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Florida Opts to Join Nurse Licensure Compact

By Debra Wood, RN, contributor

The Florida Board of Nursing has decided to pursue multistate licensure for its nurses and will seek legislative authority to join the Nurse Licensure Compact.

“Florida is a destination state with a lot of nurses coming and going,” said Dan Coble, RN, Ph.D., executive director of the Florida Board of Nursing. “We do a lot of checking and working with nurses over and over again.”

The board has found nurses often come to Florida, leave and let their licensure lapse. Later, if they decide to return to the Sunshine State, they must reapply.

Seventeen states belong to the compact, which began for registered nurses and licensed practical or vocational nurses in 2000 and for nurse practitioners in 2004. Two other states are scheduled to join soon, an additional two states must modify the legislation they passed, and about eight states have initiated plans to become compact states. It takes about a year between the time a state legislature approves the plan and full implementation.

“The biggest benefit is public protection,” said Kristin Hellquist, associate director of policy and external relations for the National Council of State Boards of Nursing Inc. (NCSBN). “States are able to share more completely, more fully and more timely information about nurses in the compact.”

NCSBN maintains a database with nurse license and discipline information provided by boards of nursing. All compact states participate, as well as some other states.

Nurses holding a multistate license can practice in other compact states, without notifying any board of nursing. In many ways, a compact license works like a driver’s license. It is automatically recognized in other compact states, but when someone moves across state lines, he or she must obtain a license from the new state.

“The benefit comes from seamlessly moving between states,” Coble said. “It’s also a benefit if you want to look for a job in a new area or spend part of the time traveling and have work opportunities while you do that.”

Many nurses currently hold licenses in more than one state. Some nurses who work in call centers may need to maintain 20 different licenses. A compact license will limit that. The nurses would need a license from their state of residence, which would be good in any compact state, and for states they practice in that do not participate in the compact.

A multistate license also would prove beneficial to nurses completing graduate studies in a fellow compact state, as universities would honor it. In addition, it would prove beneficial during natural disasters.

“It opens up the pool of available nurses from compact states,” Coble said. “It would have been a big benefit during the hurricanes.”

During Florida’s recent spate of storms, the Board of Nursing provided temporary licenses to nurses volunteering with the American Red Cross and to agency nurses working at nonprofit hospitals through a federal relief program. It also issued licenses on a case-by-case basis when requested by hospitals with facilities in other states that sought to bring nurses from those hospitals to help in Florida. The board has issued 184 temporary licenses since Hurricane Charley struck on Aug. 13.

Moving forward, Florida will fall in line with other compact states and follow the Nurse Licensure Compact’s guidelines for participation. States cannot alter those provisions. For instance, the compact does not require continuing education. Florida can still make continuing education a condition of Florida licensure but not for nurses coming from other compact states. However, Coble said employers could make some courses a prerequisite to working in their facility.

Another area of difference is conducting background screenings. Florida requires background checks. Nurse Licensure Compact supports but does not mandate that participating states perform background checks. Coble is not too concerned. He expects most nurses coming to Florida will travel from a state, such as Texas, that also requires the screenings.

NCSBN aims to convince all the states to join the compact. However, Hellquist said, some boards of nursing have expressed concern that a multistate license could decrease revenues.

“To this point, all the research we have done with the participating states has shown they have not incurred any significant financial losses by participating,” Hellquist said.

The Florida Board of Nursing projects that becoming a compact state could cost Florida $1 million annually in lost licensure fees, ongoing staffing and funding to support the compact.

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“Since this is a destination state, we will probably have compact nurses relocate to Florida and pay the endorsement fee,” Coble said. “I’m optimistic we can make up the cost.”

Only nurses who passed the NCLEX or the state board test pool exam, which was offered before NCLEX, will be eligible for multistate licenses. Florida nurses from Cuba, Puerto Rico or Canada, who have not taken a U.S. exam, and nurses who have had discipline by the board will receive single-state licenses.

The Florida Nurses Association (FNA) has not formulated an official position about Florida becoming a compact state. It has attended the board’s meetings during which the subject was discussed.

“I think they thought it out well,” said Barbara Lumpkin, RN, associate executive director of FNA. “My assumption is we will support the board in its efforts.”

Compact licensure will offer Florida nurses more freedom to move around and practice in other states, perhaps spend the hot summer months in the Tennessee mountains or at the Jersey shore.

“I think there is a tremendous benefit for a nurse to have that kind of standardization and only get one license in the state they live in,” Hellquist said. “And it increases public protection, which is the board’s vision.”

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