Multistate Nursing Licensure

The Issue

Current health care practices such as electronic / telephonic services and case management, along with an increasingly mobile US population, frequently require nurses to provide care and services to patients living in states other than their primary state of residence. A nurses’ primary state of residence regulates the nurses’ primary nursing license.

Nurse Case Managers providing nursing care and services in a state in which they are not licensed poses serious risk to the nurses’ license and to their employers.


The Impact

  • Practicing without an active, valid nursing license in the state of practice (ie, the state the patient is located in at the time service is provided or practice occurs) is against the law
  • Excessive costs and time are required to obtain and maintain nursing licenses in multiple states
  • Malpractice carriers will not cover legal actions or judgments that occur in states in which the nurse does not hold an active, valid nursing license.** Many Nurse Case Managers are working outside the scope of their nursing license

Not all healthcare organizations that employ nurses to work across state lines acknowledge this issue. Many organizations do not financially support obtaining multiple state nursing licenses. The inability to obtain malpractice coverage leaves nurses personally liable for legal action or judgments that occur in states in which they do not hold an active, valid nursing license.


The Solution

In 1999 the National Councils State Boards of Nursing (NCSBN) developed the Nurse Licensure Compact, a mutual recognition compact. This interstate Compact allows all states within the Nurse Licensure Compact (NLC) to mutually recognize the nursing licenses of nurses who have a primary residence in a Compact state. The legal right to practice in all other Compact states provides nursing license protection when nursing practice occurs across state lines. As of June, 2011, twenty four (24) states participate in the NLC, with active legislation in five (5) other states.


The Goal

To clarify its position, CMSA has released an official statement on this important issue:

Read CMSA's Position Statement on Multistate Nursing Licensure

The goal of the CMSA position statement is to encourage and support state by state adoption of the Nurse License Compact (NLC) in all non-Compact states and US territories.

Read more about the ongoing issue at the website for the National Council for State Board of Nursing (NCSBN).


Additional Resources

CMSA has assembled the following resources to help case managers, consumers and policy makers better understand the issue of multi-state licensure, and the benefit the Nurse Compact Licensure (NLC) provides. The resource section includes relevant documents and links to pages regarding the multistate licensure issue and the NLC.

CMSA Position Resources

CMSA Position Statement

Template Letters

Template Letter to Legislators
Template Letter for Your Support of the Nurse Licensure Compact

Links to Related Resources

National Council for State Board of Nursing (NCSBN)
State Nursing Associations
State Boards of Nursing

MSL Compact Map

View the MSL Compact Map on the website for the National Council for State Board of Nursing at


MSL Compact States