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How did state nursing boards or licensure compact policies change during 2017–2021 and were they influenced by federal actions?
Executive summary
Between 2017 and 2021 state nursing licensure policy shifted markedly toward wider adoption of the Enhanced Nurse Licensure Compact (eNLC) — the eNLC took effect July 20, 2017 and by 2019 had attracted dozens of states as the pandemic later accelerated interstate mobility and temporary emergency reciprocity; travel nursing grew an estimated 35% in 2020 and another 40% in 2021 [1] [2]. Federal action did not mandate a national nursing license, but federal pandemic-era measures and agency guidance effectively loosened interstate practice barriers temporarily and intersected with state and compact choices, producing what analysts call a “quasi-national” emergency authorization that most states ended beginning in April 2021 [2] [3].
1. Rapid spread of the eNLC after 2017 — a state-driven compact
The Nursing Licensure Compact was revised as the Enhanced Nurse Licensure Compact (eNLC) and became effective July 20, 2017 when North Carolina became the 26th state to join; the eNLC added uniform licensure requirements, background checks, and disciplinary provisions to the earlier model [4] [5]. NCSBN and advocacy groups pushed states to enact the model law, and between 2017 and 2021 many states debated or enacted compact legislation — implementation dates varied by state [6] [7].
2. COVID-19 created temporary national-scale licensure workarounds
During the pandemic, governors and federal actors used emergency authorities to allow nurses to practice across state lines without obtaining new licenses, producing a de facto nationalization of interstate practice for the crisis period; scholars describe these emergency authorizations as a “quasi-national emergency compact” that most states began rescinding as early as April 2021 [2] [3]. Those emergency waivers increased the practical importance of multistate licensing and travel nursing — travel nurse supply jumped ~35% in 2020 and ~40% in 2021, evidence the temporary rules changed labor flows [2] [3].
3. Federal role: influence but not pre-emption of state authority
Available reporting shows federal agencies and Congress expanded funding and issued rules affecting workforce flexibility, but they did not replace state licensure systems with a federal license; state boards retain licensure authority and must report disciplinary actions under federal law to the National Practitioner Data Bank, a longstanding federal link to state regulation [8] [9]. The American Nurses Association engaged with federal rulemaking (for example on VA authority to allow practice across state lines) and commented on federal agency proposals, illustrating federal influence through regulation and guidance rather than direct takeover of state licensing [10] [11].
4. State boards maintained control — but policy diversity grew
State boards continued to set scope, disciplinary standards, and implementation timelines; some states enacted eNLC laws with staggered implementation (Ohio enacted in July 2021 with implementation in 2023; Pennsylvania enacted in 2021 with later implementation dates), reflecting persistent state-level variation in timing and rules [7] [12]. Boards also updated rules tied to the compact’s administration (for example Interstate Commission rules effective January 1, 2021), showing technical governance occurred through state-board collaboration rather than federal fiat [13] [14].
5. Benefits and trade-offs flagged by analysts and stakeholders
Economists and public policy analysts argue compacts and emergency reciprocity increased labor market flexibility and access to care during crisis periods, but critics and some unions warned of downsides — potential effects on local workforces, oversight concerns, and fee or disciplinary implications [2] [15]. Advocacy groups like the ANA urged federal agencies to engage stakeholders and to clarify how federal actions interact with state rules, underlining contested priorities between mobility and state-based public protection [10] [11].
6. What reporting does not settle (limitations and open questions)
Available sources document the timing of the eNLC’s effective date, pandemic emergency waivers, and state adoptions through 2021, but they do not provide a single tally of every statutory change at each state board between 2017–2021 or a causal estimate isolating federal influence on each state’s decision; where sources are silent, those specifics are "not found in current reporting" [1] [2]. Likewise, while federal funding and rules influenced the environment, no provided source shows the federal government mandated compact adoption — state legislatures enacted compacts and boards implemented rules [8] [9].
7. Bottom line for readers and policymakers
From 2017–2021 the dominant change in nurse licensure policy was state-level adoption of the eNLC and pandemic-era temporary cross‑state authorizations that amplified interstate practice — federal actions shaped incentives and temporary permissions but did not replace state licensing authority [4] [2] [8]. Debates that followed emphasize trade-offs between workforce flexibility and local regulatory control; the sources show continued state-centered policymaking mediated by national organizations like NCSBN and compact governance structures [6] [16].