The COVID-19 pandemic has highlighted a major problem in how US healthcare workers withstand shock. Nurses became a hot topic due to staffing issues. In response to the public health emergency, all governors have issued executive orders allowing nurses to work more freely across state lines. This action nationalized the agreements that had been made between many states. These emergency orders have since expired, leaving room for policy interventions to make the labor market more flexible and benefit workers.
This post will focus on the Nursing Licensing Convention (NLC) and Interstate Licensing reforms, summarizing changes to nursing licensing requirements before and during the pandemic. We provide evidence on both the benefits and consequences of license changes and outline the current debates surrounding these reforms. It also provides an overview of the current state of nursing licensing in the United States and concludes by examining the future of these reforms in four states not currently in NLC.
Introducing and Expanding the Nursing Licensing Compact
of nurse license compact (NLC) has grown since its inception in 1999. This compact will increase the mobility of nurses across the country. Barrier minimization to interstate practice. Prior to its introduction, nurses had to obtain a state-by-state license to work, creating barriers to geographic movement and cross-state work. In the late 1990s, the National Board of Nursing (NCSBN) considered a “mutual recognition model” between participating states for the licensing of Registered Nurses (RN) and Practical/Vocational Nurses (LPN/VN). This will allow for in-person and virtual practices in participating states and will allow nurses to transfer to participating states without relicensing.
In 1997 the NCSBN unanimously approved A new model of nursing regulation that will lay the groundwork for the NLC to be ratified in 1999.compact membership need Nursing Board to Report to Newly Formed Interstate Commission of Nursing Licensing Compact Administrators (ICNLCA) to Stop Collection license fee Pay a $6,000 annual fee from nurses in other compact states.
Figure 1 shows the timing of adoption of the Nurse Licensing Compact in each state. Most of the hiring took place during his first two years of the compact (2000-2001). This equates to 14 states. By comparison, some believe that this plateau in new membership over the next 15 years was due to the Compact’s inadequate criminal background check requirements. On January 19, 2018, the Enhanced Nursing Licensing Compact (eNLC) was formed to address these concerns through 11 new uniform licensing requirements, aimed at facilitating nationwide adoption. Over the next two years, nine more states joined the eNLC, with all former member states transitioning to the new compact. One exception, Rhode Island, in 2008 she joined the NLC, but in 2018 she chose not to join the eNLC. Three more states joined her eNLC after the outbreak of the nationwide pandemic, which introduced emergency subnational agreements described below. Most recently in Ohio, I attended the Compact on January 1, 2023.
Evidence of Effectiveness of Nursing Licensing Agreement
Just before the pandemic, interstate nursing practices became more common in eNLC states. License rates in several states are 1.6% In 2008, the proportion of NLC nurses working in compact states was almost a quarter of all RNs holding an interstate license (twenty four%By 2020. Thirty-three percent of nurses cite the use of an interstate travel nursing license, 16% for telemedicine and 8% for teleeducation, although travel nursing is the primary motivation for obtaining this license. is only 4%.
The literature largely supports the causal effect that compact membership increases nurse mobility. Shakya, Ghosh, Norris Taking advantage of the diversity in timing of NLC recruitment by state, we calculate that compact nurses are 11% more likely to move and work in other compact states. crab found that a single-state licensing system causes a rigid labor market, whereas NLCs encourage interstate migration and may divert flows to non-compact states. . moreover, Johnson and Kleiners A report on labor force migration patterns shows that NLCs have increased job attrition within the health and social services industry by 11%. and Reduce the number of healthcare workers transitioning from compact to non-compact. vice versa, De Pasquale and Stanjistudies of commuting found no causal relationship between labor supply and mobility. A nurse living in a metropolitan statistical area that spans multiple states sees her chances of a cross-state job increase only 1.2% after a state joins her NLC. Research on commuting found no causal relationship between labor supply and movement. A nurse living in a metropolitan statistical area that spans multiple states sees her chances of a cross-state job increase only 1.2% after a state joins her NLC.
