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HOUSE BILL NO. 4046

A bill to amend 1978 PA 368, entitled

"Public health code,"

by amending sections 16170a, 16222, 16231, 16238, and 17201 (MCL

333.16170a, 333.16222, 333.16231, 333.16238, and 333.17201),

section 16170a as amended by 2013 PA 268, section 16222 as amended

by 2014 PA 97, section 16231 as amended by 2017 PA 249, section

16238 as added by 1993 PA 79, and section 17201 as amended by 2016

PA 499, and by adding sections 16190, 17225, and 17225a.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

January 27, 2021, Introduced by Rep. Whiteford and referred to the Committee on Health Policy.

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Sec. 16170a. (1) The identity of an individual submitting 1

information to the committee or the department regarding the 2

suspected impairment of a health professional is confidential. 3

(2) The identity of a health professional who participates in 4

the health professional recovery program is confidential and is not 5

subject to disclosure under discovery or subpoena or the freedom of 6

information act, 1976 PA 442, MCL 15.231 to 15.246, unless the 7

health professional fails to satisfactorily participate in and 8

complete a treatment plan prescribed under the health professional 9

recovery program or violates section 16170(3) or the information is 10

required to be disclosed for purposes of the nurse licensure 11

compact enacted in section 16190. 12

(3) If a health professional successfully participates in and 13

completes a treatment plan prescribed under the health professional 14

recovery program, as determined by the committee, the department 15

shall destroy all records pertaining to the impairment of the 16

health professional, including records pertaining to the health 17

professional's participation in the treatment plan, upon on the 18

expiration of 5 years after the date of the committee's 19

determination. This subsection does not apply to records pertaining 20

to a violation of this article, article 7, or article 8 or a rule 21

promulgated under this article, article 7, or article 8. 22

Sec. 16190. (1) The nurse licensure compact is enacted into 23

law and entered into by this state as a party state with all other 24

jurisdictions that legally join in the compact, in the form 25

substantially as follows: 26

NURSE LICENSURE COMPACT 27

ARTICLE I 28

FINDINGS AND DECLARATION OF PURPOSE 29

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a. The party states find that: 1

1. The health and safety of the public are affected by the 2

degree of compliance with and the effectiveness of enforcement 3

activities related to state nurse licensure laws; 4

2. Violations of nurse licensure and other laws regulating the 5

practice of nursing may result in injury or harm to the public; 6

3. The expanded mobility of nurses and the use of advanced 7

communication technologies as part of our nation's health care 8

delivery system require greater coordination and cooperation among 9

states in the areas of nurse licensure and regulation; 10

4. New practice modalities and technology make compliance with 11

individual state nurse licensure laws difficult and complex; 12

5. The current system of duplicative licensure for nurses 13

practicing in multiple states is cumbersome and redundant for both 14

nurses and states; and 15

6. Uniformity of nurse licensure requirements throughout the 16

states promotes public safety and public health benefits. 17

b. The general purposes of this Compact are to: 18

1. Facilitate the states' responsibility to protect the 19

public's health and safety; 20

2. Ensure and encourage the cooperation of party states in the 21

areas of nurse licensure and regulation; 22

3. Facilitate the exchange of information between party states 23

in the areas of nurse regulation, investigation and adverse 24

actions; 25

4. Promote compliance with the laws governing the practice of 26

nursing in each jurisdiction; 27

5. Invest all party states with the authority to hold a nurse 28

accountable for meeting all state practice laws in the state in 29

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which the patient is located at the time care is rendered through 1

the mutual recognition of party state licenses; 2

6. Decrease redundancies in the consideration and issuance of 3

nurse licenses; and 4

7. Provide opportunities for interstate practice by nurses who 5

meet uniform licensure requirements. 6

ARTICLE II 7

DEFINITIONS 8

As used in this Compact: 9

a. "Adverse action" means any administrative, civil, equitable 10

or criminal action permitted by a state's laws which is imposed by 11

a licensing board or other authority against a nurse, including 12

actions against an individual's license or multistate licensure 13

privilege such as revocation, suspension, probation, monitoring of 14

the licensee, limitation on the licensee's practice, or any other 15

encumbrance on licensure affecting a nurse's authorization to 16

practice, including issuance of a cease and desist action. 17

b. "Alternative program" means a non-disciplinary monitoring 18

program approved by a licensing board. 19

c. "Coordinated licensure information system" means an 20

integrated process for collecting, storing and sharing information 21

on nurse licensure and enforcement activities related to nurse 22

licensure laws that is administered by a nonprofit organization 23

composed of and controlled by licensing boards. 24

d. "Current significant investigative information" means: 25

1. Investigative information that a licensing board, after a 26

preliminary inquiry that includes notification and an opportunity 27

for the nurse to respond, if required by state law, has reason to 28

believe is not groundless and, if proved true, would indicate more 29

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than a minor infraction; or 1

2. Investigative information that indicates that the nurse 2

represents an immediate threat to public health and safety 3

regardless of whether the nurse has been notified and had an 4

opportunity to respond. 5

e. "Encumbrance" means a revocation or suspension of, or any 6

limitation on, the full and unrestricted practice of nursing 7

imposed by a licensing board. 8

f. "Home state" means the party state which is the nurse's 9

primary state of residence. 10

g. "Licensing board" means a party state's regulatory body 11

responsible for issuing nurse licenses. 12

h. "Multistate license" means a license to practice as a 13

registered or a licensed practical/vocational nurse (LPN/VN) issued 14

by a home state licensing board that authorizes the licensed nurse 15

to practice in all party states under a multistate licensure 16

privilege. 17

i. "Multistate licensure privilege" means a legal 18

authorization associated with a multistate license permitting the 19

practice of nursing as either a registered nurse (RN) or LPN/VN in 20

a remote state. 21

j. "Nurse" means RN or LPN/VN, as those terms are defined by 22

each party state's practice laws. 23

k. "Party state" means any state that has adopted this 24

Compact. 25

l. "Remote state" means a party state, other than the home 26

state. 27

m. "Single-state license" means a nurse license issued by a 28

party state that authorizes practice only within the issuing state 29

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and does not include a multistate licensure privilege to practice 1

