Through the succeeding years, several more state governments passed similar resolutions to become "compact states." Yet, there are still misconceptions about NLC and who is or is not eligible to participate. Also, some administrators at hospitals and State Boards of Nursing remain cautiously uncommitted about its value. But for the acute care recruiters in the 17 states that have endorsed the compact-and the travel companies who place NLC-eligible nurses-the changes have been welcome. The compact has cut red tape drastically, allowing smoother and faster transitions for both new hires and supplemental staff.

A historical look

Traditionally, every state was responsible for issuing legal endorsements to nurses so they could provide care under each area's own Nurse Practice Act. The only exception was federally run hospitals, such as a Veteran's Administration facility. These functioned under the premise that as long as nurses held a valid license issued in the United States, then they were cleared to work for a federal institution. Otherwise, if clinicians wished to relocate, either permanently or as travelers, they would have to apply for licensure in the chosen state and would be prohibited from treating patients until it was granted.

Although the individual state license has been a sufficient means through which to track and discipline nurses, by the mid-1990s, the healthcare industry was experiencing the beginnings one of the its worst nursing shortages. Experts warned of severe staffing problems to come. The belief that healthcare travelers would be employed more frequently-and likely on a larger scale than ever before-was soon to be proven true.

In 1994, to assist hospitals in finding sufficient staff to combat the shortage, the National Council of State Boards of Nursing (NCSBN) began to address the practicality of multistate license privileges. The idea was simple: Create a scenario in which a nurse's license would be transferable from one state to another. After three years of hashing through potential ideas of how to create a program that would allow nurses and hospital administrators as much freedom as possible, while preserving states' scopes of practice, the Nurse Licensure Compact was born.

NLC is a collection of states that have agreed to honor each other's nursing licenses without changing participating state's established legal language. Nurses who have official residency in Wisconsin, for example, can accept jobs in Texas through reciprocity. There is no need to specifically obtain Texas licensure. They literally could leave Wisconsin and begin caring for patients in the Lone Star State the next day-without completing any paperwork, other than their job applications.

Eligibility mirrors that of a state driver's license; both are based on the holder's primary residence. Clinicians can invoke the privilege if their permanent home is located in a compact state. Residency is usually determined by what is stated on a driver's license, federal income tax return, or voter registration. This is an important factor for travelers because seasoned professionals may hold licenses in more than one compact state, but not reside permanently in any of them. Consider mobile practitioners with Texas licenses who live in California. Those nurses would not be able to enact NLC rights since California is not a member. The same concept applies to nurses from NLC states who wish to accept assignments in non-compact states. They must follow the traditional regulatory route when working outside of the agreement.

State legislators must adopt the compact through legislation or via a regulatory process. By doing so, that state agrees to follow the rules and regulations established by the Nurse Licensure Compact Administrators (NLCA), which oversees the NLC. This adds a statutory layer above the individual state's Nurse Practice Act.

Each state continues to set its own laws and policies regarding how nurses practice within its boundaries. If a Wisconsin nurse accepts an assignment at a Texas acute care facility, she is bound by both Texas law and NLCA bylaws to adhere to the Texas Nurse Practice Act-despite the fact she holds a Wisconsin license. "It does not matter what compact state they come from, nurses are held to the laws of the state in which they are giving care," states Katherine Hefley, RN, vice president of Nationwide Nurses Travel Professionals, based out of Marble Falls, Arkansas. "And that applies to both travelers and permanent staff."

Benefits of NLC membership

By the year 2000-three years after NLC's inception-legislators were convinced of its benefits. Registered nurses (RNs) and licensed practical and/or vocational nurses (LPN/LVNs) were crossing state lines ready to work without having to undergo a brand-new licensing procedure. Hospitals were immediately expanding their available talent pools with fewer, if any, bureaucratic impediments. Administrators who urgently needed to fill vacancies enjoyed a broader area from which to pull clinicians-and no longer had to rely solely on those already qualified to provide care in their states.

For mobile practitioners, especially those assigned nationwide, the compact means huge savings in time and money. "I know travelers who have as many as 15 licenses-and the cost to keep them current can range in the thousands of dollars, not to mention the fees associated with required continuing education (CE) offerings," notes Ms. Hefley. "To maintain their licenses and certifications, nurses may need up to 30 contact hours per year. Some clinicians choose only to work in compact states to avoid multiple licensure renewal and CE fees."

Another perk of the compact-for institutions and professionals alike-is the speed at which nurses can begin to practice. Historically, there was not-and still is not-much conformity between states in terms of procedural details. One Board of Nursing might take a week or two to issue a license, while another could mandate a mountain of paperwork and require two months to process. "In the latter case," states Tracy Marston, a recruiter for Professional Nursing Service in South Jordan, Utah, "travelers' start dates could be delayed, which would leave both the nurses and facilities at a standstill-with neither of their needs being met." Industry experts recommend mobile providers interested in working in states with lengthy application processes and those individuals new to the lifestyle build in a scheduling buffer that would allow for any unforeseen delays so they can still begin their assignments on time.

"It is definitely beneficial to have nurses who are NLC-eligible and can start as soon as possible. When acute care facilities have immediate needs, we can service them more effectively if they are located in compact states," explains Ms. Marston. "Without the benefit of reciprocity, agencies would require more time to present qualified candidates who are prepared to practice." Conveys Ms. Hefley, "Our company markets to institutions in compact states first and offers nurses who meet NLC criteria the initial choice of contracts."