COVID-19 and Emergency License Waivers: Subnational Agreements
Due to the COVID-19 outbreak, everyone state declares a state of emergency Initiate a functionally nationwide agreement in 2020 to make the labor market more flexible and implement an emergency license exemption for health professionals. Nurses can practice effectively anywhere, regardless of their pre-pandemic state membership in the Compact, without having to apply for or pay additional fees for additional licenses. In analyzing the impact of COVID-19 on the active nursing population, Chang and collaborators “No other time in U.S. history has NLC played a more significant role in regulating nursing licensure than during the COVID-19 pandemic,” it argues.
was an estimated 35% growth The share of travel nursing will increase in 2020 and is expected to grow another 40% in 2021.The average wage for those who want to travel $154 per hour, does not include other cash incentives.For nurses who wish to transfer more permanently, the contract bonus is Up to $13,000.
States began withdrawing emergency declarations as early as April 2021, allowing the majority of states to revoke temporary emergency permits by September 2022. Figure 2 shows the timing of the withdrawal from the sub-national emergency agreement. A blank state moved from a national pact to an existing eNLC, and a horizontal line state reverted to not participating in her eNLC. But let’s be clear: historically tight labor markets during pandemic recovery have likely been and will likely be more important to the nursing labor market than changes in licensing. It means to continue.
Controversy Over the Nursing Licensing Agreement
Many states are reconsidering NLC membership following temporary measures implemented to the pandemic as a possible solution to labor shortages and turnover. The Massachusetts Legislature recently considered joining the eNLC. As of February 2023, Bill H.1284 Participate in the Joint Committee on Health Financing, Enhanced with support From the Massachusetts Health Hospital Association.State emergency declaration during pandemic approved Out-of-state licensed medical professionals practicing in Massachusetts through June 30, 2023. By May 2021, the Nursing Registry Board will: 8,500 temporary licenses issuedWashington State is also considering joining the Compact. House Bill 1417 and Senate Bill 5499 Illinois is reconsidering its licensing practices in the face of looming shortages.In response to the public health emergency in early 2020, Governor JB Pritzker said Signed multiple Executive Orders Allows temporary nursing assistants to perform tasks normally completed by certified nursing assistants. Out-of-state nurses can complete the Health Care Temporary Practicum Application to: Illinois Temporary PermitAbility to practice on temporary permit expired in February 2023.
Participation in the common market can help alleviate nurse shortages, but some states pursue more restrictive strategies for a variety of reasons. For example, California and Oregon have considered joining the Compact several times. Opposition to his NLC implementation from the Nursing Board is cited as follows: concern On declining nursing commission income and labor standards, lack of disciplinary oversight and loss of ICNLCA sovereignty. Some nursing advocacy groups and affiliates have highlighted concerns over reduced bargaining power. wage recession This is due to the influx of visiting nurses. For example, if the removal of licensing restrictions encouraged nurses to travel to states with higher wages, unionized nurses may suffer lower wages and may be forced to travel to states before joining the agreement. You could lose the above-average wages that once boasted.
State of emergency declared in California approved Out-of-state nurses can practice without a California-issued license, but that license expires at the end of February 2023. Oregon State also considered joining her in the NLC in the past, but abandoned the effort in 2016. facing opposition From the Oregon Nurses Association. Temporary emergency licenses for out-of-state nurses were granted under Gov. Kate Brown’s March 2020 state of emergency declaration. Those with such licenses will be able to practice until mid-2023.The Oregon Board of Nursing reports: 11,000 urgent approvals Issued over two years, as of June 2022, approximately One-third of 9,000 valid certifications After the state of emergency expired, he had applied for and obtained an Oregon business license.
Conclusion
Compact states are highly mobile and enjoy cross-state practices, but there is some uncertainty about the magnitude of these impacts. NLC proponents have long envisioned expanding these benefits through a standardized national framework for licensing reciprocity.
The pandemic and concurrent changes to occupational licenses have highlighted the need for policy interventions that benefit workers. Working conditions and burnout are worsening, perhaps exacerbated by significant workforce changes as more nurses temporarily move across state lines. The wave could change nursing workforce projections post-pandemic. While the current compact focuses on standardizing state nursing licenses for in-person care, the rise of telemedicine services before and during the pandemic has created barriers to providing interstate telemedicine services. presents new challenges to remaining individual state systems.
The flexibility provided to nurses during the pandemic, both in NLC’s model of allowing nurses to travel to places of high demand and the relaxation of requirements regarding telemedicine, represents a possible reform. Given demographic changes and geographic disparities in access to healthcare, it is clear that there is a need to increase the flexibility of healthcare licensing structures and care delivery, in tandem with policies to improve working conditions.
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