Progress! The Enhanced Nurse Licensure Compact is fully implemented in Indiana. Next up, Michigan, Pennsylvania or Vermont?

The Enhanced Nurse Licensure Compact (eNLC) is the easiest way to help American nurses find the jobs they need — and where they are needed most. But getting it implemented in new states can be a frustratingly drawn out and bureaucratic political process. Slowly but steadily, however, progress is being made!

The latest milestone: as of July 1, the Nurse Licensure Compact is fully implemented in the state of Indiana. Exactly a year after it was implemented in full in Louisiana and Kansas, half a year after Alabama followed suit, and three years after the original Nurse Licensure Compact (NLC) system was succeeded by the eNLC.

Now, RNs and LPNs in Indiana who want to work in one of the 33 other compact states can do so without further barriers by applying for a multistate license. You don’t need to wait until your renewal period to apply for the multistate license — just follow the instructions on the Indiana PLA website.

But it works the other way round too. Nurses from compact states like neighboring Kentucky can now practice in Indiana without having to jump through lengthy or costly administrative hoops. Like this, ever fewer nurses have to wait for months to get their license anymore.

Indiana is not the only state where the NLC has advanced. New Jersey partially implemented it last March, and now allows nurses with an active, unencumbered, multi-state license that was issued by an NLC member state to practice in the state. And legislative action is under way to get Michigan, Pennsylvania and Vermont on board as well, as we explain further down!

How the eNLC helps tackle the Coronavirus crisis

The eNLC is a godsend especially for nurses who live near a state border, but of course enormously useful for travel nurses as well. Living in a non-compact state involves a lot more hassle if you’re a travel nurse. You can still apply for a license in a compact state, but it will be limited to that single state, and for your next assignment they will have to start all over again.

But there’s an additional advantage too, which is especially important in these Coronavirus times.

With a multistate license, nurses can take up telehealth jobs in any compact state without first having to apply for specific licenses there. So when disaster strikes and local nurses are overwhelmed, nurses from any compact state can jump in without delay, providing vital services via telehealth as well as in person.

Remember when Covid-19 first struck, and a range of state legislatures and nursing boards had to pass special exemptions for licensing fees and procedures, just so nurses from other states who already had a multistate license could help out? That could have gone a lot faster, with less red tape, if their states had already joined the NLC themselves. On the flip side, it would have been that much harder to arrange exemptions for out-of-state nurses if there hadn’t been an eNLC to rely on in the first place.

Renewing your driver’s license? Take note!

The eNLC system is not without safeguards. That’s what the whole shift from NLC to eNLC was about: introducing more protections, like state and federal fingerprint-based criminal background checks. “Participating states can access a shared database that includes the licensing and disciplinary history of all nursing professionals,” NJ Spotlight explained, “and must use this system to check for job-related violations when granting new licenses”.

You can only apply for a multistate license if you are “eligible for an unencumbered license for full and unrestricted practice”. If you have restrictions on your license because of DUIs, for example, or if your track record includes a felony or a nursing-related misdemeanor, obtaining a multistate license will be hard.

But there’s something else you’ll need to keep an eye on too. To apply for a multistate license, Indiana nurses need to declare Indiana their Primary State of Residence. Same goes for other states: you need to maintain proof of residency for the state where you acquired your multistate license. Just owning property in a state is not enough to qualify. This can get tricky for travel nurses when you’re on assignment in a non-compact state. If you renew your driver’s license there, you might be losing your proof of residence. Better to make the trek back home for the occasion!

Finally, don’t forget to sign up for the free Nursys e-Notify system, which provides real-time notifications about eNLC updates, expirations, renewals, and disciplinary actions.

Why so late? And who’s next?

“Wait,” you might say, “wasn’t Indiana already supposed to be in?” You’re not wrong. We explained last year that the new law implementing the NLC in Indiana was going to “take effect on July 1, 2019”.

But the process took more time, Healthcare Traveller Today reported, coming “one year later than what was initially expected and more than a year after legislation was passed to join the compact”.

A great day for nurses, providers, and most importantly patients at the ceremonial signing of the #enlc! Thank you to all of the coalition who worked so hard to pass this bill! @hosparushealth @gwenccoop @irisbwilbur @WDantChesser https://t.co/GiKxHEI1gv

— Amelia McClure (@Amelia_McClure) June 27, 2019

Meanwhile, the legislative wheels are still turning in a number of other states.

New Jersey: partially implemented

Almost exactly a year ago, on July 19, 2019, New Jersey became the 34th state to join the NLC when Governor Phil Murphy signed the bill enacting it. At long last, we should add — because an NLC bill had been introduced twice before in the previous few years without going anywhere.

Last year, things went a little more smoothly. The state Senate passed the legislation unanimously in February, and the state Assembly did the same in May. “The enhanced Nurse Licensure Compact brings New Jersey into the 21st Century,” Democratic state Sen. Joseph F. Vitale announced triumphantly.

The bill had the “full support” of the New Jersey State Nurses Association (NJSNA) too. “Say New Jersey had Hurricane Harvey, we could get any nurse from any compact state to come and help immediately, without the red tape of paperwork,” the association’s Judith Schmidt explained, adding that “we have not heard any negative comments from other nursing associations who have nurses practicing in compact states”.

“The enhanced Nurse Licensure Compact brings New Jersey into the 21st Century”

Senator Joseph F. Vitale

But the bill included an evaluation clause: “One year after joining the NLC, the Attorney General will be required to submit a report to the governor with the pros and cons,” indicating whether it was still “in the best interest of the people” to continue participating in the compact.

