Research evidence on the use of licensure compacts to facilitate mobility and modern health care delivery while assuring public protection

Nursing in Europe is shaped by a complex interplay of demographic, social, and institutional factors that directly affect both the sustainability of health systems and the quality of care provided. A central issue concerns the attractiveness of the nursing profession and its selection by younger generations, particularly within a context of pronounced demographic ageing. The shrinking of the active population, combined with increasing demand for healthcare services, intensifies staffing pressures and positions nursing as a critical determinant of health system resilience. At the same time, European health systems are transitioning from a model primarily focused on acute care toward one centered on the management of chronic conditions and long-term care needs. This shift significantly elevates the importance of a strong nursing presence, particularly in primary and community care. Continuous patient monitoring, the management of multimorbidity, and support for self-care render the role of nurses pivotal to the effectiveness and sustainability of health services. Issues of professional mobility and regulatory frameworks also emerge as decisive factors. In the international context, examples such as the United States illustrate how state-based licensure systems may act as barriers to professional mobility, particularly during crises or in the expansion of telehealth. The adoption of interstate or interregional agreements, such as professional compacts, has contributed to reducing administrative barriers, with nursing demonstrating faster and broader implementation of such mechanisms compared to other health professions. Within the European framework, mutual recognition of professional qualifications represents a significant step toward facilitating mobility. However, practical implementation remains uneven and requires further harmonization and maturation in order to ensure quality of care and public protection. The need for a “next generation” of regulatory arrangements becomes evident, with an emphasis on integrating technology, telehealth, and clear indicators for assessing impact on safety, continuity, and quality of care. In this context, the importance of systematic data collection and analysis related to professional mobility, service delivery impacts, and patient outcomes is highlighted. Mapping regulatory gaps—particularly in areas related to digital health—and conducting comparative analyses of international models can contribute to the identification of best practices without undermining existing institutional frameworks. At the same time, enhancing the attractiveness of the profession through targeted recruitment and retention policies is recognized as a prerequisite for addressing the future challenges of European nursing.