1 South Carolina General Assembly 2 115th Session, 2003-2004 3 4 H. 4291 5 6 STATUS INFORMATION 7 8 General Bill 9 Sponsors: Reps. White, Branham, Clark, Trotter, M.A. Pitts and Owens 10 Document Path: l:\council\bills\nbd\11793ac03.doc 11 12 Introduced in the House on May 27, 2003 13 Introduced in the Senate on April 1, 2004 14 Last Amended on March 31, 2004 15 Currently residing in the Senate Committee on Medical Affairs 16 17 Summary: Nurse Licensure Compact 18 19 20 HISTORY OF LEGISLATIVE ACTIONS 21 22 Date Body Action Description with journal page number 23 5/27/2003 House Introduced and read first time HJ-334 24 5/27/2003 House Referred to Committee on Medical, Military, Public and Municipal Affairs 25 HJ-334 26 2/18/2004 House Member(s) request name added as sponsor: Clark 27 3/17/2004 House Member(s) request name added as sponsor: Trotter 28 3/24/2004 House Committee report: Favorable with amendment Medical, Military, Public and 29 Municipal Affairs HJ-25 30 3/25/2004 House Member(s) request name added as sponsor: M.A.Pitts, Owens 31 3/25/2004 Scrivener's error corrected 32 3/30/2004 House Requests for debate-Rep(s). White, Scarborough, Taylor, Harrell and Hinson HJ-19 33 3/31/2004 House Amended HJ-34 34 3/31/2004 House Read second time HJ-34 35 3/31/2004 House Roll call Yeas-94 Nays-4 HJ-36 36 4/1/2004 House Read third time and sent to Senate HJ-45 37 4/1/2004 Senate Introduced and read first time SJ-9 38 4/1/2004 Senate Referred to Committee on Medical Affairs SJ-9 39 40 41 VERSIONS OF THIS BILL 42 43 5/27/2003 44 3/24/2004 45 3/25/2004 46 3/31/2004 47 1 AMENDED 2 March 31, 2004 3 4 H. 4291 5 6 Introduced by Reps. White, Branham, Clark, Trotter, M.A. Pitts 7 and Owens 8 9 S. Printed 3/31/04--H. 10 Read the first time May 27, 2003. 11 12

1 [4291-1] 1 2 3 4 5 6 7 8 9 A BILL 10 11 TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 12 1976, BY ADDING ARTICLE 15 TO CHAPTER 33, TITLE 40 13 SO AS TO ENACT THE NURSE LICENSURE COMPACT 14 WHICH ENTERS SOUTH CAROLINA INTO A MULTI-STATE 15 NURSE LICENSURE COMPACT TO PROVIDE FOR THE 16 RECIPROCAL PRACTICE OF NURSING AMONG THE 17 STATES THAT ARE PARTIES TO THE COMPACT; TO 18 PROVIDE FOR THE STANDARDS AND PROCEDURES 19 THAT APPLY TO PRACTICING NURSING IN OTHER 20 STATES PURSUANT TO THE COMPACT; TO PROVIDE FOR 21 A COORDINATED LICENSURE INFORMATION SYSTEM 22 FOR SHARING DATA AMONG THE COMPACT STATES 23 AND TO PROVIDE PROCEDURES FOR DISPUTE 24 RESOLUTION AND DISCIPLINARY ACTION; AND TO 25 FURTHER PROVIDE FOR THE REGULATION OF NURSES 26 LICENSED IN STATES THAT ARE PARTIES TO THE 27 COMPACT. 28 Amend Title To Conform 29 30 Whereas, the General Assembly finds that: 31 (1) The health and safety of the public are affected by the 32 degree of compliance with and the effectiveness of enforcement 33 activities related to states’ nurse licensure laws. 34 (2) Violations of nurse licensure and other laws regulating the 35 practice of nursing may result in injury or harm to the public. 36 (3) The expanded mobility of nurses and the use of advanced 37 communication technologies as part of our nation’s health care 38 delivery system require greater coordination and cooperation 39 among states in the areas of nurse licensure and regulation. 40 (4) New practice modalities and technology make compliance 41 with individual states’ nurse licensure laws difficult and complex.

