The Enhanced Nurse Licensure Compact

The Enhanced Nurse Licensure Compact (eNLC) represents a significant advancement in the field of nursing licensure in the United States, providing increased mobility for nurses and addressing the growing need for nursing services across state lines. Instituted to replace the original Nurse Licensure Compact (NLC), the eNLC allows Registered Nurses (RNs) and Licensed Practical/Vocational Nurses (LPN/VNs) to hold one multistate license with the privilege to practice in their home state and other eNLC member states. This compact not only simplifies the process of working in different states but also plays a critical role in improving access to healthcare, especially in underserved areas. This article explores the origins, benefits, implications, and challenges of the eNLC, shedding light on its importance in today’s healthcare landscape.

The original NLC, established in 2000, was developed by the National Council of State Boards of Nursing (NCSBN) to facilitate the cross-border practice of nursing, recognizing the increasingly mobile nature of healthcare services and the integrated nature of the healthcare system in the United States. However, as healthcare delivery evolved and the demand for a more robust regulatory framework increased, it became clear that updates were necessary to enhance public protection and address the complexities of modern healthcare provision. Thus, the eNLC was introduced and implemented in 2018 with additional provisions to strengthen the requirements for obtaining a multistate license.

One of the primary enhancements in the eNLC is the uniform set of licensing requirements. These include stricter background checks, which encompass state and federal fingerprint-based criminal background checks. Additionally, the eNLC mandates that applicants for a multistate license meet uniform licensure requirements (ULRs), which include criteria such as meeting the home state’s qualifications for licensure, having graduated from a board-approved education program, and passing an English proficiency exam if the nursing program was not in English, among others. These standardized requirements ensure that all nurses practicing under the eNLC meet a consistent and rigorous standard of professional qualification, thereby enhancing trust and safety across state lines.

The benefits of the eNLC to the nursing profession and healthcare delivery are manifold. For nurses, the compact significantly reduces the barriers to practice in multiple states. This is particularly advantageous for those who live near state borders, travel nurses, telehealth nurses, and those responding to regional healthcare emergencies, such as natural disasters or pandemics. By simplifying the licensure process, the eNLC allows nurses to respond more quickly and flexibly to areas in need of nursing services, thereby improving the overall responsiveness of the healthcare system to patient needs.

For healthcare employers, the eNLC facilitates the hiring process by expanding the pool of potential job candidates who are already licensed to practice in multiple states. This is especially beneficial for healthcare systems that operate in several compact states and for rural and underserved areas that often struggle to attract and retain healthcare professionals. The eNLC also supports the growing sector of telehealth, allowing nurses to provide services to patients across multiple states without the need for additional licenses.

However, the eNLC also presents challenges and considerations that need to be addressed. One concern is the variability in nurse practice acts and standards among states. While the eNLC standardizes licensure requirements, practice laws and regulations can still vary significantly from one state to another, potentially leading to confusion among nurses about compliance and scope of practice issues. Nurses must be knowledgeable about the local laws and regulations of each state in which they practice, which can be a daunting requirement for those who work across multiple states.

Furthermore, not all states are members of the eNLC. As of now, while a majority of states have adopted the eNLC, there are still several that have not, limiting the geographic mobility of nurses who are licensed in those states and potentially fragmenting the healthcare labor market. Efforts continue to encourage all states to participate in the compact to truly nationalize nursing licensure mobility.

The Enhanced Nurse Licensure Compact has made significant strides in modernizing nursing licensure in the United States. By allowing for greater mobility among nurses and simplifying the licensure process across state lines, the eNLC plays a critical role in enhancing healthcare delivery and access, especially in regions most in need. Despite the challenges it poses, the eNLC represents a forward-thinking approach to healthcare regulation, promoting a more integrated and responsive healthcare system. As healthcare continues to evolve, further enhancements and widespread adoption of the compact will be essential to meeting the needs of the population and the health professionals who serve them.