Should Nurse Licenses Hold Across States?
Advocates say such a new approach to licensure is critical in an evolving health care world, but nurse unions disagree.
July 13, 2016
Motorists can cross state borders from California to Connecticut and the drivers’ licenses they got back home remain valid. But in most cases, a nurse can’t practice her profession in different states without multiple licenses.
A group of advocates wants that to change. Arizona just signed legislation to enter the Nurse Licensure Compact, joining Florida, Idaho, Oklahoma, South Dakota, Tennessee, Virginia and Wyoming. A nurse in Arizona can travel to any state that’s part of the arrangement to practice medicine, without obtaining further licenses.
With the growing importance of telemedicine, as well as the need for nurses in underserved areas, momentum for a license that transcends borders seems to be building, says Jim Puente, director of the compact with the National Council of State Boards of Nursing. “If you’re a nurse who is practicing telephonically with patients in the western part of the U.S. and that is your client base, you need to hold a license in every one of those states. That’s an onerous task, not to mention expensive,” Puente says. “We believe a nurse is a nurse from state to state, and that a multi-state license will eliminate the redundancy.”
A simpler compact was first implemented in 2000, eventually swelling to 25 states. However, growth stagnated in 2010, Puente says, because the original excluded background checks. With their inclusion this time around, Puente hopes to quickly reach, and surpass, the original 25. The old compact will stay in effect, meanwhile, until either the end of 2018, or when the new one reaches 26 states.
Some have expressed concern about the move toward multi-state licensure. Local governments are hesitant to lose revenue from licensing fees, while nurse unions worry about inconsistent state licensure regulations. They’re also afraid that if they go on strike in one state, nurses from another state could be brought in to replace them.
But other nurse groups support breaking down state boundaries. The American Organization of Nursing Executives first voiced its approval for the idea in 2002, and continues to support it, says Jo Ann Webb, vice president for federal relations and policy. Professions such as physicians, psychologists and dietitians are taking notice, and considering similar compacts.
“There is a nursing shortage, and you complicate that with the fact that somebody wants to go to work, and yet they have to go through all this rigmarole,” Webb says. “Figuring there are a lot of jobs available, they might take something in retail, as opposed to nursing, if it’s too complicated and expensive.”
Leaders in states with pending legislation are eager to join, too. Governors in Missouri and New Hampshire were poised to sign newly passed legislation in June, making those the ninth and 10th states to join the compact. Minnesota is also contemplating hopping aboard, and health systems such as the Mayo Clinic are lobbying state officials there for approval.
The Rochester, Minn., organization needs nurses with flexibility to help staff its emergency Mayo 1 helicopter, and the system operates intensive care units through video and telephone capabilities in such states as Iowa, Wisconsin and Georgia, says Sharon Prinsen, R.N., nurse administrator. Such innovative approaches to staffing are necessary for success in health care’s changing landscape, she believes.
“It really opens the door for technology and new models of care to address meeting patients wherever they are versus having to come forward to a traditional facility to be cared for,” Prinsen says.
The border reciprocity agreement allows nurses who work in the neighboring states of Iowa, South Dakota, North Dakota and Wisconsin to practice nursing in Minnesota without a Minnesota license, provided they register with the Minnesota Board of Nursing. But the Minnesota Nurses Association has expressed strong opposition to the idea. The group argues that passing the pact could weaken the state’s oversight of the practice of nursing, and result in inconsistent standards, loss of licensing revenues to Minnesota, and threatens to nurses’ rights to organize.
“For these reasons, the Minnesota Nurses Association steadfastly opposes the compact,” the group wrote in a statement last year. “We do, however, remain committed to seeking regulatory alternatives that do not put patient and nurses in harm’s way, or put states in jeopardy of financial risk and potential loss of rule-making authority and oversight accountability.”
Nurse groups are opposing legislation in Rhode Island, and state officials have considered repealing the state’s participation in the previous compact. Misconceptions and false information abound, according to Maria Ducharme, R.N., senior vice president for patient care services and chief nursing officer at the 247-bed Miriam Hospital in Providence, R.I. Nursing exams are similar from state to state, she says, and so are the duties performed by RNs.
That’s why she and others at the Lifespan hospital have been advocating for the law change. The compact, she says, would help to remedy certain challenges. For instance, when hospitals are slammed in winter months with dozens of patients suffering from the flu, respiratory ailments and injuries caused by falls on slippery outdoor surfaces, they could put out a call to nurses from nearby states to help. In some instances, Miriam’s daily admissions can swell by 100 in as little as 24 hours.
Ducharme also points out that some rural regions are struggling to find specialists in fields like peri-operative nursing or labor and delivery.
“We need to be using our resources nationally in the best way we know how,” says Ducharme, who is also president of the Organization of Nurse Leaders for Rhode Island, Massachusetts, New Hampshire and Connecticut. “We’re doing a disservice to patient care in some respects, especially as it relates to nurses who are educated and experienced in a specialty.”
Point/Counterpoint — Five Reasons For/Against the Compact:
- Eliminates redundancy, duplicative regulatory processes and unnecessary fees for nurses.
- Improves access to licensed nurses during a disaster, or other times of great need for nursing services.
- Benefits military spouses who often relocate every two years.
- Requires state boards of nursing, by statute, to participate in the national nurse license database, which shares license and discipline info among compact states.
- Removes multi-state privileges from nurses who are under discipline in compact states, thereby protecting remote states when a home state licensee is disciplined for a violation of the nurse practice act.
Source: National Council of State Boards of Nursing, 2015
- Supersedes the rights and interests of states and citizens, and enacting it requires states to cede administrative authority, removing its ability to oversee, evaluate and change.
- Compromises the state’s responsibility for establishing a requirement for initial and continued competency of nonresident nurses.
- Risks considerable financial loss to states, due to compact requirements for annual maintenance fees and the elimination of licensure and re-registration fees from nonresident nurses.
- Weakens existing public policy, state laws and rules, including union activity, and nurses’ rights to organize.
- Leaves unanswered questions related to licensure, data confidentiality and nurse discipline.
Source: Minnesota Nurses Association, 2015