Nursing Across State Lines: Telephonic Case Management and Licensure

Melissa Mills, BSN

Modern nursing is sophisticated and flexible. The days of nurses working primarily at the bedside surrounded by physicians and other staff is no longer accurate. Our tech savvy world has provided our profession with a myriad of opportunities that break out of the box and off the unit.

One such nursing specialty is telephonic or electronic case management. When working in this unique area of nursing, nurses are faced with specific challenges in regards to licensure. Many of us start working in this area before we are even aware of the issues. This article will help you understand the basics of three critical components in regards to licensure for the telephonic or electronic nurse case manager: the provision of nursing care, understanding our nurse practice act and compact versus single license states.

Understanding the Provision of Nursing Care

What is nursing care? According to the International Council of Nurses, nursing includes the promotion of health, prevention of illness and the care of ill, disabled and dying people. Quite simply, any task you perform that requires you to use your nursing knowledge is the provision of nursing care. This can be hands-on skills such as catheter insertion, performing vital signs or wound care. However, it is not limited to hands-on skills, tasks such as disease process education, medication instruction and any other instruction that promotes health or prevents illness is nursing care. This is a broad definition that certainly covers most functions performed by telephonic nurse case managers.

I have heard nurses state that telephonic nursing does not constitute nursing practice. This is not true. Telephonic nursing roles require the nurse to use knowledge obtained during initial and ongoing training and meets the definition of the provision of care. So, how does the nurse practice within their scope?

In order to practice lawful nursing, the nurse must be licensed in the state in which the patient is located at the time care or services are provided. This includes providing physical, telephonic or electronic care. Quite simply, you must have a license to practice nursing in the state in which the patient lives. This sounds simple enough, but due to both compact and noncompact licensure states, this can get tricky. The issues of licensing are explored deeper, later in this article.

Know Your State Nurse Practice Act

Because nursing care can pose a risk to the public, states must ensure citizens are safe by enforcing laws that regulate nursing practice. In order to enforce the laws, all states created a board of nursing. The board of nursing is tasked with ensuring that all nurses are prepared and competent to practice nursing in their state. This requires the board to enforce these laws through disciplinary action, should a nurse pose a risk to the public.

Every state and US territory provides the laws of nursing in a document known as the nurse practice act (NPA). The NPA is your nursing handbook to what care you can provide in each state and the laws of licensure. Below is a list of the 6 components in every NPA:

Authority, power and composition of a board of nursing
Education program standards
Standards and scope of nursing practice
Types of titles and licenses
Requirements for licensure
Grounds for disciplinary action, other violations and possible remedies (NCSBN)

In order to ensure you are compliant with the NPA of every state in which you practice, you must be familiar with the laws. While many of us trust that our employers are savvy in regards to these documents, the license to practice nursing is in your name. And, discipline is only administered by the board to you, should you not follow the NPA. Providing telephonic nursing to a patient in a state that you do not hold a license is illegal. Licensure is a privilege, not a right. Find your NPA today by visiting the National Council of State Boards of Nursing, Find Your Nurse Practice Act tool...

Compact Versus Noncompact Licensure

Today's tech-savvy world along with the ease of travel has changed the face of licensure. In 1999 the original Nurse Licensure Compact (NLC) was created. This compact allows any nurse who lives in a compact state to apply for a multi-state license. If the nurse meets eligibility, they are then licensed to practice nursing physically, telephonically or electronically in all states that are part of the NLC.

Currently, there are 25 states in the NLC. You must have a primary residence within a compact state to be eligible to apply for a multi-state license. If your home state is not in the NLC, you must apply to each individual board of nursing for licensure by endorsement, pay all applicable fees and complete all required state-specific continuing education courses. This can be an expensive and lengthy process to complete.

Employers may assist nurses with the process of applying to and paying for multiple nursing licenses. They may also assist by tracking your licenses, expiration date management and even provide access to the required continuing education courses. Just remember, that ultimately this responsibility is yours. It is important to ensure that the employer is performing this correctly. Another important fact to remember in regards to holding multiple licenses is that any discipline in one state requires you report the issue to all other states in which you hold a license.

To learn more about the NLC and to explore your state's current status, visit the Nurse Licensure Compact website.

The most important thing a nurse can do to ensure compliance when working in a telephonic case management position is be informed. What questions do you have about your license, state or job? Do you practice in a telephonic role with or without multi-licenses? What about Utilization Management nurses, do you carry multiple licenses? I would love to hear your questions and comments about this important topic.

Nursing Across State Lines: Telephonic Case Management and Licensure

Understanding the Provision of Nursing Care

Know Your State Nurse Practice Act

Compact Versus Noncompact Licensure

About Melissa Mills, BSN

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