What You Need to Know About Nursing Compact Law

Posted By Madilyn Moeller, Thursday, July 13, 2023

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By Bradford Adatto, JD, ByrdAdatto

The multi-state nursing license is issued in a nurse’s primary state of residence and is recognized across state lines, allowing nurses to have a single multi-state license to legally practice virtually or in-person in all compact states.

Once a nurse obtains a multi-state license, they can practice in any compact state without having to take an exam or apply for licensure. The National Council of State Boards of Nursing (NCSBN) has an electronic verification system so nurses can prove their credentials across state lines. The system allows nurses to easily transfer their licensure across states and practice within the compact state, whereas a single-state license limits the nurse to practice only within that particular state. This provides nurses greater mobility in their careers and opens opportunities for travel nursing, telehealth and emergency response. Additionally, patients benefit from improved access to health care services, particularly in underserved areas or during times of crisis.

Having a multi-state license also opens the door for nurses to obtain training that might not otherwise be available to them. Many courses offer live training on patients. From a compliance perspective, having a license in the state where the course is offered is the cleanest path to having the ability to participate in the live training. The multi-state license provides an elegant solution to allow nurses a broader opportunity for this type of training.

What is the Nurse Licensure Compact?

The Nurse Licensure Compact (NLC) is an agreement allowing reciprocity of a nursing license between states that are part of the NLC (compact states). Initially ratified in 1999, the NCSBN sought to minimize barriers to interstate practice. The NLC has now grown to include 38 states, with additional states pending implementation. The NLC allows a nurse whose primary state of residence (i.e., where they file their taxes) is a compact state and who possesses a nursing license in that state to obtain a multi-state license.

Only registered nurses (RNs), licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) are eligible for the multi-state license, as advanced practice nurses are not included in the NLC. In addition, the nurse must meet certain uniform licensure requirements, such as meeting the licensure requirements for their home state, graduating from a board-approved education program, passing the National Council Licensure Examination and passing a background check.

What else do you need to know about multi-state licenses for nurses?

Nurses may apply for a multi-state license only in the nurse’s primary state of residence, and obtaining one requires a one-time fee. Per the NLC rules, nurses who are licensed in and legal residents of a compact state may not hold licenses from other compact states—they can only hold one compact state license at a time and it must be from their primary state of residence. If a nurse changes their primary state of residence from one compact state to another, they must transfer their license by applying for licensure by endorsement in their new home state.

Another important note is that, regardless of where they obtained their license, nurses are still held to the standards of the compact state in which they are practicing. Nurses are responsible for complying with the provisions of the Nurse Practice Act in all compact states in which they practice. If a nurse commits a violation while practicing in another state and disciplinary action is taken, such action is reported to the nurse’s primary state of residence. The home state can then take the same action as if the nurse committed the violation there.

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If you have further questions about the NLC or other licensing requirements, schedule a consultation with ByrdAdatto today.

Bradford E. Adatto, JD, has a background in regulatory, transactional and securities law. Having worked in health care law his entire career, he has an in-depth knowledge of the “dos and don’ts” of this heavily regulated industry. Adatto has worked with physicians, physician groups and other medical service providers in developing ambulatory surgical centers, in-office and freestanding ancillary service facilities, and other medical joint ventures. He regularly counsels clients with respect to federal and state health care regulations that impact investments, transactions and contract terms, including Medicare fraud and abuse, anti-trust, anti-kickback, anti-referral and private securities laws.

(ByrdAdatto is grateful for the significant research and drafting contribution to this article from its Law Clerk, Clint Nuckolls. Nuckolls is a third-year student at SMU Dedman School of Law.)

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