With any argument and solution, there are groups who will resist your solution and ideas. There are 26 states that are hesitant about joining the nursing compact. It is to be expected that asking states to change the way they run things will stir up some commotion, and that is was these 26 states see the compact as. They think that the National Council of State Boards of Nursing (NCSBN) is trying to come into the states and run and over see every little thing and act they perform in their hospitals and other health care facilities.
Improving Healthcare Across the Nation
However, these states being uninformed of everything that the entire compact has to offer is allowing these incorrect thoughts to form within the non-compact states. What I think a lot of states forget, is the main goal of the NCSBN is to maintain their responsibility of providing regulatory excellence for the public health, safety, and welfare. By the NCSBN creating the Nurse Licensure Compact, expanding nursing job opportunities across all state lines is obviously a huge plus, but their main focus is to nationally regulate the care that is being provided in each state by ensuring that healthcare facilities have safe and competent nursing practice being provided by registered and skilled nurses.
Of the twenty-six state left that have not joined the compact, not all of them are completely against it. Florida for example wants to join the compact and is waiting for their state to implement the compact legislation.
Should We Join The Compact?
Other states, however, Massachusetts for example, is completely against it. It is states like these that are creating the most resistance when it comes to expanding the compact. Part of their resistance is based on morals and partially on loss of power and money.
Massachusetts feels that morally joining the compact is wrong based on the privacy of their patients. They feel that joining a national database will not only expose personal information of their nurses but of their patients as well. While Nursys will have information on their nurses, it is not considered too personal because the non-compact state has access to that same information if they wanted it. Nursys just compiles it all in one database, which ensures that we have competent, safe nurses practicing in our states.
Another issue they have is the expansion of telemedicine and telenursing. They view it as a poor alternative to providing patient care because they stated that “its having nurses on the phone rather than providing direct care”. This is not the case thought. While nurses and other health care providers will be practicing over the phone or Internet, they will still be practicing in person and by the bedside of the patient in their own facilities. Telehealth just increases the collaboration opportunities when caring for people who require complex care.
Some non-compact states are also worried about how disciplinary actions will be held under the compact. They think that it would be very difficult to locate and follow-up with the nurses after they have been involved in a bad incident if they can be located all of the country. While the nurse can move to somewhere else in the country, her information and the disciplinary information and outcomes will all be documented in Nursys as well. The disciplinary issue will be handled by the legislature in the state that it occurred in, and the information and outcome will be reported back to the nurses “home state” for them to enter it into the database. This documentation of disciplinary issues is beneficial for hospitals looking to hire the nurse because they are able to see what exactly happened and it ensures that we only have safe nurses practicing in the states.
Some states are also worried about the lose of revenue from requiring new licensure for their own state for a nurse that wishes to work there. While this is a reasonable concern, joining the compact will eventually save these states money. Several non-compact states are understaffed which in turns means they are not able to provide the proper care needed in nursing homes, which are becoming over populated because of the aging of America. There is a high incidence rate of nosocomial infections, which are hospital-acquired infections that patients suffer from while their stay in a health care facility, along with a high incidence rate of bed or pressure ulcers. Bed ulcers are too common in nursing comes which comes from nurses not turning and ambulating their patients every two hours. These two infections cause that health care facility and its state millions of dollars because legally through insurance, they are required to pay for the care needed to health them. By joining the compact, it allows for more nurses to move across their lines and work in their understaffed facilities. This in turn, will lower the patient to nurse ratio, allowing nurses to provide more competent individualized care for each of their patients, eliminating the high incidence rates of nosocomial infections and bed ulcers.
Many states view the compact as coming in and changing all of their rules and the way they run their facilities. This is not true. Hospitals still have complete say in who they hire and why, along with keeping or making continuing education for their nurses mandatory. The compact encourages this because continuing education means that their nurses are as highly educated as possible on new ways of practicing and health discoveries along with being aware of the current evidence based practice laws for nurses.
The non-compact states have a major influence that will make it hard to fulfill the solution created to expand the compact. Educating these states on all the benefits the compact has to offer is so important when trying to convince the states to join. There are several nurse advocates in non-compact states who are against the compact. These people are seen as community leaders and several people in their states listen to them and agree with what the nurse advocate sees as best for the state. This poses serious problems when trying to talk to other nurses because they have usually already formed an opinion on what is best for their state.
While there is resistance to the solution and expanding the nurse licensure compact, it seems to be that people are forgetting who is of the most concern here. Our patients are suffering terribly from the compact not being expanded because it is hindering the elimination of the high patient to nurse ratio. This high patient to nurse ratio is causing infections and illnesses to be acquired in our patients that are easily preventable if a facility is properly staffed.
Compact States In the United States
These states being properly educated on what the nurse compact is aiming to do and how they are planning to achieve their goals will help inform people on how beneficial the compact can be to every state and their facilities and the care being provided by their nurses. The twenty-four states that have joined the compact are perfect examples of how beneficial it can be to nursing opportunities as well as improving patient healthcare across the board.
Nine reasons nurses oppose compact. (2007). Massachusetts Nurse Advocate, 78(10), 12-13.