Case Management Across State Lines/Military (Licensing)

[MBuyer]

Hello,

I am pursuing workers' comp case management, which entails managing cases across state lines. My husband is active duty military, and there is potential we may be moving to Ohio from Texas. Our primary residence is Texas, as I have a Texas drivers' license, my vehicles are registered in Texas, our taxes will be taken from Texas, and I am registered to vote in Texas. When we move, we will not have a Texas residence, but it is our primary/permanent home of record. According to the NLC:

What determines primary residency for licensure purposes in the Nurse Licensure Compact?

"Primary state of residence" is defined by the compact as "the state of a person's declared fixed permanent and principal home or domicile for legal purposes". Evidence of a primary state of residence may be required. Sources used as evidence include, but are not limited to, driver's license, federal income tax return, military payroll documents, and voter registration. If you declare a change in your permanent residence from another compact state, you have 90 days to obtain a license in that state.

My question concerns licensing. Texas is part of the NLC, whereas Ohio is not. I understand I can hold both an NLC and non-NLC license at the same time; however, I would really like to keep my Texas multi-state license. According to the Texas BON, I must provide a Texas address in order to keep or receive another multi-state license (otherwise they will issue a single-state license ONLY). If I'm living in Ohio, obviously I won't have a Texas address, even though everything else remains in Texas.

Furthermore, if I ever move to another NLC state and if I ever want another multi-state license, I'll have to change everything over to that state.

Will I have to maintain multiple licenses for many different states, because I will no longer be able to hold a multi-state license? Or is there some way to keep the Texas multi-state license? Anybody have some creative ideas?

The military stuff really puts an extra twist on things, especially if you have to move on government orders every 2-3 years. Being able to work from home and keep the same job doing case management would be wonderful if I didn't have to keep up so many licenses. I wish more states would join the NLC and/or I wish states would recognize military spouses and make an exception.

Thanks in advance for your replies!

[SummerGarden, BSN, MSN, RN]

Thanks in advance for your replies!

I am a former multi-state compact licensed nurse and former military family too. There is no way around it... Keep your Texas license but the multi-state privledge will go away until you move to another state within that compact-state agreement, change your address, and obtian your license in that other state. Good luck.

[nurseprnRN, BSN, RN]

I am not military but I hold licenses in 8 states, all paid a la carte.PIA and expensive, but you have to do it.

If you are doing case management in multiple states as a work comp CM, you MUST have licensure to practice nursing in the state where the patient lives. Yes, you do. So wherever you live or have your primary licensure, if you case manage files in MA, KY, and CA, you need MA, KY, and CA RN licenses. Your company should pay for the extra ones; if they won't, they can't force you to and they will have to adjust your case load to be cases from your state(s) of licensure only. All the national companies know this ... and so do all the BONs.

Yes, you can get into trouble without those licenses even if you're just doing telephonic CM with people you never lay eyes or hands on. This is because you're not just making telephone calls to set up appointments like a lay secretary. The minute you say, "How are you doing? How's PT going? Are you getting around better?" you are considered to be doing a nursing assessment in that state.

[MBuyer]

Thank you so much for your response. A couple more questions:

Would you recommend letting a supervisor know we are active duty military right away in a job interview or worry about it when ever a move comes?

Second question, if I move to Ohio and do case management everywhere else but Ohio, will I necessarily need an Ohio license or stick with Texas (single) and obtain other licenses as needed where patients reside only?

We nurses know we need to cover our butts. I really appreciate your insight.

[SummerGarden, BSN, MSN, RN]

Thank you so much for your response. A couple more questions:

Would you recommend letting a supervisor know we are active duty military right away in a job interview or worry about it when ever a move comes?

I do not know how long you have been a military spouse, but I will answer this question. NO! :) DO not tell anyone about your personal relationships for any reason especially if you are a military spouse prior to employment. After you are hired then tell your supervisor that you are married and have a military spouse. During interviews, it is illegal for them to ask you of your marital status so do not volunteer this information. In fact, take off your wedding ring prior to your interview!

Also, when your spouse receives a new assignment, then you can talk about moving; not before because it will not help you while employed. In fact, it may harm your chances at additional employment (A part-time job or a future job) in the area or it might prevent any employer from wanting to provide you with additional training that can help you in your career because you may move soon.

Second question, if I move to Ohio and do case management everywhere else but Ohio, will I necessarily need an Ohio license or stick with Texas (single) and obtain other licenses as needed where patients reside only? We nurses know we need to cover our butts. I really appreciate your insight.

I think GrnTea responded best. You need a license in the state your clients are located in order to provide nursing case management services even telephonic. So, yes, obtain an Ohio license. Many of us have multiple licenses in other states. It can be expensive to maintain, so as GrnTea suggested, get your telephonic case management employers to help you out. I do not do telephonic CM so I am tasked to maintain my licenses on my own (I keep them just in case I need them in the future). Good luck!

[nurseprnRN, BSN, RN]

You might have to have an active license in the state where you are hired (OH), too, as a qualification for the job. Besides, you never know when they might throw an OH case at you and you can't be in the position of saying no. If they require you to manage cases in other states, they should pay for your extra licenses and whatever is involved in getting them. Because you wouldn't have to have them if it weren't for the job, right?

[Kooky Korky, BSN, RN]

Since the military is ordering the move, will it help pay for your expenses (new licenses)?

Tell the employer as little as possible about your personal biz. Always. Tell everyone as little as possible so that they can't accidentally let some info slip and can't gossip about you that much. They will anyway, just try not to give them fodder.

Wishing you the best...