in any other party state. 2

n. "State" means a state, territory or possession of the 3

United States and the District of Columbia. 4

o. "State practice laws" means a party state's laws, rules and 5

regulations that govern the practice of nursing, define the scope 6

of nursing practice, and create the methods and grounds for 7

imposing discipline. "State practice laws" do not include 8

requirements necessary to obtain and retain a license, except for 9

qualifications or requirements of the home state. 10

ARTICLE III 11

GENERAL PROVISIONS AND JURISDICTION 12

a. A multistate license to practice registered or licensed 13

practical/vocational nursing issued by a home state to a resident 14

in that state will be recognized by each party state as authorizing 15

a nurse to practice as a registered nurse (RN) or as a licensed 16

practical/vocational nurse (LPN/VN), under a multistate licensure 17

privilege, in each party state. 18

b. A state must implement procedures for considering the 19

criminal history records of applicants for initial multistate 20

license or licensure by endorsement. Such procedures shall include 21

the submission of fingerprints or other biometric-based information 22

by applicants for the purpose of obtaining an applicant's criminal 23

history record information from the Federal Bureau of Investigation 24

and the agency responsible for retaining that state's criminal 25

records. 26

c. Each party state shall require the following for an 27

applicant to obtain or retain a multistate license in the home 28

state: 29

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1. Meets the home state's qualifications for licensure or 1

renewal of licensure, as well as, all other applicable state laws; 2

2. i. Has graduated or is eligible to graduate from a 3

licensing board-approved RN or LPN/VN prelicensure education 4

program; or 5

ii. Has graduated from a foreign RN or LPN/VN prelicensure 6

education program that (a) has been approved by the authorized 7

accrediting body in the applicable country and (b) has been 8

verified by an independent credentials review agency to be 9

comparable to a licensing board-approved prelicensure education 10

program; 11

3. Has, if a graduate of a foreign prelicensure education 12

program not taught in English or if English is not the individual's 13

native language, successfully passed an English proficiency 14

examination that includes the components of reading, speaking, 15

writing and listening; 16

4. Has successfully passed an NCLEX-RN® or NCLEX-PN® 17

Examination or recognized predecessor, as applicable; 18

5. Is eligible for or holds an active, unencumbered license; 19

6. Has submitted, in connection with an application for 20

initial licensure or licensure by endorsement, fingerprints or 21

other biometric data for the purpose of obtaining criminal history 22

record information from the Federal Bureau of Investigation and the 23

agency responsible for retaining that state's criminal records; 24

7. Has not been convicted or found guilty, or has entered into 25

an agreed disposition, of a felony offense under applicable state 26

or federal criminal law; 27

8. Has not been convicted or found guilty, or has entered into 28

an agreed disposition, of a misdemeanor offense related to the 29

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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 3

current participation in an alternative program; and 4

11. Has a valid United States Social Security number. 5

d. All party states shall be authorized, in accordance with 6

existing state due process law, to take adverse action against a 7

nurse's multistate licensure privilege such as revocation, 8

suspension, probation or any other action that affects a nurse's 9

authorization to practice under a multistate licensure privilege, 10

including cease and desist actions. If a party state takes such 11

action, it shall promptly notify the administrator of the 12

coordinated licensure information system. The administrator of the 13

coordinated licensure information system shall promptly notify the 14

home state of any such actions by remote states. 15

e. A nurse practicing in a party state must comply with the 16

state practice laws of the state in which the client is located at 17

the time service is provided. The practice of nursing is not 18

limited to patient care, but shall include all nursing practice as 19

defined by the state practice laws of the party state in which the 20

client is located. The practice of nursing in a party state under a 21

multistate licensure privilege will subject a nurse to the 22

jurisdiction of the licensing board, the courts and the laws of the 23

party state in which the client is located at the time service is 24

provided. 25

f. Individuals not residing in a party state shall continue to 26

be able to apply for a party state's single-state license as 27

provided under the laws of each party state. However, the single-28

state license granted to these individuals will not be recognized 29

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as granting the privilege to practice nursing in any other party 1

state. Nothing in this Compact shall affect the requirements 2

established by a party state for the issuance of a single-state 3

license. 4

g. Any nurse holding a home state multistate license, on the 5

effective date of this Compact, may retain and renew the multistate 6

license issued by the nurse's then-current home state, provided 7

that: 8

1. A nurse, who changes primary state of residence after this 9

Compact's effective date, must meet all applicable Article III.c. 10

requirements to obtain a multistate license from a new home state. 11

2. A nurse who fails to satisfy the multistate licensure 12

requirements in Article III.c. due to a disqualifying event 13

occurring after this Compact's effective date shall be ineligible 14

to retain or renew a multistate license, and the nurse's multistate 15

license shall be revoked or deactivated in accordance with 16

applicable rules adopted by the Interstate Commission of Nurse 17

Licensure Compact Administrators ("Commission"). 18

ARTICLE IV 19

APPLICATIONS FOR LICENSURE IN A PARTY STATE 20

a. Upon application for a multistate license, the licensing 21

board in the issuing party state shall ascertain, through the 22

coordinated licensure information system, whether the applicant has 23

ever held, or is the holder of, a license issued by any other 24

state, whether there are any encumbrances on any license or 25

multistate licensure privilege held by the applicant, whether any 26

adverse action has been taken against any license or multistate 27

licensure privilege held by the applicant and whether the applicant 28

is currently participating in an alternative program. 29

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b. A nurse may hold a multistate license, issued by the home 1

state, in only one party state at a time. 2

c. If a nurse changes primary state of residence by moving 3

between two party states, the nurse must apply for licensure in the 4

new home state, and the multistate license issued by the prior home 5

state will be deactivated in accordance with applicable rules 6

adopted by the Commission. 7

1. The nurse may apply for licensure in advance of a change in 8

primary state of residence. 9

2. A multistate license shall not be issued by the new home 10

state until the nurse provides satisfactory evidence of a change in 11

primary state of residence to the new home state and satisfies all 12

applicable requirements to obtain a multistate license from the new 13

home state. 14

d. If a nurse changes primary state of residence by moving 15

from a party state to a non-party state, the multistate license 16

issued by the prior home state will convert to a single-state 17

license, valid only in the former home state. 18

ARTICLE V 19

ADDITIONAL AUTHORITIES INVESTED IN PARTY STATE LICENSING BOARDS 20

a. In addition to the other powers conferred by state law, a 21

licensing board shall have the authority to: 22

1. Take adverse action against a nurse's multistate licensure 23

privilege to practice within that party state. 24

i. Only the home state shall have the power to take adverse 25

action against a nurse's license issued by the home state. 26

ii. For purposes of taking adverse action, the home state 27

licensing board shall give the same priority and effect to reported 28

conduct received from a remote state as it would if such conduct 29

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had occurred within the home state. In so doing, the home state 1

