2023 -- S 0275 SUBSTITUTE A
========
LC000290/SUB A
========
S TATE OF RHODE IS LAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2023
____________
A N A C T
RELATING TO BUSINESSES AND PROFESSIONS -- NURSE LICENSURE COMP ACT
Introduced By: Senators Miller, DiPalma, Euer, DiMario, Lauria, Lawson, Ujifusa,
Kallman, Murray, and Valverde
Date Introduced: February 16, 2023
Referred To: Senate Health & Human Services
It is enacted by the General Assembly as follows:
SECTION 1. Sections 5-34.3-3, 5-34.3-4, 5-34.3-5, 5-34.3-6, 5-34.3-8, 5-34.3-9, 5-34.3-1
10, 5-34.3-12 and 5-34.3-14 of the General Laws in Chapter 5-34.3 entitled "Nurse Licensure 2
Compact" are hereby amended to read as follows: 3
5-34.3-3. Legislative findings. 4
(a) The general assembly finds and declares that: 5
(1) The health and safety of the public are affected by the degree of compliance with and 6
the effectiveness of enforcement activities related to state nurse licensure laws; 7
(2) Violations of nurse licensure and other laws regulating the practice of nursing may 8
result in injury or harm to the public; 9
(3) The expanded mobility of nurses and the use of advanced communication technologies 10
as part of our nation’s healthcare delivery system require greater coordination and cooperation 11
among states in the areas of nurse licensure and regulations; 12
(4) New practice modalities and technology make compliance with individual state nurse 13
licensure laws difficult and complex; and 14
(5) The current system of duplicative licensure for nurses practicing in multiple states is 15
cumbersome and redundant to both nurses and states.; and 16
(6) Uniformity of nurse licensure requirements throughout the states promotes public safety 17
and public health benefits. 18
(b) The general purposes of this compact are to: 19
LC000290/SUB A - Page 2 of 23
(1) Facilitate the states’ responsibility to protect the public’s health and safety; 1
(2) Ensure and encourage the cooperation of party states in the areas of nurse licensure and 2
regulation; 3
(3) Facilitate the exchange of information between party states in the areas of nurse 4
regulation, investigation and adverse actions; 5
(4) Promote compliance with the laws governing the practice of nursing in each 6
jurisdiction; and 7
(5) Invest all party states with the authority to hold a nurse accountable for meeting all state 8
practice laws in the state in which the patient is located at the time care is rendered through the 9
mutual recognition of party state licenses.; 10
(6) Decrease redundancies in the consideration and issuance of nurse licenses; and 11
(7) Provide opportunities for interstate practice by nurses who meet uniform licensure 12
requirements. 13
5-34.3-4. Definitions. 14
As used in this chapter: 15
(1) "Adverse action" means a home or remote state action any administrative, civil, 16
equitable or criminal action permitted by a state's laws which is imposed by a licensing board or 17
other authority against a nurse, including actions against an individual's license or multistate 18
licensure privilege such as revocation, suspension, probation, monitoring of the licensee, limitation 19
on the licensee's practice, or any other encumbrance on licensure affecting a nurse's authorization 20
to practice, including issuance of a cease and desist action. 21
(2) "Alternative program" means a voluntary, nondisciplinary monitoring program 22
approved by a nurse licensing board. 23
(3) "Commission" means the interstate commission of nurse license compact 24
administrators, the governing body of the nurse licensure compact. 25
(3)(4) "Coordinated licensure information system" means an integrated process for 26
collecting, storing, and sharing information on nurse licensure and enforcement activities related 27
to nurse licensure laws, which is administered by a nonprofit organization composed of and 28
controlled by state nurse licensing boards. 29
(4)(5) "Current significant investigative information" means investigative information that 30
a licensing board, after a preliminary inquiry that includes notification and an opportunity for the 31
nurse to respond if required by state law, has reason to believe is not groundless and, if proved true, 32
would indicate more than a minor infraction; or investigative information that indicates that the 33
nurse represents an immediate threat to public health and safety regardless of whether the nurse has 34
LC000290/SUB A - Page 3 of 23
been notified and had an opportunity to respond. 1
(6) "Encumbrance" means a revocation or suspension of, or any limitation placed on, the 2
full and unrestricted practice of nursing imposed by a licensing board. 3
(5)(7) "Home state" means the party state which is the nurse’s primary state of residence. 4
(6)(8) "Home state action" means any administrative, civil, equitable, or criminal action 5
permitted by the home state’s laws which are imposed on a nurse by the home state’s licensing 6
board or other authority including actions against an individual’s license such as: revocation, 7
suspension, probation or any other action which affects a nurse’s authorization to practice. 8
(7)(9) "Licensing board" means a party state’s regulatory body responsible for issuing 9
nurse licenses. 10
(8)(10) "Multistate licensure privilege" means current, official authority from a remote 11
state permitting the practice of nursing as either a registered nurse or a licensed practical/vocational 12
nurse in such party state. All party states have the authority, in accordance with existing state due 13
process law, to take actions against the nurse’s privilege such as: revocation, suspension, probation, 14
or any other action which affects a nurse’s authorization to practice a license to practice as a 15
registered nurse (RN) or a licensed practical nurse/vocational nurse (LPN/VN) issued by a home 16
state licensing board, that authorizes the licensed nurse to practice in all party states under a 17
multistate licensure privilege. 18
(11) "Multistate licensure privilege" means a legal authorization associated with a 19
multistate license, permitting the practice of nursing as either a registered nurse (RN) or licensed 20
practical nurse/vocational nurse (LPN/VN) in a remote state. 21
(9)(12) "Nurse" means a registered nurse or licensed practical/vocational nurse, as those 22
terms are defined by each party’s state practice laws. 23
(10)(13) "Party state" means any state that has adopted this compact. 24
(11)(14) "Remote state" means a party state, other than the home state, where the patient 25
is located at the time nursing care is provided, or, in the case of the practice of nursing not involving 26
a patient, in such party state where the recipient of nursing practice is located. 27
(12)(15) "Remote state action" means any administrative, civil, equitable or criminal action 28
permitted by a remote state’s laws which are imposed on a nurse by the remote state’s licensing 29
board or other authority including actions against an individual’s multistate licensure privilege to 30
practice in the remote state, and cease and desist and other injunctive or equitable orders issued by 31
remote states or the licensing boards thereof. 32
(16) "Single-state license" means a nurse license issued by a party state that authorizes 33
practice only within the issuing state and does not include a multistate licensure privilege to practice 34
LC000290/SUB A - Page 4 of 23
in any other party state. 1
(13)(17) "State" means a state, territory, or possession of the United States, the District of 2
Columbia. 3
