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Spokane, Washington  Est. May 19, 1883

Washington could join national nursing compact, but first needs legislative approval

The Washington Legislative Building and the sundial is shown on a foggy morning in this March 2018 photo. Some groups are pushing for Washington to join a national movement allowing nurses to begin practicing when crossing state lines without going through a lengthy licensure process, but unions representing the health care workers have concerns. (Ted S. Warren / AP)

A proposal for Washington to become the 35th state to join the national nursing compact survived Friday’s deadline in the Senate, although not all key stakeholders are on board.

The national nursing compact is essentially a contract that states can opt into by passing a law that allows nurses to practice in various states in the U.S. without obtaining a new license.

Washington, West Coast states and a handful of others have resisted joining the compact in recent years. Currently, if a Washington nurse relocates, they would have to apply for a new RN license in each state they move to. Conversely, if Washington were a compact license state, and a Washington nurse had the multistate license, they could move to 34 other states and begin practicing without applying for a new license.

“Nurses can begin working here right away rather than waiting for the licensure process to be completed,” Dawn Morrell, a member of the state nursing commission, told the House Health Care and Wellness Committee last month.

The state Nursing Care Quality Assurance Commission supports legislation introduced in both the House and the Senate this session that would authorize Washington state to join the nursing compact. Locally, the West Plains Chamber of Commerce, Greater Spokane Incorporated and military representatives, including those at the Fairchild Air Force Base, support the compact. On its face, the compact seems like a potentially practical solution to helping improve nursing shortages in different regions around the state.

“If you look at it on the outside you would say, ‘Since there’s an impending shortage, why wouldn’t you want compact licensure that could help mitigate some of that, hopefully?’ ” said Debbie Brinker, assistant dean for clinical affairs at WSU Nursing. “And part of that challenge is … some of the states that have been part of the compact can’t articulate a story about whether that’s really changed in their ability to meet the demands in terms of nursing. So sometimes it seems like it should, but you can have a license to practice someplace, but it doesn’t mean you’re really practicing.”

The compact does not require nurses with compact licenses moving into a state to notify anyone. This data piece is a sticking point with unions that represent nurses in the state.

“There is no data that shows how many new nurses came in under a compact license, so there’s no data showing that it’s working,” said Jennifer Muhm, director of public affairs at the Washington State Nurses Association.

Other medical compacts for physicians and physical therapists contain a reporting requirement. Jim Puente, director of the nurse licensure compact, acknowledges that the nursing compact has no data element but said that states also do not know where their registered nurses are practicing.

“We haven’t collected that data because every state would need to collect that from their own nurses to ask the question, ‘Have you practiced in other states?’ ” Puente said.

Currently, tracking more in-depth data about nurses just in Washington is a challenge. While the number of registered nurses with their licenses is available, the number of nurses actively practicing in a certain area and care setting is not available.

The University of Washington Center for Health Care Workforce Studies is working to fix that this spring with a large data analysis to be published by the Washington Center for Nursing, that will hopefully provide a clearer picture of who is practicing where (and with what license) in the state.

In an attempt to fix the lack of data reporting in the compact, lawmakers supporting the legislation, including Rep. Marcus Riccelli, D-Spokane, are looking at an amendment that would require all employers of nurses, like hospitals and nursing homes, to report how many nurses they have practicing under the compact license to the state. The Spokane lawmaker acknowledges that the data element that is missing is important, however.

The Senate version of the compact bill, which is still alive, has incorporated provider reporting requirements into it.

Riccelli, who introduced the legislation on the House side, points to telehealth and military spouses as two main reasons to support joining the nurse compact. Currently, nurses who are used for telehealth care must have a Washington nursing license in order to practice with Washington patients. If Washington joins the compact and the telehealth nurse is licensed in a compact state, they would not have to go through an entire licensing process just to call a Washington patient.

Under the compact, some spouses of military members who move here could begin practicing immediately instead of having to apply for a license. Washington currently has expedited license processing for spouses or partners of military members. From application to full license, it takes military spouses about six weeks to receive theirs, and other applicants from out-of-state eight to nine weeks, timetables from the Department of Health show.

“Washington has acted to do a number of things to speed up the process for military spouses,” Riccelli said. “I think we probably have a problem turning around licenses in general, which goes away with the compact.”

The Washington State Nurses Association met several times with the state nursing commission and lawmakers, including Riccelli, last year to discuss their concerns with the legislation. In the current session, union representatives have asked what problems the compact could solve, without data.

“What problem are we trying to solve from the compact? We have heard from Spokane legislators that we need to make it easier for military spouses and partners to work when they get to Washington state, and WSNA is 100% supportive of solving that problem,” Muhm said. “We believe there are solutions outside of the compact to get at that military issue.”

If the legislation passes in the Senate, it will still have to survive in the House. This means the legislation will have to get out of the Health Care and Wellness Committee, where Riccelli’s bill died last week.

The compact law would add the multistate compact license to the list of what nurses in the state can apply for. In other words, it does not wipe out the option to just have a Washington license. Nurses already practicing in the state would have to apply for a compact license, like an enhancement to their current license.

All stakeholders acknowledge the need for increasing the state’s nursing capacity and making the licensing process more efficient.

“Our state has an opportunity to help open that dialogue nationally with other states to say, ‘Hey, we know that compacts can be a good thing, why don’t you fix it so it is more in alignment with other health profession compacts on this registration issue, and maybe more of these states would be willing to join,’ ” Muhm told the House Health Care Committee last month.

Brinker said the focus should remain on what can be a “yes” to supporting nurses in Washington, regardless of what happens with the compact legislation.

“What’s it going to take due diligence-wise to see if this is a potential solution that we need to keep moving forward with?” Brinker said. “Right now I think there’s a commitment to work on these unresolved issues.”

Arielle Dreher's reporting for The Spokesman-Review is primarily funded by the Smith-Barbieri Progressive Fund, with additional support from Report for America and members of the Spokane community. These stories can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper’s managing editor.