1 [4291] 1 1 (5) The current system of duplicative licensure for nurses 2 practicing in multiple states is cumbersome and redundant to both 3 nurses and states. Now, therefore, 4 5 Be it enacted by the General Assembly of the State of South 6 Carolina: 7 8 SECTION 1. This act may be cited as the “Nurse Licensure 9 Compact”. 10 11 SECTION 2. Chapter 33, Title 40 of the 1976 Code is amended 12 by adding: 13 14 “Article 15 15 16 Nurse Licensure Compact 17 18 “Section 40-33-1305. (A) The Nurse Licensure Compact is 19 created and entered into by this State with all other states legally 20 joining in the form substantially as set forth in this article. 21 (B) The purposes of this compact are to: 22 (1) facilitate the states’ responsibility to protect the public’s 23 health and safety; 24 (2) ensure and encourage the cooperation of party states in 25 the areas of nurse licensure and regulation; 26 (3) facilitate the exchange of information between party 27 states in the areas of nurse regulation, investigation, and adverse 28 actions; 29 (4) promote compliance with the laws governing the practice 30 of nursing in each jurisdiction; 31 (5) through the mutual recognition of party state licenses, 32 grant all party states the authority to hold nurses accountable for 33 meeting all state practice laws in the states in which their patients 34 are located at the time care is rendered. 35 36 Section 40-33-1310. As used in this article: 37 (1) ‘Adverse’ action means a home or remote state action. 38 (2) ‘Alternative program’ means a voluntary, nondisciplinary 39 monitoring program approved by a nurse licensing board. 40 (3) ‘Coordinated licensure information system’ means an 41 integrated process for collecting, storing, and sharing information 42 on nurse licensure and enforcement activities related to nurse

1 [4291] 2 1 licensure laws that is administered by a nonprofit organization 2 composed of and controlled by state nurse licensing boards. 3 (4) ‘Current significant investigative information’ means: 4 (a) investigative information that a licensing board, after a 5 preliminary inquiry, which includes notification and an 6 opportunity for the nurse to respond, has reason to believe is not 7 groundless and, if proved true, would indicate more than a minor 8 infraction; or 9 (b) investigative information that indicates that the nurse 10 represents an immediate threat to public health and safety 11 regardless of whether the nurse has been notified and had an 12 opportunity to respond. 13 (5) ‘Home state’ means the party state that is the nurse’s 14 primary state of residence. 15 (6) ‘Home state action’ means an administrative, civil, 16 equitable, or criminal action permitted by the home state’s laws 17 that is imposed on a nurse by the home state’s licensing board or 18 another authority. This term includes the revocation or suspension 19 of a nurse’s license, placing a nurse on probation, or any other 20 action that affects a nurse’s authorization to practice. 21 (7) ‘Licensee’ means a person licensed by the South Carolina 22 Board of Nursing or the nurse licensing board of a party state. 23 (8) ‘Licensing board’ means a party state’s regulatory agency 24 that is responsible for licensing nurses. 25 (9) ‘Multi-State licensure privilege’ means current official 26 authority from a remote state permitting the practice of nursing as 27 either a registered nurse or a licensed practical or vocational nurse 28 in that state. All party states have the authority, in accordance with 29 existing state law, to take actions against a nurse’s privilege 30 including, but not limited to, revocation, suspension, probation, or 31 any other action which affects a nurse’s authorization to practice. 32 (10) ‘Nurse’ means a registered nurse or licensed practical or 33 vocational nurse as those terms are defined by each party state’s 34 practice laws. 35 (11) ‘Party state’ means any state that has adopted this compact. 36 (12) ‘Remote state’ means a party state, other than the home 37 state, where the patient is located at the time nursing care is 38 provided. In the case of the practice of nursing not involving a 39 patient, the term means the party state where the recipient of 40 nursing practice is located. 41 (13) ‘Remote state action’ means: 42 (a) an administrative, civil, equitable, or criminal action 43 permitted by the laws of a remote state that are imposed on a nurse

