Does this job put my license at risk?

Dear Nurse Beth Advice Column - The following letter submitted anonymously in search for answers. Join the conversation!

Published  

I work for a small company that is in the business of providing health care consulting related to high cost therapies. This includes network access for insurance companies and other fiduciaries along with full management of benefits to include auth approvals and member support with membership nationwide. 

The nurses are not responsible for any decision making regarding authorizations. They receive the auth requests and gather documentation to provide to the physician for review and decision. The nurse communicates the decision with hospital staff via email or phone call and sends determination letters to the provider and member. 

The members support and education is provided by non clinical staff that report to a nurse with the work ultimately being under the direction of the physicians on staff. The nurses may need to answer a call if non-clinical staff is out or call members to answer process questions. 

Some of the nurses have a compact license and others are only licensed in the state in which they reside. 

Can the nurses perform these duties for membership across the country if they are not licensed in the state in which the members resides? Is it correct that this is dependent on each state's nurse practice act and how they define nursing practice? 

The employer is stating this is not an issue because everything falls under the physicians license. 

In need of resources to prove if this is something putting the nurses license at risk. 

Share this post

+ Add A Comment
Specializes in Tele, ICU, Staff Development.

For a definitive answer, consult your legal counsel and individual state's nurse practice acts (which vary). I'm not an attorney, but I can share some thoughts.

This is a critical and nuanced question, and you're right to be cautious. Here's how it breaks down:

Licensure and Scope of Practice

In the U.S., nursing practice is regulated at the state level by each state's Board of Nursing (BON) and Nurse Practice Act.

Patient location is paramount. Generally, nurses must hold an active license in the state where the patient/member is located at the time of service. This applies whether the service is in person, by phone, or virtual.

Having a compact license (eNLC) allows a nurse to practice (telehealth included) in all compact states legally.

Nurses licensed only in their home state (non-compact) would typically need additional licenses to serve members residing in other states.

Does a Physician's License Cover Nurses?

 o. A physician's license does not "umbrella" over nursing practice.

Each nurse is personally accountable to their own state BON.

Even if tasks are administrative (gathering documentation, relaying determinations), if you're functioning as a nurse (using your RN or LPN title), the state may consider that nursing practice, and therefore, subject to licensure requirements.

Gray Zone: Clinical vs. Nonclinical Work

Some of the work you describe—like relaying pre-authorization decisions, sending determination letters, and making process calls—could arguably be done by nonclinical staff.

However, because nurses are practicing under their license/title, it could still be interpreted as the practice of nursing, depending on the state law. After all, there is a reason your company has nurses making these calls, and not nonclinical staff.

Although nurses are not responsible for decision-making, they may still need to interpret decisions using their nursing knowledge, which could make them liable.

The employer's position (“everything falls under the physician's license”) is risky. Boards of Nursing typically do not accept that rationale—nurses remain individually responsible for knowing and practicing within their scope and licensure.

Risks to Nurses

Practicing nursing across state lines without a license in that jurisdiction could be considered unlicensed practice of nursing, which is grounds for disciplinary action.

Even if no harm occurs, a complaint could lead to an investigation, fines, or license restrictions.

It's not enough that the employer "says it's fine”—Boards of Nursing enforce the law, not the employer.

Resources for Proof

You can use these to show your employer (and to protect yourself):

  • National Council of State Boards of Nursing (NCSBN) " A nurse must be licensed or have the privilege to practice in the state where the patient is located at the time care is directed or service is provided. This pertains to in-person or telehealth practice."
  • Your Nursing Insurance Carrier
  • State Nurse Practice Acts & Boards of Nursing
    • Each state BON website spells out whether telenursing or remote services are considered practice in their state.
    • Example wording: "Nursing care provided to a patient in this state, even when delivered electronically or telephonically, constitutes the practice of nursing in this state and requires a license issued by this Board.” 

Bottom line
It depends on each state's nurse practice act, and in most cases, nurses must be licensed in the state where the patient resides. A physician's license does not shield nurses from their own licensure obligations. Your employer's stance could expose nurses to regulatory risk.

Best wishes,

Nurse Beth

+ Add a Comment