This article examines the provisions of the Nursing Licensure Compact (NLC). Key provisions of this compact are reviewed with examples of how it has impacted individual nurses. The article begins by presenting the history of the NLC, followed by discussion about the effective and implementation dates and a review of key provisions of the enhanced Nurse Licensure Compact. Specific examples of disciplinary actions and implications for nurses, employers, and educators are presented. The author concludes that most nurses provide competent care, and that outside of this compact, the few who violate laws and regulations are usually disciplined by their individual state board of nursing. Under the compact, however, those violations are addressed in all jurisdictions in which the nurse holds a nursing license or a privilege to practice, thereby ensuring public safety and preventing errant nurses from moving undetected from state to state.
Key Words: multistate compact, disciplinary actions, enhanced Nursing Licensure Compact, Nursing Licensure Compact, Texas Board of Nurse Examiners, out of state, Nursys, privilege to practice, National Council of State Boards of Nursing (NCSBN), telemedicine
Relative to the history of nursing in the United States, the Nursing Licensure Compact is a new phenomenon.Relative to the history of nursing in the United States (US), the Nursing Licensure Compact (NLC) is a new phenomenon. It can be argued that familiarity with its provisions is in its infancy. However, it is imperative to understand that the provisions of this compact are of great importance to nurses because practicing in ignorance could lead to serious violations and serious consequences. Therefore, the aim of this manuscript is to examine the NLC and its disciplinary provisions and to discuss the potential consequences and implications of violating those provisions. Note that the NLC is also sometimes called the compact and the Multistate License.
History of the Nursing Licensure Compact
For decades, the licensing of nurses followed a single-state-licensing format in which a nurse was required to obtain a license in every state in which the nurse desires to practice. Depending on the number of states in which a nurse desired to practice, this could be burdensome and bureaucratically onerous. In addition, State Boards of Nursing (BON) lacked authority to act against a nurse’s license if a patient in the state was harmed by a nurse practicing remotely from another state (Texas BON, 2013b).
...dissatisfaction regarding the lack of easy mobility for healthcare professionals emerged from many sources.After a while, dissatisfaction regarding the lack of easy mobility for healthcare professionals emerged from many sources. Notable among them was the Pew Health Professions Commission (1995; [the Commission]) report. Established in 1989, the Commission mission was to assist healthcare professionals, workforce policy makers, and educational institutions manage the challenges of an increasingly changing healthcare system. The Commission would also evaluate the effectiveness of regulations from the perspective of protecting the public. The licensure, certification, and regulation of healthcare professionals was to be examined, with the goal of recommending new approaches. In 1995, the Commission released its full report: Reforming Health Care Workforce Regulation: Policy Considerations for the 21st Century. The report included 10 recommendations to promote healthcare provider mobility (Donaho, Mudge, & Price, 1997; Pew, 1995).
...the 50 states’ entry-to-practice requirements were not standardized, thereby creating unreasonable barriers to interstate mobility for many professionals.In this report, the Pew Commission noted that the 50 states’ entry-to-practice requirements were not standardized, thereby creating unreasonable barriers to interstate mobility for many professionals. It recommended, among other things, that “States should standardize entry-to-practice requirements and limit them to competence assessments for health professions to facilitate the physical and professional mobility of the health professions,” (Pew, 1995, p. ix).
Another timely development in 1996 was the enactment of the Telecommunications Act by the U.S. Congress. This was largely in response to the increase in electronic healthcare practice in the United States. The Act called for standards and infrastructure that improved telecommunications in healthcare (Texas BON, 2013b).
The following year, the National Council of State Boards of Nursing (NCSBN) Delegate Assembly made a move toward licensure uniformity by unanimously endorsing a mutual recognition model of nursing regulation (NCSBN, n.d.b). The mutual recognition initiative was designed to enhance the protection of public health and safety by promoting cooperation and exchange of information in licensure, regulation, investigation, and disciplinary action. It would give member states the authority to hold nurses accountable for the nursing practice laws of the jurisdiction in which the patient was located at the time of the infraction (NCSBN, n.d.a).
