The Multi-State Nursing Licensure Compact: Making Nurses Mobile
Licensure compacts are not new, but they are new to nursing licensure and even newer to the regulation of advanced practice nurses (APRN). State laws govern professional practice. Boards of Nursing represent the public and are responsible for the health, safety, and welfare of patients in their states. The Multi-state Nursing Licensure Compact is a coordinated effort by the regulatory boards and their state legislatures to protect the public and simultaneously minimize unnecessary barriers to access to care for their citizens. Nurses also benefit when legislators and regulators remove barriers to enhancing delivery of care through evolving technologies and to reaching patients who are remotely located and in the most need. Concerns about licensure discipline and the lack of uniformity have been addressed for the basic nursing licensure compact, but they continue to be examined for APRNs.

Nurse practitioners have two big questions about the Multi-state Nursing Licensure Compact (Compact). The first is, "What is it?" The second is, "Why doesn't the Compact remove barriers for me as an advanced practice nurse (APRN) the way that it does for me as a registered nurse (RN)?"

Years ago, when a registered nurse wanted to work in a state other than her home state (yes, years ago nurses really were all women), that nurse had to apply for licensure in that other state. There was no national licensure examination, and no National Council of State Boards of Nursing (NCSBN). Certain states used licensure examinations and rules that allowed easy licensure into other states, and some did not. For example, a nurse licensed in New York or California could easily be licensed in any other state, whereas a nurse originally licensed in one of the southern states might have to retake a nursing examination before being allowed to have a license in another state because of the different licensure examinations.

State law still governs nursing licensure. But now the nursing standards among the different states are similar, and the licensure examination for RNs is national, thanks in part to NCSBN. In addition, licensed nurses [RNs and licensed practical nurses (LPNs) or licensed vocational nurses (LVNs)] in a growing number of states benefit from the Compact. The situation for APRN certification is in an earlier phase of evolution than that for RN licensure. APRNs today find that both uniformity of standards and mutual recognition of their advanced practice expertise lags behind that of their RN status. As they move from state to state or practice in a distance care situation, APRNs experience the same barriers to providing patient care that all RNs faced until recently. From the perspective of patients, those in remote areas and those who have the greatest need continue to face the greatest barriers to receiving quality nursing care by APRNs.

In 1997, the Delegate Assembly of the NCSBN agreed to endorse a "mutual recognition model" of nursing licensure, to remove barriers, and to increase access to safe nursing care. This is a law that must be passed in each participating state legislature as part of the Nurse Practice Act in that state, and it must be exactly the same in each state ("mutual"). The RN and the LPN/LVN Compact began in 2000, when the first state legislatures (the pioneers were Maryland, North Carolina, and Texas) enacted it as law. Now, if a nurse's legal residence and state of nursing licensure is a participating Compact state (Arizona, Arkansas, Delaware, Idaho, Iowa, Maine, Maryland, Mississippi, Nebraska, New Hampshire, New Mexico, North Carolina, South Carolina, North Dakota, South Dakota, Tennessee, Texas, Utah, Virginia, or Wisconsin as of the date of writing, with the Compact pending in Colorado, Kentucky, and New Jersey), the nurse can work in any of those other states on her home state's nursing license, just like she can drive there on her home state's driver's license. Some nurses have found the transition to nursing multistate "privilege" confusing. Others have expressed concern about how it might affect discipline, or even labor laws and strikebreaking. How does a multistate licensure compact work?