October 4th Board of Nursing Meeting Agenda

The agenda for the October 4th Wisconsin Board of Nursing meeting is up on line. The Board will be discussing my complaint again after having the time since the last meeting on August 30th to read the voluminous materials that were provided to the board members by Marquette at that time. I hope the board members do not get distracted by all of the irrelevant materials that Marquette submitted and see to the heart of the issue: it is ludicrous to claim that Direct Entry students meet the legal criteria for RN licensure in Wisconsin if they have not graduated and have not been issued a degree or diploma of any kind.

As always, this meeting is open to the public. It will be held at 1400 E. Washington Avenue in Madison Wisconsin at 9 AM.

Step #10: Requests for Documentation That I Hold a "Diploma of Graduation"

The Wisconsin Department of Regulation & Licensing (DRL) continues to insist that completion of the pre-MSN phase of Marquette's Direct Entry program is sufficient for RN licensure in Wisconsin. The DRL's logic is that the "Certificate of Completion" is, in fact, a "diploma of graduation." Therefore Direct Entry students do meet the criteria for licensure in the Wisconsin Nurse Practice Act 441.04 which requires one to hold a "diploma of graduation" in order to be eligible for licensure. Even after it has been shown that the RN licensure of Marquette's Direct Entry students at the completion of the pre-MSN phase was never actually approved by the DRL or the Wisconsin Board of Nursing in the first place, they still continue to stand by their original argument. We now have a very odd set of conflicting assertions that are being held up by Marquette and the DRL:

1. Marquette adamantly and boldly proclaimed before the Board of Nursing at their meeting on August 30th that Direct Entry students are not awarded any kind of degree or diploma at the completion of the pre-MSN phase.



2. Marquette is adamant that Direct Entry students do not have graduation dates because they have not graduated from Marquette University at the completion of the pre-MSN phase of the program.



3. The DRL claims that Marquette's Direct Entry students are legally eligible for licensure in Wisconsin because a "Certificate of Completion of pre-MSN basic nursing education" is, in fact, a "diploma of graduation."

Can somebody please explain to me how it is possible that I hold a "diploma of graduation" from Marquette University, and yet I have not graduated from Marquette University nor have I been awarded any kind of degree or diploma from Marquette?

Fine. Whatever. Since the DRL and Marquette claim that this "Certificate of Completion of pre-MSN basic nursing education" is actually a "diploma of graduation," then they should not have a problem producing some documentation to this effect. I could use documentation that I hold a "diploma of graduation" from a school of nursing to appeal Mississippi's initial denial of my application for licensure here, and also for any possible future attempts to transfer my license to another state. I sent these letters out this morning requesting documentation from both the DRL and from Marquette stating that I hold a "diploma of graduation" from Marquette.
___________________________________________________

September 17, 2007

Debra J. Kraft
Interim General Counsel
Wisconsin Department of Regulation & Licensing
P.O. Box 8935
Madison, WI 53708-8935

Dear Ms. Kraft:

In your letter dated September 6, 2007 to my Father, ________, you stated that the reason that the pre-MSN part of Marquette’s Direct Entry program meets the criteria for RN licensure in Wisconsin under the Wisconsin Nurse Practice Act 441.04 is because:

the Department [of Regulation and Licensing] has determined that the Certificate of Completion awarded to students upon completion of the basic training phase of the Program by Marquette University is, in fact, a "diploma of graduation."

I request a letter from you, Debra Kraft, to me, Lydia Bertrand, stating that the "Certificate of Completion of Pre-MSN Basic Nursing Preparation" that I received from the Marquette University College of Nursing on August 13, 2005 is a "diploma of graduation" from an accredited and board-approved school of professional nursing.

Sincerely,

Lydia Bertrand
_________________________________________________

September 17, 2007

Dr. Judith Miller
Associate Dean for Graduate Programs & Research
Marquette University College of Nursing
P.O. Box 1881
Milwaukee, WI 53201-1881

Dear Dr. Miller:

A letter dated September 6, 2007 from Debra Kraft to my Father, ________, stated that the reason that the pre-MSN part of Marquette’s Direct Entry program meets the criteria for RN licensure in Wisconsin under the Wisconsin Nurse Practice Act 441.04 is because:

the Department [of Regulation and Licensing] has determined that the Certificate of Completion awarded to students upon completion of the basic training phase of the Program by Marquette University is, in fact, a "diploma of graduation."

I request a letter from you, Dr. Judith Miller, to me, Lydia Bertrand, stating that the "Certificate of Completion of Pre-MSN Basic Nursing Preparation" that I received from the Marquette University College of Nursing on August 13, 2005 is a "diploma of graduation" from an accredited and board-approved school of professional nursing.

