Twenty-six states have passed legislation to enact the enhanced Nurse Licensure Compact (NLC). Per the bill, “This Compact shall become effective and binding on the earlier of the date of legislative enactment of this Compact into law by no less than twenty-six (26) states or December 31, 2018.” The states include Arizona, Arkansas, Delaware, Florida, Georgia, Idaho, Iowa, Kentucky, Maine, Maryland, Missouri, Mississippi, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, and Wyoming.

The NLC 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. The main changes from the original NLC to the enhanced NLC are the additions of criminal background checks, developing an Interstate Commission governing body, and improvements to the dispute resolution process.  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, which 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.
  • 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.

Working in other states

Four states— Colorado, Rhode Island, New Mexico and Wisconsin­—did not enact the legislation and will remain in the current compact. The last of the 26 states to sign the enhanced NLC into law was North Carolina on July 20. This triggered a six-month transition period from July 20, 2017 to January 20, 2018 when the states that did not enact the legislation can still be in a compact with the ones that did.

Wisconsin has plans to move legislation before the end of the year with the hope that they will be joining the enhanced NLC by January. Colorado will seek legislation in 2018 since their bill did not pass in 2017. New Mexico’s earliest opportunity to seek legislation will be 2019 because their 2018 session is only 30 days long and focuses solely on budget bills.

At the end of the six-month period, states in the existing NLC that are moving to the enhanced NLC will officially be withdrawn from the existing compact. The states that have not transitioned from the NLC to the enhanced NLC will remain in the NLC until they enact the enhanced version or withdraw from the existing NLC.

The role of the Interstate Commission

July 20th also marked the day that the enhanced NLC Interstate Commission came into existence; its first face-to-face meeting took place in August and Commissioners discussed operations and implementation of the enhanced NLC. Although the enhanced NLC is already effective, the Interstate Commission must adopt rules to facilitate its implementation by January 19, 2018.

Nurses in enhanced NLC states should receive a letter from their boards of nursing indicating the actual implementation date, along with more details about the enhanced NLC. The implementation date will also be published on the National Council of State Boards of Nursing (NCSBN) website.  Nurses who had a multistate license will be grandfathered into the enhanced NLC and will be able to practice in other enhanced NLC states. In states that are new to the NLC, those nurses will be able to practice in other enhanced NLC states when their board of nursing issues multistate licenses.

More details and the latest information on the enhanced NLC is available at