In a Boon For Travel Nursing and Telehealth, New State Signs Nurse Licensure Compact

Joey Morris
Updated July 27, 2023
    Rhode Island has become the 41st jurisdiction to join the Nurse Licensure Compact.
    Buildings in Providence, Rhode IslandCredit: Getty Images
    • Rhode Island has become the 41st U.S. jurisdiction to join the Nurse Licensure Compact (NLC).
    • Once implemented, nurses in Rhode Island can apply for a multistate license to care for patients in other NLC states without applying for individual state licensure.
    • Rhode Island’s decision to join the NLC is driven by the need to address the state’s severe nursing shortage and fill staffing needs in hospitals and healthcare facilities.

    In a move that will further ease restrictions on travel nurses and telemedicine, Governor Daniel McKee signed legislation making Rhode Island the 41st U.S. jurisdiction to join the Nurse Licensure Compact (NLC).

    McKee signed the legislation June 24. Once implemented, registered nurses (RN) and licensed practice/vocational nurses (LPVN) in Rhode Island can apply for a multistate license allowing them to practice in other NLC member states.

    Established by the National Council of State Boards of Nursing (NCSBN) in 2020, the NLC is designed to make it easier and more affordable for authorized nurses to care for patients in other states. By obtaining a multistate license, nurses in NLC don’t need to apply for multiple individual state licenses. This streamlines the licensure process and reduces redundancy. According to the 2022 National Nursing Workforce Survey, 30% of RNs hold a multistate license, up from 24% in 2020.

    Rhode Island originally joined the NLC in 2008 before opting not to renew membership in 2018. Joshua Miller, a sponsor of the NLC bill, said the decision to rejoin the Nurse Licensure Compact (NLC) was driven by Rhode Island’s urgent need to address the scarcity of nurses.

    “Our state is grappling with a severe shortage of nurses,” Miller said. “Returning to the compact is a way we can make it easier and more appealing for nurses to come here for a job, making it easier for our hospitals and health facilities to fill their staffing needs. Rejoining the compact is good for our public health and safety.”

    Learnings from the COVID-19 pandemic may also factor into recent NLC adoption. During the early months of the pandemic, many states issued emergency orders allowing nurses to work across state lines without the need to apply for additional licenses or fees, regardless of NLC status. Four states have enacted the NLC since 2020.

    Nurses who regularly practice across state lines, such as travel nurses and nurses who provide telehealth services, stand to experience the greatest benefit from the compact. Nurses currently holding a multistate license in NLC states can care for patients in all but 11 states.

    The 2022 National Nursing Workforce Survey reported that approximately 6% of registered nurses reported working as travel nurses, and 50% stated they had provided telehealth services at some point.

    At the same time, the compact has not been without its share of opposition. In a recent interview with HealthLeaders, Nicole Livanos, director of state affairs at the NCSBN, noted that nursing unions have expressed concerns that the adoption of the NLC may reduce union bargaining power because employers can more quickly hire out-of-state travel nurses, including in situations where a work stoppage may occur.

    “Many different unions represent nurses, and each state has its own challenges and concerns that those unions would raise,” said Livanos. Others have highlighted concerns about the possibility of nurses evading disciplinary action by traveling between states despite the safeguards in place.

    Livanos said she hoped more states will continue to enact the NLC.

    “We are encouraged to see that, especially coming out of the pandemic, states are looking at and addressing the real issue of the nursing workforce shortage,” said Livanos. “The NLC is a tool in the toolbox, so while there is a nursing shortage of this magnitude, the NLC isn’t going to suddenly create nurses, but it is going to allow facilities that might have an acute shortage in one of their units to recruit a nurse for that unit or shift around their resources if they’re an interstate facility and moves nurses between different states.”

    As health leaders continue to search for solutions to the ongoing nursing shortage, the likelihood of more states joining the NLC appears promising. Currently, seven states and the District of Columbia have pending legislation to become part of the NLC.