Should Washington state join the Nurse Licensure Compact?

Should Washington state join the Nurse Licensure Compact? The Senate Health and Long Term Care Committee held a work session on this question on Wednesday.


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Washington State is facing a nursing shortage. A 2018 Washington State Hospital Association (WSHA) survey showed in nearly one-third of responding hospitals, it was taking longer than three months to hire for a vacant nurse position. The average number of open positions across all responding hospitals was 27, with several hospitals reporting more than 50 vacant positions. 

With the COVID-19 pandemic, the nurse shortage has grown. This is especially true for specialty nurses. However, when a qualified nurse moves to Washington with a license to practice nursing in another state (or wants to practice in Washington through telemedicine), they must obtain a license to practice in Washington. 

Thirty-four states have addressed this problem by enacting the Nurse Licensure Compact (NLC). This allows nurses who meet uniform licensure requirements to practice in all participating states without obtaining an additional license. This means a nurse who relocates from one compact state to another may start work that same day. 

According to a WSHA policy brief, from Feb. 1 to May 31, 2020, 59% of qualified nurses who applied for a license in Washington were from a NLC state.

Advocates for the NLC say that it will increase patient access to nursing care while maintaining the state’s enforcement authority over nurses to protect public safety. They also say it would help alleviate the current nursing shortage and help improve access to telemedicine services provided by nurses.

Rebecca Fotsch, director of State Advocacy and Legislative Affairs at National Council of State Boards of Nursing (NCSBN), said:

“It’s very important to remember that this is one tool that states can use to address that shortage and one of the probably the easiest ways. One good example of this is that nurses vary in their specialties. There are nurses, for instance, that are ICU. nurses or emergency room nurses. This is a specialty, and those nurses need to be specifically recruited so you know it can’t just be any RN to fill positions like that. The compact is incredibly useful to bring in those specialty nurses. Particularly, as you can imagine, during the pandemic to bring in ICU nurses to fill those gaps.”

Dr. Meredith Heyde, executive fellow at the Center for Clinical Advancement at United Health Group, said the NLC would increase access to telehealth services.

“Facilitating that exchange of information between states on uniform requirements of nurses’ licensure will, and has reduced the redundancy of licensure, improved access to care and can lead to innovative care delivery such as telehealth.”

However opponents to the compact say that many of the arguments used by advocates are myths. Vicky Byrd — CEO of the Montana Nurses Association — said though Montana is a compact member state, the NLC has not addressed the nursing shortage. 

“Our Montana legislators were sold this bill as a progressive alternative to state licensing that would address the nurse shortage by bringing in more nurses. That has not happened and that is not factual, there is no data from our Board of Nursing or our facilities or the hospital association that more nurses have come into the state due to the multistate license. We want to recruit and retain nurses. But the compact isn’t the reason why they’re coming in to live and stay here, because when you come here to move and live you have to get a Montana license anyway. So it’s kind of deceiving to think, ‘Oh I just need one license and I can go and live and work anywhere.’”

Opponents to the NLC say a better way to address the workforce shortage is to focus on  the lack of available spots in nursing schools. Vicky Hertig, dean of nursing for Seattle Colleges, said in the past several years her program has had to turn away at least 300 qualified candidates due to a lack of space.

“Our nursing schools are the solution to building our workforce. We need more nurses and we need more nursing faculty. These are the real problems that need to be addressed. One of the barriers to graduating more nurses is a bottleneck in clinical placements. These are the hours that nursing students need to spend working in a hospital or a long-term care facility in order to graduate.”

Hertig said programs like loan repayment, childcare and investments in faculty salaries are more concrete ways to increase the number of nurses in Washington.