It is noteworthy that the nursing profession led the way, among the healthcare professions, in establishing and implementing an interstate practice model.Three years later, on January 1, 2000, NLC officially began when Maryland, Texas, Utah, and Wisconsin passed it into law (Texas BON, 2013b). The main accomplishment of the NLC was that there would be one license by which a nurse may practice in multiple states, physically and by distance, without any additional application requirements or fees. Their home state licenses would be accepted in all of the NLC states and they would be subject to the laws and nurse practice acts of all the state(s) in which they practiced (NCSBN, 2011, 2016). It is noteworthy that the nursing profession led the way, among the healthcare professions, in establishing and implementing an interstate practice model (NCSBN, 2018a).
Not every nurse or nursing organization greeted the news with excitement. Some nurses and nursing organizations, such as the Ohio Nurses Association (ONA), were reluctant and were vocal with their concerns. ONA concerns were about state sovereignty, regulation, and public safety. They feared that states would lose the ability to review and approve all nurses wishing to practice in their jurisdiction. They also believed that there was a lack of clarity regarding how to check on nurses’ disciplinary infractions in remote states. Furthermore, they expressed concern about some inconsistency between some state regulations and the NLC requirements. For example, in some states, certain crimes constitute absolute bars to licensure, while the NLC Uniform Requirements do not consider those same crimes to be an absolute bar to licensure. Their other concern was financial in nature. They were displeased that the state would not only have to pay for annual membership in the NLC but also lose the ability to collect licensing fees directly from nurses seeking to practice in their state. Finally, the ONA opposed the NLC because of the belief that it would shift power and influence from the nurses and the state nurses’ associations to the Interstate Commission of Nurse Licensure Compact Administrators. This, they believed, would dilute the power of the collective voices of Ohio nurses and nurses’ associations (Ohio Nurses Association, 2017).
In spite of these concerns, as many as 25 states did join the NLC. However, by 2015, the trend had stopped. Amidst concerns that the NLC did not successfully guarantee the competence of nurses who practiced across state lines, membership in the compact stalled after the twenty-fifth state joined. This prompted the National Council of State Boards of Nursing (NCSBN) to take some corrective action. It created the Enhanced Nursing Licensure Compact (eNLC). Although quite similar to the original NLC, the eNLC was designed to repeal and replace the existing NLC and implement requirements that would improve confidence and address the issues raised by reluctant stakeholders (Evans, 2015).
The state must also have the capacity to conduct a federal criminal background check.If a state seeks to join the compact, the state, through its state legislature, must authorize the NLC and adopt rules and regulations that will govern the compact administration and implementation (Evans, 2015). The state must also have the capacity to conduct a federal criminal background check (NCSBN, 2016). In 2015, The Special Delegation Assembly approved a Model Legislation that could be used by states seeking to join the NLC (NCSBN, 2015b).
At the time of this writing, thirty-one states have joined the eNLC. These states, in alphabetical order, are: Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming (NCSBN, n.d.e).
The eNLC Effective Date and Implementation Date
The eNLC became effective on July 20, 2017, when North Carolina became the 26th member (NCSBN, 2018a). The implementation date was six months from the effective date: January 19, 2018 (NCSBN, 2018a). The significance of the implementation date is that it was the date by which nurses who possessed multistate licenses were able to begin practicing in eNLC states (NCSBN, 2018a). January 19, 2018 marked the date that multistate licensure practice via a compact would no longer be available to nurses whose states did not switch to the eNLC. In other words, nursing compact practice would be limited only to those whose home states joined the eNLC (NCSBN, 2018a).
