Gov. Kathy Hochul signed a law Monday expanding simulation training for nurses to expedite their entry into the workforce, but her plans remain unclear to address an executive order affecting health staff before it expires.

The legislation allows nursing students in New York to complete up to one-third of their clinical training via robotic or virtual simulations — up from a quarter of permitted hands-on simulation training as part of required clinical education. 

"We also have to modernize the training process, and I have been on site at a lot of institutions — I've seen what the training looks like," Hochul said in the Capitol on Monday. "I've asked a lot of questions. And right now, to become a nurse in the state of New York, you have to have clinical placement in a hospital setting."

The governor signed the legislation surrounded by dozens of health officials, graduating nursing students and advocates Monday, but shared few details about her plans to address her executive order set to sunset in one week, which waives the requirement for out-of-state health workers to practice in the state without a New York license.

The state Health Department reports 2,015 health staff are working in 65 facilities across the state under the order, which expires May 22.

It's unclear if Hochul plans to extend the waiver with another mandate, or wait on the Legislature to pass separate legislation.

"We have a few more days to see if anything is likely to happen legislatively before that monthly extension expires on Sunday," the governor said.

Officials remain focused on streamlining access and creating more pathways to rebuild the health workforce.

The state's languishing health workforce is expected continue to deteriorate through the decade. New York is estimated to be short 40,000 nurses by 2030. 

Hochul says the expansion of simulated clinical training will make nursing programs more accessible and easier to finish, helping new staff to enter the workforce more quickly.

Bill sponsor Assemblywoman Pat Fahy, an Albany Democrat, says the state must modernize its nursing requirements to address the critical staff shortage.

"Just as you would train a pilot with simulation, which is low-risk," said Fahy, who chairs the Assembly Higher Education Committee. "And we want that training. It allows for more of that type of training with a patient. ...It's using artificial intelligence in some of the best ways."

New York joins 31 other U.S. states that allow nurses to complete part of their clinical education using high-tech simulation training. 

Several nurses were unavailable or declined to be interviewed about the change, but expressed concerns about increased training with artificial intelligence. 

The sophisticated technology is not a substitute for in-person education, said Fahy, adding a hybrid of simulation training will help future nurses learn from early mistakes without life-threatening consequences.

"This is one of the best uses because it takes the stigma out," the assemblywoman said. "It allows you to make those mistakes and not fall apart."

Lawmakers have three session days to pass Fahy's legislation to extend a part of the current executive order and allow out-of-state workers who've applied for a New York license to continue working in the state for six months.

Some upstate facilities have up to 100 staffers working under the order, Fahy said.

"I have a sense of urgency not to leave the hospitals in a bind," she said.

Officials with the state Education Department could not immediately answer Monday how many of the 2,015 health workers from other states working under the executive order have applied for a New York license. 

But officials want the state's health workforce to be licensed in New York, Fahy added.

"If you are an out-of-state nurse who does not have an application in with New York, you're done as of May 23," she explained. "But I am worried about some of the shortfalls this will lead to; the bill only lets us get through the hump.

"We are trying to prevent — literally trying to prevent — hospital wings from shutting down, and that's what will happen if we don't address this or extend the executive order," Fahy continued.

Hochul is hopeful the Legislature will pass legislation to allow the health staffing practice to continue before the mandate expires at the end of the week.

Thursday marks the last scheduled day of legislative session before the order expires. Because the Senate version of the bill has not been printed, it would need the governor's message of necessity to be brought to the floor for a vote before lawmakers leave Albany this week.

Hochul could extend the waiver by declaring a new mandate citing a workforce shortage emergency since the COVID-19 pandemic emergency has concluded. But the governor Monday seemed more interested in signing legislation in place of continuing three years of executive action.

"There is an opportunity because they're still in session to remedy this with legislation," Hochul said. "We're in conversation right now to see whether or not there can be a compromise around that timeframe."