Sincerely,

Lydia Bertrand

A Good Question

People frequently ask me why I didn't try other ways of getting a Mississippi nursing license before beginning this campaign with Marquette. The answer is that I did: I tried every other reasonable method of getting a license before I discovered that there was a legal problem with the RN licensure of Direct Entry students in Wisconsin. The following is a revised version of the answer I posted to a comment on this post detailing all of the other ways I tried to get a nursing license:

As soon as I moved to Mississippi I applied to the Mississippi Board of Nursing for a Mississippi nursing license by endorsement ("licensure by endorsement" means transferring a license from another state). My application was denied because Marquette does not provide Direct Entry students with graduation dates at the completion of the pre-MSN phase. This seemed very strange to me since Marquette did provide the Wisconsin Department of Regulation & Licensing with a graduation date on my Wisconsin RN licensure application in the form of a "Statement of Graduation." [this part of the RN licensure application in Wisconsin has since been changed to have a "direct entry" box, so Marquette no longer marks that students have earned a "BSN." While Marquette no longer lies on the licensure apps for DE students, it does not matter because "completion of a direct entry program" still does not meet the legal criteria for licensure under the Wisconsin Nurse Practice Act 441.04]

There are two ways to become licensed as an RN. The very first time you get your first license it is called "licensure by examination." You must pass NCLEX to get a license by examination. If you are transferring a license from one state to another it is called "licensure by endorsement." Ordinarily getting a license by endorsement is a rubber-stamp operation: nothing more complicated than paying some fees and filling out some paperwork with the new state Board of Nursing. Some people from the Wisconsin Department of Regulation & Licensing tried to tell my parents after the August 30th Wisconsin Board of Nursing meeting that once I practice nursing in one state, then it will be much easier to transfer my license to another state. They claimed that if I were able to get a Mississippi license by appealing Mississippi's rejection of my application, that once I practice nursing then I would not have any trouble transferring my license to another state if I move again in the future. This is completely false. Whether or not I ever practiced nursing before is irrelevant: the only thing that matters is that I have a valid license in another state.

There is no use in appealing the Mississippi Board of Nursing's denial of my licensure application because the Mississippi Board of Nursing Rules & Regulations 2.3 (a)(1) clearly requires proof of graduation from a school of nursing - and I can not provide this. The criteria for RN licensure in Mississippi is exactly the same as it is in Wisconsin: you must graduate from a school of nursing and pass NCLEX. Mississippi cannot grant me a nursing license in their state even if they want to unless I can provide them with proof of graduation. They already have a copy of my "Certificate of Completion" of the pre-MSN phase of the Direct Entry program and a letter from Dr. Judith Miller explaining the program. These things do not indicate that I have graduated from a school of nursing, so Mississippi still had to deny my application.

Nobody will hire me as a nurse in Mississippi without a Mississippi nursing license because I can not legally practice nursing in this state without a Mississippi license - my Wisconsin license is meaningless here. The only exception to this would be for individuals who can take advantage of the Nurse Licensure Compact (NLC). But the NLC is for people who live in one state but work in another state - in that case you can use the license you hold in your state of residence (where you live, vote, pay taxes) to work in another state as long as both states belong to the NLC. Under the NLC you must hold a license in the state that you are a resident in. Mississippi and Wisconsin both belong to the NLC, but I am obviously not commuting to work from Wisconsin. Since I am a Mississippi state resident I must hold a Mississippi nursing license in order to work in Mississippi.

After my application for a Mississippi license was denied by the Mississippi Board of Nursing, I looked into applying to other schools of nursing in my area.The first thing I tried was to apply to a local community college ADN program. My main concern was getting someone to issue me a "graduation date" so that I could become licensed in Miss and start working to help support my family. I thought that an ADN would be cheaper and faster than a BSN even though it is below my current level of education. The director of the ADN program called me up personally after she got my application to tell me that the community college could not accept me as a student. I had already taken every single course in their entire curriculum, and they can not issue me an ADN degree from their institution unless I take at least 25% of the nursing courses at their school. I practically begged her to allow me to re-take 25% of the required classes at their school, just so that I can get a graduation date from somewhere so that I can get a valid Mississippi nursing license so that I can work to support my family. They did not allow me into the ADN program. I live in rural Mississippi and there are not any other ADN programs within driving distance of my home.

Next I tried to apply to the RN-to-BSN program at a nearby university since I do have a (Wisconsin) RN. They would not allow me into this program because you must have an ADN and a Mississippi nursing license in order to get into the program. (Even though there are no clinicals, only academic work for this kind of program). But I can't get an ADN because I am overqualified for an ADN program. And I can't get a Mississippi nursing license unless I get either an ADN or a BSN. Catch-22. The nursing department even discussed my situation at a board meeting, and still would not allow me to apply to the RN-to-BSN program, even though I am perfectly qualified for it.

My only other option at this point would be to enter a 4 year university BSN program as a freshman. I would need to re-take many courses that I have already taken because they have time limits. For example: I took sociology and statistics more than 10 years ago, so I would have to re-take those classes. I took two semesters of anatomy & physiology more than 5 years ago, so I would have to re-take those classes, too. Re-taking so many courses that I already took, and did very well in, seems quite ridiculous since I am already a nurse. I would also have to re-take the entire core curriculum for another bachelor's degree at that university. In addition, I'd have to re-take a good percentage of the nursing classes that would not transfer from Marquette. It would take a good 3 years of full-time coursework to get a BSN this way when all I really want is to get a nursing license.