1 [4291] 3 1 by the remote state’s nurse licensing board or other authority, 2 including actions against a nurse’s multi-state licensure privilege 3 to practice in the remote state; 4 (b) cease and desist and other injunctive or equitable orders 5 issued by a remote state or its nurse licensing board. 6 (14) ‘State’ means a state, territory, or possession of the United 7 States, the District of Columbia, or the Commonwealth of Puerto 8 Rico. 9 (15) ‘State practice laws’ means the laws and regulations of 10 individual party states that govern the practice of nursing, define 11 the scope of nursing practice, and create the methods and grounds 12 for disciplining nurses. This term does not include the initial 13 qualifications for licensure or the requirements necessary to obtain 14 and retain a license, except for qualifications or requirements of 15 the home state. 16 17 Section 40-33-1315. (A) A license to practice registered 18 nursing that is issued by a home state to a resident in that state 19 must be recognized by each party state as authorizing a multi-state 20 licensure privilege to practice as a registered nurse in each party 21 state. A license to practice practical or vocational nursing that is 22 issued by a home state to a resident in that state must be 23 recognized by each party state as authorizing a multi-state 24 licensure privilege to practice as a licensed practical or vocational 25 nurse in each party state. In order to obtain or retain a license, an 26 applicant must meet the home state’s qualifications for licensure 27 and license renewal and all other applicable state laws. 28 (B) A party state may, in accordance with that state’s due 29 process laws, revoke, suspend, or limit the multi-state licensure 30 privilege of any licensee to practice in its state and may take any 31 other actions under its applicable state laws that are necessary to 32 protect the health and safety of its citizens. If a party state takes an 33 action authorized in this subsection, it shall promptly notify the 34 administrator of the coordinated licensure information system. 35 The administrator shall promptly notify the home state of any 36 actions taken by remote states. 37 (C) A licensee practicing in a party state shall comply with the 38 state practice laws of the state in which the patient is located at the 39 time care is rendered. The practice of nursing is not limited to 40 patient care and includes all nursing practice as defined by the 41 state practice laws of a party state. The practice of nursing in a 42 party state shall subject a nurse to the jurisdiction of the nurse 43 licensing board and the laws and the courts in that party state.

1 [4291] 4 1 (D)(1) A registered nurse who has been granted multi-state 2 licensing privileges by a party state may practice registered 3 nursing in this State. 4 (2) A licensed practical nurse who has been granted 5 multi-state licensing privileges by a party state may practice 6 practical nursing in this State. 7 (3) A nurse who has been granted multi-state licensing 8 privileges as provided for in subsection (D)(1) or (2) shall notify 9 the board, on a standard form provided by the board, before 10 commencing any nursing practice in this State, of the identity and 11 location of the nurse’s prospective practice location. 12 (E) The compact does not effect additional requirements 13 imposed by states for advanced-practice registered nursing. A 14 multi-state licensure privilege to practice registered nursing 15 granted by a party state must be recognized by other party states as 16 a license to practice registered nursing if a license to practice 17 registered nursing is required by state law as a precondition for 18 qualifying for advanced-practice registered nurse authorization. 19 (F) A person who does not reside in a party state may continue 20 to apply for nurse licensure in party states as provided for under 21 the laws of each party state. If a license is granted to the person, 22 the license does not grant the privilege to practice nursing in any 23 other party state unless explicitly agreed to by that party state. 24 25 Section 40-33-1320. (A) Upon receiving an application for a 26 license, the licensing board in a party state shall ascertain through 27 the coordinated licensure information system whether the applicant 28 holds or has ever held a license issued by any other state, whether 29 there are any restrictions on the applicant’s multi-state licensure 30 privilege, and whether any other adverse action by any state has 31 been taken against the applicant’s license. 32 (B) A licensee in a party state shall hold licensure in only one 33 party state at a time. The license must be issued by the home state. 34 (C) A licensee who intends to change his or her primary state 35 of residence may apply for licensure in the new home state in 36 advance of the change. However, a new license must not be issued 37 by a party state until after the licensee provides evidence of a 38 change in his or her primary state of residence that is satisfactory 39 to the new home state’s licensing board. 40 (D) When a licensee changes his or her primary state of 41 residence by moving between two party states and obtaining a 42 license from the new home state, the license from the former home 43 state is no longer valid.

