When you’re a dedicated nurse who wants to work across state lines, doing so should be easy, accessible, and user-friendly. However, this was not always the case for ambitious, hard-working nurses.
In the old days, nurses needed to apply for and maintain multiple licenses, a ponderous process by any measure. Now, with the benefit of the greatly expanded Nurse Licensure Compact (NLC), nurses in most states (and some U.S. territories) have the flexibility of a portable license that allows for an easy process of working in multiple jurisdictions.
Understanding the Nurse Licensure Compact
Jim Cleghorn, the Director of Member Engagement and Government Affairs at the National Council of State Boards of Nursing (NCSBN), is an expert in all things NLC. The NCSBN is a non-profit organization that advocates on issues of public health and public policy and is the engine behind the NLC.
“The most successful aspect of the NLC is its longevity,” Cleghorn states. “For nearly 25 years, registered nurses and licensed practical nurses across compact states have had access to a flexible licensure system with public safety at its core. The NLC successfully enables licensure mobility for RNs and LPNs while ensuring that state boards of nursing remain the regulators of nursing practice in their respective jurisdictions.”
Cleghorn explains how states issue compact licenses. “Some jurisdictions issue a compact license as a default, and others allow the applicant to choose a multistate option. In Colorado, for example, the default license is a multistate license. Applicants who meet the uniform licensure requirements in addition to Colorado’s home state requirements will be issued a multistate license. Oklahoma, by contrast, allows an applicant for licensure to apply for a single state or a multistate license.”
The compact works similarly in U.S. territories like Guam and the U.S. Virgin Islands as it does for the 50 states. Cleghorn explains, “Guam and the U.S. Virgin Islands are parties to the NLC. In March 2021, Guam became the first U.S. territory to enact the NLC, and the U.S. Virgin Islands were enacted later that year.”
Unfortunately, Puerto Rico has yet to join the NLC. Puerto Rico does not require RNs and LPNs to pass the NCLEX, but nurses with multistate licenses must pass this universal measure of basic nursing competence. Cleghorn shares, “Should Puerto Rico enact the NLC legislation, nurses with a primary state of residence in Puerto Rico would need to pass the NCLEX and meet other uniform licensure requirements to obtain a multistate license.”
Can We Become a Compact Nation?
When it comes to getting every state to join the NLC, politics can be tricky. Cleghorn shares, “Every state and jurisdiction is unique, so there’s no single reason why the NLC has not yet been enacted across the country, but common threads exist.” He continues, “Some jurisdictions—including Alaska, California, Hawaii, and Massachusetts—have yet to adopt any, or many, interstate healthcare licensure compacts.”
Cleghorn explains the multifaceted nature of the barriers and the reasons for some states’ hesitancy. “Unfamiliarity with how compacts operate and what benefits they provide has been a barrier. Fortunately, as more states enact interstate compacts, lawmakers can turn to neighboring compact states to see how it safely and effectively creates licensure mobility.”
Nursing unions can be an issue with compact enactment. “For the NLC, another barrier in some remaining jurisdictions is opposition from nursing unions. While state nurses’ associations have been leaders in advocating for the NLC across most of the 41 member jurisdictions, nursing union organizations have concerns, including the potential impact joining the compact will have on collective bargaining.”
Concerning predictions about whether we’ll eventually reach all 50 states and other U.S. territories, that remains the goal of the NLC. Cleghorn is adept at illustrating the importance of this ongoing effort.
“The need for the NLC in those jurisdictions is great. Nurses across those jurisdictions must obtain and maintain multiple licenses to practice across state lines, in-person and remotely, and their patients are more mobile than ever. Stakeholders are working toward that goal every legislative session, and we’re confident that each year will bring us closer to the goal of a compact nation.”
What Does Partial NLC Implementation Mean in Practice?
“Once a jurisdiction enacts the NLC, an implementation process begins,” states Cleghorn. The implementation can be viewed as two stages: the new member state must open its doors to active multistate licensees from other states and must also begin issuing licenses to applicants for a multistate license in their state.”
The multistate license is a real boon for nurses who want to practice across state lines, both physically and remotely. And partial implementation can be helpful when full adoption hasn’t yet happened.