(14)(18) "State practice laws" means those individual party’s state laws and regulations 4
that govern the practice of nursing, define the scope of nursing practice, and create the methods 5
and grounds for imposing discipline. It does not include the initial qualifications for licensure or 6
requirements necessary to obtain and retain a license, except for qualifications or requirements of 7
the home state. 8
5-34.3-5. Permitted activities and jurisdiction. General provisions and jurisdiction. 9
(a) A license to practice registered nursing issued by a home state to a resident in that state 10
will be recognized by each party state as authorizing a multistate licensure privilege to practice as 11
a registered nurse in such party state. A license to practice licensed practical/vocational nursing 12
issued by a home state to a resident in that state will be recognized by each party state as authorizing 13
a multistate licensure privilege to practice as a licensed practical/vocational nurse in such party 14
state. In order to obtain or retain a license, an applicant must meet the home state’s qualifications 15
for licensure and license renewal as well as all other applicable state laws. 16
(b) Party states may, in accordance with state due process laws, limit or revoke the 17
multistate licensure privilege of any nurse to practice in their state and may take any other actions 18
under their applicable state laws necessary to protect the health and safety of their citizens. If a 19
party state takes such action, it shall promptly notify the administrator of the coordinated licensure 20
information system. The administrator of the coordinated licensure information system shall 21
promptly notify the home state of any such actions by remote states. 22
(c) Every nurse practicing in a party state must comply with the state practice laws of the 23
state in which the patient is located at the time care is rendered. In addition, the practice of nursing 24
is not limited to patient care, but shall include all nursing practice as defined by the state practice 25
laws of a party state. The practice of nursing will subject a nurse to the jurisdiction of the nurse 26
licensing board and courts, as well as the laws, in that party state. 27
(d) This compact does not affect additional requirements imposed by states for advanced 28
practice registered nursing. However, a multistate licensure privilege to practice registered nursing 29
granted by a party shall be recognized by other party states as a license to practice registered nursing 30
if one is required by state law as a precondition for qualifying for advanced practice registered 31
nurse authorization. 32
(e) Individuals not residing in a party state shall continue to be able to apply for nurse 33
licensure as provided for under the laws of each party state. However, the license granted to these 34
LC000290/SUB A - Page 5 of 23
individuals will not be recognized as granting the privilege to practice nursing in any other party 1
state unless explicitly agreed to by that party state. 2
(a) A multistate license to practice registered or licensed practical nursing/vocational 3
nursing issued by a home state to a resident in that state will be recognized by each party state as 4
authorizing a nurse to practice as a registered nurse (RN) or as a licensed practical nurse/vocational 5
nurse (LPN/VN), under a multistate licensure privilege, in each party state. 6
(b) A state must implement procedures for considering the criminal history records of 7
applicants for initial multistate license or licensure by endorsement. Such procedures shall include 8
the submission of fingerprints or other biometric-based information by applicants for the purpose 9
of obtaining an applicant's criminal history record information from the Federal Bureau of 10
Investigation, and the agency responsible for maintaining that state's criminal records. 11
(c) Each party state shall require the following for an applicant to obtain or retain a 12
multistate license in the home state: 13
(1) Meets the home state's qualifications for licensure or renewal of licensure, as well as 14
all other applicable state laws; 15
(2)(i) Has graduated or is eligible to graduate from a licensing board-approved RN or 16
LPN/VN prelicensure education program; or 17
(ii) Has graduated from a foreign RN or LPN/VN prelicensure education program that: 18
(A) Has been approved by the authorized accrediting body in the applicable country; and 19
(B) Has been verified by an independent credentials review agency to be comparable to a 20
licensing board-approved prelicensure education program; 21
(3) Has, if a graduate of a foreign prelicensure education program not taught in English or 22
if English is not the individual's native language, successfully passed an English proficiency 23
examination that includes the components of reading, speaking, writing and listening; 24
(4) Has successfully passed an NCLEX-RN® or NCLEX-PN® Examination or recognized 25
predecessor, as applicable; 26
(5) Is eligible for or holds an active, unencumbered license; 27
(6) Has submitted, in connection with an application for initial licensure or licensure by 28
endorsement, fingerprints or other biometric data for the purpose of obtaining criminal history 29
record information from the Federal Bureau of Investigation and the agency responsible for 30
maintaining that state's criminal records; 31
(7) Has not been convicted or found guilty nor entered into an agreed disposition of a felony 32
offense under applicable state or federal criminal law; 33
(8) Has not been convicted or found guilty nor entered into an agreed disposition of a 34
LC000290/SUB A - Page 6 of 23
misdemeanor offense related to the practice of nursing as determined on a case-by-case basis; 1
(9) Is not currently enrolled in an alternative program; 2
(10) Is subject to self-disclosure requirements regarding current participation in an 3
alternative program; and 4
(11) Has a valid United States Social Security number. 5
(d) All party states shall be authorized, in accordance with existing state due process law, 6
to take adverse action against a nurse's multistate licensure privilege such as revocation, suspension, 7
probation or any other action that affects a nurse's authorization to practice under a multistate 8
licensure privilege, including cease and desist actions. If a party state takes such action, it shall 9
promptly notify the administrator of the coordinated licensure information system. The 10
administrator of the coordinated licensure information system shall promptly notify the home state 11
of any such actions by remote states. 12
(e) A nurse practicing in a party state must comply with the state practice laws of the state 13
in which the client is located at the time service is provided. The practice of nursing is not limited 14
to patient care, but shall include all nursing practice as defined by the state practice laws of the 15
party state in which the client is located. The practice of nursing in a party state under a multistate 16
licensure privilege will subject a nurse to the jurisdiction of the licensing board, the courts and the 17
laws of the party state in which the client is located at the time service is provided. 18
(f) Individuals not residing in a party state shall continue to be able to apply for a party 19
state's single-state license as provided under the laws of each party state. However, the single-state 20
license granted to these individuals will not be recognized as granting the privilege to practice 21
