Pros and Cons of a National Nurse Licensing Compact

The enhanced Nurse Licensure Compact (eNLC) has been in the news lately, and we have been following the action pretty closely in this space.  What we haven’t spent much time on are the reasons why the eNLC makes sense to some and is less than ideal for others.  Below is a brief look at the pros and cons of having a national nurse licensing compact.

Why the eNLC Makes Sense

Healthcare Professional Mobility

Having a national nurse licensure compact supports the portability of those professionals who choose to work in a variety of locations where and when they are needed.  Like the concept of a driver’s license, proponents feel that if you are qualified to be a nurse in state A, you should also be qualified in state B.  No one is forced to pull over and apply for a new driver’s license when they drive into a new state, and nurses should receive the same courtesies.

The bottom line is that the original NLC was developed in response to the rapidly changing nature of the healthcare industry and the need to address nursing shortages in certain areas.  Unfortunately, the original compact fell short in attracting a majority of states to participate. Hence, this year’s rollout of the enhanced NLC. Supporters of eNLC point to the following:

Telehealth Coverage

  • One-way providers are increasing access to care, telehealth technologies are being made available to individuals who are seeking medical advice instead of a trip to a doctor’s office. Nurses have to be available to handle the 24 x 7 telephone coverage, and without the recognition of cross-state nursing licenses the intended purposes of telehealth will be defeated and unusable.

Provider Workforce Flexibility

  • If we have seen one thing come out of the unending changes within the healthcare industry over the past several years, it is that mergers are a popular approach to current conditions.  When a healthcare system has built up a multi-state presence, it is important for them to have the flexibility within their workforce to position their resources where needed.  Other considerations are the movement towards remote monitoring which may be across town or across states.

What Critics of eNLC are Saying

The main concern among critics is that a national compact interferes with the oversight purposes of the state nursing boards regarding vetting licensees, tracking them, and coordinating disciplinary actions.

Differing Professional Development Standards

  • One issue that is raised in opposition to the national compact is that traditionally each state has had differing requirements about professional development for nurses. The compact doesn’t address a uniform policy for continuing education which means that in some states, there may be little or no professional development.

Differing Licensure and Disciplinary Standards

  • No one will dispute that a fundamental aspect of achieving quality patient care is the skill and talent of the nurse. Critics of the compact are concerned that there are enough differences between state standards that individual nursing boards cannot effectively manage the inevitable disputes over jurisdiction.  The main concern is when a dispute arises regarding skill or judgment, which nursing board manages the investigation or takes action?

The eNLC appears to be a step in the right direction, and as hesitant states express concerns, it is clear that additional changes will be implemented.  Each of the states that have yet to take action regarding eNLC have their own reasons internal to their state legislatures.  Will we one day see a full 50 state compact?  For now, the best answer to that question is “only time will tell.”

Is your state part of the eNLC?  Do you have an opinion for or against the compact?  Please consider adding your thoughts to the conversation by commenting below or leaving us a note on our Facebook page.

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