Nursing-shortage solutions come with licensure challenges  

Nursing-shortage solutions

The nursing shortage in the US was bad before the pandemic started. Now after the double whammy of a two-year pandemic and an aging population, it’s even worse. 

The American Nursing Association estimates that this year will see more than 100,000 unfilled nursing jobs, “more than any other profession.” 

Hospitals have traditionally brought in “nurse travelers” from outside their service areas and their states to comply with state staffing requirements. In 2000, the Nursing Licensure Compact permitted nurses licensed in one participating state to practice in other participating states. In 2018 the Enhanced Nursing Licensure Compact (eNLC) added some requirements, such as state and federal fingerprint-based criminal background checks.  

With Vermont having started implementation February 1, 36½ states and territories are eNLC participants. Ohio has joined but won’t implement participation until January 2023.  Pennsylvania and the US Virgin Islands have joined but have not yet set implementation dates. The half is Guam, which recognizes eNLC licenses but whose nurses won’t be able to apply for one until later this year. 

Interstate licensing considerations for traveling nurses 

Nurse burnouts, quits, and anticipated retirements (500,000 RNs this year) have only added to the need for hiring travelers to fill the gaps. But before you do, there are potential pitfalls to watch out for:   

  • Does your state belong to the eNLC? Does the nurse’s home state? If not, what are the licensure requirements for nurses with out-of-state licenses? 
  • If your state has passed eNLC legislation, have they implemented it yet? If not, have they set a date for doing so? 
  • If eNLC legislation is pending in your state, what’s its status? 
  • Do you have a process in place for checking and verifying out-of-state licenses? 
  • If your state is not an eNLC participant, what are its regulations regarding out-of-state licensure? 
  • What if nurses you hired as travelers join your contracted staff and move to your state? Have you a process for making sure they updated their licenses from multi-state to your state? Are the in-state licenses current? If not, you’ll have been providing patient care services without a license.  

The expanding availability of out-of-state nurses can be hugely helpful for solving short-term nursing shortages. An audit of your practices against current regulations and compacts is a great first step in determining where and how to use traveling nurses in a compliant way. 

Do you have a system in place to manage regulatory changes? Having a solution that researches and analyzes regulatory changes, translates them into model procedures, and has a top healthcare law firm validate them can really pay. Read more about YouCompli’s regulatory monitoring process or schedule a demo.  

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The Pandemic Is No Excuse: Enforcement Actions Taken by the Office for Civil Rights

We’ve known that enforcement actions were going to pick up again, even though many regulations are still waived or modified during the public health emergency. In the past few months, several decisions have been rendered by the Office for Civil Rights (OCR) which prove the point. Hospitals and other healthcare organizations need remain cautious and cognizant of exactly which regulations are being enforced, and make sure that existing procedures and policies are being followed. 

Religious Rights 

For exampleOCR resolved a complaint against Prince George’s Hospital Center of the University of Maryland Medical System (UMMS). The complaint was raised by a woman who wanted to have a priest attend her critically injured husband during the pandemic. Despite the priest’s willingness to wear any necessary personal protective equipment (PPE), he was refused entry. UMMS implemented a new policy guaranteeing “adequate and lawful access to chaplains or clergy” in order to resolve the complaint. 

second religiously-based complaint was also resolved recently by OCR. In this complaint, filed by a civil rights group, a medical student at Staten Island University Hospital (SIUH) in New York City was ordered to shave his beard, which he kept for religious reasons. The hospital stated that this was in order to ensure his N95 respirator mask had a tight seal around his nose and mouth, even though he had passed a fit test. In resolving the complaint, SIUH provided the student with a Powered Air Purifying Respirator (PAPR) as a religious accommodation. 


OCR also recently resolved a HIPAA-based complaintLifespan Health System Affiliated Covered Entity (Lifespan ACE) in Rhode Island agreed to pay OCR $1,040,000 and to implement a corrective action plan to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules related to the theft of an unencrypted laptopNot only did the laptop contain electronic protected health information (ePHI) for 20,431 individuals, OCR found systemic noncompliance with HIPAAincluding lack of encryption on laptops and a lack of device and media controls. 

A Warning for Compliance 

All these enforcement actions took place during the COVID-19 pandemic. The presence of the pandemic is not being taken as a reason for not proceeding with enforcement action. Compliance professionals need to be very aware of what regulations still apply, and how their organizations are continuing to stay within the scope of existing regulations. 

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