Why do nurses get licensed by a state board instead of a federal board?

Nurses General Nursing

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Forgive my ignorance, but I've always wondered, why do nurses have to get licensed on a state-by-state basis?

Wouldn't it be easier for nurses to change jobs if there was a singular federal license board?

How does the actual practice of nursing vary from state to state?

Same reason there is no "National or Federal" drivers license.

It would require a Constitutional Ammendment to create a "National or Federal Nursing License."

However...

Article I, Section 8, Clause 3 (The Commerce Clause) could be envoked to regulate nursing although it would require a Supreme Court ruling.

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My state has fairly high standards for nursing and does a good job of regulating and disciplining nurses in our state. I would hate my state's standards and practices drop to the level of some of the other states because we had a single standard for the entire country.

Also, look at how many people here post about how much trouble they have contacting someone at their state BON and how unresponsive their BON is; that's with 50 BONs -- just think what it would be like if there were one BON for the entire country!!!!! You want to talk about "power hungry" and "unresponsive"????

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Same reason there is no "National or Federal" drivers license.

It would require a Constitutional Ammendment to create a "National or Federal Nursing License."

However...

Article I, Section 8, Clause 3 (The Commerce Clause) could be envoked to regulate nursing although it would require a Supreme Court ruling.

Even taken at it's broadest meaning, the commerce clause deals with interstate movement of goods or some other tangible asset. Human beings aren't a "good" sold in the United States (well not legally nor since slavery was ended anyway).

When a state issues a license to someone to practice a profession, it is within it's own borders. There is no intention of transferring, selling or movement of said license. If the person in question leaves the state, and or wishes to practice elsewhere, he or she must apply to their new location to be granted permission.

As for regulating nursing, and or any other healthcare profession, the federal government already has vast powers, but they are used via funding. Medicaid, Medicare and quite allot of other funds that flow to state and local governments, hospitals, nursing homes and so forth come with rules, laws, regulations and so forth. In theory the federal government could mandate "BSN" only nurses by simply altering the requirement for accepting payments to exclude any other type of nurse.

The SCOTUS ruled long ago that receiving federal money is not a right, and if one does not wish to abide by the laws/rules as written, simply refuse or return the funds and that is that. There is no mandate hospitals or other healthcare providers/services accept Medicaid/Medicare. Most began doing so because even though neither fully covers costs, it was better than having empty beds/time slots. The federal government has used this position as major player in the US healthcare market to effect regulation, even if it is not exactly named such. Most recent example was Mr. Obama in effect ordering hospitals that accept federal funding to allow "gay" visitor rights. Since virtually 98% of hospitals in this country take that funding, presto - you are regulating something that is licensed by a state.

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Specializes in US Army.

A nursing license should be just like a drivers license; licensed in TX, but still able to drive in all 50 states. This would make life so much easier.

If the compact state agreement went nation wide, this could be everyones reality. Right now, only a few states share this privilege.

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A nursing license should be just like a drivers license; licensed in TX, but still able to drive in all 50 states. This would make life so much easier.

If the compact state agreement went nation wide, this could be everyones reality. Right now, only a few states share this privilege.

That would work if the Nurse Practice Acts were very similar. I believe that is what is being considered for the Primary Care Nurse Practitioner.

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Specializes in US Army.

As far as I know, the various nurse practice acts does not have an extreme difference from state to state. And either way, knowing the local NPA is an individual professional responsibility. We all take the same NCLEX and specialty certification exams (CCRN, CEN, CNOR etc, etc).

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A nursing license should be just like a drivers license; licensed in TX, but still able to drive in all 50 states.

Too simplistic a comparison. You can drive in other states, but if you move there you need a license in your state of residence. In fact, states do have some different driving laws. Not so different from state to state nursing after all. Add to that the states area (with state nursing organizations) trying to protect jobs in border areas.

I can drive internationally with my state drivers' license - should I be able to practice nursing anywhere, too?

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A nursing license should be just like a drivers license; licensed in TX, but still able to drive in all 50 states. This would make life so much easier.

If the compact state agreement went nation wide, this could be everyones reality. Right now, only a few states share this privilege.

About half the states (I think it's around half -- I'm not sure offhand of the exact number) have chosen to join the NLC (Nurse Licensure Compact). The other states have chosen not to join -- it is each individual state's choice (a choice made by the state legislature). The states that have not joined don't want to have nurses practicing in their state who are not licensed by their state BON, and that is their right/privilege.

The only reason we're able to drive in all 50 states with our "home" license is because all 50 states have chosen to join a compact (yep, exactly the same thing as the NLC -- an actual physical document like a treaty) agreeing to recognize each other's driver's licenses temporarily for travel purposes. But there was nothing that forced the states to do that -- it was each individual state's choice. Also, as kesr noted, there are limitations on that -- if you move to another state, you have to apply for a new license in your home state (same as the NLC). The NLC really only matters to a small number of US nurses -- travel nurses, and those who happen to live close enough to another "compact state" to be able to commute there to work. For the majority of US nurses, the NLC has no impact whatsoever.

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Even taken at it's broadest meaning, the commerce clause deals with interstate movement of goods or some other tangible asset. Human beings aren't a "good" sold in the United States (well not legally nor since slavery was ended anyway).

I would agree with you but Congress does not. SCOTUS has already ruled that the Congress must only have a rationale belief that the item in question effects interstate commerce for enacting regulation. Hence the marijuana debate...SCOTUS ruled that the Feds may regulate it since there are questions where the product is grown, sold, and consumed. Funny considering many users grow their own for personal use.

VERY broad powers IMO. I do not think it is a huge jump to imagine Congress stating that nursing has an impact upon interstate commerce considering the vast majority of our drugs, products, companies, even patients are not from the state which we practice in.

The Commerce Clause has been successfully used to regulate a whole host of odd issues in the past, I am sure it will be used again in the future...even though I disagree with it.

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As far as I know, the various nurse practice acts does not have an extreme difference from state to state. And either way, knowing the local NPA is an individual professional responsibility. We all take the same NCLEX and specialty certification exams (CCRN, CEN, CNOR etc, etc).

Actually they are VERY different. Just compare California to Arizona.

In California you can only do the tasks for which the BON approves. In Arizona you can do the tasks for which you were trained/educated in, less the BON bans it. Huge legal distinction.

In addition to the NCLEX some states require a certain amount of clinicals, some do not. I reference the California/Excellsior RN ban.

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