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Physical boundaries should not compromise patient care

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A nurse wearing personal protective equipment (PPE) communicates through a glass door while attending to a patient in a Covid-19 intensive care unit (ICU) at Martin Luther King Jr. (MLK) Community Hospital on Jan. 6 in the Willowbrook neighborhood of Los Angeles.

Nurses and physicians nationwide deal with the reality that health care ends at state lines. Due to current legislative policies, nurses and physicians are licensed by states and as such cannot practice across state lines. Moreover, each hospital uses a different set of forms and requirements to credential and hire a given nurse, restricting qualified local nurses from helping at other regional hospitals in urgent situations.  

This partitioned system perpetuates the long-growing shortage of nurses in the U.S. and amplifies disparities in care. If providing high-quality care to patients is the goal of modern health care, then we cannot allow simple obstacles to limit the calling of our health care heroes.

Our society demands a health care workforce that can rapidly mobilize in times and areas of critical need. Access to quality patient care is compromised when nurses cannot cross state lines to provide their services where demand is high. Let’s take the pandemic as an example. Hard-hit COVID-19 “hot spots” were in desperate need and required clinicians from across state lines to help provide increased patient access to higher quality care. Lobbyists and policymakers had to either enact the Uniform Emergency Volunteer Health Practitioners Act or quickly draw up temporary pieces of legislation that would get their states the necessary help. We need to learn from that urgency and be prepared for future crises. 

Pandemic aside, the lack of staffing mobility also exacerbates growing health care disparities, particularly in rural areas, where we face severe physician and nurse shortages.

The solution to this first problem lies within the Nurse Licensure Compact (NLC), which enables nurses to provide care to patients across the country without having to obtain additional licenses for every state. The NLC is an agreement that allows mutual or reciprocal recognition of a nursing license between U.S. states that are members of the compact. Enacted into law by the participating states, the NLC allows a nurse who is a legal resident of and possesses a nursing license in a compact state (their home state) to practice in any of the other compact states without obtaining additional licensure. The NLC applies to both registered and practical nurses and is also referred to as a multistate license. As of June 2021, 34 states are participating in the NLC. But we need more.     

The NLC increases access to care while maintaining public protection at the state level. Obtaining a singular license as opposed to on a state-by-state basis creates a more mobile workforce and directly addresses the nursing staff shortage, while simultaneously providing nurses with increased job opportunities and easier travel. Furthermore, nurses want national licensure, so its impact would be real.

As for credentialling, state-by-state guidelines prevent the industry from being held to uniform standards. One universal set of guidelines for clinicians can help ensure safety across the board; nurses would practice everywhere using the same guidelines. A more streamlined approach to the credentialing process could alleviate clinician burnout and help staff nurses in hospitals where demand is high. With nurses accounting for the majority of health care professionals in hospitals providing direct patient care, we need to ensure that staffing gaps and shortages don’t impact the quality of care they can provide. Therefore, we need to allow nurses, and all other health care professionals, the ability to travel from institution to institution.

Shared knowledge is an additional benefit to national licensure and credentialing. Every nurse would have access to the same safety guidelines and regulations from state to state. As RN Journal pointed out, national nursing licensure would enable 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.” 

In order to satisfy the growing national demand for nurses and aid the nationwide staffing shortages, we need to make changes to existing nurse licensure, whether it’s more states joining the NLC or the inception of universal nursing certifications and requirements to ensure improved quality of care and alleviate overworked clinicians. 

Caring for patients is a nurse’s calling, they should be able to do so. We have the solutions to support our health care heroes. Let’s use them.

John A. Martins is the group president of delivery at Cross Country Healthcare. He has more than 15 years of experience in the health care staffing industry, including extensive knowledge of travel nursing and allied, per diem, locum tenens and education staffing services. He has also served in leadership roles at Onward Healthcare, AMN Healthcare and Aya Healthcare.

Tags COVID-19 crisis cross-state lines health crisis Healthcare Medicine nurses Nursing shortage patient care Physicians Telehealth

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