Although the nurse licensure compact gives nurses and employers new workplace and staffing options, critics have concerns about the process for achieving those objectives. Chief among them is that individual nursing boards and legislative entities have been left out of the loop not only in formulating compact statutory language to fit state law, but also in other key administrative ways.

Local Input

With decision makers residing elsewhere, Ohio nursing leaders complain that the compact skirts state regulations calling for anyone involved in legislative action regarding the state reside in the state. The pact’s current structure leaves Ohioans powerless to modify the pact’s language so that it addresses their state’s unique culture while honoring its sovereignty. That includes lacking the kind of transparency—e.g., complying with open meetings and records acts—required of all other legislation. “We want to make sure that if we join any compact, Ohio decision makers are at the table contributing to its content,” says Lori Chovanak, MN, APRN-BC, chief operating officer for the Ohio Nurses Association.

Board Role

Even though critics cite the inability to craft or re-craft compact language as a non-starter, they also worry about other long-term effects on the professionals who have to ensure quality patient care. For instance, Minnesota’s nursing leaders aren’t pleased that lawmakers might have to modify existing state law to accommodate a pact they didn’t help create. Yet they’re equally concerned about the state licensing board’s powers, especially regarding licensing and tracking, being usurped overtime. “Knowing which nurses are working in the states and which requirements they’ve met is very important to patient safety,” says Laura Sayles, government affairs specialist for the Minnesota Nurses Association. “But it also matters that by joining the compact, our board’s giving up its rights to do it job.”

Collective Bargaining

Not all nurses belong to unions, but for states that have strong collective bargaining sectors, there is the real fear, say critics, that the multi-state licensing compact could interfere with their efforts to either negotiate the best agreement or even deal with a potential strike. Even though there’s additional concern that a multi-state license compact just opens doors for a mass exit of talent from lower income states to greener pastures, supporters say such hasn’t been the case.

Sandra Evans, MAED, RN, executive director of the Idaho Board of Nursing, an original pact member, and chairwoman of Nurse Licensure Compact Administrators, suggests that in the 16 years since the original pact has been in play, there’s been no evidence that the agreement has interfered with existing labor laws, stymied a union’s ability to do what it needs to do in terms of collective bargaining or even facilitated a shift in manpower. “That might be more perception,” says Evans, “than reality.”

That doesn’t mean, however, that nurse leaders aren’t apprehensive. Although patient safety is its ultimate objective, Sayles admits that as a union, MNA also must focus on the compact’s potential effect on labor issues. “Anything that allows employers to move nurses in and out without our knowledge of that movement,” she says, “is going to be of concern to us.”

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