Multi-State Licensure Compact - Is It Time?

When I graduated from nursing school oh-so-many years ago, there was no National Council Licensing Exam.

Every state devised its own nursing boards, and states differed on what were passing grades. I sat for my boards in Missouri – a multiple choice test for which we used a pencil to fill in those little bubbles. The exam was a five-parter, taken over two days, and students had to travel to the state capital, Jefferson City, to take the exam.

We drove from St. Louis – four and five senior nursing students per car – and quadrupled-up in motel rooms to save money. We got little sleep the night before the first test. We had studied for weeks for the boards, but still stayed up way too late, quizzing each other for Part I, II and III. The rest of the process is a bit of a blur, but I remember returning home and dreading the three-to-four-month wait for the results.

Finally, the letter from Missouri’s board of nursing arrived; I had passed all parts. Most of my classmates were as successful, but a few had to re-test on one or two parts, and they had to wait another few months before returning to Jeff City. In the meantime, they couldn’t collect that boost in pay that we “full-fledged” nurses received as soon as we recorded our notice of passing with our employers.

A year later, I was off to California, which recognized Missouri licenses, but only if the nurse’s passing scores met a certain minimum, which was higher than Missouri’s minimum scores.

Fortunately, I qualified. I gratefully paid what was a hefty fee for those days because it saved me from taking the California boards.

Then along came the NCLEX, which was a really good idea. Physicians take national exams; why not nurses? I’m all for simplifying, and shouldn’t nurses be held to a uniform standard of skills throughout the United States?

I think the obvious next step should be license reciprocation among all of the states – or multi-state licensure – but politics, power and money are the big stumbling blocks.

In some cases, the problem lies with the state boards of nursing, and sometimes it’s the state nursing associations that are holding out joining the Nursing Licensure Compact (NLC). These organizations don’t want to relinquish control and/or the income that license applications generate. And some state nursing organizations feel that multistate licensure will make it much easier to replace striking nurses.

So far, 23 states (and one pending) have joined the NLC.

For those nurses who obtain their original licenses in compact states and who want to work in another compact state, life is easy; no applications and no waiting to practice. This can be pretty important when nurses are needed at a disaster site, and certainly removes the dilemma for telehealth nurses who work in one state and advise patients who live in another.

But for nurses who take their boards in non-compact states, there is waiting and expense. And for telehealth nurses, there is confusion about the law. It’s bound to get even murkier as technology makes patient care from a distance a more common occurrence.

One expert I spoke with had what I think is an excellent model of practice: the driver’s license.

Drivers with valid licenses can operate a vehicle in any other state without charge, but they are expected to observe the laws of each state. When drivers establish residency in another states, they must apply for a new license.

We are a mobile society and our technology takes us to places electronically that we never envisioned going. How do you feel about multi-state licensure? Is now the time for nurses to get in the driver’s seat and push for multi-state licensure? Please, share your thoughts.