DOLORES LITTLE, MN, RN, a nursing supervisor at the University of Washington Hospital, had just completed her master's degree when she wrote the award winning film Mrs. Reynolds Needs a Nurse in 1963. It documented a case study of an elderly lady who was transferred to the university hospital in multisystem failure, accompanied by her husband and multiple suitcases of her belongings. Mrs Reynolds was a needy and demanding patient whose fears and anxieties were expressed by her annoying attempts to get attention, treating the nurses like servants and complaining about much of the care given to her. Mrs Reynolds' 8-month-long hospitalization showcased the importance of individualizing care, being aware of both emotional and physical needs, collaborating with other disciplines, and it demonstrated the nurse's role as a patient advocate with clinical competencies that were an early version of today's case managers.1

Recently, a nursing colleague who lives in the Northwest was notified by an East Coast hospital that she was designated as a surrogate on the Durable Power of Attorney for Healthcare (DPOAH) for her cousin, whom she had not seen in years. The cousin had been admitted with end-stage 4 metastatic cancer. Unfortunately, the cousin had avoided discussing the severity of her illness and her DPOAH and "living will" decisions with her husband and her daughter. Neither were health care professionals, and both were stunned by the deteriorating clinical situation they were now experiencing. The nursing colleague flew to the hospital to assess the situation. Over the following week, she met with nurses and physicians, prompted a family conference, coordinated care decisions, followed the living will, facilitated family counselor referrals, chose a hospice care facility, helped transfer her cousin, and assisted the husband to make future funeral arrangements. Upon her return home after a week, she stated that she understood her cousin's decision. She was the only nurse in the family and she was perfectly positioned to understand and manage the situation, to help guide the shocked and grieving husband and daughter through complex decisions, and to interface with an extremely busy hospital staff to help facilitate care. She was also comforted using her nursing knowledge and interacting with others as a nurse because she was in a nurse licensure compact state, so she was professionally recognized as a nurse, although she was not employed as a nurse.

Both of these are examples of the complexity of nursing practice and they serve to demonstrate that managing patients along the continuum of care has existed for decades, but today it has moved beyond the hospital into the community and home. Being required to use nationally vetted standards of care, safety standards, reportable indicators, and progressive regulations that impact the length of stay, patient placement and payment amounts are contemporary health care challenges, but they do provide some measure of consistency in care across the states. Care responsibility continues to shift to patient self-care or family care using community-based services that often cross state borders with actual services or telehealth alternatives.

To help nurses meet mobile care and cross-border demands, nursing regulation responded. The Nurse License Compact (NLC) was launched by the National Council of State Boards of Nursing (NCSBN) in 2000.2 It was an initiative to facilitate nurse mobility that resulted in positively impacting patient access to nursing care. To date, 25 states have enacted NLC legislation that is based on NCSBN model statute and rule language agreed to by the member boards of nursing of NCSBN. The NLC allows nurses who are licensed in their home state of residence on a compact RN license to temporarily practice as an RN in a compact participating state using the home state license and a compact privilege. The common understandable framework for this methodology is a US driving license. People can have a driving license in their state of residence and they are allowed to drive in all other states on the basis of having a valid state-based license.

Not every nurse licensed in an individual state will have a compact license. A nurse can still receive a single-state license to practice in his or her home state even if the state commonly issues a compact license. This occurs when the individual nurse does not meet the criteria to receive a multistate license. An example is a nurse who has a previous felony conviction, even in the distant past. Some states have a lifetime restriction on issuing a license to convicted felons, whereas other states evaluate the situation on a case-by-case basis and may issue a state-based license to practice.

Individual nurse mobility benefitted from the compact, but by 2010, participation in the compact was stagnant, with no additional states planning to join. Thus, NCSBN reevaluated the existing compact rules and a national workgroup restructured participation requirements to increase opportunities for states to participate in the NLC. Some state nursing associations have historically lobbied against NLC participation in their states for a variety of reasons. Some states could not join because the board of nursing did not have legal authority to meet all of the NLC requirements of participation, such as fingerprinting, criminal background checking, and releasing or sharing information to other boards.

In 2015, the NCSBN approved updated compact participation language to meet the needs of a greater number of states and to encourage more widespread participation in the NLC. To participate in the updated NLC, all states must update their compact statute language and the supporting rule and regulation language. Nursing administrators can obtain details of the compact status in individual states by visiting the board of nursing Web sites or by discussing NLC criteria with a board of nursing compact administrator. This is particularly important for nursing administrators who employ travel nurses or who have facilities near borders with employees living in another state.

Managing the regulatory complexities of today's continuum of care impact nurses' work and include many legal aspects such as consents, HIPPA, DPOA, and living wills that did not exist for Mrs Reynolds. Navigating these complexities can be as challenging to nurses as managing the complexities of clinical care, but nurses are well placed to impact these challenges and to manage the continuum.

Mrs. Reynolds Needs a Nurse became a nursing film classic and was part of many nursing school's regular curriculum for many years. Once an observer gets past the nursing uniform dress of the early 1960s, the film's message remains timeless for the nursing profession. Nursing duties, skills, care models, and outcome expectations have been renamed and re-dressed many times over the years. Today, nurses have a wide scope of practice that is basically consistent from state to state and they impact care in many venues. Despite the passage of time and our technological advances, the film's underlying message has remained applicable-Mrs Reynolds needed a nurse.

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