WEBVTT 00:00:05.160 --> 00:00:12.640 position:50% align:middle Today, I'm honored to present to you the NCSBN compact study. 00:00:12.640 --> 00:00:21.060 position:50% align:middle Nursing regulators have taken the lead in license modernization and developed the Nurse Licensure Compact 00:00:21.060 --> 00:00:27.100 position:50% align:middle to mobilize the nursing workforce and safeguard patient safety. 00:00:27.100 --> 00:00:34.950 position:50% align:middle Today, we would like to explore nurses' views about the need for compacts. 00:00:34.950 --> 00:00:38.310 position:50% align:middle This is the outline of my presentation. 00:00:38.310 --> 00:00:45.600 position:50% align:middle We'll start with a brief history of compact. 00:00:45.600 --> 00:00:55.700 position:50% align:middle Nurse Licensure Compact (NLC) was introduced by National Council of State Boards of Nursing in 2000s. 00:00:55.700 --> 00:01:01.780 position:50% align:middle It allows a registered nurse, a licensed practical nurse, 00:01:01.780 --> 00:01:09.140 position:50% align:middle and a vocational nurse to hold one compact license obtained from their home state to practice 00:01:09.140 --> 00:01:12.020 position:50% align:middle in other compact states. 00:01:12.020 --> 00:01:24.250 position:50% align:middle Currently, 41 jurisdictions already enacted the NLC compact license legislation, 00:01:24.250 --> 00:01:31.670 position:50% align:middle making NLC the predominant license model in the United States. 00:01:31.670 --> 00:01:36.157 position:50% align:middle The APRN Compact was built in 2002. 00:01:36.157 --> 00:01:45.650 position:50% align:middle It allows the APRNs to hold a multistate license with the privilege to practice in other compact states. 00:01:45.650 --> 00:01:52.820 position:50% align:middle Currently, three states enacted the APRN Compact legislation. 00:01:52.820 --> 00:02:03.260 position:50% align:middle As Mr. Smiley just announced that South Dakota, they moved four steps ahead towards the APRN Compact. 00:02:03.260 --> 00:02:15.750 position:50% align:middle The APRN Compact will become effective once we have seven jurisdictions pass the APRN Compact legislation. 00:02:15.750 --> 00:02:23.980 position:50% align:middle This morning, my colleague, Mr. Richard Smiley, presented the NCSBN National Nursing Workforce Study, 00:02:23.980 --> 00:02:30.990 position:50% align:middle which projects a series of nursing workforce shortage after the pandemic. 00:02:30.990 --> 00:02:41.850 position:50% align:middle In response, the healthcare policies and the researchers are exploring long-term policy solution 00:02:41.850 --> 00:02:47.710 position:50% align:middle to mitigate healthcare crises and increase access to care. 00:02:47.710 --> 00:02:56.910 position:50% align:middle The purpose of our current study is to assess nurses, their opinion about the APRN Compact and 00:02:56.910 --> 00:02:59.290 position:50% align:middle the NLC Compact. 00:02:59.290 --> 00:03:06.730 position:50% align:middle So, we also would like to address some concerns, the possible concerns they may have. 00:03:06.730 --> 00:03:15.540 position:50% align:middle These online surveys were conducted by National Council of State Boards of Nursing in collaboration with the 00:03:15.540 --> 00:03:19.580 position:50% align:middle nursing regulatory bodies. 00:03:19.580 --> 00:03:25.630 position:50% align:middle In the United States, as we know, nursing regulatory bodies are boards of nursing. 00:03:25.630 --> 00:03:32.560 position:50% align:middle I would use this term, boards of nursing, during the presentation. 00:03:32.560 --> 00:03:41.790 position:50% align:middle Before the survey, all participant boards, they distributed a study announcement informing their 00:03:41.790 --> 00:03:51.400 position:50% align:middle nurses the purpose of the study and provided the background of NLC and also the APRN Compact based 00:03:51.400 --> 00:03:54.250 position:50% align:middle on the purpose of the study. 00:03:54.250 --> 00:04:06.889 position:50% align:middle Altogether 10 boards participate in the survey, 5 for the NLC survey and 5 for the APRN Compact survey. 00:04:06.889 --> 00:04:16.970 position:50% align:middle The survey instrument was developed by NCSBN with input with the boards of nursing. 00:04:16.970 --> 00:04:23.500 position:50% align:middle Standard descriptive analysis was performed on quantitative data. 00:04:23.500 --> 00:04:32.960 position:50% align:middle And the open-ended question was classified using the natural language processing. 