There aren’t any quick solutions to the state nursing shortage. There aren’t even any easy entry points. But state politicians are pressing for a roadmap nonetheless.
In April, then-Gov. Maggie Hassan, D-Newfields, ordered a commission studying workforce shortages throughout the health care industry. Health care experts were drawn in from colleges, hospitals and health care organizations, meeting monthly through the year. A report was released Dec. 21, with a range of recommendations.
Now, with a new legislative session underway, two state senators, Jay Kahn, D-Keene, and Jeff Woodburn, D-Dalton, say they’re homed in on one improvement: improving licensing time for new nurses.
The process to become licensed is two-fold. After candidates to be licensed nursing assistants (LNA), licensed practical nurses (LPN) or registered nurses (RN) pass the national nursing exams, they must apply to the New Hampshire Board of Nursing, as well as arrange for criminal background checks with the State Police Criminal Records Unit.
It’s those background checks, health care experts say, that cause the longest delays.
In an Oct. 25 written submission to the governor’s commission, Kathryn Kindopp, administrator of Maplewood Nursing Home in Westmoreland, said the licensure delays are a key part of the overall nursing shortage.
Maplewood, like other nursing homes, relies on lower qualified nursing positions like LNAs — which require an eight-week course — Kindopp explained in the letter. But after passing the test, the time it takes for the background checks to clear can deter many from actually following that career path, Kindopp wrote.
In the weeks and months they wait to be licensed, the aspiring nursing assistants will often seek other jobs in the service industry to pay the bills, Kindopp said. After time, many realize that the those temporary jobs pay the same as or better than the nursing positions they seek, she explained. Many eventually choose to stay in those other jobs, abandoning their path into health care.
As a result, Maplewood and other local clinics suffer.
“The payment structure of our system under rewards good people who care for our vulnerable population,” she said. She added that neighboring states have simpler licensing processes, creating an incentive for some nurses to seek work across the border.
Kindopp’s arguments were persuasive. In its December report, the governor’s commission dedicated a section to improving licensure, calling for a streamlined application process and better reciprocity with other states to encourage nurses licensed in other states to come into New Hampshire.
Kahn, elected to his first term in November, said he hopes to follow through on those recommendations. He said he plans to introduce legislation to improve state-to-state licensing.
But agencies overseeing licensing and background checks say the problem is more complicated than simply pushing the applications through bureaucracy faster.
Joseph Shoemaker, director of the New Hampshire Health Boards, said his department already processes the licensing applications as quickly as possible.
The real problem, he said, are the background checks. It takes the Health Boards no more than a week to process an application; it can take the state police over four weeks to turn around a background check, he said.
Applicants must give state police two pieces of information: a written form and fingerprints. That fingerprinting process causes the biggest delay; fingerprints must be collected by a state agency electronically, a process that requires booking an appointment far in advance.
Jeffrey Kellett, chief administrator of the State Police Criminal Records Unit, understands the concerns with delay. But Kellet said his office provides as many criminal background checks as it can: Last year they conducted about 250,000 checks in total.
The records unit already operates six independent checkpoints to collect those fingerprints. Applicants around Keene can go to the Troop C Field Operations Office to submit theirs.
Kellett said that in recent years, legislators have added laws so that more categories of state employees require background checks, adding to the already overloaded backlog. Every year, he said, two to five such laws are passed.
Also slowing down the process: Police must conduct two separate checks — one against state criminal records databases, and one for national crimes, with the FBI.
Kellett said his office is planning to reallocate resources to address the worsening bottleneck in background check applications this past year.
In the meantime, one senator is focusing on a quick fix. Kahn’s colleague Woodburn, the second-term N.H. Senate minority leader who has already drafted a bill to allow those waiting for their criminal background checks to be given temporary licenses to start working under close supervision.
For Woodburn, streamlining background checks isn’t the end-all solution to the nursing shortage. But it is a start.
“A lot of us believe that this is the low-hanging fruit that will be successful,” Woodburn said. “Obviously there’s a 100 other things we can do, but success is critical.”