Nurses Working Across State Lines: Are you Compliant?

As professionals, Registered Nurses have an obligation to know and follow the licensure requirements set by the state Board of Nursing in the states in which they practice. In the past, this was fairly easy as most nurses practiced in the state where they lived.

Today, due to the focus on cost containment and advances in technology, nurses are working in areas such as case management, utilization management, care coordination and workers compensation. They are able to do this work from an office in their home state while working with clients located in multiple states; and, employing organizations can regionalize operations and maximize their nurse teams to provide services for their clients nationwide.

Nurses who work across state lines need to be compliant with State Board of Nursing Regulations in the states where the patient resides. Nurses are obligated to hold nursing licenses not only in the state where they live, but also in each of the states where their client resides. To address this challenge and protect nurses, the National Council of State Boards of Nursing has been working for years to develop the Nurse Licensure Compact. The Nurse Licensure Compact (NLC) allows nurses with a multistate license to practice physically, telephonically, or electronically in their home state and in other original NLC states. This has been a challenging effort as each State Board of Nursing has their own budget, rules and regulation. The complexity of bringing the States under one umbrella was met with a great deal resistance.

The National Council of State Boards of Nursing took the time to listen to the various State Boards of Nursing and worked with them to understand their views and helped streamline processes so that most State Boards of Nursing agreed to join the eNurse Licensure Compact. Joining the eNursing Compact is not an easy task as it requires a law change in each State.

The eNLC allows a registered nurse or licensed practical nurse licensed in a Compact state to practice in multiple Compact member states without having to obtain separate licenses in each state. This reduces regulatory requirements by removing the need to obtain a license in each state. Nurses are able to practice in person or utilize telehealth in other eNLC states with just one license obtained in their state of residence. Additionally, nursing faculty and military spouses will just need one license to teach or practice across states in the eNLC.

The eNLC requires nurses to have a multi-state license from the nursing board in which they have established permanent residency. If a multi-state licensee moves from one state and establishes residency in a new state, the nurse must apply for licensure from the nursing board in the new state of primary residence.

Resources: For more information regarding the enhanced eNurse Licensure Compact, follow this link: In January 2018, CMSA Today, the official publication for the Case Management Society of America provided an update on the eNurse Licensure Compact. To read the article follow this link:

Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN


Anne is a registered nurse with close to 40 years of experience in the healthcare industry. She holds a Master’s Degree in Training and Development from St. Francis University and a Bachelor in Health Services from Barry University. Anne is a board certified case manager through the American Nurses Credentialing Center and the Commission for Case Manager Certification. She is also a certified registered rehabilitation nurse through the American Rehabilitation Nursing Association. She is past President of the Case Management Society of America and also Governor for District 27 of Quota International. Anne is a frequent speaker both nationally and internationally on issues related to the practice. Anne is a co-author of Case Management Review and Resource Manual: published by the American Nurses Credentialing Center and now in its 3rd edition.

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