Research
What a nurse licensure compact changes
A compact does not make one license work everywhere. It creates a privilege attached to a home-state license, subjects the holder to the practice laws of wherever the patient is, and wires the states' investigation files together.
What the compact says it is for
The text described here is the Nurse Licensure Compact as enacted in the Code of Virginia, which is the version that was read. It opens with findings rather than with rules, and the findings explain the design.
The party states find that the expanded mobility of nurses and the use of advanced communication technologies as part of the nation's health care delivery system require greater coordination and cooperation among states in the areas of nurse licensure and regulation, and that new practice modalities and technology make compliance with individual state nurse licensure laws difficult and complex.
They also find that the current system of duplicative licensure for nurses practicing in multiple states is cumbersome and redundant for both nurses and states, and that uniformity of nurse licensure requirements throughout the states promotes public safety and public health benefits.
The stated purposes follow from that. Among them: to facilitate the exchange of information between party states in the areas of nurse regulation, investigation, and adverse actions; and to invest all party states with the authority to hold a nurse accountable for meeting all state practice laws in the state in which the patient is located at the time care is rendered, through mutual recognition of party state licenses.
That last purpose is the whole scheme in one clause. Mutual recognition is paired with accountability to the law of the place where the patient is, not with a single national standard.
The vocabulary the scheme runs on
The definitions section carries more weight here than in most statutes, because the compact's operation is almost entirely a matter of which defined term applies.
A multistate license is a license to practice as a registered nurse or a licensed practical or vocational nurse issued by a home state licensing board that authorizes the licensed nurse to practice in all party states under a multistate licensure privilege. That privilege is defined as a legal authorization associated with a multistate license permitting practice in a remote state.
Home state means the party state which is the nurse's primary state of residence, and remote state means a party state other than the home state. A single-state license is a license issued by a party state that authorizes practice only within the issuing state and carries no privilege elsewhere.
Two definitions govern what moves between states. Adverse action means any administrative, civil, equitable or criminal action permitted by a state's laws imposed by a licensing board or other authority against a nurse, including actions against a license or multistate licensure privilege such as revocation, suspension, probation, monitoring, limitation on practice or any other encumbrance, including issuance of a cease and desist action. Encumbrance is defined separately as a revocation or suspension of, or any limitation on, the full and unrestricted practice of nursing imposed by a licensing board.
The compact's own definition of nurse is narrow, and it decides who the whole thing applies to. Nurse means a registered nurse or a licensed practical or vocational nurse, as those terms are defined by each party state's practice laws.
What holding a multistate license requires
The compact does not simply recognize whatever a home state issues. It sets out what each party state must require of an applicant.
Among the requirements: meeting the home state's qualifications for licensure or renewal as well as all other applicable state laws; graduating or being eligible to graduate from a licensing board-approved prelicensure education program, or from a foreign program approved by the authorized accrediting body in that country and verified by an independent credentials review agency as comparable; and, for a graduate of a foreign program not taught in English where English is not the individual's native language, passing an English proficiency examination covering reading, speaking, writing and listening.
The applicant must have passed the relevant national licensure examination or a recognized predecessor, and must be eligible for or hold an active, unencumbered license.
Criminal history is handled at the compact level rather than left to each state. A state must implement procedures for considering the criminal history records of applicants for an initial multistate license or licensure by endorsement, including submission of fingerprints or other biometric-based information to obtain federal and state criminal history record information. The applicant must not have been convicted or found guilty, or entered an agreed disposition, of a felony offense under applicable state or federal criminal law, nor of a misdemeanour offense related to the practice of nursing as determined case by case.
Two further conditions address monitoring programs. The applicant must not be currently enrolled in an alternative program, and is subject to self-disclosure requirements regarding current participation in one. The compact defines an alternative program as a nondisciplinary monitoring program approved by a licensing board.
Whose law applies, and what a move does
The single most consequential sentence for anyone receiving care across a state line is about jurisdiction rather than about credentials.
A nurse practicing in a party state must comply with the state practice laws of the state in which the client is located at the time service is provided. The compact adds that practicing in a party state under a multistate licensure privilege subjects the nurse to the jurisdiction of the licensing board, the courts, and the laws of the party state in which the client is located at that time.
The compact also states that the practice of nursing is not limited to patient care for this purpose, but includes all nursing practice as defined by the state practice laws of the party state in which the client is located.
Residency drives the license. A nurse may hold a multistate license issued by the home state in only one party state at a time, and a nurse who changes primary state of residence by moving between two party states must apply for licensure in the new home state, with the prior home state's multistate license deactivated under the Commission's rules. The nurse may apply in advance of the move, but the new state does not issue until satisfactory evidence of the change of residence and satisfaction of all its requirements.
