Journal of Nursing

A Battle Brews Over Nurse Licensing In The Digital Age


By Stephanie Armour

Hospitals and some nursing groups are lobbying state legislators across the nation to do away with requirements that nurses be licensed in each state where they work, arguing that the rules inhibit the use of new health-care methods such as telemedicine.

The push to get states to join nursing licensing compacts reflects growing adoption of remote health services such as patient care and monitoring online and by the phone. Telemedicine, as it is known, is expected to soar in the U.S. to $1.9 billion in 2018 from $240 million in revenue in 2013, according to research firm IHS Technology.

But advocates of the effort are up against nurses’ unions who say such compacts would jeopardize patient safety because not all states have the same licensing standards. They also say it would erode their bargaining power and make it easier for hospitals to bring in out-of-state nurses to break a strike.

“Massachusetts has higher requirements than other states,” said David Schildmeier, a spokesman with the Massachusetts Nurses Association, a union and professional group. “This would allow nurses from other states to work here. We don’t want their problems to invade our state.”

States began joining the multistate agreement known as the nurse licensure compact in 1999. Twenty-three states joined by 2010, but then interest stalled, with only two states joining after that.

Supporters hope a newer version of the compact would trigger more states to join. Unlike the earlier agreement, this one requires member states to conduct fingerprint-based state and federal criminal background checks on nurses they license. A nurse convicted of a felony can’t hold a multistate license.

So far, seven states—Florida, Idaho, Oklahoma, South Dakota, Tennessee, Virginia, and Wyoming—have enacted legislation to join the current compact.

“With more technology and different models of care, this will have increasing momentum,” said Sandra Evans, chairwoman of the Nurse Licensure Compact Administrators, a public entity made up of members from the 25 compact member states.

Under the enhanced compact, the state board that issues a nurse’s license is responsible for taking licensing sanctions against that nurse if an alleged infraction occurs in another member state. States share information on sanctions through a database so all are informed, supporters say.

Hospital officials who back the compact say it allows them to offer nurses to practice by phone or Internet without requiring multiple licensing. It also lets them staff up quickly in the case of a natural disaster or emergency.

The effort reflects a growing acceptance of telemedicine, and it could expand beyond nursing. Doctors, psychologists, physical therapists, emergency-service personnel, and dietitians are considering or moving ahead with interstate licensing models.

“I believe this will continue to catch on. It’s pro-business, pro-competition,” said Republican Florida state Rep. Cary Pigman, an emergency medicine physician who proposed legislation authorizing the state to enter the compact. The bill passed and was signed by Gov. Rick Scott in March.

In Minnesota, the Mayo Clinic has supported joining the compact in part because it has nurses who may helicopter into Wisconsin to treat a patient, said Sharon Prinsen, a nurse administrator at the nonprofit medical and research group. Nurses at its headquarters in Rochester also provide intensive-care services remotely to hospitals in other states.

A coalition is working in Minnesota to secure support, and a bill authorizing the state to join the new compact has been introduced. So far, it hasn’t moved forward—much to the relief of the Minnesota Nurses Association, which opposes the compact.

Laura Sayles, the association’s government-affairs specialist, says opposition is largely over patient-safety concerns. Nurses who come to Minnesota can get a temporary license, she said, so the nursing board knows if they are working in the state. That doesn’t occur under the compact, she said. And patients may be confused about whether to report concerns to the Minnesota nursing board or the home state where a nurse is licensed. Requirements also are more stringent in the state, she said.

“It negatively impacts patient safety,” said Ms. Sayles. “Minnesota has continuing education requirements; not every state does.”

Maureen Swick, the senior vice president and chief nurse executive for Inova Health System in Falls Church, Va., disagrees that the compact undermines safety. “That’s absolutely crazy,” she said. “We all take the same test. The curriculum from nursing school is all the same.”

Supporters say nurses who hold multiple licenses don’t alert the state when they are practicing there.

The compact makes sense for health companies that need to quickly staff up when regions across the U.S. see a population surge, said Morris Kleiner, economist and professor at the University of Minnesota’s Humphrey H. Humphrey School of Public Affairs.

“The idea of compacts are important, useful and gets practitioners to where the jobs are,” said Mr. Kleiner. “It’s a source of labor-market efficiency.”

Some nurses say the ability to practice in other states without getting another license means it is easier to find work. Ann Putnam is a 39-year-old nurse in Leavenworth, Kan., who moves often because her husband is an active duty Marine.

“There was a base on the border between Georgia and Alabama,” she said. “I had to figure out what state I was likely to get a job in. I ended up having to get licensed in both because I didn’t have a job lined up.”


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Editor-in Chief:
Kirsten Nicole

Editorial Staff:
Kirsten Nicole
Stan Kenyon
Robyn Bowman
Kimberly McNabb
Lisa Gordon
Stephanie Robinson

Kirsten Nicole
Stan Kenyon
Liz Di Bernardo
Cris Lobato
Elisa Howard
Susan Cramer