nursing in any other party state. Nothing in this compact shall affect the requirements established 22
by a party state for the issuance of a single-state license. 23
(g) Any nurse holding a home state multistate license, on the effective date of this compact, 24
may retain and renew the multistate license issued by the nurse's then-current home state, provided 25
that: 26
(1) A nurse, who changes primary state of residence after this compact's effective date, 27
must meet all applicable requirements to obtain a multistate license from a new home state; and 28
(2) A nurse who fails to satisfy the multistate licensure requirements due to a disqualifying 29
event occurring after this compact's effective date shall be ineligible to retain or renew a multistate 30
license, and the nurse's multistate license shall be revoked or deactivated in accordance with 31
applicable rules adopted by the commission. 32
5-34.3-6. Applications for licensure in a party state. 33
(a) Upon application for a license, the licensing board in a party state shall ascertain, 34
LC000290/SUB A - Page 7 of 23
through the coordinated licensure information system, whether the applicant has ever held, or is the 1
holder of, a license issued by any other state, whether there are any restrictions on the multistate 2
licensure privilege, and whether any other adverse action by any state has been taken against the 3
license. 4
(b) A nurse in a party state shall hold licensure in only one party state at a time, issued by 5
the home state. 6
(c) A nurse who intends to change primary state of residence may apply for licensure in 7
the new home state in advance of such change. However, new licenses will not be issued by a party 8
state until after a nurse provides evidence of change in primary state of residence satisfactory to the 9
new home state’s licensing board. 10
(d) When a nurse changes primary state of residence by; 11
(1) Moving between two party states, and obtains a license from the new home state, the 12
license from the former home state is no longer valid; 13
(2) Moving from a non-party state to a party state, and obtains a license from the new home 14
state, the individual state license issued by the non-party state is not affected and will remain in full 15
force if so provided by the laws of the non-party state; 16
(3) Moving from a party state to a non-party state, the license issued by the prior home 17
state converts to an individual state license, valid only in the former home state, without the 18
multistate licensure privilege to practice in other party states. 19
(a) Upon application for a multistate license, the licensing board in the issuing party state 20
shall ascertain, through the coordinated licensure information system, whether the applicant has 21
ever held, or is the holder of, a license issued by any other state, whether there are any 22
encumbrances on any license or multistate licensure privilege held by the applicant, whether any 23
adverse action has been taken against any license or multistate licensure privilege held by the 24
applicant and whether the applicant is currently participating in an alternative program. 25
(b) A nurse may hold a multistate license, issued by the home state, in only one party state 26
at a time. 27
(c) If a nurse changes primary state of residence by moving between two (2) party states, 28
the nurse must apply for licensure in the new home state, and the multistate license issued by the 29
prior home state will be deactivated in accordance with applicable rules adopted by the commission. 30
(1) The nurse may apply for licensure in advance of a change in primary state of residence. 31
(2) A multistate license shall not be issued by the new home state until the nurse provides 32
satisfactory evidence of a change in primary state of residence to the new home state and satisfies 33
all applicable requirements to obtain a multistate license from the new home state. 34
LC000290/SUB A - Page 8 of 23
(d) If a nurse changes primary state of residence by moving from a party state to a non-1
party state, the multistate license issued by the prior home state will convert to a single-state license, 2
valid only in the former home state. 3
5-34.3-8. Additional authorities invested in party state nurse licensing boards. 4
(a) Notwithstanding any other powers conferred by state law, party state nurse licensing 5
boards shall have the authority to: 6
(1) If otherwise permitted by state law, recover from the affected nurse the costs of 7
investigations and disposition of cases resulting from any adverse action taken against that nurse; 8
(2) Issue subpoenas for both hearings and investigations which require the attendance and 9
testimony of witnesses, and the production of evidence. Subpoenas issued by a nurse licensing 10
board in a party state for the attendance and testimony of witnesses, and/or the production of 11
evidence from another party state, shall be enforced in the latter state by any court of competent 12
jurisdiction, according to the practice and procedure of that court applicable to subpoenas issued in 13
proceedings pending before it. The issuing authority shall pay any witness fees, travel expenses, 14
mileage and other fees required by the service statutes of the state where the witnesses and/or 15
evidence are located. 16
(3) Issue cease and desist orders to limit or revoke a nurse’s authority to practice in their 17
state; 18
(4) Promulgate uniform rules and regulations as provided for in § 5-34.3-10(c). 19
(1) Take adverse action against a nurse's multistate licensure privilege to practice within 20
that party state. 21
(i) Only the home state shall have the power to take adverse action against a nurse's license 22
issued by the home state. 23
(ii) For purposes of taking adverse action, the home state licensing board shall give the 24
same priority and effect to reported conduct received from a remote state as it would if such conduct 25
had occurred within the home state. In so doing, the home state shall apply its own state laws to 26
determine appropriate action. 27
(2) Issue cease and desist orders or impose an encumbrance on a nurse's authority to 28
practice within that party state. 29
(3) Complete any pending investigations of a nurse who changes primary state of residence 30
during the course of such investigations. The licensing board shall also have the authority to take 31
appropriate action(s) and shall promptly report the conclusions of such investigations to the 32
administrator of the coordinated licensure information system. The administrator of the coordinated 33
licensure information system shall promptly notify the new home state of any such actions. 34
LC000290/SUB A - Page 9 of 23
(4) Issue subpoenas for both hearings and investigations that require the attendance and 1
testimony of witnesses, as well as, the production of evidence. Subpoenas issued by a licensing 2
board in a party state for the attendance and testimony of witnesses or the production of evidence 3
from another party state shall be enforced in the latter state by any court of competent jurisdiction, 4
according to the practice and procedure of that court applicable to subpoenas issued in proceedings 5
pending before it. The issuing authority shall pay any witness fees, travel expenses, mileage and 6
other fees required by the service statutes of the state in which the witnesses or evidence are located. 7
(5) Obtain and submit, for each nurse licensure applicant, fingerprint or other biometric-8
based information to the Federal Bureau of Investigation for criminal background checks, receive 9
