Historically in the U.S., regulation of health professionals has been a state-based function whereby each state or territory regulates the health care workforce within its geographic boundaries. Thus, health care professionals practicing within a state or territory are required to be licensed by the jurisdiction in which they practice. However, with the soaring popularity of telecommunication and other technologies being used to deliver health care services, practice is no longer limited by geographical boundaries. Telephone triage, telehealth consultation, and air transport nursing are just a few examples of how nursing practice is crossing state lines, either physically or via telecommunications technologies.
In 1997, the National Council for State Boards for Nursing (NCSBN), a private association of state regulatory agencies, proposed a mutual recognition model of nursing licensure, referred to as the Nurse Licensure Compact (NLC). The Compact is an agreement between two or more states to coordinate activities associated with nurse licensure. Although nurses are not usually schooled in the legal implications of interstate compact administration, it is imperative that all nurses understand the implications a regulatory change, such as a mutual recognition model of nursing licensure, may have on consumers, nurses and the profession.
The Compact concept was first introduced at ANA's 1998 House of Delegates (HOD) and resulted in a resolution outlining fourteen issues the HOD believed must be addressed for ANA to support the Compact model. Delegates reaffirmed their beliefs at the 1999 ANA House. Dialogue between ANA and NCSBN continued. Ongoing monitoring of states' experience and dialogue between ANA and NCSBN has led to dissolution of some of ANA's original concerns. For specifics, reference ANA's talking points (2013).
At this time, ANA policy prohibits the association from fully endorsing the Nurse Licensure Compact (NLC); the most significant rationale is ANA's long standing policy stipulating the state of practice, rather than state of residence holds greater logic for licensure. ANA belives the state of practice is where the nurse is located. Other concerns are the inconsistencies between states with differing requirements for licensure and re-registration, all of which leads to confusion and the potential for varying standards for nurses employed in the same state. For a complete review of ANA's policy refer to "Talking Points" (2013).