Nurse Licensure Compact Part 2 - Follow Up

Benefits for and Arguments Against the eNLC

In today's article, we're diving into the benefits of the eNLC (enhanced Nurse Licensure Compact) and the arguments some states present against the compact. For new readers, look at our 2023 Nurse Licensure Compact Updates: Ultimate Nurse's Guide. We provide a rundown of active member states and those with pending legislation or impending implementation. It's complex! We promised readers a review of the benefits states and territories gain when they join the eNLC and to look at the arguments some holdout states are presenting against joining the compact.

States Territories Not Members of eNLC

Before we dive into the benefits of the eNLC, let's do a rundown of the states who have not joined the compact:

• American Samoa - American Samoa is a U.S. territory classified as unorganized or unincorporated, meaning its residents are not considered U.S. citizens but U.S. nationals instead. The territory controls its immigration and is not part of the eNLC.
• California - California has previously had pending legislation to join the eNLC, and SB 1053 went so far as to the Senate Business, Professions and Economic Development Committee in the spring of 2020 where it ultimately lost to a vote. Despite broad support from a long list of established healthcare and nursing organizations, the California Nurses Association openly opposed the bill. 
• Connecticut - There is no current legislation for Connecticut to join the eNLC. However, in October 2022, the state "adopted the Interstate Medical Licensure Compact (IMLC) and the Psychology Interjurisdictional Compact (PSYPACT)." It remains to be seen if success with the compacts in other disciplines will lead to legislation attempts for nurses.
• District of Columbia - According to the District of Columbia's Board of Nursing, if they joined the eNLC, they would suffer significant financial loss because most of their licensees do not live within the district. As stated in one of their monthly publications, "D.C. would therefore lose licensure fees from 99% of our licensees if we join the Compact."
• Hawaii - There is no pending legislation for Hawaii to join. Nevertheless, a recent interview with the president of Hawaii's Nurses Association and Hawaii's public radio correspondent in September 2022 indicates that the organization would favor compact legislation, and discussions may be underway.
• Northern Mariana Islands - This U.S. territory is not part of the nurse compact, and there is no pending legislation. Currently, nurses can apply for licensure by endorsement to practice in the territory.
• Nevada - In February of 2021, a bill (AB 142) was introduced for the state to join but was defeated. Currently, there is no pending legislation for Nevada to join the eNLC. Nurses can apply for licensure in the form of an endorsement. 
• Oregon - The Oregon Nurses Association (ONA) opposes the eNLC. According to the ONA president, joining the compact "dramatically infringes on the state of Oregon's authority to enact and enforce standards essential for nurses to practice in our state." Nevertheless, the unprecedented backlog for the board in processing nursing applications may prompt the topic for consideration in the upcoming legislative session.

Arguments Against Joining the Nurse Compact

• The Economic Argument - All nurses know that fees are involved in obtaining and renewing their nursing licenses. There is significant concern from some parties that their own nursing board's revenue would be significantly impacted, such as expressed by the District of Columbia Board of Nursing. Currently, non-member states allow nurses from other states to practice by obtaining a state license by endorsement. If they joined the compact, they would lose the nursing by endorsement income they currently earn.
• The Training and Quality Standards Argument - Some state nursing organizations and government leaders have expressed concerns about the differences between training, continuing education, and quality standards of care among all the states. For example, not all states require continuing education hours for their licensed nurses.
• The Disciplinary Action Argument - Some states express concern over who has jurisdiction for disciplinary action in the case of a compact licensed nurse and when those laws differ between the licensing state and the state where the offense could occur. 

Benefits of the Enhanced Nurse Licensure Compact

• One of the most widely known benefits of the eNLC is that it streamlines the process for nurses licensed in one state to work across state lines to other member states. This becomes extremely important in crises, as we saw with the COVID pandemic. It also eases the process for travel nurses and military spouses (often needing to move across state lines).
• It further opens the doors for opportunities in telehealth. A compact licensed nurse in one member state can practice telehealth on patients in other member states.
• Nurses can save money and mental energy. Instead of paying for licensure in each state, you want to practice and keep detailed spreadsheets on requirements and important licensing dates for each license. One nursing license is all you need.
• Increases access to care for millions of Americans. The nursing shortage is a real crisis in some geographic areas. By allowing the mobility of nurses either by physical location or digital practice (telehealth), the nurse licensure compact allows greater access to healthcare for Americans.

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