New Jersey is closer than it has come in more than a decade to joining a multistate licensing compact that would allow nursing professionals registered here to practice in more than two dozen other states around the nation, and vice versa.
On Thursday, the state Assembly voted unanimously to advance the latest version of a bill that would enable the Garden State to sign on to a growing collaboration that already includes Delaware, Maryland, and most of the southeast.
But the measure must still pass a Senate panel and a vote in that full house — a significant challenge given that only a handful of possible voting days remain before the legislative session ends in mid-January.
Advocates for the compact argue there is a need for greater geographic mobility in the nursing workforce to meet the country’s changing healthcare needs; interstate licensing can also be important when patients are transported across state lines for treatment.
“The current system of duplicative licensure for nurses practicing in multiple states is cumbersome and redundant for both nurses and states; and uniformity of nurse licensure requirements throughout the states promotes public safety and public health benefits,” reads the latest version of the bill (A-3917), long championed by Assembly health committee chairman Herb Conaway Jr. (D-Gloucester), who is also a physician. Other sponsors include Assemblyman Paul Moriarty (D-Gloucester), Assemblywoman Angela McKnight (D-Hudson,) and Assemblywoman Sheila Oliver (D-Essex), the incoming lieutenant governor.
Less strict requirements in other states
Some nursing groups, however, have raised concerns that joining the compact could actually reduce the quality of care in the New Jersey, since professionals licensed in states with potentially less stringent requirements would be allowed to treat patients here. Others worry about the capacity of the state’s nursing board, which some believe is currently overwhelmed, to implement and sustain such an agreement.
Work on a multistate nursing licensing compact, or NLC, dates back nearly two decades, according to the National Council of State Boards of Nursing. Texas and Wisconsin were among the first to coordinate, in January 2000, and a half-dozen other states — including Delaware and North Carolina — had signed up within six months.
The group had grown to 25 states by 2015, when the initiative reorganized and adopted a list of uniform licensing requirements that nursing professionals must now meet. (Most of these are included in the New Jersey proposal.) The group will relaunch January 19 with 26 states; multistate licensing legislation is also pending in five additional jurisdictions, including New Jersey and Massachusetts.
New Jersey nearly joined the initial NLC group in 2001, but concerns about database incompatibility and the state’s stronger licensing requirements — including a required criminal background check — derailed that prospect. Lawmakers from both parties have been pushing to try again ever since 2006, introducing a bill to join the compact each legislative session, with little success in advancing the measure beyond an initial committee hearing.
The New Jersey State Nurses Association and other professional groups have had mixed feelings about the agreement. While they support efforts to expand the profession and improve mobility, they have raised concerns about the impact changes to nursing licensing protocols in other states could have on New Jersey. As conceived, the compact would be open to registered nurses (RNs) and licensed practical/vocational nurses (LPN/VNs).
Requiring attorney general’s input
The latest draft of the bill, introduced in June 2016, has been amended several times to help address the concerns of some advocates. The Senate version (S-103) now includes a provision that would require the attorney general to review the compact one year after New Jersey joined and assess whether continued participation is in the best interest of the “health, safety and welfare of its citizens.”
The Senate plan, sponsored by health committee chairman Sen. Joseph Vitale (D-Middlesex) and Sen. Colin Bell (D-Atlantic), who replaced the late Sen. Jim Whelan, an original sponsor, also would give the Legislature the power to pull out of the deal if the AG’s report revealed that another state involved in the compact had significantly lowered its licensing requirements.
Leaders at the Health Professional and Allied Employees, the state’s largest healthcare union — which represents nurses and other front-line workers — are hoping to work with Senate sponsors to craft additional amendments. HPAE is concerned about impacts on the State Board of Nursing, which they said is already struggling to process a high number of disciplinary concerns and applications, and could become overburdened with additional vetting requirements.
The nursing board, which licenses and regulates some 220,000 healthcare providers, has been plagued by staff shortages and a lack of board members, critics have said. It was short eight of its 15 members until Gov. Chris Christie appointed ten new ones in early October.
The current Assembly version would require nurses to be licensed by their home state, assuming that state is part of the compact. But their work would need to comply with the professional regulations in the state where the patient they are treating resides and any disputes that resulted from that care would subject to that state’s jurisdiction.
The bill also calls for a multistate licensing information system that would allow state officials in all the party states to determine if an applicant is licensed elsewhere, if they have previously sought multistate approval, or if they have been the subject of certain disciplinary actions. Licensing boards would be required to update the system with any violations. Nurses could only be licensed in one of the participating states and would need to re-register if they moved to a new jurisdiction.