The Nurse Licensure Compact (NLC) is legislation that allows nurses to have one license to practice in multiple states, which seems like it would be more than helpful in states and regions experiencing a nursing shortage due to the COVID-19 pandemic and other factors. Yet, not all 50 states belong to the NLC. Let’s explore the benefits and what some perceive as drawbacks to the compact.
Less red tape, more mobility
Registered nurses aren’t the only nursing professionals who can participate in the NLC, said James Puente, MS, MJ, CAE, Director, Nurse Licensure Compact, National Council of State Boards of Nursing (NCSBN). The compact is relevant to all nurses regardless of their licensure and, according to Puente, is a “modern licensure model” for health care today.
“Under the compact, a nurse residing in a compact state can apply for a multistate license which is valid in every compact state,” said Puente.
The NLC aims to replace what the NCSBN calls an antiquated model of nurses holding individual single-state licenses for each state in which they practice, which can be costly, burdensome, and inefficient for nurses. That model is no longer practical in a more mobile and technological healthcare system, according to the nursing organization.
“For their patients, the nurse licensure compact increases access to care and allows for the provider to ‘follow’ the patient, ensuring continuity of care,” said Puente.
It makes sense for nurses to become familiar with the NLC, in part because employers recognize the benefits, including having the ability to practice in person and virtually across multiple states. Many employers require a multistate license for employment, according to the NCSBN.
Nursing organizations in some states, however, have concerns.
The challenges and drawbacks
David Keepnews, PhD, JD, RN, FAAN, executive director, Washington State Nurses Association, said his state has taken no action to become a compact state due to several areas of concern.
“Among the most important, the compact carries no registration requirement for nurses coming into the state, so we would have no way of tracking the nursing workforce,” Keepnews said. “We’re also concerned that nurses coming into our state would not have to meet any of the continuing education requirements for Washington State, which could cause gaps in knowledge of how nursing is practiced here.”
The NLC could help in the nursing shortage, in efforts to strategically deploy nurses to where they’re needed most, according to the NCSBN.
“This is precisely what large multistate hospital systems do in compact states,” Puente said. “Because they employ thousands of nurses, they can shift their nursing workforce to the areas where the need is most dire. In short, the multistate license enables nurses to practice in other compact states, where the nurse’s services are needed, with no delay caused by an additional licensure process.”
Nurses residing in states that do not participate in the compact do not have access to a multistate license, which is a drawback, especially when considering telehealth, according to the NCSBN.
“Not all nursing practice is bedside care. Patients are mobile, traveling, and even residing in multiple locations and need access to trusted providers along the way,” said Puente. “Telehealth is now practiced by more nurses than ever before, and the industry continues to grow. If a nurse practices in a telehealth role, the nurse may be required to hold multiple single-state licenses — one for each jurisdiction in which their patients may be in at the time of care!”
Multistate licensure can help in times of public health emergencies and disaster preparedness by making nurse mobility easier via licensure model known as “mutual recognition.” “This means that a nurse’s license and credentials are recognized and accepted in all compact states. When nurses must wait for a licensure process to be completed, the nurse may experience unemployment, the nurse may lose a job opportunity due to the delay, and patients have longer waits before they can get access to the nursing care they need,” Puente said.
Still, Keepnews questions whether the compact solves important issues in nursing today. For example, he does not believe that the fact that Washington State is not an NLC state has impacted nurse retention or nurse satisfaction.
“The biggest driver for nurses leaving Washington over the past few years has been the opportunity to accept lucrative contracts for travel nursing positions,” Keepnews said. “We know from conversations with our members that nurses feel underappreciated for all they have done through the COVID-19 pandemic. We are starting to see some good salary increases in our bargaining that we hope will help keep Washington’s nurses in Washington, working at the bedside.”
It is unlikely that joining the compact would ease the staffing crisis in Washington, as many compact states still face staffing problems, according to Keepnews. “Washington already processes licensure applications from out-of-state nurses within a matter of days,” Keepnews said. “Washington has also demonstrated flexibility during declared emergencies such as the state’s COVID-related state of emergency.”
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