Title of Regulation: 18VAC90-20. Regulations Governing the Practice of Nursing (amending 18VAC90-20-181).

Statutory Authority: §§ 54.1-2400 and 54.1-3005 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: July 17, 2013.

Effective Date: August 2, 2013.

Agency Contact: Jay P. Douglas, R.N., Executive Director, Board of Nursing, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, telephone (804) 367-4515, FAX (804) 527-4455, or email jay.douglas@dhp.virginia.gov.

Basis: Section 54.1-2400 of the Code of Virginia establishes the general powers and duties of health regulatory boards, including the responsibility to promulgate regulations.

Article 6 (§ 54.1-3030 et seq.) of Chapter 30 of Title 54.1 of the Code of Virginia establishes the legal framework for Virginia's participation in the Nurse Licensure Compact.

Purpose: Since Virginia regulations for participation in the Nurse Licensure Compact need to be consistent with the model rules and regulations, the amendment is adopted under a fast-track action. Permitting practice for 90 days by a nurse moving from one compact state to another will ensure sufficient time to process documentation and avoid a gap in the licensure privilege. Nurses moving to Virginia will be able to begin employment without concern that the transfer to a new party state cannot be accomplished within the current 30-day window. The ability to practice for 90 days during the processing of the nurses's application may modestly increase the availability of nursing care for the health and safety of patients in Virginia.

Rationale for Using Fast-Track Process: The amendment is less restrictive, conforming to the model rules of the compact and, therefore, is not controversial.

Substance: 18VAC90-20-181 is amended to allow a nurse who is changing primary state of residence to practice under the former party state license and multistate licensure privilege for a period not to exceed 90 days rather than the current limitation of 30 days.

Issues: The primary advantage to the public is the potential increase in the employment of nurses moving from another compact state into Virginia. There are no disadvantages to the public.

The advantage to the Commonwealth is consistency with the model rules of the compact. There are no disadvantages to the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board Nursing (Board) proposes to amend its regulations so that nurses who have a license to practice in another state that is part of the multistate compact, and who are applying for licensure in Virginia, may practice in Virginia for up to 90 days while awaiting their Virginia licensure application approval.

Result of Analysis. Benefits likely outweigh costs for this proposed regulatory change.

Estimated Economic Impact. Currently, nurses who are licensed to practice nursing in another state that is part of the multistate compact can practice for 30 days in Virginia while they await approval of their application for Virginia licensure. The Board proposes to extend the time that licensed nurses can practice while awaiting Virginia licensure to 90 days and report that this will allow Virginia regulations to conform to the multistate compact rules. Affected nurses will benefit from this extension as it will allow them to continue earning a living if their application takes more than 30 days to process. No entity should be adversely affected by this change because it would only apply to nurses who are in good standing with the licensure board in their originating state.

Businesses and Entities Affected. The Department of Health Professions (DHP) reports that 3,355 registered nurses and 416 licensed practical nurses were licensed by endorsement in 2012. DHP estimates that about half of these individuals would be affected by these proposed regulations since almost half of states participate in the Nurse Licensure Compact.

Localities Particularly Affected. No localities will be particularly affected by these proposed regulatory changes.

Projected Impact on Employment. This regulatory action will likely have little impact on employment in the Commonwealth.

Effects on the Use and Value of Private Property. This regulatory action will likely have little effect on the use or value of private property in the Commonwealth.

Small Businesses: Costs and Other Effects. No affected small business is likely to incur costs on account of these proposed regulations.

Small Businesses: Alternative Method that Minimizes Adverse Impact. No affected small business is likely to incur costs on account of these proposed regulations.

Real Estate Development Costs. This regulatory action will likely have no effect on real estate development costs in the Commonwealth.

Legal Mandate. The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Administrative Process Act and Executive Order Number 14 (10). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPB's best estimate of these economic impacts.

Agency's Response to Economic Impact Analysis: The Board of Nursing concurs with the analysis of the Department of Planning and Budget on proposed amended regulations for 18VAC90-20, Regulations Governing the Practice of Nursing.

Summary:

The amendments extend the maximum time period from 30 days to 90 days that nurses who (i) have a license to practice in another state that is part of the multistate compact and (ii) are applying for licensure in Virginia can practice in Virginia while waiting for approval of their Virginia licensure application.

18VAC90-20-181. Issuance of a license with a multistate licensure privilege.

A. In order to be issued a license with a multistate licensure privilege by the board, a nurse currently licensed in Virginia or a person applying for licensure in Virginia shall submit a declaration stating that his primary residence is in Virginia. Evidence of a primary state of residence may be required to include but not be limited to:

1. A driver's license with a home address;

2. A voter registration card displaying a home address;

3. A federal or state tax return declaring the primary state of residence;

4. A Military Form No. 2058 - state of legal residence; or

5. A W-2 from the United States government or any bureau, division, or agency thereof indicating the declared state of residence.

B. A nurse on a visa from another country applying for licensure in Virginia may declare either the country of origin or Virginia as the primary state of residence. If the foreign country is declared as the primary state of residence, a single state license shall be issued by Virginia.

C. A nurse changing the primary state of residence from another party state to Virginia may continue to practice under the former party state license and multistate licensure privilege during the processing of the nurse's licensure application by the board for a period not to exceed 30 90 days.

1. If a nurse is under a pending investigation by a former home state, the licensure application in Virginia shall be held in abeyance and the 30-day 90-day authorization to practice stayed until resolution of the pending investigation.

2. A license issued by a former party state shall no longer be valid upon issuance of a license by the board.

3. If the board denies licensure to an applicant from another party state, it shall notify the former home state within 10 business days, and the former home state may take action in accordance with the laws and regulations of that state.

D. A license issued by a party state is valid for practice in all other party states, unless clearly designated as valid only in the state that issued the license. When a party state issues a license authorizing practice only in that state and not authorizing practice in other party states, the license shall be clearly marked with words indicating that it is valid only in the state of issuance.