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Nurses are waiting 6 months or more for licenses despite hospitals' need for nurses


Thousands of new nurses want to help during this pandemic, but state bureaucracies are keeping them on the sidelines. That's at a time when one of every five hospitals is critically short-staffed. Those are the findings of a new NPR investigation. NPR's Austin Fast requested records from every state nursing board in the country and has this report.

AUSTIN FAST, BYLINE: For most nurses, getting licensed is pretty straightforward. You send in documents, like school transcripts, pay some fees, get your license. For many, it takes just a few weeks.


FAST: But for others, those weeks turn into months.

UNIDENTIFIED PERSON #1: Thank you for contacting the California Board of Registered Nursing. All agents are currently assisting other callers.


COURTNEY GRAMM: It was definitely over an hour every single time.

FAST: That's nurse practitioner Courtney Gramm. At the end of 2020, during a surge of COVID-19 cases, she should have been treating patients at her new hospital job in Monterey, Calif., but Gramm was waiting on the Board of Registered Nursing. She had moved to the state six months earlier, but couldn't work without a California license.

UNIDENTIFIED PERSON #2: Thank you for waiting. Your position in the queue is...


FAST: Pick a state anywhere in the country, and you'll find similar stories. Kaede Fujiwara is a brand-new nursing graduate in Northern Virginia.

KAEDE FUJIWARA: It's frustrating. It's disappointing. It's exhausting.

FAST: She lost a job offer at a local hospital because the Virginia Board of Nursing took five months to approve her license.

FUJIWARA: I'm embarrassed, you know? I'm a nurse, and I'm unemployed in the pandemic. Like, what kind of an excuse is that?

FAST: We asked every state nursing board for licensing records; 32 handed them over. From these states, we found over a third of last year's new licenses took longer than three months to process. That's 80,000 nurses waiting. Almost one in 10 nurses waited half a year or longer. All this as hospitals can't hire enough nurses. The most recent data shows California, alone, is 40,000 nurses short, and that was before omicron hit.

GRAMM: Processing more licenses would have put more hands on the deck in a time when we really needed all hands on deck.

FAST: That's Courtney Gramm again. The nurse practitioner in California.

GRAMM: The staff at the hospital were required to work overtime, and no one was allowed to take any paid time off. And this went on for months.

FAST: The processing time for a license varies because each state has its own rules. Generally, boards have to check a nurse's education, run a criminal background check and wait for new graduates to pass a national exam. This all does take time. Georgia promises to review applications within 15 business days. In Florida, it's 30 days - in California, 90.

But NPR found states can take far longer to actually issue licenses. California's times have gotten slower through the pandemic. The registered nursing board blames an increase in applications. At a public meeting late last year, the board's leader, Lori Melby, acknowledged they're getting lots of complaints.

LORI MELBY: We do not, as a California board, want to be a hindrance to having other people be assisted.

FAST: Many boards say they're short-staffed and overworked. California's got almost a half million registered nurses, but just a few dozen people to license them.

MELBY: We serve in a role of constantly kind of putting out fires within our licensing unit.

FAST: Any little hiccup with a nurse's application will freeze up the process - maybe a nurse forgot a transcript or a signature or the board's made a mistake. That's what Courtney Gramm says happened with her application.

GRAMM: My transcripts were always sitting in some email in-box, and no one took the time to just go in, fish them out, attach them to my application and then process my application.

FAST: She tried almost seven months to tell the board they already had her transcripts. They finally got the message when Gramm asked her state assembly member to step in. When anything's missing, processing times can double, according to California's records. And it happens a lot.

Last year, three-fourths of nurses licensed after moving to California had their applications flagged as incomplete. Nurses across several states describe getting stuck in this purgatory. When Brenda McNeely moved to Pennsylvania, she needed written verification from all the states where she'd been licensed before.

BRENDA MCNEELY: California says, we sent it. Pennsylvania's saying, we never got it.

FAST: McNeely emailed and called Pennsylvania's board over and over, but they never responded.

MCNEELY: So I called Governor Wolf's office.

FAST: That'd be Pennsylvania's governor, Tom Wolf.

MCNEELY: Next thing I know, I got the license in the mail.

FAST: Pennsylvania also has some of the slowest times from the states NPR looked at, and that's as hospital leaders there are fretting over nursing shortages. They say up to 40% of their nurse jobs are unfilled.

BETSY SNOOK: This impacts patient care.

FAST: Betsy Snook leads the Pennsylvania State Nurses Association.

SNOOK: 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.

FAST: Pennsylvania's board declined to speak with NPR, but they gave us a statement saying the board has been very transparent about its processing times. They created application tip sheets, and they meet with hospitals and nurses' unions to help nurses apply.

California's boards also declined to speak on tape. They say they tried to streamline things by accepting digital documents and creating a new online portal.


FAST: Plus, they invested in a new phone system.


UNIDENTIFIED PERSON #3: Instead of waiting on hold, would you like to be called back? To receive a callback, press 1.

FAST: Here's what happened, repeatedly, when I tried getting a callback this week.

UNIDENTIFIED PERSON #3: The callback queue is currently full. Please call back at a later date.


FAST: I'll try again tomorrow.

Austin Fast, NPR News.

(SOUNDBITE OF COOPER SAMS' "WHITE WAVES") Transcript provided by NPR, Copyright NPR.

Austin Fast
Austin Fast is the inaugural Roy W. Howard Fellow on NPR's investigations team.