the results of the Federal Bureau of Investigation record search on criminal background checks and 10
use the results in making licensure decisions. 11
(6) If otherwise permitted by state law, recover from the affected nurse the costs of 12
investigations and disposition of cases resulting from any adverse action taken against that nurse. 13
(7) Take adverse action based on the factual findings of the remote state, provided that the 14
licensing board follows its own procedures for taking such adverse action. 15
(b) If adverse action is taken by the home state against a nurse's multistate license, the 16
nurse's multistate licensure privilege to practice in all other party states shall be deactivated until 17
all encumbrances have been removed from the multistate license. All home state disciplinary orders 18
that impose adverse action against a nurse's multistate license shall include a statement that the 19
nurse's multistate licensure privilege is deactivated in all party states during the pendency of the 20
order. 21
(c) Nothing in this compact shall override a party state's decision that participation in an 22
alternative program may be used in lieu of adverse action. The home state licensing board shall 23
deactivate the multistate licensure privilege under the multistate license of any nurse for the 24
duration of the nurse's participation in an alternative program. 25
5-34.3-9. Coordinated licensure information system. Coordinated licensure 26
information system and exchange of information. 27
(a) All party states shall participate in a cooperative effort to create a coordinated database 28
licensure information system of all licensed registered nurses (RNs) and licensed practical 29
nurses/vocational nurses (LPNs/VNs). This system will include information on the licensure and 30
disciplinary history of each nurse, as contributed submitted by party states, to assist in the 31
coordination of nurse licensure and enforcement efforts. 32
(b) Notwithstanding any other provision of law, all party states’ licensing boards shall 33
promptly report adverse actions, actions against multistate licensure privileges, any current 34
LC000290/SUB A - Page 10 of 23
significant investigative information yet to result in adverse action, denials of applications, and the 1
reasons for such denials, to the coordinated licensure information system. 2
(b) The commission, in consultation with the administrator of the coordinated licensure 3
information system, shall formulate necessary and proper procedures for the identification, 4
collection and exchange of information under this compact. 5
(c) All licensing boards shall promptly report to the coordinated licensure information 6
system any adverse action, any current significant investigative information, denials of applications 7
(with the reasons for such denials) and nurse participation in alternative programs known to the 8
licensing board regardless of whether such participation is deemed nonpublic or confidential under 9
state law. 10
(c)(d) Current significant investigative information shall be transmitted through the 11
coordinated licensure information system only to party state licensing boards. 12
(d)(e) Notwithstanding any other provision of law, all party states’ licensing boards 13
contributing information to the coordinated licensure information system may designate 14
information that may not be shared with non-party states or disclosed to other entities or individua ls 15
without the express permission of the contributing state. 16
(e)(f) Any personally identifiable information obtained from the coordinated licensure 17
information system by a party state’s licensing board shall from the coordinated licensure 18
information system may not be shared with non-party states or disclosed to other entities or 19
individuals except to the extent permitted by the laws of the party state contributing the information. 20
(f)(g) Any information contributed to the coordinated licensure information system that is 21
subsequently required to be expunged by the laws of the party state contributing that information, 22
shall also be expunged from the coordinated licensure information system. 23
(g) The compact administrators, acting jointly with each other and in consultation with the 24
administrator of the coordinated licensure information system, shall formulate necessary and proper 25
procedures for the identification, collection and exchange of information under this compact. 26
(h) The compact administrator of each party state shall furnish a uniform data set to the 27
compact administrator of each other party state, which shall include, at a minimum: 28
(1) Identifying information; 29
(2) Licensure data; 30
(3) Information related to alternative program participation; and 31
(4) Other information that may facilitate the administration of this compact, as determined 32
by commission rules. 33
(i) The compact administrator of a party state shall provide all investigative documents and 34
LC000290/SUB A - Page 11 of 23
information requested by another party state. 1
5-34.3-10. Compact administration and interchange of information. Establishment of 2
the interstate commission of nurse licensure compact administrators. 3
(a) The head of the nurse licensing board, or his/her designee, of each party state shall be 4
the administrator of this compact for his/her state. 5
(b) The compact administrator of each party shall furnish to the compact administrator of 6
each other party state any information and documents including, but not limited to, a uniform data 7
set of investigations, identifying information, licensure data, and disclosable alternative program 8
participation information to facilitate the administration of this compact. 9
(c) Compact administrators shall have the authority to develop uniform rules to facilitate 10
and coordinate implementation of this compact. These uniform rules shall be adopted by party 11
states, under the authority invested under § 5-34.3-8(4). 12
(a) The party states hereby create and establish a joint public entity known as the interstate 13
commission of nurse licensure compact administrators (the "commission"). 14
(1) The commission is an instrumentality of the party states. 15
(2) Venue is proper, and judicial proceedings by or against the commission shall be brought 16
solely and exclusively, in a court of competent jurisdiction where the principal office of the 17
commission is located. The commission may waive venue and jurisdictional defenses to the extent 18
it adopts or consents to participate in alternative dispute resolution proceedings. 19
(3) Nothing in this compact shall be construed to be a waiver of sovereign immunity. 20
(b) Membership, voting and meetings: 21
(1) Each party state shall have and be limited to one administrator. The head of the state 22
licensing board or designee shall be the administrator of this compact for each party state. Any 23
administrator may be removed or suspended from office as provided by the law of the state from 24
which the administrator is appointed. Any vacancy occurring in the commission shall be filled in 25
accordance with the laws of the party state in which the vacancy exists. 26
(2) Each administrator shall be entitled to one vote with regard to the promulgation of rules 27
and creation of bylaws and shall otherwise have an opportunity to participate in the business and 28
affairs of the commission. An administrator shall vote in person or by such other means as provided 29
