A Comparison of Discipline Between Nurses Holding a Multi- or Single-State License

Abstract

Background The Nurse Licensure Compact (NLC) is a modernized licensure system designed to facilitate nurse mobility in a safe and standardized way. It has demonstrated particular usefulness during the COVID-19 pandemic and other emergencies, allowing nurses to practice where they are needed without the time and cost burdens of obtaining multiple state licenses. In 2018, uniform licensure requirements were added to the NLC to strengthen the requirements for a multistate license. Nevertheless, some states have been reluctant to join the NLC, expressing safety concerns. Purpose The National Council of State Boards of Nursing compared the discipline rates of multistate license holders to nurses holding single-state licenses. Methods This cross-sectional study used discipline data from the calendar year 2019, which was chosen because it contained the most current pre-pandemic data. Discipline cases among nurses with and without a multistate license were evaluated. Using the national Nursys database, we compared discipline rates and types of violations leading to disciplinary actions by 33 NLC Boards of Nursing (BONs) and 24 non-NLC BONs. Results The overall discipline rates of nurses in NLC and non-NLC states were virtually identical (0.24% versus 0.23%). However, a further breakdown of the data revealed the annual discipline rate of nurses holding single-state licenses across both non-NLC and NLC states was between two to four times higher than the rate of multistate license holders. Conclusion Multistate license holders’ consistently low discipline rates hold across all available demographic categories, suggesting the overall safety of the NLC. The Nurse Licensure Compact (NLC) is a modernized licensure system designed to facilitate nurse mobility in a safe and standardized way. It has demonstrated particular usefulness during the COVID-19 pandemic and other emergencies, allowing nurses to practice where they are needed without the time and cost burdens of obtaining multiple state licenses. In 2018, uniform licensure requirements were added to the NLC to strengthen the requirements for a multistate license. Nevertheless, some states have been reluctant to join the NLC, expressing safety concerns. The National Council of State Boards of Nursing compared the discipline rates of multistate license holders to nurses holding single-state licenses. This cross-sectional study used discipline data from the calendar year 2019, which was chosen because it contained the most current pre-pandemic data. Discipline cases among nurses with and without a multistate license were evaluated. Using the national Nursys database, we compared discipline rates and types of violations leading to disciplinary actions by 33 NLC Boards of Nursing (BONs) and 24 non-NLC BONs. The overall discipline rates of nurses in NLC and non-NLC states were virtually identical (0.24% versus 0.23%). However, a further breakdown of the data revealed the annual discipline rate of nurses holding single-state licenses across both non-NLC and NLC states was between two to four times higher than the rate of multistate license holders. Multistate license holders’ consistently low discipline rates hold across all available demographic categories, suggesting the overall safety of the NLC.