A federal health care improvement program is putting new pressure on Alaska legislators to revive stalled efforts to ease licensing for out-of-state nurses by joining what’s known as an interstate licensure compact.
In its application for hundreds of millions of dollars in annual funding from the new Rural Health Transformation Program, Alaska’s Health Department pledged the state would make a variety of legal and regulatory changes, including by joining a number of interstate compacts for medical professionals. And when you boil it down, Alaska Hospital and Healthcare Association head Jared Kosin said joining a nurse licensure compact is pretty simple.
There would be a set of criteria nurses would demonstrate, he said.
“And if they do, then they are issued a license within whatever states (are) in the compact, and then they can practice in any states that use those same standards as set by the compact,” he said.
Proponents say joining a compact would help ease a nurse shortage across the state that’s projected to worsen. A 2023 report showed one in five registered nurse positions across Alaska were unfilled and filling those positions took more than three and a half months on average.
It’s a simple concept, Kosin said, but actually getting a bill passed to join the nurse licensure compact has been anything but.
“It's just so snagged up in politics,” he said.
A 2023 bill to join the compact was supported by most health care organizations in the state but it was opposed by nurse unions and Kosin said that created a “toxic” dynamic.
This year, there’s new pressure on the Legislature thanks to the Rural Health Transformation Program. When the state Health Department applied for the funding, it told the Centers for Medicare & Medicaid Services the state would join a nurse licensure compact, among other changes.
“CMS has been very clear that these are things that they want to see, and if you don't get them passed through legislation, there will be financial consequences to the state,” said Anne Zink, emergency room physician and former chief medical officer of Alaska.
That applies to several pieces of legislation the state promised to pass, all of which are singled out as ways to improve rural health care across the nation. CMS identified licensure compacts as a way to increase the supply of accessible rural health providers. Some of the other bills aim to increase scope of practice for health care providers and to join other interstate licensure compacts for physicians, emergency medical services, psychologists, and physician assistants. None of those compacts appear to be as controversial as the nurse compact in Alaska.
The exact financial consequences Zink alluded to are unclear. The state Department of Health doesn’t know exactly how much money would be clawed back if Alaska doesn’t pass all the required legislation, including the nurse compact bill, but Health Department spokesperson Mirna Estrada said in an email that a ballpark estimate is that millions are at stake annually, with tens of millions of dollars at risk over the five-year program.
Regardless of financial consequences, Zink said joining interstate licensure compacts would serve Alaskans in the long run.
“We have created a bureaucracy that makes it incredibly hard to both administer when you're working at the state as well as to functionally be a part of as you're trying to apply,” she said. “And I think we have a real opportunity to decrease that, and we have an opportunity to increase our workforce.”
She said even if the state joins a nurse licensure compact, state officials would still retain control over who is approved to work in Alaska.
But the bill faces stiff opposition. Despite a push from the state Board of Nursing that dates back to at least early 2020, proposals to join a license compact have so far failed to advance in the Legislature.
Anchorage Republican state Sen. Cathy Giessel, a powerful member of the bipartisan majority caucus and an advanced nurse practitioner, said she won’t vote for the bill as-is. She’s worried because she said it would mean Alaska turns over regulatory authority to a national organization.
“I certainly respect their expertise in the profession of nursing,” Giessel said. “But Alaska is different. We have reasons that we need to regulate our own nurses. We have cultural differences than other states in the lower 48. We have distances and issues like that.”
And she said even if the bill is altered, the compact can’t be. It has to be joined as written, she said.
Shannon Davenport, a union leader for Alaska Nurses Association and a nurse working in behavioral health and hospice care in Anchorage, said licensing isn’t the root cause of Alaska’s struggle to recruit and retain nurses.
“People talk about a nursing shortage,” Davenport said. “What we're actually being faced with currently is a safety-in-our-workplace situation. It's about working conditions. It's about staffing ratios and the amount of patients to nurses.”
Joining a nurse compact is “like putting a band-aid on a broken leg,” she said. Making it easier to become a nurse in Alaska would also make it easier for nurses to leave, she said, arguing the compact bill would serve the interests of hospitals and other institutions, not necessarily nurses.
“It's not the golden goose,” Davenport said. “It's not the answer to everything. It's not the magic key that's going to unlock everything.”
Even so, most nurses support a compact — almost 90% of nurses living in Alaska, according to a 2023 survey, and 85% of union nurses.
Legislative leaders said they’re reviewing the proposals closely and weighing the pros and cons. Bills that would have Alaska join the nursing compact have made little progress as this year’s regular legislative session approaches its halfway mark.
Lawmakers do have one more session to consider the idea. The deadline to join the interstate nurse licensure compact to keep the state’s rural health funding is at the end of 2027.
So for this year, Kosin said he’s not expecting much progress.
“I feel like we've completely lost vision for what the policy is, what the merits of this bill are, and it's just going to continue to be in a fight,” he said. “So at this time, am I optimistic? I'm not.”
Additional reporting by Eric Stone in Juneau.
