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In the past, nurses wanting to practice in multiple states had to apply and pay for single state licenses in every state where they’d be providing care. The cost and time constraints of this undertaking were significant. The goal of licensure compacts is to eliminate these hurdles and allow qualified nurses to practice in numerous states with one multistate license. However, there’s a difference between the Enhanced Nurse Licensure Compact and the Advanced Practice Registered Nurse Compact. Understanding this difference is especially crucial for advanced practice nurses. This guide dives into both Compacts, how they work and why APRNs are being held up.
What Is an Occupational Licensure Compact?
Occupational licenses safeguard the public from receiving services from unqualified practitioners. Licensure is especially important in the medical field, where practitioner mistakes can have dire consequences on a person’s health and life. However, incongruities arise because each state has its own licensure requirements for healthcare professionals. This is where interstate compacts come into play.
Occupational licensure compacts create reciprocal professional licensing between states while still protecting public safety and state sovereignty. Interstate compacts offer an efficient way to remove state borders and allow licensed professionals to practice in any participating state, with the ultimate goal of practicing anywhere in the United States.
The most robust occupational licensure compacts provide mutual recognition, meaning if a practitioner holds a multistate license in one compact state, they can practice in all compact states. Alternatively, a compact may take an expedited licensure approach. In this format, individuals must still obtain licensure in individual states, but the process is much quicker due to data centralization and coordinated application requirements.
As of February 1, 2023, healthcare occupations with access to an Occupational Licensure Compact of some kind included:
| Compact Name | Qualified Healthcare Professionals | # Participating States & Territories |
| Interstate Medical Licensure Compact (IMLC) | Physicians | 33 States and Guam (5 States and the District of Columbia Passed with Implementation In Process or Delayed) |
| Enhanced Nurse Licensure Compact (eNLC) | Registered Nurses (RN) Licensed Practical/Vocational Nurses (LPNs/LVNs) |
37 States, Guam and the U.S. Virgin Islands |
| Advanced Practice Nurse Compact (APRN Compact) | Certified Nurse Practitioners (CNPs) Certified Nurse Midwives (CNMS) Clinical Nurse Specialists (CNSs) Certified Registered Nurse Anesthetists (CRNAs) |
3 States |
| Emergency Medical Service Officials Licensure Compact (EMS Compact) | Emergency Medical Technicians Paramedics |
22 States |
| Physical Therapists Licensure Compact (PT Compact) | Physical Therapists Physical Therapist Assistants |
33 States |
| Psychology Interjurisdictional Compact (PSYPACT) | Psychologists | 33 States, the District of Columbia and the Commonwealth of the Northern Mariana Islands |
| Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC) | Audiologists Speech-Language Pathologists |
23 States |
| Occupational Therapy Interstate Licensure Compact (OT Compact) | Occupational Therapists Occupational Therapist Assistant |
22 States |
| Counseling Interstate Licensure Compact (Counseling Compact) | Licensed Professional Counselors Licensed Mental Health Counselors Licensed Professional Clinical Counselors (Doesn’t cover therapists, psychologists or social workers) |
17 States |
There are also compacts in the works for social workers, dieticians and school psychologists.
How Are Licensure Compacts Beneficial?
Multistate licenses significantly relieve the financial and other burdens of obtaining and maintaining licenses in multiple states. However, the benefits of multistate licenses impact not only the practitioner but also the licensure board and even consumers.
Common benefits for practitioners include:
- Streamlined licensure requirements
- Increased ability for practitioners to practice across states
- Improved portability for military spouses who often relocate every two years
- Increased ability to provide care through telehealth
- Reduced expenses related to obtaining/maintaining single state licenses
- Increased ability to obtain travel healthcare jobs
Benefits for state licensure boards:
- Reduced administrative costs
- Increased ability to share complaint and investigative information
- Shared responsibility for patient safety and commitment to improving patient protection
- Continued ability to maintain control over the state practice act and licensure process
- Added authority to request FBI criminal background checks
Benefits for consumers:
- Increased access to care
- Elevated efficiency in the distribution of services
- Increased availability and choice of qualified practitioners
- Elevated safety standards
- Improved response during disasters, pandemics or other crises that require an elevated level of medical care
- Increased ability to receive care through telehealth
How Does the eNLC Work?
The Enhanced Nurse Licensure Compact, developed by the National Council of State Boards of Nursing (NCSBN), is an interstate compact that allows qualifying RNs and LPN/LVNs to obtain one multistate license in their primary state of residency and practice in their home state and all other member states. Unless they’re under restriction, nurses with a compact license may practice physically and electronically through telehealth based on each state’s practice laws.
States wanting to become member states must enact the eNLC model language into law. They must also be able to conduct fingerprint-based federal criminal background checks on nurses when they initially apply for licensure by exam or endorsement.
