The Enhanced Nurse Licensure Compact:

The Licensure Solution for

Interstate Nursing Practice in the US

What is an Interstate Compact?

A statutory agreement between two or more states established for the

purpose of remedying a particular problem of multistate concern

A contract between two or more party states

Each party state is a signatory to the same contract. For that reason, there is

a need for “substantive sameness.”

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What is the Nurse Licensure

Compact?

The NLC is an interstate

compact.

It authorizes a nurse holding one

multistate license in the primary

state of residence to practice

(physically or via telehealth) in

any compact state.

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Why Would a Nurse Need More than One License?

A nurse must have the authority to practice in the state where the pt is located at the time service is provided.

“As the organizations representing…state…licensing boards…that regulate the practice of medicine, pharmacy and nursing, … (we) affirm that in a consumer protection model, health care practice occurs where the recipient of healthcare services is located.”

Source: The Tri-Regulator Collaborative Position Statement on Practice Location for Consumer Protection

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Two Distinct Compacts

• Original NLC is the compact that began in 2000

– 25 member states

• Enhanced NLC (eNLC)

– Updated version adopted 2015.

– Will replace the original NLC.

– States started to join in 2016.

– Became effective July 20, 2017 when the 26th state enacted.

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Original NLC – Current Status

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Original NLC -- Starting Jan 19, 2018

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NOTE: These four states will introduce eNLC legislation in 2018 (WI in Sept 2017).

The Impact of the 4 States Remaining in the Original NLC

Upon Employers/Nurses in Those 4 States

• Employers in the four states that remain in the original NLC that have nurses practicing in the 21 original NLC states that joined the eNLC will be impacted.

• As of January 19, 2018, those nurses in the 4 states holding an original NLC multistate license won’t have the authority to practice in eNLC states without applying for a single state license in each of those states.

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Impact (Continued)

• As of January 19, 2018, the original NLC multistate license held by

nurses in those 4 states will be valid in only those 4 states.

• Should an employer in the remaining 4 original NLC states rely upon the nursing workforce from the 21 original NLC states that joined the eNLC, as of January 19, 2018, those nurses in eNLC states with an eNLC multistate license won’t have the authority to practice in those four states without applying for a single state license.

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Impact (Continued)

• The original NLC is anticipated to cease in the next two years as

its member states dwindle to less than two. At that point, nurses in

the 4 remaining original NLC states will have no multistate

license.

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Effective Date

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• Effective date is whenever the 26th state enacts the eNLC.

– This happened on July 20, 2017.

– For states that enact the eNLC, in law, this date triggers the six

month notice of withdrawal of states from the original NLC.

– On this date, the compact agency is created.

– This is not the date that eNLC licenses are issued or that

nurses may practice in eNLC states.

Implementation Date

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Implementation date (Jan 19, 2018) is when:

– The eNLC becomes operational; i.e., nurses can practice in eNLC states, boards

of nursing will accept and process applications for the eNLC multistate license.

– Since we know that 6 months after July 20, 2017, 21 states will have withdrawn

from the original NLC, the implementation date must necessarily be no more

than 6 months after July 20, 2017.

– Six months later is Jan 19, 2018. If it was any later, millions of nurses would no

longer hold multistate licenses and practice would be severely curtailed. It must

be a seamless transition to avoid practice interruption.

Where are We Today with the eNLC?

2016:

• 10 states enacted eNLC

2017:

• 16 states enacted eNLC (AR, DE, GA, IA, KY, MD, ME,

MS, MT, NC, NE, ND, SC, UT, TX, WV)

• 2 states currently pending (MA, NJ)

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Enhanced NLC – Current Status

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A graphic view of the information in the preceding slide…

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The Goal: A Compact Nation One Multistate License Valid for Practice in All Jurisdictions

What’s Different in the enhanced NLC?

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11 Uniform Licensure Requirements

To receive a multistate license, a nurse must:

1) Meet the home state’s qualifications

2) Graduate from qualifying education

program (or graduated from a foreign

program verified by independent

credentials review agency)

3) Pass the NCLEX-RN® or NCLEX-PN®

exam (or predecessor)

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Uniform Licensure Requirements (Continued)

To receive a multistate license, a nurse must:

4) Have no active discipline on a license

5) Submit to a federal criminal background check

6) Not be currently enrolled in an alternative program

7) Have a valid U.S. Social Security number

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Uniform Licensure Requirements (Continued)

To receive a multistate license, a nurse must:

8) Self-disclose participation in an alternative program

9) Have no misdemeanors related to practice of nursing

10) Passed English proficiency exam if foreign grad

11) Have no prior state or federal felony convictions

• NOTE: A nurse who does not meet a requirement may receive a single state license.

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Prevalence of Criminal Background Checks (CBCs)

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Map shows 12 states without a CBC requirement. Maine and Montana will have CBC requirements in the eNLC. That leaves 10 states without.

Grandfathering

• Nurses in original NLC states (that enacted the eNLC) holding a

multistate license on the July 20, 2017 effective date will be

grandfathered into the eNLC.

• They won’t have to meet the requirements for an eNLC multistate

license.

• Nurses issued a multistate license after July 20, 2017 will be

required to meet the eNLC multistate license requirements.

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Rulemaking

Rules adopted directly by the

Commission

NOTE: Rules are limited to the

implementation and operations

of the compact and multistate

licensure.

No requirement that rules be or

adopted by individual states

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Other Interstate Licensure Compacts for

Healthcare Professions: Insight into the Future of Licensure

Compacts in Progress

1) Nursing (RN/LPN)

2) Nursing (APRN)

3) Physicians

4) Physical Therapists

5) Emergency Medical Technicians

6) Psychologists

Compacts Under Development or

Being Considered

1) Occupational Therapists

2) Speech Pathologists

3) Audiologists

4) Nutritionists

5) Dieticians

6) Physician Assistants

7) Social Workers

8) Athletic Trainers

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