The Nurse Licensure Compact, legislation that would allow licensed nurses from one state to cross borders physically or electronically, has been adopted by 25 states. The compact allows nurses to practice in other states that joined the compact without going through another licensing procedure.

While Rhode Island, New Hampshire and Maine have joined the compact, Massachusetts and the other New England states have not.

Proponents say it works like a driver’s license, in that someone is licensed in one state is allowed to drive in other states — as long as you obey their traffic laws. Opponents, most notably the Massachusetts Nurses Association, say the legislation makes it easier for hospitals to hire out-of-state nurses to replace union nurses during a strike.

According to the National Council of Boards of Registration in Nursing, the compact aligns nursing licenses with the realities of telemedicine. The provision of internet-based clinical information can include diagnostic tests, treatment results, follow-up and coordination of care.

Working in a non-compact state can make life difficult for hospital case managers, according to Jenny Quigley-Stickney, president of the Case Management Society of New England. The group supported a bill filed by state Rep. Kay Kahn, D-Newton, that would have made Massachusetts an NLC member.

For example, as a nurse-case manager at Cape Cod Hospital, if Ms. Quigley-Stickney needs to transfer a patient to a Boston-area hospital, she has no problem providing information via modern technology to the receiving hospital. But if she needs to transfer a patient to a Rhode Island hospital, her Massachusetts license is not recognized in Rhode Island, a compact-enrolled state.

“If you are following a patient to provide good, comprehensive care, you have to be able to follow through transitions of care,” she said. “For nurses to do that legally, they have to be licensed in multiple states.”

With 111 licensed nurses employed in 33 states, Night Nurse Inc. takes after-hours calls for numerous health care providers, including two pediatric groups at UMass Memorial Medical Center.

One of the largest triage services nationally, Night Nurse, based in Framingham, has “two separate teams, one a compact team and the other a non-compact team,” said Tami Regan, director of nursing triage services.

During the H1N1 flu epidemic several years ago, the agency’s Massachusetts nurses were swamped with calls, but Night Nurse could not use its compact nurse team to assist them. The reverse was true when the flu epidemic peaked in other regions of the country, according to Ms. Regan, with Massachusetts nurses prohibited from assisting.

“It would be more efficient to use the entire staff of nurses,” said Ms. Regan, “rather that just having to base their usage on the state in which they reside.”

While favorably reported out of the Joint Committee on Public Health, Rep. Kahn's bill was sent for study by the Joint Committee on Health Care, effectively killing it for this session. She plans to refile it in the next session, according to an associate.

Opposing the compact legislation, the Massachusetts Nurses Association sees it as a tool that could be used against its membership in case of a nurses’ strike. “It would make it very, very easy to have nurses from all over the country cross state lines and practice without going through an expedited process,” said David Schildmeier, director of public relations for the MNA.

As of April 1, that expedited process, known as the Initial Licensure by Reciprocity, requires licensed, out-of-state nurses to submit an application, but also requires documentation, including an official transcript sent directly from their nursing program, and documentation of “good moral character.” A $275 fee is also involved.

In addition to the MNA, other questions have been raised in other states as to the lack of background checks in some compact-member states, as well as the issues of continuing medical education and the handling of drug abuse in the nursing profession.

All states have a Nurse Practice Act that contains the rules and regulations which, along with policies promulgated by state boards of registration, govern how nurses practice. These differ from state to state.

“The Massachusetts Nurse Practice Act is much stricter and much better than the nurse practice acts in a number of other states, so you could have nurses who have been brought up under a system that has a lesser quality or doesn’t hold nurses to a higher standard coming in and practicing across state lines,” said Mr. Schildmeier.

With issues such as background checks, continuing education and drug abuse blocking passage of the compact in some states, the National Council of Boards of Registration in Nursing implemented an enhanced compact in January, according to James Puente, Nurse Licensure Compact program director.

The enhanced NLC requires all member states to do a criminal background check before a nurse can get a multi-state license, while also dealing with the issues of medical education and drug abuse, according to Mr. Puente.

“All compact states have some method for continued competency,” Mr. Puente said, although it may differ from the continuing education credits required in Massachusetts. As far as drug abuse issues, “typically most states do have an alternative to discipline program,” he said.

With 25 compact member states, the national council hopes to see the compact accepted in all 50 states within five years, according to Mr. Puente.

Original article: http://www.telegram.com/article/20160515/NEWS/160519693/101499