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pay fees to individual states, though nurses from other states may be working in their state. Currently, boards set their own fees, with some higher and some lower. In addition, nurses may have financial incentive under compact licensure to "shop around" and get licensed in a state that has lower fees. While this change appears to benefit the nurse, it hurts the overall financial health of nursing boards and there- by jeopardizes their ability to pro- tect patients. NCSBN would like to control nursing licensure, but still wants individual state boards to be responsible for investigation and discipline of RNs. If more and more states join the nurse license compact and pay their fees to the NCSBN instead of their own state boards of nursing, it's unclear how the boards will secure funding to do this important work. "Many compact states charge less than half the licensure and renewal fees that Minnesota nurses pay," said Ross during her hearing testimony. "But the bill provides no direction for how the board of nursing would continue to super- vise, investigate, and sanction its own Minnesota licensees following the significant decrease in funding from licensure and renewal fees. This bill would result in delays or even gaps in complaint investiga- tions as board capacity decreases, which endangers the public." On the flip side, what happens if, after everyone has joined the compact, the NCSBN decides to dramatically increase licensing fees for multistate licenses? Nurses would be at the mercy of whatever amount the organization decides to charge, with no recourse. Because compact licensure makes it so much easier to move from state to state, union nurses also oppose it because it helps employers bring in out-of-state traveler nurses to break strikes and lessen the impact of their decision to withhold their labor. Ross also pointed out that it potentially hurts new nurse graduates from finding jobs in their home states because employers might prefer to just hire travelers to fill empty positions. Portability and convenience should not be the overriding factors in granting someone permission to intimately care for and perform medical interventions on a patient, said Oliver. She objects to the driver license analogy that NCSBN uses because, first, "driving is a lot different than taking care of sick people." (Not to mention that permission to drive in states not your own is usually temporary.) Second, she points out that some states, such as her home state of Maine, do have more stringent requirements for drivers than other states. For example, drivers in Maine must get an annual inspection and endorsement that their vehicle is road worthy. That means no cracked windshields, no bald tires, solid brake pads, proof of insur- ance, the list goes on. In stark contrast, her son is attending college in Florida and recently texted her a photo of a car he was driving behind that had its entire bumper held on with duct tape and twine. He was a little amused, but at the same time worried because he was not sure if the bumper would fall off and hit him. Yes, because Florida had lower standards for what cars could be out on the road, this other driver was endangering her son. The same goes for nurses. "In Maine, we get a fair amount of travelers, and their skill levels are often varied, depending on what state they come from," said Oliver. "And you can tell." Ultimately, what is most disturbing about the nurse licensure compact is the way it will fundamentally change who gets to decide who can work as a nurse, and what that job even entails. If all the states eventually join the compact, it will be the NCSBN Interstate Commission calling the shots on all nursing rules and regulation, nationwide. State boards of nursing will become obsolete. The pow- ers that used to be held by public bodies run by public officials, con- ducting business within the state at a public meeting that a nurse could, ostensibly, attend, will be transferred over to a private board formed by a private organization accountable only to its private board of directors. While it is true that the Interstate Commission will be composed of the heads of state nursing boards, the commis- sion itself is not technically a public body. Currently, the commission is only obligated to meet once a year, and states its meetings will be open to the public with public notice of gatherings, but there are also many loopholes for subjects that can be discussed in closed ses- sion. The commission and its meetings will be much less accessible to nurses than their own state boards of nursing, many of which cur- rently hold meetings in various parts of their states to make it possi- ble for interested nurses to attend. National Nurses United members are also wary of how compact licensure changes what it even means to be nursing, mainly by accel- erating the adoption of telenursing or remote nursing. Can you fully assess a patient that you cannot touch or smell? Are you really com- pleting all the components of the nursing process if you can only see your patient on a screen and are physically located 1,000 miles away? Lowering labor costs is one of the top goals of corporate healthcare employers. Why hire you to do a job that a nurse in another state with lower wage standards will do for $25 less per 16 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G M A R C H | A P R I L 2 0 1 8 States with enacted enhanced NLC legislation