Numerous identification numbers are used to define personal and professional facets of our lives. From Social Security numbers assigned by the US government to employee identification numbers in our work settings, permanent identification numbers are used as unique identifiers. Adding to the long list of identification numbers that follow us throughout lives are the license numbers issued by every state in which we practice as nurses.
Until recently, tracking nurse licensure numbers across states was a laborious task, with many opportunities for error and delays in receipt of information. The risk for health care facilities, regulatory agencies, nurses, and the public has been considerable. Now, thanks to the efforts of the National Council of State Boards of Nursing (NCSBN), significant progress has been made in streamlining verification of nurse licensure, clarifying our understanding of nursing's influence on health care outcomes and, most important, protecting the public.
THE NURSYS WEBSITE
Launched in 2000 as a way for state/territorial boards of nursing (BONs) to share private information about disciplinary actions, Nursys has evolved into a dynamic website offering low-latency data on nurse licensure changes and supporting licensure endorsement between jurisdictions. To do so, Nursys automates the merger of jurisdictional-level nurse licensure data for more than 5 million licensed nurses in the United States, transmitted by 57 BONs in US states, territories, and the District of Columbia. Updates from BONs are reflected immediately on the site, including dates of last submissions by the participating board (https://www.nursys.com/LQC/LQCJurisdictions.aspx). The site also serves as the coordinating system for the Nurse Licensure Compact.
Because BONs are the primary sources of data used to populate the data set, Nursys has been designated by BONs as a primary source equivalent. The NCSBN Board of Directors approved the display of a limited data set via http://Nursys.com, a public-facing website that "provides online verification for endorsement to a nurse requesting to practice in another state and anyone who wants to verify a nurse license" (NCSBN, n.d.). The design and deployment of the Nursys site support prompt and accurate licensure verification, which meets the Joint Commission's principles for a primary source-verified credentials verification organization (The Joint Commission, 2017).
MATCHING LICENSE TO NURSE
Key to the increasing use of the licensure verification offered by Nursys is the method used to match nurses with active licenses across multiple jurisdictions. Beginning in 1994, unique identification numbers, known as NCSBN IDs, were assigned upon registration for the NCLEX(R)-RN or NCLEX(R)-PN. Nurses licensed to practice before 1994 were assigned NCSBN IDs retroactively after an extensive matching process was used to generate the unique identifiers and attach them to nurses by names and states of practice. Nurses cannot change their NCSBN IDs. Now, as nurses practice in different states, NCSBN ID numbers can match candidates for multistate licensure without the need to share personally identifiable information, such as Social Security numbers. Nurses can use their NCSBN ID for applications without providing personally identifiable information.
Use of the NCSBN ID represents a powerful method for understanding how, where, and when nurses practice throughout their careers. Because NCSBN IDs are centralized, the unalterable identification number of nurses - not state-level license numbers - can follow nurses across work settings, geographical areas, and license (licensed practical nurse, registered nurse [RN], advanced practice registered nurse [APRN]). "It's basically one ID for life. If you know the NCSBN ID number, you know that for the life of that nurse, it's that ID" (A. Guerrero, CPM, personal communication, February 4, 2020).
Nurse licensure can be verified on the Nursys site by one of three ways: 1) full name, license type, state; 2) license number, license type, state; and 3) NCSBN ID. Though most BONs maintain current nurse licensure numbering systems, 12 BONs have integrated use of the NCSBN ID. For example, nurses in New Mexico can search for their state license status using the NCSBN ID in place of their New Mexico license number. The complexity of APRN licensure across states, because of differing regulatory requirements for roles, foci, and prescriptive authority, has slowed state BON participation in Nursys APRN licensure confirmation. (At the time of this writing, Nursys contained APRN licensure information for 29 states; https://www.nursys.com/LQC/LQCJurisdictions.aspx.)
