Cross-State Nurse Licensing: One Way to Improve Care During COVID-19

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.

Cross-State Nurse Licensing Still a Hurdle for Expansion

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of Medicine published The Future of Nursing: Leading Change, Advancing Health and called on states to eliminate “outdated regulations and organizational and cultural barriers that limit the ability of nurses…to practice to the full extent of their education, training, and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 Is Reason to Reassess Cross-State Nurse Licensing

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:

• The S. Department of Health and Human Services suspended federal regulations that prevented medical professionals from practicing across state lines.
• Washington State was one of the first states to allow healthcare providers with out-of-state licenses in good standing to practice immediately without obtaining a Washington license.
• More than 40 states subsequently waived particular healthcare provider licensing requirements.

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.

Updating Licensing Laws Improves Response to COVID-19, Future Pandemics

To facilitate better access to care across state lines, states can consider making the following changes to their nursing laws and guidelines:

• Enact legislation that allows all healthcare providers to practice to the full extent of their education, training, and competence.
• Adopt universal licensure guidelines. For example, if more states join the enhanced Nursing Licensure Compact and the Interstate Medical Licensure Compact, healthcare providers could deliver care across state borders.
• Evaluate licensing requirements and assess whether the requirements genuinely protect the public. For example, political decisions or precedent, rather than evidence, drive some licensing requirements. States should remove licensing requirements that create unnecessary barriers to practice and inadvertently limit the supply of qualified healthcare providers.
• Expand access to information about a healthcare provider’s education, training, credentials, qualifications, licensure, and disciplinary history.
• Expand emergency healthcare workforce declarations authorizing out-of-state healthcare licenses, including licenses for healthcare providers with retired or inactive status who were in good standing at the time of their status change.
• Maintain emergency response volunteer rosters and conduct outreach to healthcare providers who are willing to respond to disasters. If not already in place, establish processes for contacting volunteers when they are needed, gathering the information required to determine which volunteers are ready for assignment.

The Time for Cross-State Nurse Licensing Change Is Now

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.

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

1. How Data Transforms the Hospital Command Center to Pandemic Proportions
2. How to Scale Telehealth Solutions to Increase Patient Access During COVID-19
3. Restarting Ambulatory Care and Elective Procedures: Analytics Guide Safe, Pragmatic Decisions
4. Health Systems Share COVID-19 Financial Recovery Strategies in First Client Huddle
5. COVID-19 Healthcare Cybersecurity: Best Practices for a Remote Workforce