When a Sanford Health hospital in North Dakota received an influx of patients recently, the parent organization was able to send nine critical-care nurses from a hospital in South Dakota to help.
The drive took nearly four hours. But if the states weren't part of a compact that allows nurses to practice across state lines, the licensing process to let those nurses practice in North Dakota would have taken weeks or even months .
The compact is vital to Sanford, said Meghan Goldammer, senior vice president for nursing and clinical services.
“Healthcare doesn't stop at state lines,” she said. “Those patients in the critical-care unit in North Dakota potentially would've had to travel somewhere else, taking the family away from their home and livelihood.” It could also jeopardize the patient's health, Goldammer added.
Providers like Sanford support adding more states to the interstate licensing compacts because it would allow them to be nimbler and adapt to fluctuating demand. Getting licenses for individual states is a major drain on medical professionals' time and resources. They also contend the current system limits providers' ability to follow up with patients in noncompact states and treat them via telemedicine since licenses are based on where the patient is, not the physician or clinician.
Sanford has an internal group of about 50 travel nurses who can move seamlessly to the states in the Nurse Licensure Compact. Currently 29 states are in the compact, with Louisiana and Kansas joining in 2019 and legislation pending in a few other states. This is particularly helpful as many of the health system's nurses near retirement, which is expected to widen the gap between the available supply of nurses and the growing demand. It also makes a big difference for Sanford's rural facilities, which typically struggle to attract employees.
Sanford spends less on locum tenens, or temporary nurses, and can maintain the same level of care quality and continuity, Goldammer said.
The health system can send nurses freely to each state it operates in, except for one—Minnesota.
“It would be a huge benefit if they would join the compact, especially for our patients,” she said. “When we need to send a nurse to Minnesota, it requires a nurse to apply for a separate license, which could set us back two to three months.”
But the compacts are opposed by representatives of labor unions who say that granting interstate licenses cedes control. They argue that the compacts create a loophole that invites lower-quality medical professionals with questionable backgrounds. Unions also claim that in the states where they are active, continuing education requirements, among other mandates, are more stringent than others.
“State governments believe it is their obligation to make sure someone rendering care in their state meets the state legislature's standards,” said William Horton, a partner at law firm Jones Walker, adding that states are eager to retain their policing ability. “Keeping control within the licensing process also means those who have licenses have some degree of protection from competitors.”
In addition to nursing, there are compacts for physicians, physical therapists and advanced practice registered nurses. The physician compact, or interstate medical licensure compact, includes 24 states while the physical therapist compact has 21 states. Three states are part of the advanced practice registered nurse compact.
The nursing compact works a bit differently than the agreement for physicians. When nurses earn their interstate license, they can immediately practice in any participating state. Physicians with their interstate license still have to apply through individual states, although they can do so in a matter of days rather than three to six months. This also gives state medical boards some control.
The National Council of State Boards of Nursing implemented the nursing compact in 2000, driven by the introduction of new technology that required a more fluid licensing process. By 2015, it had 25 members. The second iteration of the nursing compact took effect in January and 24 of the 25 original states signed on, with Rhode Island not participating this time around after union pushback.
The enhanced nursing compact includes a list of uniform licensing requirements, as well as federal and state criminal background checks to ensure that the nurse has no state or federal felony convictions or misdemeanor convictions related to nursing.