Cleghorn explains, “Some jurisdictions can choose to partially implement the NLC, allowing active multistate licensees to practice within their jurisdiction while implementing processes for issuing multistate licenses. An example of a jurisdiction that partially implemented the NLC is New Jersey. They enacted the NLC in 2019 and had not yet implemented it when the COVID-19 pandemic struck.”
Not having a multistate license option could be a great hindrance during an emergency like a pandemic, And Cleghorn describes how New Jersey handled it.
“In March 2020, the New Jersey Board of Nursing partially implemented the NLC, allowing active multistate licensees from other NLC jurisdictions to practice in the state. The partial implementation allowed New Jersey to call upon an active, vetted workforce to assist with the disaster response, and they fully implemented the NLC on November 15, 2021.”
Cleghorn is optimistic when asked if the NLC has influenced other professions to create similar agreements.
“I believe the success and longevity of the NLC has influenced other healthcare professionals to develop and advocate for compacts. Nursing regulators came together in the 1990s to discuss the need for licensure mobility and the inefficiencies in the 100-year-old licensure system based on a single-state model. The continued exponential growth of telehealth, more mobile patients, and the increase in distance education exacerbate the need for increased licensure mobility.”
Jolene Scatton, RN, Director of Nursing at Lehigh Valley Hospital–Hazleton always dreamed of becoming a nurse.
“The biggest joy of my career is connecting with patients. You’re like their guardian angel and their safe place,” says Scatton. “On weekends, holidays, birthdays, even during snowstorms – there are always people in the hospital who need you.”
Scatton leads a team of nursing and nursing support colleagues on the fifth-floor medical-surgical telemetry unit at Lehigh Valley Hospital (LVH)–Hazleton. Scatton has spent her 17-year nursing career with Lehigh Valley Health Network (LVHN).
Daily Nurse has recognized Jolene Scatton as Nurse of the Week for fulfilling her dream of becoming a nurse, pursuing a path to nurse leadership, and serving as a role model for nurses.
In 2007, Scatton started as a licensed practical nurse (LPN) in the same unit where she now works as director.
“I went straight from high school to the LPN program. I was not even 20 years old when I started as an LPN,” she says. “I remember being overwhelmed on my first day because it was my first job out of school, but I was amazed by the nurses around me. They knew so much. I always looked up to them and the way they interacted with patients. It inspired me to keep growing in my career.”
While working full-time at LVH–Hazleton, Scatton pursued her dream of becoming a registered nurse (RN) by enrolling in Luzerne County Community College classes. She graduated in 2016 from the top of her class and remained on the telemetry unit as an RN for a year before taking her next step.
“I took a position in the emergency room and fell in love with the critical nature of the role,” says Scatton.
Her time in the ER also sparked an interest in pursuing a leadership role, and after four years, she was well on the path to nursing leadership.
“I became the first Stroke and Chest Pain Coordinator for LVH–Hazleton, a brand-new role for the hospital,” says Scatton. “The autonomy to grow this new program helped prepare me for my first role in management.”
Returning to Her Roots
When a patient care coordinator role became available on the fifth-floor medical-surgical telemetry unit, Scatton knew it was her calling.
“Ultimately, it was the career path I was meant to take,” says Scatton. “On the telemetry unit, a person’s heart is monitored 24 hours a day. We care for people who come to the hospital with chest pain or for observation after surgery or a stroke, and monitor their heart rhythm.”
Nurses on the medical-surgical telemetry unit care for people with various health needs, so their skills must be general and specific. She learned to read heart rhythms early from her fellow nurses and now helps teach new nurses.
“I started on the night shift,” says Scatton. The night shift team trained me and taught me how to be a nurse. Now, I enjoy mentoring nurses who are new to the unit.”
She worked as a patient care coordinator until the position of unit director became available. Now, she is doing what she was always meant to do.
“Nursing directors oversee daily operations, including staffing, workflow, and scheduling. We assist on the floor at times if needed. What don’t we do?” says Scatton.
More than anything, though, Scatton is an advocate for her colleagues.
“I have the best colleagues,” she says. The people I’ve worked with from when I started 17 years ago all the way through now are what make LVH–Hazleton especially such a great place to work. It’s like a family, and you have the support of being part of a larger health network. It sounds cliché, but my colleagues are kind, caring, and compassionate. They really have become my family.”
Back to School
In 2023, Scatton earned her Bachelor of Science in Nursing and will soon begin classes to earn an MBA in health care management.
