Industry Voices—It's time for national licensure standards to become a reality

Doctors with a tablet
It's time to create national licensure standards, argues Ralph Henderson of AMN Healthcare. (Getty/Motortion)

National licensure of nurses, physicians and other healthcare professionals is an idea whose time has come. But it’s coming pretty slowly through painstaking state-by-state approval of interstate compacts.

The underlying issue is basic: Whether you’re in Maine or Arizona, Florida or Oregon, all patients deserve the same high quality of healthcare. That means quality standards for professionals who deliver patient care should be consistent no matter where you live.

There’s no evidence that healthcare professionals in one state are better or worse than in other states. Yet, in most parts of the country, healthcare professionals who can commute to several states in an hour or two must have separate licenses to work in each state.

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National licensure would offer needed flexibility

There’s an important reason for national licensure: flexibility. Clinical workforce shortages don’t follow any geographic rules. Some rural areas have severe physician or nurse shortages, but others don’t. Some cities have an adequate supply of highly skilled nurses, while others face a near crisis. Specialties like OB-GYNs, telemetry nurses, pediatric physical therapists or family nurse practitioners can be sufficient or sparse in different parts of the same region. Healthcare professionals need to be able to go where they are needed quickly and efficiently.

Another reason for national licensure is telemedicine. The immense value of telemedicine in improving patient care is widely acknowledged. Yet, invisible barriers to telemedicine arise at state lines. We need to knock down those barriers.

One argument against national licensure has come from state proponents who say they need to protect patients from problem clinicians who might move from state to state to escape their records of misconduct. But, a national system, where each healthcare professional has only one record, would, in fact, make it easier to catch offenders and protect the patient.

Then, there are purely practical reasons. Nurses commonly need about 50 documents for a license, nearly a dozen of which must be regularly updated. It’s redundant and unnecessary to demand those same documents in each state, or for clinicians to need a drug screen and TB test for every state. It’s also a waste of money for the healthcare professional or organization that’s paying for the licensure.

Licensure across state lines is already working

Interstate compacts are growing state by state, and so far, nursing is well ahead of other professions. If you qualify for the Nurse Licensure Compact, you can practice in all 31 compact states. It’s the only true multistate license.

The physician compact—called the Interstate Medical Licensure Compact—includes 24 states so far. However, under the medical licensure compact, applicants must apply separately for multistate privileges and pay for individual licenses in each state. About 3,500 medical licenses have been issued through the interstate compact.

In the Physical Therapy Compact, physical therapists and physical therapist assistants who meet all the requirements in a compact state can purchase compact privileges in other compact states. So far, only six states accept compact privileges, but more than a dozen other states have enacted legislation and will soon issue interstate privileges.

A model for an interstate Advanced Practice Nurse Compact recently began and will be implemented when 10 states have enacted legislation. For all other healthcare professions, licensure is strictly state by state.

Licensure is strongly backed by health professionals

If you live in the New York metropolitan area, you need a separate nursing license for each state within commuting distance. In the Washington metropolitan area, Virginia and Maryland are nurse compact members, but the District is not. California, New York, and Ohio aren’t members of any compact; only a few smaller population states are members of all compacts.  

Where is opposition to interstate compacts coming from? Not from healthcare professionals themselves. A 2017 survey of registered nurses by AMN Healthcare found that 68% supported national licensing instead of state by state, and among millennial nurses, 77% supported it. Instead, the resistance to this change is probably just the inertia of bureaucracy. Plus, passing state-by-state legislation on anything is a cumbersome process.  

The growing interstate licensure movement should gain steam as more states join in and as the facts come out about quality standards and cost reduction. Healthcare organizations, particularly the multistate acute care health systems, could help by providing greater advocacy. State lawmakers could also embrace the improved efficiency for hospitals in their districts and greater access to care for their constituents.

Interstate licensure has so many positives. Patients have greater access to quality care. Clinicians have more mobility and new career opportunities. Healthcare organizations can tap into larger numbers of qualified professionals. Telemedicine services can quickly expand. Underserved areas can draw upon more healthcare professionals.

In the conversation about the evolution of healthcare in the United States, interstate compacts—and eventually national licensure for all healthcare professionals—should be an important factor.

It’s a win-win for all involved—especially the patient.

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