Nurse Licensing Agreement: Who Benefits Most from Multistate Licensing?

Less bureaucracy, more mobility

Registered nurses will not be the one nursing professionals who can take part in the NLC, said James Puente, MS, MJ, CAE, director of the Nurse Licensure Compact, National Council of State Boards of Nursing (NCSBN). The agreement applies to all nurses no matter their license and, in keeping with Puente, is a “modern licensing model” in health care today. “Under the agreement, a nurse residing in a compact state can apply for a multi-state license, which is valid in every compact state,” Puente said. The goal of the NLC is to switch what NCSBN calls the outdated model of nurses being individually licensed single-state for every state through which they practice, which may be costly, burdensome and inefficient for nurses. According to the nursing organization, this model is not any longer practical in a more mobile and technological health care system.

“For patients, a nurse license agreement increases access to care and allows the provider to ‘follow’ the patient, ensuring continuity of care,” Puente said.

Nurses becoming acquainted with NLCs is smart, partially because employers recognize the advantages, including the flexibility to practice in person and virtually in lots of states. According to NCSBN, many employers require a multi-state license for employment. But nursing organizations in some states have concerns.

Challenges and downsides

David Keepnews, RN Dr. David Keepnews, JD, RN, FAAN, executive director of the Washington State Nurses Association, said his state has not taken any motion to change into a compact state due to several areas of concern. “Most importantly, the agreement does not require registration of nurses coming into the state, so we would have no way to track nursing staff,” Keepnews said. “We are also concerned that nurses coming to our state will not be required to meet any of Washington State’s continuing education requirements, which could create gaps in knowledge about practicing nursing in the state.” According to NCSBN, NLC might help address the nursing shortage by strategically placing nurses where they’re needed most. “This is what large, multi-state hospital systems in compact states do,” Puente said. “Because they employ thousands of nurses, they can redeploy their nursing staff to areas where the need is most urgent. In short, multistate licensure allows nurses to practice in other compact states where nurses’ services are needed without the delay of an additional licensing process.” According to NCSBN, nurses living in states that don’t take part in the compact wouldn’t have access to multistate licensure, which is a drawback, especially considering telehealth.

“Not every nursing practice is bedside care. “Patients are mobile, travel and even live in multiple locations and need access to trusted providers along the way,” Puente said. “Telehealth is now practiced by more nurses than ever before, and the industry continues to grow. If a nurse is working in a telehealth role, she may be required to have multiple licenses in a single state – one for each jurisdiction where her patients may be in care!”

Multistate licensing might help in public health emergencies and disaster preparedness by facilitating nurse mobility through a licensing model often called “mutual recognition.” “This means that nurses’ licensure and credentials are recognized and accepted in all compact states. “When nurses have to wait for the licensing process to be completed, the nurse may experience unemployment, the nurse may lose the opportunity to work because of the delay, and patients may have to wait longer before they can access the nursing care they need,” Puente said. Still, Keepnews doubts whether the agreement addresses vital issues in contemporary nursing. For example, he doesn’t imagine that the undeniable fact that Washington State shouldn’t be an NLC state has had an impact on nurse retention or nurse satisfaction.

“The biggest factor motivating nurses to leave Washington over the past few years has been the opportunity to accept lucrative travel nurse contracts,” Keepnews said. “We know from conversations with our members that nurses feel unappreciated for all they have done during the Covid-19 pandemic. We are starting to see good pay increases in our negotiations that we hope will help keep Washington nurses in Washington, D.C., working from the sickbed.”

According to Keepnews, joining the Compact is unlikely to alleviate the staffing crisis in Washington, as many Compacts still struggle with staffing issues. “Washington is already processing license applications from out-of-state nurses within days,” Keepnews reports. “Washington has also demonstrated flexibility during declared emergencies, such as the Covid-19 state of emergency.”