What an Interstate Nursing License Compact Actually Transfers

Answer first: the privilege moves, the rulebook does not

Virginia's enactment of the Nurse Licensure Compact defines the arrangement in two linked terms. A multistate license means a license to practice as a registered nurse or a licensed practical or vocational nurse issued by a home state licensing board that authorizes the licensed nurse to practice in all party states under a multistate licensure privilege. A multistate licensure privilege means a legal authorization associated with a multistate license permitting the practice of nursing as a registered nurse or a licensed practical or vocational nurse in a remote state.

Home state means the party state which is the nurse's primary state of residence. Remote state means a party state other than the home state. Party state means any state that has adopted the compact.

So one license, issued where the nurse lives, carries an authorization to practice in the other adopting states. What it does not carry is the law.

Code of Virginia section 54.1-3040.3 states it directly. A nurse practicing in a party state must comply with the state practice laws of the state in which the client is located at the time service is provided. The practice of nursing is not limited to patient care, but shall include all nursing practice as defined by the state practice laws of the party state in which the client is located.

And it states the jurisdictional consequence. The practice of nursing in a party state under a multistate licensure privilege will subject a nurse to the jurisdiction of the licensing board, the courts, and the laws of the party state in which the client is located at the time service is provided.

The compact's own definition explains what a state practice law is for that purpose: a party state's laws, rules, and regulations that govern the practice of nursing, define the scope of nursing practice, and create the methods and grounds for imposing discipline. The definition then excludes requirements necessary to obtain and retain a license, except for the qualifications or requirements of the home state.

What a multistate license requires before it is issued

Section 54.1-3040.3 lists what a party state shall require of an applicant to obtain or retain a multistate license in the home state, and the list is longer than a single examination.

The applicant meets the home state's qualifications for licensure or renewal of licensure, as well as all other applicable state laws. The applicant has graduated or is eligible to graduate from a licensing board-approved prelicensure education program, or has graduated from a foreign prelicensure education program approved by the authorized accrediting body in that country and verified by an independent credentials review agency as comparable to a board-approved program.

A graduate of a foreign program not taught in English, or an applicant whose native language is not English, must have successfully passed an English proficiency examination that includes the components of reading, speaking, writing, and listening.

The applicant has successfully passed the applicable national licensure examination or a recognized predecessor, is eligible for or holds an active, unencumbered license, and has submitted fingerprints or other biometric data for the purpose of obtaining criminal history record information from the Federal Bureau of Investigation and from the agency responsible for retaining that state's criminal records.

Then three disqualifiers and one disclosure duty. The applicant has not been convicted or found guilty, and has not entered into an agreed disposition, of a felony offense under applicable state or federal criminal law. The applicant has not been convicted or found guilty, and has not entered into an agreed disposition, of a misdemeanor offense related to the practice of nursing, as determined on a case-by-case basis. The applicant is not currently enrolled in an alternative program, defined in the compact as a nondisciplinary monitoring program approved by a licensing board. And the applicant is subject to self-disclosure requirements regarding current participation in an alternative program.

The list closes with a requirement that is easy to overlook: the applicant has a valid United States social security number.

The compact also requires each state to implement procedures for considering the criminal history records of applicants for an initial multistate license or licensure by endorsement, including the submission of fingerprints or other biometric-based information.

How adverse action works across state lines

The compact's enforcement architecture is where the practical consequence of a multistate license shows up, and it runs in both directions.

Adverse action is defined broadly. It means any administrative, civil, equitable or criminal action permitted by a state's laws which is imposed by a licensing board or other authority against a nurse, including actions against an individual's license or multistate licensure privilege such as revocation, suspension, probation, monitoring of the licensee, limitation on the licensee's practice, or any other encumbrance on licensure affecting a nurse's authorization to practice. Encumbrance is separately defined as a revocation or suspension of, or any limitation on, the full and unrestricted practice of nursing imposed by a licensing board.

Section 54.1-3040.3 provides that all party states shall be authorized, in accordance with existing state due process law, to take adverse action against a nurse's multistate licensure privilege — revocation, suspension, probation, or any other action affecting the authorization to practice under the privilege, including cease and desist actions. A party state taking such action shall promptly notify the administrator of the coordinated licensure information system, which shall promptly notify the home state.

