How States Changed Nurse Licensing for COVID-19

Early during the COVID-19 pandemic, federal and state governments worked together to ensure that healthcare providers were available to help patients in the areas that were hardest hit, providing travel nurses easy access to cross state lines through relaxed nurse licensing.

Many governors allowed their state boards of nursing to temporarily made changes to nurse licensure rules to speed the process and allow crisis response nursing to provide care in COVID hotspots. In 2020, all states declared an emergency. 

The Impact of the Emergency Response on Nurse Licensing

“In the early days of the pandemic, states across the country took emergency actions to create licensure flexibilities for health care professionals,” reported Nicole Livanos, JD, MPP, director, State Affairs at the National Council of State Boards of Nursing (NCSBN). “Some states waived licensure entirely, declaring that if an individual held a license as a practitioner in one state, they could practice in their state without obtaining a license or permit. Other states created temporary practice permits or registrations for providers to more easily solicit their services to assist with the state’s response.”

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However, now “most states emergency orders have expired, either by their own expiration date or by the state ending its declaration of emergency,” Livanos added.  

Those temporary nurse licensure changes are gone.

As of early March 2023, New York remains an exception. The state continues to offer nurse licensing flexibilities, but they are due to the nursing shortage, not the pandemic.

“Gov. [Kathy] Hochul issued Executive Order #4 Declaring a Statewide Disaster Emergency Due to Healthcare Staffing Shortages in the State of New York, which provides for licensed nurses from other states to practice in New York without obtaining licensure,” Livanos said.

As the federal Public Health Emergency ends in May 2023, Livanos reported that “For some states that tied various executive orders and emergency legislation to the federal emergency, it will mean that some flexibilities may come to an end.”

However, Livanos added, “We are hopeful that states will continue to push for permanent measures, like the NLC [Nurse Licensure Compact] and APRN Compact, to continue the flexibility benefits they experienced over the last few years but with a safe and proven mechanism for nurse mobility.”

Nurse Licensure Compact Continues Expansion

No emergency declaration is needed with the Nurse Licensure Compact (NLC). Nurses can hold a single state license or a multistate or compact license.

The NLC enables nurses to practice in states participating in the compact without obtaining additional licensure, and not simply for crisis response nursing. Thirty-nine jurisdictions, including the Virgin Islands and Guam, have enacted the compact to date. Five of those jurisdictions – Guam, Ohio, Pennsylvania, Vermont and the U.S. Virgin Islands – enacted the compact since the start of the pandemic.

“The realities of the pandemic amplified the existing calls for joining the compact in these jurisdictions among stakeholders and lawmakers alike,” Livanos said. “Many states are looking at both the NLC and other interstate compacts.”

Ten states have pending legislation for nurse licensure changes to approve the NLC. They are Hawaii, Illinois, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Oregon, and Washington. California, Michigan, Connecticut, and the District of Columbia have not yet initiated action on the compact.

More than 2 million nurses live in compact states that participate in the NLC and are eligible for a multistate license. They can quickly respond to disasters in other states, accept travel assignments anywhere in a compact state and practice telenursing in NLC states. 

“Additionally, NCSBN created an APRN Compact, which would allow all four advanced practice registered nurse (APRN) roles to be practiced across state lines similarly to the NLC,” Livanos said. “The APRN Compact debuted during the pandemic and since then has been enacted in three states and six others have current pending legislation.”

Preparing for the Next Emergency

The country has learned some lessons from the COVID-19 pandemic and, hopefully, that will lead to a faster response next time.

“As more states look to the NLC and APRN Compact to facilitate licensure mobility for nurses, states will have an immediate workforce to recruit during times of disaster—whether it be a health emergency, tragedy or natural disaster,” Livanos said.

Nurses wanting to provide crisis response nursing in a hard-hit area, can check with their state’s board of nursing about the type of license they hold. Or they can use NCSBN’s national Nursys online database or the state board sites to quickly check their nurse licensure status.

Additionally, American Mobile’s recruitment team can help current and prospective travel nurses with nurse licensing requirements and verify all the states where they hold a valid license to practice. They may even cover licensing fees, if necessary for an assignment.

“Emergency preparedness requires effective policy that can be immediately implemented,” Livanos said. “In the event of an emergency like COVID-19 pandemic, NLC member jurisdictions are prepared with the ability to mobilize nurses who are vetted and have undergone federal background checks. Nurses can immediately cross state lines without waiting for emergency declarations or legislation to be enacted.”

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