National Nursing Licensure v. State Licensure for Healthcare Professionals

This article discusses the pros and cons of national nursing licensure. Some of the benefits discussed are the increased mobility of nurses, alleviating the nursing shortage, and the sharing of information and technology across state borders.

National Nursing Licensure v. State Licensure for Healthcare Professionals

National nursing licensure promotes more effective licensing than does state licensure by alleviating the ever-present nursing shortage and promoting mobility among the nursing workforce. Some of the many benefits of a national nursing licensure include improved patient access to quality nursing care, enhanced discipline and information sharing among the states, physical and electronic provision of care by competent nurses, and convenience of employers to more mobile and competent nurses.

In today's world travel is no longer a problem if one decides that they would prefer to move to another area of the country they merely plan, pack up the car, and get on their way. Applications, resumes, and interviews can be gathered online with the click of a few buttons. High technology has allowed for securing your career before the move takes place, at least this is the case for most careers, however in nursing while it is possible to complete all of the tasks above it is not quite so simple once the licensure for another state comes into the picture. For a registered nurse to be licensed in another state, he or she must apply for what is termed reciprocity, this is both costly and time consuming, but it is necessary to have your licensed accepted in another state. The examination for nurse is the same nationwide, so logically should the licensure not be as well?

In effort to meet the ever growing need for nurses, "the board of nursing responded to the need to remove barriers by developing what is termed a Nurse Licensure Compact" (Poe, 2008). To date twenty three states have implemented the Nurse Licensure Compact to decrease the severity of a nursing shortage. A national nursing licensure may not completely remedy the problem of a nursing shortage that our country seems to currently be undergoing however removing the barriers of state nursing licensure would in fact alleviate the shortage of nursing personnel that are available when a state faces a disaster which results in the need for mass medical assistance. "Joining the interstate Nurse Licensure Compact probably would not alleviate Florida's long-term nursing shortage but would remove barriers to bringing nurses into the state to meet short-term needs arising from events such as hurricanes and peak visitation seasons" (OPPAGA, 2006).

National licensure for nursing would ensure that all nurses practice under one set of standards clearly defined by the National Nurse Practice Act. "Currently, each state has established Practice Acts that define the processes and procedures for granting a health professional a license, renewing a license and regulating professionals' practice within a state" (HRSA, 2010). A national nursing licensure would allow for nurses to safely perform their duties under the same scope of practice in all states because there would be a national nursing scope of practice, as opposed to the current system of scope of practice being determined by each individual state. As stated in Nursing Unleashed, "Because of variability in state practice acts, a nurse who is competent to perform a particular procedure in one state may be legally barred from doing that same procedure in another" (Munro, 2012). This factor in itself causes an interruption in the quality of care a patient may receive.

Furthermore, according to the Health Licensing Board, "Licensure portability is also seen as a way of improving the efficiency of the licensing system in this country so that scarce resources can be better used in the disciplinary and enforcement activities of state boards, rather than in duplicative licensing processes" (HRSA,2010).

Some argue that National Licensure will be difficult to establish due to the inconsistencies between states with differing requirements for licensure. This is not the case, in fact, states will actually benefit from this licensing practice according to AAOHN as nursing boards share their best practices and the logic behind those standards with one another. So rather than states lowering their standards of practice to incorporate nurses from other states, practices can be adopted among all states and one uniform practice could be established to meet the needs of patients. Another concern is the regulation of nurse licensure. Some fear that a nurse prohibited from working in one area or state could just move to another state and continue to practice due to the inability to regulate licensing on such a broad basis.

With technology and communication abilities nowadays though, a national regulation of nursing licensure is more feasible and will allow for better tools that permit the transmission of timelier and more accurate information. Lastly and most importantly, many fear that the safety of the patients is at greater risk with the incorporation of national licensing but this is inaccurate. Rather than putting the patient at risk, this licensing allows them to have greater access to qualified nurses regardless of state boundaries. Also, to protect the patient, disciplinary action will still be taken against problematic behavior and documented accordingly.

In conclusion, healthcare policy should be reformed to allow for national licensing rather than state licensing among healthcare professionals. As demonstrated, national licensing would be more beneficial to the consumer, nurses, and employers by alleviating the nursing shortage through the promotion of more mobile nursing practice, providing patients and consumers with access to more qualified nurses, and enhancing the discipline through the sharing of information such as proven quality care practices.

