In today's increasingly mobile society, and given the constant need for licensed nurses, there's an increasing demand for nurses to be able to provide services across state lines without having to be separately licensed in every state where they are needed. The Enhanced Nursing Licensure Compact (eNLC) is an agreement that allows nurses to provide care across state lines with a single, multistate license. The Enhanced Nursing Licensure Compact (eNLC) has transformed the nursing profession in the United States, making it easier for registered nurses and licensed practical/vocational nurses to practice across state lines. With the recent COVID-19 pandemic, the eNLC proved its value multiple times over as nurses could move freely to COVID "hotspots" in response to local surges, helping to ease the strain on hospital resources.
At the same time, if you're a practicing RN or LPN/LVN holding a multistate license under the eNLC, you can also be more vulnerable to allegations of misconduct while practicing in different states. A complaint lodged in any state where you've practiced could potentially result in disciplinary action, both from that state and the state where your license originates. Not only could you lose your multistate privileges, but in certain cases, you could even lose your license to practice nursing altogether. The challenge with defending multistate licenses is finding a license defense attorney who is licensed in the specific state(s) where you're facing disciplinary action. And that's where the Lento Law Firm can help.
Attorney Joseph D. Lento and his experienced Professional License Defense Team have a nationwide reach and many years of experience defending licensed professionals in every state in the Union. They understand not only the parameters and disciplinary requirements of the eNLC, but they also know the disciplinary processes of nursing boards nationwide. If your nursing license is under fire, the Lento Law Firm can greatly improve your chances of keeping your license and protecting your career. Contact us at 888-535-3686 to discuss your case.
A Brief History of the eNLC
The original Nursing Licensure Compact (NLC) was devised by the National Council of State Boards of Nursing (NCSBN) in an attempt to create more uniform licensing and allow for more mobility of nurses within their profession. The NLC first went into effect in 2000 when the first four states adopted it. However, the NLC lacked uniformity and consistent requirements, leading to discrepancies in licensing standards between states, and many states were reluctant to join the compact due to these concerns. In 2017, the Enhanced Nursing Licensure Compact (eNLC) successfully addressed the shortcomings of the original NLC by implementing uniform licensure requirements and a coordinated system for sharing information between states. This allows for better tracking and regulation of nursing professionals across participating states.
How the eNLC Works
To be clear, there is no such thing as an "eNLC license." Rather, each state participating in the eNLC offers a multistate license (typically in addition to their standard state licensure), which is also sometimes called a "compact" license. To obtain a multistate nursing license under the eNLC, nurses must meet specific uniform licensure requirements (ULRs). These ULRs encompass a range of qualifications, including holding an active, unencumbered license in their home state, submitting to a federal and state criminal background check, and meeting continuing education requirements. Once a nurse obtains a multistate license in their Primary State of Residence (PSOR), they can practice in any eNLC member state without having to apply for a separate license.
Can I Hold a Multistate License if My State Doesn't Participate in the eNLC?
No. For accountability purposes, your PSOR must participate in the eNLC for you to apply for a compact license. However, you can apply for individual licensure in any other state you choose.
If I Live in a Non-Compact State, Can I Apply for a Multistate License in a Participating State?
No, multistate licenses are only issued for nurses who declare residency in that state. However, if your state doesn't participate in the eNLC, you can apply for a "license by endorsement" in a participating state, which is easier than going through a full licensure process within that state. The license by endorsement will only be valid in the specific compact state where you applied.
If I Move to a Non-Compact State, Can I Keep My Multistate License from My Original State?
No. You can retain your nurse's license in your original PSOR if you move to a non-participating state (you can hold as many individual nurse's licenses as you like), but if you change your residence to a non-compact state, you will lose your multistate privileges.
How Is the eNLC Governed?
The eNLC is overseen by a multi-faceted governmental structure consisting of three layers:
Interstate Commission of Nurse Licensure Compact Administrators (ICNLCA)
The ICNLCA consists of representatives from each member state. This body is responsible for overseeing the eNLC's operations, ensuring compliance with the compact's provisions, and addressing any disputes or issues that arise among member states.
National Council of State Boards of Nursing (NCSBN)
The NCSBN provides support and resources to the ICNLCA and its member states. It also develops and maintains the Nurse Licensure Compact (NLC) and eNLC Model Rules and Policies, which serve as the foundation for the Compact's implementation and operation.
The Individual Licensing Boards in Participating States
State Boards of Nursing play a critical role in implementing and enforcing the eNLC within their respective jurisdictions. These boards are responsible for:
- Issuing multistate licenses: State Boards of Nursing are tasked with evaluating applicants to ensure they meet the ULRs and issuing multistate licenses to eligible nurses.
- Monitoring compliance: State Boards of Nursing monitor licensee compliance with the ULRs and enforce disciplinary actions when necessary.
- Sharing information: Member states are required to share information about nurse licensure and disciplinary actions through Nursys®, a shared online database. This system enables state boards to efficiently exchange vital information, ensuring the protection of public health and safety.
- Collaborating with other member states: State Boards of Nursing collaborate with other eNLC member states to address issues related to the Compact, including dispute resolution and policy development.
Which States Participate in the eNLC?
