LIMA — Effective Jan. 1, Ohio will become the 38th state to implement a multistate license for nurses. The term, “multistate license” (MSL) is used interchangeably with enhanced nurse compact license (eNLC) or simply, “compact license” to refer to licensure that permits a nurse to have one license with the ability to practice nursing in all NLC compact states. With an MSL, a nurse is able to practice within any state that participates in the eNLC compact without having to obtain a traditional license for that state.
Ohio joined the Nurse Licensure Compact (NLC) in July 2021. Each state must agree with the compact requirements when joining the consortium. By joining the NLC, Ohio nurses become part of a group of two million nurses practicing in compact states. The state of Pennsylvania enacted the MSL at the same time as Ohio but it has yet to establish an implementation date. Guam also has pending implementation for the MSL.
“COVID kick-started the implementation of the compact due to the need for nurse mobility,” according to Tammy Segovia, Rhodes State College RN Administrator. “We need to have increased portability in nursing.”
Nurses who believe they do not need a multistate license (MSL) can maintain their single-state license. There is no requirement to apply for and acquire an MSL. In addition, if a nurse cannot declare a compact state as his or her primary state of residence, that nurse is not eligible for a compact license. Primary state of residence is based on where the nurse pays federal income tax, votes or holds a driver’s license. The nurse has the privilege of practicing in any remote compact state with the multistate license issued by the home state.
Preparing for the MSL
The mission of the Ohio Board of Nursing (OBN) is to actively safeguard the health of the public through the effective regulation of nursing care. All applicants for an MSL will need current BCI and FBI criminal record checks before a new MSL license or MSL conversion can take place.
“[Patients] are just as protected in every state,” Segovia said.
According to the Ohio Board of Nursing website, to prepare for an MSL, the nurse must meet the following requirements:
• Meet Ohio licensure requirements
• Graduate from a Board-approved RN or LPN program or LPN pre-licensure program
• Pass the National Council Licensure Examination (NCLEX)
• Hold an active, unencumbered license
• Submit a state and federal fingerprint-based criminal background check
• Have no convictions or disciplinary action regarding felonies or misdemeanors related to nursing practice
• Not be a current participant in an alternative program
• Have a valid U.S. Social Security number.
Benefits of the MSL
According to Cory Werts, Chief Nursing Officer at Mercy Health-St. Rita’s Medical Center, this new licensure option is one that should appeal greatly to nurses.
“Nurses have wanted this for quite some time,” she said. “Nurses are mobile and look for new opportunities. Ohio is a great place to practice nursing, especially at places where the nurses feel supported. If a nurse is required to obtain a separate license to practice in another state, the nurse may not pursue employment in that state. This can impact nurses and hospitals that are located close to state borders.”
While the MSL does pose a potential risk of losing nurses to other states, Werts does not expect a mass exodus. She anticipates being able to recruit more nurses to the area. Werts also does not expect to see any immediate changes in the method of nurse recruiting at Mercy Health-St. Rita’s. The medical center attempts to recruit locally from the 10-county area it serves. Recruiting begins with high school students who are introduced to nursing through the Healthcare Futures Day led by Beth Keehn, Director of Government and Community Affairs.
Segovia identified several advantages of the MSL. One of the advantages is that nurses who travel or “snowbird” can practice where they are (provided they are in a compact state). With the MSL, nurses can be mobilized quickly to provide healthcare services during disasters and public health emergencies. Online nursing education can be facilitated with MSL because nurse educators can provide instruction to those in other states. When hiring a nurse to work in another (compact) state, there will no longer be a delay while the nurse seeks a new license in that state. Nurses can have more immediate access to jobs.
Disadvantages of the MSL
Some possible disadvantages of the MSL include the cost of background and fingerprinting, the cost of the MSL (which has not yet been published) and possible loss of nurses to other states.
“I don’t see that [loss of nurses] as an issue [that we will experience in Ohio],” Segovia said.
Another con of the eNLC is that it is not recognized by every state. The state the nurse is currently licensed in must become a member of the compact before recognizing licenses from other compact states. If a nurse is currently licensed in a state that is not a member of the compact, then the nurse’s license will not be recognized by the compact.
Another disadvantage of the eNLC is that only an enhanced compact license is eligible for automatic recognition by other states within the compact. Traditional licenses from the state are not part of the agreement. One of the biggest cons of the enhanced nurse licensure compact is that the nurse is still required to abide by each state’s regulations and requirements.
In Ohio, Registered Nurses (RNs) renew their licenses every two years on the odd year. Licenses must be renewed by October 31st on the renewal year. Licensed Practical Nurses (LPNs) renew their licenses every two years on the even years. After January 1, 2023, RNs can begin the process to apply for an MSL. If a nurse moves between a compact and a non-compact state, the nurse must contact the Board of Nursing in the states in which the nurse has relocated. If a nurse moves to a non-compact state, such as California, the nurse is not eligible for an MSL while residing in that (non-compact) state.
Those nurses serving in the military and nurse spouses of military personnel need to check with the Board of Nursing in their state of residency for specific requirements related to their nursing practice.
Many telehealth jobs will require a nurse to hold an enhanced nurse compact license to be considered for a position. The eNCL allows for telehealth practice across state borders.