How the NLC Redefined Mobility, Opportunity, and Patient Access in Nursing

More than 2 million nurses across 43 jurisdictions have Nurse Licensure Compact privileges, reaching the vast majority of American patients. And when surges happen, NLC licensed nurses able to quickly jump in across the country to help patients in need of care.

Before the NLC Compact, nurses had to apply for individual licenses in every single state. That meant extra fees, fingerprints, and background checks.

Not only did the delay derail nursing careers, hospitals had difficulty finding staff during natural disasters or surges. Administrators couldn’t hire qualified nurses because they didn’t have a state license.

Why is a Compact Nursing License Needed?

Can you imagine waiting several months to fill nursing positions in an already taxed ICU or emergency department? The staff overworked, stressed, getting sick.

Mental health and morale at an all-time low. All while you have nurses ready to fill the position, they’re just waiting on the State Board of Nursing to get around to approving applications.

Without the Compact Nursing License, travel nurses had to maintain several single-state licenses just to work. If a travel nurse didn’t have the right license, hospitals couldn’t hire them.

A 21st Century Solution to a 20th Century Problem

In 1995, the National Council of State Boards of Nursing (NCSBN) realized that state-by-state licensing caused harm to patients, hospitals, and nurses.

Something had to change.

The NCSBN worked with focus groups to develop the precursor to the Nurse Licensure Compact, creating a multistate licensure system in 1997. This initial step allowed LPNs, VNs, and RNs to work across states without having to apply in every state.

In 2000 the Nurse Licensure Compact as we know it today developed set rules, updating in 2022 for a “Consensus Model” that encouraged uniform regulations across state boards.

At the very beginning, only Wisconsin, Utah, and Texas joined, but now nearly every state has joined the NLC Compact.

What the NLC Is and How It Works

If you hold a multistate NLC license, you can work in any compact state without having to reapply for a license. However, there are some specific rules.

You need to apply for the NLC license in your Primary State of Residence (PSOR). PSOR is established by your driver’s license, tax forms, and voter registration.

Once approved for an NLC license, you can practice in any other compact state. Each state has some differences in requirements, but overall, there are uniform requirements like a federal background check and fingerprinting.

The PSOR 60-Day Rule for a Compact Nursing License

When you change permanent residence from one NLC state to another, you have a 60-day window to reapply for a license in your new PSOR. This doesn’t apply to temporary residence, a vacation home, or renting in another state during an assignment.

Travel nurses, especially, should carefully keep track of deadlines and application status to avoid delays and losing out on possible career opportunities.

Why the Compact Matters Now

According to the Bureau of Labor Statistics, nursing jobs will grow by over five percent by 2034. And there’s an estimated 189,100 nurse openings yearly.

With the demand for nurses growing nationwide, the NLC license allows nurses from across state lines to easily respond to these needs.

Staffing Shortages and Quick Credentialing

Rural hospitals benefit the most from NLC healthcare staffing. There are only 5.1 primary care doctors per 10,000 rural residents, notably fewer than in congested urban areas, according to the National Rural Health Association.

With compact state licenses, rural patients can receive quality care through telehealth with licensed nurses. This especially benefits homebound individuals, seniors, and low-income families.

Telehealth and Cross-State Practice

There was a notable surge in interstate telehealth during the pandemic. Telehealth not only gives nurses opportunities to practice across state lines, it offers patients access to care they might not be able to because of cost, location, or disability.

In North America alone, telehealth makes up almost 40% of all healthcare. With the NLC license, nurses can work with patients across the country without having to worry about hefty application fees or delays.

Telehealth will only continue to grow as digital infrastructure improves to meet growing chronic disease management needs and an aging American population. And NLC healthcare staffing provides the skilled medical personnel Americans need.

What It Means for Nurses

Mobility and Continuity of Income: With the NLC license, you can move quickly between assignments instead of waiting months for state approval.

Negotiation Power: You have more options and can compare benefits packages across states. Find the right assignment for your budget, career goals, and lifestyle. Possibilities are nearly endless.

For the latest state-specific licensing rules, renewal checklist, and information on the 60-day rule, you can use trusted resources like the Compact Nursing License Map and Nursing License & Renewal Guide.

Find your PSOR’s NLC status and licensing rules, as well as step-by-step guidance.

Limitations and Challenges

Perhaps the biggest challenge to the Nurse Licensure Compact involves very large states like New York, California, and Oregon opting out of compact licensing. These states have massive populations in need of healthcare and a large medical industry.

If you want to practice in a non-compact state, you will need to obtain an individual license through the endorsement process.

The Road Ahead

While 43 jurisdictions are now part of the Nurse Licensure Compact, several states are still pending but are facing committee delays. Legislation is currently underway in Oregon, Nevada, Alaska, Illinois, and New York.

APRN Compact

Currently, a compact nursing license does not apply to APRNs. The APRN Compact needs seven states to adopt it before it can be implemented. The delay has been considerable, although some states have legislation pending.

Without an APRN compact license, nurse practitioners, nurse anesthetists and clinical nurse specialists face weeks or months of waiting, exorbitant application fees, different state requirements, and barriers to opportunities.

Modern Workforce Expectations

A compact nursing license addresses the needs of the modern workforce: career flexibility, opportunities to travel, work-life balance, and an appealing lifestyle. Younger nurses especially expect to enjoy life outside of work and appreciate good mental and physical health.

Compact Nursing License: Modern License for a Mobile Era

Mobility remains the biggest benefit of a compact nursing license. Changing hospitals frequently has become the norm, much more than in previous generations.

Telehealth and travel nursing assignments give nurses an opportunity to expand their skills and their experiences.

They can reach a wider array of patients across the country. And they can reach rural and marginalized communities desperate for quality medical care.

The Compact’s Promise

The Nurse Licensure Compact dramatically modernized American healthcare. Over two million nurses hold a compact nursing license. The NLC allows them to work across the state with rural and marginalized patients via telehealth or enjoy traveling across the country, gaining valuable experience in other compact states.

The NLC meets the needs of the modern nurse, providing flexibility, convenience, work-life balance, and greater career opportunities.

Hospitals further benefit from better patient outcomes, and NLC healthcare staffing ready to jump in during surges and emergencies.

With the Nurse Licensure Compact, we all benefit from a system that meets modern healthcare demands.