H1944, An Act relative to nurse licensure compact in Massachusetts NLC Coalition Letter

The Honorable Jennifer Benson, House Chair  Joint Committee on Health Care Financing State House, Room 236 Boston, Massachusetts 02133
The Honorable Cindy Friedman, Senate Chair Joint Committee on Health Care Financing State House, Room 413-D Boston, Massachusetts 02133 

Dear Chair Benson, Chair Friedman, and Distinguished Members of the Committee:

 As organizations representing nurses, providers, leading healthcare organizations and other stakeholders, we are writing to express our strong support for H1944, An Act relative to nurse licensure compact in Massachusetts. Adoption of this legislation would further cement Massachusetts’ status as a leader in healthcare reform, promote and support the nursing profession, and provide relief to the numerous providers that currently struggle to recruit and retain nursing staff.

The mutual recognition model facilitated by the Nurse Licensure Compact (NLC) allows registered nurses and licensed practical nurses to have one multistate license in the state in which they reside, with the privilege to practice in their home state and all other states that are members of the NLC. Adoption of the Compact would enhance the commonwealth’s efforts to respond to the changing landscape of healthcare delivery, permit qualified nurses to care for patients across the health care continuum, allow for better emergency preparedness and more rapid medical staff response in times of disaster,1 and bolster access to quality nursing care for all residents of the commonwealth.

Misinformation has led to confusion around the NLC and its conditions, unfairly stigmatizing qualified nurses that are licensed to practice in other more rural states. Every nurse in the United States has to pass the same test to become a registered nurse or licensed practical nurse, and nursing school curricula across the country are relatively uniform. Moreover, the licensing requirements under the NLC are more stringent than those in the commonwealth. A registered nurse or licensed practical nurse who wishes to obtain a multistate license must meet their home state’s requirements for licensure, in addition to passing a state and federal background check. Currently, nurses applying for licensure under the Massachusetts Board of Registration in Nursing (BORN) are not required to undergo a background review. Our organizations, comprised of a wide array of experienced healthcare professionals, are confident that nurses licensed by the Compact are eminently qualified to treat our patients.
On a system-wide basis, Massachusetts healthcare providers hire roughly 5,500 new nurses in a typical year. The commonwealth’s acute care hospitals currently have a vacancy rate of 5.3% and are struggling to fill 1,200 full-time, budgeted registered nurse positions.2 This shortage is more prevalent in inpatient psychiatric units (7.8%) and emergency departments (7.5%).3 Regionally, these vacancy rates are highest in Western Massachusetts facilities (7.7%) and hospitals in the central part of the state (6.7%).4

By joining the NLC, Massachusetts can decrease avoidable barriers to the provision of nursing care in our world-class facilities and help to ensure the availability of licensed nurses during a disaster or other times of great need for qualified nursing services. In times of an endemic event or flu outbreak, healthcare facility staffing is stressed, not only due to increased patient volume but also loss of healthcare workers due to the spread of illness. These challenges delay response times for emergency department and telephonic triage response, which results in overcrowded waiting rooms and compounds the spread of an outbreak. Nurses licensed in contiguous states would be unable to immediately assist Massachusetts facilities during flu season unless they also maintain a license in the Commonwealth.

For these out-of-state nurses, Massachusetts’ membership in the NLC would streamline the licensing process. The current practice – licensure by endorsement – is often administratively burdensome, time-consuming and resource-intensive, and may unnecessarily delay a registered nurse or licensed practical nurse from starting a new position and delivering patient care. In fact, qualified nurses with spouses in the military have cited long bureaucratic delays in applying for and receiving their nursing license when transferred to a different state, discouraging them from continuing their professional practice.5 A 2017 national survey by AMN Healthcare and The Center for the Advancement of Healthcare Professionals found that 68% of registered nurses support national nurse licensure, with 77% of millennial nurses responding in favor.6

