Nursing is the nation’s largest healthcare profession, with more than 3.9 million registered nurses (RNs) across the United States. The novel coronavirus (COVID-19) has highlighted the importance of RNs to the healthcare delivery system, as many RNs and advanced practice registered nurses (APRNs) have stepped forward, volunteering to provide care in the states hardest hit by COVID-19. While many clinicians have been willing to cross state lines to serve in the areas with the greatest need, differing state requirements and processes for healthcare provider licensure have delayed, or in some cases impeded, the ability for RNs and APRNs to quickly respond to emerging needs.
State licensing requirements define the required training, knowledge, and experience to act as a licensed healthcare professional in a specific field, such as nursing. Licensing laws are supposed to protect the healthcare consumers by ensuring practitioners only perform activities for which they have the training and can carry out safely.
While patient safety is the expressed intent, licensing laws have become a political battlefield. For example, in 2010, the National Academy of Medicine published The Future of Nursing: Leading Change, Advancing Health and called on states to eliminate “outdated regulations and organizational and cultural barriers that limit the ability of nurses…to practice to the full extent of their education, training, and competence.”
Despite evidence that outcomes for patients who receive care from an APRN are comparable to the outcomes for patients who receive care from a medical doctor, the American Medical Association (AMA) has continuously blocked legislation that would allow APRNs to practice independently. For example, the AMA has strongly opposed the APRN Compact—similar to the enhanced Nursing Licensure Compact, which allows nurses to have a license in one state but the ability to practice in other member states—effectively blocking the APRN Compact’s implementation.
COVID-19 has placed a severe strain on hospital resources, including hospital workforce. With limited staffing available in states hit hardest by COVID-19, clinicians and providers from less affected states have the resources and bandwidth to deliver care to highly impacted areas. These unprecedented changes resulting from COVID-19 have driven the following disruptions in standard licensing processes:
COVID-19 has also driven the dramatic expansion of telehealth, likely increasing the number of healthcare providers who need multistate licensure. Changes in healthcare provider licensing can help meet these demands by ensuring an adequate amount of healthcare providers are available across the U.S.
To facilitate better access to care across state lines, states can consider making the following changes to their nursing laws and guidelines:
COVID-19 impacts encourage states to reconsider the cross-state nurse licensing laws, guidelines, and practices they have in place around healthcare provider licensure. Outdated approaches prohibit nurses, and other providers, from swiftly responding to a pandemic, such as COVID-19. The cross-state nurse licensing barriers have prevented nurses in low-risk states from applying their clinical knowledge and expertise in harder-hit states, delayed care for sicker patients, and increased the burden of patient care on the limited staff legally permitted to work in a specific state.
States need to respond to an ever-changing healthcare landscape with flexibility and prioritize the best way to deliver care to patients. Updating old state licensure limitations and permitting clinicians to provide care across state borders will increase access to care and health systems’ ability to respond to an emergency. Such changes will help organizations avoid workforce burnout while saving lives during the 2020 pandemic and beyond.
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