Allied Health Professions Allied Health Professions and Licensure Effortsand Licensure Efforts
Can We Go for One National Can We Go for One National License?License?
NONO
Why Not?Why Not?
Feds don’t want itFeds don’t want it States want to keep itStates want to keep it *Decades of precedent*Decades of precedent
Licensure is to Protect the Health Licensure is to Protect the Health and Safety of the Citizensand Safety of the Citizens
of the Stateof the State Licensure regulates both the Practice of Licensure regulates both the Practice of
the Profession and those who render those the Profession and those who render those defined servicesdefined services
Must Define Parameters within the Scope Must Define Parameters within the Scope of Practice sectionof Practice section
Then must set standards/requirements for Then must set standards/requirements for those who will provide that scope of those who will provide that scope of practicepractice
Regulating the PracticeRegulating the Practice
Professions scope of practice can Professions scope of practice can vary state to state. vary state to state.
Meet the needs of the citizens: what Meet the needs of the citizens: what you can’t do in CA you could do in you can’t do in CA you could do in AlaskaAlaska
States, not the feds, set the States, not the feds, set the parameters what can and cannot be parameters what can and cannot be donedone
Regulating the PractitionersRegulating the Practitioners
Process applications -is it filled out right?Process applications -is it filled out right? Issue and renew licenses – have they Issue and renew licenses – have they
met the CEs requirements, etc? Is that met the CEs requirements, etc? Is that course really acceptable for a CE credit?course really acceptable for a CE credit?
Disciplinary complaints: must Disciplinary complaints: must investigateinvestigate
Provide procedural rights for practitioner Provide procedural rights for practitioner with disciplinary action takenwith disciplinary action taken
Collect the fees (States want the $$$)Collect the fees (States want the $$$)
Nurse CompactNurse Compact
Comes close to national license for Comes close to national license for nurses-sort of…….nurses-sort of…….
License issued in nurses resident License issued in nurses resident state; can work “off” of license state; can work “off” of license issued in one state in those states issued in one state in those states participating in Nurse Compactparticipating in Nurse Compact
Advocated by National Council of Advocated by National Council of State Boards of Nursing State Boards of Nursing
Nurses Participating in NC Nurses Participating in NC MustMust
Adhere to all state laws where practicingAdhere to all state laws where practicing
between states in relation to licensure /between states in relation to licensure /
re-registration requirements, such re-registration requirements, such
as mandatory continuing education,as mandatory continuing education,
criminal background checks, disciplinary criminal background checks, disciplinary
causes of action, and evidentiary causes of action, and evidentiary
standardsstandards
Since 1997 -21 states participate in Since 1997 -21 states participate in Nurse CompactNurse Compact
Requires each state legislature to Requires each state legislature to enact and change current laws- Not enact and change current laws- Not very eager very eager
American Nurses Association: American Nurses Association: “agrees to disagree” with details of “agrees to disagree” with details of the complicated NC processthe complicated NC process
State by State EffortState by State EffortWhat Do You Need to Have in What Do You Need to Have in
Place?Place? Professional InfrastructureProfessional Infrastructure
Strong State AssociationStrong State Association
Strong (Central) National AssociationStrong (Central) National Association
Professional InfrastructureProfessional Infrastructure
Are there enough practitioners to Are there enough practitioners to make a state by state case?make a state by state case?
Is there a rationale for patient safetyIs there a rationale for patient safety Licensure is NOT for professional Licensure is NOT for professional
enhancement or job securityenhancement or job security States want to license “professions” States want to license “professions”
not occupations or disciplinesnot occupations or disciplines
Profession= nationwide accredited Profession= nationwide accredited education/training programseducation/training programs
Are they educated the same; Are they educated the same; curricula the same?curricula the same?
Are there enough schools across the Are there enough schools across the country?country?
Consistent and valid competency testConsistent and valid competency test Are they all tested on the same Are they all tested on the same
content?content? States will use the professional States will use the professional
competency test as state licensure competency test as state licensure examexam
Cost of developing a state based test Cost of developing a state based test is $50Kis $50K
Strong State SocietyStrong State Society
Will lead the legislative effortWill lead the legislative effort Accept the fact it may take several Accept the fact it may take several
yearsyears Does the state society have the people, Does the state society have the people,
time, and money?time, and money? Leaders in the state will be the “face” Leaders in the state will be the “face”
of the profession to the legislatorsof the profession to the legislators Will have to convince rank and file to Will have to convince rank and file to
support licensure effortssupport licensure efforts
Need to have the support from other Need to have the support from other key licensed professions key licensed professions
Physicians are crucial, so are nursesPhysicians are crucial, so are nurses Already a powerful, influential factor Already a powerful, influential factor
in state health policy in state health policy Have legislators/policy makers earsHave legislators/policy makers ears
State hospital associations State hospital associations traditionally oppose licensing traditionally oppose licensing professionsprofessions
Argument: it will cost more moneyArgument: it will cost more money No proven evidence to that, but has No proven evidence to that, but has
impact anywayimpact anyway Therefore need other professions Therefore need other professions
(docs) support to offset(docs) support to offset
Most state societies are volunteer Most state societies are volunteer Lobbying is Lobbying is notnot their profession their profession Licensure effort takes timeLicensure effort takes time Many states if the can afford it hire state a Many states if the can afford it hire state a
lobbyist to spearhead effortlobbyist to spearhead effort Still need cohort of state leaders to carry it Still need cohort of state leaders to carry it
through- Gov’t/Leg Affairs Cmte.through- Gov’t/Leg Affairs Cmte. What are the financial resources of the What are the financial resources of the
state society? state society?