00:04:32.960 --> 00:04:43.127 position:50% align:middle Let's look at the NLC survey first, 66,054 nurses participated in the NLC survey 00:04:43.127 --> 00:04:46.990 position:50% align:middle between 2018 and 2020. 00:04:46.990 --> 00:04:54.305 position:50% align:middle The response is 24%. 00:04:54.305 --> 00:05:03.875 position:50% align:middle In the NLC survey, we gathered basic information about nurses' out-of-state practice experience, 00:05:03.875 --> 00:05:10.219 position:50% align:middle their opinion about the NLC model, and their need for the NLC model. 00:05:10.219 --> 00:05:16.996 position:50% align:middle And also for the nurses who already obtained their compact license from their home state, 00:05:16.996 --> 00:05:25.436 position:50% align:middle we wanted to know their experience with the compact license. 00:05:25.436 --> 00:05:33.331 position:50% align:middle Our data showed that over 40% of the nurses at the time of survey, they already hold an active license 00:05:33.331 --> 00:05:43.221 position:50% align:middle in other states, and about 45% of them, they practiced nursing in other state in the 00:05:43.221 --> 00:05:49.280 position:50% align:middle past two years. 00:05:49.280 --> 00:05:55.544 position:50% align:middle At the time of the survey, none of the five participant boards of the states, 00:05:55.544 --> 00:05:57.343 position:50% align:middle they were part of NLC. 00:05:57.343 --> 00:06:07.875 position:50% align:middle However, two boards asked their nurses about the compact license practice experience when they got the 00:06:07.875 --> 00:06:11.907 position:50% align:middle license from their home state. 00:06:11.907 --> 00:06:18.298 position:50% align:middle Our study shows that nearly a quarter of the nurses from these two states, 00:06:18.298 --> 00:06:24.167 position:50% align:middle they already obtained an NLC license from their home state. 00:06:24.167 --> 00:06:29.307 position:50% align:middle And 68% of them, they use their license, the compact license. 00:06:29.307 --> 00:06:38.398 position:50% align:middle Among the nurses who hold a compact license, and they reported the compact license were 00:06:38.398 --> 00:06:39.514 position:50% align:middle beneficial to them. 00:06:39.514 --> 00:06:49.625 position:50% align:middle And this statistic is even higher among the nurses who hold a compact license and practiced the... 00:06:49.625 --> 00:07:01.524 position:50% align:middle About 96% of them thought the compact license benefited their nursing practice. 00:07:01.524 --> 00:07:08.069 position:50% align:middle So, here we can see the nurses' opinion about their states' joint compact. 00:07:08.069 --> 00:07:19.910 position:50% align:middle Among those who expressed their support or opposition, 95 of them thought compacts are beneficial to them. 00:07:19.910 --> 00:07:34.194 position:50% align:middle These supports are consistent across states and across nurses' demographic characteristics. 00:07:34.194 --> 00:07:41.422 position:50% align:middle So, among the nurses who opposed the compact, their major concern raised by the nurses were the 00:07:41.422 --> 00:07:44.920 position:50% align:middle compact may lower the patient safety. 00:07:44.920 --> 00:07:57.553 position:50% align:middle So, about 700 nurses reported their licensing state imposes more stringent license requirement than the 00:07:57.553 --> 00:08:00.255 position:50% align:middle other states, so they are better. 00:08:00.255 --> 00:08:05.412 position:50% align:middle So, the nurses from other states may not be safe to practice. 00:08:05.412 --> 00:08:13.588 position:50% align:middle They worry the NLC may let these unsafe nurses to practice in their states, 00:08:13.588 --> 00:08:17.336 position:50% align:middle which will lead to negative patient outcomes. 00:08:17.336 --> 00:08:27.990 position:50% align:middle The second concern was the compact may lower nurses' bargaining power. 00:08:27.990 --> 00:08:37.168 position:50% align:middle So, this morning, Dr. Linda Aiken also mentioned that unions are against the compact, 00:08:37.168 --> 00:08:43.440 position:50% align:middle though they are supportive for the stacking ratio requirement. 00:08:43.440 --> 00:08:52.660 position:50% align:middle Since the implementation of compact 20 years ago, there is no evidence that facilities would use compact 00:08:52.660 --> 00:08:55.320 position:50% align:middle to break strides. 