1 [4291] 5 1 (E) When a licensee changes his or her primary state of 2 residence by moving from a nonparty state to a party state and 3 obtains a license from the new home state, the license issued by 4 the nonparty state is not affected and shall remain in full force if 5 authorized under the laws of the nonparty state. 6 (F) When a licensee changes his or her primary state of 7 residence by moving from a party state to a nonparty state, the 8 license issued by the former home state converts to an individual 9 state license that is valid only in the former home state. The license 10 does not grant the multi-state licensure privilege to practice in 11 other party states. 12 13 Section 40-33-1325. (A) The licensing board of a remote state 14 shall promptly report to the administrator of the coordinated 15 licensure information system any remote state actions, including 16 the factual and legal basis for the actions, if known. The licensing 17 board of a remote state shall also promptly report any current 18 significant investigative information yet to result in a remote state 19 action. The administrator of the coordinated licensure information 20 system shall promptly notify the home state of these reports. 21 (B) The licensing board of a party state may complete any 22 pending investigation of a licensee who changes his or her primary 23 state of residence during the course of the investigation. The 24 licensing board of that state also may take appropriate action 25 against a licensee and shall promptly report the conclusion of the 26 investigation to the administrator of the coordinated licensure 27 information system. The administrator of the coordinated 28 licensure information system shall promptly notify the new home 29 state of any action taken against a licensee. 30 (C) A remote party state may take adverse action that affects 31 the multi-state licensure privilege to practice within that party 32 state. However, only the home state may take adverse action that 33 effects a license that was issued by the home state. 34 (D) For the purposes of imposing an adverse action, the 35 licensing board of the home state shall give the same priority and 36 effect to the reported conduct received from a remote party state as 37 it would if the conduct had occurred in the home state. In so 38 doing, the licensing board of the home state shall apply its own 39 state laws to determine appropriate action to be taken against the 40 licensee. 41 (E) The home state may take adverse action based upon the 42 factual findings of the remote party state if each state follows its 43 own procedures for imposing the adverse action.

1 [4291] 6 1 (F) This compact does not prohibit a party state from allowing 2 a licensee to participate in an alternative program instead of taking 3 adverse action against the licensee. If required by the party state’s 4 laws, the licensee’s participation in an alternative program is 5 confidential information. A party state shall require a licensee 6 who enters an alternative program to agree not to practice in any 7 other party state during the term of the alternative program without 8 prior authorization from the other party state. 9 10 Section 40-33-1330. (A) If a licensing board finds current 11 significant investigative information, the licensing board, after 12 giving the licensee notice and an opportunity to respond, shall 13 conduct a hearing and decide what adverse action, if any, to take 14 against the licensee. 15 (B) If a licensing board finds current significant investigative 16 information, the licensing board may take adverse action against 17 the licensee without first providing the licensee notice or an 18 opportunity to respond to the information. A hearing must be 19 promptly commenced and determined. 20 21 Section 40-33-1335. A party state nurse licensing board may: 22 (1) if otherwise permitted by state law, recover from licensees 23 the costs of investigating and disposing of cases that result in 24 adverse action; 25 (2) issue subpoenas for both hearings and investigations that 26 require the attendance and testimony of witnesses and the 27 production of evidence. Subpoenas issued by a nurse licensing 28 board in a party state for the attendance and testimony of witnesses 29 or the production of evidence from another party state must be 30 enforced in the other party state by any court of competent 31 jurisdiction according to the practice and procedure of that court. 32 The issuing authority shall pay any witness fees, travel expenses, 33 mileage, and other fees required by the laws of the party state 34 where the witnesses or evidence are located; 35 (3) issue cease and desist orders to limit or revoke a licensee’s 36 authority to practice in the board’s state; 37 (4) promulgate uniform regulations that are developed by the 38 compact administrators. 39 40 Section 40-33-1340. (A) A party state shall participate in a 41 cooperative effort to create a coordinated data base of all licensed 42 registered nurses and licensed practical or vocational nurses. This 43 system must include information on the licensure and disciplinary

1 [4291] 7 1 history of each licensee, as contributed by party states, to assist in 2 the coordination of nurse licensure and enforcement efforts. 3 (B) Notwithstanding any other provision of law, a party state’s 4 licensing board shall promptly report to the coordinated licensure 5 information system any adverse action taken against a licensee, 6 action against multi-state licensure privileges, any current 7 significant investigative information yet to result in adverse action, 8 and any denials of applications for licensure and the reasons for 9 the denials. 10 (C) Current significant investigative information must be 11 transmitted through the coordinated licensure information system 12 only to party state licensing boards. 13 (D) Notwithstanding any other provision of law, a party state’s 14 licensing board, which contributes information to the coordinated 15 licensure information system, may designate information that must 16 not be shared with nonparty states or disclosed to other entities or 17 individuals without the express permission of the contributing 18 party state. 19 (E) Any personally identifiable information obtained by a party 20 state licensing board from the coordinated licensure information 21 system must not be shared with nonparty states or disclosed to 22 other entities or individuals except to the extent permitted by the 23 laws of the party state contributing the information. 24 (F) Any information contributed to the coordinated licensure 25 information system that is subsequently required to be expunged 26 by the laws of the party state contributing the information must be 27 expunged from the coordinated licensure information system. 28 (G) The compact administrators, acting jointly and in 29 consultation with the administrator of the coordinated licensure 30 information system, shall formulate necessary and proper 31 procedures for the identification, collection, and exchange of 32 information under this compact. 33 34 Section 40-33-1345. (A) The administrator or head of the 35 nurse licensing board of each party state or that person’s designee 36 must be the administrator of this compact for that state. 37 (B) To facilitate the administration of this compact, the 38 compact administrator of each party state shall furnish to the 39 compact administrators of all other party states information and 40 documents concerning each licensee, including a uniform data set 41 of investigations, identifying information, licensure data, and 42 disclosable alternative program participation.

