Labor unions push back on proposal to allow licensure reciprocity for nurses

Lawmakers’ desire to remove barriers to entry for out-of-state nurses considering working in Nevada is clashing with labor unions who say it will only exacerbate the subpar conditions instituted by their employers.

Assembly Bill 108 would enter Nevada into the Nurse Licensure Compact (NLC), which allows nurses in participating states to practice across state lines.

The Nurse Licensure Compact has been operational for more than two decades, and 37 states currently participate. Nevada neighbors Arizona, Utah and Idaho are already in the compact. California and Oregon are not.

Under the compact, registered nurses and licensed practical nurses are licensed by their state of residency but can opt into a multi-state license that allows them to practice in other participating states without the burden or delay of applying for a second license.

Proponents of the compact say it allows hospitals and other facilities to easily bring in additional nurses during times of emergency. During the covid pandemic, then-Gov. Steve Sisolak issued an emergency directive waiving the requirement for nurses licensed in other states to obtain a temporary license to work in Nevada. More recently, in December, the Nevada State Board of Nursing fast-tracked the process for receiving a temporary nursing license. At that time, pediatric units were strained by a high caseloads related to RSV, flu and covid.

The NLC is also particularly useful for nurses who live in cities or towns near a state border and military spouses who may relocate often.

“Nursing is becoming an increasingly mobile profession,” said Democratic Assembly Majority Leader Sandra Jauregui, who presented the bill to the Assembly Committee on Commerce and Labor on Friday. “Nevada should make it as easy as possible for nurses to come here in our times of need, and also for Nevada nurses to help in other states to meet their own professional and family needs as they arise.”

A letter submitted by the Interstate Commission of Nurse Licensure Compact Administrators, which regulates the compact, states the compact “does not purport to alleviate a state nursing shortage” and is intended only to “enable nurse mobility” during extreme times of shortage.

But many supporters referenced Nevada’s extreme overall shortage and suggested Nevada needs to use every tool available to them. Jauregui said the state needs to recruit more than 5,000 registered nurses just to meet the national average.

The Nevada Hospital Association has long pushed for the state to enter the NLC.

The Nevada Nurses Association is supporting the bill. The organization previously opposed the compact but in December began signaling support, which they attributed to changes like adding background checks which they said addressed their concerns.

Other supporters of joining the compact include Sunrise Hospital, the Nevada Health Workforce Research Center, and the Nevada Rural Children’s Mental Health Consortium.

But the compact faces strong resistance from labor unions affiliated with the AFL-CIO that say joining the compact benefits hospitals over workers, undermines collective bargaining, and fails to address bigger problems like patient-to-nurse ratios.

“We need to be discussing working conditions,” said Grace Vergara-Mactal, executive director of SEIU 1107, which represents more than 8,000 nurses and health care workers in Nevada. “Right now the grueling working conditions of nurses is the number one barrier to addressing the nursing shortage. Often our health care members are working 12 to 14 hours a day and seeing 10 patients an hour.”

She continued by calling out the operator of Sunrise, Mountain View and Southern Hills hospitals in Las Vegas: “When hospitals like HCA are bringing in $5.6 billion — with a B — in profits yearly there is no reason HCA should be staffing 34% below the national average.”

Renee Ruiz of National Nurses United, which represents approximately 3,000 nurses in Nevada, told the committee that compact states were not better off during the covid pandemic than Nevada.

“We were all beholden to these very expensive agencies that took more than 10 days, two weeks, to bring nurses,” she said. “(The compact) does not help. What helps is employers who want to work with nurses and who want to improve conditions and improve patient care.”

Ruiz pointed out nurses have been laid off across Nevada.

“We have nurses who do not want to go back to the bedside because of conditions set up by their employers that make it impossible to be a healthy nurse in Nevada.”

Opponents argued the compact enables hospitals to circumvent labor strikes by quickly bringing in cheaper labor from other states. Health care unions are required to give 10 days notice before striking.

Jauregui has proposed an amendment to require all major hospitals to provide new full-time nurses with union information and request that they meet with their union representative. In her closing comments, she stuck to her position that AB 108 is not intended to hurt collective bargaining rights.

AB 108 is not the only compact bill being considered by the legislature this session. Assembly Bill 158 would have Nevada join an emergency medical services (EMS) compact, Senate Bill 97 would have Nevada join a physical therapist (PT) compact, and Senate Bill 442 would have Nevada join a teachers compact.

The EMS compact bill passed out of the assembly commerce committee. The PT and education compact bills have both received hearings but have not advanced out of their respective originating committees.

The assembly commerce committee took no action on AB 108 Friday.

Other health care bills heard

AB 108 was one of a trio of nursing bills presented by Jauregui to the Assembly Committee on Commerce and Labor on Friday.

Assembly Bill 401 would allow schools of nursing to increase their student-to-teacher ratio to 11-to-1. Schools are currently capped at eight students per teacher. Jauragui said the bill would be amended to make clear that schools are not obligated to enroll at the maximum ratio. She acknowledged she is working with Nevada System of Higher Education institutions on “concerns” they have.

Assembly Bill 445 would expand the types of higher education institutions where students may use the Millennium Scholarship to include those with accredited clinical programs.

Jauregui told the committee that no one bill can fully address the nursing shortage but that each bill works toward the same goal of getting more licensed nurses in the state.

“In addition to these bills, yes, we need to pay our nurses more and find additional ways to support them,” she added. “One solution is not going to solve our nursing shortage. This is an all-of-the-above approach to tackle this problem and ensure we stabilize and support Nevada’s health care system.”

A fourth bill, Assembly Bill 270, presented Friday by Assemblywoman Elaine Marzola (D-Las Vegas), would authorize certified anesthesiologist assistants (CAAs) to practice in Nevada. Currently, 21 states and U.S. jurisdictions certify anesthesiologist assistants. CCAs are highly trained practitioners who have graduated from master’s degree-level programs typically housed within medical schools, similar to a physician assistant.

They work under the supervision of a supervising anesthesiologist. According to the American Society of Anesthesiologists, CAAs are clinically interchangeable with nurse anesthetists, which already practice in Nevada.

Marzola told the committee allowing for the new type of licensure would help the state’s overall medical provider shortage.

Dr. Scott Parkhill, chairman of the anesthesiology department at Renown Medical Center in Reno, said that the hospital currently has approximately 60 anesthesiologists on staff and that staff is “dedicated to serving our community” but “severely overworked, leading to both recruitment and retention challenges.”

“We are actively recruiting up to 12 anesthesia providers, increasing our current workforce by about 20%,” he added in his letter of support for the bill.

The bill saw no opposition testimony.

Several Nevada graduates now licensed as anesthesiologist assistants in other states testified in support of the bill, saying it would allow them to return home.

The Assembly Committee on Commerce and Labor took on no action on any of the health care bills. April 14 is the deadline for passing most bills out of their originating committee.