When cases and death tolls were starting to spike early in the COVID-19 pandemic, many states enacted emergency license waivers for nurses.
Emergency license waivers allowed nurses to practice across state lines without going through standard licensure procedures, a process for which many hospitals did not have time.
The critical decision to enact emergency license waivers was taken to keep hospitals across the nation from becoming overwhelmed. New York City and Los Angeles County are both major metropolitan areas significantly affected by COVID-19. However, cases in New York City spiked early in the pandemic only to be surpassed by a surge of Los Angeles County cases in July of 2020.
Scrambling to license new nurses could have been avoided if more states participated in the Nurse Licensure Compact (NLC), which allows nurses to hold multistate licenses. The enhanced NLC, which provided some updates and additions to the compact, was made part of Florida Law in 2016.
While states could quickly implement the emergency measures, the allowances are only temporary. Will the shock of the pandemic prompt more states to enter the NLC?
Here are some critical updates and information on the NLC, the enhanced NLC (eNLC), and the influence COVID-19 may have on future legislation.
The History of the NLC
Prior to the creation of the NLC, nurses in the U.S. needed to obtain licensure in each state in which they practiced. If you were a licensed nurse in New Jersey, you would still need an additional license to work in the neighboring state of New York. This changed when Maryland signed the first NLC into law in the year 2000. Created by the National Council of State Boards of Nursing (NCSBN), the NLC permits nurses — both registered nurses (RNs) and licensed practical/vocational nurses (LPN/LVNs) — to practice in other compact states with no additional licenses required. The agreement allows for both in-person employment and telehealth services.
By joining in July 2020, Indiana became the 34th state to jump on board. Several other states had pending legislation in 2020. Unfortunately, the pandemic drew attention away from those bills. Jim Puente, Director of the NLC for the NCSBN, anticipates that NLC-related bills that did not pass legislation in 2020 will be reintroduced in 2021.
Transition from NLC to eNLC
The terms NLC, eNLC, and multistate license can be confusing, but they represent the same concept. The traditional NLC was officially replaced by the enhanced Nurse Licensure Compact (eNLC) on July 18, 2018. This transition continued the mission of the original NLC, while providing some updates and additions to the compact.
For example, the newer version of the compact requires fingerprinted criminal background checks on initial licensure (both state and federal) and prohibits convicted felons from acquiring a multistate license.
All of the original compact states adopted the more recent eNLC guidelines, except for Rhode Island, which is no longer part of the compact.
This map indicates which states have enacted/implemented NLC/eNLC and which states have pending legislation.
Nurses who work or reside in NLC-participating states don't automatically receive a multistate license. They must go through an application process, including a background check. There is also an application fee, which varies by state.
In the state of Florida, which joined the eNLC in 2018, nurses with single-state licenses must pay a $100 fee and provide their fingerprint results no more than 90 days prior to submitting their application. Check with the Board of Nursing website for your state of residence to get more details on application requirements and processes.
Restrictions and additional considerations also apply to military and federal nurses. Per the NLC, "Although federal supremacy exempts a nurse from holding a license in the state of practice when they hold an active nurse license in any state, this pertains to a single state license. If a nurse in this category wishes to hold a multistate license, the nurse must have legal residency in an NLC state."
Nurses who are spouses of active military follow the same guidelines as non-military spouses. This means if a nurse's partner is deployed to another state, they can practice in that state, provided it is an NLC-participating state and they have obtained a multistate license.
Benefits for Nurses and States Alike
The implementation of the NLC has dramatically expanded access to care. Even before the pandemic, there was a need for nurses to cross geographic boundaries. Travel nurses have benefited from the eNLC since they don't have to worry about applying for or renewing licenses in every state. The eNLC has also saved nurses significant amounts of time and money.
The Nursing Licensure Compact benefits nurses who are:
- Looking for work in the short-term and need to cross state lines to secure employment
- Interested in travel nursing
- In a relationship with someone whose job involves frequent relocation
Participating states also enjoy the advantages of the NLC. They have access to a wider variety of mobile, readily available, and first-rate nursing professionals — including RNs who have earned their Bachelor of Science in Nursing (BSN) degree.
Will the Pandemic Increase NLC Participation?
The pandemic has highlighted the effectiveness of NLCs. States that had to implement emergency orders to hire more nurses may find themselves in a complicated situation. Accounting for the differences among each state's licensure requirements can be difficult for hospital administrators and health officials.
The pandemic could also serve as a motivating factor for non-NLC states to join the movement.
"Many states said, 'If we were only in the compact, we wouldn't be in this predicament with temporary emergency orders.' So COVID-19 has caused states that may not have previously considered the compact to consider it," notes Jim Puente, director of the Nurse Licensure Compact for the National Council of State Boards of Nursing.
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