BY MOLLYMAEVE LUSK
The Nurse Licensure Compact (NLC) is a multistate licensure solution, which allows nurses (RNs and LPN/VNs) to have one license, issued by their primary state of residence, with the privilege to practice in both their primary state of residence as well as other participating NLC states without obtaining additional licensure. Operational for over 20 years, the NLC increases access to care while promoting patient safety and decreasing burdens on nurses and employers alike by enabling nurses to provide care across state lines, both in person and via telehealth.
The NLC Today
Currently, the NLC has been enacted in 39 U.S. jurisdictions with 37 states and two U.S. territories as part of its membership. Of the recent enactments, the NLC is partially implemented in Guam, allowing nurses holding multistate licenses to practice in Guam, but the jurisdiction has yet to begin issuing multistate licenses. The NLC is pending implementation in Pennsylvania and the Virgin Islands. As of January 1, 2023, the NLC has been fully implemented in Ohio.
2022 Legislative Session: Key Highlights
The NLC saw a lot of positive movement among the 13 non-NLC state legislatures during the 2022 legislative session. In Minnesota, the Mayo Clinic led in building a robust and diverse coalition of nearly 60 members dedicated to supporting passage of the NLC. The NLC bill successfully passed out of the Republican-controlled Senate; however, it did not pass out of the Democrat-controlled House of Representatives and had strong opposition from the Minnesota Nurses Association.
In New York, Governor Kathy Hochul included the NLC in her 2022 State of the State Agenda as one solution to strengthen the state’s healthcare system. Subsequently, the bill was included in Governor Hochul’s 2022-2023 proposed state budget and supported in the Senate’s version of the budget. The Assembly, however, did not include it in their proposal. This welcome support from Governor Hochul has galvanized NLC efforts in the state, and the policy will likely be before the legislature again in the 2023 legislative session.
In Nevada, there is growing support for the NLC among stakeholders and lawmakers. As Nevada enters its biennial 2023 session, the NLC has already received significant airtime in the legislature. Over the summer, the NLC was presented in the Joint Interim Standing Committee on Commerce and Labor. The Assembly Committee on Commerce and Labor later filed a Bill Draft Request for the NLC indicating intent to consider the bill in the upcoming 2023 session.
In addition to positive legislative movement, the NLC has also seen strong voices raised in support of adopting the compact. Outgoing Nevada Governor Steve Sisolak, a Democrat, expressed strong support for the adoption of the NLC on a UNLV Nursing School podcast. On Hawaii Public Radio, both the President of the Healthcare Association of Hawaii and the President of the Hawaii Nurses’ Association OPEIU Local 50 made passionate arguments in favor of enacting the NLC as one tool to fight the nursing shortage within the state.
Telehealth: Highlighting the Need for Borderless Licensure
While the utilization of telehealth has begun to level off since the onset of the pandemic, in 2021, telehealth utilization remained nearly 40 times higher than pre-pandemic levels. This sustained growth in telehealth is reflected in the volume of bill enactments at state legislatures that allow for healthcare providers licensed in good standing in other jurisdictions to provide care via telehealth in the state after obtaining a telehealth registration. These enactments are a continuation or modification of many states’ executive orders issued at the height of the pandemic, which waived licensure requirements to increase access to care.
One state that codified these telehealth waivers was Delaware. House Bill 334, enacted in October 2022, specifically highlighted the importance of licensure compacts, stating that providers who were licensed in a state that had not adopted an applicable interstate compact may provide care via telehealth under an interstate telehealth registration obtained through the state. For in-person practice, those treating patients located in Delaware will continue to need to hold licensure issued by the state or have authorization under a compact.
In addition to increasing access to care for patients, the growth in telehealth finds a corresponding increase in opportunities for nurses to be employed in the area. Nurses can work remotely using telehealth modalities to conduct remote patient monitoring, managing patients with chronic conditions, providing triage services, and more. However, to ensure nurses remain present and competitive in the industry, licensure flexibilities must be present to eliminate the burden of nurses having to obtain and maintain multiple licenses to provide care across state lines.
Adopting the NLC and providing multistate licensure for nurses across the country is more relevant now than ever before.
The NLC as a Tool to Aid the Nursing Workforce
Consistently among top legislative priorities across the country is how to combat pervasive nursing workforce shortages. Legislative strategies to both creatively supplement the existing workforce as well as incentivize nurses to both remain in and join the nursing workforce have been implemented across the country. While many of these policies present strong, long-term solutions, immediate relief is needed. The NLC is one tool in the toolbox to assist in lessening the impact of the nursing shortage. Once a state enacts the compact, they can quickly look to a pool of safe and qualified nurses to provide care in areas of need.
In New York, COVID-19 licensure waivers have expired along with many of the flexibilities put into place during the public health emergency. However, Governor Hochul has issued new emergency licensure provisions, declaring a statewide disaster emergency due to healthcare staffing shortages. The order waives licensure for healthcare providers, including nurses, licensed and in current good standing in any state, to enable them to practice in New York to aid in the workforce crisis. While the order demonstrates that licensure flexibility is crucial in addressing the nursing workforce crisis, this temporary solution creates a confusing practice environment for hospitals and nurses and have patient safety ramifications. The NLC, in contrast, promotes licensure flexibility while maintaining patient safety. Those states in the compact can be assured that each nurse practicing under a multistate license is highly qualified, meeting 11 uniform licensure requirements, including undergoing a federal criminal background check. Additionally, in the event of a disciplinary incident, the NLC provides a framework for clear jurisdiction among home and party states to act on a licensee’s multistate privilege to practice and ensures effective communication between party states.
The NLC is a safe and effective tool to aid states in combatting the nursing workforce shortage. Across the country, stakeholders including the Alaska Hospital & Healthcare Association and Mayo Clinic in Minnesota have touted the NLC as a policy to address the nursing shortage.
2023 Legislative Session: Looking Ahead
Currently, there are active NLC bills in Illinois, Massachusetts, Michigan, New York and Rhode Island. In November, Nevada submitted a Bill Draft Request for the NLC to be introduced in the 2023 legislative session. We anticipate many of the remaining states and jurisdictions that have yet to join the NLC to file legislation to do so.
The NLC facilitates modern healthcare delivery by providing a streamlined licensure solution. The NLC reduces financial and administrative burdens on nurses, promotes the nursing workforce participation in the growing telehealth economy, and both efficiently and safely supplements nursing workforces in times of shortage.
CMSA continues to be an important ally in demonstrating how the old model of licensure is outdated and not nimble enough for the workforce today, and certainly not for the workforce of tomorrow.
MollyMaeve Lusk is an Associate within the State Affairs department at the National Council of State Boards of Nursing (NCSBN) where she works on three national legislative efforts, including the Nurse Licensure Compact (NLC). For more information about the NLC, please email [email protected] and visit www.nursecompact.com or www.nlc.gov.