Her advice for nursing students in the thick of schooling? Keep going.
“Nursing school is so hard,” she says. “Long hours, long nights of studying, but the career is rewarding. I go home and think, ‘We brought a patient back after a code,’ and there’s nothing like that feeling – knowing you saved someone’s life. I’ll never regret my career path – it’s always been nursing.
How did you feel when you graduated from nursing school, and what were you planning for your exciting new career? What were you thinking? Was there fear and trepidation or excitement and anticipation? It was a mixture of all of the above. For some new nurses, this can be a magical time, but only sometimes, and sometimes the magic never happens. Where’s your nursing magic these days?
The Magic of New Beginnings
In the mid-1990s, I graduated with my associate degree in nursing. I was in my early 30s, had a young son in junior high, and until then, I only had a high school diploma and certifications in yoga instruction and massage.
Getting that degree fulfilled my promise to myself to set an example for my son by having a respectable, meaningful career. It also fulfilled my desire to do something productive with my life. Helping people and being of service were (and are) important values for me.
I was chosen to give the student address at graduation, and it was a highly emotional moment for me, my fellow students, and my family and friends. We laughed, we cried, we celebrated, and then we all went on our merry way and began our careers along the various paths we’d chosen.
The beginning of my career was magical in specific ways, and that magic has followed me over the years a fair amount. I’ve also experienced significant burnout and compassion fatigue, unhappiness, lack of inspiration, confusion, and just not knowing what to do next. Even so, nursing has been good to me overall, and my investment in that associate degree and the BSN that came a few years later has paid substantial dividends.
Where Was Your Magic?
If you think back to the beginning of your career, was there magic as your career got underway? If so, how did that magic look, feel, and taste? The circumstances of your career launch were informed by myriad factors, including, but not limited to:
What were those first weeks and months like? Were you traumatized by this new career, or did you dive headfirst and thrive? Examining what happened in those early years can inform the present.
When the Magic Wanes
If the magic has waned, have you been able to get it back again? And if you haven’t been able to find it again, how have you coped?
None of us want to feel like the magic of a career we once loved has drained away like the colors fading from a watercolor painting left in the rain. However, it happens, and nurses and their interdisciplinary colleagues can struggle with compassion fatigue, burnout, and a sense that things aren’t right anymore. It all adds up, whether it’s due to bullying and incivility, being underpaid and undervalued, unsafe staffing, or poor leadership.
Has your magic waned? Have you lost touch with why you’re a nurse? If your magic has waned, consider the following:
Change specialties and do something novel — new environments, patient populations, or responsibilities can renew your interest and curiosity.
Your nursing career magic can be whittled away in a multitude of ways. Nursing isn’t generally a walk in the park, and being a member of the most trusted profession isn’t always enough compensation for the toll it can take in its worst moments.
If you have your magic, the fire of inspiration is burning inside of you, and you feel like you’re in the right place at the right time doing work that matters; not much can beat that feeling.
When you received your degree, passed the NCLEX, and held your nursing license in your hand for the first time, your new career may have felt like the promise of a beautiful sunrise. If that sun is no longer shining on you, you can fight to get it back. You deserve to be happy and to feel that magic again.
If the magic is still within your grasp, you can seize it. Our profession has a noble and significant place in history, and there’s no doubt that every nurse has the right to feel that magic as they go about their important work. Here’s to the hope that you can feel it again if you’ve lost it and that, if you’ve managed to retain it, the magic remains burning in your heart for many years to come.
Eileen Mahler, PhD, RNC-OB, NE-BC, a resident of Oceanside, NY, was honored for her 45 years of service as a nurse at Mount Sinai South Nassau with a surprise retirement celebration. Hundreds of hospital staff attended the event, and Mahler was given a chauffeured ride home in a BMW convertible escorted by the Oceanside Fire Department Fire Engine.
Daily Nurse has named Eileen Mahler Nurse of the Week for her illustrious 45-year nursing career and lifetime dedication to the nursing profession.
Mahler began her nursing career in 1979 at South Nassau Communities Hospital (now Mount Sinai South Nassau), where she served on the Maternity Unit. She worked at the hospital for the entirety of her nursing career. She steadily rose through the ranks of nursing leadership, concluding her career as Director of Nursing Education: Professional Development, Practice and Research. Mahler assisted the hospital through numerous challenges, including the COVID-19 pandemic; the conversion from hand-written patient medical records, patient triage and admissions; pharmacy orders; inpatient census; and discharge orders to Electronic Medical Records; automated patient triage; admissions and inpatient census;computerized pharmacy order entry; and electronic discharge orders.
