ABSTRACT
The COVID-19 pandemic put an unprecedented strain on the nursing workforce. In response, many states issued executive orders waiving licensure requirements for their state if nurses have a license in good standing in another state. However, such efforts were not without risk. For example, a nurse who was working in a state under an executive order was terminated by the employer after the nurse was found diverting controlled substances and diluting vials of controlled substances with normal saline. This case study highlights the importance of the authority provisions granted in the Nurse Licensure Compact and the risk to public protection that can potentially result when executive orders waive the requirement for an in-state nursing license.
ABSTRACT
We examine to what extent relaxing occupational licensing results in labor mobility. For this, we consider the case of the Nurse Licensure Compact (NLC). NLC permits registered nurses and licensed practical/vocational nurses to have one multistate license enabling them to practice in their state of residency and other NLC states (compact states) without obtaining additional licenses. The nursing profession has led the way among the healthcare professions in establishing and implementing an interstate practice model, yet how it affects the mobility of practitioners remains unanswered. As of March 2021, 34 states are within the compact. We exploit the state-level staggered adoptions of compact and use the regression method to estimate the compacts’ impact on the mobility of registered nurses and licensed practical/vocational nurses. We find an 11% increment in the mobility of registered nurses and licensed practical/vocational nurses within the compact states. During the COVID-19 pandemic, among other policies, joining to compact may help relax the urgent needs of health care professionals. © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
ABSTRACT
Background: The COVID-19 pandemic has stimulated interest in potential policy solutions to improve working conditions in hospitals and nursing homes. Policy action in the pandemic recovery period must be informed by pre-pandemic conditions. Purpose: To describe registered nurses' (RNs') working conditions, job outcomes, and measures of patient safety and care quality in hospitals and nursing homes just before the pandemic. Methods: Cross-sectional study using descriptive statistics to analyze survey data from RNs in New York and Illinois collected December 2019 through February 2020. Results: A total of 33,462 RNs were included in the final analysis. Before the pandemic, more than 40% of RNs reported high burnout, one in four were dissatisfied with their job, and one in five planned to leave their employer within 1 year. Among nursing home RNs, one in three planned to leave their employer. RNs reported poor working conditions characterized by not having enough staff (56%), administrators who did not listen/respond to RNs' concerns (42%), frequently missed nursing care (ranging from 8% to 34% depending on the nursing task in question), work that was interrupted or delayed by insufficient staff (88%), and performing non-nursing tasks (82%). Most RNs (68%) rated care quality at their workplace as less than excellent, and 41% gave their hospital an unfavorable patient safety rating. Conclusion: Hospitals and nursing homes were understaffed before the COVID-19 pandemic, and many RNs were dissatisfied with their employers' contribution to the widespread observed shortage of nursing care during the pandemic. Policy interventions to address understaffing include the implementation of safe nurse staffing standards and passage of the Nurse Licensure Compact to permit RNs to move expeditiously to locales with the greatest needs.