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Changes in nurse licensure will impact profession’s future

Back in the day, when you became licensed as a registered nurse, a licensed practical/vocational nurse or an advanced practice nurse, you sat for your NCLEX-RN or NCLEX-PN boards and met the requirements for an APN license in your state. When you passed your exams or met APN requirements, you were issued a license to practice nursing as an RN, an LPN/VN or APN in your state.

If you decided to practice in another state, you applied for a second license while keeping your first license. This approach to licensure has been in existence for 100 years.

Obtaining a license in every state a nurse sought employment was cumbersome and costly but necessary because practicing nursing in any state without a valid and current license is not legal. A nurse doing so could face state criminal charges.

This approach to licensure continued until after much work by state boards of nursing led to the National Council of State Boards of Nursing implementing the initial Nurse Licensure Compact in 2000.

The NLC provided model legislation and rules that state legislatures could adopt. The NLC allowed an RN or LPN/LVN to possess one multistate license in their primary state of residence (the home state) and practice in other member compact states (remote states) seamlessly while meeting the requirements of the respective nurse practice acts.

Currently, 25 states are members of the NLC, which is explained in this video.

With the many changes in healthcare and healthcare delivery since 2000, including increased nurse mobility and the need to clarify the authority to practice for many nurses engaged in telenursing or interstate practice, boards of nursing continued to evaluate the current NCL.

On May 4, 2015, the NCSBN approved an enhanced NLC. The council and its member boards believe the enhanced NLC will increase access to care, maintain quality in the delivery of nursing care, decrease overall costs and provide continued high standards of public protection.

One new component of the enhanced NLC centers on criminal background check. The enhanced compact requires such checks and mandates that if a nurse’s CBC is positive for a felony under federal or state law, the nurse will not be issued a multistate license. The positive finding includes a nurse’s conviction, being found guilty or entering into an agreed settlement of a felony.

The nurse with a positive felony background may be issued a single-state license in his or her home state, but would not be afforded the privilege of practicing in remote states with a multistate license.

If a nurse’s background check shows a conviction, being found guilty or entering into an agreed settlement for a misdemeanor offense related to the practice of nursing, a case-by-case analysis will be made before a multistate license is issued.

As is the case with a positive check for a felony, the nurse with a positive misdemeanor offense may be issued a single-state license in his or her state.

Nurses who hold a multistate licensed under the current NLC will be grandfathered in and are not affected by the new provision concerning positive background checks.

Details about the NLC, including a map of compact states and those with pending NLC legislation, can be viewed on this web page.

For APRNs, the NCSBN also approved an enhanced Advanced Practice Registered Nurse Compact on May 4 that allows an advanced practice registered nurse to “hold a multistate license with a privilege to practice in other APRN compact states,” according to the new compact.

On Nov. 25, a new website will be initiated that will detail the enhanced compacts and their rules.

If your state has not yet considered either compact, contact your representatives after reviewing the documents and encourage them to pass the newly adopted compacts. The compacts clearly benefit nursing practice, you and the public as well.

Editor’s note: Nancy Brent’s posts are designed for educational purposes and are not to be taken as specific legal or other advice.

By | 2015-11-18T16:38:24-05:00 November 18th, 2015|Categories: Nursing careers and jobs|5 Comments

About the Author:

Nancy J. Brent, MS, JD, RN
Our legal information columnist Nancy J. Brent, MS, JD, RN, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Her posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.

5 Comments

  1. Avatar
    Marisela Cigliuti BSN RN November 24, 2015 at 11:07 am - Reply

    Nancy, it is important to note that even though the APRN compact was passed in May – it will take effect after 10 states pass the law.

    Marisela Cigliuti BSN RN
    CEO of TeleNurse Network

  2. Avatar
    Lillian Martin November 25, 2015 at 4:31 pm - Reply

    The biggest flaw with the compact law is that it is tied to residence and not state licensure. I live in a non-compact state but have worked for 33 years as an RN in a compact state. My license to practice and the board which supervises that license should be the determinant for multi-state transferral not where I live. I was educated and work in a compact state but my license is limited by residency which shouldn’t be the factor, state licensure should.

