Chapter 43-12.4 NURSE LICENSURE COMPACT

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CHAPTER 43-12.4 NURSE LICENSURE COMPACT 43-12.4-01. Nurse licensure compact

ARTICLE I - FINDINGS AND DECLARATION OF PURPOSE The party states find that: a

The health and safety of the public are affected by the degree of compliance with and the effectiveness of enforcement activities related to state nurse licensure laws; Violations of nurse licensure and other laws regulating the practice of nursing may result in injury or harm to the public; The expanded mobility of nurses and the use of advanced communication technologies as part of our nation's health care delivery system require greater coordination and cooperation among states in the areas of nurse licensure and regulation; d. New practice modalities and technology make compliance with individual state nurse licensure laws difficult and complex; The current system of duplicative licensure for nurses practicing in multiple states is cumbersome and redundant for both nurses and states; and f. Uniformity of nurse licensure requirements throughout the states promotes public e

safety and public health benefits

The general purposes of this compact are to: a

Facilitate the states' responsibility to protect the public's health and safety; Ensure and encourage the cooperation of party states in the areas of nurse licensure and regulation; Facilitate the exchange of information between party states in the areas of nurse regulation, investigation, and adverse actions; Promote compliance with the laws governing the practice of nursing in each jurisdiction; Invest all party states with the authority to hold a nurse accountable for meeting all state practice laws in the state in which the patient is located at the time care is rendered through the mutual recognition of party state licenses; f. Decrease redundancies in the consideration and issuance of nurse licenses; and g

Provide opportunities for interstate practice by nurses who meet uniform licensure requirements

ARTICLE II - DEFINITIONS "Adverse action" means any administrative, civil, equitable, or criminal action permitted by a state's laws which is imposed by a licensing board or other authority against a nurse, including actions against an individual's license or multistate licensure privilege such as revocation, suspension, probation, monitoring of the licensee, limitation on the licensee's practice, or any other encumbrance on licensure affecting a nurse's authorization to practice, including issuance of a cease and desist action

"Alternative program" means a nondisciplinary monitoring program approved by a licensing board

"Coordinated licensure information system" means an integrated process for collecting, storing, and sharing information on nurse licensure and enforcement activities related to nurse licensure laws which is administered by a nonprofit organization composed of and controlled by licensing boards

"Current significant investigative information" means: a

Investigative information that a licensing board, after a preliminary inquiry that includes notification and an opportunity for the nurse to respond, if required by state law, has reason to believe is not groundless and, if proved true, would indicate more than a minor infraction; or As used in this compact: 1

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Investigative information that indicates that the nurse represents an immediate threat to public health and safety regardless of whether the nurse has been notified and had an opportunity to respond

"Encumbrance" means a revocation or suspension of, or any limitation on, the full and unrestricted practice of nursing imposed by a licensing board

"Home state" means the party state that is the nurse's primary state of residence

"Licensing board" means a party state's regulatory body responsible for issuing nurse licenses

"Multistate license" means a license to practice as a registered or a licensed practical/vocational nurse issued by a home state licensing board which authorizes the licensed nurse to practice in all party states under a multistate licensure privilege

"Multistate licensure privilege" means a legal authorization associated with a multistate license permitting the practice of nursing as either a registered nurse or licensed practical/vocational nurse in a remote state

"Nurse" means registered nurse or licensed practical/vocational nurse, as those terms are defined by each party state's practice laws

"Party state" means any state that has adopted this compact

"Remote state" means a party state, other than the home state

"Single-state license" means a nurse license issued by a party state which authorizes practice only within the issuing state and does not include a multistate licensure privilege to practice in any other party state

"State" means a state, territory, or possession of the United States and the District of Columbia

"State practice laws" means a party state's laws, rules, and regulations that govern the practice of nursing, define the scope of nursing practice, and create the methods and grounds for imposing discipline. "State practice laws" do not include requirements necessary to obtain and retain a license, except for qualifications or requirements of the home state

ARTICLE III - GENERAL PROVISIONS AND JURISDICTION A multistate license to practice registered or licensed practical/vocational nursing issued by a home state to a resident in that state will be recognized by each party state as authorizing a nurse to practice as a registered nurse or as a licensed practical/vocational nurse, under a multistate licensure privilege, in each party state