00:08:55.320 --> 00:09:04.130 position:50% align:middle Based on the finding from the two states that asked the union question, we found that 94% of the nurses who 00:09:04.130 --> 00:09:15.320 position:50% align:middle were members of a union still reported they support compact. 00:09:15.320 --> 00:09:25.310 position:50% align:middle So, the major reason for supporting compact reported by the nurses who support compact include, first, 00:09:25.310 --> 00:09:30.610 position:50% align:middle increased access to care, increased job opportunity and 00:09:30.610 --> 00:09:34.230 position:50% align:middle cost-effective licensure process. 00:09:34.230 --> 00:09:44.420 position:50% align:middle In addition, the responses also believe that the compact lead to a higher patient safety because of the 00:09:44.420 --> 00:09:48.440 position:50% align:middle uniform licensure requirements. 00:09:48.440 --> 00:09:56.725 position:50% align:middle Now, we should look at the patient safety issue again. 00:09:56.725 --> 00:10:00.770 position:50% align:middle Patient safety is a mandate for all of us. 00:10:00.770 --> 00:10:10.840 position:50% align:middle In this study, 700 nurses believed that compact would lower the patient safety. 00:10:10.840 --> 00:10:22.140 position:50% align:middle In the same survey, 945 nurses believed that…they supported compact because the compact will lead to the 00:10:22.140 --> 00:10:25.630 position:50% align:middle safe patient care. 00:10:25.630 --> 00:10:30.210 position:50% align:middle So, what did the research tell us? 00:10:30.210 --> 00:10:44.120 position:50% align:middle Studies consistently show that the uniform licensure requirement provides the extra layer for patient safety 00:10:44.120 --> 00:10:48.520 position:50% align:middle through the mandatory criminal background check. 00:10:48.520 --> 00:10:58.550 position:50% align:middle It requires no active disciplinary action on their license and no current enrollment in an alternative 00:10:58.550 --> 00:11:03.190 position:50% align:middle to discipline program. 00:11:03.190 --> 00:11:08.200 position:50% align:middle According to nurses, the only national nurse license and 00:11:08.200 --> 00:11:13.640 position:50% align:middle discipline database, we found that the annual discipline rates for nurses 00:11:13.640 --> 00:11:19.089 position:50% align:middle holding a compact license, the discipline rate is 0.11%. 00:11:19.089 --> 00:11:31.307 position:50% align:middle It's about a quarter of the discipline rate for nurses holding a single-state license. 00:11:31.307 --> 00:11:38.520 position:50% align:middle So, these statistics suggest that compact license are safe practitioners. 00:11:38.520 --> 00:11:43.950 position:50% align:middle They are not worse. 00:11:43.950 --> 00:11:54.187 position:50% align:middle Let's look at the APRN Compact Survey, 8,453 nurses participated in the study. 00:11:54.187 --> 00:12:03.049 position:50% align:middle The survey was conducted between 2021 and 2023. 00:12:03.049 --> 00:12:09.570 position:50% align:middle The response is 24%. 00:12:09.570 --> 00:12:14.480 position:50% align:middle In the compact survey, we asked three questions. 00:12:14.480 --> 00:12:18.870 position:50% align:middle First, did the nurses, the APRNs, experience a need 00:12:18.870 --> 00:12:23.360 position:50% align:middle for across-the-board practice analysis? 00:12:23.360 --> 00:12:30.630 position:50% align:middle And what their state...the interest or concerns about the compact model? 00:12:30.630 --> 00:12:41.010 position:50% align:middle Finally, we asked, will they apply for an APRN Compact license when it becomes available? 00:12:41.010 --> 00:12:53.661 position:50% align:middle First, we assess the need for the cross-state nursing practice based on their practice experience. 00:12:53.661 --> 00:13:02.630 position:50% align:middle First, we found that 46% of the nurses, they already hold an active APRN license 00:13:02.630 --> 00:13:11.220 position:50% align:middle in other states, and 67% of them, they practiced, they provided APRN services, 00:13:11.220 --> 00:13:18.620 position:50% align:middle so APRN education across the state boards. 00:13:18.620 --> 00:13:27.440 position:50% align:middle Again, when we asked the nurses’ opinion about adopting the APRN compact, we found that a vast majority of them 00:13:27.440 --> 00:13:36.975 position:50% align:middle are supportive of APRN Compact, so 96%. 