The Nurse Licensure Compact and Advance Practice

Registered Nurse Compact

The Nurse Licensure Compact (NLC) and Advance Practice Registered Nurse Compact are model pieces of legislation designed to advance “public protection and access to care through the mutual recognition of one state-based license that is enforced locally and recognized nationally”. Compacts allow nurses to practice and communicate with patients across state lines. The enhanced model legislation addresses physical and electronic communication and practice.

Nurse Licensure Compact (NLC): A form of interstate compact specific to nurse licensure that provides an agreement between two or more states for the purpose of recognizing nurse licensure between and among a group of participating states. States must enter into one in order to achieve mutual recognition.

In 2000, the NCSBN launched the NLC initiative to advance the mobility of nurses’ practice. Maryland was the first state to implement an NLC in 1999. Since that time, 25 states have enacted NLC legislation. In May 2015, new versions of the NLC and APRN Compact were adopted by the NCSBN. The enhanced model language will be adopted by future states enacting compacts.

Compacts allow a nurse or advance practice nurse to be licensed in his or her state of primary residency and to practice in other compact states that agree to mutually recognize that nurse’s single multistate license from the primary resident state. Essentially, the compacts authorize licensed nurses who reside in a compact-participating state to practice in another compact-participating state without obtaining additional practice licenses.

Participating states acknowledge another state’s licensure through an NLC or APRN Compact. Currently, multistate licensure privilege means that a nurse has the privilege of practicing in any participating compact state that is not his/her state of residency. As long as a nurse remains in good standing, renews his/her multistate licensure and continues to reside in a primary state of residence that is a compact state, there is no time limit for working in other compact states

Compacts allow nurses to practice in other states both physically and electronically through multistate licensure privilege. However, it is important to note that nurses residing in states that participate in an NLC or APRN compact who want to practice across state lines in other participating states are subject to the laws and regulations of each state they practice within.

Although nursing licensure is tied to the nurse’s state of primary residence, accountability for nursing practice is tied to the laws and regulations of the state where a patient is located at the time nursing care and services are rendered. This type of accountability is not unique to nursing licenses; it also applies to other licenses such as a driver’s license. For example, a person driving in Indiana must obey the speeding laws of Indiana even if his or her driver’s license was issued in Ohio. Similarly, nurses must abide by the nursing practice laws in the states where they are practicing. For example, a nurse whose primary residence is in the state of Kentucky, but who is providing case management services through telehealth, Internet, or telephone connections to a patient who resides in South Carolina, would be governed by the South Carolina nurse practice act for care provided to that patient.

Nursing practice is no longer limited to the provision of physical patient care but also includes nursing care such as counseling, education, and prior authorization of services through the use of technology. The expansion of digital and electronic services makes this concept even more significant for nurses.

To be eligible to hold multistate licensure through the NLC, a nurse must declare primary residence in a state that has joined the compact. A nurse’s primary state of residence (PSOR) or home state is defined by the mutual recognition model as “the state of a person’s declared fixed permanent and principal home or domicile for legal purposes” (New Hampshire Board of Nursing. Sources used to verify a nurse’s PSOR include federal income tax returns, driver’s license, voter registration cards, etc.

The state of primary residence is used to determine jurisdiction for nursing licensure. Nurses changing permanent residence from one NLC state to another NLC party state must relinquish their licensure in their previous home state and apply in their new home state. Nurses should apply for licensure in advance if they anticipate a change in their PSOR. Nurses generally have 90 days to obtain a license in their new PSOR. Nurses should not wait until their current license expires before applying for a license in their new home state.

However, if a nurse moves from a non-NLC state to an NLC state and declares the NLC state as their PSOR, they must apply for a new license but can still keep their noncompact license. Although this may seem confusing, nurses are not allowed to have more than one multistate compact license at a time. Licensure is not based on the state of practice because with the implementation of telenursing and other forms of nursing such as case management through managed care, it is sometimes difficult to determine the state of practice for the specific purpose of licensure.

In addition, nurses who are not currently in the workforce or who are working temporarily could be subject to difficulties with state licensure. Tracing complaints and investigations is also facilitated by linking licensure to the state of primary residence rather than employment. For states not participating in the mutual recognition model, nurses must apply for separate licensure within the state where they are going to practice either physically or electronically, regardless of residence. Even though there is a national licensure examination, individual state licensure in noncompact participating states is required.

There is no limit placed on the number of licenses that a nurse may hold from nonnoncompact states. There are many positive outcomes associated with the mutual recognition model and only very few potential negatives. The mutual recognition model and NLC clarify the practice of telehealth and interstate nursing practice. In addition, the NLC provides greater mobility for nurses and improves access to care. This is critical in times of disaster when nurses need to mobilize to areas of need. The NLC also promotes information sharing among participating NLC states that recognize the mutual recognition model to promote quality of care and discipline if necessary.

One potential negative is the need for increased vigilance on the part of nurses who practice across state lines to understand the particular standards of care, scope of practice, and state laws that apply within the state where care is rendered. Without separate application for licensure, it may be less apparent to nurses that they must fully understand each state’s nurse practice act and governing laws where they render care.

Mutual recognition model: A model that allows a nurse to have one license in his or her state of residency with the ability to practice (electronically or physically) across state lines in other states that participate in this model if there are no restrictions on his or her license and that person acknowledges that he or she is subject to each state’s practice laws and rule.

History of the Nurse Licensure Compact

The NCSBN Delegate Assembly began the creation of the NLC in 1996. At that time, NCSBN delegates voted to begin the process of studying and inspecting various mutual recognition models and report their findings. By 1997, the NCSBN Delegate Assembly unanimously agreed to endorse a mutual recognition model. In 1998, the NCSBN Board of Directors endorsed the goal to remove regulatory barriers to increase access to safe nursing care. The RNs and licensed practical nurses and vocational nurses (LPN/VN) compact was initiated on January 1, 2000.

The first states to pass the RN and LPN/VN NLC into law were Maryland, Texas, Utah, and Wisconsin. Also in 2000, the Nurse Licensure Compact Administrators (NLCA) was organized to protect the public’s health and safety. The mission of the NLCA is to promote compliance with laws governing the practice of nursing in each party state through the mutual recognition of party state licenses. In 2002, the NCSBN adopted the APRN Compact to complement the NLC for advanced practice nurses. However, due to lack of uniformity in advanced practice nursing, the compact faced implementation challenges and was only partially implemented in Iowa, Utah, and Texas.

In 2008, the Consensus Model for APRN Regulation was adopted to promote uniformity in advance practice. Two years later, the APRN Consensus Model language was integrated into the APRN Compact. In May 2015, the NCSBN Delegate Assembly met and adopted enhanced compact language to align the NLC and APRN Compact and promote implementation.

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