shall apply its own state laws to determine appropriate action. 2

2. Issue cease and desist orders or impose an encumbrance on a 3

nurse's authority to practice within that party state. 4

3. Complete any pending investigations of a nurse who changes 5

primary state of residence during the course of such 6

investigations. The licensing board shall also have the authority 7

to take appropriate action(s) and shall promptly report the 8

conclusions of such investigations to the administrator of the 9

coordinated licensure information system. The administrator of the 10

coordinated licensure information system shall promptly notify the 11

new home state of any such actions. 12

4. Issue subpoenas for both hearings and investigations that 13

require the attendance and testimony of witnesses, as well as, the 14

production of evidence. Subpoenas issued by a licensing board in a 15

party state for the attendance and testimony of witnesses or the 16

production of evidence from another party state shall be enforced 17

in the latter state by any court of competent jurisdiction, 18

according to the practice and procedure of that court applicable to 19

subpoenas issued in proceedings pending before it. The issuing 20

authority shall pay any witness fees, travel expenses, mileage and 21

other fees required by the service statutes of the state in which 22

the witnesses or evidence are located. 23

5. Obtain and submit, for each nurse licensure applicant, 24

fingerprint or other biometric-based information to the Federal 25

Bureau of Investigation for criminal background checks, receive the 26

results of the Federal Bureau of Investigation record search on 27

criminal background checks and use the results in making licensure 28

decisions. 29

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6. If otherwise permitted by state law, recover from the 1

affected nurse the costs of investigations and disposition of cases 2

resulting from any adverse action taken against that nurse. 3

7. Take adverse action based on the factual findings of the 4

remote state, provided that the licensing board follows its own 5

procedures for taking such adverse action. 6

b. If adverse action is taken by the home state against a 7

nurse's multistate license, the nurse's multistate licensure 8

privilege to practice in all other party states shall be 9

deactivated until all encumbrances have been removed from the 10

multistate license. All home state disciplinary orders that impose 11

adverse action against a nurse's multistate license shall include a 12

statement that the nurse's multistate licensure privilege is 13

deactivated in all party states during the pendency of the order. 14

c. Nothing in this Compact shall override a party state's 15

decision that participation in an alternative program may be used 16

in lieu of adverse action. The home state licensing board shall 17

deactivate the multistate licensure privilege under the multistate 18

license of any nurse for the duration of the nurse's participation 19

in an alternative program. 20

ARTICLE VI 21

COORDINATED LICENSURE INFORMATION SYSTEM AND EXCHANGE OF 22

INFORMATION 23

a. All party states shall participate in a coordinated 24

licensure information system of all licensed registered nurses 25

(RNs) and licensed practical/vocational nurses (LPNs/VNs). This 26

system will include information on the licensure and disciplinary 27

history of each nurse, as submitted by party states, to assist in 28

the coordination of nurse licensure and enforcement efforts. 29

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b. The Commission, in consultation with the administrator of 1

the coordinated licensure information system, shall formulate 2

necessary and proper procedures for the identification, collection 3

and exchange of information under this Compact. 4

c. All licensing boards shall promptly report to the 5

coordinated licensure information system any adverse action, any 6

current significant investigative information, denials of 7

applications (with the reasons for such denials) and nurse 8

participation in alternative programs known to the licensing board 9

regardless of whether such participation is deemed nonpublic or 10

confidential under state law. 11

d. Current significant investigative information and 12

participation in nonpublic or confidential alternative programs 13

shall be transmitted through the coordinated licensure information 14

system only to party state licensing boards. 15

e. Notwithstanding any other provision of law, all party state 16

licensing boards contributing information to the coordinated 17

licensure information system may designate information that may not 18

be shared with non-party states or disclosed to other entities or 19

individuals without the express permission of the contributing 20

state. 21

f. Any personally identifiable information obtained from the 22

coordinated licensure information system by a party state licensing 23

board shall not be shared with non-party states or disclosed to 24

other entities or individuals except to the extent permitted by the 25

laws of the party state contributing the information. 26

g. Any information contributed to the coordinated licensure 27

information system that is subsequently required to be expunged by 28

the laws of the party state contributing that information shall 29

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also be expunged from the coordinated licensure information system. 1

h. The Compact administrator of each party state shall furnish 2

a uniform data set to the Compact administrator of each other party 3

state, which shall include, at a minimum: 4

1. Identifying information; 5

2. Licensure data; 6

3. Information related to alternative program participation; 7

and 8

4. Other information that may facilitate the administration of 9

this Compact, as determined by Commission rules. 10

i. The Compact administrator of a party state shall provide 11

all investigative documents and information requested by another 12

party state. 13

ARTICLE VII 14

ESTABLISHMENT OF THE INTERSTATE COMMISSION OF NURSE LICENSURE 15

COMPACT ADMINISTRATORS 16

a. The party states hereby create and establish a joint public 17

entity known as the Interstate Commission of Nurse Licensure 18

Compact Administrators. 19

1. The Commission is an instrumentality of the party states. 20

2. Venue is proper, and judicial proceedings by or against the 21

Commission shall be brought solely and exclusively, in a court of 22

competent jurisdiction where the principal office of the Commission 23

is located. The Commission may waive venue and jurisdictional 24

defenses to the extent it adopts or consents to participate in 25

alternative dispute resolution proceedings. 26

3. Nothing in this Compact shall be construed to be a waiver 27

of sovereign immunity. 28

b. Membership, Voting and Meetings 29

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1. Each party state shall have and be limited to one 1

