The Hawaii-American Nurses Association (Hawaii-ANA) is the state’s premier professional nursing association, speaking for the 15,000-plus registered nurses who live in Hawaii. We have concerns that the message in the commentary by the Grassroot Institute of Hawaii (“Expand interstate licensure compacts,” Island Voices, Nov. 29) assumes all state licensure compacts are the same, when in fact, they are not.

While we agree the Interstate Medical Licensure Compact (IMLC) has promise based on its model design, the Nurse Licensure Compact (NLC) model is dramatically different and its risks and expense far outweigh its benefits.

The IMLC is based on a reciprocity model where multistate physicians practicing in Hawaii will have a Hawaii state license and the state Department of Commerce and Consumer Affairs will keep its oversight for individual physicians and workforce data, necessary to fulfill its purpose to protect consumers of healthcare in Hawaii. The NLC model, however, is based on a mutual recognition model. Multistate licensed nurses from other states could practice in Hawaii without a Hawaii License, increasing risk for nurses engaged in unprofessional conduct in other states practicing here unbeknownst to our Hawaii public protection agencies.

In addition to public safety issues under the NLC, Hawaii would lose invaluable workforce data about nurses working here, a key component for advancing workforce recruitment and retention. Nurse state practice acts and state laws on licensing and certain practices, particularly around women’s reproductive health, would also be affected and the lack of clarity and conformity on all these issues puts nurses and the public at risk.

The fiscal impact of the NLC in Hawaii is extreme and would result in an annual revenue loss of over $1 million not to mention the steep costs to reconstruct the governing licensing bodies to assume new NLC licensing laws, as well as alternative administrative measures to protect the public due to loss of oversight. Of even more importance, there is a serious risk of Hawaii nurse outmigration to lower cost mainland states.

The interstate compacts exist to expedite license portability, but the NLC has been touted as a solution to the nursing shortage. There is no evidence to show that more nurses would be available through the NLC.

The 2023 Hawaii Legislature tasked stakeholders to examine the NLC proposal as a solution to the Hawaii nursing shortage; however, the root causes of the shortage are multifaceted and will not be solved by fixing license portability alone.

Hawaii nurses respect the Legislature for examining changes in our laws and regulations to protect the integrity of our health-care delivery system. The Grassroot Institute of Hawaii would do well to join us in respecting the process and refrain from touting simplistic blanket solutions to problems plaguing our health-care system.

There are efforts underway to expedite nurse temporary license portability and shorten the application process such that nurses can readily be available to practice once a local employer hires them. By resuming the issuance of temporary permits, licensing delays that affect employers’ ability to recruit nurses from out of state would be mitigated without any of the costs, risks and licensing infrastructure deconstruction over the several years it would take to implement the NLC.

We applaud the state for adopting a sensible interstate compact for physicians with the IMLC. However, even if the state mitigates the extreme risks with the NLC model, the value to effort ratio does not equate.

We have a solution: Accelerate the temporary practice permit process within our current infrastructure, to allow for quick availability of nurses hired for temporary service in Hawaii. This can be done in a matter of months.

Linda Beechinor, DNP, APRN, is executive director and vice president of the Hawaii-American Nurses Association.