Even as hospitals across the country struggle with staffing shortages, many nurses are prevented from entering the workforce due to licensing delays—which can sometimes stretch for months, Austin Fast writes for NPR.

Some nurses are waiting months for their licenses

According to federal data, one out of every four hospitals nationwide faced critical staffing shortages during the recent omicron surge—a situation that was exacerbated by backlogged license applications that kept many nurses from entering the workforce.

For instance, an NPR analysis of licensing records from 226,000 nurses in 32 states found that more than a third waited at least three months to get their licenses, and almost 10% waited six months or longer.

Morris Kleiner, a licensing expert who researches labor economics at the University of Minnesota, called the delays "huge bottlenecks" that mean patients will "have much less access and will have to wait longer when they are asking for the services of nurses," particularly during a pandemic. He added that these delays could result in sicker patients or even deaths.

In addition, several nurses have reported losing out on job opportunities due to licensing delays. For example, Kaede Fujiwara, a nurse from Virginia, said it took more than five months for her to get a license, and only after she asked a state delegate to contact the nursing board on her behalf. Due to the delay, a local hospital rescinded its job offer and moved on to more available nurses.

"It's frustrating. It's disappointing. It's exhausting," Fujiwara said. "I'm embarrassed, you know? I'm a nurse, and I'm unemployed in a pandemic. Like, what kind of an excuse is that?"

Why nurses get 'stuck in licensing limbo'

It takes time to review license applications since nurse boards typically  verify nurses' education, run criminal background checks, and wait for new graduates to pass a national exam, but many nurses get "stuck in licensing limbo" due to simple mistakes. According to Fast, these mistakes include misplaced files, miscommunication between different states, and missed or ignored emails, and can result in a nurse's application being marked incomplete and stretch out the process much longer than needed.

"Each time there's a discrepancy or you give them a call about the discrepancy, they do not review your application again for almost two weeks, so you're placed back in the queue," said Lynn-Marie Charles, a nurse practitioner who teaches nursing at a Philadelphia-area community college. "And when your number comes up again, someone will review your application. It's just a waiting game."

Some nursing boards, including Alaska, Georgia, and Texas, have also blamed slow processing times on staff shortages, increased workloads, and remote work. In fact, many states saw thousands more applications in 2021 compared to 2020 as the use of travel nurses became more prevalent.

Another potential issue is that nurses who are already licensed in one state must apply for a new license when they move to a different state, Fast writes. Currently, the Nurse Licensure Compact (NLC), which covers 35 states and Guam, allows nurses to take short-term jobs in other states without going through another lengthy licensing process, but several states with the most nurses, including California, New York, Illinois, and Massachusetts, have not joined the compact.

According to Fast, many nursing boards and unions have not joined the compact due to concerns about losing licensing fees, which often make up most of boards' funding. Some states, such as California, said the compact would prevent the state from ensuring nurses meet certain educational standards before they are licensed.

Reeny Pereira, who had to reapply for her license when she moved to Pennsylvania, which is not part of the NLC, said she waited five months for a new license. In the future, Pereira said if she moved, she would "definitely see if that state is a compact state, which is a little bit easier to get a license."

How to improve the nurse licensing process

According to Fast, digital tools, such as online portals, digital fingerprints for background checks, and more, could help many states streamline their licensing processes.

For example, Vermont adopted an all-digital licensing process several years ago, which includes a centralized, online customer service system that allows employees to send and receive messages from applicants who have questions.

"Frequently, we're processing RN endorsement applications within 45 minutes of them being submitted," said Lauren Hibbert, who directs Vermont's Office of Professional Regulation. In addition, nurses who moved to the state last year were able to get their licenses in as little as one day, Fast writes.

Although Vermont only handles a fraction of applications compared to larger states like California, New York, and Texas, Hibbert said digitalization and cross-training staff should help reduce licensing delays in larger states, too.

"Having those licensure applications move quickly through the system—having your potential workforce be unlocked faster—is in the entire state's interest," Hibbert said. "Everyone is experiencing staffing shortages. The faster we can get a nurse into the system, the better." (Fast, NPR, 3/10)