Vital Views

Joe Gaccione 0:00
Welcome to Vital Views, podcast for UNLV School of Nursing. I'm Joseph Gaccione, Communications Director for the School of Nursing. We created this podcast to help share tales from our hard working fantastic nurses out there, whether they're students, faculty, staff, alumni or donors. These stories focus on work on the frontlines, in the classrooms, in the lab, wherever our nurses are making a difference. But we don't just talk about nursing; we dive into broader healthcare topics to bring attention to bigger issues that impact everybody. We also talk about ways to keep you, your family, and your community healthier, both physically and mentally. There is a nationwide agreement that could enhance nursing care state by state, but Nevada is on the outside looking in. This agreement is called the Nursing Licensure Compact, or NLC. It allows nurses in one state to practice in another without having to go after additional licenses as long as those states are in the compact. Currently, the National Council of State Boards of Nursing has 39 states listed as part of this compact, but Nevada is not one of them. Last year, it was introduced in the Nevada legislature as Assembly Bill 142 but it didn't pass. We have two very special guests to talk more about what the NLC is and why Nevada lawmakers may be hesitant from a health perspective. We have Dr. Susan VanBeuge, professor-in-residence with UNLV nursing. She's also the president of the Nevada State Board of Nursing. And we also have Cathy Dinauer, who is the Executive Director with the Nevada State Board of Nursing. Thank you both for coming in.

Susan VanBeuge 1:29
Thank you, Joe.

Cathy Dinauer 1:30
Thank you.

Joe Gaccione 1:31
Let's start with why the NLC was created in the first place. Now this is to alleviate state resources in times of crisis without a lot of red tape. Is that correct?

Cathy Dinauer 1:39
Yeah, that is part of it and it also is a way to facilitate nurses’ ability to practice rather quickly in, in another state with one license. So, it's cost effective for them and it, and it's really helpful for them when they're starting, starting a job in another state and they don't have to wait as long as maybe it would take in getting a single state license.

Joe Gaccione 2:03
Now, is the quick turnaround to start practicing without that additional licensure, is that the biggest benefit it can provide Nevada nurses in health care or are there others as well?

Susan VanBeuge 2:12
Well, I think there's a lot of benefit for Nevada nurses, if an, if a Nevada nurse also works in the telehealth space, so they work in an organization where they are consulting with patients in other states, that nurse, if they had a compact license, would be able to give care in that telehealth space to patients in other states if they were part of that compact license, right? So, for example, if you had a compact license, and you were here in Nevada, and you were talking to a patient in Iowa, and that state was also in the compact, then they would not have to get an Iowa license. But if Nevada is not in the compact, and Iowa was not in the compact, they'd have to have a Nevada license, with all of the fees and all the regulatory requirements, and then also have to apply for an Iowa license with the fees and the regulatory requirements that go along with that. I know that's kind of a simple explanation but that's kind of the down and dirty of what, how that works.

Joe Gaccione 3:14
You bring up an interesting point about telehealth because on the surface, it sounds like telehealth could trump almost anything because technically, it's pretty simple, but the licensure part of that is still a major component.

Susan VanBeuge 3:25
Telehealth is simple in some ways, in that you can get on the phone or get on a computer and reach out to a health care provider across the United States, but it's also complex in that in the regulatory space, we do have to make sure that those providers who are providing care are doing that under those regulatory rules state by state and our United States in terms of nursing is very much a patchwork. Every state has their own rules, regulations, and laws that we are, govern practice. And so, the NLC is just one of those pieces that perhaps Nevada might be able to modernize and be part of that NLC compact that would allow for that being part of a bigger group, a bigger consortium of nurses across the United States. There's about 2 million nurses right now already in the compact throughout the United States and Nevada's 60,000 licensees could be part of that as well.

Joe Gaccione 4:28
What are the benefits education wise?

Susan VanBeuge 4:30
When we talk about education, I think that's a really good question, a lot of folks think, “Well wait a second, is education even practice?” and it is nursing practice. We have highly educated nursing faculty here at UNLV and also throughout the state. And if you have a student that is in another state and you have a faculty that wants to mentor them or work with them in that educational space, that nurse needs to be licensed in the other state. So, if a student was up in Utah, for example, a nurse educator would also have to get a license in that state to be able to deliver the education to that student. If we were part of that Nurse Licensure Compact and Utah was part of that as well and the nurse had a compact license that they had applied for and had, they would not have to apply for that additional licensure and the fees and all the things that go along with that.

Joe Gaccione 5:28
It sounds a little bit, again, on the surface sounds a little bit like travel nursing. They sound like similar practices, but I imagine they're very different. How do they, I guess, intertwine?