administrator. The head of the state licensing board or designee 2

shall be the administrator of this Compact for each party state. 3

Any administrator may be removed or suspended from office as 4

provided by the law of the state from which the Administrator is 5

appointed. Any vacancy occurring in the Commission shall be filled 6

in accordance with the laws of the party state in which the vacancy 7

exists. 8

2. Each administrator shall be entitled to one (1) vote with 9

regard to the promulgation of rules and creation of bylaws and 10

shall otherwise have an opportunity to participate in the business 11

and affairs of the Commission. An administrator shall vote in 12

person or by such other means as provided in the bylaws. The bylaws 13

may provide for an administrator's participation in meetings by 14

telephone or other means of communication. 15

3. The Commission shall meet at least once during each 16

calendar year. Additional meetings shall be held as set forth in 17

the bylaws or rules of the commission. 18

4. All meetings shall be open to the public, and public notice 19

of meetings shall be given in the same manner as required under the 20

rulemaking provisions in Article VIII. 21

5. The Commission may convene in a closed, nonpublic meeting 22

if the Commission must discuss: 23

i. Noncompliance of a party state with its obligations under 24

this Compact; 25

ii. The employment, compensation, discipline or other 26

personnel matters, practices or procedures related to specific 27

employees or other matters related to the Commission's internal 28

personnel practices and procedures; 29

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iii. Current, threatened or reasonably anticipated litigation; 1

iv. Negotiation of contracts for the purchase or sale of 2

goods, services or real estate; 3

v. Accusing any person of a crime or formally censuring any 4

person; 5

vi. Disclosure of trade secrets or commercial or financial 6

information that is privileged or confidential; 7

vii. Disclosure of information of a personal nature where 8

disclosure would constitute a clearly unwarranted invasion of 9

personal privacy; 10

viii. Disclosure of investigatory records compiled for law 11

enforcement purposes; 12

ix. Disclosure of information related to any reports prepared 13

by or on behalf of the Commission for the purpose of investigation 14

of compliance with this Compact; or 15

x. Matters specifically exempted from disclosure by federal or 16

state statute. 17

6. If a meeting, or portion of a meeting, is closed pursuant 18

to this provision, the Commission's legal counsel or designee shall 19

certify that the meeting may be closed and shall reference each 20

relevant exempting provision. The Commission shall keep minutes 21

that fully and clearly describe all matters discussed in a meeting 22

and shall provide a full and accurate summary of actions taken, and 23

the reasons therefor, including a description of the views 24

expressed. All documents considered in connection with an action 25

shall be identified in such minutes. All minutes and documents of a 26

closed meeting shall remain under seal, subject to release by a 27

majority vote of the Commission or order of a court of competent 28

jurisdiction. 29

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c. The Commission shall, by a majority vote of the 1

administrators, prescribe bylaws or rules to govern its conduct as 2

may be necessary or appropriate to carry out the purposes and 3

exercise the powers of this Compact, including but not limited to: 4

1. Establishing the fiscal year of the Commission; 5

2. Providing reasonable standards and procedures: 6

i. For the establishment and meetings of other committees; and 7

ii. Governing any general or specific delegation of any 8

authority or function of the Commission; 9

3. Providing reasonable procedures for calling and conducting 10

meetings of the Commission, ensuring reasonable advance notice of 11

all meetings and providing an opportunity for attendance of such 12

meetings by interested parties, with enumerated exceptions designed 13

to protect the public's interest, the privacy of individuals, and 14

proprietary information, including trade secrets. The Commission 15

may meet in closed session only after a majority of the 16

administrators vote to close a meeting in whole or in part. As soon 17

as practicable, the Commission must make public a copy of the vote 18

to close the meeting revealing the vote of each administrator, with 19

no proxy votes allowed; 20

4. Establishing the titles, duties and authority and 21

reasonable procedures for the election of the officers of the 22

Commission; 23

5. Providing reasonable standards and procedures for the 24

establishment of the personnel policies and programs of the 25

Commission. Notwithstanding any civil service or other similar laws 26

of any party state, the bylaws shall exclusively govern the 27

personnel policies and programs of the Commission; and 28

6. Providing a mechanism for winding up the operations of the 29

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Commission and the equitable disposition of any surplus funds that 1

may exist after the termination of this Compact after the payment 2

or reserving of all of its debts and obligations; 3

d. The Commission shall publish its bylaws and rules, and any 4

amendments thereto, in a convenient form on the website of the 5

Commission. 6

e. The Commission shall maintain its financial records in 7

accordance with the bylaws. 8

f. The Commission shall meet and take such actions as are 9

consistent with the provisions of this Compact and the bylaws. 10

g. The Commission shall have the following powers: 11

1. To promulgate uniform rules to facilitate and coordinate 12

implementation and administration of this Compact. The rules shall 13

have the force and effect of law and shall be binding in all party 14

states; 15

2. To bring and prosecute legal proceedings or actions in the 16

name of the Commission, provided that the standing of any licensing 17

board to sue or be sued under applicable law shall not be affected; 18

3. To purchase and maintain insurance and bonds; 19

4. To borrow, accept or contract for services of personnel, 20

including, but not limited to, employees of a party state or 21

nonprofit organizations; 22

5. To cooperate with other organizations that administer state 23

compacts related to the regulation of nursing, including but not 24

limited to sharing administrative or staff expenses, office space 25

or other resources; 26

6. To hire employees, elect or appoint officers, fix 27

compensation, define duties, grant such individuals appropriate 28

authority to carry out the purposes of this Compact, and to 29

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establish the Commission's personnel policies and programs relating 1

to conflicts of interest, qualifications of personnel and other 2

related personnel matters; 3

7. To accept any and all appropriate donations, grants and 4

gifts of money, equipment, supplies, materials and services, and to 5

receive, utilize and dispose of the same; provided that at all 6

times the Commission shall avoid any appearance of impropriety or 7

conflict of interest; 8

8. To lease, purchase, accept appropriate gifts or donations 9

of, or otherwise to own, hold, improve or use, any property, 10

whether real, personal or mixed; provided that at all times the 11

Commission shall avoid any appearance of impropriety; 12

9. To sell, convey, mortgage, pledge, lease, exchange, abandon 13

or otherwise dispose of any property, whether real, personal or 14

mixed; 15

10. To establish a budget and make expenditures; 16

11. To borrow money; 17

12. To appoint committees, including advisory committees 18

comprised of administrators, state nursing regulators, state 19

legislators or their representatives, and consumer representatives, 20

and other such interested persons; 21

13. To provide and receive information from, and to cooperate 22

with, law enforcement agencies; 23

14. To adopt and use an official seal; and 24

15. To perform such other functions as may be necessary or 25

appropriate to achieve the purposes of this Compact consistent with 26

the state regulation of nurse licensure and practice. 27

h. Financing of the Commission 28

1. The Commission shall pay, or provide for the payment of, 29

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the reasonable expenses of its establishment, organization and 1

