Introduction
In the modern world, the shortage of medical personnel is acute, especially with the high demand for nurses. Any economic, social, and, more so, legislative barriers impede the free movement of medical workers across the country. Therefore, it is essential to establish uniform standards for licensing nurses and to automatically recognize their qualifications, regardless of the state in which they practice. The Nurse Licensure Compact (NLC) has advanced this issue by allowing many nurses to move more freely between states. Thus, the medical labor market responded more flexibly to changing conditions.
Importance
In the past, U.S. medical professionals could only work in the state where they were licensed. If a medical practice crossed state lines, obtaining licensing in several jurisdictions was necessary, which was costly and time-consuming. In 1995, the National Council of State Boards of Nursing (NCSBN) recognized this system as creating barriers to healthcare development and failing to address the needs of future medicine (Adashi et al., 2021).
In 1997, the first model of mutual recognition of licenses was adopted, which became the predecessor of the NLC, released in 1999 (Adashi et al., 2021). The NLC is an agreement between states that allows them to recognize each other’s nursing licenses. In 2000, the first states joined the agreement – Texas, Wisconsin, and Utah (Adashi et al., 2021). Over the following years, debates arose regarding multi-state licensure, with discussions focusing on the format of interaction and the degree of autonomy each state had in the licensing process (Adashi et al., 2021). Many states feared that this would reduce the level of medical staff training and compromise the quality of healthcare provided.
Trial and error, as well as professional community debate, around this issue led to the development of a new model – the Enhanced Nursing Licensure Compact (eNLC) – in 2015. By 2019, 31 states had joined the agreement. This legislation allows a nurse to continue practicing in another state by obtaining a license in one of the compact states. The document provides uniform licensing requirements, background checks, and prescribed provisions for disciplinary measures (Kappel, 2018).
In her article, Oyeleye describes a 2016 court case as an example of a settlement of disciplinary issues. In this incident, the nurse had a multi-state license in Texas to practice telemedicine in West Virginia (2019). However, nurse privileges vary between states; it is illegal to prescribe drugs without face-to-face contact in West Virginia (Oyeleye, 2019). Consequently, Texas has revoked the nurse’s license due to violating professional guidelines.
Pros and Cons
Multi-state licensure has benefits for both the nurse and society at large. First, health workers are becoming more flexible and have the opportunity to travel and gain various professional experiences. Second, NLC opens up the possibility of finding a higher-paying job or internship that would be easier for someone with no experience to start. Third, nurses with a multi-state license can engage in telemedicine, a promising area in the modern world. Ultimately, it is beneficial for American society to have a flexible labor market for medical workers, allowing personnel to be easily redirected to areas with greater demand.
The disadvantages of multi-state licenses include the fact that not all states are included in the program. Moreover, nurses with traditional licenses cannot simply get a new type; they must learn new standards and get a new license format. By practicing medicine in different states, nurses must become more legally literate and understand the rules, regulations, requirements, and laws of each state. There are numerous legal questions regarding the monitoring and evaluation of professional activities of nurses residing in one state and practicing in another.
However, NLC and eNLC have demonstrated significant benefits during the coronavirus period, indicating that their presence effectively meets the needs of communities. For example, the COVID-19 outbreak has created a workforce shortage in New Jersey. The accelerated implementation of NLC has enabled the rapid relocation of new staff to the state, thereby avoiding the collapse of the healthcare system under the pressure of the emergency (Carr & Gavin, 2022). The community’s welfare and well-being depend on the healthcare system’s flexibility and the medical labor market.
Present and Future
Currently, three types of licenses are in use simultaneously: traditional, NLC, and eNLC. In 2020, the NLC was adopted by 32 states, and the eNLC was adopted by 37 states (Adashi et al., 2021). Several questions and problems arise in implementing a multi-state license, including the previously mentioned legal issues. Moreover, some medical institutions reserve the right to accept a traditional license exclusively.
At the same time, telemedicine is implemented only under the NLC (Carr & Gavin, 2022). A literature review indicates that further development of multi-state licensure is inevitable, particularly in light of the lessons learned by the healthcare system from the pandemic. However, further development of the NLC requires more active cooperation between the states and the NCSBN in resolving disputes.
Conclusion
I believe that developing multi-state licensure is a crucial step in enhancing the U.S. healthcare system, considering the interests of all stakeholders. I also believe that multi-state licensing should increase the mobility of nurses. There is an increase in movement from compact state to compact state. In contrast, movement in non-compact territories remains unchanged (Shakya et al., 2022). I graduated and took my state licensing exam in Tennessee. I have a family in California and would consider taking a temporary position there.
References
Adashi, E. Y., Cohen, I. G., & McCormick, W. L. (2021). The interstate medical licensure compact: Attending to the underserved. JAMA, 325(16), 1607-1608. Web.
Carr, B. G., & Gavin, N. (2022). Interstate Licensure: Has The Time Come? Perspective discusses lessons learned from programs states developed in response to COVID-19 to recognize out-of-state practitioners’ licenses. Health Affairs, 41(8), 1133-1135. Web.
Kappel, D. M. (2018). The Enhanced Nurse Licensure Compact (eNLC): Unlocking access to nursing care across the nation. NASN School Nurse, 33(3), 186-188. Web.
Oyeleye, O. A. (2019). The nursing licensure compact and its disciplinary provisions: What nurses should know. The Online Journal of Issues in Nursing, 24(2). Web.
Shakya, S., Ghosh, S., & Norris, C. (2022). Nurse Licensure Compact and Mobility. Journal of Labor Research, 1-15. Web.