Home > Keeping in Touch> Nurses: You Now Have Permission to Move About the Country

Nurses: You Now Have Permission to Move About the Country

The major nursing shortage facing our nation has put RNs in demand across the country. Nurses can write their ticket to anywhere, and skipping from state to state is getting even easier. Currently, almost half of our 50 states have agreed to partake in a multi-state licensure agreement and that number will continue to grow.

This new ease of mobility is all thanks to the Nurse Licensure Compact (NLC). The NLC makes it possible for a nurse in one state to travel and work in another state without applying for a new license. Essentially, here’s how it works: a nurse whose primary state of residence (the state of a person's declared fixed permanent and principal home for legal purposes) is a compact state is issued a license by that state and no longer needs an additional license to practice in other compact states (remote states). By virtue of the compact, the licensee is granted the “multi-state privilege to practice” in other compact states.

Currently, 23 states have enacted the legislation allowing for participation in the NLC. These states include: Arizona, Arkansas, Colorado (still to be implemented), Delaware, Idaho, Iowa, Kentucky (still to be implemented), Maine, Maryland, Mississippi, Nebraska, New Jersey (still to be implemented), New Hampshire, New Mexico, North Carolina, North Dakota, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia and Wisconsin

Safety in Numbers

The National Council of State Boards of Nursing (NCSBN) views the NLC as a way to improve patient care by encouraging cooperative efforts among the party states in nurse licensing and regulation. The NCSBN hopes that eventually this will become a nationwide agreement creating an “ideal” situation to monitor nursing practice to protect public health and safety.

The Compact creates a coordinated licensure information system called NURSYS that will include information on the licensing and disciplinary history of each nurse. Each party state must report any adverse disciplinary action against a home state license or a multi-state privilege in a timely manner. The party states must also submit information on any current significant investigation and any denials of applications for licensure. State confidentiality laws will still control the release and use of such information, but the database will be an invaluable tool to the party states in tracking and monitoring ongoing investigations and disciplinary action of nurses.

The NLC also offers standardization amongst the dynamic background of our healthcare system. Plus, the compact offers such benefits as:

• The variety of settings in which nurses work and the technologies (i.e. telehealth) they use that may cross state lines.
• The expectation and desire by consumers to have access to qualified nurses regardless of state lines.
• The need for more expedient and efficient authorization to practice.
• More uniformity in approaches to new technology and practice modalities across states.

Rules Do Apply

Strict guidelines have been put in place in order for the Nurse Licensure Compact to work. Nurses who live in a non-compact state but practices in a compact state will be issued a nursing license that is valid only in that compact state (single state license). The licensee will not be granted the “multi-state privilege to practice“ in any other compact states. A nursing license issued by a non-compact state is valid only in the state in which it is issued.

States continue to have complete authority to determine licensure requirements. A nurse must comply with practice laws and regulations in any state where he or she practices, including compact states. Each state must carry out its disciplinary review process in the same manner for both the nurse licensed in the state as well as the nurse practicing in that state under the “multi-state privilege to practice.” In either case the nurse is afforded due process protection.
However:

• Only the compact state (home state) that issues the nursing license may take action against that license.
• If the nurse is practicing in another compact state (remote state), that state may only take action against the nurse’s “multi-state privilege to practice.”

Seeing Eye-to-Eye

Not every organization or state sees the benefits to the multi-state licensing. Many feel that this situation will result in creating the “lowest common denominator” of state licensure standards. There also is a fear that a home state may not follow up as energetically on a complaint filed in a remote state. In addition, there are concerns that because nurses are not required to register when they begin practicing across state lines, it's conceivable that it's going to be difficult for consumers to identify or file complaints about a nurse's practice with the appropriate board of nursing. There is a belief that in order for this “driver’s license” approach to work there must be an all-powerful regulating board to oversee and make sure that everything is going smoothly.

Some states also see the compact as a financial burden because nurses who live in compact states would no longer have to pay a license fee to work in another compact state. Those costs can add up and result in the state losing a large dollar amount over the year.

In the end, there are obviously states that whole-heartedly agree with the Nurse Licensure Compact and then there are ones that don’t agree. But rather than go back and forth on the negatives and positives, the powers that be need to focus on how to make the system that’s already in place work to the best of its ability.

For more information on the Nurse Licensure Compact, visit www.ncsbn.org.