I am writing to you on behalf of our collective team. We have read some of your previous letters and replies on the topic of telehealth nursing across state borders. We agree with your stand that we are practicing nursing in whatever state the patient is located on the other end of the phone. In reviewing almost every states nurse practice act, it appears once you identify yourself as a nurse you had better hold a license in that state or be part of the compact if applicable. If not, in providing the services we have been hired to do, it seems we would be in violation.
Our concern revolves around our employer and its unwillingness to take our concerns seriously. Some of the nurses have voiced that we need to be licensed in all 50 states because of the possibility that a patient can be located in any of them. We have no control over which calls we take. Additionally, we have provided feedback from various state nursing boards in writing, which states we cannot practice telehealth in these state without licensure.
The company we work for is only willing to provide reimbursement for seeking licensure in 18 specific states, but requires us to speak a patient in any state or says it will breach our policy.
Our concerns have been taken up to the legal department with the supporting documents and they continue to state that they have done their due diligence regarding our concern but they do not feel we need to be licensed in every state. We have asked if they can provide us with supporting documentation and a policy that supports it. Weve been told there isnt anything in writing, but we should have faith in our legal department in having done its due diligence.
We are desperately seeking your input as our licenses and our livelihood seem to be on the line. Paying for the remaining licenses is not an option for many of us or that would be an easy way to fix it. What other avenues can we explore to avoid jeopardizing our nursing licenses?
Dear Nancy replies:
There is no doubt, as you have discovered with your research and by contacting several boards of nursing, one cannot practice nursing in a state in which one does not hold a valid and current license, either through individual licensure in that state or through a declared multistate license to practice in any and all states that are part of the Nurse Licensure Compact. There is simply no alternative to this basic fact.
It is commendable that your employer is willing to pay for your licenses in 18 states. Despite the financial difficulty in having to pay for other state licensure fees yourself, it is your only option at this point insofar as practicing nursing legally in those states.
You indicated that you are required to speak with any patient in any location or if you do not, you will be in breach of the employer policy. Although no one wants to be the first to challenge the policy, it may be that one or more of you will have to do so and then challenge the repercussions of the breach.
Another issue to evaluate is if any of the state nurse practice acts, other than the 18 you are licensed in, includes any prohibition of an employer hiring someone who does not have a license in that state and, if so, what are the ramifications for the employer. For example, the act may clearly prohibit an employer, whether a firm, a corporation or an individual, from hiring a nurse to practice nursing without a current license in that state. The penalty for doing so is often a misdemeanor, but other penalties may exist.
If your employer is found to be in violation of employing nurses not licensed in a specific state, especially with the probability of a large number of employed nurses providing nursing services without a license in that one state, it would be financially problematic and very poor press for the employer. Think about the effect on the employer multiplied in all of the states that contain the same language in their respective acts, but for which the prohibition is ignored.
As a collective team, you may want to consult with a nurse attorney or other attorney in order to obtain specific advice about this issue. Once it is carefully evaluated, the employer’s legal team could be approached by the attorney in the hopes that a resolution, albeit based on the potential liability for the employer supporting unlicensed practice, can be obtained.