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How did the CARES Act or other federal actions affect interstate nurse licensure and the Nurse Licensure Compact during 2020–2021?
Executive summary
Federal actions during the COVID-19 emergency did not directly rewrite the Nurse Licensure Compact (NLC); instead, governors’ emergency orders and preexisting compact rules made interstate practice vastly easier in 2020–2021, producing a de‑facto national loosening of state licensure barriers while the NLC continued to expand separately [1] [2]. Research and policy groups report that by 2020 roughly 24% of RNs held an interstate license and that pandemic emergency authorizations allowed out‑of‑state nurses to practice broadly until many waivers expired in 2021–2023 [2] [1].
1. Emergency waivers produced a temporary, nationwide effect
When COVID‑19 erupted, nearly every governor issued emergency declarations that authorized rapid temporary licensing waivers or emergency privileges for out‑of‑state nurses; scholars say this created “a functionally national compact” for the crisis period because nurses could practice across state lines without the usual licensing process [2] [1]. Brookings and The Hamilton Project both summarize that these emergency orders, not a new federal law, drove short‑term interstate mobility by allowing nurses licensed elsewhere to respond to hotspots [2] [1].
2. The NLC’s role: preexisting multistate license that eased cross‑state care
The NLC already allowed nurses in member states to hold one multistate license to practice in all compact jurisdictions, and the compact’s utility became highly visible during the pandemic because it enabled telehealth and surge response without extra licenses [3] [4]. NCSBN and related reviews emphasize that the NLC facilitates telemedicine and deployment in disasters — benefits that were repeatedly invoked during COVID‑19 [5] [6].
3. Expansion continued during and after the acute emergency, but by state action
States continued to adopt the enhanced NLC (eNLC) through 2020–2021 and beyond; this growth was driven by state legislatures, not Congress or the CARES Act, and NCSBN pushed for more jurisdictions to join after seeing the pandemic’s pressures [7] [8]. Reporting shows multi‑state licensure take‑up rose over time (from 1.6% in 2008 to about 24% by 2020), and advocates argued the crisis would encourage remaining states to join the compact [2] [7].
4. The CARES Act itself: not a direct driver of licensure reform in sources
Available sources do not cite the CARES Act as having directly changed interstate nurse licensure or the NLC rules in 2020–2021; instead, the change agents discussed are governors’ emergency orders, state legislatures, and the NCSBN’s compact processes [1] [2]. If you are looking for a federal statutory trigger in the CARES text altering licensing law, that is not mentioned in the current reporting provided (not found in current reporting).
5. Two distinct mechanisms: emergency authorizations vs. compact permanence
Analysts distinguish temporary emergency authorizations (fast, broad, time‑limited) from the permanent multistate mechanism of the NLC (structural, state‑by‑state adoption). During the pandemic, emergency authorizations allowed nurses to practice widely even in non‑compact states; the NLC provided a durable pathway for mobility where enacted and has been promoted as a way to avoid the need for future emergency waivers [2] [1].
6. Evidence on scale and persistence: what the numbers show
Brookings and Hamilton Project summaries underline that interstate licensure was already growing pre‑pandemic (24% of RNs with interstate licenses by 2020), and pandemic authorizations produced tens of thousands of emergency authorizations in some states — for example, Oregon reported over 11,000 emergency authorizations in two years, many of which led to state licensure after waivers ended [2]. These figures show both the scale of temporary measures and the NLC’s growing footprint [2].
7. Contested tradeoffs and lingering debates
Commentators and state actors raised tradeoffs: supporters point to increased access, telehealth expansion, and surge capacity; critics warn about oversight, variable background‑check standards, and potential wage or regulatory impacts that require monitoring [4] [9]. Some states delayed or rejected the eNLC citing concerns that predated the pandemic; pandemic experience intensified but did not resolve those debates [7] [9].
8. Practical takeaway for policymakers and nurses
If you are tracking what changed in 2020–2021: the functional increase in interstate practice came mainly from state emergency orders and from the NLC where states already participated; the CARES Act is not described in the supplied sources as a direct mechanism for licensure change [2] [1]. For permanent reform, the evidence and advocacy in these sources point to continued state legislative adoption of the eNLC and to attention to uniform standards such as background checks and disciplinary data sharing [4] [5].