it and report it? 00:51:29.718 --> 00:51:30.801 position:50% align:middle - Absolutely not. 00:51:30.802 --> 00:51:36.182 position:50% align:middle The law says they shall complete the investigation and put the report together. 00:51:36.183 --> 00:51:40.937 position:50% align:middle And if you think about it, we're all concerned about protecting the public. 00:51:40.938 --> 00:51:44.857 position:50% align:middle If Florida doesn't complete the process, and we're not picking on Florida, 00:51:44.858 --> 00:51:46.567 position:50% align:middle it applies to all states. 00:51:46.568 --> 00:51:53.866 position:50% align:middle If that state doesn't complete that investigative process, there's nothing to send to Maryland. 00:51:53.867 --> 00:51:59.121 position:50% align:middle Maryland has no ability at that point to take action against the license 00:51:59.122 --> 00:52:02.250 position:50% align:middle to protect the citizens of other states. 00:52:02.251 --> 00:52:03.876 position:50% align:middle That's very powerful. 00:52:03.877 --> 00:52:09.173 position:50% align:middle And the other thing, Florida or any other state should always remember, 00:52:09.174 --> 00:52:14.512 position:50% align:middle if you don't complete that process and get that to the home state, 00:52:14.513 --> 00:52:16.639 position:50% align:middle in this case, Maryland, 00:52:16.640 --> 00:52:19.684 position:50% align:middle what's to stop that individual four weeks later, 00:52:19.685 --> 00:52:22.812 position:50% align:middle unbeknownst to you, to drive right back into Florida? 00:52:22.813 --> 00:52:28.109 position:50% align:middle He or she may think, "Well, look, hey, I got away with a lot of fentanyl." 00:52:28.110 --> 00:52:30.111 position:50% align:middle It's very popular right now. 00:52:30.112 --> 00:52:31.445 position:50% align:middle "Nothing happened to me. 00:52:31.446 --> 00:52:34.323 position:50% align:middle They stopped once I left that place of employment. 00:52:34.324 --> 00:52:38.160 position:50% align:middle I'm going back down, maybe this time I'll go down to the Florida Keys. 00:52:38.161 --> 00:52:40.663 position:50% align:middle I hear there's [inaudible] down and not really busy. 00:52:40.664 --> 00:52:42.707 position:50% align:middle Maybe I won't get reported." 00:52:42.708 --> 00:52:44.875 position:50% align:middle They can come back on you. 00:52:44.876 --> 00:52:52.341 position:50% align:middle But remember it's, do unto others as you would want done to you. 00:52:52.342 --> 00:52:57.763 position:50% align:middle And ultimately, our jobs are to protect the public. 00:52:57.764 --> 00:52:59.307 position:50% align:middle So, complete that report. 00:52:59.308 --> 00:53:01.642 position:50% align:middle You're not going to have that many of them anyway. 00:53:01.643 --> 00:53:05.229 position:50% align:middle Complete it, put it together, contact Maryland, 00:53:05.230 --> 00:53:08.399 position:50% align:middle see exactly what they need, and send it to them. 00:53:09.691 --> 00:53:10.943 position:50% align:middle - Fred, thank you so much. 00:53:10.944 --> 00:53:17.575 position:50% align:middle And I just want to reiterate what you said that the states we're using as examples are purely examples. 00:53:17.576 --> 00:53:22.997 position:50% align:middle None of this is intended to implicate any particular state. 00:53:22.998 --> 00:53:23.998 position:50% align:middle Thank you. 00:53:23.999 --> 00:53:25.374 position:50% align:middle We are out of time. 00:53:25.375 --> 00:53:29.478 position:50% align:middle I want to thank you for your guidance and expertise in this area, 00:53:29.479 --> 00:53:31.547 position:50% align:middle and for sharing your time with us. 00:53:31.548 --> 00:53:35.468 position:50% align:middle We do have a few minutes left to take questions, and for that, 00:53:35.469 --> 00:53:38.763 position:50% align:middle I want to turn it back over to our facilitator, Lisa. 00:53:41.056 --> 00:53:43.225 position:50% align:middle - [Lisa] Thank you, Jim. Thank you, Fred. 00:53:43.226 --> 00:53:45.811 position:50% align:middle If anyone has a question, 00:53:45.812 --> 00:53:50.983 position:50% align:middle please unmute yourself or you can type your question into the chat. 00:54:06.206 --> 00:54:07.750 position:50% align:middle Any questions out there? 00:54:18.134 --> 00:54:19.970 position:50% align:middle Check the chat. Explore. 00:54:26.935 --> 00:54:30.147 position:50% align:middle Again, if anyone has a question, please unmute yourself, 00:54:30.148 --> 00:54:33.484 position:50% align:middle or you can type your question into the chat box. 00:54:38.446 --> 00:54:40.282 position:50% align:middle We do have a question. 