July 13, 2023
Nyasha Smith
Secretary of the Council
1350 Pennsylvania Avenue NW
Washington, DC 20004
Dear Secretary Smith:
Today, I am introducing the “District of Columbia Nurse Licensure Compact Authorization Act of
2023,” alongside Councilmember Christina Henderson, Chair of the Committee on Health,
Councilmember Vince Gray, Chair of the Committee on Hospital and Health Equity, and
Councilmembers Zachary Parker, Brooke Pinto, Robert White, and Kenyan McDuffie.
Like much of the country, the District faces an acute shortage of registered nurses, licensed practical
nurses, and vocational nurses, which has become more severe since the peak of the Covid-19
pandemic.1 A 2022 survey by the District of Columbia Nurses Association found that more than 95%
of nurses in the District believe inadequate staffing was a “major issue” at their facility and that, on
average, respondents observed insufficient staffing of registered nurses on their unit during more than
one shift per week.2 Overworked nurses and understaffed health care centers can lead to worse
outcomes in patients: there is a correlation between patient mortality and a shortage of nurses.3
While these issues are not unique to the District, we are one of only a small handful of states and
territories that is not a member of the national Nurse Licensure Compact (NLC). The NLC is an
1
Colleen Grablick, ‘We were already stretched thin:’ A nursing shortage is straining D.C.-area hospitals, WAMU 88.5,
(Sep. 28, 2022),
https://www.npr.org/local/305/2022/09/28/1125406790/we-were-already-stretched-thin-a-nursing-shortage-is-straining-d-
c-area-hospitals.
2
District of Columbia Nursing Association, DCNA Releases Results of Nurse Staffing Survey, (Sep. 4, 2022)
https://www.dcna.org/assets/DCNA%20Releases%20Results%20of%20Nurse%20Staffing%20Survey.pdf.
3
Peter Griffiths, et al., Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study,
BMJ Quality & Safety 2019; 28:609-617 (Apr. 17, 2019)
https://qualitysafety.bmj.com/content/28/8/609.
interstate agreement that allows for nurses licensed in NLC member states and territories to practice in
other NLC states and territories without obtaining an additional license. More than 41 states and
territories are already members, including neighboring Maryland, Virginia, West Virginia, North
Carolina, Delaware, and New Jersey, with Pennsylvania having enacted and awaiting implementation.4
Joining the NLC will expand the number of available licensed nurses in the District and help
alleviate the current nursing shortage, while allowing the District to maintain the high standards
and quality of service our residents expect.
This legislation, which would enter the District into the NLC, is supported by the District of Columbia
Hospital Association, District of Columbia Health Care Association, District of Columbia Primary
Care Association, Maryland-National Homecare Association, DC Coalition on Long Term Care,
George Washington University, Georgetown University School of Nursing, Children’s National
Hospital, Mary’s Center, Forest Hills of DC, Iona Senior Services, VMT Home Health Agency, Home
Care Partners, Stoddard Baptist Nursing Home, Livingston Place at Southern Avenue, and The
Residences at Kenilworth Park. These hospitals, health care providers, and organizations understand
the real harm and impact of the nursing shortage for employers, health care workers, and most
importantly patients. They concur that entering the NLC can be a first step to achieving parity
with our neighboring states and reversing the current shortage to ensure all District residents,
from students to seniors, have access to the care they deserve.
I look forward to working with health care providers and nurses in the District, alongside the
Committee on Health and Chairperson Henderson, to advance this legislation and pursue a
collaborative approach to address the underlying causes of the nursing shortage in the District.
Should you have any questions about this legislation, please contact my Legislative Assistant, Elias
Benda, at ebenda@dccouncil.gov or (202) 394-8293.
Sincerely,
Matthew Frumin
Councilmember for Ward 3
4 National Council of State Boards of Nursing, https://nursecompact.com/index.page#map
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3 Councilmember Christina Henderson Councilmember Matthew Frumin
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6 _____________________________
7 Councilmember Brooke Pinto Councilmember Zachary Parker
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10 ______________________________
11 Councilmember Kenyan McDuffie Councilmember Robert White
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15 Councilmember Vincent C. Gray
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19 A BILL
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23 IN THE COUNCIL OF THE DISTRICT OF COLUMBIA
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26 To authorize the Mayor to execute and enter, on behalf of the District, the Nurse Licensure
27 Compact to permit licensed registered and licensed practical/vocational nurses in party
28 states to practice in the District and for multistate licensed nurses in the District to
29 practice in other party states; to increase the availability of licensed nurses; to standardize
30 minimum requirements for education and training for participating compact nurses; to
31 establish requirements for the administration of interstate licenses; to join the compact
32 licensure information system; to require all compact states to share licensee information
33 with other compact states; to establish the Interstate Commission of Nurse Licensure
34 Compact Administrators; to allow the Board of Nursing to charge an additional fee for
35 the issuance of a multistate license; and to require individuals or hospitals that employ
36 nurses to report the number of multistate license holding nurses to the Board of Nursing
37 and to prepare and provide each nurse with a copy of laws and rules specific to the
38 practice of nursing in the District.
