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.

Quick Facts #

  • 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.
  • Washington state already has expedited licen­sure for military spouses and partners seeking a nursing license.
  • The Nursing Commis­sion would not be able to track who is working in Washington state under a Compact license for purposes of disci­pline or workforce planning.
  • Joining the NLC could push home state nursing license fees upwards of $200.
  • Washington state is unable to make desired changes to the Compact to reflect our state’s values.