00:54:40.283 --> 00:54:43.911 position:50% align:middle Explain privilege to practice versus license? 00:54:46.413 --> 00:54:52.628 position:50% align:middle - Well, privilege to practice is as close to licensure as you can get 00:54:52.629 --> 00:54:58.759 position:50% align:middle without actually having a specific license in that state. 00:54:58.760 --> 00:55:06.726 position:50% align:middle And what you're saying is in effect is that we're so comfortable with the licensing process, 00:55:06.727 --> 00:55:09.937 position:50% align:middle your ULRs in the state you're in, 00:55:09.938 --> 00:55:14.024 position:50% align:middle that we're going to let you work in our state on that license. 00:55:14.025 --> 00:55:16.694 position:50% align:middle You're working on a license. 00:55:16.695 --> 00:55:21.699 position:50% align:middle But while they are practicing in the remote state, 00:55:21.700 --> 00:55:26.245 position:50% align:middle they are working under what the framers 00:55:26.246 --> 00:55:30.166 position:50% align:middle of this particular compact decided to call 00:55:30.167 --> 00:55:36.589 position:50% align:middle or identify that ability as the privilege to practice license. 00:55:36.590 --> 00:55:46.056 position:50% align:middle And so it carries all the same rights and abilities as a license does. 00:55:46.057 --> 00:55:49.018 position:50% align:middle Remember, you've always got to meet the requirements of the state 00:55:49.019 --> 00:55:51.645 position:50% align:middle in which you're actually practicing in. 00:55:51.646 --> 00:55:57.026 position:50% align:middle But it carries exactly the same rights as you had in the other state. 00:55:57.027 --> 00:56:02.031 position:50% align:middle As long as those rights are available in the particular state in which you're working, 00:56:02.032 --> 00:56:04.992 position:50% align:middle and that's where the patient's located. 00:56:04.993 --> 00:56:10.039 position:50% align:middle So there's not a lot of difference, legally, in the two, 00:56:10.040 --> 00:56:13.167 position:50% align:middle but as we noted in our discussion today, 00:56:13.168 --> 00:56:19.882 position:50% align:middle only the home state can take any kind of disciplinary action on the physical license 00:56:19.883 --> 00:56:22.009 position:50% align:middle because they're the one that issued it. 00:56:22.010 --> 00:56:25.054 position:50% align:middle And interesting, I didn't touch upon it, and I'll try to be quick. 00:56:25.055 --> 00:56:27.323 position:50% align:middle I'm not noted for being quick. 00:56:27.324 --> 00:56:33.729 position:50% align:middle But remember, it's only the remote state that can, in some ways, 00:56:33.730 --> 00:56:37.942 position:50% align:middle take action against the privilege in their state. 00:56:37.943 --> 00:56:41.237 position:50% align:middle The home state should deal with the license. 00:56:41.238 --> 00:56:46.033 position:50% align:middle They have the ability to suspend the privilege to practice 00:56:46.034 --> 00:56:48.911 position:50% align:middle but they can't tell your state, 00:56:48.912 --> 00:56:53.249 position:50% align:middle the remote state, what to do to the privilege in that state. 00:56:53.250 --> 00:56:54.792 position:50% align:middle It's up to that state. 00:56:55.750 --> 00:57:01.632 position:50% align:middle - So, Fred, as I'm listening to this, I'm thinking of other words that might apply, 00:57:01.633 --> 00:57:06.011 position:50% align:middle and as I'm trying to piece it together, 00:57:06.012 --> 00:57:12.643 position:50% align:middle a license would give me the authority to practice in a state. 00:57:12.644 --> 00:57:16.054 position:50% align:middle If I wanted to work in a remote state, 00:57:16.055 --> 00:57:20.509 position:50% align:middle the privilege is my authority to practice in that state. 00:57:20.509 --> 00:57:23.863 position:50% align:middle Would that be a good way, a correct way to say it? 00:57:23.864 --> 00:57:25.990 position:50% align:middle - Yeah, that's a very good way of saying it. 00:57:25.991 --> 00:57:31.036 position:50% align:middle And it's there because state legislators and governors said, 00:57:31.037 --> 00:57:36.458 position:50% align:middle "As a matter of law, we're doing this and you have the right to do that. 00:57:36.459 --> 00:57:38.544 position:50% align:middle We're recognizing that." 00:57:38.545 --> 00:57:42.631 position:50% align:middle - And earlier we were talking about the driver's license compact, 00:57:42.632 --> 00:57:46.844 position:50% align:middle and that's another place where I've seen the word privilege 00:57:46.845 --> 00:57:52.808 position:50% align:middle related to driving privileges and privileges being revoked or taken away. 00:57:52.809 --> 00:57:54.643 position:50% align:middle So you have a driver's license, 00:57:54.644 --> 00:57:59.064 position:50% align:middle but it seems that your ability or authority to drive 00:57:59.065 --> 00:58:03.819 position:50% align:middle in another state is a privilege that can be taken away. 00:58:03.820 --> 00:58:10.659 position:50% align:middle But it authorizes you as long as you have it to drive in some other state. 