00:13:36.975 --> 00:13:45.310 position:50% align:middle So, for those nurses who opposed the APRN Compact, so we found this time, 00:13:45.310 --> 00:13:50.841 position:50% align:middle the major concern is the 2,008 hours of practice requirement. 00:13:50.841 --> 00:13:57.150 position:50% align:middle That’s equal to about one-year practice. 00:13:57.150 --> 00:14:03.030 position:50% align:middle This requirement, in fact, it's a policy solution to address the increasing number 00:14:03.030 --> 00:14:20.218 position:50% align:middle of states requiring the transition to practice period as a pathway toward the full practice authority. 00:14:20.218 --> 00:14:26.870 position:50% align:middle That also reflects the current APRN policy nationwide. 00:14:26.870 --> 00:14:41.440 position:50% align:middle This requirement increased the pool of states eligible for enacting the APRN Compact. 00:14:41.440 --> 00:14:54.409 position:50% align:middle So, regarding the concern about lack of APRN representation, the bill languages creating 00:14:54.409 --> 00:14:57.240 position:50% align:middle the APRN commission. 00:14:57.240 --> 00:15:02.590 position:50% align:middle In fact, that mirrored the NLC compact commission. 00:15:02.590 --> 00:15:12.590 position:50% align:middle It also aligns with the structures observed in others healthcare compacts. 00:15:12.590 --> 00:15:21.670 position:50% align:middle So, when we look at the reason for supporting compact, increased access to care and the increase improved 00:15:21.670 --> 00:15:30.180 position:50% align:middle patient safety, of course the cost effectiveness of the licensure application. 00:15:30.180 --> 00:15:40.046 position:50% align:middle Many of the APRN license application requirements mirror the NLC standards that’s already adopted 00:15:40.046 --> 00:15:44.080 position:50% align:middle by 41 jurisdictions. 00:15:44.080 --> 00:15:56.850 position:50% align:middle We expect that the stringent licensure application requirements for APRN Compact will lead to safer 00:15:56.850 --> 00:16:08.500 position:50% align:middle patient care as evident in other NLC… already evident in other NLC states. 00:16:08.500 --> 00:16:16.240 position:50% align:middle Finally, we found that 84% of the nurses, the respondents showed an interest to apply 00:16:16.240 --> 00:16:23.490 position:50% align:middle for an APRN Compact once it becomes available. 00:16:23.490 --> 00:16:24.380 position:50% align:middle Limitations. 00:16:24.380 --> 00:16:30.620 position:50% align:middle This study was based on self-reported data. 00:16:30.620 --> 00:16:38.640 position:50% align:middle Even though we conducted the survey consistently across states and the executive officers participating were 00:16:38.640 --> 00:16:47.010 position:50% align:middle already distributed the standard information, we cannot exclude the possibilities of unobserved 00:16:47.010 --> 00:16:55.010 position:50% align:middle factors unique to each state may affect nurses’ response. 00:16:55.010 --> 00:17:08.660 position:50% align:middle In particular, COVID-19 pandemic could affect a nurse’s opinion about the compact. 00:17:08.660 --> 00:17:18.570 position:50% align:middle Like other healthcare compacts, the NLC and the APRN Compact provides a permanent 00:17:18.570 --> 00:17:29.170 position:50% align:middle solution to license portability in emergency and non-emergency time. 00:17:29.170 --> 00:17:38.590 position:50% align:middle Compacts benefited the public by enabling nurses to practice across states. 00:17:38.590 --> 00:17:50.010 position:50% align:middle In addition, compacts facilitated telehealth, which lead to increased access to care. 00:17:50.010 --> 00:17:58.590 position:50% align:middle For boards of nursing, compact licensure happened to reduce duplicated 00:17:58.590 --> 00:18:11.111 position:50% align:middle licensure process, allowing them to using limited manpower and resources toward speeding up the initial 00:18:11.111 --> 00:18:19.470 position:50% align:middle licensure and develop more efficient discipline and remediation programs. 00:18:19.470 --> 00:18:32.120 position:50% align:middle For nurses, compact provided them with optional and additional opportunities of mobility and relieve 00:18:32.120 --> 00:18:46.930 position:50% align:middle from the burden of the licensure managing extra and paying for multiple licenses. 