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What Every Nurse Should Know about the Nurse Licensure Compact

After looking closely at the Nurse Licensure Compact pros and cons, the Alaska Nurses Association strongly believes that the compact would be a bad fit for Alaska. At first pass, joining the compact might sound like a great idea, something that would bring more nurses to our state to practice and fill the open jobs in communities in need. After a closer look, we’ve broken down some key reasons why staying out of the compact will make Alaska a better and safer place to give and receive health care.

What is the Nurse Licensure Compact?

The Nurse Licensure Compact was created by the National Council of State Boards of Nursing, a private, non-regulatory, non-governmental trade association. The compact acts as a multistate license, allowing nurses licensed in compact states to practice in all other compact states under one license. If Alaska became a compact state, anyone licensed in other compact states could practice here without obtaining a separate Alaska license. Sounds like an intriguing idea, right? Let’s take a closer look at why this would actually be a bad idea for Alaska, Alaskan nurses, and Alaskan patients.

Loss of state sovereignty

Under our current system, local experts right here in Alaska get to make local decisions that are best for our state. Under the compact, Alaska would lose the ability to establish rules that cover all nurses working in the state. This means that nurses operating under the compact license wouldn’t have to abide by all of the rules and regulations set forth by our state, which weakens our standards overall. These lowered standards for nurses will result in worse care for patients.

Imagine going to work and realizing that you and your coworker are working under completely different sets of expectations. It would make it hard to get the job done or know what you need to do. One example of this is in the scope of practice that various states allow their nurses. Each state has its own Nurse Practice Act that defines what a nurse can or cannot do. In Alaska, registered nurses cannot dispense medication or perform examinations. Every nurse in Alaska has to be familiar with these rules. Under the compact, there would be no way to enforce or verify that compact nurses are aware of these practices, causing needless confusion and disagreement for nurses working side by side caring for a single patient.

Bottom line, there’s no question that Alaskans know what’s best for Alaskans. Handing over important decisions to out-of-state agencies is not what’s best for our state.

Threat to public health and safety

This is a big one. The purpose of the Alaska Board of Nursing, which currently administers Alaska nursing licenses and oversees regulations, is to protect the health and safety of Alaskans. Under the compact, we would have no way of tracking or monitoring nurses who come into our state to work.

Past experience shared by the Alaska Board of Nursing tells us that it is not uncommon for nurses to try to come practice in Alaska. To date, the Alaska Board of Nursing has been able to use its ability to enforce Alaska’s high standards for quality nurses and to deny licenses to unqualified nurses. Allowing nurses from other compact states to practice here means we lose the ability to enforce those high standards.

One of the most important functions of the Board of Nursing is to investigate complaints for nurses working in the state and take action on a nurse’s license if there’s been unsafe or inappropriate conduct. Under the compact, Alaska would have to investigate complaints for all nurses working here, regardless of where they are licensed, but wouldn’t have the ability to discipline compact nurses. Instead, issuing discipline would be left to the nurse’s home state, and there are worrisome inconsistencies between states in relation to discipline is handled, including:

  • Each state has different criteria for disciplinary action.
  • Each state is able to make its own case-by-case determination of whether a criminal misdemeanor conviction is related to the practice of nursing, and to decide whether – and what type of – disciplinary action should be taken.
  • Felony offense statutes are not standardized across states. What constitutes a misdemeanor in Arkansas may arise to the level of a felony under Alaska law, yet the State of Alaska would no longer have the ability to bar that nurse from coming to Alaska and caring for patients in our state.

In fact, we decided to do some research to see just how differently states treat discipline for nurses. We looked for similar cases – where a nurse was accused of patient abuse – in three states. Here’s what we found:

  • In State #1, a nurse was angry, raised her voice, and spit at a patient. The nurse received a public reprimand, was ordered to complete additional education within 30 days, paid a $3,000 fine, and had her license put on probation for one year. This discipline was issued just 2.5 months after the incident.
  • In State #2, a nurse pushed an elderly patient to the ground. The nurse received a public reprimand and was ordered to complete additional education within 6 months. The nurse did not pay a fine, and their license was not put on probation or suspended. This discipline was issued 12 months after the incident.
  • In State #3, a nurse placed a disabled toddler in scalding bathwater, causing severe burns to the patient. The toddler died two days later. The nurse was originally charged with second-degree murder, but eventually reached a deal to instead plead guilty to felony assault and serve four years in prison. The nurse did not receive any discipline for this incident, continuing to hold an unencumbered license that eventually lapsed without license action being taken.

In addition to concerns about disciplinary action and criminal offenses, we have concerns about the nursing education programs and continuing education requirements for compact nurses. Of course, the Nurse Licensure Compact does have minimum licensure requirements, but they are less stringent and robust than Alaska’s requirements, which were set in place by our policymakers who determined what was necessary to protect the public. Alaska requires nurses prove their continued competency to renew their license by making sure they complete continuing education, continue to work as a nurse, or spend time using their nursing expertise to volunteer. Many states do not have these renewal requirements. Alaska requires that nurses have graduated from a nationally accredited school, the compact does not. This means that under the compact, Alaskans could be taken care of by new nurses who have received subpar education and have little hands-on experience with patients.

Loss of revenue and increased burden to Alaska nurses

Since compact nurses working in our state wouldn’t have to pay for an Alaska license, the Alaska Board of Nursing would see a significant loss of revenue, making it harder for it to carry out its duties and potentially forcing it to increase Alaska licensing fees, already among the highest in the nation. Calculations show that fees would increase by $46-$83 at renewal periods for Alaska nurses.  

Compact will not solve workforce needs or improve access to care

On the surface, it seems like joining the compact would bring a flood of nurses into the state, but it is important to note that there is no evidence to suggest that joining the compact would bring more nurses to Alaska. The nursing shortage is not a uniquely Alaska issue and joining the compact will not suddenly or magically create a pool of nurses to fill staffing vacancies at needy facilities. Nurses who want to practice here already do so because Alaska is a great place to work, and it’s a dream travel destination for many. Licensing costs for travel nurses are covered by nurse staffing agencies and other employers, and the Alaska Board of Nursing is able to issue licenses in a timely manner, even expediting the licensing process if needed, or granting temporary licenses or courtesy licenses in times of emergent needs.

The Alaska Nurses Association remains committed to working with the Alaska Board of Nursing and others on effective regulatory measures that are workable and realistic, that offer real solutions, and that respect state sovereignty. None of this, unfortunately, describes the Nurse Licensure Compact. The compact would harm Alaskans. We can and must work toward better approaches that put Alaskans first.


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