Nursing Across State Lines: Becoming Stronger

For 17 years, healthcare consumers in Texas have enjoyed increased access to registered nurses, courtesy of an agreement known as the Nurse Licensure Compact, or NLC, a mutual recognition consortium of 25 states.

NLC affords eligible nurses who live in Compact States the privilege of practicing in any of these states without having to produce evidence of their qualifications, such as original college transcripts and licensure examination scores. This mutual recognition, or reciprocity, agreement is subject to the laws of each member state, further protecting the interests of the public.

With the adoption of the compact 20 years ago and its subsequent implementation three years later, America’s state Boards of Nursing (BONs) became the first healthcare provider regulatory group to develop this visionary model of multi-state practice.

In an age when Americans move more than ever, or commute across state lines, it has been a boon for the nursing profession. And, in an era in which much of the nation, including Texas, is beset by a nursing shortage that shows no signs of abating, the compact has been a godsend for employers—and for the public.

Ordinarily, obtaining a nursing license in another state that has no reciprocity agreement with your previous state is a meticulous process, sometimes lasting weeks or even months, and frustrating both nurses and prospective employers. The compact provides much needed relief that ultimately benefits Texas and Dallas-Fort Worth, which attracts one million new residents every eight years and is one of the nation’s fastest-growing metropolitan areas. It also benefits the state’s rural areas, which are hardest hit by a dearth of health care professionals.

Now, the compact is about to get even stronger.

In recent years, it has undergone significant revisions. Beginning next January, it will transition into a new and improved version known as the enhanced Nurse Licensure Compact, or eNLC.

In June, Gov. Greg Abbott signed a bill that allows Texas to join 25 other states that have adopted eNLC.

The new compact is stronger and a better deal for the people of Texas for several reasons.

First, it permits nurses to practice physically and electronically in other states within the compact. Nurses who live on our borders can care for patients who live in an eNLC state, increasing the patient follow-up, quality of care, and patient outcomes. In effect, nurses may now provide services to patients in member states without having to obtain additional licenses. This could be particularly helpful during natural disasters such as Hurricane Harvey.

Second, the changing nature of healthcare in America has made it routine for an array of nurses, including primary care, transport, school, and hospice nurses to cross state borders to provide services.

Third, the implementation of the eNLC is an idea long overdue. According to the Chicago-based National Council of State Boards of Nursing, between 2000, when NLC was first implemented, and 2010, the compact grew to 24 member states. But between 2010 and 2015, the council reported, only one new state joined the compact.

The council attributes the drop-off in new memberships to the absence of uniform criminal background check requirements. Under eNLC, all member states will be required to conduct background checks on nurses upon initial licensure. This requirement is to safeguard the public, a goal we all share, and will likely result in increased membership.

Much of the transition from NLC to eNLC is pretty straightforward. Nurses in the former NLC states transitioning into eNLC will be able to practice in other compact states after implementation in January 2018.

But there is one wrinkle.

To date, four of the original NLC states have not opted to be a part of eNLC. They include two neighboring states—Colorado and New Mexico—as well as Rhode Island and Wisconsin. That could pose some major challenges for our state and its health care consumers.

Nurses who are licensed in states that were part of the original compact but failed to transition to eNLC will be barred from practice in Texas (and other eNLC states). They must apply for a single license to practice in each eNLC member state. For example, nurses licensed in New Mexico or Colorado will need to apply for and receive a Texas RN license in order to practice here, after Jan. 19, 2018. This has implications for our health care facilities, which need to check how their RNs are licensed. If a nurse is from a state that did not join eNLC, then an application for a Texas license is required.  Our Board of Nursing ( is ready to accept applications, so facilities are not caught without licensed nursing staff come January.

Anne R. Bavier is dean of the College of Nursing and Health Innovation at the University of Texas at Arlington and immediate past president of the National League for Nursing.

Posted in Expert Opinions.