The Key Provisions of the Enhanced Nursing Licensure Compact
Under the eNLC the states have uniform licensure requirements, are authorized to obtain and submit criminal background checks, and are required to report all disciplinary measures (NCSBN, n.d.j, 2015a, 2016). The sections below will briefly describe the uniform license requirements and the background checks, key disciplinary provisions, and the process for reporting disciplinary actions against the licenses and privileges of nurses with multistate licenses.
Uniform License Requirements and Background Checks
All applicants must also have passed the applicable licensing examination and be eligible to hold an unencumbered license.In a new provision, the eNLC established some eligibility and uniform license requirements that an applicant must meet before receiving an Licensed Vocational Nurse/Licensed Practical Nurse (LVN/LPN) or Registered Nurse (RN) license. These requirements are as follows: applicants must have graduated from a program approved by a board of nursing, and must qualify for licensure in their home state (NCSBN, n.d.j). If outside the United States, applicants must have graduated from a program approved by authorized accrediting body and must have passed an English proficiency examination. All applicants must also have passed the applicable licensing examination and be eligible to hold an unencumbered license (NCSBN, n.d.j).
As part of the measures to protect the public, the uniform license requirements also state that when an applicant seeks initial licensure or licensure by endorsement, the states must obtain the applicant’s criminal history record through fingerprints or biometric data from the Federal Bureau of Investigation (FBI), and the state (NCSBN, n.d.j). The applicant’s criminal history should not contain a conviction, a plea, or an agreed disposition of a felony offense at the state or federal level, or a misdemeanor offense committed during the practice of nursing. Misdemeanor convictions are considered on a case-by-case basis (NCSBN, n.d.j).
To be eligible for a multistate license, the applicant must not currently be in an alternative program (NCSBN, n.d.j). An alternative program is utilized when the Board of Nursing seeks to avoid issuing the traditional discipline that an offense may deserve, thereby allowing the individual to remediate her behavior under conditions that are less restrictive than is normal (Texas BON, 2013a). Examples of alternative disciplinary programs include deferred discipline or any stipulation that is different from the traditional supervisory stipulations (Texas BON, 2013a). The applicant must also possess a valid United States social security number (NCSBN, n.d.j).
Key Disciplinary Provisions
In addition to the eligibility requirements, the eNLC contains key provisions that are explained in eleven articles. However, only three of these articles relate to disciplinary actions: Articles III, V, and VI (NCSBN, n.d.d). The relevant parts of Article III require that nurses must comply with the practice laws in each state where they practice. Article III also grants compact states the authority to take disciplinary action against a nurse’s privilege to practice (PTP) status when the nurse violates the state laws and the state nurse practice act. For example, a nurse that obtains a conviction of driving under the influence (DUI) is subject both to the penal code of the state, and the disciplinary provisions of the state nurse practice act (NCSBN, n.d.d). Under Article V of the eNLC, member states may take adverse action, including revoking a nurse’s PTP in their state, even while the nurse is still under investigation or if the license is encumbered in any way (NCSBN, n.d.d).
...all disciplinary actions are documented in one depository known as Nursys®.Mandatory Reporting Process Regarding Disciplinary Actions
Article VI of the eNLC requires prompt reporting of any information that results from an investigation of a complaint against a nurse. (NCSBN, n.d.d). Therefore, all disciplinary actions are documented in one depository known as Nursys® (NCSBN, 2016). Nursys® is an online database of the NCSBN that stores nurse licensure and disciplinary information. To varying degrees, it allows employers and the public easy access to information about the status of nurses’ licensure and any disciplinary actions taken against them (NCSBN, 2011).
Services provided by Nursys® include automated license status updates, and regular updates to institutions regarding any changes to their nurses’ licenses. State boards of nursing provide the information through the Nursys® eNotify program. At the time of this writing, fifty-five jurisdictions, comprising states and territories, were participating in eNotify. The only non-participants were Alabama and Michigan. Hawaii recently signed an agreement to participate (NCSBN, n.d.c).
