From 2000–2015, twenty-five states passed legislation to join the Nurse Licensure Compact (NLC, or Compact). The Compact license allows nurses (RNs and LPNs) whose primary state of residence is a compact state to practice in all other compact states whether that be physically, electronically or telephonically. For nurses who live in the current compact states, licenses automatically become multi-state licenses, as long as the nurse is in good standing. In addition to the requirements of their home states, nurses are subject to the nurse practice act and regulations in the state of practice, i.e., the state where the patient is located at the time nursing service is rendered.

An enhanced version of the NLC was adopted in 2015 by the National Council of State Boards of Nursing. States that previously adopted NLC legislation must now pass the enhanced legislation, which simultaneously repeals the earlier version. This year, 16 states introduced enhanced NLC legislation. Florida, Wyoming, and Oklahoma are new states that previously did not have a NLC and now enacted the enhanced NLC. All states enacting the enhanced NLC will likely become effective in 2018 or 2019. Legislation is still pending in several states and their current status can be viewed on a map at

Nephrology nurses have been active in supporting advocacy efforts to pass NLC legislation by providing testimony at committee hearings and contacting state legislators encouraging support for the NLC. The NLC is important to nephrology nurses for several reasons. Natural or other types of disasters impact both patients and nurses. Given the small window of time for dialysis patients to receive their life-saving treatments, nurse staffing during times of emergency can be expedited quickly in states that are members of the NLC. Such is not the case for states that are not in the Compact. The NLC also helps meet economic demands that allow nurses the mobility to meet staffing requirements and increases employment opportunities.

With the new emphasis on integrated care and case management, nurses who provide telephonic services must be licensed in all the states where their patients reside. These specialized programs are geared toward wellness, education, early diagnosis of some illnesses, early intervention, prevention of complications, avoiding hospital readmissions, and overall better management of medical conditions. The NLC reduces the administrative burden of nurses having multiple state licenses and allows more access for patients to these important services.

Nurses have increased opportunities to lead innovative strategies to improve the health care system through the NLC. In the future, it may become a model for other types of licensed health care professionals.


Nurse Licensure Compact:

“Nurse Licensure Compact: 5 Reasons to Endorse the NLC.”

“ANNA Position Statement: Nursing Licensure Compact,” March 2014