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When you’re a dedicated nurse who wants to work across state lines, doing so should be easy, accessible, and user-friendly. However, this was not always the case for ambitious, hard-working nurses.

In the old days, nurses needed to apply for and maintain multiple licenses, a ponderous process by any measure. Now, with the benefit of the greatly expanded Nurse Licensure Compact  (NLC), nurses in most states (and some U.S. territories) have the flexibility of a portable license that allows for an easy process of working in multiple jurisdictions.

Understanding the Nurse Licensure Compact

Jim Cleghorn, the Director of Member Engagement and Government Affairs at the National Council of State Boards of Nursing (NCSBN), is an expert in all things NLC. The NCSBN is a non-profit organization that advocates on issues of public health and public policy and is the engine behind the NLC.

“The most successful aspect of the NLC is its longevity,” Cleghorn states. “For nearly 25 years, registered nurses and licensed practical nurses across compact states have had access to a flexible licensure system with public safety at its core. The NLC successfully enables licensure mobility for RNs and LPNs while ensuring that state boards of nursing remain the regulators of nursing practice in their respective jurisdictions.”

Cleghorn explains how states issue compact licenses. “Some jurisdictions issue a compact license as a default, and others allow the applicant to choose a multistate option. In Colorado, for example, the default license is a multistate license. Applicants who meet the uniform licensure requirements in addition to Colorado’s home state requirements will be issued a multistate license. Oklahoma, by contrast, allows an applicant for licensure to apply for a single state or a multistate license.”

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The compact works similarly in U.S. territories like Guam and the U.S. Virgin Islands as it does for the 50 states. Cleghorn explains, “Guam and the U.S. Virgin Islands are parties to the NLC. In March 2021, Guam became the first U.S. territory to enact the NLC, and the U.S. Virgin Islands were enacted later that year.”

Unfortunately, Puerto Rico has yet to join the NLC. Puerto Rico does not require RNs and LPNs to pass the NCLEX, but nurses with multistate licenses must pass this universal measure of basic nursing competence. Cleghorn shares, “Should Puerto Rico enact the NLC legislation, nurses with a primary state of residence in Puerto Rico would need to pass the NCLEX and meet other uniform licensure requirements to obtain a multistate license.”

Can We Become a Compact Nation? 

When it comes to getting every state to join the NLC, politics can be tricky. Cleghorn shares, “Every state and jurisdiction is unique, so there’s no single reason why the NLC has not yet been enacted across the country, but common threads exist.” He continues, “Some jurisdictions—including Alaska, California, Hawaii, and Massachusetts—have yet to adopt any, or many, interstate healthcare licensure compacts.”

Cleghorn explains the multifaceted nature of the barriers and the reasons for some states’ hesitancy. “Unfamiliarity with how compacts operate and what benefits they provide has been a barrier. Fortunately, as more states enact interstate compacts, lawmakers can turn to neighboring compact states to see how it safely and effectively creates licensure mobility.”

Nursing unions can be an issue with compact enactment. “For the NLC, another barrier in some remaining jurisdictions is opposition from nursing unions. While state nurses’ associations have been leaders in advocating for the NLC across most of the 41 member jurisdictions, nursing union organizations have concerns, including the potential impact joining the compact will have on collective bargaining.”

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Concerning predictions about whether we’ll eventually reach all 50 states and other U.S. territories, that remains the goal of the NLC. Cleghorn is adept at illustrating the importance of this ongoing effort.

“The need for the NLC in those jurisdictions is great. Nurses across those jurisdictions must obtain and maintain multiple licenses to practice across state lines, in-person and remotely, and their patients are more mobile than ever. Stakeholders are working toward that goal every legislative session, and we’re confident that each year will bring us closer to the goal of a compact nation.”

What Does Partial NLC Implementation Mean in Practice? 

“Once a jurisdiction enacts the NLC, an implementation process begins,” states Cleghorn. The implementation can be viewed as two stages: the new member state must open its doors to active multistate licensees from other states and must also begin issuing licenses to applicants for a multistate license in their state.”

The multistate license is a real boon for nurses who want to practice across state lines, both physically and remotely. And partial implementation can be helpful when full adoption hasn’t yet happened.

Cleghorn explains, “Some jurisdictions can choose to partially implement the NLC, allowing active multistate licensees to practice within their jurisdiction while implementing processes for issuing multistate licenses. An example of a jurisdiction that partially implemented the NLC is New Jersey. They enacted the NLC in 2019 and had not yet implemented it when the COVID-19 pandemic struck.”

 Not having a multistate license option could be a great hindrance during an emergency like a pandemic, And Cleghorn describes how New Jersey handled it.

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“In March 2020, the New Jersey Board of Nursing partially implemented the NLC, allowing active multistate licensees from other NLC jurisdictions to practice in the state. The partial implementation allowed New Jersey to call upon an active, vetted workforce to assist with the disaster response, and they fully implemented the NLC on November 15, 2021.”

Cleghorn is optimistic when asked if the NLC has influenced other professions to create similar agreements.

“I believe the success and longevity of the NLC has influenced other healthcare professionals to develop and advocate for compacts. Nursing regulators came together in the 1990s to discuss the need for licensure mobility and the inefficiencies in the 100-year-old licensure system based on a single-state model. The continued exponential growth of telehealth, more mobile patients, and the increase in distance education exacerbate the need for increased licensure mobility.”

Keith Carlson
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