A state shall implement procedures for considering the criminal history records of applicants for initial multistate license or licensure by endorsement. Such procedures shall include the submission of fingerprints or other biometric-based information by applicants for the purpose of obtaining an applicant's criminal history record information from the federal bureau of investigation and the agency responsible for retaining that state's criminal records

Each party state shall require the following for an applicant to obtain or retain a multistate license in the home state: a. Meets the home state's qualifications for licensure or renewal of licensure, as well as, all other applicable state laws; (1) Has graduated or is eligible to graduate from a licensing board-approved licensed practical/vocational nurse prelicensure b

registered nurse or education program; or (2) Has graduated from a foreign registered nurse or licensed practical/vocational nurse prelicensure education program that: (a) Has been approved by the authorized accrediting body in the applicable country; and (b) Has been verified by an independent credentials review agency to be comparable to a licensing board-approved prelicensure education program; c. Has, if a graduate of a foreign prelicensure education program not taught in English or if English is not the individual's native language, successfully passed Page No. 2 an English proficiency examination that includes the components of reading, speaking, writing, and listening; d. Has successfully passed an NCLEX-RN® or NCLEX-PN® Examination or recognized predecessor, as applicable; Is eligible for or holds an active, unencumbered license; e

f. Has submitted, in connection with an application for initial licensure or licensure by endorsement, fingerprints or other biometric data for the purpose of obtaining criminal history record information from the federal bureau of investigation and the agency responsible for retaining that state's criminal records; g. Has not been convicted or found guilty, or has entered an agreed disposition, of a felony offense under applicable state or federal criminal law; i

h. Has not been convicted or found guilty, or has entered an agreed disposition, of a misdemeanor offense related to the practice of nursing as determined on a case-by-case basis; Is not currently enrolled in an alternative program; Is subject to self-disclosure requirements regarding current participation in an alternative program; and k. Has a valid United States social security number

All party states may, in accordance with existing state due process law, to take adverse action against a nurse's multistate licensure privilege such as revocation, suspension, probation, or any other action that affects a nurse's authorization to practice under a multistate licensure privilege, including cease and desist actions. If a party state takes such action, it promptly shall notify the administrator of the coordinated licensure information system. The administrator of the coordinated licensure information system promptly shall notify the home state of any such actions by remote states

A nurse practicing in a party state shall comply with the state practice laws of the state in which the client is located at the time service is provided. The practice of nursing is not limited to patient care, but includes all nursing practice as defined by the state practice laws of the party state in which the client is located. The practice of nursing in a party state under a multistate licensure privilege will subject a nurse to the jurisdiction of the licensing board, the courts, and the laws of the party state in which the client is located at the time service is provided

Individuals not residing in a party state continue to be able to apply for a party state's single-state license as provided under the laws of each party state. However, the single-state license granted to these individuals will not be recognized as granting the privilege to practice nursing in any other party state. This compact does not affect the requirements established by a party state for the issuance of a single-state license

Any nurse holding a home state multistate license, on the effective date of this compact, may retain and renew the multistate license issued by the nurse's then- current home state, provided that: a

A nurse, who changes primary state of residence after this compact's effective date, shall meet all applicable requirements of subsection 3 of article III to obtain a multistate license from a new home state

A nurse who fails to satisfy the multistate licensure requirements in subsection 3 of article III due to a disqualifying event occurring after this compact's effective date is ineligible to retain or renew a multistate license, and the nurse's multistate license must be revoked or deactivated in accordance with applicable rules adopted by the Interstate Commission of Nurse Licensure Compact Administrators ("commission")

ARTICLE IV - APPLICATIONS FOR LICENSURE IN A PARTY STATE 4

1. Upon application for a multistate license, the licensing board in the issuing party state shall ascertain, through the coordinated licensure information system, whether the applicant has ever held, or is the holder of, a license issued by any other state, whether there are any encumbrances on any license or multistate licensure privilege held by the applicant, whether any adverse action has been taken against any license Page No. 3 or multistate licensure privilege held by the applicant, and whether the applicant is currently participating in an alternative program

A nurse may hold a multistate license, issued by the home state, in only one party state at a time

If a nurse changes primary state of residence by moving between two party states, the nurse shall apply for licensure in the new home state, and the multistate license issued by the prior home state will be deactivated in accordance with applicable rules adopted by the commission

