License to Go: Nursing Across State Lines
By E’Louise Ondash, RN, contributor
Many of us received our first license at an early age, when, after a few months of practicum we proved that we could pass the written exam, a skills test and the physical requirements. Our home state then gave us the license — to drive, and not only in our own state, but also across state lines. Nurse licensing should work the same way, according to those who would like to expand the multi-state Nurse Licensure Compact.
Not only would it make life easier for nurses, but it would clarify inter-state laws and ensure patient safety, according to the country’s leading ambulatory care nursing organization.
Lilly Correa, BSN, BCRN, graduated in 2006 from a San Antonio school of nursing and received her first license from Texas, which is a compact state. That means a seamless, no-cost transition when she wants to work in another compact state, which she is currently doing as a travel nurse with American Mobile Healthcare.
“Having compact licensure makes it so easy to go to different states,” said the PICU specialist who is working at Children’s Hospital of Wisconsin in Milwaukee.
It’s been more than a decade since the National Council of State Boards of Nursing (NCSBN) proposed and created the Nurse Licensure Compact (NLC). The NLC allows for the mutual recognition of nurse licensure for registered nurses and licensed vocational/practical nurses who acquire and maintain licensure in a compact member state.
To date, 23 states have become members of the NLC, with one more pending.
The concept of multi-state licensure is important not only to traveling nurses, but to those who answer the call during major disasters like Hurricane Katrina. A third category of nurses who need multiple licenses include the staff at call centers or any organization in which nurses communicate with patients across state lines via telephone or email.
The growing use of telecommunications technologies and telehealth nursing has fueled the push for multi-state licensure, explained Carol Rutenberg, RNC-BC, MNSc, a telehealth specialist and president of Telephone Triage Consulting in Hot Springs, Ark. Geographical barriers to patient care have dissolved in many instances, a fact that affects as many as a quarter of all nurses in this country.
“We know that 26 percent of nurses in the U.S. are ambulatory care nurses,” said Rutenberg, chair of the American Academy of Ambulatory Care Nursing (AAACN) task force which authored a recent position paper supporting the NLC. “This includes nurses who are in public health, community health, surgicenters and telehealth. All ambulatory care nurses practice telehealth nursing. This raises the question of licensure for all these nurses.”
It also creates this conundrum: In which state is a nurse practicing when he/she is speaking to a patient in another state? Is it the state in which the nurse resides or the one from which the patient is calling? The consensus among most of the states is that the nurse is practicing where the patient is, raising the question about licensure in that state.
“Without the adoption of the compact, it puts nurses in tenuous position,” Rutenberg said. “It’s an overwhelming problem, which is why the AAACN wanted to develop this position paper ― to encourage nurses to get involved in their own state and encourage their legislatures to support the compact.”
The AAACN task force also pointed out that the licensure compact benefits more than just nurses. “Adoption [of the licensure compact] would ultimately serve to improve patient care and safety,” according to the August 2009 position paper.
Until all states become members of the compact, what are call centers and other institutions doing to try to comply with the law?
“They basically have three options,” Rutenberg explained. “Some organizations are purchasing a license from each state for each nurse. These organizations often have to hire a full-time compliance officer to make sure the licenses are current. Other organizations are purchasing the most obvious state licenses for their nurses, like in border cities such as Portland and Kansas City. Others are just choosing to ignore the problem and provide care to the patients who call them, whether licensed in their state or not.”
The argument for and against joining the compact revolve around control, revenue and job security, and can pit the state boards of nursing against state nursing associations.
For instance, Washington State’s nursing board, called the Nursing Care Quality Assurance Commission, “feels strongly in favor of joining the compact,” said Terry West, deputy executive director of the commission. “We went on record 10 years ago in favor of it and we are starting again. It’s back on the commission’s agenda.”
But, she added, “The biggest obstacle has to do with labor issues.” If nurses at a hospital in a compact state go on strike, for instance, some state nurses’ associations believe employers can easily bring in nurses and break the strike.
Some states resisting the compact may have boards of nursing that depend heavily on the income that license applications bring, while other states fear a loss of control of the nurses practicing within their borders.
Rutenberg favors the “driver’s license model” for multi-state licensure.
“It’s a wonderful analogy,” she said. “I have an Arkansas license but I can drive in all states with a caveat that I have to follow the laws of that state, and if I move to that state, I must get a license there.”
For more information:
List of states in the NLC - Nurse Licensure Compact Administrators (NLCA)
AAACN Position Statement on NLC
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