Q&A with Kathy Apple, CEO of the National Council of State Boards of Nursing

By Laura Trude, HWIC Information Specialist

The National Council of State Boards of Nursing (NCSBN) is the organization through which boards of nursing act and counsel together on matters of common interest related to their mission of regulating the practice of nursing to protect the public. Currently, there are 60 boards of nursing.

Health Workforce News had the opportunity to interview Kathy Apple, the CEO of NCSBN, about changes being considered to state nursing practice acts, NCSBN’s progress in collecting national nursing supply data, research funded by the NCSBN, and more.

What new policies or regulations have been implemented recently by state nursing boards?

The regulatory and policy review that has gone on in the past year relates to implementation of the APRN Consensus Model. This new regulatory model for Advanced Practice Registered Nurses (APRNs) was built by the consensus of all relevant nursing community stakeholders.

NCBSN used this model to build regulatory language that can be used and implemented in state nurse practice acts. We’ve had about half of the states in this past year review their own nurse practice acts to see what they need to do in order to be congruent with the APRN consensus model.

This model has become more important, especially with the passage of health care reform legislation, because APRNs (nurse practitioners, clinical nurse specialists, nurse midwives and nurse anesthetists) have an increasingly important role to play in the delivery of primary care. Right now, there is a fair amount of variation in how an APRN is licensed from state to state. This model helps standardize the licensing requirements for APRNs across the country allowing for improved mobility and increased access to safe and competent APRNs.

Does the consensus model address how many nurse practitioners can be under a physician’s supervision?

The APRN consensus model calls for independent practice for all APRNs.

Have any states implemented changes to their nurse practice acts as a result of the APRN consensus model?

The states are in various stages of evaluating their own nurse practice acts and strategizing on the legislative process in order to come into congruence with the model.

Are any states looking at adopting a four-year degree requirement for RNs?

The states are talking about how to advance nursing education. NCSBN has supported articulation programs for some time now. That means whatever level you enter into the practice of nursing, you continue your education. Specific to your question, the New York State Board of Nursing is probably the best example. They are considering legislation that would require a nurse who has been educated with an associate degree or a diploma degree to work towards obtaining a baccalaureate in nursing degree within 10 years of being licensed.

Tell me a little about the Nurse Licensure Compact.

In the 1990s, our members took a look at all possible licensure models in existence and asked, the question, “Which model of licensure should move forward into the next century?” Historically the state-based licensure model has worked very well but during these discussions, our members looked at what environmental factors would make the future of nursing look different and explored what the future health care needs might be.

Based on that, our members voted to adopt a licensure model of mutual recognition, which is exactly how drivers’ licenses work. Drivers licenses are issued in the state you live in and that gives you the privilege to drive in every other state. This happens because state legislatures adopt an interstate agreement or compact where they essentially agree to recognize each other’s licenses. So that’s basically how the nurse licensure compact works. If a nurse lives in a compact state, they are issued what we refer to as a compact license, and that gives that nurse the privilege to practice nursing in all participating states.

Currently, 24 states have decided to participate in this model of licensing. I know that there is dialogue in a lot of states, but I don’t know of any other state that has actively made the decision to move in that direction at this time.

Where is NCSBN at in the process of collecting nursing supply data for a minimum data set?

This has been an important initiative for us. Our ultimate goal is to collect and aggregate national minimum supply data. There is no one else who does this and we think we can. One way we can do this is by utilizing the process of renewing a nurse license online as a collection method. We think the online renewal process is readily-available and an easy way to ask nurses to provide minimum supply data. The states that have agreed to do this provide the data which is then submitted to a national database here at NCSBN. Additionally we recognize the good work of the existing state nurse workforce centers and we are currently looking at how we might partner with the centers.

Do you currently have nurse supply data from the states that are working with you?

We do and we are making progress towards our national goal. What we are focused on now is making sure we have the ability to give the data back to the states that collected and shared their data with us.

We’ve actually set up a very good process where the state can go into their own data and run a whole range of different statistical reports. Since the states own their own data, the information is currently only available to participating states. We anticipate the data will be used to help with the development of health care policy from both a state and a national view point. From the beginning our goal has been to share nationally aggregated data with all relevant policymakers and stakeholders.

The Health Resources and Services Administration plans to work with organizations like NCSBN towards a national database of all licensed health care professionals. Has HRSA talked with you?

We’ve had some initial conversations. Part of their goal is examining how to routinely collect standardized data from all of the health care professions and that is a huge task. It’s an important one, but it’s huge.

What types of research projects are currently being funded by the NCSBN Center for Regulatory Excellence Grant Program?

We have a large variety of programs that have been funded. This was set up because we believe in and value evidence-based regulation, and in order to make evidence-based regulatory decisions, you need to have data. This center was created by our board of directors in order to increase the body of knowledge related to nursing regulation. If you explore the program parameters on our website, you’ll see the criteria we use to select programs for funding. Since 2007, we’ve funded almost $5 million dollars worth of research projects. The topics are widely varied encompassing advanced practice nursing, patient safety, clinical judgment, just culture, faculty internships, transition-to-practice programs, assessing the work environment and patient outcomes, competence when it comes to communication, consumer views and practice break-down. This fall we will host our first conference on nursing regulation science where we will highlight research completed from the first year of the program. We plan to tag this conference onto the National Institute of Nursing Research (NINR) conference at the end of September.

Are there any other NCSBN activities or regulatory changes you would like to highlight?

We have a national nurse licensure database where licensure data is submitted by the majority of state boards of nursing. Utilizing this database we have developed a new service to emergency responder organizations. In crisis situations or adverse events, emergency responder organizations often need to move large numbers of nurses to disaster sites to provide care. These organizations cannot ignore their duty to verify that the nurse has an active license in good standing. We know that during times of disaster, imposters–people who exploit a very difficult situation–show up. So it’s imperative that health care licenses are verified. This service allows preapproved responders such as the American Red Cross to go to our website and access the database during emergencies without charge and verify nurse licenses in bulk eliminating the need to check on a state-by-state or license-by-license basis.

Additionally our board of directors has just completed a strategic planning year and will be taking new strategic initiatives to our members at our annual meeting in August. These new initiatives will set us on course to do new and exciting things focusing on patient safety and providing state boards of nursing products and services that support the important work of public protection.

Please note that the views expressed in this article are the opinions of the interviewee and do not reflect the official policies, positions, or opinions of the Health Workforce Information Center or its funder.