Disclaimer: rant ahead.
To preface, I am a well-educated, skilled and experienced, willing and able Nurse Practitioner actively seeking work in my new home state of Colorado. The need for NPs in this state abounds wildly, as it suffers from the same disturbing shortage of health care providers that plagues every single state in the US of A. You’d think they’d want me to hit the ground running…
Very familiar with the US system, I began the paperwork long before I anticipated working, as I’ve previously experienced bureaucracy-induced delays. However, two months later, I am still unable to work. I’ve had plenty of job offers. But I’ve had to walk away because I’m not yet fully licensed and certified in CO. To add insult to injury, along the way I’ve paid over $350 out of pocket just to apply [much less maintain all of the certifications]. Now, that’s actually not that much money, but it stings more combined with the opportunity cost of idling on the couch, especially when that the same system benefitting from your dwindling savings is preventing you from earning income.
The process, in short, is the following:
A: Transfer Registered Nursing license from GA to CO
B: Transfer Nurse Practitioner license from GA to CO
C: Obtain provisional prescriptive authority in CO
D: Transfer DEA from GA to CO
E: Develop an “Articulated Plan” with a Physician or APRN and apply for Full Prescriptive authority
I’ve detailed each of these steps below and colored the redundancies, as each of the above requires essentially the same paperwork. And along the way, I discovered that it’s processed by the same person in the CO Board of Nursing. Uh. I’ve literally sent three college transcripts to her. Can’t you look at the two others on your desk?!
I’ll spare you from actually reading the details and go ahead and close [but they’re there for ya if you’re interested].
So here I am. A skilled and experienced NP. Color coding a blog post [refraining from adding color commentary…] instead of contributing her healthcare knowledge and experience to the betterment of society at large. Meanwhile I’ve been looking at other jobs. Get one in sales? Marketing? Accounting? I’d start tomorrow.
Edit: Since I have time on my hands, I made an attempt to quantify the wasted human capital of NPs alone involved with the credentialing process.
Once this process finishes I’ll need to renew my DEA in December for nearly $800. Then in January it’s time to renew my GA RN and NP licenses for at least a few hundred dollars each. Then next September, I’m due to renew my CO RN and NP licenses–again for a few hundred dollars. Oh and then the following year, I need to renew my ANCC national board certification. For another fee. Thats four separate licenses and two certifications all with separate applications [more of the same] and, of course, fees.
Step A: Transfer Registered Nursing (RN) License from GA to CO*
Since I hold an active license in GA, I’m eligible to obtain a “License by Endorsement” versus re-take the NCLEX exam or go through other hoops to re-activate an expired license. Should be the fast track, right? Here’s what it involves:
- Pay the required fee: Endorsement = $43 [a deal compared to Examination route, which is $88]
- Fill out online application: Contact info, SSN, demographics, yada yada yada
- Criminal History: Answer questions about criminal history and any cases against your license, Medicare/Medicaid eligibility etc. And provide any documentation. Pretty important.
- Verify other Licenses: Visit Nursys, which is a pretty cool official registry of licenses.And it’s FREE! Interestingly, the NP licence cannot be verified via this system.
- Complete Affidavit of Eligibility: essentially promise that you are, in fact, legally allowed to work in the US. This also appears in the applications in the steps below.
- Provide verification of original license: [Wait, wasn’t that Step A#1…?] Oh wait, no. This involves a separate application where I repeat the same questions as A4 and send to the GA Board of Nursing, which they process [for a $25 fee] and send back to the CO Board of Nursing.
- Create a Healthcare Professions Profiling Program (HPPP) profile: asks questions about the type of work you do and whatnot. I assumed that this database stores commonly needed information to make the following steps quicker. [Aww, how cute of me…]
- Declaration of Primary State of Residence: On the surface, this is reasonable in order to avoid confusion with the Compact Agreement. However, especially as a traveling nurse, why does it matter? I’d pay income tax to the state registered to the agency who is actually paying my income, which is very likely none of the states I’m licensed in. But it’s a moot point for me, since I’m not eligible for Compact licensure anyway.
CO RN license is good for two years, well except that all expire on September 30th–so shorter than that depending on when you obtain it.
Step B: Transfer GA Nurse Practitioner License to CO
I cannot be an NP without also being an RN. So the NP license should suffice without the RN. However, I must hold both licenses and complete the requirements and paperwork to keep them active separately [which often differ greatly and occur on different time lines]. So inherently, if I competed step B, it would eliminate the need for step A.
So, I must submit the RN application before proceeding with the NP. I later learned that they won’t process the NP license until the RN license is approved. WTF.
