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.