All 50 states use the same licensing exam for nurses. Nurses can apply in the state where they live or intend to work. Traditionally, nurses need to hold a license for each state in which they practice through an endorsement process. Streamlining the process for nurses to practice through a multi-state compact license is critical to meet the needs of our evolving, increasingly complex healthcare system.
What Is the eNLC?
The eNLC (enhanced Nursing Licensure Compact), according to Nurse.org, is "an agreement between states that allows nurses to have one license but the ability to practice in other states that are part of the agreement." It allows nurses to have one multistate license with the ability to practice in their home state and other compact states. All nurses applying for an eNLC multistate license must meet the same standards, which include a federal and state criminal background check.
Why Is the eNLC important?
There are many instances in which the eNLC has been beneficial for nurses, patients and healthcare systems. These include natural disasters, attempts to relieve the nursing shortage, telehealth and practice in border areas.
Natural Disasters: When natural disasters strike, nurses are often among the first responders to provide relief. As natural disasters grow more frequent and more severe, the importance of nurses' ability to practice across state lines becomes more and more apparent.
Nursing Shortage: As the Baby Boomer population ages and older nurses retire, we expect to see the nursing shortage continue. Rural areas are hit harder than most, and some rural facilities already rely on travel nurses to fill the gaps. The eNLC can help fill this nursing shortage and help nurses respond quickly to patient needs without the red tape.
Telehealth: Telehealth nursing is the use of technology to conduct nursing care over long distances, even across state lines. Telehealth sessions can be anywhere — patients' homes, prisons or clinics. Nurses can monitor a patient's oxygen levels, heart rate and rhythm, blood glucose, and more. For example, nurses working for a third-party-payer (insurance company) can call and offer counseling or wellness nurse visits over the phone. Another example involves pharmaceutical companies employing nurse educators who may cover more than one state or nurses who work at a call center to provide support and customer service to patients receiving complex oncology drugs.
Border Areas: Some nurses may live and work in an area that is on the border of more than one state. As healthcare systems expand, they may have multiple locations in more than one state, or a nurse may choose to work for different systems in different states. For example, nurses living in Kansas City may choose to practice in Missouri and Kansas. The eNLC helps ease the process, meaning nurses do not have to maintain individual state licensure.
What States Participate in eNLC?
As of 2018, 29 states are participants in the eNLC program. Nurses who hold an eNLC are able to practice across state lines and respond to the needs of patients, wherever the patient may live. Obviously, not all states participate in the eNLC. These are mainly states on the west coast and upper east coast.
Nurses who hold a multi-state license and are living in one of the original participating states were "grandfathered" into the eNLC program. For nurses living in Florida, Georgia, Oklahoma, West Virginia and Wyoming, the process is as simple as completing the eNLC application on the respective state board of nursing website. You must claim residency in an eNLC state to apply for a compact license. If you live in a non-compact state, you can hold multiple single-state licenses.
How Do Nurses Upgrade to eNLC?
Nurses living in a state that does not participate in the eNLC program can petition their state government to enact legislation to recognize the eNLC. Some states already have legislation in process, so communicating with your elected officials is important. You can sign up to Nursys for real-time notifications.
How Can a BSN help?
Although the eNLC is applicable for all RNs, some employers require a BSN when hiring nurses. Some states like New York require RNs to achieve a BSN within 10 years of receiving their initial license. In the Future of Nursing report, the National Academy of Medicine (formerly known as the Institute of Medicine) recommended that the nursing profession increase the percentage of nurses with a BSN to 80% by 2020. Additionally, the American Association of Colleges of Nursing (AACN) strongly believes that the BSN should become the minimum educational requirement for registered nurses.
Learn more about Austin Peay State University's online RN to BSN program.
Sources:Institute of Medicine: The Future of Nursing - Leading Change, Advancing Health
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