00:18:46.930 --> 00:18:58.120 position:50% align:middle In conclusion, our studies revealed a clear need for compact across the boarder nursing practice, 00:18:58.120 --> 00:19:07.900 position:50% align:middle and the majority of the respondents, they welcome the NLC and the APRN Compact. 00:19:07.900 --> 00:19:17.570 position:50% align:middle The NLC and APRN Compact are for and supported by the nurses. 00:19:17.570 --> 00:19:33.750 position:50% align:middle So, the time for implementing the NLC nationally and enact the APRN Compact is now. 00:19:33.750 --> 00:19:43.617 position:50% align:middle Before I want to close my talk, I want to thank the co-authors of this study 00:19:43.617 --> 00:19:48.375 position:50% align:middle from NCSBN, and some of them are within us here. 00:19:48.375 --> 00:19:54.000 position:50% align:middle And I would thank Dr. Brendan Martin. 00:19:54.000 --> 00:19:59.140 position:50% align:middle He is organizer and the brain of the compact projects. 00:19:59.140 --> 00:20:05.490 position:50% align:middle And Dr. Maryann Alexander, she is the driving force and a leader of the 00:20:05.490 --> 00:20:12.950 position:50% align:middle NCSBN Compact team. 00:20:12.950 --> 00:20:17.810 position:50% align:middle In addition, we would like to thank the boards who participated in the study, 00:20:17.810 --> 00:20:26.600 position:50% align:middle especially the executive officers who initiated the process of contacting their nurses to invite them and 00:20:26.600 --> 00:20:31.400 position:50% align:middle encourage them to participate in the study. 00:20:31.400 --> 00:20:41.110 position:50% align:middle Furthermore, we really appreciate all the support from over 75,000 nurses who took their time 00:20:41.110 --> 00:20:43.130 position:50% align:middle to join our study. 00:20:43.130 --> 00:20:48.970 position:50% align:middle Thank you for your support and all your services. 00:20:48.970 --> 00:20:54.910 position:50% align:middle So, now I would like to thank all of you who take the time to be here. 00:20:54.910 --> 00:20:57.935 position:50% align:middle So, now I will be glad to take any questions. 00:21:06.479 --> 00:21:08.900 position:50% align:middle - Thank you for this great presentation. 00:21:08.900 --> 00:21:09.890 position:50% align:middle It was really informative. 00:21:09.890 --> 00:21:11.470 position:50% align:middle I have two quick questions for you. 00:21:11.470 --> 00:21:18.730 position:50% align:middle The first being, how were the five states chosen for the APRN component of the survey? 00:21:18.730 --> 00:21:25.240 position:50% align:middle And also, were you able to identify the APRNs by type? 00:21:25.240 --> 00:21:34.050 position:50% align:middle Because, you know, there are four distinct types and so not all four share the same transition to practice 00:21:34.050 --> 00:21:35.860 position:50% align:middle hours that you see across the country. 00:21:35.860 --> 00:21:43.250 position:50% align:middle And I think, when you look at the 500,000 or so nurses who are represented by the four APRN groups who are all 00:21:43.250 --> 00:21:50.010 position:50% align:middle fairly strongly in opposition to the APRN Compact, I would wonder if you decipher that a little bit. 00:21:50.010 --> 00:21:51.400 position:50% align:middle - Thank you very much. 00:21:51.400 --> 00:21:54.270 position:50% align:middle This is a good question. 00:21:54.270 --> 00:21:54.740 position:50% align:middle Yeah. 00:21:54.740 --> 00:21:59.370 position:50% align:middle First, the truth of the participation. 00:21:59.370 --> 00:22:05.460 position:50% align:middle So, in fact, NCSBN did not choose any of the participant boards. 00:22:05.460 --> 00:22:11.630 position:50% align:middle At the time of the survey, these boards, they showed interest to pass there either the NLC or 00:22:11.630 --> 00:22:14.030 position:50% align:middle the APRN Compact legislation. 00:22:14.030 --> 00:22:17.890 position:50% align:middle They contacted us, and then we worked together. 00:22:17.890 --> 00:22:23.430 position:50% align:middle And the second question about—I think that's what you talked about—the transition to practice, 00:22:23.430 --> 00:22:25.990 position:50% align:middle the impact on the funding. 00:22:25.990 --> 00:22:34.450 position:50% align:middle For the APRN Compact survey, altogether five states, two of them, they required a transition 00:22:34.450 --> 00:22:36.200 position:50% align:middle to practice requirement. 00:22:36.200 --> 00:22:37.930 position:50% align:middle We looked over the findings. 