The nurse may apply for licensure in advance of a change in primary state of residence

A multistate license may not be issued by the new home state until the nurse provides satisfactory evidence of a change in primary state of residence to the new home state and satisfies all applicable requirements to obtain a multistate license from the new home state

If a nurse changes primary state of residence by moving from a party state to a nonparty state, the multistate license issued by the prior home state will convert to a single-state license, valid only in the former home state

ARTICLE V - ADDITIONAL AUTHORITIES INVESTED IN PARTY STATE LICENSING BOARDS 2

In addition to the other powers conferred by state law, a licensing board may: a

Take adverse action against a nurse's multistate licensure privilege to practice within that party state

(1) Only the home state has the power to take adverse action against a nurse's license issued by the home state

(2) For purposes of taking adverse action, the home state licensing board shall give the same priority and effect to reported conduct received from a remote state as it would if such conduct had occurred within the home state. In so doing, the home state shall apply its own state laws to determine appropriate action

Issue cease and desist orders or impose an encumbrance on a nurse's authority to practice within that party state

c. Complete any pending investigations of a nurse who changes primary state of residence during the course of such investigations. The licensing board also may take any appropriate action and promptly shall report the conclusions of such investigations to the administrator of the coordinated licensure information system. The administrator of the coordinated licensure information system promptly shall notify the new home state of any such actions

Issue subpoenas for both hearings and investigations which require the attendance and testimony of witnesses, as well as, the production of evidence. Subpoenas issued by a licensing board in a party state for the attendance and testimony of witnesses or the production of evidence from another party state must be enforced in the latter state by any court of competent jurisdiction, according to the practice and procedure of that court applicable to subpoenas issued in proceedings pending before it. The issuing authority shall pay any witness fees, travel expenses, mileage, and other fees required by the service statutes of the state in which the witnesses or evidence are located

e. Obtain and submit, for each nurse licensure applicant, fingerprint or other biometric-based information to the federal bureau of investigation for criminal background checks, receive the results of the federal bureau of investigation record search on criminal background checks, and use the results in making licensure decisions

If otherwise permitted by state law, recover from the affected nurse the costs of investigations and disposition of cases resulting from any adverse action taken against that nurse

Take adverse action based on the factual findings of the remote state, if the licensing board follows its own procedures for taking such adverse action

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If adverse action is taken by the home state against a nurse's multistate license, the nurse's multistate licensure privilege to practice in all other party states must be deactivated until all encumbrances have been removed from the multistate license. All home state disciplinary orders that impose adverse action against a nurse's multistate license shall include a statement that the nurse's multistate licensure privilege is deactivated in all party states during the pendency of the order

This compact does not override a party state's decision that participation in an alternative program may be used in lieu of adverse action. The home state licensing board shall deactivate the multistate licensure privilege under the multistate license of any nurse for the duration of the nurse's participation in an alternative program

ARTICLE VI - COORDINATED LICENSURE INFORMATION SYSTEM AND EXCHANGE OF INFORMATION All party states shall participate in a coordinated licensure information system of all licensed registered nurses and licensed practical/vocational nurses. This system includes information on the licensure and disciplinary history of each nurse, as submitted by party states, to assist in the coordination of nurse licensure and enforcement efforts

The commission, in consultation with the administrator of the coordinated licensure information system, shall formulate necessary and proper procedures for the identification, collection, and exchange of information under this compact

All licensing boards promptly shall report to the coordinated licensure information system any adverse action, any current significant investigative information, denials of applications (with the reasons for such denials), and nurse participation in alternative programs known to the licensing board regardless of whether such participation is deemed nonpublic or confidential under state law

4. Current significant investigative information and participation in nonpublic or confidential alternative programs must be transmitted through the coordinated licensure information system only to party state licensing boards

5. Notwithstanding any other provision of law, all party state licensing boards contributing information to the coordinated licensure information system may designate information that may not be shared with nonparty states or disclosed to other entities or individuals without the express permission of the contributing state

Any personally identifiable information obtained from the coordinated licensure information system by a party state licensing board may not be shared with nonparty states or disclosed to other entities or individuals except to the extent permitted by the laws of the party state contributing the information

