Nurse Licensure Compact — Myth vs. Fact

Myth

The Nurse Licensure Compact (NLC) will improve access to care and help with the state’s nursing shortages.

Fact

Because a registration requirement for nurses entering a state under a Compact license is not allowed under the Compact, no data exists to prove that access to care has improved under the NLC. In fact, many states in the NLC still say they have a nursing shortage.

Myth

Nurse licensure is a long and cumbersome process for military spouses.

Fact

Washington state already has expedited licensure for military spouses and partners seeking a nursing license. The Nursing Commission says it takes about 10 days for processing these licensing requests — and they then know that a nurse has requested a Washington state license and intends to practice in our state.

Last year, you may have heard us say that we believed the best way to support military spouses who want to obtain a Washington nursing license is to either waive the $125 application fee or waive or reduce the $125 license fee. Then we learned that the Department of Defense (DOD) provides $1,000 to military families when they move to cover incidental expenses such as licensure — so DOD said these fee waivers are unnecessary.

Myth

The NLC will make nurse licensure faster and easier in the case of a disaster or public health emergency.

Fact

Under RCW 70.15, The Uniform Emergency Volunteer Health Practitioners Act, health practitioners can practice across state borders when an emergency declaration is in effect. Health practitioners, registered with a registration system and with a license in good standing in their home state, may practice in Washington during the emergency declaration. This act applies to health care practitioners from out of state and those whose licenses are inactive.

This act was put into practice at the start of the COVID-19 outbreak. In March 2020, over 4,500 health care workers submitted emergency volunteer practitioner applications. The Department of Health (DOH) maintains a roster of volunteer health care practitioners practicing under the emergency declaration. Under the act, DOH has the authority to regulate any matters necessary to coordinate the provision of health services during an emergency, including where a practitioner works, how long they work and what types of practitioners can volunteer.

Under the NLC, this type of registration and regulation does not exist.

During the COVID-19 pandemic, when preparing for surge capacity, Washington’s Nursing Commission issued new licenses within 24 hours.

Additionally, with the federal State of Emergency declaration, the U.S. Department of Health and Human Services (HHS) declared that health care providers may practice across state lines as long as they are in good standing with their home state license.

In the end, when Washington state did not have as great a surge in spring COVID-19 cases as initially feared, WSNA members were low-censused, furloughed, or experienced layoffs, while travelers from other states stayed on contract. Providers from other states displaced members licensed in Washington, who were best equipped in skills and experience to care for patients in our state.

This current public health crisis has proven that being in the NLC would be a moot point in a disaster or a public health emergency — and it has shown that our state already has the correct systems in place to ensure licensure is easy and fast, and that nurses coming into Washington state are registered with the Department of Health so that we know they are here.

Myth

The NLC will have no financial impact on Washington state.

Fact

State Boards of Nursing have faced various financial loss scenarios when implementing the NLC. While states that were early adopters of the NLC only offered a multi-state license, states joining more recently have offered the NLC as an option in addition to a regular home state license. So far, many of these states have experienced an average of 12-16% of nurses opting for the Compact license.

It is imperative that states considering joining the NLC have a better understanding of how such a decision would financially impact their State Board of Nursing and nurse home state licensure fees. For example, Vermont’s Board of Nursing performed a fiscal analysis that showed it could lose a quarter of its revenue if the state joined the NLC. In Washington state, limited fiscal analysis has indicated that joining the NLC could push home state nursing license fees upwards of $200.

Myth

Washington state can amend NLC legislation to comply with Washington state laws or to require registration.

Fact

States are not allowed to amend NLC legislation. The legislation must be identical to NLC legislation in all Compact states. The New Mexico Legislature recently passed a bill outside of the NLC legislation that would require nurses entering New Mexico under a Compact license to register within 30 days with the State Board of Nursing. The NLC administration — National Council of State Board of Nursing (NCSBN) — sent them a cease and desist order stating that if this clause remains, New Mexico will be removed from the Compact.

Because of this restriction, Washington state is unable to make desired changes to the Compact to reflect our state’s values, such as adding a registration requirement or requiring that out-of-state nurses comply with our suicide prevention training for Washington state nurses.