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Interstate Nurse Licensure Compact

Traditionally, health care professionals in the U.S. must be licensed by the state or jurisdiction in which they practice—this means licensure in multiple jurisdictions if their practice crosses state lines.

However, the regulatory landscape began to shift in 2000 when Maryland signed into law the first health care compact – the Nurse Licensure Compact (NLC). In light of the changes, the American Nurses Association (ANA) raised a number of concerns, and continues to work to achieve better clarity for our members on a number of issues.

For a complete review of ANA's policy as it pertains to the Compact - refer to "Talking Points" (2015).

What is the NLC?

Created by the National Council of State Boards of Nursing (NCSBN), the NLC reflects an interstate agreement permitting registered nurses (RNs) and licensed practical/vocational nurses (LPN/LVNs) to have one license. The license issued by their primary state of residence allows the nurse to practice in other compact states (both physically and via technology) without having to secure an additional license.

How does it work?

The NLC is a form of mutual recognition in which “the licensing authorities voluntarily enter into an agreement to legally accept the policies and processes (licensure) of a licensee’s home state.”

Under the NLC, Registered Nurses (RN) are obliged to abide by the nursing practice laws in the state where the patient is located (their “location of practice”) – and are subject to having the privilege to practice revoked in that state if deemed necessary. However, the RN’s home state is still responsible for any discipline against the license of the nurse.

The Compact requires state nursing boards to participate in a national database, Coordinated Licensure Information System (CLIS), or Nursys License Verification database. This allows states to share information for verification of nurse licensure, discipline, and practice privileges.

How many states participate in the NLC?

 As of 2015,  a total of 25 states adopted the NLC: Arizona, Arkansas, Colorado, Delaware, Idaho, Iowa, Kentucky, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, and Wisconsin.

The “enhanced” RN Compact and the APRN Compact

In May 2015, the National Council of State Boards of Nursing (NCSBN) adopted two new Compacts: the “enhanced” RN Compact and the APRN Compact.

The “enhanced” Compact is intended to replace the NLC and must be advanced through state legislatures and signed by the Governor to go into effect. The NCSBN reports the newer version is based on higher standards which include:

  1. Required criminal background check (CBC) (state and federal) on initial licensure;
  2. Restriction from acquiring a multistate license if ever convicted of a felony;

Additionally, the enhanced Compact must include the NCSBN’s Uniform Licensure Requirements (ULRs). The ULRs establish consistent standards for initial, endorsement, renewal, and reinstatement licensure needed and must be adopted by any Compact state.

The APRN Compact allows an Advanced Practice Registered Nurse (APRN) to hold one multistate license that allows them to practice in other compact states and includes a required provision of full practice authority.

ANA’s concerns with location of practice

ANA and NCSBN have a fundamental difference of opinion about the location of practice. Even before the NLC was first enacted, ANA took the position that the location of practice is where the registered nurse is  located – given the knowledge, skill, and judgment applied to practice rests with the registered nurse. Our position on the state of practice was reaffirmed by the 2015 Membership Assembly. However, the Compact is based on the understanding that the location of practice is defined as where the patient is physically located. 

Variations between states in relation to licensure / re-registration requirements

Variations in licensure can be confusing and burdensome for nurses. Examples where clarity is required include:

  • The frequency and associated requirements for re-licensure and re-registration;
  • Recognition of non-traditional education programs particularly with regard to number of clinical hour requirements for entry into practice;
  • Requirement for continuing education, if any;
  • What constitutes an infraction and resultant actions taken by the Board;
  • How nurse diversions & addictions are addressed; and
  • Lack of uniformity among state boards around the administration of criminal background checks (which are now a provision of the Compact).
    • As of June 2015, 36 states require criminal background checks, 20 of the 25 NLC states require a CBC.
    • Of the 14 states that do not require fingerprint-based criminal background checks, five require a state record search for information on past criminal history by name checks and state court records;
    • Nine states require self-disclosure of any criminal history.

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