1. Alexander, Mary MA, RN, CRNI(R), CAE

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In a society that is increasingly mobile and technology driven, the old rules governing nurse licensure are failing to keep up with current patient needs and nursing employment opportunities. With the growth of distance learning programs, increasing numbers of patients who receive homecare, and medical advice dispensed online and on the phone (telehealth), the healthcare profession must come to grips with new and different approaches to nursing.

Figure. Mary Alexand... - Click to enlarge in new windowFigure. Mary Alexander MA, RN, CRNI(R), CAE

Most states currently require nurses to be licensed in the state in which they work. However, this regulation can be onerous for traveling nurses; nurses who provide homecare across state lines; and those who use phones, satellites, or computers for teaching, consulting, or advising because they must be licensed in more than one state. In addition, multiple license fees can be costly, and the time it takes to earn a license can delay employment, particularly for traveling nurses.


One solution for multiple nursing licenses, already enacted in 23 states as of July 1, is the Nurse Licensure Compact (NLC). The NLC is an agreement among state Boards of Nursing that could alleviate some of the burdens on nurses who seek licenses in multiple states in order to practice. The compact acts in much the same way as a driver's license-all states agree to recognize the driver's license from the licensee's home state. For the purposes of the NLC, "home state" is defined as the state in which the nurse declares residency and receives the license that allows participation in the NLC. Any disciplinary action may be taken by the state where the patient is located at the time an incident occurred as well as the nurse's home state.


Any nurse living in an NLC state can practice across state lines without acquiring another license. A nurse practicing under the NLC saves money on licensing fees, has more job opportunities, and can make better use of new technology. The NLC also makes it easier to track information, thus increasing patient safety. When nurses can easily work across state lines, more of them are readily available to assist in emergencies and disasters, such Hurricane Katrina.


Under the NLC, all nurses practicing in a "party" state will have to comply with the state practice laws of the state in which the patient is located at the time care is provided. The nurse must be familiar with and practice within the scope of the nurse practice act in the state where services are delivered.


Some of the arguments against the NLC include decreased job security for some nurses, since there will be increased competition for jobs. There could be some confusion about states' standards of practice, and some patients may lose continuity of care as nurses move about more frequently.


The INS Board of Directors is currently reviewing the mutual recognition model of nurse licensure and is considering supporting legislation and regulation authorizing the NLC in each state. If you do not live in an NLC state, consider contacting your state Board of Nursing or your state legislators to advocate for mutual recognition of nurse licensure. For more information about the NLC, visit the Nurse Licensure Compact Administrators Web site at