00:22:37.930 --> 00:22:46.350 position:50% align:middle We found that boards required the transition hours and those who did not require, 00:22:46.350 --> 00:22:48.610 position:50% align:middle there are no significant difference. 00:22:48.610 --> 00:22:57.827 position:50% align:middle And as we showed in the presentation, the majority of the nurses they supported. 00:22:57.827 --> 00:23:01.570 position:50% align:middle - Maybe I didn’t clearly articulate my question. 00:23:01.570 --> 00:23:08.900 position:50% align:middle So, the nurse practitioners or CRNAs, even in states that require a transition to practice 00:23:08.900 --> 00:23:11.830 position:50% align:middle hours for a nurse practitioner, you may not see that transition to practice hour 00:23:11.830 --> 00:23:13.720 position:50% align:middle requirement for CRNAs. 00:23:13.720 --> 00:23:17.400 position:50% align:middle So, my question really was, were you able to identify if the participants were 00:23:17.400 --> 00:23:20.840 position:50% align:middle nurse practitioners or CRNAs or cloned specs or midwives? 00:23:20.840 --> 00:23:26.460 position:50% align:middle And did that have any impact on their response to your survey? 00:23:26.460 --> 00:23:29.580 position:50% align:middle - Wonderful, so sorry. 00:23:29.580 --> 00:23:38.220 position:50% align:middle In fact, we did tether the data about the four rules of the APRN rules, and we break down the analysis. 00:23:38.220 --> 00:23:40.370 position:50% align:middle And we found that there are no differences. 00:23:40.370 --> 00:23:47.460 position:50% align:middle In fact, the detailed finding has been published in the Journal of Nursing Regulation in the January issue. 00:23:47.460 --> 00:23:51.210 position:50% align:middle So, we'll be happy to share with you more detailed information. 00:23:51.210 --> 00:23:52.034 position:50% align:middle Great question. 00:23:57.490 --> 00:24:03.097 position:50% align:middle So, any other questions? 00:24:03.097 --> 00:24:06.636 position:50% align:middle So, it seems we do not have… 00:24:06.636 --> 00:24:07.620 position:50% align:middle - I have a question. 00:24:07.620 --> 00:24:08.809 position:50% align:middle - Oh, yeah. 00:24:08.809 --> 00:24:09.896 position:50% align:middle So, [inaudible]. 00:24:09.896 --> 00:24:10.398 position:50% align:middle Yeah. 00:24:10.398 --> 00:24:10.894 position:50% align:middle - Thank you. 00:24:10.894 --> 00:24:12.550 position:50% align:middle Very interesting. 00:24:12.550 --> 00:24:20.250 position:50% align:middle And I have a question about the APRN Compact, so this might just… Are there plans at this point to go 00:24:20.250 --> 00:24:28.010 position:50% align:middle sit back down with the APRN organizations and try to figure out how to come together? 00:24:28.010 --> 00:24:32.350 position:50% align:middle Because there’s so much opposition by one major organization. 00:24:32.350 --> 00:24:34.820 position:50% align:middle I just don’t want to say their name here in the room, but everybody knows. 00:24:34.820 --> 00:24:45.620 position:50% align:middle But is there plan for NCSBN to go try to rekindle the conversation and figure out where the impasses and how 00:24:45.620 --> 00:24:46.240 position:50% align:middle to go from there? 00:24:46.240 --> 00:24:48.379 position:50% align:middle Is there any thought? 00:24:48.379 --> 00:24:49.503 position:50% align:middle - That’s a great… - Yeah, it’s a good question. 00:24:49.503 --> 00:24:50.909 position:50% align:middle - Excellent question. 00:24:50.909 --> 00:24:51.524 position:50% align:middle Yes. 00:24:51.524 --> 00:24:58.080 position:50% align:middle However, for me, I’m a researcher, so I represent the result to you. 00:24:58.080 --> 00:24:59.835 position:50% align:middle But definitely… 00:24:59.835 --> 00:25:08.157 position:50% align:middle But definitely the NCSBN and also will walk with the board to go through this finding to try 00:25:08.157 --> 00:25:12.286 position:50% align:middle to identify the real barriers and try to move forward. 00:25:12.286 --> 00:25:13.813 position:50% align:middle Yeah. 00:25:13.813 --> 00:25:14.286 position:50% align:middle Thank you. 00:25:14.286 --> 00:25:15.303 position:50% align:middle That’s really great. 00:25:15.303 --> 00:25:21.299 position:50% align:middle Next step. 00:25:21.299 --> 00:25:26.572 position:50% align:middle So, if there is no further question, I think I will pass the podium to our next speaker. 00:25:26.572 --> 00:25:27.687 position:50% align:middle Thank you.