Any information contributed to the coordinated licensure information system which is subsequently required to be expunged by the laws of the party state contributing that information also must be expunged from the coordinated licensure information system

The compact administrator of each party state shall furnish a uniform data set to the compact administrator of each other party state, which must include, at a minimum: a

d. Other information that may facilitate the administration of this compact, as Identifying information; Licensure data; Information related to alternative program participation; and 7

determined by commission rules

The compact administrator of a party state shall provide all investigative documents and information requested by another party state

ARTICLE VII - ESTABLISHMENT OF THE INTERSTATE COMMISSION OF NURSE LICENSURE COMPACT ADMINISTRATORS 1

The party states hereby create and establish a joint public entity known as the Interstate Commission of Nurse Licensure Compact Administrators

The commission is an instrumentality of the party states

Venue is proper, and judicial proceedings by or against the commission must be brought solely and exclusively, in a court of competent jurisdiction where the principal office of the commission is located. The commission may waive venue Page No. 5 2. Membership, voting, and meetings

and jurisdictional defenses to the extent it adopts or consents to participate in alternative dispute resolution proceedings

This compact may not be construed to be a waiver of sovereign immunity

Each party state must have and be limited to one administrator. The head of the state licensing board or designee is the administrator of this compact for each party state. Any administrator may be removed or suspended from office as provided by the law of the state from which the administrator is appointed. Any vacancy occurring in the commission must be filled in accordance with the laws of the party state in which the vacancy exists

Each administrator is entitled to one vote with regard to the promulgation of rules and creation of bylaws and otherwise has an opportunity to participate in the business and affairs of the commission. An administrator shall vote in person or by such other means as provided in the bylaws. The bylaws may provide for an administrator's participation in meetings by telephone or other means of communication

The commission shall meet at least once during each calendar year. Additional meetings must be held as set forth in the bylaws or rules of the commission

All meetings are open to the public, and public notice of meetings must be given in the same manner as required under the rulemaking provisions in Article VIII

The commission may convene in a closed, nonpublic meeting if the commission discusses: (1) Noncompliance of a party state with its obligations under this compact; (2) The employment, compensation, discipline, or other personnel matters, practices, or procedures related to specific employees or other matters related to the commission's internal personnel practices and procedures; (3) Current, threatened, or reasonably anticipated litigation; (4) Negotiation of contracts for the purchase or sale of goods, services, or real estate; (5) Accusing any person of a crime or formally censuring any person; (6) Disclosure of trade secrets or commercial or financial information that is privileged or confidential; (7) Disclosure of information of a personal nature if disclosure would constitute a clearly unwarranted invasion of personal privacy; (8) Disclosure of investigatory records compiled for law enforcement purposes; (9) Disclosure of information related to any reports prepared by or on behalf of the Commission for the purpose of investigation of compliance with this compact; or (10) Matters specifically exempted from disclosure by federal or state statute

If a meeting, or portion of a meeting, is closed pursuant to this provision, the commission's legal counsel or designee shall certify that the meeting may be closed and shall reference each relevant exempting provision. The commission shall keep minutes that fully and clearly describe all matters discussed in a meeting and shall provide a full and accurate summary of actions taken, and the reasons for the actions taken, including a description of the views expressed. All documents considered in connection with an action must be identified in such minutes. All minutes and documents of a closed meeting must remain under seal, subject to release by a majority vote of the commission or order of a court of competent jurisdiction

By a majority vote of the administrators, the commission shall prescribe bylaws or rules to govern its conduct as may be necessary or appropriate to carry out the purposes and exercise the powers of this compact, including: a

Establishing the fiscal year of the commission; Providing reasonable standards and procedures: (1) For the establishment and meetings of other committees; and Page No. 6 4

(2) Governing any general or specific delegation of any authority or function of the commission; c

Providing reasonable procedures for calling and conducting meetings of the commission, ensuring reasonable advance notice of all meetings and providing an opportunity for attendance of such meetings by interested parties, with enumerated exceptions designed to protect the public's interest, the privacy of individuals, and proprietary information, including trade secrets. The commission may meet in closed session only after a majority of the administrators vote to close a meeting in whole or in part. As soon as practicable, the commission shall make public a copy of the vote to close the meeting revealing the vote of each administrator, with no proxy votes allowed; Establishing the titles, duties, and authority and reasonable procedures for the election of the officers of the commission; Providing reasonable standards and procedures for the establishment of the personnel policies and programs of the commission. Notwithstanding any civil service or other similar laws of any party state, the bylaws exclusively must govern the personnel policies and programs of the commission; and Providing a mechanism for winding up the operations of the commission and the equitable disposition of any surplus funds that may exist after the termination of this compact after the payment or reserving of all of its debts and obligations; The commission shall publish its bylaws and rules, and any amendments thereto, in a convenient form on the website of the commission