Examples of Reported Disciplinary Actions under the Nursing Licensure Compact
This section describes some specific Texas disciplinary cases in which the disciplinary action taken by the BON was directly related to the nurses’ multistate compact license. For example, the case relating to the 'one primary residence' rule highlights the extended reach of the nursing licensure compact. It demonstrates the concept that under the NLC, nurses are disciplined regardless of which compact state was the location of the infraction.
The impact of a criminal conviction is also presented. The case involving telehealth practice exemplifies the pitfalls that nurses may encounter while engaging in practice at a distance and across state lines. Another scenario concerns the impact of the automatic reporting of disciplinary actions on an individual nurse’s license. Finally, one case demonstrates the impact of a BON investigation on a nurse’s ability to continue practice.
Actual cases of disciplinary actions against nurses are used in this article; several measures have been taken to preserve anonymity and confidentiality. Identification of the nurses involved have been replaced by assigned numbers (e.g. Case #1). In addition, all disciplinary cases discussed utilize the feminine pronoun, regardless of the actual gender of the nurse involved.
The “One Primary Residence” Requirement
...the state in which nurses obtain a license is considered the primary residence or home state.Article III of the NLC requires that a nurse follow the rules of the compact state. One such rule is the “one primary residence rule” (NCSBN, n.d.d). Under this rule, the state in which nurses obtain a license is considered the primary residence or home state. When nurses extend practice into another compact state, they do not obtain another license, but will work under a PTP. If, at any time, nurses decide to permanently reside in the PTP state, they must surrender the previous home state license and exchange their PTP for a license in the new state of residence. In other words, the PTP is only used in a state other than the primary residence. While nurses may have the privilege to practice in many compact states, they can have only one nursing license. (NCSBN, 2017).
For example, this author’s original nursing license was obtained in the State of Texas. Upon moving to the Commonwealth of Virginia, and not being aware of the nursing compact rules, I tried to renew the Texas license. The Texas Board of Nursing explained to me that I could only continue to practice with a Texas license if Texas was my state of residence. Since my move to Virginia was permanent, and both Texas and Virginia were compact states, I could only hold a license in my state of residence. I was advised to surrender the Texas license and apply for a license in my new home state. Once the Virginia license was granted, the Texas license became invalid. When I moved back to Texas permanently a few years later, the reverse was the case.
While nurses may have the privilege to practice in many compact states, they can have only one nursing license.If a nurse moves permanently into a state and fails to apply for that state’s nursing license but continues to use the compact state PTP, he/she violates the NLC, and can be disciplined by the BON in the state where she now lives. This is exemplified in Case #1, an LVN with a license from South Carolina and a PTP in Texas. She received disciplinary action by the Texas Board of Nurse Examiners (BNE), for failing to obtain a Texas license after she moved from South Carolina to Texas. After she changed her primary residence to Texas, she continued to practice under a PTP for 3 years. She was sanctioned by the BON (Texas BNE, n.d.).
In a similar scenario, Case #2, an LVN with a license from Virginia, with a PTP in Texas, was charged with practicing without a valid license in 2016. She had initiated the paperwork to change her primary residence to Texas and was issued an Agreed Eligibility Order by the Texas BNE. However, she failed to complete all steps necessary to endorse her license to Texas. This led to disciplinary action by the BNE (Texas BNE, n.d.). It is not enough to initiate paper work to start the process. It must be completed within the required deadline. Partial paper work constitutes an infraction.
It is not enough to initiate paper work to start the process. It must be completed within the required deadline.The paper work and change of license must also occur within a specified time. In Case #3, a registered nurse from the Commonwealth of Virginia, with a PTP in Texas, the timeline requirement for endorsing a PTP to a license was in issue in 2013. One allegation brought against her was failing to apply for licensure in Texas within 30 days of establishing residence in Texas. At the time of this action, Texas required that the change of license process begin within 30 days of the nurse’s move. This led to a charge before the BON, and some disciplinary action (Texas BNE, n.d.). As of this writing, the deadline has been changed from 30 days to 90 days in Texas and in most compact states. Some states may still be in the process of changing, so each nurse must do due diligence to confirm a specific state's regulations (NCSBN, n.d.a).
