NLC Talking Points

Nurse Licensure Compact: Talking Points

Under current laws, a nurse must have proper state licensure, recognized endorsement or statutory waiver (typically limited to nurses working with the Veterans Administration or military services) to provide professional nursing services in a state. Therefore, the nurse must apply for a license in every state in which s/he works. It is a lengthy and costly process particularly for nurses who maintain a license in more than one state. In 1998, the National Council of State Boards of Nursing (NCSBN), developed model legislation for the mutual recognition compact, known as the Nurse License Compact (NLC). The Compact was designed to address these issues among others.

The Compact creates a system similar to a state drivers license. We are allowed to drive in another state even though we are not licensed to do so and even though the laws differ from state to state. Just as in driving in another state, under the NLC nurses are subject to individual state practice and discipline laws.

The benefits of the Compact includes:

Expanding Opportunities for Nurses

Allows a nurse to practice in any of the other Compact states.
Expands the variety of settings in which nurses can practice work, e.g., traveling nurses.
Expands the technologies, such as telehealth and consultation services, that nurses use across state lines.

Administrative Burden and Duplication

Eliminates unnecessary duplicative licensure procedures by permitting a nurse licensed in one Compact state to practice in all other Compact states without the need to apply for separate licenses, thus, providing a more expedient and efficient authorization to practice.
Provides more uniformity in laws and approaches to new technology and practice modalities across states.

Disciplinary Actions

Nursing is committed to providing high quality patient care and when a nurse moves to another state to avoid a disciplinary action, it affects all nurses. The Compact creates a uniform system for the sharing of information on disciplinary and licensure issues among the Compact states, thus, enabling states to take disciplinary action allowed by law for untoward actions. This dramatically decreases the ability of a nurse to move to another state to avoid disciplinary actions. While states will impose disciplinary actions as they have in the past, they will be operating with better tools that give them more timely and accurate information.
Each Compact state is given the same priority to complaints about nurses who render services in any Compact state as they would as if those services were provided to in-state residents.
Under the Compact, each state has the right and responsibility to enforce its own Nurse Practice Act and to impose an appropriate penalty, including due process clauses. There is no change in the imposition of penalties from that imposed in a non-Compact state.

States Rights

The Compact helps simplify difficult jurisdictional issues.
Each state has the option to join the Compact and may choose to leave at any time.
The Compact is adopted into the Nurse Practice Act of each state. The Compact does not define the practice or scope of nursing, those rights and responsibilities remain with each state.
All provisions that are not specifically addressed in the Compact or those in direct conflict with the Compact rely on existing state law.
States retain the ability to revoke the licensure privilege of any nurse practicing in that state.
A Compact state may take any administrative, civil, equitable, or criminal actions permitted under that state’s laws.

Consumer Protection

Consumers expect and desire to have access to qualified nurses regardless of state boundaries. To protect the consummer, the state of residence and the Compact states must be able to take disciplinary actions allowed by law, such as issuing fines or placing limitations on practice privileges.

Consumer protection is enhanced under the Compact in two ways.

The Compact clarifies that the clent’s home state is where service is considered to have been rendered.
There is a growing need for nurses to practice across state lines, e.g., providing occupational health services such as disability management and workers' compensation, alleviating nursing shortages, impact of technology on practice patterns, such as telehealth and nurse triage services.

Nursing Boards

The Compact provides Nursing Boards with tools that allow them to more effectively investigate disciplinary actions along with opportunities for greater collaborative and innovation within and between other nursing boards.
Nursing Boards have a greater ability of sharing resources, thus, decreasing costs, and reducing administrative burdens.

Nursing Standards

Nursing standards have become more consistent across Compact states as nursing boards share their best practices and the logic behind those standards with one another.

In addition to the above information, you might be interested in reviewing a document created by the NCSBN, "Just the Facts on Nurse Licensure Compact" (http://www.ncsbn.org/pdfs/NLCA_Fact_Nov02.pdf), which describes the Compact and its benefits. You can also review the implementation status of various states at http://www.ncsbn.org/nlc/rnlpvncompact_mutual_recognition_state.asp.

According to the 2003 survey evaluation of the Nurse Licensure Compact, most nursing boards experienced an increase in revenue from licensure renewals and in revenue, overall, after implementing the Compact. Costs related to the implementation of the nurse licensure compact have been minimal for most state nursing boards and individual nurses. The report is available at http://www.ncsbn.org/pdfs/CompactSurvey.pdf. In this document, you will see what nurses and employers have to say about the realities of working in a Compact state.

In most cases passage and implementation has been rather smooth. The NCSBN is pleased with their progress starting with five states that initially signed on in 1998 to over 22 states in 2007. However issues have been raised in Compact states specifically criminal background checks and continuing nursing education (CNE). In summary:

Criminal checks have been an issue mostly related to pre-passage versus post passage. The main reason may be that criminal checks are not a required component of the NLC, so it surfaces as the parties begin to think through pros and cons and/or as a part of implementation. The major concern is that one state may have a requirement of criminal checks or a more stringent requirement, than a state with no requirement or less stringent requirement. However, the NCSBN continues to work with states to resolve these issues, through some other policy avenue or other reasons that override this specific issue. For example, Compact states have more and faster information related to incidents and disciplinary action than ever before that far outweighs the lack of or less stringent requirements for criminal checks.

The NCSBN has adopted a position recommending mandatory criminal checks following the federal requirement of fingerprints. The NCSBN have set a target goal of 2006 for the Compact states to adopt the mandatory criminal checks recommendation, which has to be done legislatively. To date they have not reached this goal.

SLCs & AAOHN Advocates need to be aware that this issue may surface as you work in your respective states for NLC passage or related to implementation.

Regarding CE, this issue has come up, but less often. The NCSBN is focusing on the broader framework of "competency over time", not just CE. The NCSBN recommends a portfolio approach, where several methods are used to ensure competency over one’s professional career.

For both of these and others, SLCs and AAOHN Advocates need to focus on the following reasons to support the NLC:

1. Clarification of the authority to practice for many nurses
    currently engaged in telenursing or interstate practice;
2. Greater mobility for nurses;
3. Improved access to licensed nurses during a disaster or
   other time of great need for qualified nursing service;
4. More importantly, improved access to nursing care; and
5. Enhance discipline and information sharing among
   participating NLC states.

Additional Resources for Legislators:

AAOHN: http://www.aaohn.org/public_policy/state_advocacy/licensure.cfm

NCSBN: http://www.ncsbn.org

Model Legislation: http://www.ncsbn.org/160.htm

Enabling Language: http://www.ncsbn.org/375.htm

Participating States: http://www.ncsbn.org/158.htm