TravelByte #37 Your Job Options Are More Limited than They Should Be – Here’s Why

Maybe when you hear the word “compact” you think about a small cosmetic case with a mirror in it. Hopefully, when you finish this, you’ll think about something much more important, something that is already impacting your career opportunities: the nursing compacts.

Before the current coronavirus pandemic, few nurses were engaged in providing telehealth services. In-person clinic visits were the norm, even though the pre-travel evaluation and often the post-travel evaluation lend themselves very well to this approach (Kaiser was a notable exception to this convention pre-pandemic, as their pre-travel nurse visits were done by phone).

As soon as the SARS-CoV-2 paid the world a visit, however, health care professionals everywhere had to rethink “business as usual” and get up to speed on the nuances of Zoom and other platforms, sometimes within hours, as we all embraced telehealth.

Actually, telehealth isn’t anything new. It was initially developed to improve access to health care to underserved patients, especially those in more remote areas. Over the last few years, various companies have cropped up providing telehealth services to the elderly, international travelers, patients needing after-hours care or specialist care, etc. It has the potential to not only improve access but promote greater efficiency and better outcomes.  Now that everyone is more familiar with this approach and can see that not only is it feasible, it has many benefits both to patients and organizations, it’s clear we won’t return to our old way of doing things.

Unfortunately, nurses won’t be able to fully avail themselves of the opportunities in the telehealth job market due to the limits of state licensure and the lack of standardization of nursing practice from state to state.  The Nurse Licensure Compact (NLC) is the solution to this problem.  Promoted by the non-profit National Council of States Boards of Nursing, the NLC is an agreement across states that allows a nurse to get a multi-state license to practice either physically or via telehealth in member states.  Currently 34 states have enacted the NLC and several having pending legislation.

Recognizing telehealth as an emerging trend  and the need for physicians to practice in multiple states, physicians introduced their own compact in 2014 which currently includes 29 states, the District of Columbia, and the Territory of Guam.  It became operational in 2017.

Unfortunately, Advanced Practice RNs lag well behind organized medicine in their efforts. Their compact was approved in 2015 and will be implemented when 10 states have enacted the legislation.  Currently, only 3 states, Idaho, Wyoming, and North Dakota have enacted legislation.

Multiple nursing organizations already support the Nursing Compacts.  Scroll down to the bottom here for a list.  You too can assist:

  1. Reach out to your governor, state senators, and state representatives using this form.
  2. Get updates on the latest developments and engage in activities in your state.

Nursing compacts not only support telehealth services but also improve access to care by providing first responders to victims in an overwhelming pandemic or other crisis. Nurses really should do what they can to advocate for the nursing compacts in their individual states, patients will have more options and so will they.

-Julie Richards, Past President


  1. Center for Connected Health Policy, State Telehealth Laws and Reimbursement Policy Report Spring 2020
  2. Balestra, M., Telehealth and Legal Implications for Nurse Practitioners, The Journal for Nurse Practitioners, Jan. 2018.