The COVID-19 pandemic accelerated the adoption of telehealth, transforming how healthcare services are delivered. What started as a temporary solution is now a permanent feature of the medical landscape, and nurses are at the forefront of this shift. Telehealth nursing allows Registered Nurses (RNs) to deliver care remotely—monitoring vitals, conducting consultations, managing chronic diseases, and supporting mental health.
But before you switch from in-person to digital care, it’s essential to understand the licensing requirements for telehealth nurses. Because you’re providing care across state lines, the rules are different—and sometimes confusing.
In this guide, we break down what RNs need to know about telehealth licensure, state regulations, and how to unlock exciting career opportunities in this growing field.
What is Telehealth Nursing?
Telehealth nursing (also called telenursing) involves providing nursing services via phone, video, and other digital platforms. This includes:
- Assessing symptoms
- Conducting remote triage
- Patient education and follow-ups
- Chronic care management
- Behavioral health check-ins
- Care coordination and case management
- Telehealth expands access to care, especially for patients in rural, underserved, or mobility-restricted environments.
Why Licensing Matters in Telehealth
In traditional settings, nurses are licensed by the state where they physically work. In telehealth, the key legal principle is that you must be licensed in the state where the patient is located at the time of care—even if you’re working remotely.
So if you’re based in Texas and providing telehealth care to a patient in Illinois, you must be licensed in Illinois, regardless of where your employer is headquartered or where you live.
Licensing Scenarios in Telehealth
How the Nurse Licensure Compact (NLC) Helps
The NLC allows nurses to practice in other compact states with a single multi-state license. This is ideal for telehealth because:
- You can care for patients in all NLC states with one license.
- You only need to maintain one primary license (in your state of residence).
- Great for nationwide telehealth employers who prioritize NLC-licensed RNs.
As of 2025, 40+ states are part of the NLC, including Texas, Florida, Georgia, North Carolina, and Missouri.
Non-Compact States (require separate licenses):
- California
- New York
- Oregon
- Washington
- Nevada
- Hawaii
Licensing Requirements for Telehealth Nurses
1. Valid RN License in Patient’s State
This can be a compact license (if both states are NLC members) or a single-state license obtained via endorsement.
2. State-Specific Rules
Some states have additional requirements, including:
- Continuing education (e.g., New York mandates infection control)
- Jurisprudence exams (Texas)
- Telehealth regulations for scope of practice
- Always check the Board of Nursing (BON) for the patient's state.
3. HIPAA & Data Security Compliance
You must use secure platforms that comply with HIPAA and protect patient confidentiality.
Steps to Get Licensed for Telehealth Practice
Step 1: Identify Your Target States
Where do your patients live? Identify all current and potential states you’ll be serving.
Step 2: Check NLC Eligibility
- If your home state is in the NLC, apply for a compact license.
- If not, prepare to apply for licensure by endorsement in each required state.
Step 3: Apply for Licenses
Follow each state's process:
- Submit applications via the state’s BON
- Complete background checks and fingerprinting
- Provide license verification (usually via Nursys)
- Pay application and renewal fees
Step 4: Stay Current
- Track renewal dates and CEU requirements for each license.
- Use Nursys e-Notify to get renewal reminders.
Top Opportunities in Telehealth Nursing
Telehealth is growing rapidly across various specialties. Here are some high-demand roles:
Chronic Disease Management
Diabetes, hypertension, and heart failure patients benefit from remote monitoring.
Behavioral Health & Psychiatry
Mental health nursing via telehealth is expanding due to high demand and accessibility.
Triage & Care Coordination
Telehealth nurses help patients determine care needs and reduce unnecessary ER visits.
Post-Discharge Follow-Up
Nurses can check on medication adherence, wound care, or symptoms after a procedure.
Remote Patient Monitoring (RPM)
Using wearable devices and apps, nurses track real-time vitals and trends.
Telehealth Nursing Salary and Job Outlook
Telehealth nursing is one of the fastest-growing fields. According to recent industry surveys:
- Average salary: $75,000–$100,000+ depending on location, experience, and employer
- Flexible schedules and remote work options
High demand in:
- Behavioral health
- Rural health systems
- Direct-to-consumer platforms (e.g., Teladoc, Amwell, MDLIVE)
Telehealth Licensing Challenges
Multiple Licenses = More Paperwork
RNs must track CEUs, fees, and renewal timelines for every non-NLC license they hold.
Slow State Processing
Licensure by endorsement can take weeks or months—plan ahead.
Changing Telehealth Laws
Some states are still adjusting laws post-pandemic. Stay updated through each state BON.
Best Practices for Multi-State Telehealth Licensure
- Maintain a license tracking spreadsheet or use platforms like CE Broker or Nurse.com.
- Enroll in Nursys e-Notify to receive alerts.
- Use HIPAA-compliant video platforms (e.g., Doxy.me, Zoom for Healthcare).
- Work with an agency or employer that helps with licensing logistics.
- Stay current on state and federal telehealth regulations.
FAQs About Telehealth Nursing Licensure
1. Do I need a license in every state where I provide telehealth care?
Yes, unless you're using an NLC multi-state license and practicing only in compact states.
2. Can I get a temporary license for telehealth?
Some states offer temporary or emergency licenses, especially during public health emergencies. Check individual BONs.
3. Are there special telehealth certifications for nurses?
While not required, certifications like Telehealth Nursing Certification (TNC) or American Academy of Ambulatory Care Nursing (AAACN) credentials can boost your résumé.
4. Can I practice telehealth across state lines?
Yes, if you're licensed in a compact state and your primary residence is in that state, you can practice telehealth in other compact states. However, you must comply with the nursing practice laws of the state where the patient is located during a telehealth session
Telehealth nursing offers flexibility, autonomy, and the chance to make a wide-reaching impact—but it comes with unique licensing responsibilities. Understanding the state-by-state requirements and leveraging the Nurse Licensure Compact can help streamline your practice across borders.
By staying organized, choosing the right employers, and keeping all licenses current, you can thrive in this high-growth field without the stress of paperwork holding you back.
Let DirectShifts Help You with Telehealth Licensing
At DirectShifts, we specialize in multi-state licensing for telehealth RNs. Whether you're launching a remote career or scaling your telehealth practice, we take care of:
License verification and applications
- NLC guidance
- Endorsement and renewals
- Document management
Looking for your next nursing position? DirectShifts offers a variety of job openings just for you. Explore the latest opportunities in nursing today!
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