Easing the way for out-of-state nurses to work in Massachusetts
Nurses fill a vital role in patient care, and Massachusetts’ nursing workforce desperately needs shoring up. Even prepandemic, its nursing workforce was older, on average, than the country’s, creating an environment ripe for labor shortages as those nurses retired, according to 2019 data cited by the Health Policy Commission. Challenging work conditions during the pandemic accelerated burnout and retirements.
A 2022 survey by the Massachusetts Health and Hospital Association estimated that there were 5,100 vacant nursing positions in Massachusetts at the time. The Center for Health Information and Analysis’s newly released 2024 annual report found that in fiscal 2022, the state’s hospitals spent a staggering $1.2 billion hiring registered nurses working on temporary contracts — like those hired through an agency to fill immediate staffing needs. That same report cited staffing shortages as a factor leading to the temporary closure of beds in psychiatric and substance abuse units. Hospitals have reported that staffing shortages in home care, rehabilitation facilities, and nursing homes limit their ability to discharge patients.
The Legislature should, finally, authorize Massachusetts to join the Nurse Licensure Compact. The compact is an agreement through which 41 US jurisdictions allow a nurse licensed in their home state to practice in other participating states. Maine, New Hampshire, Rhode Island, and Vermont are all part of the compact.
Participating in the compact would not entirely solve the state’s nursing shortage. It would let more out-of-state nurses enter Massachusetts to work but would also offer flexibility for Massachusetts-based nurses to travel elsewhere. Yet, as the Massachusetts Health Policy Commission found in a 2021 report evaluating whether Massachusetts should join the compact, there are potential upsides to joining, without major downsides.
The commission found that joining the compact could help Massachusetts adapt to unforeseen changes in nursing needs that require temporary staffing, like a natural disaster or pandemic or seasonal fluctuations, like an influx of summer visitors to Cape Cod. It would make it easier for nurses who live in neighboring states to work in Massachusetts. (Today, a nurse licensed in another state needs to apply for a reciprocal license to work in Massachusetts.) With the rise of telehealth, joining the compact would make it easier for Massachusetts patients to receive telehealth care from out-of-state nurses and for Massachusetts nurses who care for out-of-state patients to provide follow-up care. This could be important if a New Hampshire resident has surgery in Massachusetts or a Texas resident has an abortion here. It could allow more nurse educators to teach remotely, amid a shortage of nursing faculty.
Charlene Craven, a registered nurse who works in a Central Massachusetts outpatient practice, said many of her patients live in Rhode Island or Connecticut, and she hesitates to provide advice over the phone in all but the simplest cases. “If I know that patient is out of state at home, technically I’m not allowed to provide care for them because I’d be acting as a nurse in a jurisdiction where I don’t have a license,” Craven said.
The nurse licensure compact has its own credentialing requirements, and after a 2018 change to require criminal background checks, some of the compact’s requirements are stricter than Massachusetts’. Massachusetts’ licensing board could still set its own criteria that would apply to every nurse practicing here, like requirements for continuing education.
Carmela Daniello, executive director of the American Nurses Association Massachusetts, a trade association that supports joining the compact, compared a nursing license to a driver’s license. “You don’t go to every state and get a new driver’s license, but you are
The Legislature should, finally, authorize Massachusetts to join the Nurse Licensure Compact.
responsible for understanding the driving restrictions in a state through which you’re driving,” Daniello said.
Groups representing nurses are split. The National Council of State Boards of Nursing, which developed the compact, conducted a survey of Massachusetts-licensed nurses in October 2023, which found that 90 percent of nurses support joining the compact, with only 3 percent opposed and 7 percent having no opinion. But compact opponents say the survey is flawed because it did not detail the downsides of joining the compact.
The Massachusetts Nurses Association, a union representing 25,000 Massachusetts nurses and health care professionals, has long opposed joining the compact.
MNA President Katie Murphy said Massachusetts already has a pool of instate nurses, and the reason hospitals struggle to hire and retain them relates to working conditions. Nurses may be uninterested in accepting a part-time or temporary job, or one where they are caring for too many patients. Murphy worries that entering the compact will compromise patient care if it results in more temporary, out-of-state nurses or more reliance on out-of-state nurses to remotely monitor patients.
The union is right that providers must offer nurses working conditions that make it appealing to work here, and that may become even more important if the compact is approved and makes the labor market more competitive. Employers would have to ensure they use out-of-state nurses wisely without compromising patient care.
But patient care is compromised now when hospitals can’t find staff, and if the union is worried about nurses being overworked, it should support a measure that would help employers fill vacancies. If joining the compact removes administrative barriers to licensure and provides nurses with more flexibility, while upholding the quality of care, it is worth pursuing.