ongoing activities. 2

2. The Commission may also levy on and collect an annual 3

assessment from each party state to cover the cost of its 4

operations, activities and staff in its annual budget as approved 5

each year. The aggregate annual assessment amount, if any, shall be 6

allocated based upon a formula to be determined by the Commission, 7

which shall promulgate a rule that is binding upon all party 8

states. 9

3. The Commission shall not incur obligations of any kind 10

prior to securing the funds adequate to meet the same; nor shall 11

the Commission pledge the credit of any of the party states, except 12

by, and with the authority of, such party state. 13

4. The Commission shall keep accurate accounts of all receipts 14

and disbursements. The receipts and disbursements of the Commission 15

shall be subject to the audit and accounting procedures established 16

under its bylaws. However, all receipts and disbursements of funds 17

handled by the Commission shall be audited yearly by a certified or 18

licensed public accountant, and the report of the audit shall be 19

included in and become part of the annual report of the Commission. 20

i. Qualified Immunity, Defense and Indemnification 21

1. The administrators, officers, executive director, employees 22

and representatives of the Commission shall be immune from suit and 23

liability, either personally or in their official capacity, for any 24

claim for damage to or loss of property or personal injury or other 25

civil liability caused by or arising out of any actual or alleged 26

act, error or omission that occurred, or that the person against 27

whom the claim is made had a reasonable basis for believing 28

occurred, within the scope of Commission employment, duties or 29

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responsibilities; provided that nothing in this paragraph shall be 1

