Will the NLC Go Nationwide? Should It?
The NLC has been a plus for travel nurses. But does everyone agree?
The Nurse Licensure Compact (NLC) enables nurses to practice in multiple states. Provided that your home state is a member of the Nursing
Compact, you may apply for a multi-state license. A Compact License opens up a world of career options and facilitates a travel nursing career. The
National Council of State Boards of Nursing (NCSBN) describes the Compact as a quasi-governmental and joint public agency of the member states.
Nursing Licensure State-by-State. Burden on Nurses?
The traditional way that nurses were able to practice in other states prior to the NLC was through passing the target state’s nursing licensure exam and then maintaining an active nursing license there. As described by the
American Nurses Association (ANA), this meant that nurses needed to take the time to take each targeted state’s licensure exam and pay the targeted
state’s licensure fee which could be costly for them. For travel nurses, this can become disruptive to their lives as well as expensive. In contrast, holding a multistate license to practice nursing can expedite placement in a travel nursing job anywhere that the multi-state license is honored.
Consequently, the NLC has benefitted the contingent staffing industry, helping health system employers fill job vacancies filled more quickly. Furthermore – as telehealth visits have become more common – the inability to provide assistance to patients residing in another state due to the absence of licensure in that state is also affecting the
provision of preventive care by nurses without NLC licensure. Some of the
11 requirements of the NLC for participating states pertaining to the multi-state licensure of individual nurses are:
- Nurses must meet the requirements for licensure in their home state.
- Nurses must either (a) graduate from a board-approved education program or (b) graduate from an international education program (approved by the authorized accrediting body in the applicable country and verified by an independent credentials review agency).
- Nurses must submit to state and federal fingerprint-based criminal background checks.
- If a nurse holding an NLC license, is disciplined in an NLC state and has their license revoked, the ability to practice in any other NLC state is also terminated.
Why A State Might Not Want to Join the NLC
Not everyone agrees on whether the NLC is a positive or a negative for the profession. Some political groups and individuals are opposed to joining the NLC and have successfully lobbied against it. In the Courts, cases involving an issue of “states’ rights” – in which federal oversight would shift the overall balance of power to the federal government – usually are determined in favor of the state. Although these political issues have not gone away, some non-NLC states have come under increased pressure to enter the Compact in the aftermath of the COVID-19 pandemic.
Four of the primary reasons expressed by states for not joining the NLC are:
- Stronger existing nurse licensure requirements in that state than under the NLC.
- Potential of reducing the availability of jobs to in-state Registered Nurses, due to a larger candidate pool inclusive of out-of-state RNs.
- Potential for disciplinary measures levied against nurses under the NLC that differ from that of a given state.
- Potential for loss of in-state Board of Nursing revenue due to decreased requests for licensure in that state by nurses who might otherwise seek licensure by endorsement.
National Nurses United, the largest professional membership organization of RNs in the US, is opposed to the NLC based on the perspective that nurses engaged in collective action, such as a strike, can be replaced relatively quickly by out-of-state nurses holding a multi-state license. There is also a lack of clarity about whether any disciplinary action against a nurse should be determined by the state in which an RN holds their primary license or by the state in which patient care was administered.
States that Do Not Yet Participate in the NLC
There are 40 states that currently participate in the NLC. The following states do not yet participate in the NLC:
- California
- Illinois
- Massachusetts
- Alaska
- Nevada
- Michigan
- Minnesota
- New York
- Oregon
- Hawaii
- (District of Columbia)
As of November 2024, the NCBSN reports that Pennsylvania is partially implemented. Several other states have legislation pending. In today's healthcare climate, the legislative environment is pressure-filled. Expect several states to alter their approaches toward joining the NLC in the coming months.
Last Modified On: Jan 04, 2024
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