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US States Implement Emergency Measures to Recruit Staff

The majority of US states have made emergency provisions to waive or ease licensing requirements to meet the challenge of nursing shortages created by the COVID-19 epidemic. As the number of cases has escalated to hundreds of thousands across the country, a state of disaster has now been declared in all US states. Most are implementing various, previously unimaginable, measures to ensure adequate staffing of hospitals and other health care facilities. Provisions in various states are changing daily. Nurses or nursing students who are prepared to assist in the hotspot areas, or to provide telemedicine services across state lines, are advised to visit the websites of the relevant state boards of nursing.

Legislative provision for changes in licensure requirements

Nurses in the 32 states which are already part of the Nurse Licensure Compact already hold multistate licenses and these states are experiencing fewer challenges in recruiting nurses from other states. Some of the states currently hardest hit by COVID-19, including California and New York, have however not joined the NLC. Here governors have issued executive orders to temporarily waive or ease licensing requirements to enable health care facilities to recruit and employ additional staff. The Emergency Management Assistance Compact (EMAC), which was ratified by Congress and adopted by all states, makes allowance for this. Even in some NLC compact states executive orders have been issued to ease licensing requirements for nurses who are inactive or retired, those who qualify for but are waiting take the NCLEX, and even to make allowance for student nurses to work in health services.

Nursing Licensing waiver for COVID-19

To date over half of US states have waived licensing requirements for nurses who hold a valid license from another state. Many do however require nurses, or their employers, to apply for a permit. The validity of these permits varies between states and can be anything from 30 days to the duration of the state of the emergency. Some states have limited the practice of these nurses to COVID-19 response, while others are allowing nurses and advanced nurse practitioners to go beyond their scope of practice. In Washington, California and South Dakota applicants need to register as volunteers on state-wide systems. In other states, nurses need to register with the state board of nursing so that their licensing status can be verified. EMAC advises anyone who accepts work in another state in response to the emergency situation to carry a copy of their valid license and certifications as this may be required by the healthcare facility for insurance purposes. A number of states have not fully waived licensing requirements for out-of-state nurses but have implemented measures to expedite licensing, often within days. A state board of nursing might, for example, issue the temporary license before completing the full background checks.

Recruiting inactive and retired nurses, student nurses

There are also states who are making exceptions so that inactive and retired nurses can return to work quickly. Depending on the state, temporary emergency licenses or permits can be issued even though the person does not meet the usual practice and/or continuing education requirements. A reduction or a waiver of the normal licensing fee might also apply. Some provisions apply only to those who have not been out of nursing for more than five years and, in other instances, practice is limited to COVID-19 patients. Many states have also indicated that should nurses’ licenses expire during this time, they would remain valid for the duration of the crisis and generally for a period after the state of emergency has been lifted – usually 30 days. This mostly also applies to the graduate permits of nurses who have been issued with an authorization to test by their state board of nursing but are unable to take the NCLEX exam due to cancellations. Furthermore, a few states have made plans to bring student nurses on board. In California, student nurses can join the volunteer Health Corps. In Idaho, nursing students who have completed a “fundamentals of nursing” course can apply for a Nurse Apprenticeship program and may use the hours worked towards their clinical practice hours.

Rapidly changing requirements

The responses of different states to meeting staffing needs for the COVID-19 pandemic will most likely continue to change rapidly as the disease spreads to different areas. The National Council of State Boards of Nursing is providing a regularly updated spreadsheet, “State response to COVID-19” which provides a summarized overview for each state. Visit the website of the relevant state board of nursing for details on whether you need to apply for a temporary license or permit, and how to apply if necessary.


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