WSNA opposes the Nurse Licensure Compact, SB 6209

WSNA statement on the Nurse Licensure Compact

The Washington State Nurses Associ­a­tion is committed to supporting nurses and reducing barriers to licen­sure, especially for military spouses and partners. However, WSNA does not support the NLC. 

Between the 2019 and 2020 legisla­tive session, WSNA spent dozens of hours meeting with propo­nents of the NLC, other states, and legis­la­tors to really under­stand the compo­nents of the NLC and how it is working in partic­i­pating states. Our research and conver­sa­tions found that key elements of the NLC need to be changed at the national level – and that the current risks are too great for our members and our state.

Registration requirement / data collection #

Propo­nents of the NLC say that the NLC will improve access to care and help with states’ nursing shortage. However, because a regis­tra­tion require­ment for nurses entering a state under a Compact license is not allowed under the Compact, no data exists to prove either of these state­ments are true. In fact, many states in the NLC still say they have a nursing shortage. 

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. Regis­tra­tion allows a state to know who is practicing within its borders and to track the flow of nurses into the state – helping us under­stand how and where the NLC is making a differ­ence. For example, is the NLC being used by predom­i­nantly by nurses living in border cities? Is the NLC bringing additional nurses into New Mexico? Or are more nurses leaving New Mexico to work across the border in Texas? 

Knowing who carries a Compact versus a home state license and where they are practicing is neces­sary to under­standing our national, regional, and state-based nursing workforce – and critical to workforce planning and development. 

Propo­nents of the NLC also say that a state’s partic­i­pa­tion in the NLC will help improve access to disci­pli­nary infor­ma­tion against a nurse license. They say that states will have access to infor­ma­tion when a nurse is under inves­ti­ga­tion. But if states don’t know who is practicing in a partic­ular juris­dic­tion, having advance notice of a disci­pli­nary inves­ti­ga­tion of a nurse for NLC states is not useful.

Education requirements and education tool for nurses #

Because practice acts vary from state to state, NCSBN should make educa­tional infor­ma­tion avail­able for nurses practicing under a Compact license to ensure under­standing of the biggest differ­ences between Nurse Practice Acts. Because liability of a nurse’s practice and license is based in the state where the patient is, nurses opting for a Compact license need to both under­stand that this is the case and have a refer­ence tool that calls out major differ­ences and links to each state practice act. 

For example, some states allow regis­tered nurses to perform conscious sedation using the drug propofol, while others do not. If admin­is­tered incor­rectly, this drug can be deadly – it is widely associ­ated with the death of pop star Michael Jackson. Another example is delega­tion, where practices vary greatly from state to state. It is in the interest of patient safety to assure that nurses are aware of the Nurse Practice Act in each state in which they are practicing, including major differences. 

When WSNA raised this with its our State Nursing Commis­sion, we were told that NCSBN expects that perhaps WSNA or the American Nurses Associ­a­tion could create such a document. As national admin­is­tra­tors of the NLC, who states pay to be party to the Compact, we believe that NCSBN must not abdicate its respon­si­bility to party states and to nurses who pay for a Compact license. 

Addition­ally, states have widely variant educa­tion and contin­uing educa­tion require­ments for nurse licen­sure. Some state legis­la­tures have deter­mined that specific courses are neces­sary for nurses or all health profes­sions, such as a law passed by the Washington State Legis­la­ture that requires all health profes­sionals to take a suicide preven­tion course. We must ensure that nurses practicing in Washington state uphold our state’s high standards of nursing.

Fiscal analysis of NLC impact on state boards of nursing #

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 percent 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 provided has indicated that joining the NLC could push home state nursing license fees upwards of $200.

NCSBN should provide a fiscal analysis of states party to the Compact showing the finan­cial impact the NLC has had on their State Boards of Nursing and on their state-only license fees. 

Transparency of proceedings and finance #

WSNA joins other state nurses associ­a­tions in asking NCSBN provide full trans­parency of all meetings and documents related to the NLC and its admin­is­tra­tion to ensure compli­ance with state laws regarding open public meetings. When New Mexico’s legis­la­ture passed a law requiring documents related to admin­is­tra­tion of the NLC be released per New Mexico’s public disclo­sure laws, the NLC sent back a letter threat­ening New Mexico with legal action.

However, states partic­i­pating in the NLC have a right to request NCSBN provide finan­cial trans­parency allowing states to under­stand how much revenue in multi-state license fees NCSBN is collecting to admin­ister the Compact and how those funds are being spent. These funds would come from Washington state nurses’ license fees and we need to under­stand how that money is being spent. The admin­is­tra­tive body that oversees the NLC is a non-govern­mental entity that is not regulated – making increased trans­parency imperative.

WSNA has have spent consid­er­able time and effort attempting to better under­stand the impact that the NLC is having on nursing short­ages, on individual nurses, and on revenue and license fee projec­tions for Washington state’s Nursing Commis­sion. Without this infor­ma­tion, our state legis­la­ture does not have a clear picture of whether the NLC is meeting its intended goals or how it would poten­tially impact our associ­a­tions’ members and our Nursing Commission. 

WSNA is asking our legis­la­ture to not pass the NLC and instead formally request that NCSBN make these critical changes. We will remain opposed to this legis­la­tion until these changes are made.