The Case for National Licensure

Author: 
Earl Dalton

As COVID-19 began to ravage communities across the country in early 2020, hospital sand other healthcare institutions stepped up to the challenges of the pandemic in extraordinary ways, drawing from their institutional knowledge and experience in responding to health crises.

Nurses, physicians and respiratory therapists worked around the clock to stabilize patients, save lives, and comfort families. Patient transporters, cleaning staff, food service workers and maintenance folks kept hospitals humming through the crisis. The pandemic also spawned innovations like a hospital supply trading platform set up by Stanford Health and the supply chain company Resilinc. \(^1\) Health systems forged new partnerships in an effort to defeat COVID-19. Health Carousel and other staffing companies pivoted quickly to deploy ICU nurses and respiratory therapists to pandemic hot spots.

Health Carousel also played a role in advancing the understanding supply elasticity of nurses. In an analysis of our staffing data during the pandemic, Joshua D. Gottlieb of the University of Chicago and Avi Zenilman, RN, of Yale University showed that nurses were ready to take on assignments far from home out of a sense of duty to help. The nurses’ commitment to help increased the elasticity and allowed U.S. hospitals to respond to the ups well in demand for ICU nurses when the virus surged in communities across the country. However, the elasticity of supply was not infinite. One of the factors that suppressed elasticity was state-specific licensure requirements.

The findings lend support for expanding the Nurse Licensure Compact (NLC) to all 50 states, making way for a national licensure model. Currently, 34 states are participating eNLC,(Enhanced Nurse Licensure Compact) an agreement that allows nurses to practice in other participating states without having to apply for licensure in each state. Non-participating states like New York and California temporarily relaxed licensing requirements to support struggling hospitals. In fact, in addition to the eNLC, 18 states issued executive orders to allow nonstate licensed nurses to practice in their state.

National licensure makes way for a larger country-wide pool of nurses with the ability to practice anywhere in the country without the need for emergency legislation. The value of a national pool, echoed in a white paper by Health Carousel, became apparent during simultaneous surges of COVID cases in multiple states and the resulting sharp increase in demand for qualified nurses. During the first period of ups well in COVID-19 infections from January-April 2020, travel ICU nurse jobs in Massachusetts and New York increased by 612% and 1,038% respectively. States not yet designated as hot spots during this time such as Arizona and Texas had increases of 265% and 59% respectively. \(^2\)

Health Carousel and other large staffing companies are perfectly positioned to manage large national talent pools and deploy nurses quickly to places where there is an immediate need, whether it’s an epidemic, pandemic, riot or natural disaster. Staffing companies have protocols in place to identify, screen and credential qualified candidates. They also have the logistical expertise required to speedily deploy qualified healthcare professionals to where they are needed nationally.

The nurse shortage that healthcare systems have struggled with for decades and the pandemic experience, underscore the importance of contingent workforce planning and staffing for hospitals. The need to identify and build strong partner relationships with staffing companies such as Health Carousel well before surges in demand for clinicians has never been greater. This is likely no greater indicator than the fact that according to Staffing Industry Associates (SIA), the US healthcare staffing industry has ballooned to an estimated $17.8 billion. Such relationships allow hospitals to continue to provide high quality care without the head aches and interruptions in care that result from understaffing. The strength of such collaborations will play a key role in how in how hospitals respond to meet the needs of their communities  in the years and decades to come.

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