As of the time of this writing, 39 states have enacted legislation approving the eNLC, with eight other states currently considering legislation. The territories of Guam and the Virgin Islands have also approved the eNLC and are moving toward implementation. The states currently participating in the eNLC (or in the process of implementing it) are:
- New Hampshire
- New Jersey
- New Mexico
- North Carolina
- North Dakota
- Pennsylvania (pending implementation)
- South Carolina
- South Dakota
- Washington (pending implementation)
- West Virginia
Advantages and Benefits of the eNLC
The implementation of the eNLC affords many benefits to nurses, healthcare facilities, and patients alike. These include, but are not limited to:
- More mobility for nurses. The eNLC enables nurses to practice in multiple states without the need for additional licensure. This flexibility lets them respond quickly to localized health crises, natural disasters, or temporary staffing shortages in other states, all without the burden of additional paperwork for licensure.
- More professional opportunities. If you are a practicing nurse with an eNLC multistate license, you can take advantage of a broader range of professional opportunities, including travel nursing positions, telehealth services, and temporary assignments in areas with nursing shortages.
- Larger talent pool for employers. The eNLC helps healthcare employers by allowing them to recruit from a larger pool of qualified nurses who hold multistate licenses. This expanded workforce also allows them to better address the demand for specialized nursing care and fill staffing gaps during times of crisis. (The COVID pandemic is a perfect recent example).
- Telehealth benefits. The eNLC has played a huge role in the expansion of telehealth services in the United States (another much-utilized resource during the pandemic). By allowing nurses to practice in multiple states under a single license, the eNLC also enables healthcare providers to offer telehealth services across state lines, increasing access to quality care for patients in underserved or remote areas.
- Patient access to specialized care. The eNLC allows patients in member states to receive care from highly skilled nurses who may not be available locally.
How Disciplinary Actions Can Endanger Your Multistate Nursing License
Just as allegations of misconduct or code violations can put your single-state nurse's license at risk, so can they also put your eNLC multistate license in jeopardy. This typically happens in one of two ways:
Disciplinary Action by the Board of Nursing in Your Home State (PSOR)
The validity of your multistate license depends on your original license remaining in good standing. If the BON in your primary state of residence receives a complaint and launches an investigation against you, any resulting disciplinary action could impact your compact license as well as your original license. Depending on the facts of your case and the Board's final decision, they could:
- Assess minor penalties (such as fines or reprimands) while allowing both your state and multistate license to remain in effect;
- Revoke your multistate privileges while allowing you to keep your home-state license; or
- Revoke your original license (which will also disqualify you from holding the multistate license).
Disciplinary Action by a Participating eNLC State
When you work as a nurse in another state, you are subject to the rules and regulations of the Nurses Practices Act in that state. If you are the subject of a complaint or are accused of wrongdoing while practicing in another eNLC state, that state's Board of Nursing has the authority to bring disciplinary action against you just as if were licensed in that state. The results could also cause you to lose your eNLC privileges...but that's just the start.
Under the eNLC, any participating state that brings you up for license discipline is required to share that information with all participating states via the Nursys® system. This means if your multistate privileges are revoked in one state, they will likely be revoked in all participating states. Furthermore, in reporting the offense to your PSOR, your own state Board of Nursing may also launch a separate disciplinary process against you, potentially putting your original license in jeopardy, as well!
What Types of Allegations Can Jeopardize My eNLC Multistate License?
The types of offenses that can endanger a nurse's license are fairly common among all states. Thus, any of the following allegations could potentially put your eNLC multistate privileges at risk:
- Patient abuse or neglect. If you're accused of physically, verbally, sexually, or mentally mistreating a patient, or if you fail to provide a patient with needed timely care, you could face disciplinary action against your multistate license.
- Fraud. Examples include falsifying patient records, "upcoding" insurance claims, or acting outside the scope of your license.
- Unprofessional conduct. This refers to a broad range of behaviors that are considered unacceptable in the healthcare setting. Examples include behaving inappropriately on the job or engaging in romantic/sexual relationships with colleagues, patients, or superiors.
- Mishandling/misuse of drugs. While nurses cannot prescribe medications, they are responsible for administering them to patients--so they are held to strict standards of excellence and accuracy as a result. Examples of mishandling drugs include diverting medications intended for patients, stealing medications for personal use or sale, inaccurate documentation of medications, or sending unauthorized prescriptions to pharmacies.
- Criminal convictions. Being convicted of certain crimes (e.g., theft, DUI, drug possession, or crimes of moral turpitude) can disqualify you from practicing as a nurse in many states. Most felony convictions will also likely result in the loss of your multistate license (and possibly your original license, as well).
Nationwide License Discipline Attorney for eNLC Disciplinary Cases
If you're accused of wrongdoing under a multistate nurse's license, your case may be more complex than standard disciplinary actions because you may be facing disciplinary action in multiple states. The stakes are also higher because having your eNLC practice privileges revoked can severely hinder your professional opportunities--even if you're allowed to keep your original license. For these reasons, you need a license defense attorney with experience in the disciplinary processes of all states involved.
The Lento Law Firm has experience representing nurses who are up against disciplinary action in multiple states. Attorney Joseph D. Lento and his License Defense Team understand the complex nuances of eNLC license defense and will work hard to protect both your multistate privileges and your original license. The sooner in the process you hire competent legal counsel, the better your chances of emerging unscathed from the disciplinary process. Contact the Lento Law Firm at 888-535-3686 or contact us using our online form.