Multistate License Comes in a Compact Package

June 14th, 2011


By , BSN, RN

A host of new nursing school grads are preparing for their state licensing exams. The NCLEX is just one of several criteria a new nurse must meet in order to obtain a state's nursing license. In some states, new nurses will be granted a license which will allow them to practice in other states as well without taking any more tests and, a compact license as it is known, can be a very handy thing.

The first nursing license in the United States was issued in 1903 in North Carolina, and the rest of the states followed suit shortly thereafter. Each state has its own licensure laws and responsibility for patient health, safety, and welfare in that state. A nurse with a license in Ohio was expected to work in Ohio, for example, and if she moved to Wyoming, she had to re-license in that state. Nursing licenses were simply not portable.

This lack of license portability wasn't much of a problem initially, but as communication and transportation in this country developed, people started to move around more. The whole field of travel nursing developed. When disaster struck stories made the news and nurses wanted to go help — like during this summer's tornado crises — but were unable to because of licensing restrictions. Portability has also become an issue as nurses are finding jobs outside the traditional career choices and are now working as hotline or telephone triage nurses. Patients calling in can be from any state, nationwide. Then there is the Internet and all of the opportunities it is opening up for teleconferencing, team care, and even telesurgery. What state is responsible for the safety of these patients? Is it the nurse's home state or the patient's?

In 1996, the United States Congress passed a Telecommunications Act. Developed because of the increasing practice of healthcare electronically, the act called for the development of standards and an infrastructure for telecommunications in healthcare specifically. The traditional nursing regulatory model is that for individual states, individual licenses exist. This left state's no authority to take action against a nurse’s license if, for example, a patient in Texas was harmed by a nurse practicing remotely from Maine, or anywhere else.

In response to the mandate the National Council of State Boards of Nursing (NCSBN) embarked on a three-year journey, developing a model of Multistate nursing licensure recognition that would "remove regulatory barriers to increase access to safe nursing care." The RN and LPN/VN Nurse Licensure Compact began January 1, 2000, when it was passed into law by the first participating states: Maryland, Texas, Utah and Wisconsin.

The issue today is observing the multistate licensure law is a choice for every individual state. It is not imposed by the NCSBN, by the federal government, or any other body. The states that enact the Compact agree to work toward general uniformity in the laws that license nurses to promote and protect patient access to quality care; however, the individual states retain complete authority in licensing.

So how does this work on an individual basis? It is determined by the nurse's state of legal residency. Legal residency is recognized as the state the nurse tells the Internal Revenue Service she lives in when she files her taxes each year. Typically, this is where the nurse files federal taxes, lives most of the time and has a driver's license.

Nurses with a Compact license have met the requirements for a nursing license in the resident state. The nurse with a Compact license may practice in any of the Compact states using his or her Compact license.

Other states belonging to the Nurse Licensure Compact are known as “Party” states because their state governments have also agreed to recognize nurses licensed in other compact-member states. There are currently 24 states active in the Compact. A nurse practicing in another party state must comply with the state practice laws of the state in which the patient is located at the time care is given.

A nurse can hold a home state license in only one state at a time. If she or he moves to another party state, they must apply for licensure in the new home state. There is a grace period, and during that time, the nurse can start a new job without any delays.

If a nurse in a Compact state wishes to work in a non-compact state, they must apply for and receive a license before practicing there. And, if a nurse is not a resident of one of the Compact states and wishes to work in a participating state, they must apply for and receive a "single-state" license in each Compact state before practicing.

If a problem arises and a complaint or disciplinary action is filed against a nurse working on a multistate license, it is processed in the state where the nursing care was rendered. If the nurse violates the Nursing Practice Act (NPA) or rules of the party state, the nursing board of the party state may revoke or restrict the nurse’s privilege to practice in that state, but cannot directly sanction the nurse’s home state license.

Violations occurring in a remote party state will be reported to the nurse’s home state nursing board. The home state nursing board will then investigate and take appropriate disciplinary action for a violation that occurred in a party state.

It has been 11 years since the Nurse Licensure Compact came into being, and obviously not all the states have joined. Worries that nurses found guilty of misconduct in one state will continue being allowed to work in another keeps some states at bay. Some states require criminal background checks and fingerprinting as conditions of getting a license…others do not. Fewer checks are a cause for concern for officials in  some states who believe every legal means possible should be taken to confirm a nurses qualifications to work with the public.

Another concern for some states, is the money that is made from licensing fees. Nursing licenses have very different prices in different states, and the fewer criteria, the less the license costs. In states that require specific continuing education courses, fingerprinting, different background checks, more state income is generated.

There are also some state nursing organizations that feel multistate licensure will make it much easier to replace striking nurses. Opposition also comes from nursing unions worrying about losing the power of collective bargaining. The NCSBN does not consider these concerns valid as the Compact legislation does not supersede existing labor laws.

Mutual recognition of a nurse’s license in states belonging to the Compact increases nurse mobility and allows for delivery of health care by increasingly innovative communication practices. Additionally, the Compact promotes public health and safety by encouraging cooperative efforts among the party states in nurse licensing and regulation. If the concerns of the non-participating states can be addressed and overcome more career doors in nursing will open. As more state legislatures enact the Nurse Licensure Compact the United States will move closer to allowing one home state license to grant a nursing privilege nationwide.

2 Responses to “Multistate License Comes in a Compact Package”

  1. registered nurse salary Says:

    Journey nursing as well as the Travel Nursing Trade established in response on the nursing scarcity by which nurses journey to work short-term short-term nursing positions. The existing intense shortage of nurses while in the America has greater the necessity for this kind of position.

  2. Rita Gillian Lawrence Says:

    The model of multistate nursing license has the potential for the SBRN to refer a case to any other participating state which could be all at some point and keep a case going despite being resolved in the state of the complaint(s) origin.
    The SBRN is not legally obliged to notify the nurse or her lawyer that the case has been referred on to another state and may be missed until it is too late for the nurse to act.
    I hope nurses will become adept at handling legal problems with the SBRN and always hire a license lawyer from the start of any SBRN notification. They should have a response rehearsed so that they are not taken off guard and surrender their license before seeking legal council. That would consist of limiting their interaction to the specific request for the SBRN investigators business card and informing them that they will have their lawyer contact them.
    I read in one of your articles that the SBRN can force a nurse to surrender his/her license and I am not sure if this is so or not I think that nurses do surrender licenses in mass because they are afraid and overwhelmed at the initial impact.

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