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.
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.
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.
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.
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.