Avoiding Liability Bulletin – November 15, 2015

The importance of your license to practice as a registered professional nurse (RN) or an advanced practice nurse (APRN) cannot be overestimated. Without it, you cannot practice nursing legally in any state in the U.S. or its territories.

As you know, one licensure model that has existed for too many years is one of applying for a license to practice in each and every state where one practices. Back in the day, I was one of those nurses who moved frequently to new states and to explore new practice experiences.

At one time, I held 4 registered nurse (RN) licenses. Each time, I had to apply for a license, pay the application fee, and wait for what seemed months (sometimes it WAS months) until I received my license so I could begin my practice. The process was cumbersome and costly.

With today’s delivery of healthcare advancements, including telehealth nursing and nurses’ ability to move from one practice setting to another and to many states, there developed a need to help enhance the ability for nurses to legally practice across state lines without having to apply for a license in each and every state in which they practiced.

State boards of nursing have been reviewing this antiquated process since 1997 and in 2000, the National Council of State Boards of Nursing (NCSBN) implemented the first Nurse Licensure Compact (NLC). It has operated successfully for 15 years.

Under the current NLC, nurses can apply for a multistate license in their home state and that license is recognized by all other remote compact states. The nurse can practice in her home state or any other state that is a member of the Compact. Obviously, the nurse must adhere to any state’s nurse practice act and rules in which nursing practice takes place.

On May 4, 2015, the NCSBN has adopted an enhanced NLC that the Council and its board members believe increases access to care, maintains quality of care, and decreases costs. With uniform licensure requirements by those states who have adopted or who adopt the enhanced Compact, nursing care delivery can be further improved.

One new component of the enhanced Compact focuses on criminal background checks (CBCs). The enhanced compact says that a nurse whose criminal background check is positive for a conviction, has been found guilty, or has entered an agreed settlement about the conviction will not be issued a multistate license.

Those nurses whose background checks return a positive find for a conviction, has been found guilty, or has entered an agreed settlement for a misdemeanor relating to the practice of nursing will have their situation reviewed on a case-by case basis in regards to the issuance of a multistate license.

If affected by either one of the above situations, a nurse may still be issues a single state license in his or her home state.

Regarding the CBCs, those of you who already hold a multistate license under the current NLC will be “grandfathered” in and can still maintain that license.

APRN license holders will be pleased to know that on May 4, 2015, the NCSBN also approved an Advanced Practice Registered Nurse Compact (APRNC). This Compact will allow advanced practice registered nurses to hold one multistate license with a privilege to practice in other APRN compact (member) states.

If you already hold a multistate license in your state (there are currently 25 states that are members of the Compact), you know the benefits it affords you. If you do not have a multistate license, or your legislature is considering passing this enhanced legislation or the APRNC, you need to voice your support for them to your legislators. Their passage will not only benefit you but your patients and the delivery of nursing care as well.

You can view details about the Compacts. For the NLC, go to:https://www.ncsbn.org/NCL_Final_050415.pdf . For the APRNC, go to https://www.ncsbn.org/aprn-compact.htm .

On November 25, 2015, the Compacts will be available at www.nursecompact.com.


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About the Author

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Nancy Brent

Nancy J. Brent, RN, MS, JD, a nurse attorney in private law practice in Wilmette, IL, represents nurses and other health care providers before the state agency that regulates health professionals. Brent graduated from Loyola University of Chicago School of Law in 1981. Her experience prior to opening her private practice included a year of insurance defense for a major insurance company and establishing a law firm with two other attorneys. After three years of doing defense work at the firm, Brent decided to establish a private practice in 1986. Brent has published extensively and has lectured across the country in the area of law and nursing practice. She is a member of several legal and nursing professional associations, including the American Nurses Association, Sigma Theta Tau International Honor Society of Nursing, the Illinois State Bar Association, and The American Association of Nurse Attorneys (TAANA).