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40 BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this
41 act may be cited as the “District of Columbia Nurse Licensure Compact Authorization Act of
42 2023”.
43 Sec. 2. Findings and declaration of purpose.
44 The nurse licensure compact is enacted into law and entered into by the District, with all
45 other party states legally joining therein in the form substantially as follows:
46 “Sec. 1. Findings and Declaration of Purpose:
47 (a) The party states find that:
48 (1) The health and safety of the public are affected by the degree of compliance
49 with, and the effectiveness of enforcement activities related to state nurse licensure laws;
50 (2) Violations of nurse licensure and other laws regulating the practice of nursing
51 may result in injury or harm to the public;
52 (3) The expanded mobility of nurses and the use of advanced communication
53 technologies as part of our nation’s health care delivery system require greater coordination and
54 cooperation among states in the areas of nurse licensure and regulation;
55 (4) New practice modalities and technology make compliance with individual
56 state nurse licensure laws difficult and complex;
57 (5) The current system of duplicative licensure for nurses practicing in multiple
58 states is cumbersome and redundant for both nurses and states; and
59 (6) Uniformity of nurse licensure requirements throughout the states promotes
60 public safety and public health benefits.
61 (b) The general purposes of this Compact are to:
62 (1) Facilitate the states’ responsibility to protect the public’s health and safety;
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63 (2) Ensure and encourage the cooperation of party states in the areas of nurse
64 licensure and regulation;
65 (3) Facilitate the exchange of information between party states in the areas of
66 nurse regulation, investigation, and adverse actions;
67 (4) Promote compliance with the laws governing the practice of nursing in each
68 jurisdiction;
69 (5) Invest all party states with the authority to hold a nurse accountable for
70 meeting all state practice laws in the state in which the patient is located at the time care is
71 rendered through the mutual recognition of party state licenses;
72 (6) Decrease redundancies in the consideration and issuance of nurse licenses; and
73 (7) Provide opportunities for interstate practice by nurses who meet uniform
74 licensure requirements.
75 “Sec. 2. Definitions
76 As used in this Compact:
77 (1) “Adverse action” means any administrative, civil, equitable, or criminal action
78 permitted by a state’s laws which is imposed by a licensing board or other authority against a
79 nurse, including actions against an individual’s license or multistate licensure privilege such as
80 revocation, suspension, probation, monitoring of the licensee, limitation on the licensee’s
81 practice, or any other encumbrance on licensure affecting a nurse’s authorization to practice,
82 including issuance of a cease and desist action.
83 (2) “Alternative program” means a non-disciplinary monitoring program
84 approved by a licensing board.
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 85 (3) “Coordinated licensure information system” means an integrated process for
86 collecting, storing, and sharing information on nurse licensure and enforcement activities related
87 to nurse licensure laws, which is administered by a nonprofit organization composed of and
88 controlled by licensing boards.
89 (4) “Current significant investigative information” means:
90 (A) Investigative information that a licensing board, after a preliminary
91 inquiry that includes notification and an opportunity for the nurse to respond, if required by state
92 law, has reason to believe is not groundless and, if proved true, would indicate more than a minor
93 infraction; or (B) Investigative information that indicates that the nurse
94 represents an immediate threat to public health and safety regardless of whether the nurse has
95 been notified and had an opportunity to respond
96 (5) “Encumbrance” means a revocation or suspension of, or any limitation on, the
97 full and unrestricted practice of nursing imposed by a licensing board.
98 (6) “Home state” means the party state that is the nurse’s primary state of
99 residence.
100 (7) “Licensing board” means a party state’s regulatory body responsible for
101 issuing nurse licenses.
102 (8) “Multistate license” means a license to practice as a registered nurse (RN) or a
103 licensed practical/vocational nurse (LPN/VN) issued by a home state licensing board that
104 authorizes the licensed nurse to practice in all party states under a multistate licensure privilege.
105 (9) “Multistate licensure privilege” means a legal authorization associated with a
106 multistate license permitting the practice of nursing as either a registered nurse (RN) or a
107 licensed practical/vocational nurse (LPN/VN) in a remote state.
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108 (10) “Nurse” means RN or LPN/VN, as those terms are defined by each party
109 state’s practice laws.
110 (11) “Party state” means any state that has adopted this Compact.
111 (12) “Remote state” means a party state, other than the home state.
112 (13) “Single-state license” means a nurse license issued by a party state that
113 authorizes practice only within the issuing state and does not include a multistate licensure
114 privilege to practice in any other party state.
115 (14) “State” means a state, commonwealth, territory, or possession of the United
116 States, and the District of Columbia.
117 (15) “State practice laws” means a party state’s laws, rules, and regulations that
118 govern the practice of nursing, define the scope of nursing practice, and create the methods and
119 grounds for imposing discipline. “State practice laws” do not include requirements necessary to
120 obtain and retain a license, except for qualifications or requirements of the home state.