Section 54.1-3040.5 divides the powers. Only the home state shall have the power to take adverse action against a nurse's license issued by the home state. But for purposes of taking adverse action, the home state licensing board shall give the same priority and effect to reported conduct received from a remote state as it would if such conduct had occurred within the home state, applying its own state laws to determine appropriate action. A licensing board may also take adverse action based on the factual findings of the remote state, provided it follows its own procedures for doing so.

The switch-off provision is the one that matters most. If adverse action is taken by the home state against a nurse's multistate license, the nurse's multistate licensure privilege to practice in all other party states shall be deactivated until all encumbrances have been removed from the multistate license. All home state disciplinary orders imposing adverse action against a multistate license shall include a statement that the privilege is deactivated in all party states during the pendency of the order.

The section also lets a board issue cease and desist orders or impose an encumbrance on a nurse's authority to practice within that party state, complete any pending investigation of a nurse who changes primary state of residence during the investigation and report the conclusions to the coordinated licensure information system administrator, issue subpoenas for hearings and investigations enforceable in another party state by a court of competent jurisdiction, obtain and submit biometric information for Federal Bureau of Investigation criminal background checks and use the results in licensure decisions, and — if otherwise permitted by state law — recover from the affected nurse the costs of investigations and disposition of cases resulting from adverse action.

One carve-out preserves state discretion about monitoring rather than punishment. Nothing in the compact shall override a party state's decision that participation in an alternative program may be used in lieu of adverse action, and the home state licensing board shall deactivate the multistate licensure privilege for the duration of the nurse's participation in an alternative program.

What the compact does not do

Several provisions exist specifically to prevent the arrangement from being read as broader than it is.

Individuals not residing in a party state shall continue to be able to apply for a party state's single-state license as provided under the laws of each party state. A single-state license is defined as a nurse license issued by a party state that authorizes practice only within the issuing state and does not include a multistate licensure privilege to practice in any other party state. And the compact states plainly that such a single-state license will not be recognized as granting the privilege to practice nursing in any other party state.

Nothing in the compact shall affect the requirements established by a party state for the issuance of a single-state license.

The compact also addresses what happens when a nurse moves. A nurse holding a home state multistate license on the compact's effective date may retain and renew it, but a nurse who changes primary state of residence after that date must meet all the applicable multistate qualifications to obtain a multistate license from the new home state. And a nurse who fails to satisfy those requirements due to a disqualifying event occurring after the effective date shall be ineligible to retain or renew a multistate license, which shall be revoked or deactivated in accordance with the rules adopted by the compact's commission of administrators.

The compact's information plumbing is a defined term rather than an assumption. Coordinated licensure information system means an integrated process for collecting, storing, and sharing information on nurse licensure and enforcement activities related to nurse licensure laws, administered by a nonprofit organization composed of and controlled by licensing boards.

Three limits on what this file establishes. It quotes Virginia's enacted text of a model compact; it does not identify which other states have adopted it or list party states. Nursing is not the only profession for which Virginia's code lists a licensure compact — the chapter listing for physician assistants includes a separate PA Licensure Compact section, whose text is not quoted here. And a compact of this kind governs nursing licensure; it says nothing about the separate licenses a pharmacy, a wholesaler or a medical practice must hold, which are covered elsewhere in this corpus.

How to read a claim that a clinician is licensed in many states

Three questions follow directly from the text, and each has a determinate answer in the statute.

Which state's rules is the clinician actually following? Under section 54.1-3040.3, the practice laws of the state where the client is located at the time service is provided — including that state's definition of the scope of nursing practice and its methods and grounds for discipline.

Whose board could act? Under the same section, the nurse practicing under the privilege is subject to the jurisdiction of the licensing board, the courts, and the laws of the party state where the client is located. Under section 54.1-3040.5, only the home state may act against the home state license, but any party state may act against the privilege within its own borders, and the home state must give reported conduct from a remote state the same priority and effect as if it had happened at home.

What is the effect of an action anywhere? If the home state encumbers the multistate license, the privilege is deactivated in all party states until the encumbrance is removed, and the order itself must say so.

The phrase licensed in all fifty states, when it appears on a marketing page, is therefore doing less work than it appears to. A multistate privilege is one route to practicing in more than one state, it exists only among adopting states, it is subject to the destination state's own practice laws, and it can be switched off everywhere by a single action at home.