Conn. could soon join multi-state nursing compact
HARTFORD — A growing health care worker shortage is placing more stress on nurses as they work to help more patients, leading to burnout.
One survey found that nearly one in five health care workers nationally had quit their job since the start of the pandemic, and almost a third of those who stayed had considered quitting.
State lawmakers took a major stride to address the issue by passing legislation to enter the national nurse licensure compact. The bill passed unanimously in the Senate on Wednesday, the last day of the legislative session, after passing unanimously in the House last month. The bill awaits Gov. Ned Lamont’s signature.
Joining the compact will allow registered nurses and licensed practical nurses to provide care in Connecticut and 41 other states without needing individual state licenses.
Much like a driver’s license, a multi-state license under the compact is issued by the nurses’ primary state of residence, but is recognized across state borders, according to the National Council of State Boards of Nursing.
“When we think about the nursing shortage, we think about what are the ways that we can recruit and retain our nurses? This is one of those tools we can use,” said Lisa Sundean, assistant professor and director of the Healthcare Administration Program at Fairfield University’s Egan School of Nursing and Health Studies.
All registered nurses take the same nurse licensure exam, which Sundean said is nationally regulated. However, to practice, nurses must apply for a license through the state they plan to work in.
Obtaining a multi-state license allows nurses to provide care in person or via telehealth in compact states without applying for and paying for a new state license.
According to the National Council of State Boards of Nursing, Rhode Island is the most recent state to start issuing multi-state licenses, but New York and Massachusetts are developing their legislative packages to join.
Sundean said the national compact opens a two-way street between states to fill gaps and address health care shortages.
For example, if a Connecticut nurse was interested in picking up a weekend shift in Rhode Island, they can without needing to apply for an individual state license, Sundean said. The opposite is also true, so a nurse from Rhode Island can easily work in Connecticut if they wanted.
“I don’t want to leave anybody with the impression in Connecticut that the nurse licensure compact is an exit pass out of Connecticut. It’s a twoway street,” Sundean said. “We benefit by being able to have nurses who are living in other states, but want to also practice in Connecticut to be able to do that. There’s the sense of fluid practice across state borders.”
According to the National Council of State Boards of Nursing, other benefits of the compact include facilitating online nursing education while eliminating expenses for organizations employing nurses. The agreement also allows nurses to quickly cross state borders to provide care in case of a disaster.
“It’s really a way of modernizing the nurse licensure process, a way of creating efficiencies in the administration of the nurse licensure process, and it helps to modernize health care as well,” Sundean said.
What does the bill say?
Legislation to involve Connecticut in the licensure compact has been in the works for over a decade, Sundean said. Over the years, concerns around the legislation have slowly been worked out.
Although licenses are enacted and issued by the state, the Interstate Commission of Nurse Licensure Compact Administrators manages the compact licenses. Connecticut’s NLC legislation, House Bill 5058, details the role of the interstate commission within the state and creates a coordinated licensure information system to share licensure and disciplinary information between states.
HB 5058 also sets specific license and education requirements and mandates applicants to undergo a fingerprint or biometric-based criminal background check. It also establishes a working group to evaluate participation in the licensure compact network to ensure continued surveillance over the implementation process. The bill’s provisions would be effective from October 2025 to January 2028.
Sundean said the Connecticut Nurses Association has been the leader in developing the compact legislation over the last decade.
On its website, the association shared several concerns about HB 5058, noting that the bill as it’s written may potentially move the state “backward.” Concerns included confidentiality issues, gaps in data collection about nurses working in the state, fingerprinting requirements and losses in licensing revenues.
The association also reported issues with the funding streams to the Health Assistance InterVention Education Network. HAVEN is a statefunded health assistant program that offers confidential alternatives to public disciplinary action for staff dealing with a chemical dependency, emotional or behavioral disorder or physical or mental illness.
Some of the association’s concerns were addressed when HB 5058 passed the House anonymously with amendments, like adding more funds for HAVEN, creating a license cancellation process, updating the background check requirements and covering the loss of funds from fewer nurses purchasing a Connecticut-only license.
The House amendments added a task force to advise and evaluate the implementation process. The task force would also help create a system that doesn’t stigmatize nurses seeking a single-state license and coordinate data collection on licensing trends.
“Joining this compact will provide Connecticut residents with even more access to health care, including the expansion of telehealth visits that became so important during the pandemic,” Rep. Tami Zawistowski, a cosponsor of the bill, said in a press release after the bill passed in the House.
Sundean said the nurses association and other advocates will continue to work with legislators to implement the compact. She said advocates will also monitor nurse staffing levels and continue to add flexible work schedules for nurses.
“All policy breaks down in implementation,” she said, “so that is a really important part of the process to make sure that we get it right so it is as seamless as the bill says it would be.”