The commission shall maintain its financial records in accordance with the bylaws

The commission shall meet and take such actions as are consistent with the provisions of this compact and the bylaws

The commission may: a

Promulgate uniform rules to facilitate and coordinate implementation and administration of this compact. The rules have the force and effect of law and are binding in all party states; Bring and prosecute legal proceedings or actions in the name of the commission, provided that the standing of any licensing board to sue or be sued under applicable law may not be affected; Purchase and maintain insurance and bonds; Borrow, accept, or contract for services of personnel, including, but not limited to, employees of a party state or nonprofit organizations; e. Cooperate with other organizations that administer state compacts related to the regulation of nursing, including sharing administrative or staff expenses, office space, or other resources; b

f. Hire employees, elect or appoint officers, fix compensation, define duties, grant such individuals appropriate authority to carry out the purposes of this compact, and to establish the commission's personnel policies and programs relating to conflicts of interest, qualifications of personnel, and other related personnel matters; Accept any and all appropriate donations, grants, and gifts of money, equipment, supplies, materials, and services, and to receive, utilize, and dispose of the same if at all times the commission avoids any appearance of impropriety or conflict of interest; Lease, purchase, accept appropriate gifts or donations of, or otherwise to own, hold, improve or use, any property, whether real, personal, or mixed if at all times the commission avoids any appearance of impropriety; Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of any property, whether real, personal, or mixed; Establish a budget and make expenditures; Borrow money; j

Page No. 7 9. Qualified immunity, defense, and indemnification

Appoint committees, including advisory committees comprised of administrators, state nursing regulators, state legislators or their representatives, consumer representatives, and other such interested persons; Provide and receive information from, and to cooperate with, law enforcement agencies; Adopt and use an official seal; and Perform such other functions as may be necessary or appropriate to achieve the purposes of this compact consistent with the state regulation of nurse licensure and practice

Financing of the commission

The commission shall pay, or provide for the payment of, the reasonable expenses of its establishment, organization, and ongoing activities

The commission may also levy on and collect an annual assessment from each party state to cover the cost of its operations, activities, and staff in its annual budget as approved each year. The aggregate annual assessment amount, if any, must be allocated based upon a formula to be determined by the commission, which shall promulgate a rule that is binding upon all party states

The commission may not incur obligations of any kind before securing the funds adequate to meet the same, nor may the commission pledge the credit of any of the party states, except by, and with the authority of, such party state

The commission shall keep accurate accounts of all receipts and disbursements. The receipts and disbursements of the commission are subject to the audit and accounting procedures established under its bylaws. However, all receipts and disbursements of funds handled by the commission must be audited yearly by a certified or licensed public accountant, and the report of the audit must be included in and become part of the annual report of the commission

The administrators, officers, executive director, employees, and representatives of the commission are immune from suit and liability, either personally or in their official capacity, for any claim for damage to or loss of property or personal injury or other civil liability caused by or arising out of any actual or alleged act, error, or omission that occurred, or that the person against which the claim is made had a reasonable basis for believing occurred, within the scope of commission employment, duties or responsibilities. However, this subdivision may not be construed to protect any such person from suit or liability for any damage, loss, injury, or liability caused by the intentional, willful, or wanton misconduct of that person

The commission shall defend any administrator, officer, executive director, employee, or representative of the commission in any civil action seeking to impose liability arising out of any actual or alleged act, error, or omission that occurred within the scope of commission employment, duties, or responsibilities, or that the person against which the claim is made had a reasonable basis for believing occurred within the scope of commission employment, duties, or responsibilities. However, this subdivision may not be construed to prohibit that person from retaining that person's own counsel and provided further that the actual or alleged act, error, or omission did not result from that person's intentional, willful, or wanton misconduct

