Allied Health Professions and Licensure Efforts

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  • 1. Allied Health Professions and Licensure Efforts
  • 2. Can We Go for One National License?
    • NO
    • Why Not?
    • Feds don’t want it
    • States want to keep it
    • *Decades of precedent
  • 3. Licensure is to Protect the Health and Safety of the Citizens of the State
    • Licensure regulates both the Practice of the Profession and those who render those defined services
    • Must Define Parameters within the Scope of Practice section
    • Then must set standards/requirements for those who will provide that scope of practice
  • 4. Regulating the Practice
    • Professions scope of practice can vary state to state.
    • Meet the needs of the citizens: what you can’t do in CA you could do in Alaska
    • States, not the feds, set the parameters what can and cannot be done
  • 5. Regulating the Practitioners
    • Process applications -is it filled out right?
    • Issue and renew licenses – have they met the CEs requirements, etc? Is that course really acceptable for a CE credit?
    • Disciplinary complaints: must investigate
    • Provide procedural rights for practitioner with disciplinary action taken
    • Collect the fees (States want the $$$)
  • 6. Nurse Compact
    • Comes close to national license for nurses-sort of…….
    • License issued in nurses resident state; can work “off” of license issued in one state in those states participating in Nurse Compact
    • Advocated by National Council of State Boards of Nursing
  • 7. Nurses Participating in NC Must
    • Adhere to all state laws where practicing
    • between states in relation to licensure /
    • re-registration requirements, such
    • as mandatory continuing education,
    • criminal background checks, disciplinary
    • causes of action, and evidentiary
    • standards
  • 8.
    • Since 1997 -21 states participate in Nurse Compact
    • Requires each state legislature to enact and change current laws- Not very eager
    • American Nurses Association: “agrees to disagree” with details of the complicated NC process
  • 9. State by State Effort What Do You Need to Have in Place?
    • Professional Infrastructure
    • Strong State Association
    • Strong (Central) National Association
  • 10. Professional Infrastructure
    • Are there enough practitioners to make a state by state case?
    • Is there a rationale for patient safety
    • Licensure is NOT for professional enhancement or job security
    • States want to license “professions” not occupations or disciplines
  • 11.
    • Profession= nationwide accredited education/training programs
    • Are they educated the same; curricula the same?
    • Are there enough schools across the country?
  • 12.
    • Consistent and valid competency test
    • Are they all tested on the same content?
    • States will use the professional competency test as state licensure exam
    • Cost of developing a state based test is $50K
  • 13. Strong State Society
    • Will lead the legislative effort
    • Accept the fact it may take several years
    • Does the state society have the people, time, and money?
    • Leaders in the state will be the “face” of the profession to the legislators
    • Will have to convince rank and file to support licensure efforts
  • 14.
    • Need to have the support from other key licensed professions
    • Physicians are crucial, so are nurses
    • Already a powerful, influential factor in state health policy
    • Have legislators/policy makers ears
  • 15.
    • State hospital associations traditionally oppose licensing professions
    • Argument: it will cost more money
    • No proven evidence to that, but has impact anyway
    • Therefore need other professions (docs) support to offset
  • 16.
    • Most state societies are volunteer
    • Lobbying is not their profession
    • Licensure effort takes time
    • Many states if the can afford it hire state a lobbyist to spearhead effort
    • Still need cohort of state leaders to carry it through- Gov’t/Leg Affairs Cmte.
    • What are the financial resources of the state society?
  • 17. Communication System
    • Must have a good communication system in place
    • Need to let members and supporters know what is happening and when to make contact with their legislators
    • Need to communicate with legislators
    • Internet vastly makes this easier
  • 18. Strong National Association
    • Act as ringmaster/cheerleader
    • May act as financier
    • Develop a Model Practice Act, should use as a template in every state
    • Key to that: consistent scope of practice
    • Clearinghouse for support documents
    • Advice on what worked elsewhere
  • 19. Model Licensure Language will change over time
    • Each state is unique
    • Services provided may differ to some extent in different states
    • Interested parties are different with different agendas
    • Compromises will be made
  • 20. State By State Licensure Takes Time
    • Scope of Practice will evolve
    • RTs licensed in the 1980’s no smoking cessation, telecommunications, Dx. Mgt.
    • More focus on alternate site care
    • patients leave hospital “sicker and quicker”
    • New disciplines emerge, overlap of practice
  • 21. Respiratory Therapy Experience
    • Model Practice Act developed as template
    • Licensure first began in early ’80s
    • Currently there are 48 states, DC and PR that are licensed.
    • Hawaii and Alaska not yet licensed
    • Last state to gain licensure was Alabama-2004
  • 22.
    • Similarities among states:
    • Licensure requirements: graduates of accredited schools of RT
    • Take the national credentialing exam used as state licensure exam
    • Majority (but not all) of scope of practice is the same
  • 23. Examples of Political Compromise
    • Under Medical Direction
    • Supervision: only by a Doc
    • Supervision: Doc, Nurse Practitioner, Physician Assistant (LA revised 2007)
    • Continuing ed:
    • 3 states none required (UT, CO, WI)
    • 24 biennially in Al, 12 biennially in RI
  • 24. Compromise
    • Scope of practice issues
    • ECMO: No way in NJ, absolutely in TX
    • Protocols: Can do in most states, only in an emergency in OH
  • 25. Compromise
    • 18 RC “Boards” are under Board of Medicine
    • Most fully independent RC Licensure Bds.
    • Some are Advisory Councils rarely meet, paid state staff administers and addresses issues (WA)
  • 26. Regulatory Agencies
    • Depending on the state, some state licensure boards have sweeping authority to “creatively” interpret the law
    • Others extremely restrained in what they can do
    • Just the nature of the state government psyche
  • 27. The way a state licenses
    • States like to follow similar formula
    • What did they do for other allied health professions in the state?
    • License renewal: annual/biennial?
    • Most now all follow same disciplinary criteria (liability reasons)
    • States make revisions that affect all licensure boards
  • 28.
    • Once licensure is gained must be tended to: new/revised regulations
    • Advise state societies to fight the urge to tweak the law, can be a Pandora’s box
  • 29. Licensure Like a Chess Game
    • Get all the pieces on the board before you make your first move
    • And have patience