...each nurse must do due diligence to confirm a specific state's regulations.These cases illustrate that a nurse in a compact state can only hold one license and that must change if her residence changes. This license switch must be done in a timely manner.
Disciplinary Impact of a Criminal Conviction
As stated in the eNLC uniform license requirements, a state or federal felony conviction or plea precludes an applicant from obtaining a multistate license. Applicants for the eNLC license must not have pled guilty to or have been convicted of a felony. Misdemeanor offenses are viewed on a case by case basis. It is noteworthy, however, to understand that a nurse with a felony plea or conviction may still obtain a single state nursing license. Each member state may issue a single state license to such an applicant, upon consideration of each individual case. If a nurse with a past felony conviction or a guilty plea obtains a license under the original NLC, the nurse remains eligible to hold a multistate privilege under the new eNLC (NCSBN, 2012)
Applicants for the eNLC license must not have pled guilty to or have been convicted of a felony.Not only will a felony conviction prevent an applicant from obtaining an initial multistate nursing license, it will most certainly lead to disciplinary sanctions for a nurse who is already licensed (NCSBN, n.d.d). For example, Case #4 was a registered nurse with a license from Kentucky and a PTP in Texas, who was convicted of DUI and possession of marijuana, both of which were misdemeanor offenses. Though already licensed, and though neither of the offenses occurred during the conduct of her nursing practice, she received disciplinary sanctions from the Texas BNE. (Texas BNE, n.d.).
Disciplinary Impact on Telehealth Practice
One of the advantages of the multistate nursing privilege is that nurses can be physically located in one state while engaging in nursing practice in another state through technology and telehealth services. These technologies are increasingly being utilized; they are transforming care delivery, and erasing geographical boundaries (NCSBN, 2016, 2017).
...even when nurses practice in a remote location from the patient, they are subject to disciplinary measures both by the state where the patient is located, and by their home state.The possibility of long distance or telehealth practice will be of great financial benefit to military spouses who may move from state to state. Nursing faculty will also need only one license to practice in compact states. However, even when nurses practice in a remote location from the patient, they are subject to disciplinary measures both by the state where the patient is located, and by their home state (NCSBN, 2017).
Exemplifying telehealth discipline is Case #5, an RN with a Tennessee license and also an advanced practice registered nurse (APRN) license from many states, including Texas and West Virginia. She faced sanctions with multiple states in 2016 based on an event that happened in a telemedicine practice in West Virginia. Her APRN license in Texas included prescriptive privileges, but her West Virginia license did not. While living in Tennessee, she contacted West Virginia residents by phone and wrote prescriptions for patients with whom she had no provider/patient relationship. She never conducted any face-to-face evaluations of any of these patients. West Virginia suspended her license immediately and scheduled a hearing. In lieu of a hearing, she surrendered her West Virginia license. Based on this West Virginia event, Texas filed formal charges against her and she voluntarily surrendered her license. Additionally, North Dakota, Vermont, Oregon, and Washington, also took disciplinary action against her license; and she also voluntarily surrendered her license in those states (NCSBN, n.d.h; Texas BNE, 2016).
...each one of the states took a disciplinary stance, their stipulations and sanctions differed.An important point in this case is that while each one of the states took a disciplinary stance, their stipulations and sanctions differed. For example, the length of time for which she was barred from practice was different from state to state respectively. West Virginia barred her for five years, Oregon for three, and Minnesota and Texas for one year (NCSBN, n.d.h).
Impact of Automatic Reporting on Disciplinary Action
Article VI of the eNLC requires that states share freely any information that pertains to disciplinary actions. So, much like in some of the cases cited above, a nurse who is disciplined in one state can reasonably expect that similar charges will be filed by other states (NCSBN, n.d.d).
