New Multistate License Aims To Reduce Red Tape For Travel Nurses

Lauren Bond, a travel nurse, has held licenses in five states and Washington, D.C. She maintains a detailed spreadsheet to keep track of license fees, expiration dates and the different courses each state requires.

The 27-year-old got into travel nursing because she wanted to work and live in other states before settling down. She said she wished more states accepted the multistate license, which minimizes the hassles nurses face when they want to practice across state lines.

“It would make things a lot easier — one license for the country and you are good to go,” said Bond, who recently started a job in California, which does not recognize the multistate license.

The license, known as the Nurse Licensure Compact , was launched in 2000 to address nursing shortages and enable more nurses to practice telehealth. Under the agreement, registered nurses licensed in a participating state can practice in other NLC states without needing a separate license. They must still abide by the laws that govern nursing wherever their patients are located.

About half of the states joined the original compact, which was modeled on the portability of a driver’s license. Some states that declined to sign on cited a major flaw: The agreement didn’t require nurses to undergo federal fingerprint criminal background checks.

The National Council of State Boards of Nursing recently launched a new version of the NLC that requires those checks. Twenty-nine states, including Virginia, have passed legislation to join the new agreement.

Jim Puente, who oversees the compact for the council, said he expects even more states to sign the agreement now that criminal background checks are required. He noted that several states have legislation pending .

California does not plan to join the new compact, largely because of concern about maintaining state training and quality standards. The state, like many others, already requires nurses to undergo background checks.

Proponents of the nurse licensing agreement – both the old and new versions – argue that it helps fill jobs in places where there aren’t enough nurses and enables nurses to respond quickly to natural disasters across state lines.

“The nurse shortage tends to wax and wane regionally, so being able to move nurses where the needs are is really, really important,” said Marcia Faller, chief clinical officer at AMN Healthcare, a San Diego-based medical staffing company that employs Bond. The multistate license “really helps with that mobility … to deliver care to patients across state lines.”

In some states, the multistate nursing license is helpful because it streamlines the process for nurses doing case management or telehealth, said Sandra Evans, executive director of the Idaho Board of Nursing. Getting nurses to work in the rural areas of Idaho is a challenge, and hospitals often rely on telemedicine in places where the closest health care facility might be in Montana, she said.

Before Idaho joined the original NLC in 2001, nurses doing telehealth or case management needed numerous licenses to work across state lines, but now they “can travel virtually – electronically or telephonically – to help their clients,” she said.

Joey Ridenour, executive director of the Arizona State Board of Nursing, said one of the biggest advantages of the compact for her state is that it allows authorities to share information and collaborate with other states to investigate and discipline problem nurses. “We are able to take action faster,” she said.

Opponents of the compact argue that states have different standards, course requirements and guidelines and that nurses licensed in one state may lack the necessary knowledge or experience to practice in another one.

“The ability to control the standards of training and quality are of some concern to us,” said Linda McDonald, president of United Nurses and Allied Professionals union in Rhode Island, which participated in the original NLC but hasn’t signed on to the new one. “We want them trained in Rhode Island. We want them licensed in Rhode Island.”

“We really want to make sure that nurses who are entering our state and taking care of our patients are competent and qualified,” said Catherine Kennedy, a Sacramento-area nurse who is secretary of the California Nurses Association. Some traveling nurses haven’t been, she added.

Kennedy said California does not have difficulty recruiting nurses, even without the compact, because of the state’s relatively high salaries and strict nurse-to-patient ratios in hospitals.




What do you think? Share your thoughts in the comments section below.


  1. There are some good thoughts here. I think the real reason is as basic as the concept of state’s autonomy in relationship to the feds. Administration fees drive up costs in every aspect of every business (those people who do that checking, tracking, enforcing, administrating have to be paid some kind of way), yet some things require regulation. People in different parts of the country think differently for a multitude of reasons. While it sounds good in concept. Back in 1974, Cali and NY didn’t allow reciprocity if your test scores were not high enough. You had to actually take their test. This is a concept to help the travel nurse business. These agencies get paid big bucks to find nurses. There are hassles with every job known to man, but the state of our society right now is clear indication that there are plenty of people pissing on you and trying to convince you it’s rain! Understand this for what it is!

  2. Hope I am not speaking out of turn but isn’ t NCLX all the same regardless were you take it? If yes then why the states can not agree on developing a national requirement on CEU that will cover the basics for all of them? Some of the hospitals have their own requirements for education anyway… I agree that some of the nurses show a lack of knowledge but that might be the result of the nursing program they attend?

  3. All states should have the same requirements for graduation, licensing, and continuing education. That way we can move through each state w/o all the hassle. All nurses should be fingerprinted and have a back ground check.

  4. As a Travel RN I have had as many as 11 licenses, several of which cost hundreds and were never used (but were required to be considered for certain jobs). I have to laugh that CA refuses to participate. It took me 15 months, 2 applications, 3 sets of transcripts, and finally a flight to Sacramento (to reach a human) to get an acknowledgement that they had all they needed. They still couldn’t give me license on the spot and 5 weeks later instead of a long censor I got a “we need your transcripts” letter! I’m now waiting on an APRN license from them. As high as they think they’re standards are, that BON is a hot mess.

  5. What a click-bait title. There is no ‘multi-state’ license at all; it’s a national legal Compact agreement between States, sanctioned by the NCSBN/NLC prawns. California, if the article would come clean with real data, rejects the NLC agreement because they’d loose billions of dollars in license fees. Governor Moonbeam is happy to take your $$$.

    Modern Nurse better stick to its pretty articles about cooking and lifestyles for nurses; or just put out cartoons like all the rest of the hard-core nursing sites. Or, like the side-bar links on this page beckon, stick to the “8 Hilarious Ways to Tell You’re Actually a Nurse”. Click-bait title, worthless High School insulting content.

    Good Grief.

  6. The military has maintained a long-standing model for nursing practice by allowing any nurse, regardless of the state in which he/she was originally licensed, to work in any military/federal facility or on any military base under that original license. This has been in place for quite some time and seems to work without any significant problem. Nurses need to pull together and demand the Nurse Licensure Compact or, something similar, be adopted across all states, including California which has always acted as though it was something “special”. Having worked there, trust me, it’s not.

  7. Dear Modern Nurse,
    Oregon RN’s just recently rejected joining the NCSBN. The reason for this, as good as the idea sounds on the surface, is that we would have forfeited the ability to have any control over regulation of nursing practice in our state. The idea of national reciprocity is a good one, and serves many concerns nurses have regarding the ability to relocate and seek employment without worries of the time or expense it currently takes to re-license. Giving up the ability to have control over practice standards, and the ability to influence the development of our profession should not be a sacrifice we need to make in order to have the convenience of mobility. Let us continue to consider, as professionals, how to achieve and fulfill both of these concerns.
    Paul Seer, RN
    Portland, OR

  8. More standardized CE requirements would fix that problem. As an RN licensed in one state and living in another, I can attest to the fact that logistics has left me unemployed when I could be helping out in the nursing shortage. I am totally for a national license!!!


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