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Providers blame state for delays in licensing ready-to-work nurses

New Hampshire Union Leader

December 19. 2016 9:23PM

About this series
Silver Linings is a continuing Union Leader/Sunday news report focusing on the issues of New Hampshire's aging population and seeking out solutions.

Union Leader reporter Gretchen Grosky would like to hear from readers about issues related to aging. She can be reached at or (603) 206-7739. See more at

Barbara Laganiere of the Homemakers Health Services in Rochester hired an LPN who recently moved to New Hampshire from Kansas. The nursing and home health care agency promised to pay the woman until New Hampshire approved her license.

That was 18 weeks ago. After six weeks of waiting for the license, Laganiere said they couldn’t pay her any longer and had to lay off the LPN before she could even start.

“Her fingerprints were lost. It was the background check wasn’t done. It’s excuse after excuse,” Laganiere said.

The delay in the state’s licensing of nurses was among the major complaints found by a survey released in September by the New Hampshire Health Care Association. That complaint was repeated by many in attendance at last week’s annual meeting of the Home Health Care Association of New Hampshire. These two groups represent the bulk of New Hampshire’s elder health care providers, including nursing homes, assisted living facilities, at-home care and adult day cares — and they are feeling the brunt of a nursing shortage.

The survey of 50 nursing and assisted living facilities found 74 percent of LNA candidates experienced delays and difficulties with obtaining their license from the state’s Board of Nursing. Twelve percent reported they had three or more candidates ready to work, but were delayed by a wait on licenses — with 18 percent of those reporting their candidates have been waiting more than a month.

But Joseph Shoemaker, director of the state’s Divisions of Health Professions, said there is no back log and estimates a licensing wait time of four weeks. He admits there were some issues in the spring and summer with a new computer system, as well as delays in getting criminal background checks from State Police. He said some applicants don’t follow all the guidelines.

“We licensed 100 nurses today,” Shoemaker said last Thursday. “Once we get all the paperwork, we can do it in a day.”

The compact problem

New Hampshire is among 24 states belonging to the National Licensure Compact. Nurses from compact states like Maine and Rhode Island can work in the Granite State for up to 90 days without getting a New Hampshire license or while they are waiting to be approved.

Nurses from non-compact states, like Vermont and Massachusetts, cannot perform nursing duties until they fill out the application, pass a criminal and a FBI background check, certify their education and pay the fees.

Craig Labore, administrator for the Grafton County Nursing Home in North Haverhill, said he has a number of open nursing positions. “Being so close, we have the ability to recruit and hire from Vermont, but we’re not,” he said. “It’s not an easy process and we have openings now.”

Shifting responsibility

Donald Capoldo, executive director of The Homemakers, has worked in health care in several states, including Florida, California and Maine. His experience is that the employer is responsible for obtaining all the necessary background checks and ensuring applications were complete and verified. In New Hampshire, it’s the responsibility of the Board of Nursing.

Denise Nies oversees the state’s Board of Nursing. She said putting the onus on the employer is not the solution.

“The board exists for public safety purposes,” she said. “We’re not an advocate for the licensees. We’re an advocate for public safety.”

With the computer kinks worked out and processes like fingerprinting now being done online, Nies expects the licensing process to improve.

“We’re in much better shape than we were,” she said.

From outside the U.S.

Labore has a registered nurse from the Philippines who is currently working for him as a LNA while she goes back to school to become an RN again. The difference in pay is about $10 an hour between the job she has and the one she’s already once been trained for.

John Getts, president and CEO of Home Health & Hospice Care in Merrimack, points to the New Hampshire’s aging demographic and said the state needs to get rid of the barriers to filling nursing jobs.

“We should really be trying to bring in skilled workers from other states and on visas,” he said. “That is what we have to be focused on.”

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