in the bylaws. The bylaws may provide for an administrator's participation in meetings by telephone 30
or other means of communication. 31
(3) The commission shall meet at least once during each calendar year. Additional meetings 32
shall be held as set forth in the bylaws or rules of the commission. 33
(4) All meetings shall be open to the public, and public notice of meetings shall be given 34
LC000290/SUB A - Page 12 of 23
in the same manner as required under the rulemaking provisions in § 5-34.3-10.1. 1
(5) The commission may convene in a closed, nonpublic meeting if the commission must 2
discuss: 3
(i) Noncompliance of a party state with its obligations under this compact; 4
(ii) The employment, compensation, discipline or other personnel matters, practices or 5
procedures related to specific employees or other matters related to the commission's internal 6
personnel practices and procedures; 7
(iii) Current, threatened or reasonably anticipated litigation; 8
(iv) Negotiation of contracts for the purchase or sale of goods, services or real estate; 9
(v) Accusing any person of a crime or formally censuring any person; 10
(vi) Disclosure of trade secrets or commercial or financial information that is privileged or 11
confidential; 12
(vii) Disclosure of information of a personal nature where disclosure would constitute a 13
clearly unwarranted invasion of personal privacy; 14
(viii) Disclosure of investigatory records compiled for law enforcement purposes; 15
(ix) Disclosure of information related to any reports prepared by or on behalf of the 16
commission for the purpose of investigation of compliance with this compact; or 17
(x) Matters specifically exempted from disclosure by federal or state statute. 18
(6) If a meeting, or portion of a meeting, is closed pursuant to this provision, the 19
commission's legal counsel or designee shall certify that the meeting may be closed and shall 20
reference each relevant exempting provision. The commission shall keep minutes that fully and 21
clearly describe all matters discussed in a meeting and shall provide a full and accurate summary 22
of actions taken, and the reasons therefor, including a description of the views expressed. All 23
documents considered in connection with an action shall be identified in such minutes. All minutes 24
and documents of a closed meeting shall remain under seal, subject to release by a majority vote of 25
the commission or order of a court of competent jurisdiction. 26
(c) The commission shall, by a majority vote of the administrators, prescribe bylaws or 27
rules to govern its conduct as may be necessary or appropriate to carry out the purposes and exercise 28
the powers of this compact, including, but not limited to: 29
(1) Establishing the fiscal year of the commission; 30
(2) Providing reasonable standards and procedures: 31
(i) For the establishment and meetings of other committees; and 32
(ii) Governing any general or specific delegation of any authority or function of the 33
commission; 34
LC000290/SUB A - Page 13 of 23
(3) Providing reasonable procedures for calling and conducting meetings of the 1
commission, ensuring reasonable advance notice of all meetings and providing an opportunity for 2
attendance of such meetings by interested parties, with enumerated exceptions designed to protect 3
the public's interest, the privacy of individuals, and proprietary information, including trade secrets. 4
The commission may meet in closed session only after a majority of the administrators vote to close 5
a meeting in whole or in part. As soon as practicable, the commission must make public a copy of 6
the vote to close the meeting revealing the vote of each administrator, with no proxy votes allowed; 7
(4) Establishing the titles, duties, authority, and reasonable procedures for the election of 8
the officers of the commission; 9
(5) Providing reasonable standards and procedures for the establishment of the personnel 10
policies and programs of the commission. Notwithstanding any civil service or other similar laws 11
of any party state, the bylaws shall exclusively govern the personnel policies and programs of the 12
commission; and 13
(6) Providing a mechanism for winding up the operations of the commission and the 14
equitable disposition of any surplus funds that may exist after the termination of this compact, after 15
the payment or reserving of all of its debts and obligations. 16
(d) The commission shall publish its bylaws and rules, and any amendments thereto, in a 17
convenient form on the website of the commission. 18
(e) The commission shall maintain its financial records in accordance with the bylaws. 19
(f) The commission shall meet and take such actions as are consistent with the provisions 20
of this compact and the bylaws. 21
(g) The commission shall have the following powers: 22
(1) To promulgate uniform rules to facilitate and coordinate implementation and 23
administration of this compact. The rules shall have the force and effect of law and shall be binding 24
in all party states; 25
(2) To bring and prosecute legal proceedings or actions in the name of the commission, 26
provided that the standing of any licensing board to sue or be sued under applicable law shall not 27
be affected; 28
(3) To purchase and maintain insurance and bonds; 29
(4) To borrow, accept or contract for services of personnel, including, but not limited to, 30
employees of a party state or nonprofit organizations; 31
(5) To cooperate with other organizations that administer state compacts related to the 32
regulation of nursing, including, but not limited to, sharing administrative or staff expenses, office 33
space or other resources; 34
LC000290/SUB A - Page 14 of 23
(6) To hire employees, elect or appoint officers, fix compensation, define duties, grant such 1
individuals appropriate authority to carry out the purposes of this compact, and to establish the 2
commission's personnel policies and programs relating to conflicts of interest, qualifications of 3
personnel and other related personnel matters; 4
(7) To accept any and all appropriate donations, grants and gifts of money, equipment, 5
supplies, materials and services, and to receive, utilize and dispose of the same; provided that at all 6
times the commission shall avoid any appearance of impropriety or conflict of interest; 7
(8) To lease, purchase, accept appropriate gifts or donations of, or otherwise to own, hold, 8
improve or use, any property, whether real, personal or mixed; provided that at all times the 9
commission shall avoid any appearance of impropriety; 10
(9) To sell, convey, mortgage, pledge, lease, exchange, abandon or otherwise dispose of 11
any property, whether real, personal or mixed; 12
(10) To establish a budget and make expenditures; 13
(11) To borrow money; 14
(12) To appoint committees, including advisory committees comprised of administrators, 15
state nursing regulators, state legislators or their representatives, and consumer representatives, and 16
other such interested persons; 17
(13) To provide and receive information from, and to cooperate with, law enforcement 18
agencies; 19
(14) To adopt and use an official seal; and 20
(15) To perform such other functions as may be necessary or appropriate to achieve the 21
purposes of this compact consistent with the state regulation of nurse licensure and practice. 22
(h) Financing of the commission. 23
(1) The commission shall pay, or provide for the payment of, the reasonable expenses of 24
its establishment, organization and ongoing activities; 25
(2) The commission may also levy on and collect an annual assessment from each party 26
