Rhode Island rejoins multistate nurse licensure compact

RHODE ISLAND has rejoined the Nurse Licensure Compact, a multistate program that permits nurses to practice in other member states without obtaining additional licensure. Pictured is John Schreiber, one of about 50 travel nurses who had been hired to fill open positions at Kent County Memorial Hospital in Warwick last year. / COURTESY CARE NEW ENGLAND HEALTH SYSTEM/RYAN PICKERING

PROVIDENCE – Following a six-year pause, Rhode Island has opted back into a shared licensure program that allows nurses to practice throughout most of the U.S. without obtaining additional state licenses.

Under the Nurse Licensure Compact, nurses belonging to a member state can automatically practice in any of the 41 states belonging to the compact – meaning nurses can now exit or enter Rhode Island with greater ease.

The legislation, introduced by state Sen. Joshua Miller, D-Cranston, and signed into law by Gov. Daniel J. McKee on June 24, has a three-year sunset clause.

Whether the compact will help the state’s dire nursing shortages remains to be seen when the program goes into effect in 2024. But historically, the state’s largest health systems and the Rhode Island State Nurses Association have advocated for the compact, while the Rhode Island Hospital United Nurses & Allied Professionals union has voiced concerns with the program.

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Ara Millette, director of talent acquisition and workforce development at Lifespan Corp. and  treasurer at RISNA, believes the increased mobility the compact facilitates will bolster the Ocean State’s workforce.

“The greatest benefit of being in the Nurse Licensure Compact is around the portability of the workforce,” Millette said, “and using that to continue to move towards greater staffing adequacy.” 

This past legislative session, Rhode Island also passed a bill allowing a similar multistate licensure system for psychologists. And the state passed a multistate physicians compact in 2022, though its implementation has been delayed, according to the Interstate Medical Licensure Compact, which oversees the program for doctors.

Nurses are already practicing across state lines, Millette said, especially with an increase in virtual health care and travel nursing since the COVID-19 pandemic. Particularly in a small state such as Rhode Island, Millette said, not being part of the compact can deter nurses from living and working in the state.

“Someone interested in Rhode Island would need to forfeit their [previous] license to practice in Rhode Island,” Millette said, and invest time and money into obtaining an Ocean State certification. That’s additional stress on a nurse’s wallet – a $135 application fee for registered nurses and a $45 fee for licensed practical nurses – and adds weeks before a nurse can start a new position in the strained workforce. 

By contract, a nurse with the multistate license could begin working immediately, Millette said.

But that same portability makes it just as easy for nurses to leave Rhode Island for positions in other states, said Lynn Blais, president of UNAP. 

“One of our biggest concerns is this may increase the number of nurses that leave the state,” Blais said. “Now, it’s going to be much easier for them to work in other compact states.”

But recently, the union has become more open to the compact, at least temporarily. This year, UNAP took part in a commission to review and consider rejoining the compact, and eventually agreed to the proposal in its current form.

“We were able to come up with at least a proposal that we could all live with,” Blais said, “and the perk is we’ve also frozen the cost to renew our licenses for the next three years.”

The three-year sunset clause played an essential role in gaining UNAP’s support.

That period “allows us the ability to get data,” Blais said, “and I think that was the most important part – to know how many nurses are working from other states, how many are working in the state on travel assignments … and then decide in three years” if the program should stay. 

In the past, union leadership has voiced discomfort over the compact shifting some state oversight to the National Council of State Boards of Nursing, a nonprofit overseeing the compact. But Blais says the trial period again provides some relief to these concerns.

Service Employees International Union 1199, another union representing nurses in Rhode Island, declined to comment.

Sherri Sprague, senior vice president of patient care service and chief nursing officer at Kent County Memorial Hospital, which belongs to the Care New England Health System, joined Millette in voicing strong support for the compact.

“Nurse vacancy rates remain critical as we continue to recover from the ‘great resignation,’ ” Sprague said. “Rejoining the Nurse Licensure Compact will provide us with the flexibility necessary to recruit and fill specialized vacancies.”

The program’s role in facilitating remote health services and appointments across state lines “is especially important for patients with rare diseases,” Sprague added, and rejoining will assist the state in recruiting nurses from highly mobile populations such as military families.

The multistate licensure also makes it easier for nurses to not only practice but teach across state lines, Millette said.

Rhode Island joined the compact in 2008 but did not renew its membership following updates to the program’s requirements in 2017, making it the only original member state that did not choose to remain within the program.

Among the few states that haven’t joined the compact are neighboring Massachusetts and Connecticut, though Massachusetts has a legislative proposal under consideration.

Organizations such as RISNA have pushed to readopt the Nurse Licensure Compact since Rhode Island exited the program in 2017, but Millette said that COVID-19-induced staffing shortages were a tipping point for rejoining.

Jacquelyn Voghel is a PBN staff writer. You may reach her at Voghel@PBN.com.Nurse 

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