construed to protect any such person from suit or liability for any 2

damage, loss, injury or liability caused by the intentional, 3

willful or wanton misconduct of that person. 4

2. The Commission shall defend any administrator, officer, 5

executive director, employee or representative of the Commission in 6

any civil action seeking to impose liability arising out of any 7

actual or alleged act, error or omission that occurred within the 8

scope of Commission employment, duties or responsibilities, or that 9

the person against whom the claim is made had a reasonable basis 10

for believing occurred within the scope of Commission employment, 11

duties or responsibilities; provided that nothing herein shall be 12

construed to prohibit that person from retaining his or her own 13

counsel; and provided further that the actual or alleged act, error 14

or omission did not result from that person's intentional, willful 15

or wanton misconduct. 16

3. The Commission shall indemnify and hold harmless any 17

administrator, officer, executive director, employee or 18

representative of the Commission for the amount of any settlement 19

or judgment obtained against that person arising out of any actual 20

or alleged act, error or omission that occurred within the scope of 21

Commission employment, duties or responsibilities, or that such 22

person had a reasonable basis for believing occurred within the 23

scope of Commission employment, duties or responsibilities, 24

provided that the actual or alleged act, error or omission did not 25

result from the intentional, willful or wanton misconduct of that 26

person. 27

ARTICLE VIII 28

RULEMAKING 29

22

EMR 01332'21

a. The Commission shall exercise its rulemaking powers 1

pursuant to the criteria set forth in this Article and the rules 2

adopted thereunder. Rules and amendments shall become binding as of 3

the date specified in each rule or amendment and shall have the 4

same force and effect as provisions of this Compact. 5

b. Rules or amendments to the rules shall be adopted at a 6

regular or special meeting of the Commission. 7

c. Prior to promulgation and adoption of a final rule or rules 8

by the Commission, and at least sixty (60) days in advance of the 9

meeting at which the rule will be considered and voted upon, the 10

Commission shall file a notice of proposed rulemaking: 11

1. On the website of the Commission; and 12

2. On the website of each licensing board or the publication 13

in which each state would otherwise publish proposed rules. 14

d. The notice of proposed rulemaking shall include: 15

1. The proposed time, date and location of the meeting in 16

which the rule will be considered and voted upon; 17

2. The text of the proposed rule or amendment, and the reason 18

for the proposed rule; 19

3. A request for comments on the proposed rule from any 20

interested person; and 21

4. The manner in which interested persons may submit notice to 22

the Commission of their intention to attend the public hearing and 23

any written comments. 24

e. Prior to adoption of a proposed rule, the Commission shall 25

allow persons to submit written data, facts, opinions and 26

arguments, which shall be made available to the public. 27

f. The Commission shall grant an opportunity for a public 28

hearing before it adopts a rule or amendment. 29

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EMR 01332'21

g. The Commission shall publish the place, time and date of 1

the scheduled public hearing. 2

1. Hearings shall be conducted in a manner providing each 3

person who wishes to comment a fair and reasonable opportunity to 4

comment orally or in writing. All hearings will be recorded, and a 5

copy will be made available upon request. 6

2. Nothing in this section shall be construed as requiring a 7

separate hearing on each rule. Rules may be grouped for the 8

convenience of the Commission at hearings required by this section. 9

h. If no one appears at the public hearing, the Commission may 10

proceed with promulgation of the proposed rule. 11

i. Following the scheduled hearing date, or by the close of 12

business on the scheduled hearing date if the hearing was not held, 13

the Commission shall consider all written and oral comments 14

received. 15

j. The Commission shall, by majority vote of all 16

administrators, take final action on the proposed rule and shall 17

determine the effective date of the rule, if any, based on the 18

rulemaking record and the full text of the rule. 19

k. Upon determination that an emergency exists, the Commission 20

may consider and adopt an emergency rule without prior notice, 21

opportunity for comment or hearing, provided that the usual 22

rulemaking procedures provided in this Compact and in this section 23

shall be retroactively applied to the rule as soon as reasonably 24

possible, in no event later than ninety (90) days after the 25

effective date of the rule. For the purposes of this provision, an 26

emergency rule is one that must be adopted immediately in order to: 27

1. Meet an imminent threat to public health, safety or 28

welfare; 29

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EMR 01332'21

2. Prevent a loss of Commission or party state funds; or 1

3. Meet a deadline for the promulgation of an administrative 2

rule that is required by federal law or rule. 3

l. The Commission may direct revisions to a previously adopted 4

rule or amendment for purposes of correcting typographical errors, 5

errors in format, errors in consistency or grammatical errors. 6

Public notice of any revisions shall be posted on the website of 7

the Commission. The revision shall be subject to challenge by any 8

person for a period of thirty (30) days after posting. The revision 9

may be challenged only on grounds that the revision results in a 10

material change to a rule. A challenge shall be made in writing, 11

and delivered to the Commission, prior to the end of the notice 12

period. If no challenge is made, the revision will take effect 13

without further action. If the revision is challenged, the revision 14

may not take effect without the approval of the Commission. 15

ARTICLE IX 16

OVERSIGHT, DISPUTE RESOLUTION AND ENFORCEMENT 17

a. Oversight 18

1. Each party state shall enforce this Compact and take all 19

actions necessary and appropriate to effectuate this Compact's 20

purposes and intent. 21

2. The Commission shall be entitled to receive service of 22

process in any proceeding that may affect the powers, 23

responsibilities or actions of the Commission, and shall have 24

standing to intervene in such a proceeding for all purposes. 25

Failure to provide service of process in such proceeding to the 26

Commission shall render a judgment or order void as to the 27

Commission, this Compact or promulgated rules. 28

b. Default, Technical Assistance and Termination 29

25

EMR 01332'21

1. If the Commission determines that a party state has 1

defaulted in the performance of its obligations or responsibilities 2

under this Compact or the promulgated rules, the Commission shall: 3

i. Provide written notice to the defaulting state and other 4

party states of the nature of the default, the proposed means of 5

curing the default or any other action to be taken by the 6

Commission; and 7

ii. Provide remedial training and specific technical 8

assistance regarding the default. 9

2. If a state in default fails to cure the default, the 10

defaulting state's membership in this Compact may be terminated 11

upon an affirmative vote of a majority of the administrators, and 12

all rights, privileges and benefits conferred by this Compact may 13

be terminated on the effective date of termination. A cure of the 14

default does not relieve the offending state of obligations or 15

liabilities incurred during the period of default. 16

3. Termination of membership in this Compact shall be imposed 17

only after all other means of securing compliance have been 18

exhausted. Notice of intent to suspend or terminate shall be given 19

by the Commission to the governor of the defaulting state and to 20

the executive officer of the defaulting state's licensing board and 21

each of the party states. 22

4. A state whose membership in this Compact has been 23

terminated is responsible for all assessments, obligations and 24

liabilities incurred through the effective date of termination, 25

including obligations that extend beyond the effective date of 26

termination. 27

5. The Commission shall not bear any costs related to a state 28

that is found to be in default or whose membership in this Compact 29

26

EMR 01332'21

has been terminated unless agreed upon in writing between the 1

Commission and the defaulting state. 2

6. The defaulting state may appeal the action of the 3

Commission by petitioning the U.S. District Court for the District 4

of Columbia or the federal district in which the Commission has its 5

principal offices. The prevailing party shall be awarded all costs 6

of such litigation, including reasonable attorneys' fees. 7

c. Dispute Resolution 8

1. Upon request by a party state, the Commission shall attempt 9

to resolve disputes related to the Compact that arise among party 10

states and between party and non-party states. 11

2. The Commission shall promulgate a rule providing for both 12

mediation and binding dispute resolution for disputes, as 13

appropriate. 14

3. In the event the Commission cannot resolve disputes among 15

party states arising under this Compact: 16

i. The party states may submit the issues in dispute to an 17

arbitration panel, which will be comprised of individuals appointed 18