Trust for America’s Health; Robert Wood Johnson Foundation Ready or Not? Protecting The Public’s Health From Diseases, Disasters, And Bioterrorism, Report December, 2012 – Scores States’ levels of Emergency Preparedness, and lists States’ participation in the Nurse Licensure Compact as an indicator of better preparedness. “The ability for nurses to be able to work across state lines can be a tremendous benefit during disasters or disease outbreaks, when affected communities may experience severe workforce shortages.”
2 http://patientcarelink.org/wp-content/uploads/2016/08/MHA-ONL-2015-Nursing-Survey-Highlights.pdf.
3 Ibid.
4 Ibid.
5 https://campaignforaction.org/multistate-licenses-help-military-spouse-and-other-nurses-begin-working-right-away/

With the rise of telehealth, nurses are now able to assist in a patient’s progress after they leave the hospital and can rely on technology to prevent costly and unnecessary hospital visits. As Massachusetts is a mecca for medical care, this bill would provide predictability to Massachusetts nurses who are following up with out-of-state patients upon discharge from Massachusetts hospitals, thereby improving the quality of patient care. It would also allow for nurse educators in NLC states with multistate licenses to teach via distance education to students in NLC states, helping to improve the registered nurse educational pipeline. Over the last twenty years, Massachusetts nursing colleges have produced an annual average of less than 3,200 bachelor’s degree graduates.7

The NLC has recently undergone certain revisions that have resulted in new model legislation, which was adopted by the National Council of State Board of Nursing on May 4, 2015. The updated bill prohibits those with a felony conviction from receiving a multistate license and improves the operations of the Compact – including the adoption of model rulemaking provisions and improved dispute resolution processes for states who are compact members.

The NLC was reported favorably last session by both the Joint Committee on Public Health and the Joint Committee on Health Care Financing. Since then, NLC membership has grown to 34 participating states, including Maine and New Hampshire.8 Membership in the NLC will provide Massachusetts with the ability to build and maintain a robust nursing workforce, provide accountable healthcare, and rapidly respond to public health emergencies, and it is essential that we join the effort as soon as possible.

We look forward to an opportunity to speak with you and other legislative leaders regarding the Nurse Licensure Compact and the provisions of H1944. Should you have any questions or concerns or need further information, please do not hesitate to contact Emily Dulong, MHA’s Sr. Director of Strategy & Government Advocacy, at edulong@mhalink.org.


Amanda Stefancyk Oberlies, MSN, MBA, RN, CENP, PhD
Chief Executive Officer, Organization of Nurse Leaders, MA-RI-NH-CT

Julie Ann Cronin, RN, DNP, OCN
President, American Nurses Association Massachusetts

Steve Walsh
President & CEO, Massachusetts Health & Hospital Association

Daniel Benton, RGN, RMN, BSc, M Phil, PhD, FFNF, FRCN
Chief Executive Officer, National Council of State Boards of Nursing

Kimberly Christopher, PhD, RN
Chair, Massachusetts Association of Colleges of Nursing

JoAnn Mulready-Shick, EdD, RN, CNE, ANEF
President, Massachusetts-Rhode Island League for Nursing

Roxanne Dunn, RN, BSN
State Council President, Emergency Nurses Association Massachusetts State Council

Tish McMullin
Executive Director, Conference of Boston Teaching Hospitals

Jenny Quigley-Stickney, RN, MSN, MHA, CCM, CPHM
President, Case Management Society of New England

Stuart Pologe
Chief Operating Officer, Night Nurse, Inc.

Collan B. Rosier
Director of Government Affairs, Maxim Healthcare Services, Inc.

Michael E. Festa
State Director, AARP Massachusetts

Pat Kelleher
Executive Director, Home Care Alliance of Massachusetts

Marci Sindell
Chief Strategy Officer & Senior Vice-President, Atrius Health

Cathleen O’Keefe, RN, JD
Vice-President, Regulatory Government Affairs, Fresenius Medical Care North America

cc: Representative Robert A. DeLeo, Speaker of the House
Senator Karen Spilka, President of the Senate
Representative Tackey Chan, Chair, Joint Committee on Consumer Protection & Professional
Senator Paul Feeney, Chair, Joint Committee on Consumer Protection & Professional