Six months after she'd moved from Florida and applied for her license, the state board told her would-be employer that Gramm still hadn't submitted her college transcripts. Many delays are caused when simple mistakes lob a wrench into the gears of the machine: misplaced files, bad communication between states, and emails missed or ignored.Ĭourtney Gramm, the nurse practitioner in California, was rattled when her new boss threatened to retract her job offer. The remaining boards denied NPR's request - citing state privacy laws or claiming they couldn't provide application dates - or they requested fees, including Georgia, which demanded more than $434,000 to provide the records. We calculated each nurse's total processing time, along with averages for the 32 states that provided records.
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NPR asked every state nursing board in the country for records showing when nurses submitted an application and when their license was issued over the last three years. "Your mother, your father, your grandmother, your grandfather are not going to get the level of care that they should have if staffing were appropriate." We add to that the frustration of not being able to get your license," Snook says. Plus, they typically last just a few months.īetsy Snook, CEO of the Pennsylvania State Nurses Association, says her team has fielded dozens of requests per week from nurses desperate for help. It's an additional cost, and many nurses don't apply for them. Some states have tried to mitigate these delays by issuing temporary licenses, which can get nurses working as boards process their applications. Early retirements and employee burnout have already chipped away at the nursing workforce, and backlogged license applications can exacerbate shortages by keeping eager replacements off the front lines. Two years of the pandemic have pushed health care workers to the brink, with federal data showing that critical staffing shortages plagued 1 of every 4 hospitals nationwide through the omicron wave.
One reason is that nursing boards make most of their money, sometimes tens of millions of dollars, from licensing fees. Several large states have refused to join an interstate agreement that allows nurses to use licenses across state lines - sort of like a driver's license lets you drive across borders.
Many state boards don't count that lost time when measuring how long it takes to process an application. But nurses NPR spoke with described scenarios where they spent weeks or longer arguing that their applications were in fact complete. NPR's investigation found that states often start the clock on processing times only after an application is marked complete.
More than a third of these 226,000 registered nurses and licensed practical nurses waited at least three months. Almost 1 in 10 nurses who were issued new licenses last year waited six months or longer, according to an analysis of licensing records from 32 states.An NPR examination of license applications found that nurses fresh out of school and those moving to new states often get tangled in bureaucratic red tape for months, waiting for state approval to treat patients.
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