State lawmakers mull out-of-state nurse licenses after pandemic rollbacks

Worker shortages early in the COVID-19 pandemic led some states to temporarily waive licensing requirements, and many brought in traveling nurses as supply and demand ebbed and flowed among regional hotspots.

Now, as state emergency declarations begin to expire, legislators are looking for ways to maintain access to the nation’s supply of nurses again and avoid scrambling through future emergencies.

A number of bipartisan bills moving through state legislatures could add more states to the Nurse Licensure Compact — a multistate agreement that allows nurses to have one license but the ability to practice in other participating states without having to pay for and obtain another license.

“The key factor of the Nurse Licensure Compact is interoperability, which seamlessly allows clinicians to flow from one state to another and serve an urgent need without going through a time-intensive relicensing process,” April Hansen, executive vice president of nurse staffing firm Aya Healthcare, said.

“The pandemic exploited the fact that states who don’t already operate with a mindset of interoperability are disadvantaged,” Hansen said.

Allowing such interoperability would benefit traveling nurses and the systems that need them, but unions tend to oppose entering the compact because it would allow hospitals to more easily hire replacement nurses in the event of a strike. Those nurses are also often paid more than full-time staff, breeding some tension between the groups, which flared during the pandemic.

Thirty-four states are in the compact, as well as U.S. territory Guam, which joined in March. Fourteen states have pending legislation to join, including Oregon, where it’s been introduced for the first time.

Many have either joined or tried even before the pandemic, Rebecca Fotsch, director of state advocacy and legislative affairs at the National Council of State Boards of Nursing said.

“But COVID was a kind of glaring example of how the compact could help,” Fotsch said.

A number of West Coast states — Washington, Oregon, Nevada and California — have been previously unsuccessful in joining the compact, due in part to strong labor groups there, Fotsch said.

A handful of states in the upper Midwest have also held out on joining the compact, though there’s momentum in some, such as Illinois, to add it to the nurse licensing pact.

The Illinois Nurses Association, a labor union representing nurses, opposes the bill that would accept licenses from nurses credentialed in other states. The group argues the varying education and skills requirements across different states can undermine quality of care.

In order to receive a nursing license in Illinois one must verify their graduation from a nursing program, pass a state exam, file their application, submit documents for a background check, get their fingerprint taken by a licensed vendor and pay all necessary fees. Illinois also has continuing education requirements for RNs and LPNs, mandating 20 contact hours every two years.

Neighboring Missouri is a compact state and doesn’t have that continuing education requirement, Victoria Dameron, a nurse and INA vice president, said.

Some nurses have been out of school for several years, “that doesn’t seem like a long time, but for a nurse things change, especially within the last year, things change every week,” Dameron said.

If the legislation passes and Illinois joins the compact, the state will maintain authority over issuing licenses, fees and disciplinary issues, according to NCSBN. But it would also agree to accept other state standards as acceptable.

Nurse licensing is just one medical credentialing reform issue spurred by the pandemic. Staffing shortages that could persist due to widespread burnout have states looking at other ways to broaden their access to healthcare workers.

Following a trial period with pandemic-related rollbacks, a number have bills that could permanently allow providers to virtually treat patients in states they aren’t currently licensed or located in. And others in states such as Louisiana and Pennsylvania would expand nurse practitioners’ scope of practice by eliminating the need for them to sign a practice agreement with a supervising physician.

It remains to be seen whether lawmakers will end up tossing the old rules permanently, though many efforts have bipartisan support.