Cathy Dinauer 5:39
Well, a travel nurse is it's, it's a, it's a job. It's, you're usually hired by a company that sends you out to a facility that needs a nurse. The compact is a licensure agreement. It is, it is, it's licensure. And so yes, they, they sort of operate the same, but they're not the same in that nurses that have a compact license aren't necessarily travelers, they can be nurses in the, in their home state of Nevada that just want to have that compact license just in case one day they decide to, to go somewhere and practice in another state. So, they're sort of similar, but they're not. They're not the same.

Joe Gaccione 6:16
Okay. Now, back in August, we had Nevada Governor Steve Sisolak on the podcast, and he voiced his support for it but he also admitted, “I'm not sure,” I'm quoting, “I'm not sure why it hasn't passed, but it should.” What would be drawbacks to the NLC?

Cathy Dinauer 6:30
Well, there really aren't any drawbacks. There, there is some opposition to the compact and that's generally coming from the nursing unions. Most other organizations that we, not only in Nevada but nationally, have engaged with, many organizations are very much in support of the nursing compact, including national education organizations, the national practice organizations, the Department of Defense, the veterans’ groups, they're all very supportive. It's, it's really coming simply from, it's really coming from the nursing unions who are in opposition of the Compact.

Joe Gaccione 7:10
Why would they oppose it? Is it because of pay? Is it because of nurse safety or another reason?

Cathy Dinauer 7:15
Well, there really aren't any, there's no evidence to show that there are safety issues with a compact, there really aren't any drawbacks. It's probably a question for the unions to ask them. But from what they've said, in, in statements, it has to do with crossing a picket line. If there's a strike, how would that impact, how would a compact nurse impact that? Is there a drawback with the continuing education requirements, but all of their questions have been, have been addressed and have been answered.

Joe Gaccione 7:44
For a bill like this to get passed, and I apologize if this is above the NSBN scope, but what would it take to get this passed now?

Cathy Dinauer 7:52
Well, I can, I can go ahead and take that on. It requires a change in our statute, which is a change in our law. So, in order for that to happen, it has to go before the legislature and the Nevada State Board of Nursing has been trying for at least 10 years to try to get the nursing compact passed. It does take a legislative push to get that done. The last session, there was a bill to go before the legislature but it didn't ever get introduced. So, now what we're waiting for is a bill draft. We have had some conversations with individuals who have voiced support for the nursing compact who would be willing to carry a bill draft before the legislature for the next, next session.

Susan VanBeuge 8:36
And I think, Joe, that what's really important to note is that nothing happens before it's time, right? So, you know, when you talk about legislative action and things happening, you know, it's really about just modernizing. It’s modernizing statute to what's going on today. And perhaps the other attempts going before the legislature, it just wasn't the right time. So, you know, you ask, “Well, gosh, why didn't it happen before? How do we get there today?” Right now we've just come out of and we're just still in, you know, COVID, and we've learned a lot of lessons about portability of health care across state lines, not only from nursing, but from medicine and every other profession. And so, we've learned some things and we've realized, too, that this compact could be one way that we could have some lasting effects of being able to have that portability of nursing care across the state line with our colleagues throughout the United States. And that safe, effective care can be delivered to the patients and having access to care is really important. And this is part of that access to care that people can have, our citizens can have, and the Nurse Licensure Compact is just one of those things that can impact that access to care, not only in the cities, but out in the rural areas as well.

Joe Gaccione 9:55
One of the ways this could help would be in rural and frontier areas. There are so many out here, outside Las Vegas, outside of Southern Nevada, what are the ways that the compact can help those communities?

Cathy Dinauer 10:04
A lot of Nevada is, is very, very rural. And access to care has always been a challenge. And with the implementation of a compact here, there would be a much quicker way to get resources to facilities, especially in our rural areas. An example would be last year having fires all over in California, and it was encroaching on Lake Tahoe, and there was a small facility in California that was going to need to transfer to the east, which was into Nevada. Had we had the compact, their nurses there would have been able to easily come over, transport their patients that were being evacuated, and it would have been a much easy, streamlined process, but not having the compact, it was very challenging for those nurses who are transporting patients in an immediate evacuation rural facility trying to get their patients into Nevada and it was hard trying to get them a license because they needed to be able to practice in Nevada, and that happens all over our rural areas, that access to care is such a challenge and having the compact, they'd be able to get nurses in from, from states that that are right nearby, on the border, and they would be able to get nurses in those states who are compact states,

Susan VanBeuge 11:16
You know, we have so many towns that are in our rural and frontier areas. And sometimes, I think in Nevada, we tend to think of the urban areas only, we think of the Las Vegas area, we think of Reno, Carson, Sparks area. But there's a whole lot more to our state than just these, you know, kind of populated areas. And we have towns like jackpot, Nevada, that is up on that northern border with Oregon. And there's a robust community there that also, you know, has health care needs and the compact could make a difference.