00:58:10.660 --> 00:58:13.579 position:50% align:middle And it sounds like a parallel to this, 00:58:13.580 --> 00:58:18.375 position:50% align:middle when we use the word privilege to practice compared to privilege to drive. 00:58:18.376 --> 00:58:23.216 position:50% align:middle It authorizes you to do so, but it's something that can be taken away. 00:58:23.224 --> 00:58:24.506 position:50% align:middle - Correct. 00:58:26.925 --> 00:58:28.928 position:50% align:middle - Lisa, any other questions? 00:58:28.929 --> 00:58:31.013 position:50% align:middle - Does anyone else have any questions? 00:58:32.555 --> 00:58:35.267 position:50% align:middle You can unmute yourself or type it in the chat. 00:58:37.936 --> 00:58:39.647 position:50% align:middle So, no more questions in the chat. 00:58:40.855 --> 00:58:44.902 position:50% align:middle - Fred, I didn't want to cut you off there, did you have any closing comments? 00:58:44.903 --> 00:58:48.447 position:50% align:middle - I would just say this on the privilege. 00:58:48.448 --> 00:58:54.036 position:50% align:middle I think it helps folks to think of it as a different layer of licensure. 00:58:55.954 --> 00:59:00.042 position:50% align:middle But with exactly the same rights as far as what you can and can't do, 00:59:00.043 --> 00:59:03.712 position:50% align:middle as long as that's allowed in the remote state you're working in. 00:59:03.713 --> 00:59:08.384 position:50% align:middle Jim, it's not unlike when we have a national emergency. 00:59:08.385 --> 00:59:11.595 position:50% align:middle We just went through a horrific pandemic in this country. 00:59:11.596 --> 00:59:13.305 position:50% align:middle We're still dealing with it. 00:59:13.306 --> 00:59:14.598 position:50% align:middle All over the countries, 00:59:14.599 --> 00:59:21.605 position:50% align:middle Governors were lifting in certain areas licensure requirement 00:59:21.606 --> 00:59:25.275 position:50% align:middle to get nurses into hotspots and physicians. 00:59:25.276 --> 00:59:31.865 position:50% align:middle And it didn't mean you could go to that new city and just do anything you wanted to. 00:59:31.866 --> 00:59:36.120 position:50% align:middle It meant you didn't have to stop at the border and get a license, 00:59:36.121 --> 00:59:39.039 position:50% align:middle but you were still bound 00:59:39.040 --> 00:59:42.793 position:50% align:middle by the laws of the state in which you were practicing 00:59:42.794 --> 00:59:47.840 position:50% align:middle and the requirements of the profession in the state you were practicing 00:59:47.841 --> 00:59:50.509 position:50% align:middle as toward the patients you were taking care of. 00:59:50.510 --> 00:59:55.139 position:50% align:middle So there are a variety of ways we see this privilege used. 00:59:55.140 --> 01:00:00.602 position:50% align:middle The term we use is privilege to practice for this particular compact. 01:00:00.603 --> 01:00:02.104 position:50% align:middle - Sure. 01:00:02.105 --> 01:00:03.272 position:50% align:middle Thank you. 01:00:03.273 --> 01:00:06.567 position:50% align:middle Lisa, one more check with you on questions. 01:00:06.568 --> 01:00:08.402 position:50% align:middle - No more questions in the chat. 01:00:08.403 --> 01:00:10.612 position:50% align:middle Does anyone else have a question? 01:00:14.282 --> 01:00:16.535 position:50% align:middle I think that's all. 01:00:16.536 --> 01:00:17.161 position:50% align:middle - Okay. 01:00:17.162 --> 01:00:22.166 position:50% align:middle Well, I think we went right about one full hour, and thank you. 01:00:22.167 --> 01:00:24.835 position:50% align:middle And Lisa, we'll turn it back to you. 01:00:24.836 --> 01:00:31.800 position:50% align:middle - Thank you, everyone, for attending This session will be on the website, 01:00:31.801 --> 01:00:36.096 position:50% align:middle on the NLC website in the next couple two or three weeks. 01:00:36.097 --> 01:00:37.681 position:50% align:middle And thank you for attending. 01:00:38.806 --> 01:00:40.601 position:50% align:middle - Thank you. Thanks again, Fred. 01:00:40.602 --> 01:00:42.561 position:50% align:middle - Thank you. Thanks, everybody.