References

Munro, C. Savel, R. (2012). Nursing Unleashed. American Journal of Critical Care. July vol. 21 no. 4 p.222-224. http://ajcc.aacnjournals.org

Nurse Licensure Compact
National Council for State Board of Nursing (NCSBN) www.ncsbn.org

Poe, L.(2008). Nursing Regulation, the Nurse Licensure Compact, and NurseAdministrators: Working Together for Patient Safety: Nursing Administration Quarterly. October/December. Vol. 32 Iss. 4 p267-272

U.S. Department of Health and Human Services: HRSA.(2010). Health Licensing Board Report to Congress. www.hrsa.gov/ruralhealth/about/telehealth/licenserpt10.pdf

NURSE LICENSURE COMPACT.(2012). Iowa Board of Nursing Newsletter, 31(3), 4.
OPPAGA. (2006). Nurse Licensure Compact Would Produce SomeBenefits But Not Resolve the Nurse Shortage. Report No. 06-02 www.oppaga.state.fl.us/reports/pdf/0602rpt.pdf

York, C. (2009). Messagefrom the president. Nurse licensure compact -- a state nursing licenserecognized nationally and enforced locally. Missouri State Board Of NursingNewsletter, 11(2), 1.

Litchfield, S. (2010).Update on the Nurse Licensure Compact. AAOHN Journal, 58(7), 277-279

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Specializes in ICU + Infection Prevention.
alleviating the ever-present nursing shortage

The what now???

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The what now???

Yeah, the many references to the "nursing shortage" kinda brought me up short, too.

I doubt individual states will ever give up their right to license and regulate the practice of various professions (or driving, or anything else) within their own borders, and I don't want them to -- I think national licensure would be a bad idea.

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Specializes in OR, CVOR, Clinical Education, Informatic.

Any credibility to this argument was lost with the opening sentence.

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Specializes in Med/Surg.

I'm guessing a move to consolidate power in the hands of the federal government. They definately NEED control over us to nationalize the entire healthcare industry. How well you deal with the state government will be nothing like how you deal with the federal government.

Try this:

Nursing shortage? "Yes", they say. "We cannot find qualified candidates at this blighted, nearly bankrupt hospital with terrible management. Therefore, we will not renew or issue licenses in other areas of your state until Blighted Hospital is fully staffed."

Step two: "There is a shortage of PCP's, so we like the idea of more NP's" sound good? "The government obviously needs graduated licenses for LPN, RN, APN, & NP's." Then it only takes a rules committee somewhere to determine what constitutes adequate staffing at your facility or clinc and thus, whether or not you have a job!

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Voluntarily entering the compact- ok. But there's some constitutional issues to forcing it on states.

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Specializes in Emergency & Trauma/Adult ICU.

The authors might want to consider the larger context of professional licensure by states. Is there any licensed profession with "national licensure"? What national board/licensing body would issue such a license?

Consider also the U.S. Constitution, Amendment X.

This article also makes plain the very limited employment experience of the authors. Obtaining employment "with a click of a few buttons" ... technologically possible, yes. Advisable (for prospective employees or prospective employers) ... no.

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Specializes in Emergency, Med-Surg, Progressive Care.
The authors might want to consider the larger context of professional licensure by states. Is there any licensed profession with "national licensure"? What national board/licensing body would issue such a license?

Consider also the U.S. Constitution, Amendment X.

This article also makes plain the very limited employment experience of the authors. Obtaining employment "with a click of a few buttons" ... technologically possible, yes. Advisable (for prospective employees or prospective employers) ... no.

All pilots (including those who fly for a living) are licensed by the Federal Aviation Administration. This license is also recognized internationally by all members of the International Civil Aviation Organization.

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Specializes in ICU + Infection Prevention.
All pilots (including those who fly for a living) are licensed by the Federal Aviation Administration. This license is also recognized internationally by all members of the International Civil Aviation Organization.

That is necessary by definition of the profession... pilots don't stay within one state... or nation... on a daily basis!

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Specializes in LTC Family Practice.

I'm all for a national licensure and have been for years, however, I doubt it would happen anytime soon, it's a money maker for the states.

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What does has having separate scopes of practice done for us except cause confusion? Especially when it comes to LPNs. This is why nobody really knows exactly what a LPN can do. It varies from state to state.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Pilot licensing is actually certification in US.

Pilot licensing and certification - Wikipedia, the free encyclopedia

Pilot licensing or certification refers to permits to fly aircraft that are issued by the National Aviation Authority (NAA) in each country, establishing that the holder has met a specific set of knowledge and experience requirements. This includes taking a flying test. The certified pilot can then exercise a specific set of privileges in that nation's airspace. Despite attempts to harmonize the requirements between nations, the differences in certification practices and standards from place to place serve to limit full international validity of the national qualifications. In addition, U.S. pilots are certificated, not licensed, although the word license is still commonly used informally.[1] Legally, pilot certificates can be revoked by administrative action, whereas licensing (e.g., a driver's license) requires intervention by the judiciary system.

In the United States, pilot certification is regulated by the Federal Aviation Administration (FAA), a branch of the Department of Transportation (DOT). A pilot is certified under the authority of Parts 61 and 141 of Title 14 of the Code of Federal Regulations, also known as the Federal Aviation Regulations (FARs).[2]

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