I would be closer to getting a Mississippi nursing license if I had never taken a single nursing course before in my life. If I had never entered the Direct Entry program at Marquette, then at least I would have the option of going to a community college and getting an ADN in two years.

The "Memorandum of Understanding" that I signed when I entered the Direct Entry program said that I could get a license in Wisconsin without a BSN degree. It was not unreasonable for me to assume that this meant that the pre-MSN phase of the Direct Entry program would legally meet the requirements for RN licensure in Wisconsin - but this is simply not the case.

Marquette Didn't Like Trib Article

Apparently Marquette did not like the Marquette Tribune article about the Direct Entry program. It looks like there may have been some errors relating to attributing quotes. This was in yesterday's paper:

Editor's Note

Marquette is now claiming that there is no "Special Agreement." This is very interesting since I was told verbally on numerous occasions by Dr. Judith Miller that there was a "Special Agreement."

Step #9: Marquette Tribune Reports on "Direct Entry" Problems

Today's issue of the Marquette Tribune, the official student newspaper, has an article on the problems brought up at the last Wisconsin Board of Nursing meeting regarding Marquette's Direct Entry nursing program:

"Direct Entry" Raises Questions

The article gives a brief, but accurate, overview of the main problem with the Direct Entry program - that students are not legally eligible for RN licensure in Wisconsin unless Marquette starts granting them a "diploma of graduation" at the completion of the pre-MSN phase.

In order to post comments to articles on the MU Trib website you need to register with the site, but this is easy to do and is open to the public.

Madeline Wake Steps Down

Madeline Wake announced that she is stepping down from her current position as Provost of Marquette University. Read about it in the Marquette Tribune.

Licensure of Direct Entry Students Was Never Approved By The Wisconsin Board of Nursing in the First Place

There has been quite a bit of confusion about the two conflicting versions of what I am calling the "Special Agreement" - a 1999 letter from Wayne Austin (then legal counsel for the Wisconsin Board of Nursing) to Madeline Wake (Then Dean of Marquette's College of Nursing). I first brought up the issue here. Both Marquette and the Department of Regulation & Licensing have been claiming that this "Special Agreement" allows Marquette's Direct Entry students to become licensed as RNs in Wisconsin without graduation from a nursing program - even though this is a violation of the Wisconsin Nurse Practice Act 441.04.

The two letters are identical except for the single most important sentence in the letter (this sentence can be found at the bottom of the second page of both letters). One version states that only "graduates" of the Direct Entry program are eligible for RN licensure in Wisconsin. The other version states that "persons completing the basic nursing education phase of the program" are eligible for RN licensure in Wisconsin, with no mention of graduation being a requirement. Both versions of this 1999 letter from Mr. Austin to Ms. Wake end by indicating that the letter was approved by the Wisconsin Board of Nursing at their meeting held on January 28, 1999 - but obviously only one version of the letter was actually approved by the Board on that date. The minutes for the January 28, 1999 meeting can be found here; approval of the letter is shown on page 4 of the pdf.

Madeline Wake was interviewed by one of Marquette's lawyers before the August 30th Board of Nursing meeting about the two versions of this letter. Ms. Wake admitted that she received the first version of the letter, the one stating that only graduates of the Direct Entry program would be eligible for RN licensure in Wisconsin, in early February 1999 after it was approved by the Board of Nursing the previous month. She did not like what the letter said, so she requested that Mr. Austin alter the letter and re-send it to her: which Mr. Austin complied with! Wayne Austin altered the letter after it was approved by the Board of Nursing to indicate that students did not need to graduate from the program in order to become licensed. He did not change the last paragraph in the letter which falsely indicates that the letter was approved by the Board of Nursing on January 28, 1999, even though the alterations in the letter were not approved.

Even if the version of the letter that states that "persons completing the basic nursing education phase of the program" would be eligible for RN licensure in Wisconsin had been approved by the Wisconsin Board of Nursing (which it was not) this agreement would be invalid anyway. Neither Wayne Austin nor the Wisconsin Board of Nursing hold the authority to make exceptions to Wisconsin state law. The Wisconsin Nurse Practice Act 441.04 clearly requires one to hold a "diploma of graduation" in order to become eligible to become licensed as a nurse in Wisconsin. This is a state law that was voted on and passed by the Wisconsin state legislature. The only body that has the authority to make exceptions to the law is the state legislature itself.

If Marquette wants their Direct Entry nursing students to be legally eligible for RN licensure in Wisconsin at the completion of the pre-MSN phase of the program, then they must issue a "diploma of graduation" of some variety to students at that time.

Minutes for July 26 Board of Nursing Meeting

The minutes from the July 26th Wisconsin Board of Nursing meeting can be found here. I gave a presentation to the Board in person at this meeting.