- Pay the required application fee: $75
- Fill out online application: the questions were almost identical to step A2. None of them carried over.
- Select your population/focus: This is specific for NPs, as we semi-specialize (as opposed to PAs who kinda learn a bit of everything)
- Verify Certification as APN in Role and Population Focus: Fill out a form and send to the ANCC (my licensing board), and allow 7 days to process. For a fee, of course. $50 this time. If I were certified in multiple populations, which I could technically do in Emergency Medicine. I don’t want to, though, for reasons like this.
- Complete Online Healthcare Professions Profile: Done! Why do they even tell me this. Shouldn’t I have inherently completed this by their own design?
- Verify ALL APN Registrations (in every state, every population AND past and present): Luckily I only have one state and one population to work with. So go to GA board of nursing and scan NP license. Could have been more complicated for me. Also, this essentially achieves A4, A6, C2.
- Confirm active practice: provide documentation of active practice for the past 2 of 5 years in each population I wish to work in. This required me reaching out to my old bosses and having them write a letter to the CO board of nursing. Step C5 achieves the same.
- Criminal history: answer questions and provide documentation as necessary.
Step C: Obtain Provisional Prescriptive Authority in CO
I had to wait for the above to process before I could proceed. The CO RN license went quite quickly (relatively speaking) and I think I received it within 8 weeks of submitting the application. My NP license took forever because I originally sent a copy of my original ANCC verification letter. After following up a few weeks after submission, I was told I had to have it sent directly from them, which took 7 days to process. Only then did the CO board of nursing begin this verification. That took a good 12+ weeks to process.
Only after I obtained these could I apply for prescriptive authority. Which is a preeeetty important thing in my world.
- Pay required fee: $150–ouch!
- Complete written application: Why can’t they do this online like the others? Same questions…
- Provide copies of CO RN and NP Licenses: Uh.. shouldn’t they have these?
- Attach official transcripts in official sealed envelopes: For me, this meant paying Emory School of Nursing $25. Since CO BON won’t allow online transcripts, I have to have this sent to me and then I have to send it to them. WTF. Interestingly, this is the first time I had to do this… This also involved reactivating my Emory account, which added time and inconvenience to the process.
- Copy of National Certification: ANCC in my case. Did this step B4.
- ALL out of state prescriptive authority verifications: For me just GA. Pay GA Composite Medical Board $25 so that they send a letter to CO.
- Criminal Background: and whatnot.
- Update HPPP: Again. AKA A3, B8.
- Declare Primary State of Residency: Did this.
- Promise to maintain liability insurance: Ok
Step D: Transfer DEA from GA to CO
Quite easy actually.
- Fill out transfer form on DEA’s website.
- Wait. A long time. 10-12+ weeks.
Step E: Obtain Full Prescriptive Authority in CO
As you recall, I just applied for Provisional Rx Auth. Now I also have to apply again for “full” Rx Auth. Luckily, the board allows Steps C and D to be done simultaneously and there was no fee for step D! Amazing. Wonder how long that will last…
- Complete online application: Very similar to A2 and B2. This needs to be repeated for each population.
- Provide copy of CO RN and NP Licenses: [Shouldn’t they have these on file…?] Since I have prescriptive authority in GA, I filled out a form and sent it to the GA Board of Nursing. It simply asked if I had an active license in good standing and if any disciplinary action had been taken against it. These, as you recall are Steps A3, A4, A6, B4, B6, B7, B8.
- Attestation of Prescribing Experience: You must prove that you have had supervised prescribing experience of at least 1,000 hours. I had to send the form to my former boss to sign and submit to the board of CO. Which is what I did in B7.
- Create an Articulated Plan verified by a CO MD or NP with Full Prescriptive Authority: Uuhh so I actually have to wait until I start a job to achieve this. I’ll use provisional prescriptive authority in the interim.
- Criminal History: The same as A3, B8 and C7. Ok, I get that this is important, but it seriously hasn’t changed. Can’t I just sign a blurb that states nothing new has come up?
- Declaration of Primary State of Residence: Uh I did that A8. And C9.
- Update HPPP: At least I didn’t have to start from scratch. They emphasize that it is my responsibility to keep this correct and current.
*To our system’s credit, here is the one and only area I’ve identified where some effort at streamlining and creating efficiency has transpired. There’s such thing as a “compact agreement” where one bout through the process enables you to work in multiple states. GA, however, isn’t a “Compact State”. So even though CO participates, I’m eligible only to get a CO license and not the other Compact State licenses.