As the Director of Nursing Education, Mahler played a pivotal role in the hospital’s journey to earning the prestigious American Nurses Credentialing Center Nurse Magnet designation and re-designation for three consecutive four-year terms, starting in 2014. Her certifications by the American Nurses Credentialing Center in nursing professional development and as a nurse executive are a testament to her expertise and dedication to the profession. Notably, she pursued her PhD while working as a nurse, demonstrating her commitment to continuous learning and professional growth.
Dr. Mahler’s exceptional contributions to the nursing profession have been acknowledged with several prestigious awards, including the Town of Hempstead’s Pathfinder Award and the DAISY Foundation Lifetime Achievement and Leadership awards. The DAISY Foundation’s recognition is a testament to her impact throughout her career, inspiring others in the nursing profession.
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter.
Supporting someone with a life-limiting diagnosis or talking about death can be difficult for many people, but not for a hospice nurse.
What’s it like to care for patients and their families in the end-of-life process?
Maryette Williamson, RN, BSN, knows firsthand from working as a BAYADA Hospice Nurse in Fayetteville, North Carolina.
We asked her about her work. What follows is our interview, edited for length and clarity.
Maryette Williamson, RN, BSN, is a BAYADA Hospice Nurse in Fayetteville, North Carolina.
How did you get interested in working as a home hospice nurse? What drew you to it? How long have you been doing it?
I had a home hospice rotation in nursing school, and I loved it. Shortly after graduation, my mom passed, then my sister, then my dad. I was working through my grief at that point. Both my dad and my sister passed away in hospice. That was pivotal because it was such a beautiful experience. It was the best situation a bad situation could be, and I realized then that I wanted to provide that for other people. I’ve been doing it for a year and nine months.
Briefly explain what you do as a home hospice nurse. What types of patients do you serve? What ages are they, and how are they approved for the program? What do you provide for them?
I have several facility patients, but I also have patients in their homes. Building on what patients and their families already know, I provide a lot of education on what to expect near the end of life.
I provide nursing care to manage symptoms and prevent complications, such as positioning, skin care, respiratory, and hydration support. I may also identify and treat an infection. I provide both physical and emotional comfort care—anything from ordering a wheelchair to promote mobility to holding the phone up to a dying patient’s ear so they can hear their family member say, “I love you.”
If I have a relatively stable patient who hasn’t had many changes, I go in and talk with them. I reconcile their medications and make sure they’re still on the same medications we have listed. Then, I check their vital signs, do a head-to-toe assessment, and ask if they have any questions. I chart most of my visits, then go to my next visit. I see about five patients a day.
I’ve had a patient who was 57, and I’ve had a patient who was 106. Hospice can run the gamut in ages—younger patients typically have cancer.
Patients qualify for hospice if their doctor gives them a life expectancy of six months or less. Specific Hospice Local Coverage Determination (LCD) guidelines consider different disease processes, functional limits, and co-morbidities when referring someone to hospice care. We have recertification periods, so every six months, their doctor can recertify someone in decline to comfortably remain in hospice care for the remainder of their life.
Did you need to get additional education to become a hospice nurse?
No, I’ve done long-term care for most of my nursing career. I became familiar with many disease processes people face at the end of life. In long-term care, I did a lot of end-of-life care, even though patients weren’t necessarily in hospice.
However, there was a learning curve from long-term care to hospice. The most significant difference in hospice is our focus on quality of life rather than a cure. That was the most important change for me. Even in a facility, people look for ways to treat a progressive disease. But when a patient has chosen hospice, we prioritize making them comfortable. We treat anything to optimize their quality of life but don’t try to cure their life-limiting disease.
In hospice nursing, you have to meet people where they are.
What do you like most about working in your job?
I like the fact that I get to be with the whole family. It’s almost like you become part of their family; they trust you, and you comfort people through your presence. It’s rewarding to educate a family so they know what to expect and how to help, so they’re not scared and can make the most of their time together with someone they love.
What are your biggest challenges?
