Pennsylvania on Tuesday became the latest state to join the nurse licensure compact, which is expected to aid efforts by Pennsylvania providers to recruit nurses.
The addition of Pennsylvania means 41 states and territories allow registered, licensed practical and vocational nurses to practice in those areas without obtaining individual state licenses. Nurses who have a multistate compact license will be able to immediately start working in Pennsylvania. As a result, health systems and other provider organizations in the Keystone State can more easily send nurses where they are needed, expedite the licensure and onboarding process and recruit nurses from more states.
Pennsylvania is rolling out the compact in stages, meaning it will take time for the state to issue multistate licenses as it works to certify its criminal background check process. Even so, the impact will likely be immediate, said Steve Wehn, head of government relations at the staffing agency AMN Healthcare who tracks compact legislation.
As of late last week, there were 500 open orders filed through AMN from Pennsylvania hospitals seeking to fill vacant nursing positions, he said.
"Some nurses wouldn't even look at Pennsylvania because it took so long to get a license," Wehn said. "Now, they can start immediately. It is a huge differentiator."
Prior to joining the interstate licensure agreement, it took many registered nurses several months to obtain their Pennsylvania license and start working, said Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania. Now that Pennsylvania joined the compact, getting nurses ready to work will take a matter of days instead of months.
"This is a great thing. It takes away the bureaucratic delay,” Aiken said. "There is not a strong rationale for having all these separate licenses."
Health systems are employing multiple strategies to fill staffing gaps, which were laid bare during the COVID-19 pandemic. More than 275,000 additional nurses are needed from 2020 to 2030, according to the most recent estimate from the U.S. Bureau of Labor Statistics.
The nurse licensure compact is an important tool for health systems, said Abhi Rastogi, president and CEO of Temple University Hospital and executive vice president of Philadelphia-based Temple University Health System. The interstate license will help not only Pennsylvania hospitals, but their referral partners who are managing similar staffing constraints, he said.
“Over the last three years, I can’t tell you one day where we had no vacancies in our emergency departments, operating rooms or [catheterization] labs,” Rastogi said. “Joining the compact will help us attract workers and get back to pre-pandemic staffing levels. This helps us collectively provide care to patients who need it.”
The nursing compact may also help Temple recruit nurses who had retired, using lighter workloads and better-staffed departments as bargaining chips, he said.
Research has shown the multistate licensure agreement has improved recruitment. Nurses who have a compact license are 11% more likely to move and work in other participating states, according to a 2022 peer-reviewed study published in the Journal of Labor Research.
Other states are mulling legislation required to implement the nursing compact. Massachusetts and Washington, D.C., are actively reviewing related bills, while Hawaii officials have commissioned a study that would inform legislation, said Nicole Livanos, director of state affairs at the National Council of State Boards of Nursing. Legislation has been introduced in Alaska, Minnesota, Illinois, Michigan and New York. That leaves California, Oregon, Nevada and Connecticut as the only states not considering it.
“I suspect many holdouts will eventually come into the compact," Aiken said.
Before the COVID-19 pandemic, only 34 states were part of the nursing compact. “It might’ve taken an emergency to realize how critical it is to have a mobile workforce,” Livanos said.
States that aren't part of the compact typically have strong unions, which claim the compact licensing training, continuing education and quality standards aren’t as rigorous and that their states would lose licensing revenue.
The Pennsylvania State Nurses Association, a labor union, initially opposed interstate licensing, but the compact’s updates, including mandatory background checks, helped allay its concerns. After surveying more than a dozen nursing associations in states that joined the interstate licensing agreement, the union found that concerns regarding public safety and lost revenue had not materialized.
"The association became one of the biggest advocates,” Livanos said.