New Hampshire, like many states, is facing a nursing shortage. The problems associated with this shortage are often exacerbated by delays in the New Hampshire nurse licensure process principally caused by the Department of Safety’s lengthy processing time for required criminal background checks. These delays have forced health care facilities to tell prospective employees who are not yet licensed by the Board of Nursing that they cannot start working for a month or two until they receive criminal background check results. This unwelcome news leads some candidates, especially those from out-of-state, to decline employment. For those candidates who wait patiently for the licensure process to run its course, facilities are often forced to hire temporary help through staffing agencies to resolve staffing shortages at great expense.
To buy the State time to address the root cause of the delays in the criminal background check process, Governor Sununu recently signed two bills that allow nurses to practice in New Hampshire pending receipt of their criminal background check results: Senate Bills 137 and 152.
I. Senate Bill 137
Due to the shortage of qualified nurses, New Hampshire health care facilities often recruit in surrounding states. New Hampshire is a party to the Nurse Licensure Compact, which allows a nurse licensed in another compact state to practice nursing in New Hampshire after completing an abbreviated licensure process, known as “licensure by endorsement”, without having to complete the full nurse licensing process here. Unfortunately, three key states in the region—Massachusetts, Vermont, and Connecticut—are not compact states. Therefore, nurses hired from those states must seek a new license in New Hampshire and deal with the delays described above.
To solve this problem, Governor Sununu signed Senate Bill 137 which allows registered nurses (RNs) and licensed practical nurses (LPNs) who are already licensed in any of these three states to seek licensure by endorsement in New Hampshire. After an application for licensure by endorsement is filed in New Hampshire, SB 137 allows the nurse to practice in New Hampshire for a period of 120 days while the Board of Nursing processes the license and waits for the criminal background check results. The ability to practice immediately prevents out-of-state nurses from being scared off by the prospect of not being able to work at their new jobs while awaiting the results of criminal background checks, and gives understaffed facilities immediate relief. Notably, the bill does not apply to licensed nursing assistants (LNAs).
Although many industry players such as Dartmouth Hitchcock, the New Hampshire Health Care Association and the New Hampshire Association of Counties supported this legislation, the New Hampshire Board of Nursing opposed it because (a) Massachusetts, Vermont, and Connecticut all plan to introduce legislation to adopt the Nurse Licensure Compact in the next year or two, and (b) the Board was concerned about the safety of residents in being treated by nurses who have not been fully vetted by the Board. Ultimately, however, proponents of the bill convinced the Legislature and Governor that public safety will not be jeopardized because a nurse must already be licensed by one of these three states to qualify for the 120-grace period in New Hampshire.
Senate Bill 137 takes effect on August 9, 2017, and is codified at RSA 326-B:20-a.
II. Senate Bill 152
LNAs provide day-to-day care to patients in residential care settings such as assisted living facilities or nursing homes. LNAs are, by far, the hardest nurses to hire amidst the nursing shortage in New Hampshire. As a result, Governor Sununu recently passed Senate Bill 152, which is specifically targeted at getting LNAs into practice faster and avoiding the delays with the criminal background check process.
Senate Bill 152 first addresses LNAs who have graduated from their education program and are now seeking licensure in New Hampshire. For these candidates, the bill requires the Board of Nursing to grant them temporary licenses to practice so long as: (a) they have passed the New Hampshire LNA examination; (b) they are awaiting the results of their criminal background check; and (c) they have passed a criminal background check within the past 12 months as part of an approved nursing assistant education program. Once the temporary license is granted, these LNAs must practice under the supervision of a licensed RN. A temporary license lasts for 120 days or until the Board issues a permanent license, whichever is sooner.
Senate Bill 152 then addresses LNAs who have been given an offer of employment by a licensed health care facility in New Hampshire, but who are awaiting the results of their criminal background check. For these nurses, the bill allows them to practice for up to 90 calendar days on a conditional basis so long as: (a) they practice under the direct supervision of a licensed staff person; (b) they have passed a criminal background check within the past 12 months as part of a nursing assistant education program approved by the Board of Nursing; (c) they have provided the facility with a copy of the criminal background check conducted within the prior 12 months; and (d) they have provided a written attestation to the facility that no disqualifying criminal history exists. This 90-day period allows LNAs to start working immediately and not wait for the results of their criminal background checks.
Senate Bill 152 takes effect on September 3, 2017, and will be codified at RSA 151:2-d, III and RSA 326-B:24, III. Interestingly, however, this bill is only effective for two years. This temporary measure was put in place to give the State time to resolve the delays in the criminal background check process.