state to cover the cost of its operations, activities and staff in its annual budget as approved each 27
year. The aggregate annual assessment amount, if any, shall be allocated based upon a formula to 28
be determined by the commission, which shall promulgate a rule that is binding upon all party 29
states; 30
(3) The commission shall not incur obligations of any kind prior to securing the funds 31
adequate to meet the same; nor shall the commission pledge the credit of any of the party states, 32
except by, and with the authority of, such party state; 33
(4) The commission shall keep accurate accounts of all receipts and disbursements. The 34
LC000290/SUB A - Page 15 of 23
receipts and disbursements of the commission shall be subject to the audit and accounting 1
procedures established under its bylaws. However, all receipts and disbursements of funds handled 2
by the commission shall be audited yearly by a certified or licensed public accountant, and the 3
report of the audit shall be included in and become part of the annual report of the commission. 4
(i) Qualified immunity, defense and indemnification. 5
(1) The administrators, officers, executive director, employees and representatives of the 6
commission shall be immune from suit and liability, either personally or in their official capacity, 7
for any claim for damage to or loss of property or personal injury or other civil liability caused by 8
or arising out of any actual or alleged act, error or omission that occurred, or that the person against 9
whom the claim is made had a reasonable basis for believing occurred, within the scope of 10
commission employment, duties or responsibilities; provided that nothing in this paragraph shall 11
be construed to protect any such person from suit or liability for any damage, loss, injury or liability 12
caused by the intentional, willful or wanton misconduct of that person; 13
(2) The commission shall defend any administrator, officer, executive director, employee 14
or representative of the commission in any civil action seeking to impose liability arising out of 15
any actual or alleged act, error or omission that occurred within the scope of commission 16
employment, duties or responsibilities, or that the person against whom the claim is made had a 17
reasonable basis for believing occurred within the scope of commission employment, duties or 18
responsibilities; provided that nothing herein shall be construed to prohibit that person from 19
retaining their own counsel; and provided further that the actual or alleged act, error or omission 20
did not result from that person’s intentional, willful or wanton misconduct; 21
(3) The commission shall indemnify and hold harmless any administrator, officer, 22
executive director, employee or representative of the commission for the amount of any settlement 23
or judgment obtained against that person arising out of any actual or alleged act, error or omission 24
that occurred within the scope of commission employment, duties or responsibilities, or that such 25
person had a reasonable basis for believing occurred within the scope of commission employment, 26
duties or responsibilities, provided that the actual or alleged act, error or omission did not result 27
from the intentional, willful or wanton misconduct of that person. 28
5-34.3-12. Entry into force, withdrawal and amendment. Effective date, withdrawal 29
and amendment. 30
(a) This compact shall enter into force and become effective as to any state when it has 31
been enacted into the laws of that state. Any party state may withdraw from this compact by 32
enacting a statute repealing the same, but no such withdrawal shall take effect until six (6) months 33
after the withdrawing state has given notice of the withdrawal to the executive heads of all other 34
LC000290/SUB A - Page 16 of 23
party states. 1
(b) No withdrawal shall affect the validity or applicability by the licensing boards of states 2
remaining party to the compact of any report of adverse action occurring prior to the withdrawal. 3
(c) Nothing contained in this compact shall be construed to invalidate or prevent any nurse 4
licensure agreement or other cooperative arrangement between a party state and a non-party state 5
that is made in accordance with the other provisions of this compact. 6
(d) This compact may be amended by the party states. No amendment to this compact shall 7
become effective and binding upon the party states unless and until it is enacted into the laws of all 8
party states. 9
(a) This compact shall become effective upon passage. All party states to this compact, that 10
also were parties to the prior nurse licensure compact superseded by this compact ("prior 11
compact"), shall be deemed to have withdrawn from said prior compact within six (6) months after 12
the effective date of this compact. 13
(b) Each party state to this compact shall continue to recognize a nurse's multistate 14
licensure privilege to practice in that party state issued under the prior compact until such party 15
state has withdrawn from the prior compact. 16
(c) Any party state may withdraw from this compact by enacting a statute repealing the 17
same. A party state's withdrawal shall not take effect until six (6) months after enactment of the 18
repealing statute. 19
(d) A party state's withdrawal or termination shall not affect the continuing requirement of 20
the withdrawing or terminated state's licensing board to report adverse actions and significant 21
investigations occurring prior to the effective date of such withdrawal or termination. 22
(e) Nothing contained in this compact shall be construed to invalidate or prevent any nurse 23
licensure agreement or other cooperative arrangement between a party state and a non-party state 24
that is made in accordance with the other provisions of this compact. 25
(f) This compact may be amended by the party states. No amendment to this compact shall 26
become effective and binding upon the party states unless and until it is enacted into the laws of all 27
party states. 28
(g) Representatives of non-party states to this compact shall be invited to participate in the 29
activities of the commission, on a nonvoting basis, prior to the adoption of this compact by all 30
states. 31
5-34.3-14. Construction and severability. 32
(a) This compact shall be liberally construed so as to effectuate the purposes thereof. The 33
provisions of this compact shall be severable and if any phrase, clause, sentence or provision of 34
LC000290/SUB A - Page 17 of 23
this compact is declared to be contrary to the constitution of any party state or of the United States 1
or the applicability thereof to any government, agency, person or circumstance is held invalid, the 2
validity of the remainder of this compact and the applicability thereof to any government, agency, 3
person or circumstance shall not be affected thereby. If this compact shall be held contrary to the 4
constitution of any state party thereto, the compact shall remain in full force and effect as to the 5
remaining party states and in full force and effect as to the party state affected as to all severable 6
matters. 7
(b) In the event party states find a need for settling disputes arising under this compact: 8
(1) The party states may submit the issues in dispute to an arbitration panel which will be 9
comprised of an individual appointed by the compact administrator in the home state; an individual 10
appointed by the compact administrator in the remote state(s) involved; and an individual mutually 11