The commission shall indemnify and hold harmless any administrator, officer, executive director, employee, or representative of the commission for the amount of any settlement or judgment obtained against that person arising out of any actual or alleged act, error, or omission that occurred within the scope of commission employment, duties, or responsibilities, or that such person had a reasonable basis for believing occurred within the scope of commission employment, duties, or responsibilities provided that the actual or alleged act, error, or omission did not result from the intentional, willful, or wanton misconduct of that person

Page No. 8 ARTICLE VIII - RULEMAKING 1

The commission shall exercise its rulemaking powers pursuant to the criteria set forth in this article and the rules adopted under this article. Rules and amendments become binding as of the date specified in each rule or amendment and have the same force and effect as provisions of this compact

2. Rules or amendments to the rules must be adopted at a regular or special meeting of the commission

Before the promulgation and adoption of a final rule or rules by the commission, and at least sixty days in advance of the meeting at which the rule will be considered and voted upon, the commission shall file a notice of proposed rulemaking: a. On the website of the commission; and b. On the website of each licensing board or the publication in which each state would otherwise publish proposed rules

The notice of proposed rulemaking must include: a

The proposed time, date, and location of the meeting at which the rule will be considered and voted upon; The text of the proposed rule or amendment, and the reason for the proposed rule; A request for comments on the proposed rule from any interested person; and The manner in which interested persons may submit notice to the commission of their intention to attend the public hearing and any written comments

Before adoption of a proposed rule, the commission shall allow persons to submit written data, facts, opinions, and arguments, which must be made available to the public

The commission shall grant an opportunity for a public hearing before it adopts a rule or amendment

The commission shall publish the place, time, and date of the scheduled public hearing

a. Hearings must be conducted in a manner providing each person that wishes to comment a fair and reasonable opportunity to comment orally or in writing. All hearings will be recorded, and a copy must be made available upon request

This section may not be construed as requiring a separate hearing on each rule. Rules may be grouped for the convenience of the commission at hearings required by this section

If no one appears at the public hearing, the commission may proceed with promulgation of the proposed rule

Following the scheduled hearing date, or by the close of business on the scheduled hearing date if the hearing was not held, the commission shall consider all written and oral comments received

By majority vote of all administrators, the commission shall take final action on the proposed rule and shall determine the effective date of the rule, if any, based on the rulemaking record and the full text of the rule

11. Upon determination that an emergency exists, the commission may consider and adopt an emergency rule without prior notice, opportunity for comment, or hearing. However, the usual rulemaking procedures provided in this compact and in this section must be retroactively applied to the rule as soon as reasonably possible, in no event later than ninety days after the effective date of the rule. For the purposes of this provision, an emergency rule is one that must be adopted immediately in order to: a. Meet an imminent threat to public health, safety, or welfare; b

c. Meet a deadline for the promulgation of an administrative rule that is required by Prevent a loss of commission or party state funds; or federal law or rule

The commission may direct revisions to a previously adopted rule or amendment for purposes of correcting typographical errors, errors in format, errors in consistency, or grammatical errors. Public notice of any revisions must be posted on the website of the commission. The revision is subject to challenge by any person for a period of Page No. 9 thirty days after posting. The revision may be challenged only on grounds that the revision results in a material change to a rule. A challenge must be made in writing, and delivered to the commission before the end of the notice period. If a challenge is not made, the revision will take effect without further action. If the revision is challenged, the revision may not take effect without the approval of the commission

ARTICLE IX - OVERSIGHT, DISPUTE, RESOLUTION AND ENFORCEMENT 1. Oversight

2. Default, technical assistance, and termination

default

Each party state shall enforce this compact and take all actions necessary and appropriate to effectuate this compact's purposes and intent

The commission is entitled to receive service of process in any proceeding that may affect the powers, responsibilities, or actions of the commission, and has standing to intervene in such a proceeding for all purposes. Failure to provide service of process in such proceeding to the commission renders a judgment or order void as to the commission, this compact, or promulgated rules

If the commission determines a party state has defaulted in the performance of its obligations or responsibilities under this compact or the promulgated rules, the commission shall: (1) Provide written notice to the defaulting state and other party states of the nature of the default, the proposed means of curing the default, or any other action to be taken by the commission; and (2) Provide remedial training and specific technical assistance regarding the If a state in default fails to cure the default, the defaulting state's membership in this compact may be terminated upon an affirmative vote of a majority of the administrators, and all rights, privileges, and benefits conferred by this compact may be terminated on the effective date of termination. A cure of the default does not relieve the offending state of obligations or liabilities incurred during the period of default

