Traditionally in the U.S., health care professionals wishing to practice within a state or territory are required to be licensed by that jurisdiction or multiple jurisdictions if crossing borders. The regulatory landscape began to change in 2000 when Maryland signed into law the first health care compact – the Nurse Licensure Compact (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 the primary state of residence gives the nurse the privilege to practice in other compact states (both physically and via technology) without having to secure an additional license. Similar to the drivers’ license model, should the nurse change the state of residence, a new license must be secured in the new state while surrendering the former multistate license.
Since the inception of the NLC, 25 states have joined. 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 and (2) restriction from acquiring a multistate license if ever convicted of a felony. (3) 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 to hold one multistate license with a privilege to practice in other compact states and includes a required provision of full practice authority.
ANA members first discussed the NLC at the 1998 House of Delegates (HOD) which 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. With almost two decades of experience with the NLC, many of ANA’s original issues have been refuted. However, two major areas of concern were reaffirmed by ANA representatives during the 2015 Membership Assembly. Although members found they were still unable to fully support, the dialogue between ANA and NCSBN has continued as well as ongoing monitoring of states' experience.
(1) Location of practice
ANA and the National Council of State Boards of Nursing (NCSBN) have a fundamental difference of opinion about the location of practice. In 1998, 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. ANA’s 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 located.
(2) Variations between states in relation to licensure / re-registration requirements
Variations in licensure can be confusing and burdensome for nurses. Examples include:
- frequency & 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;
- required continuing education, if any;
- what constitutes an infraction and resultant actions taken by the Board.
- how nurse diversions & addictions are addressed; is a program available?
- criminal background checks (CBC) * now a provision of the enhanced 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.
For a complete review of ANA's policy as it pertains to the Compact - refer to "Talking Points" (2015).
States in which the Compact is recognized
Read the Nurse Licensure Compact Frequently Asked Questions
Members only link
Last updated 05/2016