An APRN Compact for nurse practitioners does exist on paper, but it is not yet active. Unlike the Nurse Licensure Compact (NLC) that allows registered nurses to practice across 43 states with a single license, the APRN Compact has not reached the seven-state threshold needed to take effect. As of the most recent count, only four states have enacted the APRN Compact into law: Delaware, North Dakota, Utah, and South Dakota. Until at least three more states sign on, nurse practitioners must hold a separate license in every state where they practice.
How the APRN Compact Differs From the Nurse Licensure Compact
The Nurse Licensure Compact is well established. It covers RNs and LPNs/VNs, and 43 states have enacted it, with Connecticut and Pennsylvania joining in 2025. Many nurse practitioners already hold a multistate RN license through the NLC and assume it extends to their advanced practice role. It does not. The NLC explicitly does not apply to APRN practice, which includes nurse practitioners, certified nurse midwives, clinical nurse specialists, and certified registered nurse anesthetists.
The APRN Compact was designed to fill that gap. Modeled after the NLC, it would let a nurse practitioner hold one multistate APRN license in their home state and practice in any other compact state without obtaining additional licenses. The first APRN Compact bills were introduced in state legislatures in early 2021, and the four states that have enacted it so far did so between 2021 and 2023. Progress has been slow compared to the NLC, which took years to build momentum before reaching critical mass.
Why It Needs Seven States to Launch
The APRN Compact includes a built-in activation rule: it becomes operational only after seven state legislatures have enacted it into law. This threshold exists to ensure enough geographic coverage for the compact to function as a meaningful interstate agreement. With four states currently on board, the compact needs three more before any multistate APRN licenses can be issued. No timeline has been set for when that might happen, as it depends entirely on individual state legislative sessions.
What This Means for Telehealth
The lack of an active APRN Compact creates a significant barrier for nurse practitioners who provide telehealth across state lines. The rule is straightforward: you must be licensed in the state where your patient is physically located, not the state where you are sitting. If you’re a nurse practitioner in Virginia seeing a patient in California via video, you need a California APRN license.
This gets more complicated because states vary widely in how much independence they grant nurse practitioners. Some states allow full practice authority, meaning NPs can evaluate, diagnose, and prescribe without physician oversight. Other states require supervision, collaboration agreements, or practice agreements with a physician. If you hold a license in a full practice authority state but your telehealth patient is in a restricted state, you must follow the restricted state’s rules, including any requirements for physician collaboration. Knowing the nurse practice act in every state where your patients live is essential for legal compliance.
What NPs Must Do Right Now
Until the APRN Compact activates, nurse practitioners who want to work in multiple states have one option: apply for a separate APRN license in each state. This means submitting individual applications through each state’s board of nursing, paying separate fees (which vary by state), and maintaining each license independently with its own renewal cycle and continuing education requirements. For NPs working with staffing agencies, doing locum tenens work, or running a multistate telehealth practice, the cost and administrative burden add up quickly.
Each state application typically requires verification of your national certification, graduate transcripts, and proof of current licensure in other states. Processing times range from a few weeks to several months depending on the state. Some states also require additional documentation like collaborative practice agreements before they will issue the license.
How the Compact Would Work Once Active
When the APRN Compact eventually reaches its seven-state threshold, it will work similarly to the existing NLC. Your home state, called your Primary State of Residence (PSOR), would issue your multistate APRN license. Your PSOR is determined by where you legally reside, based on your driver’s license, voter registration, and the state listed on your federal tax return. It has nothing to do with where you own property, and you can only have one PSOR.
With a multistate APRN license, you would be able to practice in any other state that has also enacted the compact, without applying for an additional license there. You would still need to follow the laws and scope of practice rules in whichever state you’re practicing in at any given time. A compact license removes the licensing barrier but does not override individual state practice regulations.
States to Watch
The four states that have enacted the APRN Compact so far (Delaware, North Dakota, Utah, and South Dakota) are all relatively small in population. For the compact to have broad practical impact, it will need adoption by larger states with more NPs. Several states have introduced APRN Compact bills in recent legislative sessions, though none beyond the original four have completed the enactment process. If you practice in one of the four enacted states, your state is ready, but the compact will not function until three more join.
NPs who want to track legislative progress can monitor updates through the National Council of State Boards of Nursing, which administers both the NLC and the APRN Compact, at aprncompact.com.