The Garden State will partner with 33 other states to address its nursing shortage, which is the third most severe in the U.S.
After nearly two decades of debate, nurses licensed in New Jersey will soon be able to work in dozens of other states — and those in other participating jurisdictions can also now practice in the Garden State.
Gov. Phil Murphy signed legislation Friday that adds New Jersey to an existing multistate nursing licensing compact that will soon connect it with 33 other states, including Delaware and Maryland — but not Pennsylvania or New York. The system enables registered nurses and licensed practical nurses who hold credentials in any of the participating states to work legally in other member states, under that “host” state’s regulations.
The — which saw support from many lawmakers, business leaders and some nursing professionals — is designed to address a growing labor shortage by making it easier for hospitals and healthcare organizations to recruit and hire nurses.
But nurses unions have raised concerns about the potential for these professionals to be working under unfamiliar regulatory structures of host states, which could lead to gaps in patient care, record-keeping errors, or other confusions — especially in states like New Jersey, which have several unique patient protection laws that impact nursing.
Demand for nurses outpaces supply
Everyone seems to agree the workforce is in need of a boost. Federal reports suggest that by 2030, New Jersey is projected to have the third most severe nursing shortage nationwide, with a need for 11,400 more professionals, thanks to changes in the healthcare system that have increased the demand for nurses as well as the fact that the massive baby-boom generation is getting older and needs more care.
“The world is smaller than ever, and our state has some of the best medical facilities in the world,” said Sen. Joseph Vitale (D-Middlesex), the lead Senate sponsor and longtime chairman of the health committee. “Making it easier for people to relocate will ensure that our hospitals and clinics remain fully staffed with the best and brightest, not only from New Jersey but from around the country.”
Sen. Troy Singleton (D-Burlington), co-sponsor of the legislation, said the change also eases the paperwork burden for nursing professionals — especially those seeking to practice in multiple states. (Previously, New Jersey nurses would also need a license from the other state to work in that state.) “This alleviates a major professional barrier in an industry where there is constant demand, especially with our aging population,” he said.
“Our health care system received a shot in the arm when New Jersey entered the multistate compact,” said Judy Schmidt, a nurse and CEO of the New Jersey State Nurses Association. “It will make it easier for more nurses to relocate here and help us with the pending shortage.”
Supporters of the law suggest it could also ease the load on the New Jersey Board of Nursing, which oversees the credentials of more than 220,000 licensed professionals, at least half of them nurses, by creating a ready-made labor pool from other states and easing the pressure for Garden State nurses to get licensed. The board has to keep pace with these requirements at times, critics note, based in part on staffing and member shortages.
More issues for NJ Board of Nursing
But others worry the new law will create more work, and therefore new problems, for the board; the measure calls on the board to manage its role in the program, including the database work, but did not provide new additional resources. “Without funding for the Board of Nursing to address its current backlog (of license applications) as well as process the expected increase in its workload, this law runs the unintended risk of shortchanging both nurses and patients,” said Douglas Placa, executive director of JNESO, a nursing union.
Among other things, Placa is concerned that overworked boards in other states will have trouble managing the new system, resulting in inaccurate information about nurses licenses and disciplinary actions being shared throughout the system — without a clear path to get it corrected. This could lead nurses to be shut out of work while the electronic system catches up with reality, he said.
The program, known as the enhanced multistate Nurse Licensure Compact, or eNLC, has roots in a 2000 agreement developed by the National Council of State Boards of Nursing; it began with Texas and Wisconsin and soon grew to involve other states, including Delaware and North Carolina. The collaboration continued to expand, and in 2018, the national council relaunched the program with new, stricter guidelines and more than two dozen participants.
New Jersey nearly joined the partnership in 2001, but the process was derailed by concerns about database incompatibility and the fact that in other states did not meet those in place here; a particular concern was that the Garden State’s license process involves a criminal background check, something that was not standard in all other compact states. (Similar concerns emerged in New York, which has also considered joining the compact.)
But when it relaunched the program last year, the nursing council updated its requirements for participating in the multistate partnership and made background checks a requirement, among other changes. Lawmakers in New Jersey have also tweaked the bill to join the compact in recent years, and the version Murphy signed addressed some of the concerns raised earlier in the process.
Shared database on work histories
Under the new law, New Jersey joins a system in which nurses are licensed in their home state but can work in other member states, under those states’ regulations and oversight. Participating states can access a shared database that includes the licensing and disciplinary history of all nursing professionals, and must use this system to check for job-related violations when granting new licenses.
“New Jersey should be part of the eNLC because it allows states to exchange information and better coordinate licensing and regulatory efforts,” said Tony Bawidamann, a vice president at the New Jersey Business and Industry Association. “And as telemedicine expands and nursing become more mobile, it is especially important that geographical boundaries not impede licensed nurses from delivering care to patients.”
The other states participating in the eNLC are: Alabama (starting date to be determined), Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Indiana (starting in 2020), Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin and Wyoming.