HPC: Multi-state nursing compact offers numerous benefits

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BOSTON (SHNS) – The Health Policy Commission said there are benefits to entering a multi-state compact that allows nurses to practice across state lines for individual nurses and the state’s health care system generally, and found no negatives to joining.

The HPC’s board voted Wednesday afternoon to submit to the Legislature the agency’s report on Massachusetts’ entry into the Nurse Licensure Compact, which recommends that lawmakers pass a bill (H 1284/S 163) to sign Massachusetts up as a participating state. Only one board member, health care workers union 1199SEIU Executive Vice President Tim Foley, opposed the recommendation.

The HPC’s report concluded that joining the compact could help Massachusetts deal with workforce issues that could be looming on the horizon and better prepare the state to react to sudden and unforeseen changes in nursing needs, like another pandemic.

“While Massachusetts has a higher rate of RNs per capita than the U.S. in the aggregate, data suggest that the registered nurse labor market in the commonwealth may experience slower growth and tightening in the coming years,” HPC Assistant General Counsel Kate McCann said. “The RN workforce here is older and the age differences are even greater for acute and critical care RNs. Furthermore, growth in nursing graduates is slower here than other areas of the country.”

The Nurse Licensure Compact currently includes 34 states and Guam, but not Massachusetts. In New England, both New Hampshire and Maine belong to the compact while legislation to enter the compact is pending in Massachusetts, Rhode Island and Vermont.

The compact was established in 2000 by the National Council of State Boards of Nursing and revised in 2015. It is governed by the Interstate Commission of Nurse Licensure Compact Administrators, a quasi-governmental organization made up of representatives from each member state.

To be able to practice across state lines, a nurse must be a legal resident of a member state, satisfy that state’s licensure criteria and meet the compact’s uniform license requirements, including a background check. A compact license allows a nurse to practice in person or via telehealth in any compact member state, though each nurse is accountable for compliance with practice laws in each state.

“Those requirements, and in particular the requirement that applicants submit to state and federal fingerprint-supported criminal background checks, which are not currently required in Massachusetts, would help strengthen BORN’s licensure process, bringing it in line with the highest regulatory standards for licensed health care professionals,” McCann said.

During the COVID-19 pandemic, the Board of Registration in Nursing (BORN) issued 8,569 temporary nursing licenses. Of those temporary nurses, 21 of them or 0.2 percent have had a complaint lodged against them in Massachusetts including 13 from the same non-compact state, according to the HPC. McCann said BORN “has not identified any issues with the quality of the nurses practicing in Massachusetts with temporary licenses.”

The HPC said its analysis of the compact and the possibility of Massachusetts joining it “has not identified negative effects of joining.”

“The COVID-19 pandemic highlighted the importance of and potential for telehealth and demonstrated the need to remove barriers to cross-state practice in order to strengthen the ability of the health care system to adapt care delivery modes and respond to needs more flexibly in a post-COVID-19 world,” the agency wrote in its report. “There is no evidence that joining the Compact would have a negative effect on quality of nursing care in the Commonwealth, and the ability to fill short-term staffing needs and facilitate telehealth could yield positive effects for health care access, quality, and cost.”

Foley, who voted in opposition to submitting the report and recommendations, said it was important to keep in mind that the out-of-state nurses who might practice in Massachusetts through the compact would be “temporary travelers who get paid a high rate because they don’t have health insurance coverage” or other benefits of nurses employed full-time in Massachusetts.

“There is a potential and there’s disagreement on a staffing shortage or needs in the future and I think the report indicates that this is not a solution to our staffing needs … it’s a short-term, fill-a-void, temporary crisis-based approach and a patchwork approach,” Foley said. “I think some of the conversation needs to be [about] what are we doing to recruit and retain nurses for full-time work.”

The HPC’s analysis and the recommendations it made Wednesday were required by the Legislature. The fiscal year 2021 budget, which was signed into law Dec. 11, gave the commission until June 15, 2021 to file a report on the potential entry into the multi-state nurse licensure compact.

The idea of entering the national consortium of states that allow nurses to obtain one license to practice in all participating states has come up on Beacon Hill before. Gov. Charlie Baker included entry into the compact in his health care bill last session, Secretary of Health and Human Services Marylou Sudders said, but the Legislature opted instead to have the HPC study the idea.

“I’m not at all objective about this since I was the one who had suggested we actually file this bill to begin with,” Sudders said Wednesday.

In 2019, the Massachusetts Health and Hospital Association and AARP testified side-by-side in support of a bill to move Massachusetts into the Nurse Licensure Compact, pitching it as a solution to a shortage of qualified nurses to hire in Massachusetts.

But the Massachusetts Nurses Association fought the idea, suggesting that it would weaken nursing standards in Massachusetts and be used by the hospitals to outsource nursing using technology to cheaper labor in other states.

Rep. Kay Khan and Sen. Joseph Boncore filed the legislation (H 1284/S 163) necessary for Massachusetts to enter the compact. Aside from the chief sponsors, only Reps. Colleen Garry and Joseph McKenna have signed on as co-sponsors.

The House version went to the Joint Committee on Health Care Financing and the Senate version of the bill is before the Joint Committee on Consumer Protection and Professional Licensure.

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