9 states still block multistate nursing licenses, trapping nurse supply

Despite a nationwide nursing shortage, 9 US states plus DC have not joined the Nurse Licensure Compact (NLC), meaning nurses licensed in those states must obtain a separate license for every state where they want to work. Obtaining an additional state license typically costs $100-400, requires weeks of processing, and may demand a new background check and additional paperwork — even for a nurse who has practiced safely for 20 years. So what? Nurses in non-compact states like California, New York, and Illinois — three of the largest nursing workforces in the country — cannot quickly relocate to states with critical shortages. So what? During COVID, emergency executive orders temporarily waived these barriers, proving the system works without them, but the waivers expired and the walls went back up. So what? The inability to move nurses fluidly across state lines means that local shortages become crises even when there are idle nurses in neighboring states. Why does this persist? State nursing boards derive revenue from licensing fees and resist ceding regulatory authority. Nursing unions in holdout states (particularly New York and California) oppose the compact, arguing it could undermine local labor protections and wage standards.