Multistate Licensing:
Makes Telephone Triage Easier for Nurses

By Mike Wilson, J.D.

Spring, 2004

One of the most common uses of telenursing is telephone triage with centralized phone banks.  However, telephone triage by a nurse can run afoul of licensing laws when calls are taken from states in which the nurse is not licensed to practice.

Licensing of professionals historically has been a state matter.  Recent technological advances make it easy for professionals to provide services in other states via the phone or Internet.  Nurses, under the leadership of the National Counsel of State Boards of Nursing (NCSBN), are ahead of other medical professions in addressing the legalities of multistate practice with the Nursing Licensure Compact (NLC), approved by the NCSBN in 1998.  Because regulation of nurses is a state matter, the decision to join the NLC must be addressed legislatively on a state-by-state basis.

According to the NSCBN, the Nursing Licensure Compact has been adopted and implemented in the following states: Arizona, Arkansas, Delaware, Idaho, Iowa, Maine, Mississippi, Nebraska, New Mexico, North Carolina, North Dakota, South Dakota, Tennessee, Texas, Utah, and Wisconsin.  States in which the Compact has been adopted but is not yet fully implemented include Indiana, New Jersey, and Virginia.

The Compact allows for mutual recognition of state licensure among states that have adopted the Compact.  A nurse who obtains a multi-state license in the state of his or her residence may practice in other states that belong to the compact.  Individual states still establish their own rules and regulations related to licensure, practice, and disciplinary action while adopting their own administrative rules to implement the Compact.  However, employers verify licensure through the state where the license is issued.

The multi-state license dispenses with the need to obtain a separate license in states that belong to the Compact.  Nurses in compact states need not apply for multi-state licensing, but doing so has become popular.  A survey by NSCBN found that 86% of nurses in Compact states have multi-state privileges.  Employers report it is less cumbersome to hire nurses from a NLC state because there is no time wait for licensure.  Nurses report that multi-state licensing saves them time, money, and trouble.  Benefits of NLC cited by the Nurse Licensure Compact Administrators include the growing need for nursing practice to occur across state lines and the technologies nurses use that may cross state lines.

Even with a multi-state license, nurses still must obey the laws and rules of any state in which they practice.  Also, each state still carries out disciplinary proceedings with reference to nursing practice in that state, whether the nurse involved is a resident or is a non-resident practicing under a multi-state license.  A survey by NSCBN found that nearly 40% of employers of nurses say they do not understand the disciplinary proceedings under the NLC.  Basically, only the nurse's home state that issued the multi-state license can take action against that license.  However, other states in which the nurse practices but does not reside can take action against the nurse's privilege to practice in that state.  As multi-state licensing is adopted by more states and nurses sign up for multi-state privileges, licensing concerns that arise in nurse triage by telephone should diminish. 

Mike Wilson is an attorney and author.  He teaches at Sullivan University in Lexington, KY.