Moving out of the compact converts rather than cancels. If a nurse changes primary state of residence by moving from a party state to a non-party state, the multistate license issued by the prior home state converts to a single-state license, valid only in the former home state. Individuals not residing in a party state may still apply for a party state's single-state license, which grants no privilege to practice in any other party state.
What a remote state can do, and what the file carries
The compact gives every party state real authority over practice inside its own borders while reserving the license itself to the home state.
All party states are authorized, in accordance with existing state due process law, to take adverse action against a nurse's multistate licensure privilege, and a licensing board may issue cease and desist orders or impose an encumbrance on a nurse's authority to practice within that party state. Only the home state has the power to take adverse action against the license it issued.
The home state is told how to treat what a remote state sends. For purposes of taking adverse action, the home state licensing board shall give the same priority and effect to reported conduct received from a remote state as it would if the conduct had occurred within the home state, applying its own state laws to determine appropriate action. A board may also take adverse action based on the factual findings of a remote state, provided it follows its own procedures.
The consequence of a home state action is automatic and portable. If adverse action is taken by the home state against a nurse's multistate license, the privilege to practice in all other party states is deactivated until all encumbrances have been removed, and every such home state disciplinary order must include a statement saying so. Participation in an alternative program deactivates the privilege for its duration.
The information system is the machinery underneath all of it. All party states participate in a coordinated licensure information system holding licensure and disciplinary history, and all licensing boards must promptly report any adverse action, any current significant investigative information, denials of applications with reasons, and known participation in alternative programs, regardless of whether that participation is nonpublic or confidential under state law. Current significant investigative information and nonpublic alternative program participation are transmitted only to party state licensing boards, personally identifiable information may not be shared with non-party states or other entities except as the contributing state's laws permit, and anything a contributing state must later expunge is expunged from the system as well.
Key takeaways
- The compact creates a privilege attached to a home-state multistate license, not a national license.
- Its own definition of nurse covers registered nurses and licensed practical or vocational nurses.
- A nurse must comply with the practice laws of the state where the client is located at the time of service.
- A nurse may hold a multistate license in only one party state at a time, tied to primary residence.
- Any party state may act against the privilege; only the home state may act against the license.
- Boards must report adverse action and current significant investigative information to a shared system.
Frequently asked questions
Does a compact license work everywhere?
It works in party states, through a defined mechanism. A multistate license is issued by the home state, which the compact defines as the nurse's primary state of residence, and it authorizes practice in other party states under a multistate licensure privilege. A single-state license issued by a party state authorizes practice only within that state and carries no privilege elsewhere.
Which state's rules apply during a telehealth encounter?
The compact states it directly. A nurse practicing in a party state must comply with the state practice laws of the state in which the client is located at the time service is provided, and practicing under a multistate licensure privilege subjects the nurse to the jurisdiction of the licensing board, the courts and the laws of that state. The compact adds that this covers all nursing practice as defined by that state, not only patient care.
Who does this compact cover?
Its own definition of nurse is a registered nurse or a licensed practical or vocational nurse, as those terms are defined by each party state's practice laws. Nothing in the sections read here extends it beyond those two categories, and no claim is made about other professions or about other interstate compacts, whose texts were not read.
What happens if a nurse moves?
A nurse may hold a multistate license in only one party state at a time. Moving between two party states requires applying for licensure in the new home state, with the prior multistate license deactivated under the Commission's rules, and the new state does not issue until it has satisfactory evidence of the change of residence and all its requirements are met. Moving from a party state to a non-party state converts the multistate license to a single-state license valid only in the former home state.
Can a state other than the home state act?
Yes, against the privilege rather than the license. All party states are authorized, in accordance with existing state due process law, to take adverse action against a nurse's multistate licensure privilege, and a board may issue cease and desist orders or impose an encumbrance on authority to practice within that state. Only the home state may take adverse action against the license it issued.
What does the shared information system hold?
Licensure and disciplinary history submitted by party states, plus prompt reports from every licensing board of any adverse action, any current significant investigative information, denials of applications with reasons, and known participation in alternative programs, regardless of whether that participation is nonpublic or confidential under state law. Investigative information and nonpublic program participation go only to party state licensing boards, and material a contributing state must expunge is expunged from the system too.
Sources
Each document below is named as it names itself, with the date printed on that document rather than the day it was read.
- Code of Virginia section 54.1-3040.1, Nurse Licensure Compact findings and purposes
- Code of Virginia section 54.1-3040.2, Nurse Licensure Compact definitions
- Code of Virginia section 54.1-3040.3, general provisions and requirements for a multistate license, including compliance with the practice laws of the state where the client is located
- Code of Virginia section 54.1-3040.4, applications for licensure in a party state and the effect of a change of primary residence
- Code of Virginia section 54.1-3040.5, Additional authorities invested in party state licensing boards, including deactivation of the multistate licensure privilege
- Code of Virginia section 54.1-3040.6, Coordinated licensure information system and exchange of information