Understanding Which States Allow Online RN Practice for Telehealth Services
- blabla190
- Dec 30, 2025
- 4 min read
Nursing professionals increasingly use telehealth to provide care remotely. Registered Nurses (RNs) can offer valuable services through online platforms, improving access to healthcare for many patients. However, the ability to practice as an RN via telehealth depends heavily on state regulations. Knowing where you can legally provide online nursing care is essential to avoid legal issues and ensure quality patient care.
This post explains which states allow RNs to practice online, the restrictions involved, and practical tips for navigating telehealth nursing across state lines.
How State Licensure Affects Online RN Practice
Each state in the U.S. regulates nursing practice through its Board of Nursing. These boards set the rules for licensure, scope of practice, and telehealth services. Unlike physicians, RNs do not have a national license that covers all states. Instead, they must hold a valid license in the state where the patient is located at the time of care.
This means:
If you are licensed in State A but your patient is in State B, you generally need a license in State B to provide online care.
Some states participate in the Nurse Licensure Compact (NLC), which allows nurses to practice in multiple states with one license.
States not in the NLC require separate licenses for each state where you provide care.
Understanding these rules helps RNs avoid unintentional violations and ensures patients receive care from properly licensed professionals.
States Participating in the Nurse Licensure Compact
The Nurse Licensure Compact simplifies telehealth nursing by allowing RNs to hold one multistate license valid in all member states. As of 2024, 39 states participate in the NLC. Since I hold an active RN license in the state of Arizona, I can practice nursing in the following states:
Alabama
Arizona
Arkansas
Colorado
Delaware
Florida
Georgia
Idaho
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Mississippi
Missouri
Montana
Nebraska
New Hampshire
New Jersey
New Mexico
North Carolina
North Dakota
Ohio
Oklahoma
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Pennsylvania (fully implemented July 7, 2025)
Connecticut (fully implemented October 1, 2025) NurseZee
Important: The NLC applies only to RNs practicing in states that are members of the compact. If your patient is in a non-compact state, you must have a license in that state.
States That Do Not Allow Online RN Practice Without a Local License
Several states do not participate in the Nurse Licensure Compact and require RNs to hold a license issued by their Board of Nursing to provide telehealth services.
❌ States that are not part of the Nurse Licensure Compact (NLC)
These states currently do not participate in the compact: Expert Nurse Consultants+1
Alaska
California
District of Columbia (DC)
Hawaii
Illinois
Massachusetts (has enacted NLC but is still implementing as of 2025 — not yet active)
Michigan
Minnesota
Nevada
New York
Oregon
Non-participating states mean your Arizona compact license won’t give you automatic practice privileges there —I am not licensed there as an RN and cannot provide RN services to residents of that state while in that state.
Special Considerations for Telehealth Nursing
When practicing as an RN online, consider these factors:
Scope of Practice: Telehealth nursing must comply with the scope of practice defined by the state. Some states limit what RNs can do remotely, such as restrictions on assessments or medication administration.
Patient Location: The patient’s physical location determines which state’s laws apply. Always verify where the patient is during the consultation.
Documentation: Maintain thorough records of telehealth encounters, including patient consent for remote care.
Technology Requirements: Use secure, HIPAA-compliant platforms to protect patient privacy and data.
Emergency Protocols: Have clear plans for emergencies or situations requiring in-person care.
Examples of Telehealth RN Practice Across States
Example 1: An RN licensed in Texas (an NLC state) can provide telehealth services to patients in Florida and Arizona without additional licenses.
Example 2: An RN licensed in New York must obtain a New York license to provide telehealth care to patients in that state, even if licensed in a compact state like Ohio.
Example 3: An RN practicing from California must have a California license to provide online nursing care to California residents, regardless of where the nurse is physically located.
Tips for RNs Starting Telehealth Practice
Verify your license status and ensure it is active before offering telehealth services.
Confirm the patient’s location at the start of each session.
Use secure communication tools that comply with privacy laws.
Stay updated on state laws, as telehealth regulations are evolving.
Join professional nursing associations that provide resources on telehealth practice.
Resources for Telehealth Nursing Licensure
National Council of State Boards of Nursing (NCSBN): Provides information on the Nurse Licensure Compact and state licensing requirements.
State Boards of Nursing: Each state’s official website offers detailed licensure information.
Telehealth Resource Centers: Offer guidance on telehealth laws and best practices.
Knowing where you can legally provide online nursing care is crucial for protecting your career and your patients. The Nurse Licensure Compact offers a convenient option for many states, but several require separate licenses. By understanding state rules and planning accordingly, you can expand your telehealth practice safely and effectively.
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