Rhode Island is not included in an agreement that takes effect Jan. 19 allowing out-of-state nurses to work in the state.
PROVIDENCE, R.I. — For more than a decade, Rhode Island licensed nurses have been able to practice in 24 other states across the country under an agreement that honors the state’s nursing license the same way a driver’s license is valid from one state to the next.
The agreement, known as the Nurse Licensure Compact, has also enabled hospitals to easily use “traveling” nurses with out-of state licenses to quickly fill open positions and temporarily beef up staff.
On Jan. 19, that will all change as a new version of the agreement takes effect. Rhode Island is not included in the new alliance because it — along with Colorado, New Mexico and Wisconsin — did not pass legislation last year to join.
In fact, a bill was never even introduced in last year’s General Assembly thanks in part to strong resistance from nurses unions that argue the compact has deprived Rhode Island nurses from opportunities to work here.
The situation has left local nurses who pick up out-of-state work scrambling to quickly acquire other state’s licenses. Meanwhile, out-of-state nurses currently working in Rhode Island under the compact are flocking to the Department of Health with their $139 applications for Rhode Island licenses in tow.
Donna Policastro, executive director of the Rhode Island State Nurses Association, which supports the compact, said she’s been fielding calls from concerned nurses who’ve learned about the change. In one case, a nurse is working from home advising for a national company in 16 states. The woman now needs 16 additional licenses.
“It’s going to affect nurses. It’s going to affect their pocketbooks,” Policastro said.
The National Council of State Boards of Nursing is the driving force behind the compact. It’s pushing for legislation to be introduced in 2018 that would bring Rhode Island into the updated agreement.
Thousands of nurses across the state recently received a letter from the council warning that come Jan. 19 “the ability for nurses in Rhode Island to practice in other [compact] states will be significantly curtailed." The letter encouraging nurses to contact state lawmakers.
The General Assembly reconvenes Jan. 3.
Dulce Cruz, a nurse from Exeter, was distraught when she received the letter and rapidly began contacting legislators. Cruz said she uses the compact license to do volunteer work in New Hampshire and Maine (the nearest compact states), but she's mostly concerned about fellow nurses who rely on out-of-state work for supplemental income.
"Some of these nurses are single mothers. Some are parents working the night shift just so they can be with their young children during the day. Some are in the military and working as a nurse part-time in the community," she said.
On the other side of the equation are the hospitals and health-care providers that hire out-of-state nurses — the main point of contention for nurses unions.
Ray Sullivan, a spokesman for United Nurses and Allied Professionals (UNAP), said the union opposes the compact because it thinks it takes job opportunities away from local nurses.
"Hospital executives often use the compact to avoid filling open positions with permanent, qualified Rhode Island RNs," Sullivan said in an email.
Lifespan, Rhode Island's largest hospital network, doesn't heavily staff "travel nurses." It currently has 26 nurses out of some 3,000 with out-of-state licenses. They have all been notified they now need Rhode Island licenses.
Cathy Duquette, executive vice president of nursing affairs for Lifespan, said they're disappointed to not be part of the compact because it gave the hospital system the ability to quickly "flex up" during peak times of demand, like flu season.
Care New England, the state's second largest hospital system, "very much" relies on travel nurses "particularly during summer months and holiday seasons," company spokesman Jeremy Milner said. He declined to provide specific numbers, saying "the need is always changing."
The lack of data was problematic when the issue arose last year. The state currently does not track how many out-of-state nurses are employed in Rhode Island. Beginning in 2018, under a new law hospitals will have to tell the Department of Health how many out-of-state nurses they employ. UNAP and Rhode Island SEIU backed the bill.
"This data should be analyzed in 2018 before Rhode Island jumps into another nurse licensure compact which jeopardizes quality and diminishes opportunities for locally educated and trained nurses," said Emmanuel Falck, director of the Rhode Island SEIU State Council.
But Policastro, of the nurses association, said there are a lot of misconceptions and assumptions floating around the issue. For example, students come to the state's graduate nursing schools with out-of-state licenses.
"It doesn't mean they're taking away jobs from a nurse in Rhode Island," she said.
One of the most significant changes in the updated compact is an added requirement that all states signing on require criminal background checks. New membership to the compact had slowed in recent years among concerns that some states weren’t requiring such checks, prompting the change. Rhode Island already requires background checks.
On its website, the National Council of State Boards of Nursing said its goal is for all states to be a part of the compact.
—jbogdan@providencejournal.com
(401) 277-7493
On Twitter: @JenniferBogdan