  3. Avatar
    Jennifer Miller February 1, 2016 at 5:36 pm - Reply

    As a nursing graduate student, I recently attended the New Hampshire Nursing Association’s Legislative Town Hall. One of the bills up for consideration was Senate Bill 329 which would adopt the revised model for the nurse licensure compact under RSA 326-B:46. In New England, there are many nurses who reside in one state and practice in a neighboring state. The compact states include New Hampshire, Rhode Island and Maine. The non-compact states include Vermont, Massachusetts and Connecticut. At our meeting site in Manchester, the discussion surrounded the potential reasons for states not to join the compact licensure agreement. The possibility of lost income from licensure payments and the concern regarding disciplinary action were brought forward as potential barriers. Is there a common rationale from the non-compact states on their decision to remain independent?
    After reviewing information on the National Council of State Boards of Nursing website, I was not able to determine which state would have jurisdiction in the following case, which was presented at our site meeting-A nurse lives in State A, which is a compact state and holds her primary license there. After obtaining a multi-state license, she takes travel nursing assignment in State B, also a compact state. While in State B, she is involved with an event that requires disciplinary action. Which state would have jurisdiction?
    Thank you for your time!

    • Avatar
      James Bichler, RN-BC May 22, 2017 at 5:58 am - Reply

      Hi Jennifer,

      I have been a travelling nurse for over a year now and can fully answer your question.

      Under the rules developed by the NLC the nurse described in your scenario is subject to discipline in the remote state that patient care occurred. Let’s use the following example:

      John Smith is a Registered Nurse and resident of the state of Wisconsin, a compact state. He decides to take a job as a travel nurse in Utah, also a compact state. While on his assignment in Utah he commits a potential violation of the Utah Nurse Practice Act. The violation would be investigated by the state of Utah, because the violation of law occurred in Utah. The Utah board of nursing can take action on John’s multi-state license by revoking or suspending his privilege to practice in their state.

      The Utah Board of Nursing would then notify the nurse licensure compact administrators to let them know his privilege to practice nursing in Utah was revoked. They would submit a disciplinary report with details related to the violation of nursing practice. This report would then be forwarded to John’s “home state” board of nursing, in Wisconsin.

      The Board of Nursing in Wisconsin would then evaluate the violation that occurred, and treat the case as if it occurred in Wisconsin. Only a “home state” board of nursing can deactivate multi-state licensure privilege in ALL other states. Utah took action against John and suspended his privilege to practice in Utah and only Utah. Wisconsin will then take action against their nurse and either reprimand, suspend, or revoke their nursing license. Once action is taken by a home state, the licensee’s multi-state license is deactivated until the home state returns John’s license to a “full unencumbered license.”

      Any compact state can revoke the privilege to practice in their state, but only a nurse’s home state can “encumber” a license and suspend a license. It would be like moving violations while driving a car. The local jurisdiction can suspend the licensee’s privilege to drive in their state, but only the persons home state can suspend or revoke the driver’s license.

  4. Avatar
    homemade December 7, 2019 at 6:13 am - Reply

    As noted in Chapter 3, the nursing workforce historically has been composed predominantly of women. While the number of men who become nurses has grown dramatically in the last two decades, men still make up just 7 percent of all RNs (HRSA, 20). While most disciplines within the health professional workforce have become more gender balanced, the same has not been true for nursing. For example, in 2009 nearly half of medical school graduates were female (The Kaiser Family Foundation statehealthfacts.org, 2010), a significant achievement of gender parity in a traditionally male-dominated profession. Stereotypes, academic acceptance, and role support are challenges for men entering the nursing profession. These barriers must be overcome if men are to be recruited in larger numbers to help offset the shortage of nurses and fill advanced and expanded nursing roles. Compounding the gender diversity problem of the nursing profession is the fact that fewer men in general are enrolling in higher education programs (Mather and Adams, 2007). While more men are being drawn to nursing, especially as a second career, the profession needs to continue efforts to recruit men; their unique perspectives and skills are important to the profession and will help contribute additional diversity to the workforce.

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