Nursing Across State Lines (Healthcare sample)

April 30, 2017

Writer: Karen Chronister

Sample Healthcare Blog

Nursing horizons are expanding at barrier-breaking speeds with advances in mobile medicine, tele-health, informatics, and more. At the same time the internet is shrinking the distance between us, some borders remain firm—or, at least, sluggish. To date, half of US states have enacted multi-state licensure for nurses and the advantages are clear. If a nurse has a a multi-state license, mobilizing quickly during a crisis and or shortage, taking their specialization on the road, and teaching outside their state of residence are all possibilities. As the world becomes more agile, so must healthcare. Facilitating licensed nursing across state lines is one solution.

The NLC, a bright penny in a continually disrupted industry, provides a current, viable framework for states to offer multi-licenses, while increasing the availability, acquisition, and mobility of qualified nurses to those who need them most. Designed by the National Council of the State Boards of Nursing (NCSBN), the NLC, or Nursing Licensure Compact, makes it possible for nurses residing in compact states to practice within their twenty-five state network.

What is the NLC?

For nearly 100 years, a nurse could hold a license in only one state at a time, generally the state of legal residence. This still stands for non-compact states. If the nurse moves to another state, the procedure to become licensed in the new state of residency can be costly, lengthy, and cumbersome. Bogged down by a lot of unnecessary and redundant red tape. The NCL advocates that mutual recognition and interstate licensure is a best practice for nurses, healthcare providers, disaster preparedness agencies, and, most importantly, patients. The NCL cuts through, by considering—and, at times—streamlining, the vetting process to place the most qualified nurse with their patient, especially where specialized skills are concerned.

Since its inception over 15 years ago, the NLC model continues to evolve and strives to include all of the US states. With the current shortage of nurses (a projected shortfall of 25,000 nurses in 2025 in Florida alone), multi-platform, interstate practice could not come at a better time.

RELATED- America’s Nursing Shortage: The New Healthcare Epidemic Who benefits from the NLC?

States — Joining the NLC network allows healthcare providers to compete for the most qualified nurses, while still retaining state autonomy and authority; a nurse practicing in another compact state is subject to the laws of that state, rather than the state of residence. Florida, a non-compact state, faces a nursing shortage forecasted to grow at alarming rates. For a state that frequently experiences acute natural disasters and has a growing —and aging—population, expediting healthcare preparedness measures and winnowing down the nursing shortage will consequentially increase efficacies and quality of life outcomes.

Nurses — It is rarely disputed that nursing is a demanding profession. In fact, the average three day workweek plays like a full week with long shifts and high stress, urgent situations. The NLC, by opening state borders and widening job choices for nurses, facilitates the ability and freedom to respond to disasters, travel opportunities, and to practice and teach physically and electronically across state lines. Relocation, as in the case of military spouse nurses, is much easier as most move every two years. In other words, nurses in compact states have more flexibility and control over their career.

Patients — Patients benefit because compact states can—and do—compete for the most qualified nurses as the NLC network expands. As medicine deepens into highly specialized areas, so does nursing. With a bigger pool to choose from, healthcare providers can best match nurses with their patients’ needs to achieve optimum heath and quality of living.

Who Qualifies to Practice Across State Lines?

As it stands now, half of the US states have enacted the NLC, with a handful more in process. Some points to consider:

*To qualify to practice across state lines, a nurse must legally reside in a compact state and hold an active “RN or LPN/VN in good standing, the participating NLC states are potential places of simultaneous practice”;

*A nurse, as described above, must declare the NLC state as the legal state of residence before qualifying to practice in another NLC state; *If a nurse wishes to practice in tele-healthcare, the qualifications stated above stand;

*A licensed nurse, who legally resides in a compact state, can seek and procure a travel nursing assignment within the NLC network;

*If a licensed nurse, who legally resides in a compact state, wishes to respond to a natural disaster in another state, that state where the disaster has occurred also must be a compact state.

NLC States: Arizona, Arkansas, Colorado, Delaware, Idaho, Iowa, Kentucky, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia and Wisconsin.

What about states not in the NLC network?

Some hurdles slow a state’s pace to adopt multi-state licensure, for example: vastly mismatched state continuing education requirements; risk-management questions; and the slow, state-by-state process of introducing new legislation. The NLC actively addresses the concerns of states slow to the table. In 2015, the NLC amended to include federal fingerprint criminal background checks in which a nurse will “be held accountable to the nurse practice act of the state where the patient is located or where practice occurs.” This paves the way for the public to have better access to the safest nursing care available, while still protecting citizen-patients and individual state licensure laws. So, if a nurse “comes back positive for a felony under federal or state law, the nurse will not be issued a multi-state license.” Here, the process of protecting the state from liability and patients from potential harm is in place. Florida is one state that requires federal fingerprint criminal background checks. The advantages that the NLC network offers the healthcare industry appear to outweigh opposing arguments.

Nurses have a few choices if their state of residence is not a compact state: 1) Contact state representatives to encourage them to start the process; or 2) Move to a state that is in the NLC network. To start the process or check on the status of your state’s admittance into the NLC, visit

In many ways, the US healthcare industry is adapting vigorously to these new opportunities with the integration of tele-health services, expansive disaster preparedness, online learning, and specializations that meet current needs. One delivery system that still demands attention involves nurses who want to practice without borders.