Interstate compact: Answers to your frequently asked questions and a checklist for every practitioner

What is the Interstate Compact?

 
Just like your state driver’s license means you can drive anywhere; the interstate compact allows licensed practitioners to work in multiple states. With a clinical license in a participating interstate compact state, providers can work in person or over telemedicine across borders in dozens of other states. It’s part of what makes travel nursing so popular and gives citizens in rural counties access to significantly more providers over telehealth.

The interstate compact also gives states access to more clinicians when needed, which was crucial during COVID-19 surges in specific U.S. geographical areas.

Which Healthcare Disciplines Do Interstate Compacts Apply to?

 
Interstate compacts apply to the following healthcare disciplines:

• Nurses and nurse practitioners
• Occupational therapists
• Speech therapists
• Physical therapists
• Dental hygienists
• Mental health therapists
• And more

Utah recently passed legislation to participate in an interstate compact for physician associates (also known as physician assistants), pending approval by seven other states.

Licensure training and national testing in every discipline are the same, says Gigi Avecedo-Parker, a nurse practitioner and licensed attorney who is HUB International’s national clinical risk management leader in the risk services division. Some nuances make practicing in one state different from another, but these are usually minor and easy to understand by reviewing each state’s policies and procedures. The interstate compact benefits healthcare organizations, clinicians and patients.

“Since COVID, more states are voting to join a compact licensure because of the increase of telehealth, as well as the critical nursing shortage,” says Acevedo-Parker.

Are There Any Downsides to the Interstate Compact?

 
While the interstate compact widens practitioners’ access to opportunities across state lines, it also opens clinicians up to more risk.

You must know how to manage those risks and ensure you aren’t liable for unintentional wrongdoing while working in a state outside of your license. Read our checklist to learn what you need about the interstate compact.

Interstate Compact Checklist for Practitioners

1. Check if your state license is part of the interstate compact.
   • Check your board of licensure online to see if your license gives you access to work in other states as part of the interstate compact. Each board maintains an updated list of states participating in the interstate compact.
   • Check back for revisions annually. States can choose to withdraw from the interstate compact at any time.
2.  Get licensed in a state that gives you access to the interstate compact.
   • For clinicians not licensed in a state that is part of the interstate compact, becoming licensed in another state to work there is not difficult. The process takes about a month. It typically requires the following:
   • If your new state license participates in the interstate compact, this gives you immediate access to work in any state that is part of the compact.
     • Some coursework – often on the topic of ethics
     • Registration forms
     • License fee payment
     • Fingerprinting, which can be done from your home state
3. Get additional licenses in states where you plan to work privately across state lines
   • If you plan to practice privately in another state, Acevedo-Parker recommends getting licensed there, even if your home state license gives you access to the interstate compact. Without the support of a hospital network or corporate entity, the onus is on you to remain compliant.
   • Obtaining state licensure ensures you’ll be notified electronically and by mail whenever care policies and procedures change or additional training is necessary. Plus, handling issues like how to activate an emergency response and prevent someone from self-harm are more likely to arise in a telemedicine private practice than in a hospital. “If you know you’re going to be practicing independently across state lines, it doesn’t hurt to get some additional layers of protection by being a practitioner under that state,” says Acevedo-Parker.
4. Review the professional practice guidelines for the board of your discipline.
   • Even when a placement agency, such as a travel nursing firm, helps match you with a job in a new state, it’s your responsibility to understand any nuances of care there. Every licensure board lists the rules and regulations for practicing in each state. Before working in a new state under the interstate compact, understand any state-specific policies and procedures. Reach out directly to the state’s licensure board for any clarification.
   • Reminder: The burden of liability is on you as the practitioner.
5. Ensure your new employer gives you proper training – especially when your position is temporary.
   • Just because you are working in a healthcare facility temporarily doesn’t exempt you from knowing and abiding by the organization’s and state’s rules and regulations. Acevedo-Parker recommends asking your new employer directly if your training matches an employee’s training. If it’s different – two hours instead of two days – ask why. “Know the differences and then evaluate whether you feel comfortable,” she says. Training is crucial to avoiding unnecessary mistakes, like what resulted in the conviction of a Vanderbilt Hospital ICU nurse after a medical error that led to the death of her patient in May 2022. The American Academy of Nurses released a statement supporting the nurse, saying, “We are deeply distressed by this verdict and the harmful ramifications of criminalizing the honest reporting of mistakes. Healthcare delivery is highly complex. It is inevitable that mistakes will happen, and systems will fail. It is completely unrealistic to think otherwise.”
   • While every healthcare organization sets up guardrails to prevent medical errors, they still occur. The Vanderbilt case highlighted how high the stakes are when a clinician makes a mistake. It is also a stark reminder for practitioners that the liability burden falls upon them.
   • Once you’re working in a new state, be sure to ask questions to appropriate leadership when they arise. If you see other practitioners in the same discipline doing anything different from the way you practice, stop and go to the appropriate leadership to ask about it.
6. Self-assess your ability
   • Acevedo-Parker warns that just because your license allows you to work in a specific role doesn’t mean you can do that work.
   • Post-COVID, hospitals and senior care centers desperately recruit practitioners to return to the bedside at hard-to-resist wages. For clinicians in management positions or those who haven’t worked in many years, Acevedo-Parker recommends considering whether you feel comfortable still doing that level of practice before returning to the frontlines. “Every practitioner must evaluate their competency above and beyond what state licensure says.”
   • Instead, she recommends retraining and refreshing before returning to work at the bedside. “If something happens, it will be hard in litigation to say you didn’t know how to use some equipment because everything changed in 20 years.”
7. Get professional liability insurance
   • Whether you’re practicing across state lines over telehealth or moving to a new state to practice under your original license as part of the interstate compact, professional liability insurance includes malpractice coverage for all patient care delivery methods as long as they are within the scope of practice according to relevant state laws.
   • Learn more about CM&F Group’s professional liability insurance.

Gigi Acevedo-Parker, EJD, MSN, APN, RN, PMHNCNS-BC, HCRM, CPS, is HUB’s National Clinical Risk Management Leader, Risk Services Healthcare Vertical Lead, Risk Services Division and an advanced practice nurse with clinical specialty in psychiatry/behavioral health.