by the Compact administrator in each of the affected party states 19

and an individual mutually agreed upon by the Compact 20

administrators of all the party states involved in the dispute. 21

ii. The decision of a majority of the arbitrators shall be 22

final and binding. 23

d. Enforcement 24

1. The Commission, in the reasonable exercise of its 25

discretion, shall enforce the provisions and rules of this Compact. 26

2. By majority vote, the Commission may initiate legal action 27

in the U.S. District Court for the District of Columbia or the 28

federal district in which the Commission has its principal offices 29

27

EMR 01332'21

against a party state that is in default to enforce compliance with 1

the provisions of this Compact and its promulgated rules and 2

bylaws. The relief sought may include both injunctive relief and 3

damages. In the event judicial enforcement is necessary, the 4

prevailing party shall be awarded all costs of such litigation, 5

including reasonable attorneys' fees. 6

3. The remedies herein shall not be the exclusive remedies of 7

the Commission. The Commission may pursue any other remedies 8

available under federal or state law. 9

ARTICLE X 10

EFFECTIVE DATE, WITHDRAWAL AND AMENDMENT 11

a. This Compact shall become effective and binding on the 12

earlier of the date of legislative enactment of this Compact into 13

law by no less than twenty-six (26) states or December 31, 2018. 14

All party states to this Compact, that also were parties to the 15

prior Nurse Licensure Compact, superseded by this Compact, ("Prior 16

Compact"), shall be deemed to have withdrawn from said Prior 17

Compact within six (6) months after the effective date of this 18

Compact. 19

b. Each party state to this Compact shall continue to 20

recognize a nurse's multistate licensure privilege to practice in 21

that party state issued under the Prior Compact until such party 22

state has withdrawn from the Prior Compact. 23

c. Any party state may withdraw from this Compact by enacting 24

a statute repealing the same. A party state's withdrawal shall not 25

take effect until six (6) months after enactment of the repealing 26

statute. 27

d. A party state's withdrawal or termination shall not affect 28

the continuing requirement of the withdrawing or terminated state's 29

28

EMR 01332'21

licensing board to report adverse actions and significant 1

investigations occurring prior to the effective date of such 2

withdrawal or termination. 3

e. Nothing contained in this Compact shall be construed to 4

invalidate or prevent any nurse licensure agreement or other 5

cooperative arrangement between a party state and a non-party state 6

that is made in accordance with the other provisions of this 7

Compact. 8

f. This Compact may be amended by the party states. No 9

amendment to this Compact shall become effective and binding upon 10

the party states unless and until it is enacted into the laws of 11

all party states. 12

g. Representatives of non-party states to this Compact shall 13

be invited to participate in the activities of the Commission, on a 14

nonvoting basis, prior to the adoption of this Compact by all 15

states. 16

ARTICLE XI 17

CONSTRUCTION AND SEVERABILITY 18

This Compact shall be liberally construed so as to effectuate 19

the purposes thereof. The provisions of this Compact shall be 20

severable, and if any phrase, clause, sentence or provision of this 21

Compact is declared to be contrary to the constitution of any party 22

state or of the United States, or if the applicability thereof to 23

any government, agency, person or circumstance is held invalid, the 24

validity of the remainder of this Compact and the applicability 25

thereof to any government, agency, person or circumstance shall not 26

be affected thereby. If this Compact shall be held to be contrary 27

to the constitution of any party state, this Compact shall remain 28

in full force and effect as to the remaining party states and in 29

29

EMR 01332'21

full force and effect as to the party state affected as to all 1

severable matters. 2

(2) Subsection (1) shall be known as the "nurse licensure 3

compact". 4

Sec. 16222. (1) A licensee or registrant who has knowledge 5

that another licensee or registrant has committed a violation under 6

section 16221, article 7, or article 8 or a rule promulgated under 7

article 7 or article 8 shall report the conduct and the name of the 8

subject of the report to the department. Information Subject to 9

sections 16238 and 16244, information obtained by the department 10

under this subsection is confidential. and is subject to sections 11

16238 and 16244. Failure of a licensee or registrant to make a 12

report under this subsection does not give rise to a civil cause of 13

action for damages against the licensee or registrant, but the 14

licensee or registrant is subject to administrative action under 15

sections 16221 and 16226. This subsection does not apply to a 16

licensee or registrant who obtains the knowledge of a violation 17

while providing professional services to the licensee or registrant 18

to whom the knowledge applies, who is serving on a duly constituted 19

ethics or peer review committee of a professional association, or 20

who is serving on a committee assigned a professional review 21

function in a health facility or agency. 22

(2) Unless the licensee or registrant making a report under 23

subsection (1) otherwise agrees in writing, the The identity of the 24

licensee or registrant making a report under subsection (1) shall 25

remain is confidential unless disciplinary any of the following 26

apply: 27

(a) Disciplinary proceedings under this part are initiated 28

against the subject of the report and the licensee or registrant 29

30

EMR 01332'21

making the report is required to testify in the proceedings. 1

(b) The licensee or registrant making the report under 2

subsection (1) otherwise agrees in writing. 3

(c) The information is required to be disclosed for purposes 4

of the nurse licensure compact enacted in section 16190. 5

(3) A licensee or registrant shall notify the department of 6

any criminal conviction within 30 days after the date of the 7

conviction. Failure of a licensee or registrant to notify the 8

department under this subsection shall result in administrative 9

action under sections 16221 and 16226. 10

(4) A licensee or registrant shall notify the department of 11

any disciplinary licensing or registration action taken by another 12

state against the licensee or registrant within 30 days after the 13

date of the action. This subsection includes, but is not limited 14

to, a disciplinary action that is stayed pending appeal. Failure of 15

a licensee or registrant to notify the department under this 16

subsection shall result in administrative action under sections 17

16221 and 16226. 18

Sec. 16231. (1) A person or governmental entity that believes 19

that a violation of this article, article 7, or article 8 or a rule 20

promulgated under this article, article 7, or article 8 exists may 21

submit an allegation of that fact to the department in writing. 22

(2) Subject to subsection (3) and section 16221b, if the 23

department determines after reviewing an application or an 24

allegation or a licensee's or registrant's file under section 25

16211(4) that there is a reasonable basis to believe that a 26

violation of this article, article 7, or article 8 or a rule 27

promulgated under this article, article 7, or article 8 exists, 1 28

of the following applies: 29

31

EMR 01332'21

(a) Unless subdivision (b) applies, subject to subsection 1

(10), with the authorization of a panel of at least 3 board members 2

that includes the chair and at least 2 other members of the 3

appropriate board or task force designated by the chair, the 4

department shall investigate the alleged violation. Subject to 5

subsection (10), if the panel fails to grant or deny authorization 6

within 7 days after the board or task force receives a request for 7

authorization, the department shall investigate. If the department 8

believes that immediate jeopardy exists, the director or his or her 9

designee shall authorize an investigation and notify the board 10

chair of that investigation within 2 business days. 11

(b) If it reviews an allegation in writing under subsection 12

(1) that concerns a licensee or registrant whose record created 13

under section 16211 includes 1 substantiated allegation, or 2 or 14

more written investigated allegations, from 2 or more different 15

individuals or entities, received in the preceding 4 years, the 16

department shall investigate the alleged violation. Authorization 17

by a panel described in subdivision (a) is not required for an 18

investigation by the department under this subdivision. 19

(3) If a person or governmental entity submits a written 20

allegation under subsection (1) more than 4 years after the date of 21

the incident or activity that is the basis of the alleged 22

violation, the department may investigate the alleged violation in 23

the manner described in subsection (2)(a) or (b), as applicable, 24

but is not required to conduct an investigation under subsection 25

(2)(a) or (b). 26

(4) If it receives information reported under section 16243(2) 27

that indicates 3 or more malpractice settlements, awards, or 28

judgments against a licensee in a period of 5 consecutive years or 29

32

EMR 01332'21

1 or more malpractice settlements, awards, or judgments against a 1

licensee totaling more than $200,000.00 in a period of 5 2

consecutive years, whether or not a judgment or award is stayed 3

