1. How and Why Did The Nurse Licensure Compact Begin?
The United States Congress passed the Telecommunications Act of 1996 in response to the rapidly increasing practice of healthcare by electronic means. The Telecommunications Act called for development of standards and an infrastructure for telecommunications in healthcare. The nursing regulatory model in place at that time required a nurse to obtain licensure in each state where the nurse wished to practice. In addition to the obvious bureaucratic constraints of this model, the Texas Board also had no authority to take action against a nurse’s license if a patient in Texas was harmed by a nurse practicing remotely in another state.
In response to the mandate of the Telecommunications Act, the National Council of State Boards of Nursing (NCSBN) embarked on a 3-year journey to develop a model of Multistate nursing licensure recognition that would "remove regulatory barriers to increase access to safe nursing care." The RN and LPN/VN Nurse Licensure Compact began January 1, 2000, when it was passed into law by the first participating states: Maryland, Texas, Utah and Wisconsin.
2. How Does This Multistate Licensure Model Work?
It is very similar to the driver’s license model. A person holding a driver’s license in his/her home state is permitted to drive in other states without applying for a driver’s license in every state he/she drives through. Though requirements for a driver’s license are similar across states, each state may determine and vary its own licensure requirements. The Nurse Licensure Compact is similar in that it allows a nurse licensed in one “home” compact state to practice in a party compact state without seeking an additional nursing license. Another similarity to the driver’s license model is that the Nurse Licensure Compact is implemented through laws passed by the legislature of each participating state. The essence of any state Compact law must permit the nursing board of that state to recognize individuals licensed as nurses from other participating compact states.
In order to enjoy the multistate licensure privilege, the Compact requires that the nurse be licensed in the state in which he/she permanently resides. This license is known as a home state license. The nurse must meet the licensure criteria of his/her home state in order to obtain and retain multistate licensure recognition (MSR) privileges on his/her home state nursing license.
Other states belonging to the Nurse Licensure Compact are known as “Party” states because their state governments have also agreed to recognize nurses licensed in other compact-member states. This recognition allows a nurse to practice in a party state on his/her home state license. A nurse practicing in another party state pursuant to the multistate privilege must comply with the state practice laws of the state in which the patient is located at the time care is given.
3. What Happens If A Nurse Moves To Another State?
A nurse can hold a home state license in only one state at a time. If a nurse changes permanent residence from one party state to another party state, then the nurse must relinquish licensure in the previous state of residence and apply for licensure in the new home state. Rule 220.2(f) permits a nurse to practice on a home state license other than Texas for a maximum of 90 days when the nurse is changing permanent residence. Under the Compact, the nurse may move back to his/her previous party state and re-establish licensure or move to another party state and apply for licensure there.
If a nurse moves to a state that has not enacted or does not recognize the Compact, the previous home state license converts to a Single-State license valid only in the former home state. A single-state nursing license does not entitle the nurse to practice under multistate privilege in other party states.
4. What About Disciplinary Action Against A Nurse’s License?
The compact is enforceable as law and cannot be changed without the consent of all party states. In Texas, Chapter 304 of the Nursing Practice Act and Rule 220 establish the requirements regarding the Nurse Licensure Compact.
A nurse practicing in a party state will be subject to the nursing practice laws and regulations of that remote party state. The nurse must know and conform to the laws, rules and regulations affecting his/her practice in the remote party state. If a nurse violates the Nursing Practice Act (NPA) or rules of the party state, the nursing board of the party state may revoke or restrict the nurse’s privilege to practice in that state, but cannot directly sanction the nurse’s home state license.
Violations of nursing practice occurring in a remote party state will be reported to the nurse’s home state nursing board. The home state nursing board will then investigate and take appropriate disciplinary action for a violation that occurred in a party state. Administrative procedures according to individual state law, including due process rights of a nurse, will apply to disciplinary proceedings related to violations occurring under a compact license privilege.
The shared goal of all US nursing boards is to protect public health and safety through the regulation and monitoring of nursing education and practice. A coordinated licensure information system called NURSYS promotes ongoing attainment of this goal through access to information on the licensing and disciplinary history of each nurse. A party state must submit information on any current significant investigation, action against a nurse’s compact privilege, or any denials of applications for licensure.
5. What is the impact of the Nurse Licensure Compact?
Mutual recognition of a nurse’s license in states belonging to the Compact increases nurse mobility and facilitates delivery of health care by innovative communication practices such as telenursing. Additionally, the Compact promotes the public health and safety by encouraging cooperative efforts among the party states in nurse licensing and regulation. As more state legislatures enact the Nurse Licensure Compact, the number of party states will increase and the nation will move closer to allowing one home state license to grant a nursing privilege nationwide.
For questions regarding the Compact or its impact on your nursing license, contact BON staff at (512) 305-6809 or e-mail via email@example.com. General questions about the Compact language or the concept of mutual recognition of licensure can be obtained from the National Council of State Boards of Nursing website at https://www.ncsbn.org/156.htm.