agreed upon by the compact administrators of all the party states involved in the dispute. 12
(2) The decision of a majority of the arbitrators shall be final and binding. 13
SECTION 2. Sections 5-34.3-7 and 5-34.3-11 of the General Laws in Chapter 5-34.3 14
entitled "Nurse Licensure Compact" are hereby repealed. 15
5-34.3-7. Adverse actions. 16
In addition to the provisions described in § 5-34.3-5, the following provisions apply: 17
(1) The licensing board of a remote state shall promptly report to the administrator of the 18
coordinated licensure information system any remote state actions including the factual and legal 19
basis for such action, if known. The licensing board of a remote state shall also promptly report any 20
significant current investigative information yet to result in a remote state action. The administrator 21
of the coordinated licensure information system shall promptly notify the home state of any such 22
reports. 23
(2) The licensing board of a party state shall have the authority to complete any pending 24
investigations for a nurse who changes primary state of residence during the course of such 25
investigations. It shall also have the authority to take appropriate action(s), and shall promptly 26
report the conclusions of such investigations to the administrator of the coordinated licensure 27
information system. The administrator of the coordinated licensure information system shall 28
promptly notify the new home state of any such actions. 29
(3) A remote state may take adverse action affecting the multistate licensure privilege to 30
practice within that party state. However, only the home state shall have the power to impose 31
adverse action against the license issued by the home state. 32
(4) For purposes of imposing adverse action, the licensing board of the home state shall 33
give the same priority and effect to reported conduct received from a remote state as it would if 34
LC000290/SUB A - Page 18 of 23
such conduct had occurred within the home state. In so doing, it shall apply its own state laws to 1
determine appropriate action. 2
(5) The home state may take adverse action based on the factual findings of the remote 3
state, so long as each state follows its own procedures for imposing such adverse action. 4
(6) Nothing in this compact shall override a party state’s decision that participation in an 5
alternative program may be used in lieu of licensure action and that such participation shall remain 6
non-public if required by the party state’s laws. Party states must require nurses who enter any 7
alternative programs to agree not to practice in any other party state during the term of the 8
alternative program without prior authorization from such other party state. 9
5-34.3-11. Immunity. 10
No party state or the officers or employees or agents of a party state’s nurse licensing board 11
who act in accordance with the provisions of this compact shall be liable on account of any act or 12
omission in good faith while engaged in the performance of their duties under this compact. Good 13
faith in this article shall not include willful misconduct, gross negligence, or recklessness. 14
SECTION 3. Chapter 5-34.3 of the General Laws entitled "Nurse Licensure Compact" is 15
hereby amended by adding thereto the following sections: 16
5-34.3-10.1. Rulemaking. 17
(a) The commission shall exercise its rulemaking powers pursuant to the criteria set forth 18
in this section and the rules adopted thereunder. Rules and amendments shall become binding as of 19
the date specified in each rule or amendment and shall have the same force and effect as provisions 20
of this compact. 21
(b) Rules or amendments to the rules shall be adopted at a regular or special meeting of the 22
commission. 23
(c) Prior to promulgation and adoption of a final rule or rules by the commission, and at 24
least sixty (60) days in advance of the meeting at which the rule will be considered and voted upon, 25
the commission shall file a notice of proposed rulemaking: 26
(1) On the website of the commission; and 27
(2) On the website of each licensing board or the publication in which each state would 28
otherwise publish proposed rules. 29
(d) The notice of proposed rulemaking shall include: 30
(1) The proposed time, date and location of the meeting in which the rule will be considered 31
and voted upon; 32
(2) The text of the proposed rule or amendment, and the reason for the proposed rule; 33
(3) A request for comments on the proposed rule from any interested person; and 34
LC000290/SUB A - Page 19 of 23
(4) The manner in which interested persons may submit notice to the commission of their 1
intention to attend the public hearing and any written comments. 2
(e) Prior to adoption of a proposed rule, the commission shall allow persons to submit 3
written data, facts, opinions and arguments, which shall be made available to the public. 4
(f) The commission shall grant an opportunity for a public hearing before it adopts a rule 5
or amendment. 6
(g) The commission shall publish the place, time and date of the scheduled public hearing. 7
(1) Hearings shall be conducted in a manner providing each person who wishes to comment 8
a fair and reasonable opportunity to comment orally or in writing. All hearings will be recorded, 9
and a copy will be made available upon request. 10
(2) Nothing in this section shall be construed as requiring a separate hearing on each rule. 11
Rules may be grouped for the convenience of the commission at hearings required by this section. 12
(h) If no one appears at the public hearing, the commission may proceed with promulgation 13
of the proposed rule. 14
(i) Following the scheduled hearing date, or by the close of business on the scheduled 15
hearing date if the hearing was not held, the commission shall consider all written and oral 16
comments received. 17
(j) The commission shall, by majority vote of all administrators, take final action on the 18
proposed rule and shall determine the effective date of the rule, if any, based on the rulemaking 19
record and the full text of the rule. 20
(k) Upon determination that an emergency exists, the commission may consider and adopt 21
an emergency rule without prior notice, opportunity for comment or hearing, provided that the 22
usual rulemaking procedures provided in this compact and in this section shall be retroactively 23
applied to the rule as soon as reasonably possible, in no event later than ninety (90) days after the 24
effective date of the rule. For the purposes of this provision, an emergency rule is one that must be 25
adopted immediately in order to: 26
(1) Meet an imminent threat to public health, safety or welfare; 27
(2) Prevent a loss of commission or party state funds; or 28
(3) Meet a deadline for the promulgation of an administrative rule that is required by federal 29
law or rule. 30
(l) The commission may direct revisions to a previously adopted rule or amendment for 31
purposes of correcting typographical errors, errors in format, errors in consistency or grammatical 32
errors. Public notice of any revisions shall be posted on the website of the commission. The revision 33
shall be subject to challenge by any person for a period of thirty (30) days after posting. The revision 34
LC000290/SUB A - Page 20 of 23
may be challenged only on grounds that the revision results in a material change to a rule. A 1
challenge shall be made in writing, and delivered to the commission, prior to the end of the notice 2
period. If no challenge is made, the revision will take effect without further action. If the revision 3