Cathy Dinauer 11:51
Yeah, during the, during the height of the pandemic, there were emergency directives that were established by the governor and to allow for access and easy access to, to get licensure, so that we could get our healthcare providers out in the field to do what they needed to do not be held up by any kind of bureaucracy or red tape and/or licensure requirements. I mean, you know, the laws and whatnot. So, it was put forth and we had, people could come to the state and practice without having to check in with our licensing board. We had over 6000 waivers and of those 6000 waivers, we had very few issues or concerns or problems with individuals that were, were coming here. And I think that as Dr. VanBeuge mentioned, what's so important too, is in the face of a disaster, you really want to get those health care providers out and ready to go immediately, not the two or three days it might take to get a license. That doesn't sound like very long, but in that heat of a pandemic, or the October 1 shooting that happened here, facilities needed nurses immediately, and they couldn't wait a couple of days. So, the license, the compact would help with that.

Joe Gaccione 13:00
Even if nurses that are part of this compact, even if they're skipping that additional licensure, they're not just going out into the workforce, there still needs to be background checks and routine research to make sure that these nurses are qualified to do this, correct?

Cathy Dinauer 13:12
Oh, absolutely. There are mandatory uniform licensure requirements that every nurse must meet in order to be eligible for a multi-state license. They have to have graduated from an approved nursing program, they have to have taken the, the National Nursing exam, they have to submit a background check. There are several requirements, there's eleven of them. And right now, in the state of Nevada just for our licensure, and we're not part of the Compact, we would match, for the most part, every single one of those uniform licensure requirements right now as it is. So, it's important that every nurse meet those requirements in order to be eligible for a multi, multi-state license.

Susan VanBeuge 13:51
And Joe, I think, too, I hope it's okay, if I jump in here, but you talked a little bit about military, right? So, the Department of Defense has also, you know, backed this Nurse Licensure Compact and, and they've had a really strong voice in this and, and I'll just share my experience. I was a military spouse for a lot of years and I was working as a registered nurse. And I was just telling Ms. Dinauer before we came in, I said, “You know, at one point, I was carrying six state licenses, because I worked and we moved so often.” In 16 years, I moved 10 times and each time I was working and going through all of those things that you have to do. At one point, I had six different state licenses that I had to pay for and maintain. And it's not just the matter of, “Oh, you pay X number of dollars to get that license,” but it's also the continuing education and all the other kinds of things that you have to do to really be cognizant of your license and also any state laws that may change in the interim and all those things that you're kind of responsible for. If the state was part of that compact, and you were going to another compact state, you wouldn't have to pay that money all over again for the reapplication. So, there's some benefits there as well. So, as a military spouse, it would have been of benefit for me and I can see that for many, and we have many military members here in our state. We have, here in Las Vegas, we have Nellis Air Force Base and we have Creech Air Force Base and up in the north, we have Fallon and many other, and I'm sorry, I've not mentioned every military base here, but we have many people in the military here in our wonderful state. So, and I think this would directly impact their family members.

Joe Gaccione 15:34
At the time that this episode drops, we will still be a few months away from the Nevada legislative session set for February 2023. What can people do? Nurses, non-nurses, where can they go to find more information about this to be more aware?

Cathy Dinauer 15:47
They can go to the National Council of State Boards of Nursing website, it's ncsbn.org. There is an icon on their website that directs you right to all the facts about the Nurse Licensure Compact, lots of information, lots of FAQs, you can go to the Nevada Nurse, our Board of Nursing website as well, and get some information there. But the National Council of State Boards of Nursing website does have a lot of FAQs.

Susan VanBeuge 16:15
I think too, after they've done that, after a nurse or, or a citizen has looked at that and become acquainted with that, I would say reach out to your elected officials and let them know what you think. We hope that you would be in support of this Nurse Licensure Compact and that you would reach out to those elected officials and tell them that you would like them to support this or maybe you'd like them to put their name on the bill as it goes forward. And stay engaged and let your voice be heard because we would like to see this go from a bill draft request to a bill and go through the whole process of the committees and end up on the governor's desk for a signature next year at the end of that session. But I think that being informed and then being engaged are probably the two biggest things that citizens and nurses can do.

Cathy Dinauer 17:06
Something I do want to mention is that this year, we did a survey of all the nurses, the RNs and LPNs in our state, to see what they thought about having the compact, and it was overwhelmingly in support. The results were overwhelming, overwhelmingly in support of a compact of 92% of the nurses in the state of Nevada, want the compact, so it is something that they want. And they are the, you know, they are the folks that we license and I think that this would be a great benefit for the nurses.

Joe Gaccione 17:36
Dr. VanBeuge. Ms. Dinauer, thank you so much for joining us today. That's all the time we have.

Susan VanBeuge 17:40
Thanks, Joe.

Cathy Dinauer 17:41
Thanks, Joe.

Joe Gaccione 17:42
For everyone out there, thank you for listening. Have a great day.

Transcribed by https://otter.ai