Communication SystemCommunication System
Must have a good communication Must have a good communication system in place system in place
Need to let members and supporters Need to let members and supporters know what is happening and when to know what is happening and when to make contact with their legislatorsmake contact with their legislators
Need to communicate with legislatorsNeed to communicate with legislators Internet vastly makes this easierInternet vastly makes this easier
Strong National AssociationStrong National Association
Act as ringmaster/cheerleaderAct as ringmaster/cheerleader May act as financierMay act as financier Develop a Model Practice Act, should Develop a Model Practice Act, should
use as a template in every stateuse as a template in every state Key to that: consistent scope of Key to that: consistent scope of
practicepractice Clearinghouse for support documentsClearinghouse for support documents Advice on what worked elsewhereAdvice on what worked elsewhere
Model Licensure Language will Model Licensure Language will change over timechange over time
Each state is uniqueEach state is unique Services provided may differ to some Services provided may differ to some
extent in different statesextent in different states Interested parties are different with Interested parties are different with
different agendasdifferent agendas Compromises will be madeCompromises will be made
State By State Licensure Takes State By State Licensure Takes TimeTime
Scope of Practice will evolveScope of Practice will evolve RTs licensed in the 1980’s no smoking RTs licensed in the 1980’s no smoking
cessation, telecommunications, Dx. cessation, telecommunications, Dx. Mgt.Mgt.
More focus on alternate site careMore focus on alternate site care patients leave hospital “sicker and patients leave hospital “sicker and
quicker”quicker” New disciplines emerge, overlap of New disciplines emerge, overlap of
practicepractice
Respiratory Therapy Respiratory Therapy ExperienceExperience
Model Practice Act developed as Model Practice Act developed as templatetemplate
Licensure first began in early ’80s Licensure first began in early ’80s Currently there are 48 states, DC and Currently there are 48 states, DC and
PR that are licensed. PR that are licensed. Hawaii and Alaska not yet licensedHawaii and Alaska not yet licensed Last state to gain licensure was Last state to gain licensure was
Alabama-2004Alabama-2004
Similarities among states:Similarities among states: Licensure requirements: graduates of Licensure requirements: graduates of
accredited schools of RTaccredited schools of RT Take the national credentialing exam Take the national credentialing exam
used as state licensure examused as state licensure exam Majority (but not all) of scope of Majority (but not all) of scope of
practice is the samepractice is the same
Examples of Political Examples of Political CompromiseCompromise
Under Medical DirectionUnder Medical Direction Supervision: only by a DocSupervision: only by a Doc Supervision: Doc, Nurse Practitioner, Supervision: Doc, Nurse Practitioner,
Physician Assistant (LA revised 2007)Physician Assistant (LA revised 2007)
Continuing ed: Continuing ed: 3 states none required (UT, CO, WI)3 states none required (UT, CO, WI) 24 biennially in Al, 12 biennially in RI24 biennially in Al, 12 biennially in RI
CompromiseCompromise
Scope of practice issuesScope of practice issues
ECMO: No way in NJ, absolutely in TXECMO: No way in NJ, absolutely in TX
Protocols: Can do in most states, only Protocols: Can do in most states, only in an emergency in OHin an emergency in OH
CompromiseCompromise
18 RC “Boards” are under Board of 18 RC “Boards” are under Board of MedicineMedicine
Most fully independent RC Licensure Most fully independent RC Licensure Bds.Bds.
Some are Advisory Councils rarely Some are Advisory Councils rarely meet, paid state staff administers and meet, paid state staff administers and addresses issues (WA)addresses issues (WA)
Regulatory AgenciesRegulatory Agencies
Depending on the state, some state Depending on the state, some state licensure boards have sweeping authority licensure boards have sweeping authority to “creatively” interpret the lawto “creatively” interpret the law
Others extremely restrained in what they Others extremely restrained in what they can docan do
Just the nature of the state government Just the nature of the state government psyche psyche
The way a state licensesThe way a state licenses
States like to follow similar formulaStates like to follow similar formula What did they do for other allied What did they do for other allied
health professions in the state?health professions in the state? License renewal: annual/biennial?License renewal: annual/biennial? Most now all follow same disciplinary Most now all follow same disciplinary
criteria (liability reasons) criteria (liability reasons) States make revisions that affect all States make revisions that affect all
licensure boardslicensure boards
Once licensure is gained must be Once licensure is gained must be tended to: new/revised regulationstended to: new/revised regulations
Advise state societies to fight the Advise state societies to fight the urge to tweak the law, can be a urge to tweak the law, can be a Pandora’s boxPandora’s box
Licensure Like a Chess Licensure Like a Chess GameGame
Get all the pieces on the board Get all the pieces on the board before you make your first movebefore you make your first move
And have patienceAnd have patience