In the ever-evolving landscape of advanced practice nursing, the demand for highly qualified and skilled healthcare providers continues to grow. Advanced Practice Registered Nurses (APRNs) play a crucial role in meeting this demand by providing a wide range of services across various healthcare settings. However, as healthcare needs expand, so do the challenges faced by APRNs in navigating the complexities of multistate licensure.

The current model of APRN licensure, while essential, can be rigid and cumbersome when it comes to practicing across state boundaries. The process of obtaining individual licenses in multiple states can be time-consuming, and costly, and hinder the timely deployment of healthcare professionals where they are most needed. These limitations highlight the need for a more flexible and streamlined approach to licensure, leading to the potential emergence of the APRN Compact.

What Is the APRN Compact?

Proposed in August 2020 and backed by the National Council of State Boards of Nursing (NCSBN), the APRN Compact is a progressive and forward-thinking solution designed to revolutionize the way APRNs practice across state lines. It poses a multistate licensure agreement that allows APRNs to obtain a single, unified license, granting them the freedom to practice in multiple states without the need for additional individual licenses. It’s important to note that at this point, the APRN Compact has not been officially enacted, but supporters are trying to get the proposal to gain traction in more states.

By breaking down barriers to practice, the APRN Compact aims to facilitate the mobility of APRNs, providing them with increased opportunities to contribute their expertise and skills to underserved areas and communities in need. As a result, patients in remote and rural regions can benefit from improved access to high-quality healthcare services, ultimately bridging the gap between healthcare supply and demand.

Benefits of the Proposed APRN Compact

According to supporters, the introduction of the APRN Compact presents a myriad of advantages that have the potential to transform the landscape of advanced practice nursing. One of the most significant benefits is the enhanced mobility and professional freedom it offers to APRNs. With a unified license that grants them the ability to practice in multiple states, APRNs can respond swiftly to changing healthcare demands and contribute their specialized skills where they are most needed.

The APRN Compact is founded on the principles of standardization and public protection. Participating states adhere to uniform regulations for APRN practice, ensuring that patients receive consistent, safe, and high-quality care regardless of geographical location. This standardization fosters patient trust in the healthcare system and enhances the overall quality of healthcare delivery. The APRN Compact will also streamline the licensing process, saving valuable time and costs for APRNs. The elimination of the need to obtain multiple licenses translates to a more efficient and effective workforce, where healthcare professionals can focus their energy on patient care and professional development.

What Are the Requirements for the New APRN Compact?

Obtaining the APRN Compact license, should it be adopted, requires meeting specific prerequisites, completing the application process, and fulfilling examination requirements. The prerequisites are as follows:

  • Graduate of a Qualifying Nursing Education Program: Prospective nurses must complete their education from an accredited nursing program that meets the qualifying standards set by regulatory bodies.
  • Passing the NCLEX-RN or NCLEX-PN (or Predecessor Exam): Candidates are required to pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) or the National Council Licensure Examination for Practical Nurses (NCLEX-PN) to validate their clinical knowledge and readiness to practice nursing.
  • Possessing an Active, Unencumbered Nursing License: To qualify for licensure, candidates must either possess an active nursing license or be eligible to obtain one without any restrictions or disciplinary actions.
  • Meeting Home State’s Nurse Licensure Qualifications: Each state in the U.S. has specific licensure qualifications, and candidates must meet the requirements set by their home state before obtaining a nursing license.
  • Disclosure of Current Participation in an Alternative Program: Applicants must disclose their current participation in any alternative programs related to nursing practice. If the applicant is enrolled in an alternative program, they will not be allowed to apply.
  • Fingerprint-Based Criminal Background Checks: As part of the licensing process, candidates must undergo state and federal fingerprint-based criminal background checks to ensure patient safety and protect against potential risks

For nurses seeking a multistate license, they must adhere to the nurse practice act in each state where they practice. Notably, when providing care through telehealth or over the phone, the state of practice is determined by the location of the patient, not the nurse. Currently, registered nurses (RNs) and licensed practical nurses/licensed vocational nurses (LPN/LVNs) holding a Nurse Compact License (NLC) can practice across borders in 41 jurisdictions (states and U.S. territories).

The application process for the APRN Compact entails submitting the required documentation and meeting the designated criteria set forth by the participating states. Once approved, APRNs can enjoy the benefits of a unified license, empowering them to deliver care in multiple states with ease and efficiency.

What's Holding Up the APRN Compact?

Despite its numerous potential benefits, the APRN Compact faces certain challenges that have hindered its widespread adoption. Some professional organizations, such as the American Association of Nurse Practitioners (AANP), have expressed concerns about the compact’s potential implications on APRN practice and scope of authority. Additionally, state-level legislative and regulatory complexities can pose obstacles to the uniform implementation of the compact. The APRN Compact can only officially come into effect once seven states have enacted the legislation. As of May 2024, only four states have done so. These states include:

  • Utah
  • Delaware
  • North Dakota
  • South Dakota

One state, Arizona, is pending legislation.

Nurse Licensure Compact (NLC) vs. the APRN Compact

To avoid confusion, it’s important to distinguish between the Nurse Licensure Compact (NLC) for Registered Nurses (RNs) and the proposed APRN Compact for APRNs. While both agreements aim to facilitate multistate practice, they cater to different segments of the nursing profession.

The NLC allows registered nurses and licensed practical nurses to practice in their home state and other compact states without obtaining additional licenses. The APRN Compact is similar, but it applies to advanced practice registered nurses, such as nurse practitioners and nurse anesthetists, and it grants them full practice authority and prescriptive authority in compact states.

The NLC allows RNs with a multistate license to practice in any participating state without the need for additional licensure. In contrast, the APRN Compact aims to extend this model to APRNs, thereby increasing their practice options and professional mobility.