An audit of mental health questions on US nursing licensure applications: Evidence to guide urgent action for change

BackgroundNurses often forgo needed mental healthcare due to stigma and fear of losing their license. The decision to access care or disclose mental health struggles is intensified when registered nurses (RNs) or advanced practice registered nurses (APRNs) discover that licensure applications ask invasive mental health questions that could impact their ability to work.AimsThis study highlights findings from an audit of mental health and substance use questions included in RN and APRN licensure applications across the United States.MethodsA sequential 4-step approach was used to retrieve RN and APRN licensure applications: (1) review of Board of Nursing (BON) websites, (2) communication with BON staff, (3) communication with Deans of Nursing to ask for retrieval assistance, and (4) creation of mock applicants. An embedded checklist within the Dr. Lorna Breen Heroes Foundation's Remove Intrusive Mental Health Questions from Licensure and Credentialing Applications Toolkit guided the audit. Two study team members reviewed the applications independently for intrusive mental health questions, which were designated as non-compliant with the Toolkit's recommendations and arbitrated for consensus. States were designated as non-compliant if >= 1 item on the checklist was violated.ResultsAt least one RN and APRN application was obtained from 42 states. Only RN applications were obtained from five states, while only APRN applications were obtained from three states. Only 13 states (26%) fully adhered to the Took-Kit checklist.Linking Evidence to ActionThe majority of BONs did not fully adhere to the Took-Kit checklist. Guidance from national organizations and legislation from state governments concerning the removal or revision of probing mental health and substance use questions is urgently needed to cultivate a stigma-reducing environment where nurses are supported in seeking needed mental health treatment.

Automated summary

This study audits mental health and substance use questions in RN and APRN licensure applications across the United States. The majority of nursing boards did not fully adhere to the recommendations, highlighting the need for guidance and legislation to create a stigma-reducing environment where nurses can seek mental health treatment.