Regulation of health professionals in the U.S.has traditionally 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 discussed by ANA members at the 1998 House of Delegates (HOD) and resulted in a resolution outlining fourteen concerns the Delegates believed must be addressed for ANA to support the Compact model. Delegates reaffirmed their beliefs at the 1999 ANA House. Since then dialogue between ANA and NCSBN has continued as well as ongoing monitoring of states' experience. The result has been the dissolution of many of the Delegates' original concerns. Some state Attorneys General and policy makers are hesitant to adopt the Compact model, while ANA has long standing policy that is in concflict with the Compact.
The Nurse Licensure Compact (NLC), is an example of a mutual recognition licensure model, requiring a nurse to hold a license in the state in which the nurse resides. ANA's long standing policy stipulates the state of practice, rather than the state of residence holds greater logic for license jurisdiction. This position is predicated by the belief that nursing is a knowledge-based profession and that knowledge resides with the nurse. Therefore, it is ANA's belief that the state of practice is where the nurse is located. The NLC also raises concerns due to the variations between states with regards to licensure and re-registration requirements.
For a complete review of ANA's policy as it pertains to the Compact - refer to "Talking Points" (2013).
States in which the Compact is recognized