Nurse Licensure Compact States and Telephone Triage
A triage nurse must be licensed where your patient is located — not where the nurse or your practice sits. Here is which states are in the Nurse Licensure Compact, which are not, and what that means for an after-hours nurse triage service.
Last verified October 14, 2026 against the NurseCompact.com status map.
Clinically reviewed by Amber Girard, RN, Founder & CEO · Reviewed October 2026
jurisdictions have enacted the NLC
states have implemented it (multistate license valid)
enacted but awaiting implementation (MA, Guam, USVI)
PCTS covers all 50 states and the District of Columbia
Why the patient's state is what counts
Telephone triage is nursing practice: the nurse assesses symptoms and advises the patient on what to do next. Nursing regulators treat that care as taking place where the patient is located at the time of the call. So a nurse working from home in Arizona who triages a patient in Ohio must be licensed to practice in Ohio.
The Nurse Licensure Compact makes this manageable. A nurse whose home state is a compact state can hold one multistate license and practice in every other state that has implemented the compact — including over the phone.
States outside the compact
Ten jurisdictions are not in the compact: Alaska, California, Hawaii, Illinois, Michigan, Minnesota, Nevada, New York, Oregon and the District of Columbia. Massachusetts has enacted it but not yet implemented it. A multistate license does not authorize triage for patients located in any of them; the nurse needs that state's own license. That matters for practices in those states and for national groups with patients across state lines.
PCTS RNs hold individual licenses in every one of these jurisdictions alongside compact licenses, so one triage service can cover your patients in all 50 states and the District of Columbia.
Compact status by state
Implemented — multistate license valid (40 states)
| State | NLC implemented |
|---|---|
| Alabama | Jan. 1, 2020 |
| Arizona | Jan. 19, 2018 |
| Arkansas | Jan. 19, 2018 |
| Colorado | Jan. 19, 2018 |
| Connecticut | Oct. 1, 2025 |
| Delaware | Jan. 19, 2018 |
| Florida | Jan. 19, 2018 |
| Georgia | Jan. 19, 2018 |
| Idaho | Jan. 19, 2018 |
| Indiana | July 1, 2020 |
| Iowa | Jan. 19, 2018 |
| Kansas | July 1, 2019 |
| Kentucky | Jan. 19, 2018 |
| Louisiana | July 1, 2019 |
| Maine | Jan. 19, 2018 |
| Maryland | Jan. 19, 2018 |
| Mississippi | Jan. 19, 2018 |
| Missouri | Jan. 19, 2018 |
| Montana | Jan. 19, 2018 |
| Nebraska | Jan. 19, 2018 |
| New Hampshire | Jan. 19, 2018 |
| New Jersey | Nov. 15, 2021 |
| New Mexico | Jan. 19, 2018 |
| North Carolina | Jan. 19, 2018 |
| North Dakota | Jan. 19, 2018 |
| Ohio | Jan. 1, 2023 |
| Oklahoma | Jan. 19, 2018 |
| Pennsylvania | July 7, 2025 |
| Rhode Island | Jan. 8, 2024 |
| South Carolina | Jan. 19, 2018 |
| South Dakota | Jan. 19, 2018 |
| Tennessee | Jan. 19, 2018 |
| Texas | Jan. 19, 2018 |
| Utah | Jan. 19, 2018 |
| Vermont | Feb. 1, 2022 |
| Virginia | Jan. 19, 2018 |
| Washington | Jan. 31, 2024 |
| West Virginia | Jan. 19, 2018 |
| Wisconsin | Jan. 19, 2018 |
| Wyoming | Jan. 19, 2018 |
Enacted, awaiting implementation
- Massachusetts
- Guam
- U.S. Virgin Islands
A compact license is not valid here until implementation is complete. Massachusetts details.
Not in the compact
A state license is required. PCTS RNs hold licenses in each of these.
What to ask a nurse triage vendor about licensure
- Which states are your nurses licensed in, and how do you make sure each call goes to a nurse licensed in the patient's state?
- Do you cover non-compact states where we have patients, such as California, New York or Illinois?
- How do you handle patients who call while traveling in another state?
Licensure and telephone triage: common questions
Does a triage nurse need a license in the patient's state?
Yes. Under the Nurse Licensure Compact and state nursing law, nursing practice happens where the patient is located at the time of the call. A nurse giving telephone triage advice to a patient in Texas must hold a Texas license or a multistate compact license; a patient in California requires a California license.
How many states are in the Nurse Licensure Compact?
As of our last check (October 14, 2026), 43 jurisdictions have enacted the NLC. 40 states have implemented it, so a multistate license is valid there. Massachusetts has enacted the compact but has not yet implemented it, along with Guam and the U.S. Virgin Islands.
Are California and Oregon in the compact?
No. California and Oregon are not Nurse Licensure Compact states, so nurses need a California or Oregon license to triage patients located there. PCTS RNs hold California and Oregon licenses in addition to compact licenses.
Which states does PCTS cover?
All 50 states and the District of Columbia. PCTS RNs hold multistate compact licenses for the 40 implemented compact states and individual state licenses for every jurisdiction outside the compact: Alaska, California, Hawaii, Illinois, Massachusetts (until its compact implementation is complete), Michigan, Minnesota, Nevada, New York, Oregon and the District of Columbia.
How does a triage service cover a non-compact state?
Through individual licenses. A compact license does not authorize practice in a non-compact state, so a service covering patients in, say, New York or Illinois needs nurses who hold a New York or Illinois license, and must route those patients' calls to them. Ask any vendor how that routing works.
This guide summarizes publicly available licensure information for practice administrators and is not legal advice. Compact status changes; confirm current status at NurseCompact.com and with the relevant board of nursing.
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