Issue: May 2022
Disclosures: Schrag reports no relevant financial disclosures.
May 18, 2022
2 min read

Compact acts expand flexibility in nursing licensure across state lines

Issue: May 2022
Disclosures: Schrag reports no relevant financial disclosures.
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Modern health care delivery requires nursing care that is dynamic and fluid across state boundaries. The current 100-year-old model of nurse licensure is not flexible or adaptable enough to meet those needs.

The Nurse Licensure Compact (NLC) is an ideal solution for those who need dialysis and for dialysis providers who need to staff their facilities with experienced dialysis nurses in emergency situations or times of staffing shortages. In operation for more than 18 years and now approved by 39 states and U.S. territories with more pending, nurses licensed in their NLC state of residence can practice in other NLC states without having to obtain additional licenses.

Ohio, Pennsylvania and the U.S. Virgin Islands are the most recent to enact the NLC and are working on implementation.

Wendy Schrag

CMS has strict requirements for registered nurses in the dialysis setting, requiring only nurses with dialysis experience to fill in during times of shortages, natural disasters or other times when providing nursing care across state boundaries may be necessary.


During the COVID-19 pandemic, the issue of access to care became particularly acute. When COVID-19 surges occurred, the ability to bring in qualified out-of-state nurses was critical for dialysis facilities and hospitals to provide life-sustaining treatments for patients.

An additional benefit is the ability to provide telehealth services to patients on dialysis. Nurses may provide these services for patients located in multiple states. Nurses providing telehealth are required to be licensed in the state where a patient resides. The NLC provides an avenue for nurses to provide telehealth without obtaining multiple licenses, which can be costly.

Finally, more patients are dialyzing independently at home. A compact license allows nurses to continue to provide services if a patient travels out of state and needs nursing advice while dialyzing in a different state.

Licensure requirements

All the safeguards built into the current state licensing process are required before a nurse is issued a multistate license. The NLC has uniform licensure requirements, so all states can be confident that nurses practicing within the NLC have met a set of minimum requirements, regardless of the home state in which they are licensed.

With a goal of all states and U.S. territories being part of the NLC, more are joining every year.

For more information on the status of the NLCs across the United States, visit the National Council of State Boards of Nursing at A “Take Action” page on the website provides information on how nurses can contact state legislators to sponsor legislation supporting an NLC.