The infraction is handled as if the offense took place in their jurisdiction, even if it happened in a remote location.The nurse’s state of primary residence, and the compact states in which the nurse has a PTP, often automatically take action against a nurse’s license and PTP respectively. The infraction is handled as if the offense took place in their jurisdiction, even if it happened in a remote location (NCSBN, 2017). In other words, it will not be necessary for the nurse to appear before the BON of the home state or of the states where PTP are held, unless the nurse wishes to offer a defense. If a PTP is revoked in one compact state, that will preclude the nurse from practicing in other compact states. If an infraction is committed in a PTP location, the home state may or may not revoke the nurse’s license, but it will certainly result in some form of disciplinary action, as determined by the state nurse practice act (NCSBN, 2017).
Such was Case #6, a registered nurse licensed in the Commonwealth of Virginia, with a PTP in Texas. Following some charges against her in Texas. She voluntarily surrendered her PTP in Texas. That action did not stop the Commonwealth of Virginia from placing her license on probation. The States of Illinois and California also brought charges against her based solely on the Texas action (Texas BNE, n.d.). This case clearly invalidates the notion that the NLC allows nurses to fly under the radar when they practice on a compact license.
Limitations on Nursing Practice Due to Disciplinary Action
The singular fact that an investigation is initiated could immediately limit a nurse’s opportunity to practice.The singular fact that an investigation is initiated could immediately limit a nurse’s opportunity to practice. When the BON enacts a disciplinary measure that includes a limitation on the nurse’s ability to practice, such as a revocation, suspension, or voluntary surrender, the nurse will also be required to limit her nursing practice to her home state during the disciplinary period (NLC Administrators, 2012). This does not preclude a non-compact state from issuing a single-state license to that nurse during the same period. Once the terms of the disciplinary measures have been satisfied, the original home state may re-issue a multistate license (NLC Administrators, 2012).
Case #7, a Texas registered nurse with a PTP in Arizona, illustrates this. Following an investigation, Texas suspended her license and also prohibited her from working in any compact state without obtaining a written permission from both the Texas BON and the BON in the compact state where she desired to work. (Texas BNE, n.d.). She was given the liberty, however, to seek a single-state license from a non-compact until she had fulfilled the conditions of her disciplinary sanctions. After that, she would then be eligible once again for a multistate license (NLC Administrators, 2012).
Implications of the Compact
In the sections above, I have discussed the provisions and provided some examples of disciplinary actions of the multistate nursing licensure compact. Below, I will discuss the implications of the NLC for nurses, employers, and educators.
Implications for Nurses
This section includes some important reminders for nurses regarding license compacts. Implications for nurses include the concept that a compact does not affect nurses who only hold one license, and also that idea that greater privileges for nurses bring greater risk as well.
The Compact Does Not Affect Everybody. First, it is important to remember that the multistate NLC does not change anything for a nurse who obtains one license and does not seek to move to or to practice in another state (NCSBN, n.d.d). Therefore, there is no reason for such a nurse to be concerned about disciplinary provisions of the multistate compact. Nurses with multistate licenses, however, are subject to the laws and nurse practice acts of both their home state, and all the compact states in which they hold a PTP (Ridenour, 2011).
...it is important to remember that the multistate NLC does not change anything for a nurse who obtains one license and does not seek to move to or to practice in another state.Secondly, nurses should know that even when they do not qualify for a multi-state license, a single-state license may still be obtained (NLC Administrators, 2012). Although the NLC limits the nurse to only one license at a time, this does not apply to non-compact states. States that have not subscribed to the NLC continue to issue single-state licenses; and a nurse may hold as many of those single state licenses as desired, in addition to holding a compact license (Ridenour, 2011). Furthermore, a compact state may issue a single-state license to a nurse who resides in its jurisdiction but does not qualify for a multistate license, such as a nurse whose permanent address is in a foreign country (Ridenour, 2011; NLC Administrators, 2012). The decision to grant such a license is at the discretion of each state (Texas BON, 2017).