E-NOTIFY AND IMPLICATIONS FOR EDUCATION
Besides serving as a primary source verification equivalent for nurse licensure, Nursys offers nurses and institutions an option to create an account with its e-Notify licensure update notification system. Enrolling in Nursys e-Notify is free to individuals and institutions. Individual nurses who enroll receive electronic updates about their licensure status changes, reminders of approaching licensure expiration, and verifications about licensure by endorsement; more than 600,000 nurses have enrolled in self-enroll services. Institution-level accounts deliver real-time notifications about license status, including multistate and single-state license changes; more than 9,500 institutions have registered for the program. Registration gives institutions the opportunity to incorporate the nurse NCSBN ID into their processes and procedures for licensure verification, other database lookups, and matching where applicable. An Application Programming Interface is available for institutions that want to automate license status lookup from the Nursys site to their software applications.
The dynamic flow of students and faculty makes e-Notify especially useful for educational programs in nursing. Many programs are already enrolled, and many more would benefit from ingesting the NCSBN ID and enrolling students, faculty, and preceptors in existing workflows. Institutional accounts can be configured to send notifications about changes in licensure status or license renewal reminders to staff members. Daily summary reports containing licensure updates are especially valuable for educational programs that are often required to monitor faculty, student, and graduate changes. In Missouri, which did not have its own system of license verification, almost 93 percent of nurses are enrolled in Nursys e-Notify. The executive director of the Missouri state BON states, "We use Nursys exclusively. We advise nurse employers to create a Nursys e-Notify institution account and enroll all their nurses in that system. This allows the employer to receive alerts before a license expires, when it expires, and if any discipline is added to the nurse's record" (L. Scheidt, personal communication, February 10, 2021).
Licensed Students
The NCSBN ID can increase the efficiency of many internal processes needed to meet faculty/employee requirements for the organization while addressing compliance requirements for the program's accreditation agency. At the University of Alabama in Huntsville College of Nursing (UAH CON), the first step in adopting NCSBN IDs was to enroll students in nurse practitioner programs in the institutional e-Notify account. In doing so, faculty would know which students completed or needed to complete RN license renewal during their educational program. To capture data on pass rates for NP certification exams following graduation from master's programs, the UAH CON uses a Nursys summary report that is cross-referenced with program completion dates tracked internally. A comparison of dates for licensure changes (from RN to certified nurse practitioner) on the summary report with the student's graduation date provides information for the program on its student pass rates for certification exams. This method of certification tracking provides primary source data on cohorts of students without reports from certification companies, which may not provide student-level data to nursing programs.
Faculty and Clinical Preceptors
NCSBN ID numbers have been retrieved for all licensed faculty in the UAH CON. Automating notifications of faculty licensure changes for program administrators has eliminated a time-consuming step in workflow. A next step in the use of NCSBN IDs will be to configure notifications for license changes in clinical preceptors work with nursing students. Documentation of the method of verification combined with reports generated by Nursys e-Notify may satisfy requirements for documentation of clinical preceptors' licensure to practice needed for evaluation of NP programs by the National Task Force on Quality Nurse Practitioner Education (2016).
GOING FORWARD
The widespread use of NCSBN ID numbers and products available on the Nursys platform has been encouraged by multiple stakeholders in the nursing profession, including the Alliance of Nursing Informatics (2020). The Nursing Knowledge: Big Data Science Health Information Technology Policy Workgroup has also noted the importance of adopting identifier numbers for nurses: "The NCSBN ID should be used by key stakeholders as a nurse identifier to help demonstrate the value of nursing through research and enhance individual care and health outcomes via more comprehensive documentation in the electronic health record, enterprise resource planning, and other health IT systems" (Nursing Knowledge: 2018 Big Data Science Conference, 2018, p. 11).
The adoption of a unique nurse identifier number into the workflow processes of national associations, health care organizations, educational programs in nursing, and government agencies is a needed step that will enable the extraction and use of nurse-specific data to better define the effect of nursing practice on health outcomes (Sensmeier et al., 2019). Integrating use of the NCSBN ID and Nursys e-Notify reporting features by nursing education programs could provide an inexpensive, reliable program evaluation method for tracking the percentage of bachelor of science in nursing graduates who become APRNs. Exciting research opportunities are possible if nursing education programs partner with health care organizations to examine the effect of curriculum and instruction practices on nurse competencies in the first year of practice.
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