As healthcare systems across the U.S. confront growing nursing shortages and increasingly mobile patient populations, a once-static model of state licensure is giving way to a more flexible alternative. In Pennsylvania, that shift took formal shape in 2021 with the state’s legislative approval of the Nurse Licensure Compact (NLC)—a multistate agreement that allows registered nurses (RNs) and licensed practical nurses (LPNs) to practice across state lines with a single license.
For a state with one of the largest healthcare workforces in the country, joining the NLC marks a strategic move to expand access, modernize regulation, and keep pace with national labor trends. While the state’s adoption of the compact came later than many of its neighbors, Pennsylvania’s entry into the agreement is expected to have far-reaching implications for hospitals, long-term care providers, telehealth platforms, and nurses themselves.
A License That Crosses Borders
At its core, the Nurse Licensure Compact is a mobility mechanism. Participating states agree to honor a common nursing license for RNs and LPNs who meet uniform standards. Nurses whose primary residence is in a compact state can apply for a multistate license, which allows them to practice physically or virtually in any of the other compact states without obtaining additional credentials.
The compact does not create national licensure. Instead, it establishes mutual recognition, akin to a driver’s license being valid across state lines. The system preserves each state’s disciplinary authority while streamlining the licensure process in an era of growing workforce flexibility.
As of early 2025, 41 states and territories have joined the compact. Pennsylvania’s inclusion, long sought by hospital associations and professional groups, brings one of the nation’s healthcare heavyweights into the fold.
Delayed But Decisive Adoption
Pennsylvania’s path to joining the NLC was not without obstacles. While legislation authorizing participation passed in 2021, the state was slow to operationalize the compact. Regulatory and IT infrastructure had to be updated, and legal coordination with the National Council of State Boards of Nursing (NCSBN)—which administers the compact—required careful alignment.
In 2023, the Pennsylvania Department of State announced the state was finally ready to implement the compact. As of September that year, nurses in Pennsylvania could apply for multistate licenses, and nurses from other compact states could begin practicing in Pennsylvania without additional credentialing.
The rollout came at a critical time. Hospitals, especially in rural and underserved areas, were reporting acute shortages of nursing staff. Long-term care facilities faced similar staffing strains. And as telehealth gained traction, especially in behavioral health and chronic disease management, the need for licensure flexibility became more urgent.
Impacts on the Healthcare Workforce
For healthcare employers, the NLC offers immediate relief from licensure-related friction. Hospitals can now recruit from a larger pool of nurses without navigating the patchwork of state-specific credentialing timelines. Staffing agencies and travel nurse firms can more easily deploy personnel across multiple regions. And cross-border providers—especially those operating in areas near state lines—can fill shifts with fewer administrative delays.
Nurses benefit from increased mobility and job flexibility. Those who hold multistate licenses can practice in person or via telehealth in any compact state, often without needing to file paperwork or pay fees in each jurisdiction. For new graduates, the compact offers a more streamlined entry into multistate practice—particularly appealing to those eyeing mobile careers or temporary assignments.
The system also benefits the state’s educational institutions. Pennsylvania trains thousands of nurses each year, many of whom seek opportunities outside state borders. With the NLC in place, Pennsylvania-based nursing schools can market their programs to out-of-state students interested in multistate licensure without relocation barriers.
Telehealth, Triage, and Flexibility
One of the most consequential aspects of the NLC lies in its impact on telehealth. With digital care now a standard part of healthcare delivery, especially in behavioral health, addiction treatment, and chronic condition management, nurses who deliver care remotely need to be licensed in the state where the patient resides.
Without the compact, this requirement meant separate licenses for each state—a costly and time-consuming burden. With the NLC, Pennsylvania-based telehealth nurses can treat patients in dozens of states with a single license, assuming their home state is also in the compact. This flexibility expands the reach of Pennsylvania’s healthcare workforce and enables providers to scale services more efficiently.
Similarly, the compact allows for faster triage and surge response in public health emergencies. During the COVID-19 pandemic, many states issued temporary waivers to allow out-of-state nurses to provide care. The NLC formalizes and streamlines this process, giving Pennsylvania more flexibility to bring in emergency staff quickly when needed.
Safeguards and Oversight
While the NLC eases licensing burdens, it does not reduce standards. To obtain a multistate license, nurses must meet specific criteria, including background checks, fingerprinting, and adherence to disciplinary and practice standards set by the compact. States retain full authority to investigate and take action against nurses practicing within their borders, regardless of where the license was issued.
Disciplinary actions in one compact state are reported to a centralized database, which is shared among member boards. If a nurse loses the privilege to practice in one state, that action may extend across all compact states, depending on the circumstances.
Pennsylvania’s Board of Nursing has worked to integrate these safeguards into its own licensing infrastructure. Nurses applying for a multistate license must complete additional documentation, and the state conducts ongoing audits to ensure compliance. These checks are designed to maintain quality while preserving the benefits of mobility.
Resistance and Concerns
Not all stakeholders support the compact without reservation. Some labor organizations have raised concerns that easier cross-border staffing could lead to wage suppression or an overreliance on travel nurses at the expense of stable, long-term staff. Others warn that out-of-state nurses may be less familiar with Pennsylvania-specific policies or institutional cultures.
The compact also applies only to RNs and LPNs—not advanced practice registered nurses (APRNs), who must still obtain separate licenses in each state. Efforts to create an APRN Compact are underway but remain less widely adopted.
Despite these limitations, the majority of Pennsylvania’s healthcare industry has embraced the compact as a necessary step forward. In a system defined by workforce shortages and increasing care complexity, few tools offer such immediate administrative relief.
A Model for Other Professions?
The success of the Nurse Licensure Compact in Pennsylvania has sparked interest in similar models for other healthcare professions. Compact agreements already exist for physical therapists, EMS providers, and physicians through the Interstate Medical Licensure Compact (IMLC). Pennsylvania has joined some of these and is evaluating others.
For policymakers, the compact system represents a practical solution to the geographic rigidity of traditional licensure. As healthcare delivery becomes more integrated and mobile, multistate licensure models could become standard rather than exception.
Still, careful implementation remains key. Each profession has different regulatory needs, and the balance between access and accountability must be preserved. Pennsylvania’s experience with the NLC provides a working example of how that balance can be managed.
Looking Ahead
The Nurse Licensure Compact marks a strategic shift in how Pennsylvania governs its nursing workforce. By joining the compact, the state has opened the door to greater flexibility, broader recruitment, and more seamless care delivery—especially in border regions and virtual environments.
While no policy is without tradeoffs, the compact offers a strong foundation for modern workforce management. In an era where healthcare is increasingly defined by its ability to move—across platforms, borders, and disciplines—the NLC gives Pennsylvania the regulatory infrastructure to keep up.
For nurses, patients, and providers alike, that flexibility may prove as valuable as any clinical tool.