Allied Health Professions and Licensure Efforts


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Allied Health Professions and Licensure Efforts

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