pending appeal, the department shall investigate. 4

(5) At any time during an investigation or following the 5

issuance of a complaint, the department may schedule a compliance 6

conference under section 92 of the administrative procedures act of 7

1969, MCL 24.292. The conference may include the applicant, 8

licensee, registrant, or individual, the applicant's, licensee's, 9

registrant's, or individual's attorney, 1 member of the 10

department's staff, and any other individuals approved by the 11

department. One member of the appropriate board or task force who 12

is not a member of the disciplinary subcommittee with jurisdiction 13

over the matter may attend the conference and provide any 14

assistance that is needed. At the compliance conference, the 15

department shall attempt to reach agreement. If an agreement is 16

reached, the department shall submit a written statement outlining 17

the terms of the agreement, or a stipulation and final order, if 18

applicable, or a request for dismissal to the appropriate 19

disciplinary subcommittee for approval. If the agreement or 20

stipulation and final order or request for dismissal is rejected by 21

the disciplinary subcommittee, or if no agreement is reached, the 22

department shall schedule a hearing before an administrative law 23

judge. A party shall not make a transcript of the compliance 24

conference. All records and documents of a compliance conference 25

held before a complaint is issued are subject to section 16238. 26

(6) Within 90 days after an investigation is initiated under 27

subsection (2), (3), or (4), the department shall do 1 or more of 28

the following: 29

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EMR 01332'21

(a) Issue a formal complaint. 1

(b) Conduct a compliance conference under subsection (5). 2

(c) Issue a summary suspension. 3

(d) Issue a cease and desist order. 4

(e) Dismiss the allegation. 5

(f) Place in the complaint file not more than 1 written 6

extension of not more than 30 days to take action under this 7

subsection. 8

(7) Unless the person submitting an allegation under 9

subsection (1) otherwise agrees in writing or the information is 10

required to be disclosed for purposes of the nurse licensure 11

compact enacted in section 16190, the department shall keep the 12

identity of a person that submitted the allegation confidential 13

until disciplinary proceedings under this part are initiated 14

against the subject of the allegation and the person that made the 15

allegation is required to testify in the proceedings. 16

(8) The department shall serve a complaint under section 17

16192. The department shall include in the complaint a notice that 18

the applicant, licensee, registrant, or individual who is the 19

subject of the complaint has 30 days from the date of receipt to 20

respond in writing to the complaint. 21

(9) The department shall treat the failure of an applicant, 22

licensee, registrant, or individual to respond to a complaint 23

within the 30-day period set forth in subsection (8) as an 24

admission of the allegations contained in the complaint. The 25

department shall notify the appropriate disciplinary subcommittee 26

of the individual's failure to respond and shall forward a copy of 27

the complaint to that disciplinary subcommittee. The disciplinary 28

subcommittee may then impose an appropriate sanction under this 29

34

EMR 01332'21

article, article 7, or article 8. 1

(10) All of the following apply for purposes of subsection 2

(2)(a): 3

(a) If the chair of the board or task force has a conflict of 4

interest, he or she shall appoint another member of the board or 5

task force as his or her designee and shall not participate in the 6

panel's decision to grant or deny authorization to the department 7

to investigate an individual. 8

(b) A member of the board or task force shall not participate 9

in the panel's decision to grant or deny authorization to the 10

department to investigate an individual if that member has a 11

conflict of interest. If the chair of the board or task force is 12

notified that a member of the panel has a conflict of interest, the 13

chair shall remove him or her from the panel and appoint another 14

member of the board or task force to serve on the panel. 15

(c) A member of the board or task force who participates in or 16

is requested to participate in the panel's decision to grant or 17

deny authorization to the department to investigate an individual 18

shall disclose to the department, to the chair of the board or task 19

force, and to the other member of the panel a potential conflict of 20

interest before those participants make that decision. 21

(11) As used in subsection (10), "conflict of interest" means 22

any of the following: 23

(a) Has a personal or financial interest in the outcome of the 24

investigation of or the imposition of disciplinary sanctions on the 25

licensee, registrant, or applicant for licensure or registration. 26

(b) Had a past or has a present business or professional 27

relationship with the individual that the department is 28

investigating or requesting authorization to investigate. 29

35

EMR 01332'21

(c) Has given expert testimony in a medical malpractice action 1

against or on behalf of the individual that the department is 2

seeking authorization to investigate. 3

(d) Any other interest or relationship designated as a 4

conflict of interest in a rule promulgated or order issued under 5

this act. 6

Sec. 16238. (1) Except as otherwise provided in section 7

13(1)(u) (i) 13(1)(t)(i) and (ii) of the freedom of information act, 8

Act No. 442 of the Public Acts of 1976, being section 15.243 of the 9

Michigan Compiled Laws, 1976 PA 442, MCL 15.243, or for purposes of 10

complying with the nurse licensure compact enacted in section 11

16190, the information including, but not limited to, patient 12

names, obtained in an investigation or a compliance conference 13

before a complaint is issued, is confidential and shall must not be 14

disclosed except to the extent necessary for the proper functioning 15

of a hearings examiner, a disciplinary subcommittee, or the 16

department. 17

(2) A compliance conference conducted under this part before a 18

complaint is issued shall must be closed to the public. 19

Sec. 17201. (1) As used in this part: 20

(a) "Advanced practice registered nurse" or "a.p.r.n." means a 21

registered professional nurse who has been granted a specialty 22

certification under section 17210 in 1 of the following health 23

profession specialty fields: 24

(i) Nurse midwifery. 25

(ii) Nurse practitioner. 26

(iii) Clinical nurse specialist. 27

(b) "Nurse licensure compact" means the nurse licensure 28

compact as enacted in section 16190. 29

36

EMR 01332'21

(c) (b) "Physician" means a physician who is licensed under 1

part 170 or part 175. 2

(d) (c) "Practice of nursing" means the systematic application 3

of substantial specialized knowledge and skill, derived from the 4

biological, physical, and behavioral sciences, to the care, 5

treatment, counsel, and health teaching of individuals who are 6

experiencing changes in the normal health processes or who require 7

assistance in the maintenance of health and the prevention or 8

management of illness, injury, or disability. 9

(e) (d) "Practice of nursing as a licensed practical nurse" or 10

"l.p.n." means the practice of nursing based on less comprehensive 11

knowledge and skill than that required of a registered professional 12

nurse and performed under the supervision of a registered 13

professional nurse, physician, or dentist. 14

(f) (e) "Registered professional nurse" or "r.n." means an 15

individual who is licensed under this part article or authorized 16

under section 17225 to engage in the practice of nursing which and 17

whose scope of practice includes the teaching, direction, and 18

supervision of less skilled personnel in the performance of 19

delegated nursing activities. 20

(2) In addition to the definitions in this part, article 1 21

contains general definitions and principles of construction 22

applicable to all articles in the code and part 161 contains 23

definitions applicable to this part. 24

Sec. 17225. (1) An individual who holds a multistate license 25

to practice registered nursing under the nurse licensure compact is 26

authorized to engage in the practice of nursing under this article. 27

(2) For purposes of this article, including the obligations of 28

an individual who is licensed as a registered professional nurse 29

37

EMR Final Page 01332'21

except for the requirements necessary to obtain and retain a 1

license in this state, an individual who holds a multistate license 2

to practice registered nursing under the nurse licensure compact is 3

considered a registered professional nurse who is licensed under 4

this part. 5

Sec. 17225a. (1) An individual who holds a multistate license 6

to practice licensed practical/vocational nursing under the nurse 7

licensure compact is authorized to engage in the practice of 8

nursing as a licensed practical nurse under this article. 9

(2) For purposes of this article, including the obligations of 10

an individual who is licensed as a licensed practical nurse except 11

for the requirements necessary to obtain and retain a license in 12

this state, an individual who holds a multistate license to 13

practice licensed practical/vocational nursing under the nurse 14

licensure compact is considered a licensed practical nurse who is 15

licensed under this part. 16

Enacting section 1. This amendatory act takes effect 90 days 17

after the date it is enacted into law. 18