APRN compact draws high-stakes debate: supporters cite workforce gains, critics warn of governance and practice risks

Sen. Antonio Hayes presented Senate Bill 359 to authorize Maryland to join the Advanced Practice Registered Nurse (APRN) Compact, which would let qualified APRNs elect a multistate license to practice across participating states, in person and via telehealth.

Proponents included hospitals, the Maryland Board of Nursing, the National Council of State Boards of Nursing (NCSBN) and the Department of Defense liaison. They emphasized benefits in workforce mobility, emergency response and reduced licensing burden and cited federal preference for compacts to help military spouses. Nicole Evanos of the NCSBN and Jane Krenke of the Maryland Hospital Association highlighted examples from other states and the compact’s alignment with pandemic lessons about cross-state practice.

Organized opposition — notably the Nurse Practitioner Association of Maryland (NPAM), the American Association of Nurse Practitioners (AANP) and individual APRNs — raised a set of recurring concerns. Speakers including Nicole Lalo, Dr. Dale Jafari and Nyla Russell argued the draft compact is flawed: it requires a 2,080-hour (1-year full-time) prerequisite before a new APRN can obtain a multistate license; it does not guarantee an APRN seat on the interstate commission that makes operational rules; and the compact’s amendment procedure requires unanimous enactment across member legislatures, making later fixes difficult. Several witnesses urged pursuing reciprocity arrangements or other state-level tools instead of adopting the compact in its current form.

Committee members asked detailed operational questions: how the 2,080-hour requirement relates to Maryland mentorship rules, how controlled-substance prescribing would be handled under compact privileges, and whether Maryland would retain regulatory authority. Witnesses clarified that compact licensing would not change scope-of-practice laws in Maryland but could limit some practices in remote states with different rules; DEA-controlled-substance registration remains federally regulated.

The hearing record is extensive and split: many institutional backers urged a favorable report to address shortages and support military mobility; many practicing APRNs asked for changes to the compact text or delay to allow negotiated revisions. The committee did not vote that day.