1 [4291] 8 1 (C) Compact administrators shall develop uniform rules and 2 regulations to facilitate and coordinate implementation of this 3 compact. These uniform rules and regulations must be adopted by 4 party states as authorized in this article. 5 6 Section 40-33-1350. A party state or the officers, employees, or 7 agents of a party state’s nurse licensing board who act in 8 accordance with this compact are not liable for any good faith act 9 or omission committed while engaged in the performance of their 10 duties under this compact. ‘Good faith’ as used in this section does 11 not include willful misconduct, gross negligence, or recklessness. 12 13 Section 40-33-1355. (A) This compact becomes effective as to 14 a state when the compact has been enacted into the laws of that 15 state. A party state may withdraw from this compact by enacting a 16 statute repealing the compact, but the withdrawal does not take 17 effect until six months after the withdrawing state has given notice 18 of the withdrawal to the compact administrators of all other party 19 states. 20 (B) No withdrawal affects the validity or applicability of any 21 report of adverse action taken by the licensing board of a state that 22 remains a party to the compact if the adverse action occurred 23 before the withdrawal. 24 (C) This compact does not invalidate or prevent a nurse 25 licensure agreement or other cooperative arrangement between a 26 party state and a nonparty state that is made in accordance with 27 this compact. 28 (D) This compact may be amended by the party states; however 29 an amendment to this compact does not become effective and 30 binding upon the party states unless and until it is enacted into the 31 laws of all party states. 32 33 Section 40-33-1360. If there is a dispute that cannot be 34 resolved by the party states involved, the following procedure must 35 be used: 36 (1) The party states may submit the issues in dispute to an 37 arbitration panel that consists of an individual appointed by the 38 compact administrator in the home state, an individual appointed 39 by the compact administrator in the remote states involved, and an 40 individual appointed by the compact administrators of all the party 41 states involved in the dispute. 42 (2) The decision of a majority of the arbitrators is final and 43 binding.

1 [4291] 9 1 Section 40-33-1365. (A) This compact must be liberally 2 construed so as to effectuate the purposes as stated in Section 3 40-43-1305 (B). 4 (B) The provisions of this compact are severable and if any 5 phrase, clause, sentence, or provision of this compact is declared to 6 be contrary to the constitution of any party state or of the United 7 States, or if the applicability of any of them to any government, 8 agency, person, or circumstance is held invalid, the validity of the 9 remainder of this compact and the applicability of it to any 10 government, agency, person, or circumstance is not affected. If 11 this compact is held contrary to the constitution of any party state, 12 the compact remains in full force and effect as to the remaining 13 party states and in full force and effect as to the party state affected 14 as to all severable matters.” 15 16 SECTION 2. A nurse whose license has been restricted by the 17 South Carolina Board of Nursing as of this act’s effective date 18 must not practice in any other state that has adopted the Nurse 19 Multi-State Licensure Compact, a compact substantially the same 20 as the compact enacted in Section 1 of this act, during the time in 21 which the license is restricted unless the nurse receives prior 22 authorization from another state that is a party to such compact. 23 24 SECTION 3. The South Carolina Board of Nursing shall 25 periodically report to the General Assembly on the implementation 26 of the provisions of the Nurse Licensure Compact, Article 15, 27 Chapter 33 of Title 40 of the 1976 Code, as added by Section 1 of 28 this act, and no later than January 1, 2006. 29 30 SECTION 4. Chapter 33, Title 40 of the 1976 Code is amended 31 by adding: 32 33 “Section 40-33-525. Beginning January 1, 2006, the State 34 Board of Nursing shall require foreign-educated candidates for 35 licensing as registered nurses to pass: 36 (1) the National Council Licensure Examination (NCLEX); 37 and 38 (2) an English language proficiency test that determines 39 whether or not the license applicant is proficient in conversational 40 English with regard to medical terminology and the skills required 41 of a registered nurse.” 42

1 [4291] 10 1 SECTION 5. This act takes effect upon approval by the 2 Governor. 3 ----XX---- 4

1 [4291] 11