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Enhanced Nurse Licensure Compact Implemented in 29 States

On January 19, 2018, the enhanced Nurse Licensure Compact (eNLC) was implemented in all 29 participating states including Colorado, West Virginia and Kentucky. Illinois[1] and Michigan[2]are among the states with current legislation pending to adopt the eNLC, while Indiana, Ohio, Pennsylvania, California and a handful of other states do not yet have pending legislation.

The eNLC allows a nurse practicing in a state that has adopted the compact to practice in other eNLC states without obtaining an additional license.  While the eNLC became effective July 20, 2017, the Interstate Commission of Nurse Licensure Compact Administrators (the Commission) may now begin issuing multistate licenses and those holding multistate licenses may now start to practice in states that have enacted the eNLC.  The eNLC final rules were adopted December 12, 2017, and became effective January 19, 2018.  The rules require each state licensing body must submit data to the Coordinated Licensure Information System and query this database before issuing new multistate licenses, and also sets procedures for transitioning licenses, lists requirements for application forms, and stipulates other administrative duties.[3]

The Nurse Licensure Compact (NLC) was the predecessor to the eNLC, which 25 states had adopted, including Kentucky.  These original states, except for Rhode Island, transitioned to the eNLC as of the implementation date.  Five new states, including West Virginia, passed legislation adopting the eNLC, bringing the total number of eNLC participating states to 29.  Border states of either or both Kentucky and West Virginia that have adopted the eNLC include Virginia, Tennessee, Maryland and Missouri.  All of Colorado’s border states with the exception of Kansas (which has legislation pending)[4] have implemented the eNLC.

The primary goal of the eNLC is to make it easier for nurses to practice across state lines, including through telenursing.  A nurse living in Virginia and holding a multistate license issued by Virginia may be employed by an entity located in West Virginia and may provide nursing services in person or via telehealth to a patient in West Virginia.  It also may allow nurses to teach via distance education if both physically located and teaching remotely in eNLC states.

The eNLC enacted higher standards than the NLC by requiring federal and state fingerprint-based criminal background checks, placing restrictions on holding a multistate license if a nurse is convicted of a felony, and establishing 11 uniform licensure standards.[5]  Many of these requirements will be familiar to nurses, such as graduating from a board-approved education program and passing the NCLEX-RN® or other exam.  However, others, such as not being enrolled in an alternative program and the criminal background standards, may be more stringent criteria than most have been subject to previously.  Nurses who do not meet these heightened standards may still eligible for a single state license.

For those who held a multistate license under the NLC, no additional action needs to be taken to transition a license to comply with the eNLC.  In those five states that have just adopted the eNLC, nurses may transition their single state license to a multistate license and all state licensing bodies are currently accepting applications.  Importantly, the eNLC affects registered nurses and licensed practical nurses only, and does not apply to advanced practice nurses (APRNs).  There is a separate compact for APRNs called the Advanced Practice Registered Nurse Compact.


[1] S.B. 0677, 100th General Assemb. (Ill. 2017).

[2] H.B. 4938 (Mich. 2017).

[3] eNLC Rules, National Council of State Boards of Nursing, https://www.ncsbn.org/enlcrules.htm (last visited Feb 15, 2018).

[4] H.B. 3496 (Kan. 2018).

[5] National Council of State Boards of Nursing, Uniform Licensure Requirements for a Multistate License, , https://www.ncsbn.org/eNLC-ULRs_082917.pdf.

© 2018 Dinsmore & Shohl LLP. All rights reserved.

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About this Author

Jennifer Mitchell, health care practice group partner, Dinsmore Shohl, law firm,
Partner

Jennifer is a Partner in the Health Care Practice Group and leads the firm’s HIPAA Privacy and Security practice and initiatives. In her HIPAA practice, she works with clients to minimize the risk of privacy and data security issues, assisting with all aspects of HIPAA privacy and security compliance, governance, audits/investigations, breach analyses, training and strategic planning. She has a thorough understanding of federal and state privacy and confidentiality laws and has served as a health care privacy expert witness. 

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