I have long been opposed to this idiotic system of licensing nurses (and other healthcare professionals) state by state. There is one national licensing exam, and therefore, there should be one national nursing license.

The system as it exists now, allows individuals who have lost a license in one state, who are considered incompetent or even dangerous, to simply pack-up and move across state borders.

From the LATimes:

Because there is no federal licensing of nurses, each state sets its own standards on punishable behavior.

In general, states can discipline a nurse based solely on the actions taken by another state. But they vary widely in how quickly — or harshly — they act on this information, according to interviews with regulators in 14 states.

Under the law in Virginia and Louisiana, for instance, officials must immediately suspend nurses’ licenses for serious misconduct in another state. Nurses are barred from practicing unless they successfully appeal.

Missouri, on the other hand, must personally serve all accused nurses with written charges and offer hearings to contest them. If nurses can’t be found, their licenses remain clear and they are free to continue practicing, said Lori Scheidt, executive director of Missouri’s nursing board.

Delays in several states left Craig Smart free to practice. In 2000, he surrendered his license in Florida after testing positive for cocaine and flunking a treatment program. It took eight years for five other states in which he was licensed to respond to Florida’s action. California was the last to revoke his license, in 2008, after he had practiced here for several years, apparently without incident.

Even when states share borders, they sometimes fail to heed each other’s disciplinary actions. At least 10 nurses, for example, hold clear licenses in Massachusetts despite being disciplined next door in Rhode Island, including suspensions for drug thefts and violence.

Nurse Karen Rheuame’s Rhode Island license was suspended in 2007 after she was arrested on suspicion of assaulting a woman in a wheelchair in a hospital emergency room and trying to steal her pocketbook, according to state disciplinary records. She also had numerous other convictions and, records show, had once brought two beers to work, which she explained to her boss were for “the ride home.”

But she’s free to practice in Massachusetts. A health department official there said regulators are reviewing Rheuame’s case and others to see if action is warranted, but they haven’t received any complaints about the nurses in Massachusetts.

A unified national system would eliminate this. But of course, state Boards of Nursing would be reduced in size and number. They basically exist to keep this inefficient and dangerous system alive, and as we can see, they are totally inept in doing their job. Having dealt with the Board of Nursing in Washington state, regarding renewing a license, I can vouch for the lack of professionalism and total self-importance seen at least in this state. It took a threat to the governor’s office and other state regulatory agencies, for them to refund money owed to me for licensing fees.

State agencies would need to exist, but in a smaller form, and with less power (and yes, the BOR does not want to get off its power trip). Forcing a nurse to be licensed in each state is simply a means of revenue–it supports an unnecessary BOR, and allows incompetent/dangerous nurses to continue working.