Licensure follows the patient
The location that matters for telehealth is generally the patient’s, not yours. Sitting in one state and caring for a patient in Guam generally means you need authority to practice in Guam — via compact privilege or a Guam license. See telehealth: patient in another state.
The law that governs this in Guam
Caring for a patient located in Guam is practice in Guam, so it is Guam’s own nurse practice act that defines what you may do and the Guam Board of Nurse Examiners that applies it. That act is Guam nursing licensure law (Guam Board of Nurse Examiners, HPLO).
The compact itself is separate law. Guam adopted it at 10 GCA ch. 12, art. 3A (Nurse Licensure Compact); added by P.L. 36-006:1 (5 March 2021), which is what allows a multistate license issued elsewhere to reach Guam at all — the practice act still decides what you may do once it does.
Compact status is not the only consideration
Even where a multistate license reaches Guam, your employer and the Guam Board of Nurse Examiners may impose additional requirements, and some roles carry their own rules. Compact status answers one question — it is not a blanket authorization to practice remotely.
APRN telehealth is separate
The compact covers RN and LPN/LVN licenses only. If you work as an APRN, your advanced-practice authority is granted state by state and is not carried by a multistate RN license — a point that catches out a lot of remote NP roles.
Compact privilege in Guam
Nurses holding another state’s multistate license may practice in Guam under compact privilege. We have not been able to confirm the date that started, so we do not print one — Guam has implemented the half of the compact that recognizes visiting nurses without completing the half that issues multistate licenses to its own residents, and the jurisdiction has published no clean date for the first. The Guam Board of Nurse Examiners is the authority if you need one.
The compact statute in Guam: Read off the compiled article published by Guam’s own Health Professional Licensing Office, headed “10 GCA Health and Safety, Ch. 12 Medical Practices” and sourced to P.L. 36-006:1. Guam did something almost no other jurisdiction did: it legislated ONGOING MEASUREMENT of the compact alongside joining it. P.L. 36-006 requires the Board of Nurse Examiners to report quarterly to the licensing office how many nurses hold a multistate license issued by Guam and how many licensed by other compact jurisdictions are working here, and to file an annual fiscal impact report on licensure fee revenue and operating costs with the Speaker. Most compact statutes are silent on what joining costs or achieves.