Nursing License Compact: Downside?

OK.....any comments on this? http://www2.journalnow.com/content/2...rsing-compact/

Sometimes, great ideas don't work as well in the real world as they do on paper.

That appears to be the case with a 24-state compact that provides license reciprocity for nurses. It's a great idea but it has a serious flaw in its implementation.

If the flaw can't be fixed, then the idea may have to be dropped.

The compact allows nurses licensed in any one of the 24 states, including North Carolina, to work in all 24. It's a great idea because it allows areas with nursing shortages to fill them from a much larger potential employee pool. It also allows nurses more flexibility in where they live. Ask any employee whose job requires frequent transfer -- having a nurse for a spouse makes moving a lot easier.

But there is a downside in implementation. ProPublica, a nonprofit journalism organization, reported recently that nurses who have had their licenses revoked in one state have skipped to others and kept working. In the process, they endangered their patients, in some cases significantly. The report included four dozen cases from just five of the states. North Carolina was one of the five.

In one case, a nurse from Wisconsin was working in a North Carolina hospital after being charged with narcotics possession. He was fired by the hospital for refusing a drug test and banned from working in the state, but Wisconsin did not revoke his multistate license until the following year.

A second case involved a nurse banned from working in North Carolina because of substance abuse who went to Texas and worked for two more years until he passed out during a surgery.

The flaw in the system appears to be one of communication. When nurses lose their licenses in one of the compact states, the rest of the compact states are not receiving that critical information quickly enough. The nurses' multi-state licenses are not being promptly revoked. ProPublica reports that the delays can take months or more.

The compact's administrators say that even the best communication system cannot foil a nurse intent on deception. We find that hard to believe -- especially considering the number of cases ProPublica found. It may be that a stronger revocation system would be more expensive and more work, but with the well-being of patients involved, that should not be a factor.

Administrators must realize that the compact's very existence rides in the balance. If the compact cannot guarantee that multistate license holders are, in fact, nurses in good standing in their home states, then states will leave the compact.
That would be a shame because the compact does have a reputation for advancing the practice of nursing. The compact seeks to raise nursing standards in all 24 states.

Nursing regulators in North Carolina should study the report carefully. They need to examine current procedures to see if these cases exposed any obvious flaws that can be corrected.