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Why WSNA is opposed to the proposed NCSBN Enhanced Nurse License Compacts

In 1998, a private chicago-based trade group for staff of state boards of nursing, called the National Council of State Boards of Nursing (NCSBN), developed what is known as the Nursing Interstate License Compact (NLC). NCSBN at that time was responding to executives of managed care organizations who sought a quick and inexpensive way to facilitate nurses practicing in more than one state or moving from one state to another.

On first review, a multistate license does sound appealing and simple. For nurses who practice in more than one state, only a license in their state of residence would be needed. The nurse or employer would pay only one license fee as well. However, these incremental benefits for a small number of nurses are overshadowed by potential risks to states like Washington that have worked hard to establish high nursing standards, and they pose unnecessary risks to the quality of patient care for the public and to the nurses practicing within those states.

At the time it was originally proposed, the American Nurses Association (ANA), WSNA, the Oregon Nurses Association and many other states raised a number of concerns about the original NLC, and since 1998, only 25 states ultimately joined the original NCSBN interstate compact.

In 2014, NCSBN proposed a new Enhanced NLC for both RNs and APRNs (in Washington state, APRNs are called ARNPs), and the organization has been aggressively pushing states to adopt them. In theory, the NLC would allow nurses in states who joined the compact to practice in any other compact state using their current home state license. For example, if Oregon and Washington both signed the compact, a nurse could practice in either or both states using a license from their state of residence.

After careful review, WSNA and ANA continue to have numerous concerns and remain strongly opposed at this time to adoption of the proposed enhanced Nursing Licensure Compacts in their current form.

One of our major concerns is license jurisdiction for practice in which the patient and nurse are located in different states. We strongly believe that the practice is located at the site where the nurse is practicing, and therefore, license jurisdiction follows.

The proposed enhanced NLC is based on the premise that practice occurs where the patient is located. That is logical only when that patient–provider interaction occurs face-to-face; however, the NLC was conceived prior to the widespread use of cell phones, e-mail and the internet. When a nurse is providing consultation or follow-up care using one of these methods, he or she may not even know the exact location of the patient. The patient may be on a cruise ship, located in another country or in an entirely different state than the actual home residence of the patient. It only makes sense that the nurse should be held to the standards of the home state in which she or he is actually practicing and where the patient originally sought care.

In the NCSBN’s plan, the compact is overseen by an interstate commission of compact administrators that can make binding decisions on member states, without being held accountable to any state or government. WSNA believes that handing over our state’s practice authority is not in the best interest of the public or of practicing nurses.

Another problem with the NLC premise that practice occurs where the patient is located is the NLC assumes that scope of practice in all states is the same for the registered nurse and that the practicing nurse is familiar with every state’s scope of practice in which they are practicing. This is especially problematic for cross-border telehealth post-hospitalization follow-up calls.

That’s why WSNA and ANA have been working towards identifying new solutions that address telehealth and simplify multistate practice for nurses, protect the public and retain individual states’ authority to establish and enforce practice standards.

Efforts to resolve these concerns have resulted in a special work group between ANA and NCSBN that we hope will result in a possible third option or other alternatives to appropriately address interstate nurse-patient communications and telehealth issues and resolve license jurisdiction.

At the time the Summer 2016 issues of The Washington Nurse magazine went to press, these follow up discussions to explore mutually agreeable solutions to the concerns raised about location of practice as well as advancement of cross-border practice were continuing between ANA and NCSBN.

As we consider important health care decisions like multistate licensure, it is critical that all nurses have access to the information we need to weigh both the risks and benefits of policy decisions and take an active role in the decision-making process. We strongly encourage you to read the accompanying Executive Summary of the WSNA Board position statement, “The Nursing Licensure Compact and APRN Compact:  A Bad Option for Washington.”  The WSNA full position statement can be found at

WSNA firmly believes in protecting patient safety and the public as well as advancing nursing practice, and it is in all of our best interests to work together to resolve our differences. We look forward to more discussions before any legislative action is proposed in Washington state.