It isn’t the end-all solution to the nursing shortage, advocates say — but it’s a start.
Two bills passed by the N.H. Legislature last week are being hailed by local and state health care officials, who say the policies could reduce licensing hurdles for new and out-of-state nurses.
Officials say the bills, which were co-sponsored by Sen. Jay V. Kahn, D-Keene, will help New Hampshire health care facilities attract more nurses by easing some of the regulatory entry burdens that can discourage them from the profession.
One bill, Senate Bill 152, addresses mandatory criminal background checks for recent graduates of licensed nursing assistant (LNA) programs. Health care administrators say those checks can take weeks and even months to clear through state agencies, putting many graduates into a frustrating limbo.
The new legislation would allow graduates to start nursing jobs while they wait for their background checks, provided they’re supervised by a licensed nurse and already passed an earlier criminal background check at the start of their LNA program.
A second bill, Senate Bill 137, would ease the transition process for those from neighboring states seeking to work in the Granite State. The bill would allow the New Hampshire Board of Nursing to accept licenses from Vermont, Massachusetts, New York and Connecticut through a simplified process called endorsement. Presently, nursing candidates from those states must undergo a lengthy application process to earn their New Hampshire credentials.
“This is really good news,” said Kahn of the bills’ passage. “This is a really good outcome.”
The bills, which each passed by voice vote last Thursday with bipartisan support, will now head to Gov. Chris Sununu, R-Newfields.
Sununu spokesman Ben Vihstadt said Monday the governor is reviewing the bills and will decide whether to sign them when they reach his desk.
Advocates say the legislation would provide much-needed relief to a growing statewide problem.
Already grappling with a rapidly aging population and a heroin and opioid crisis, New Hampshire’s nursing homes and care facilities are struggling to fill nursing positions amid plummeting interest in the profession.
Training opportunities, once plentiful, have become scarce, requiring long drives by interested candidates. Low Medicaid reimbursement rates for nursing homes have depressed salaries in New Hampshire, eroding the job’s appeal even as the industry overall remains a reliable source of employment. The low pay and the long waits caused by licensing requirements have driven some across state lines for better options, or into other careers entirely.
And the shortfall has had wide ramifications, affecting bed counts in the state psychiatric hospital and wait times in emergency rooms. In the Monadnock Region, 229 nursing positions across 16 facilities have been left unfilled, Cathy Gray, CEO of Cedarcrest Center for Children with Disabilities in Keene, said late last year.
Last December, an eight-month commission by then-Gov. Maggie Hassan, D-Newfields, released a report looking into the problem and making recommendations for action.
And a local group of stakeholders, the Monadnock Region Healthcare Workforce Group, has met since late 2015 to discuss the employment shortages and lobby legislators.
Both groups recommended legislative changes to modify out-of-state licensing procedures, known as reciprocity, and ease the burdens caused by the criminal background check system.
Now, health care administrators say they’re satisfied with the bills that have emerged.
“I think that both are going to really make a difference,” said Gray, head of the Monadnock workforce group.
Cedarcrest frequently hires out-of-state nurses, but has often struggled to retain them, Gray said. The applicants, newly hired, move to New Hampshire and begin applying to the state to transfer their credentials. But the slow pace quickly discourages them.
“We’ve had people that got frustrated and pulled their application,” Gray said, adding that the low staff levels have created operational hardship.
Kathryn Kindopp, administrator for Maplewood, the county-owned nursing home in Westmoreland, also praised the new legislation. Kindopp, who had presented a written submission to the governor’s commission in support of change, criticized the present system as inefficient and dangerous to the state’s health care system.
“If you have trained to be a nursing assistant, and have completed all necessary requirements, including the exam and initial criminal background check, you will reasonably expect to begin your work and start earning a paycheck,” she said. “Our state is not in the position to take this situation for granted and possibly lose a trained health care worker — particularly due to lengthy administrative burdens.”
Brendan Williams, president and CEO of the New Hampshire Health Care Association, which represents nursing homes and other facilities, said that the licensing reciprocity policy would be beneficial to making the state attractive.
New Hampshire and Maine are already part of a reciprocal agreement with other U.S. states — the Enhanced Nurse Licensure Compact, which the state joined in 2016. But that agreement does not include any nearby states beyond Maine, which Williams said puts New Hampshire at a competitive disadvantage. The provisions in Senate Bill 137, Williams said, would even the scales.
“I think they’re great bills,” Williams said. “New Hampshire has been a really tough state to get licenses.”
For Kahn, the bipartisan success of the legislation is a welcome surprise.
His colleague Sen. Jeff Woodburn, D-Whitefield, a co-sponsor of Senate Bill 152, said the political calculus for the Legislature was simple.
“If you have an employer that wants to hire an employee, you don’t want to get in the way,” he said. “You want to get them working.”
But despite some alleviation provided by the bill, Williams said the main inhibitor for New Hampshire’s nursing industry is the low pay. As long as the state’s low Medicaid reimbursement rates strain nursing home budgets, wages will stay low and facilities will have trouble recruiting talent.
It’s an assessment Kindopp agrees with.
“This (legislation) is like a pressure release valve,” she said. “It does release some of the strain, but the pressure is still building.”