is challenged, the revision may not take effect without the approval of the commission. 4
5-34.3-10.2. Oversight, dispute resolution, enforcement and department of health 5
obligations. 6
(a) Oversight. 7
(1) Each party state shall enforce this compact and take all actions necessary and 8
appropriate to effectuate this compact's purposes and intent. 9
(2) The commission shall be entitled to receive service of process in any proceeding that 10
may affect the powers, responsibilities or actions of the commission, and shall have standing to 11
intervene in such a proceeding for all purposes. Failure to provide service of process in such 12
proceeding to the commission shall render a judgment or order void as to the commission, this 13
compact or promulgated rules. 14
(b) Default, technical assistance and termination. 15
(1) If the commission determines that a party state has defaulted in the performance of its 16
obligations or responsibilities under this compact or the promulgated rules, the commission shall: 17
(i) Provide written notice to the defaulting state and other party states of the nature of the 18
default, the proposed means of curing the default or any other action to be taken by the commission; 19
and 20
(ii) Provide remedial training and specific technical assistance regarding the default; 21
(2) If a state in default fails to cure the default, the defaulting state's membership in this 22
compact may be terminated upon an affirmative vote of a majority of the administrators, and all 23
rights, privileges and benefits conferred by this compact may be terminated on the effective date 24
of termination. A cure of the default does not relieve the offending state of obligations or liabilities 25
incurred during the period of default; 26
(3) Termination of membership in this compact shall be imposed only after all other means 27
of securing compliance have been exhausted. Notice of intent to suspend or terminate shall be given 28
by the commission to the governor of the defaulting state and to the executive officer of the 29
defaulting state's licensing board and each of the party states; 30
(4) A state whose membership in this compact has been terminated is responsible for all 31
assessments, obligations and liabilities incurred through the effective date of termination, including 32
obligations that extend beyond the effective date of termination; 33
(5) The commission shall not bear any costs related to a state that is found to be in default 34
LC000290/SUB A - Page 21 of 23
or whose membership in this compact has been terminated unless agreed upon in writing between 1
the commission and the defaulting state; 2
(6) The defaulting state may appeal the action of the commission by petitioning the U.S. 3
District Court for the District of Columbia or the federal district in which the commission has its 4
principal offices. The prevailing party shall be awarded all costs of such litigation, including 5
reasonable attorneys' fees. 6
(c) Dispute Resolution. 7
(1) Upon request by a party state, the commission shall attempt to resolve disputes related 8
to the compact that arise among party states and between party and non-party states; 9
(2) The commission shall promulgate a rule providing for both mediation and binding 10
dispute resolution for disputes, as appropriate; 11
(3) In the event the commission cannot resolve disputes among party states arising under 12
this compact: 13
(i) The party states may submit the issues in dispute to an arbitration panel, which will be 14
comprised of individuals appointed by the compact administrator in each of the affected party states 15
and an individual mutually agreed upon by the compact administrators of all the party states 16
involved in the dispute; 17
(ii) The decision of a majority of the arbitrators shall be final and binding. 18
(d) Enforcement. 19
(1) The commission, in the reasonable exercise of its discretion, shall enforce the 20
provisions and rules of this compact; 21
(2) By majority vote, the commission may initiate legal action in the U.S. District Court 22
for the District of Columbia or the federal district where the commission has its principal offices, 23
against a party state that is in default, to enforce compliance with the provisions of this compact 24
and its promulgated rules and bylaws. The relief sought may include both injunctive relief and 25
damages. In the event judicial enforcement is necessary, the prevailing party shall be awarded all 26
costs of such litigation, including reasonable attorneys' fees; 27
(3) The remedies herein shall not be the exclusive remedies of the commission. The 28
commission may also pursue any other remedies available under federal or state law. 29
(e) Data collection - Reporting. 30
(1) Data collection. Commencing in calendar year 2025, Rhode Island employers who 31
employ registered nurses or licensed practical or vocational nurses shall report to the Rhode Island 32
department of health (“RIDOH”), not later than January 30 of each year, the following information 33
and data for the employer, for the period of the immediately preceding calendar year (the “reporting 34
LC000290/SUB A - Page 22 of 23
period”): 1
(i) The number of new hires of registered nurses during the reporting period; 2
(ii) The number of new hires of registered nurses who hold multistate licenses and are not 3
licensed in Rhode Island during the reporting period; 4
(iii) The number of new hires of licensed practical nurses and vocational nurses during the 5
reporting period; 6
(iv) The number of new hires of licensed practical nurses and vocational nurses who hold 7
multistate licenses and are not licensed in Rhode Island during the reporting period; 8
(v) The total number of registered nurses employed during the reporting period; and 9
(vi) The total number of licensed practical nurses and vocational nurses employed during 10
the reporting period. 11
(2) Reporting. RIDOH shall annually compile the data received from employers pursuant 12
to subsection (a)(1) of this section and prepare a report that aggregates the information, and 13
disaggregated by new hires and retained employees, for registered nurses, license practical nurses, 14
and vocational nurses, from the results of the data collected pursuant to subsection (e)(1) of this 15
section. This compiled data shall be incorporated into a report which shall be provided to the 16
governor, the speaker of the house, and the president of the senate, not later than March 1 of each 17
year, with the first report due on March 1, 2025. 18
(f) Nurse license fees. RIDOH shall not increase the amount of any licensing fee for 19
registered nurses or a licensed practical nurse or vocational nurse, including, but not limited to, 20
license renewals, for a period of three (3) years commencing on January 1, 2024. 21
SECTION 4. This act shall take effect on January 1, 2024, and shall sunset and expire on 22
January 1, 2027. 23
========
LC000290/SUB A
========
LC000290/SUB A - Page 23 of 23
EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO BUSINESSES AND PROFESSIONS -- NURSE LICENSURE COMP ACT
***
This act would amend the interstate nurse licensure compact and would adopt an enhanced 1
and more comprehensive version of the compact, to allow nurses to hold a multi-state license which 2
would allow them to practice across state lines without having to obtain multiple licenses. 3
This act would take effect on January 1, 2024, and would sunset and expire on January 1, 4
2027. 5
========
LC000290/SUB A
========