Termination of membership in this compact may be imposed only after all other means of securing compliance have been exhausted. Notice of intent to suspend or terminate must be given by the commission to the governor of the defaulting state and to the executive officer of the defaulting state's licensing board and each of the party states

A state whose membership in this compact has been terminated is responsible for all assessments, obligations, and liabilities incurred through the effective date of termination, including obligations that extend beyond the effective date of termination

The commission may not bear any costs related to a state that is found to be in default or whose membership in this compact has been terminated unless agreed upon in writing between the commission and the defaulting state

The defaulting state may appeal the action of the commission by petitioning the United States district court for the District of Columbia or the federal district in which the commission has its principal offices. The prevailing party must be awarded all costs of such litigation, including reasonable attorney's fees

3. Dispute resolution

a. Upon request by a party state, the commission shall attempt to resolve disputes related to the compact which arise among party states and between party and nonparty states

The commission shall promulgate a rule providing for both mediation and binding dispute resolution for disputes, as appropriate

If the commission cannot resolve disputes among party states arising under this compact: (1) The party states may submit the issues in dispute to an arbitration panel, which will be comprised of individuals appointed by the compact administrator in each of the affected party states and an individual mutually c

Page No. 10 agreed upon by the compact administrators of all the party states involved in the dispute

(2) The decision of a majority of the arbitrators is final and binding

Enforcement

The commission, in the reasonable exercise of its discretion, shall enforce the provisions and rules of this compact

By majority vote, the commission may initiate legal action in the United States district court for the District of Columbia or the federal district in which the commission has its principal offices against a party state that is in default to enforce compliance with the provisions of this compact and its promulgated rules and bylaws. The relief sought may include both injunctive relief and damages. If judicial enforcement is necessary, the prevailing party must be awarded all costs of such litigation, including reasonable attorney's fees

The remedies herein are not the exclusive remedies of the commission. The commission may pursue any other remedies available under federal or state law

ARTICLE X - EFFECTIVE DATE, WITHDRAWAL, AND AMENDMENT This compact becomes effective and binding on the earlier of the date of legislative enactment of this compact into law by no less than twenty-six states or December 31, 2018. All party states to this compact, that also were parties to the prior nurse licensure compact, superseded by this compact, ("prior compact"), are deemed to have withdrawn from said prior compact within six months after the effective date of this compact

Each party state to this compact shall continue to recognize a nurse's multistate licensure privilege to practice in that party state issued under the prior compact until such party state has withdrawn from the prior compact

Any party state may withdraw from this compact by enacting a statute repealing the same. A party state's withdrawal does not take effect until six months after enactment of the repealing statute

A party state's withdrawal or termination does not affect the continuing requirement of the withdrawing or terminated state's licensing board to report adverse actions and significant investigations occurring prior to the effective date of such withdrawal or termination

This compact may not be construed to invalidate or prevent any nurse licensure agreement or other cooperative arrangement between a party state and a nonparty state that is made in accordance with the other provisions of this compact

This compact may be amended by the party states. An amendment to this compact does not become effective and binding upon the party states unless and until it is enacted into the laws of all party states

7. Representatives of nonparty states to this compact must be invited to participate in the activities of the commission, on a nonvoting basis, prior to the adoption of this compact by all states

ARTICLE XI - CONSTRUCTION AND SEVERABILITY This compact must be liberally construed so as to effectuate the purposes thereof. The provisions of this compact are severable, and if any phrase, clause, sentence, or provision of this compact is declared to be contrary to the constitution of any party state or of the United States, or if the applicability thereof to any government, agency, person, or circumstance is held invalid, the validity of the remainder of this compact and the applicability thereof to any government, agency, person, or circumstance may not be affected thereby. If this compact is held to be contrary to the constitution of any party state, this compact remains in full force and effect as to the remaining party states and in full force and effect as to the party state affected as to all severable matters

The term "head of the state licensing board" as used to define the compact administrator in subdivision a of subsection 2 of article VII means the executive director of the state board of nursing

Page No. 11

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