The Nurse Licensure Compact, generally referred to as the NLC, allows a registered nurse or licensed practical nurse who holds a multistate license issued by a compact member state to practice in any other NLC member state without obtaining a separate license there. States that have not joined the compact continue to operate under the traditional single-state licensure model.
How multistate licensure works
A nurse who lives in an NLC member state and meets the compact's eligibility standards can typically apply for a multistate license through their home state's board of nursing. That license generally carries privileges to practice, in person or via telehealth, in all other current NLC member states, subject to each state's substantive practice laws and scope-of-practice rules, which still apply even though a separate license is not required.
What happens in non-compact states
In a state that has not joined the NLC, a nurse generally needs to obtain a full, separate license issued directly by that state's board of nursing in order to practice there, whether the care is delivered in person or remotely. This typically means going through that state's standard application process, including its own verification, fee, and renewal requirements, independent of any multistate license the nurse may already hold elsewhere.
A multistate NLC license extends practice privileges across compact states — it simply does not exist for states that never joined the compact.
Why this matters for telehealth nursing
For nurses delivering care across state lines through telehealth, the practical effect of NLC status is significant. A single multistate license can generally support telehealth encounters with patients located throughout the compact's member states, while any patient located in a non-compact state typically requires the nurse to hold a separate license issued by that state. Because compact membership has grown over time and can continue to change, nurses building a multistate telehealth practice generally need to periodically recheck which states currently participate.
Given the mix of compact and non-compact states, and the fact that a state's status can shift, nurses generally find it useful to confirm current NLC participation directly before assuming multistate privileges apply. Requirements vary by state and change over time — always confirm current requirements directly with the relevant state board or agency before making a compliance decision.