State nursing boards in compact states must participate in a national database, Coordinated Licensure Information System or Nurses License Verification database to share information with other state nursing boards regarding nurse discipline, licensure verification and practice privileges.
Nurses wanting to apply for a multistate license must meet the uniform licensure requirements, which include the following:
- Graduate of a qualifying nursing education program
- Pass an English proficiency exam if English isn’t the applicant’s native language or the nursing program wasn’t taught in English
- Pass the NCLEX-RN or NCLEX-PN or predecessor exam
- Meet their home state’s nurse licensure qualifications
- Have (or eligible to have) an active, unencumbered nursing license
- Submit to state and federal fingerprint-based criminal background checks
- Have a valid United States Social Security number
- Have not been convicted or found guilty of a felony or a nursing practice-related misdemeanor
- Disclose current participation in an alternative program
- Not currently participating in an alternative program
Nurses qualifying for a multistate license must adhere to the nurse practice act in each state of practice. When providing care over the phone or electronically via telehealth, the state of practice is the state in which the patient is located, not the nurse. Currently, RNs and LPN/LVNs holding a compact license can practice across borders in 36 states, with three more states or U.S. territories in the process of implementing the eNLC.
Source: NCSBN
How the APRN Compact Works
The APRN Compact, also developed by the NCSBN, is very similar to other medical and nursing licensure compacts. It allows CNPs, CMNs, CNSs and CRNAs to hold one multistate license and practice physically or via telehealth in other states that have enacted the compact without obtaining additional licenses. Like the eNLC, states wanting to join the APRN Compact must enact the APRN Compact model legislation and implement a federal criminal background check for licensure.
APRNs must also meet uniform licensure requirements like RNs and LPN/LVNs under the eNLC. The requirements under the APRN Compact are similar but have some key differences. Those requirements include the following:
- Graduate from an accredited graduate-level education program that prepares them for one of the four recognized APRN roles
- Pass an English proficiency exam if English isn’t the applicant’s native language or the nursing program wasn’t taught in English
- Pass a national certification exam measuring APRN, role and population-focused competencies and maintaining continued competence as proven through recertification
- Pass the NCLEX-RN or predecessor exam
- Meet their home state’s nurse licensure qualifications
- Have an active, unencumbered RN license and active, unencumbered authorization to practice as an APRN
- Practice 2,080 hours or more as an APRN in a role and population focus matching the applicant’s education and training (can’t include hours obtained during APRN education program)
- Submit to state and federal criminal background checks
- Have a valid United States Social Security number
- Have not been convicted or found guilty of a felony or a nursing practice-related misdemeanor
- Disclose current participation in an alternative program
- Not currently participating in an alternative program
APRNs with a multistate license may assume responsibility and accountability for patient care and practice without supervisory or collaborative agreements with physicians. They may also prescribe non-controlled substances. However, prescriptive authority for controlled substances must only occur in accordance with the state laws and regulations in the state of practice.
What’s Holding APRNs Back
Unfortunately, the APRN Compact just can’t seem to get any traction. Adopted on August 12, 2020, the advanced nursing compact still only has three states (Utah, North Dakota and Delaware) that have enacted legislation to go forward with multistate privileges for NPs, CNMs, CNSs and CRNAs. It needs seven states total to join the compact before it can actually be implemented.
Source: NCSBN
As of February 1, 2023, only Arizona (SB 1334), Kentucky (HB 108), New York (SB 1230) and Maryland (HB475) have pending legislation to attempt to join the APRN Compact. Should all four states be successful, the Compact could be implemented. However, if more states don’t participate above these seven, the number of states APRNs can practice in with their multistate licenses would remain extremely limited.
APRNs have come up against various roadblocks, including from one of their own professional organizations. The American Association of Nurse Practitioners (AANP) opposes the revised APRN Compact because it’s against including practice hours as a prerequisite to applying for a multistate APRN license. It believes this directly conflicts with the Consensus Model for APRN Regulation and creates unnecessary and costly regulations for all states.
The AANP has been instrumental in securing full practice authority for NPs and finalizing over 100 state statutes benefiting NPs and their patients. Without this esteemed organization’s endorsement, the NCSBN could face an uphill battle in getting the advanced practice compact implemented and accepted by more states.
APRNs Can’t Practice Under an eNLC License
The most significant thing to note is that APRNs can’t apply for a multistate license under the eNLC and practice as an APRN across state lines. Advanced practice professionals practice under different rules than lower-level nurses. The eNLC applies to RNs and LPN/LVNs only.
All CNPs, CNMs, CNSs and CRNAs must wait until the APRN Compact is fully implemented before applying for a multistate license if they qualify and live in a participating state. APRNs interested in advocating for the APRN Compact have access to a customizable letter to send to lawmakers on the NCSBN advocacy site.
