Nursing CE Central
Connecticut will soon become the latest state to allow nurses to practice across state lines.
The Connecticut General Assembly approved on May 17 H.B. 5058, which allows the state to adopt the Nurse Licensure Compact, meaning nurses can work outside of the Constitution State without needing to be licensed in other states. Membership will begin Oct. 1, 2025, and run through Jan. 1, 2028.
The measure was introduced at Gov. Ned Lamont’s request, received bipartisan support, and was approved unanimously in both the House of Representatives and the Senate. It’s currently awaiting Lamont’s signature.
“Joining this compact will provide Connecticut residents with even more access to healthcare, including the expansion of telehealth visits that became so important during the pandemic,” said Rep. Tami Zawistowski, who co-sponsored the bill. “Nursing shortages are happening statewide, and I’m encouraged that this important healthcare bill to support our residents and provide another avenue to employment passed the House with such overwhelming support.”
The Nurse Licensure Compact was established in 1999 to remove barriers related to practicing in multiple states for RNs and LPNs. Previously, nurses had to be licensed “state-by-state, creating barriers to geographic mobility and interstate work,” according to a February 2023 Brookings commentary.
“In the late 1990s, the National Council of State Boards of Nursing (NCSBN) explored a ‘mutual recognition model’ between participating states for licensing of registered nurses (RNs) and practical/vocational nurses (LPN/VNs),’ the commentary stated.
In addition to allowing nurses to practice across state lines, both in person and via telehealth, the compact:
Nurses must maintain legal residency in the state where their compact license was issued and remain in good standing, though there’s no expiration on a compact, or multi-state, license.
Kimberly Sandor, executive director of the Connecticut Nurses Association, wrote to the state’s public health committee in March opposing the measure. She specifically noted a loss of confidentiality for nurses using the Health Assistance InterVention Education Network (HAVEN) and a loss of funds for HAVEN, the state’s confidential program for nurses that offers support for those who have a chemical dependency, emotional/behavioral disorder, or physical/mental illness.
“This is a major step backwards for nurses in CT, to lose the privilege of confidentiality, and potentially threaten the finances of HAVEN,” Sandor wrote. “CT’s HAVEN program stands out across the country, and this would move mental health and the CT approach backwards.”
HAVEN’s funding, according to CNA, comes from professional licensure fees, rather than the state of Connecticut.
CNA conducted an informal member survey this year, in which 75% of respondents were in favor of the idea of a compact. However, Sandor wrote that when they were “educated about the potential harmful impact on a nurse receiving confidential services from HAVEN, and loss of funding to HAVEN,” many changed their position.
A May Connecticut Insider report noted that some of CNA’s concerns (HAVEN funding and a license cancellation process, for example) have been addressed through amendments.
But the organization’s initial concerns about joining the NLC are not unique. Others have voiced opposition due to “falling nursing board revenues and work standards, a lack of disciplinary oversight, and a loss of sovereignty to the [Interstate Commission of Nurse Licensure Compact Administrators] ICNLCA,” according to the Brookings commentary. Advocacy groups also had concerns about less bargaining power and “wage depression” under the compact.
“If, for example, the removal of licensing restrictions encourages nurses to travel to a state that enjoys elevated wages, then unionized nurses may suffer from declining wages, erasing the above-average wages that the state boasted before joining the compact,” the Brookings commentary authors stated.
A majority of U.S. jurisdictions participate in the NLC, according to the National Council of State Boards of Nursing.
Connecticut is one of eight states (and the District of Columbia) with pending legislation. Only Oregon and Nevada have no pending or enacted legislation related to the NLC, while Pennsylvania and Guam have partial implementation, and the Virgin Islands are awaiting implementation.
Citing multiple studies, the Brookings commentary stated that even before the onset of the COVID-19 pandemic, “interstate nursing practice was becoming more common.”
“Multi-state licensure take-up has been steadily increasing from 1.6% of NLC nurses working in a compact state in 2008, to almost a quarter of all RNs holding an interstate license (24%) by 2020,” the authors stated. “Thirty-three percent of nurses cite using their interstate license for travel nursing, with 16% for telehealth and 8% for distance education, yet only 4% cite travel nursing as their main motivation for obtaining this license.”
Pandemic-induced State of Emergency declarations waived license requirements, allowing nurses to “effectively practice anywhere without applying for an additional license or paying additional fees, regardless of a state’s pre-pandemic membership in the compact,” the Brookings commentary stated.
A majority of jurisdictions in the U.S. and its surrounding territories have entered into the Nurse Licensure Compact, with Connecticut being one of the most recent additions. The compact allows practitioners to pursue opportunities across state lines so long as they maintain their license in the issuing state and remain in good standing.
Despite concerns about wage depression and oversight, the compact had been gaining popularity even prior to the awareness it received among the general public during the COVID-19 pandemic.
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