These and similar state statutes present formidable obstacles for medical call centers. If a court determines that the nurses' activities amounts to the practice of medicine, the nurses and perhaps their employers could be subject to civil and criminal penalties for practicing medicine without a license. Call centers have devised several strategies for dealing with this problem. Even this careful regulation of the call centers leaves many legal questions unanswered. The situation is further complicated by the fact that nursing duties have expanded greatly in recent years, and the limits of the authority of nurses are increasingly unclear.
Additional issues arise when nurses give advice to callers in different states.
As outlined above, health providers may risk sanctions by rendering services to a patient in a state where the health provider is not licensed. Until the states, with the assistance of the Federation of State Medical Boards and federal agencies, clarify licensing requirements for telemedicine projects, call centers would be wise to ensure that nurses are licensed in all of the jurisdictions in which they could be considered to be practicing. Even if nurses are licensed to practice in other states, they may risk sanctions by taking calls from patients in such other states. Each state has a different definition of what constitutes the practice of medicine and practice of nursing. Call centers should also ensure that nurses assisting callers from other states are authorized to provide such services under all applicable state laws.