A Needed Change in Nursing

Submitted by Teressa Smith

Tags: change licensure nurse licensure nurse shortage nursing nursing shortage

A Needed Change in Nursing

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Written by Antonia Frazier and Teressa Smith at Miami University.

National nursing licensure promotes more effective licensing than does state licensure by alleviating the ever-present nursing shortage and promoting mobility among the nursing workforce. Some of the many benefits of a national nursing licensure include improved patient access to quality nursing care, enhanced discipline and information sharing among the states, physical and electronic provision of care by competent nurses, and convenience of employers to more mobile and competent nurses.

In today’s world travel is no longer a problem if one decides that they would prefer to move to another area of the country they merely plan, pack up the car, and get on their way. Applications, resumes, and interviews can be gathered online with the click of a few buttons. High technology has allowed for securing your career before the move takes place, at least this is the case for most careers, however in nursing while it is possible to complete all of the tasks above it is not quite so simple once the licensure for another state comes into the picture. For a registered nurse to be licensed in another state, he or she must apply for what is termed reciprocity, this is both costly and time consuming, but it is necessary to have your licensed accepted in another state. The examination for nurse is the same nationwide, so logically should the licensure not be as well?

In effort to meet the ever growing need for nurses, “the board of nursing responded to the need to remove barriers by developing what is termed a Nurse Licensure Compact” (Poe, 2008). To date twenty three states have implemented the Nurse Licensure Compact to decrease the severity of a nursing shortage. A national nursing licensure may not completely remedy the problem of a nursing shortage that our country seems to currently be undergoing however removing the barriers of state nursing licensure would in fact alleviate the shortage of nursing personal that are available when a state faces a disaster which results in the need for mass medical assistance. “Joining the interstate Nurse Licensure Compact probably would not alleviate Florida’s long-term nursing shortage but would remove barriers to bringing nurses into the state to meet short-term needs arising from events such as hurricanes and peak visitation seasons” (OPPAGA, 2006).

National licensure for nursing would ensure that all nurse practice under one set of standards clearly defined by the National Nurse Practice Act. “Currently, each state has established Practice Acts that define the processes and procedures for granting a health professional a license, renewing a license and regulating professionals’ practice within a state” (HRSA, 2010).  A national nursing licensure would allow for nurses to safely perform their duties under the same scope of practice in all states because there would be a national nursing scope of practice, as opposed to the current system of scope of practice being determined by each individual state. As stated in Nursing Unleashed, “Because of variability in state practice acts, a nurse who is competent to perform a particular procedure in one state may be legally barred from doing that same procedure in another” (Munro, 2012). This factor in itself causes an interruption in the quality of care a patient may receive.

Furthermore according to the Health Licensing Board, “Licensure portability is also seen as a way of improving the efficiency of the licensing system in this country so that scarce resources can be better used in the disciplinary and enforcement activities of state boards, rather than in duplicative licensing processes” (HRSA, 2010).

Some argue that National Licensure will be difficult to establish due to the inconsistencies between states with differing requirements for licensure. This is not the case, in fact, states will actually benefit from this licensing practice according to AAOHN as nursing boards share their best practices and the logic behind those standards with one another. So rather than states lowering their standards of practice to incorporate nurses from other states, practices can be adopted among all states and one uniform practice could be established to meet the needs of patients. Another concern is the regulation of nurse licensure. Some fear that a nurse prohibited from working in one area or state could just move to another state and continue to practice due to the lack of being able to regulate licensing on such a broad basis. With technology and communication abilities nowadays, a national regulation of nursing licensure is more feasible and will allow for better tools that give provide more timely and accurate information. Lastly and most importantly, many fear that the safety of the patients is at greater risk with the incorporation of national licensing but this is inaccurate. Rather than putting the patient at risk, this licensing allows them to have greater access to qualified nurses regardless of state boundaries. Also, to protect the patient, disciplinary action will still be taken against problematic behavior and documented accordingly.

In conclusion, healthcare policy should be reformed to allow for national licensing rather than state licensing among healthcare professionals. As demonstrated, national licensing would be more beneficial to the consumer, nurses, and employers by alleviating the nursing shortage through the promotion of more mobile nursing practice, providing patients and consumers with access to more qualified nurses, and enhancing the discipline through the sharing of information such as proven quality care practices.


  1. Munro, C. Savel, R. (2012). Nursing Unleashed. American Journal of Critical Care. July vol. 21 no. 4 p.222-224. http://ajcc.aacnjournals.org
  2. Nurse Licensure Compact National Council for State Board of Nursing (NCSBN) www.ncsbn.org
  3. Poe, L. (2008). Nursing Regulation, the Nurse Licensure Compact, and Nurse Administrators: Working Together for Patient Safety: Nursing Administration Quarterly. October/December. Vol. 32 Iss. 4 p 267-272
  4. U.S. Department of Health and Human Services: HRSA. (2010). Health Licensing Board Report to Congress. www.hrsa.gov/ruralhealth/about/telehealth/licenserpt10.pdf
  5. NURSE LICENSURE COMPACT. (2012). Iowa Board of Nursing Newsletter, 31(3), 4.
  6. OPPAGA. (2006). Nurse Licensure Compact Would Produce Some Benefits But Not Resolve the Nurse Shortage. Report No. 06-02 www.oppaga.state.fl.us/reports/pdf/0602rpt.pdf
  7. York, C. (2009). Message from the president. Nurse licensure compact -- a state nursing license recognized nationally and enforced locally. Missouri State Board Of Nursing Newsletter, 11(2), 1.
  8. Litchfield, S. (2010). Update on the Nurse Licensure Compact. AAOHN Journal, 58(7), 277-279