For now, New Jersey has only partially implemented it. What that means is that nurses from other compact states with an active, unencumbered, multi-state license can come practice in New Jersey. But nurses in New Jersey cannot yet upgrade to a multistate license. That will only be possible once the state has fully implemented the compact, which is expected to happen “in the 4th quarter of 2020”.

Michigan and Pennsylvania

By years’ end of 2019, bills to enact the compact nurse licensure in Pennsylvania and Michigan had come to “a standstill.” The Nurse Licensure Compact (NLC) Biennial Report that was published last January was hopeful about “the possibility of Michigan or Vermont passing legislation either this year or next,” but it didn’t mention Pennsylvania.

It looks like things are moving there again though! State Representative Bridget Kosierowski and State Senator Lisa Boscola, both Democrats, introduced legislation for the state to join the NLC last year. For a long while, nothing seemed to happen, despite grassroots pressure from among nurses. But last month procedures sped up, and on June 24 the Senate unanimously passed an amended bill. What happens next is up to the state House, but the bill’s bipartisan support bodes well.

In Michigan, a bill to enact the NLC was introduced a year and a half ago and slowly wound its way through committees of the state House of Representatives. It then passed the full House last February in a relatively narrow 55-50 vote. In states like Indiana, passing the NLC had found broad bipartisan approval, but in Michigan the vote broke down by party lines, with all Democrats opposing. Now the bill is under review in the Michigan Senate. Republicans hold a majority there as well, but it looks like it’s been a good five months since anything has happened.

Vermont

There’s been progress in Vermont as well. Having worked its way through different Senate committees, the Vermont Senate bill about joining the eNLC was passed in late May. As in Michigan and Pennsylvania, though, that means we’re only halfway there. Now the ball is in the court of the state House, whose Health Care Committee “will likely take it up when the legislature resumes business in late August”.

Explanation of the Nurse Licensure Compact for Nurses

This short video helps explain the Nurse Licensure Compact to all nurses. It explains what an NLC multistate license is and provides a broad overview of steps nurses need to take when permanently changing their home states.

Posted by Nurse Licensure Compact on Thursday, August 29, 2019

Nurses and nursing organizations like the eNLC

The eNLC is broadly popular among nurses. A 2014 study showed 70% of nurses in favor of their state joining the NLC.

A 2019 survey of RNs with a Vermont license by the state’s Office of Professional Regulation (OPR) found 59% in support of the state joining the compact, and just 25% opposed. Especially in a small state like Vermont, staying outside the compact causes additional hassles. Take Brattleboro’s Pine Heights Center for Nursing and Rehabilitation, for example, where a quarter of staff live outside the state! Heeding the call of the nurses it surveyed, the OPR asked lawmakers “to pass legislation for Vermont to join the Nurse Licensure Compact in 2020”.

The NLC doesn’t just make it easier for nurses to pursue new job opportunities, it makes them more attractive candidates for employers as well, since they can fill a vacancy immediately. Michigan State Rep. Mary Whiteford, who introduced the House bill about joining the eNLC in that state, emphasized how it faced a disadvantage in attracting the nurses it needs as long as it stays outside. She was a nurse herself, and warned that “these young nurses who want the flexibility to be a travel nurse, or go to different parts of the county, are choosing to go and get licenses in a Compact state, and not in Michigan”.

No wonder that the eNLC has a wide range of institutional supporters. The American Association of Colleges of Nursing, the National Patient Safety Foundation, the American Association of Neuroscience Nurses, the Commission for Case Manager Certification, the Emergency Nurses Association, the Organization for Associate Degree Nursing, the Oncology Nursing Society, and the American Organization for Nurse Leaders (AONL) are among the many nursing-related organizations who have lent their support.

Voices of criticism

But not everyone is on the same page. Some state Boards of Nursing in non-compact states, for example in Washington, remain staunchly opposed over safety concerns. Not all nurse unions have been on board either. The Washington State Nurses Association shares the board’s patient safety reservations, pointing to state-by-state differences in what practice acts allow nurses to do, and what educa­tion require­ments nurses need to fulfill to be licensed. The WSNA also raised objections about the NCSBN’s lacking financial transparency.

“In the compact, it’s a matter of the lowest common denominator among states. Patients deserve better than that.”

Jamie Brown, MICHIGAN NURSES ASSOCIATION

In Michigan, the Health and Hospital Association has backed the bill to join the eNLC, and the American Nurses Association-Michigan has pleaded with the state’s politicians to speed up the process. But the President of the Michigan Nurses Association, Jamie Brown, came out against it, arguing that standards of care would suffer: “In the compact, it’s a matter of the lowest common denominator among states. Patients deserve better than that.” Citing the costs involved, the Department of Licensing and Regulatory Affairs (LARA) opposed the bill as well.

In Vermont, Deb Snell has been a fairly lone voice of opposition. Referring to the state’s nursing shortage, the president of Vermont’s Federation of Nurses and Health Professionals worries that joining the compact might rather lead to more nurses “leaving instead of coming”. The president of the American Nurses Association-Vermont, Meredith Roberts, also doesn’t share the enthusiasm of her peers in Michigan. She is concerned about the prospect of the state, which will lose out on some $900,000 in licensing revenue if it joins the eNLC, looking to nurses to make up the shortfall by making them pay a much higher annual fee.

Which side are you on? Are you grateful for living in a compact state, or frustrated by how slow the political process has been if you live in a non-compact state? Or do you share some of the objections and hesitations the critics have voiced?