One year ago, an article appeared in the April 2009 issue of Case In Point titled “Is Your Job Putting You at Risk?” The article’s subject matter—the issue of multistate licensure—garnered a fair amount of attention over the ensuing few months. Throughout the past year, a tremendous groundswell of attention directed to nursing licensure has grown within the case management community.

The concept of multistate licensure has captivated the interest of nurse case managers across the country. The background of licensure is important to understanding what’s currently at stake. As many of us know, nursing licenses are state-regulated. For many years the only way a nurse could obtain a license in another state was to apply for a license through endorsement, pay a fee, and wait several weeks to several months for the new license. In most cases, a new license was required because the nurse relocated to another state.

However, times have changed. Providing nursing case management services across state lines has become commonplace due to changes in our health care system, which have led to an increasingly mobile nursing workforce. Provider delivery systems like supra-state health care organizations and health care payer strategies such as telephonic case and disease management have become regular entities and initiatives.

To address these profound changes in the nursing workforce, the National Council State Boards of Nursing (NCSBN) proposed a solution in the late 1990s that is known as the Nurse Licensure Compact, or NLC. This legal compact was developed to address a fragmented licensure process and to assist nurses in securing safe employment in new areas of health care.

The NLC is a mutual-recognition pact based on model legislation enacted through a state’s legislative process. The NLC allows for recognition of a nurse’s “home state” license by all other “party” states in the compact. This allows nurses in some states to work either on-site or electronically in all other states in the compact without the need to fill out applications, pay fees or wait for another state’s licensure process. To date, 24 states have passed legislation to join the NLC.

According to data collected by the NCSBN, the compact has been working well since its inception in 2000. Positive outcomes include increased discipline and information sharing among compact state boards of nursing, streamlined regulatory processes, improved nursing mobility, and clarification of the right to practice for many nurses currently working in telenursing and/or interstate nursing practice. These findings as well as other related information can be found at www.ncsbn.org.