I have a great team, but at the end of the day, you’re out there on your own. You don’t have anybody standing next to you to chime in. You can’t draw a blank, so the biggest challenge is the autonomy of it. I’m grateful for the experience and clinical skills I learned in long-term care because they made me more confident in hospice nursing.
What are your greatest rewards in your work?
When the family wants and trusts you to be there and says, “We couldn’t have done this without you.” I want to be that calming presence and provide the knowledge so they can be present for their loved ones’ passing. That’s the biggest reward.
Is there anything else that is important for our readers to know?
Death is a part of life. We’re all going to die. I don’t find that depressing when I am in a place to make that as positive of an experience as possible.Don’t let the idea of hospice scare you away from becoming involved. People think it’s doom and gloom, but there’s so much more than that.
If you decide to become a hospice nurse, don’t think you’ll learn it all in a month. I’m still learning. It’s a different kind of nursing, and there’s a lot of room to grow your skills and experience. Getting your bearings and building your confidence takes time.
In a significant development for mental health services in the military, U.S. Navy Lieutenant j.g. Lindsay Bender demonstrated strong leadership and empathy in her contributions throughout her military career, particularly at Walter Reed National Military Medical Center. This resulted in her being chosen to fill the critical leadership billet of Assistant Service Chief.
U.S. Army Col. Wendy Woodall, Walter Reed’s director of nursing, emphasized that “This role is typically for an O-3 or higher and GS-12,” acknowledging the significance of Bender’s assignment.
Additionally, in March 2024, Bender was accepted into the Uniformed Services University (USU) Psychiatric Mental Health Nurse Practitioner, Doctor of Nursing Practice Program. This achievement and progress involved Bender’s leadership ability, empathy, and collaborative mentality.
Daily Nurse named U.S. Navy Lieutenant j.g. Lindsay Bender the Nurse of the Week for her outstanding contributions as a Navy nurse, including her caring nature, innovative mindset, clinical expertise, commitment to nursing excellence, and military mental health services.
While at Walter Reed, Bender took on multiple roles, notably serving as the Assistant Service Chief of a 20-bed medical-surgical unit and efficiently leading more than 60 military and civilian personnel. The George Mason University graduate understood the gravity of occupying a role usually reserved for higher-ranking individuals, crediting her success to the guidance received and her experience in nursing leadership.
“I feel very fortunate to have been selected to fill this role,” Bender remarked. “I owe a lot of gratitude to the mentors and leaders I’ve worked with throughout my career, who have helped shape me into who I am today.”
Recognizing her work as Assistant Service Chief as a continuation of her recent experience as a floor nurse, which influenced leadership decisions, Bender added, “Nursing is a team effort, and I approach each day as a unique opportunity to improve upon the previous day, with the awareness that influence can be felt throughout every level of the leadership structure.”
She also acknowledged her “floor experience” for providing a distinctive perspective when discussing unit operations and management with other nursing leaders, underlining the significance of a supportive and collaborative environment.
Additionally, Bender was a Patient Safety Advisor and ‘Super User’ for MHS GENESIS, the DOD’s new electronic health records system.
As a Patient Safety Advisor, Bender played a significant role in enhancing patient safety and quality improvement, fostering an environment of understanding and compassion essential for patient care.
Adapting to change, Bender led efforts during the MHS GENESIS implementation as a ‘Super-User,’ contributing to staff proficiency by linking traditional practices with new technology.
Committed to innovation and process improvement, Bender used her ‘why’ approach to revamp the nursing workflow for lab specimen handling across the directorate, improving policies and resulting in increased scanning compliance rates among nursing staff.
Bender’s dedication to military mental health services was further fueled by her personal experiences, leading to her pursuit of a degree in Psychiatric Mental Health from USU. This degree program begins this month.
“Throughout my career, I have encountered various stigmas and barriers toward seeking mental health care, which has fueled my passion for advocacy for change,” Bender explained. “This is why the opportunity to complete the Psychiatric Mental Health Nurse Practitioner, Doctor of Nursing Practice degree through USUHS is so exciting!”
Her advocacy was driven by recognizing the need among service members, including the challenges of military life and seeking mental health treatment.
“I hope to be an advocate for change and another person in the fight to increase mental health services for service members,” shared Bender. “The opportunity to attend USUHS and receive a top-quality education is life-changing, and I’m extremely grateful.”
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter.