121 “Sec. 3. General provisions and jurisdiction.
122 (a) A multistate license to practice registered or licensed practical/vocational nursing
123 issued by a home state to a resident in that state will be recognized by each party state as
124 authorizing a nurse to practice as a registered nurse (RN) or as a licensed practical/vocational
125 nurse (LPN/VN), under a multistate licensure privilege, in each party state.
126 (b) A state must implement procedures for considering the criminal history records of
127 applicants for initial multistate license or licensure by endorsement. Such procedures shall
128 include the submission of fingerprints or other biometric-based information by applicants for the
129 purpose of obtaining an applicant’s criminal history record information from the Federal Bureau
130 of Investigation and the agency responsible for retaining that state’s criminal records.
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131 (c) Each party state shall require the following for an applicant to obtain or retain a
132 multistate license in the home state:
133 (1) Meets the home state’s qualifications for licensure or renewal of licensure, as
134 well as, all other applicable state laws;
135 (2)(A) Has graduated or is eligible to graduate from a licensing board-approved
136 RN or LPN/VN prelicensure education program; or
137 (B) Has graduated from a foreign RN or LPN/VN prelicensure education
138 program that:
139 (i) has been approved by the authorized accrediting body in the
140 applicable country, and:
141 (ii) has been verified by an independent credentials review agency
142 to be comparable to a licensing board-approved prelicensure education program.
143 (3) Has, if a graduate of a foreign prelicensure education program not taught in
144 English or if English is not the individual’s native language, successfully passed an English
145 proficiency examination that includes the components of reading, speaking, writing and
146 listening;
147 (4) Has successfully passed an NCLEX-RN® or NCLEX-PN® Examination or
148 recognized predecessor, as applicable;
149 (5) Is eligible for or holds an active, unencumbered license;
150 (6) Has submitted, in connection with an application for initial licensure or
151 licensure by endorsement, fingerprints or other biometric data for the purpose of obtaining
152 criminal history record information from the Federal Bureau of Investigation and the agency
153 responsible for retaining that state’s criminal records;
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154 (7) Has not been convicted or found guilty, or has entered into an agreed
155 disposition, of a felony offense under applicable state or federal criminal law;
156 (8) Has not been convicted or found guilty, or has entered into an agreed
157 disposition, of a misdemeanor offense related to the practice of nursing as determined on a case-
158 by-case basis;
159 (9) Is not currently enrolled in an alternative program;
160 (10) Is subject to self-disclosure requirements regarding current participation in an
161 alternative program; and
162 (11) Has a valid United States Social Security number.
163 (d) All party states shall be authorized, in accordance with existing state due process law,
164 to take adverse action against a nurse’s multistate licensure privilege such as revocation,
165 suspension, probation or any other action that affects a nurse’s authorization to practice under a
166 multistate licensure privilege, including cease and desist actions. If a party state takes such
167 action, it shall promptly notify the administrator of the coordinated licensure information system.
168 The administrator of the coordinated licensure information system shall promptly notify the
169 home state of any such actions by remote states.
170 (e) A nurse practicing in a party state must comply with the state practice laws of the
171 state in which the client is located at the time service is provided.
172 (1) The practice of nursing is not limited to patient care, but shall include all
173 nursing practice as defined by the state practice laws of the party state in which the client is
174 located.
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175 (2) The practice of nursing in a party state under a multistate licensure privilege
176 will subject a nurse to the jurisdiction of the licensing board, the courts and the laws of the party
177 state in which the client is located at the time service is provided.
178 (f) Individuals not residing in a party state shall continue to be able to apply for a party
179 state’s single- state license as provided under the laws of each party state. However, the single-
180 state license granted to these individuals will not be recognized as granting the privilege to
181 practice nursing in any other party state. Nothing in this Compact shall affect the requirements
182 established by a party state for the issuance of a single-state license.
183 (g) Any nurse holding a home state multistate license, on the effective date of this
184 Compact, may retain and renew the multistate license issued by the nurse’s then-current home
185 state, provided that:
186 (1) A nurse, who changes primary state of residence after this Compact’s effective
187 date, must meet all applicable Section 3(c) requirements to obtain a multistate license from a new
188 home state.
189 (2) A nurse who fails to satisfy the multistate licensure requirements in Section
190 3(c) due to a disqualifying event occurring after this Compact’s effective date shall be ineligible
191 to retain or renew a multistate license, and the nurse’s multistate license shall be revoked or
192 deactivated in accordance with applicable rules adopted by the Interstate Commission of Nurse
193 Licensure Compact Administrators (“Commission”).
194 “Sec. 4. Applications for licensure in a party state.
195 (a) Upon application for a multistate license, the licensing board in the issuing party state
196 shall ascertain, through the coordinated licensure information system, whether the applicant has
197 ever held, or is the holder of, a license issued by any other state, whether there are any
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198 encumbrances on any license or multistate licensure privilege held by