With increased privilege to practice comes increased exposure to disciplinary action.Greater Privileges Equal Greater Risk and Financial Burden. Although the NLC makes nursing practice across state lines more uniform and less costly, it could also have a serious impact on a nurse’s ability to practice, especially if the nurse is under investigation or is disciplined by a state BON. When nurses are disciplined in a compact state, the action directly impacts their practice in all the compact states (NLC Administrators, 2012; Texas BNE, n.d.). The inability to practice when under investigation and the burden of having to defend one’s license and one’s privilege to practice could take a great toll, both financially and otherwise. As has been shown above, there can be a domino effect of disciplinary actions against nurses’ licenses. With increased privilege to practice comes increased exposure to disciplinary action.
Implications of the Compact for Employers
Although it used to be sufficient to verify a nurse’s license with the state board of nursing, it is no longer so. It has become necessary to ensure that a nurse’s license is unrestricted in her home state and/or that it includes multi-state privileges to work in the employers’ own state, if necessary. The avenue by which an employer may verify multistate licensure is through Nursys® (NCSBN, n.d.h).
Although it used to be sufficient to verify a nurse’s license with the state board of nursing, it is no longer so.Secondly, it is important that employers know that there is no extra paperwork required, nor does the BON need notified that a nurse with a compact license is working on a PTP. Employers may not require such from their employees, nor should they require that prospective employees using a PTP also apply for a license in the employers’ state. Current employees should not be disciplined or discharged for not having a license in the employer’s location (Ridenour, 2011). Such actions would be unlawful and would violate public policy, since the nurse practice acts prohibit a nurse from holding more than one license under the eNLC (NLC Administrators, 2013).
Employers should also be aware that their employees are subject to the rules of other jurisdictions. This means that an event in another state could have an impact on the practice and availability of their nursing employees (NCSBN, n.d.d). Therefore, it is prudent to verify nursing licenses for all employees at Nursys.com, both at the beginning of employment and at intervals. This ensures that a license to practice has not been compromised or encumbered at a remote location.
Implications of the Compact for Educators
Educators are not exempt from licensure requirements.Educators are not exempt from licensure requirements. Where prelicensure nursing programs offer courses to students outside of their jurisdiction, nursing faculty may need to obtain a license in every state in which the students are enrolled for didactic or clinical courses. However, if the faculty is in a compact state, and the student is in a remote compact state, the multistate license will suffice. Unless the nursing program limits student enrollment to its own state, or to other compact states, faculty that teach those courses will do well to avoid BON discipline by ensuring that they also comply with the rules and regulations of the remote state (NCSBN, n.d.f, n.d.g, 2017).
Furthermore, because the multistate compact is a fairly new concept, nursing educators should begin to include in program courses information about multistate practice and its potential impact on licensure and practice. Students need to know about how they might prevent actions that could cause disciplinary sanctions.
...most nurses render care in a competent manner and that only a very small minority are charged with violations. It must be emphasized that most nurses render care in a competent manner and that only a very small minority are charged with violations. In the multistate licensure context, however, those violations will be addressed, both at the location of the offense and in all the compact states where the nurse has a license or PTP. (NCSBN, 2017). While that may create anxiety for some nurses, it should comfort others that the eNLC will not be an avenue for errant nurses to practice under the radar. The provisions of the eNLC highly reduce the likelihood that public safety will be compromised.
Omobola Awosika Oyeleye, EdD, JD, MSN, MEd, BSN, BA, RN-BC, CNE, CHSE, CPHQ
Dr. Oyeleye is an assistant professor of nursing at the Cizik School of Nursing, University of Texas at Houston. Her experience includes teaching students and nurses about legal issues that impact nurses. She also has legal experience in assisting nurses with BNE disciplinary matters.
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