An Overview of the Campaign So Far

I realized recently that this blog may be confusing for new visitors. In order to help clarify this blog's objectives and history I will give a chronological summary of the campaign.

I completed the first 15 months (the pre-MSN phase) of Marquette University's Direct Entry nursing program back in August of 2005, and passed NCLEX and got my Wisconsin nursing license shortly after that. In the spring of 2006 my husband got a job in Mississippi, so we moved there. The Mississippi Board of Nursing rejected my application for RN licensure because I could not provide proof of graduation.

This is when I realized that something funny was going on with Marquette's Direct Entry program. Marquette provided proof of graduation to the Wisconsin Board of Nursing, while at the same time claiming that Direct Entry students do not graduate at the completion of the first 15 months of the program and refusing to provide proof of graduation to any other state.

As I researched the issue further, I discovered that the Wisconsin Nurse Practice Act 441.04, a state law, requires graduation from a school of nursing in order to be eligible for RN licensure in Wisconsin. As a student at Marquette, they told us that they had a "Special Agreement" with the State that allows Direct Entry students to become licensed as RNs. But this explanation no longer made any sense: the State of Wisconsin can't simply make a "Special Agreement" with a private university that contradicts State Law.

I sent a letter to Dr. Judith Miller, associate dean for graduate programs in Marquette's College of Nursing, asking that Direct Entry students be granted degrees for the work they do in the first 15 months of the program so that the program will meet the legal criteria for licensure in Wisconsin. Dr. Miller would not resolve the problem.

Next, I sent a letter to Father Wild, President of Marquette University. I didn't get a response, so I sent a letter to each member of Marquette's Board of Trustees explaining the problem, and again asking Marquette to grant Direct Entry students degrees at the end of the first 15 months of the program so that the program would meet the criteria for licensure in Wisconsin. The day after the Board of Trustee's got their letters, Father Wild responded to me, again unwilling to fix the problem.

Meanwhile I requested a copy of the "Special Agreement" from the Wisconsin Department of Regulation and Licensing. At first they tried blow me off, but eventually I was provided with the documents I requested. All the "Special Agreement" was was a 1999 letter from Wayne Austin, then legal counsel for the Board of Nursing, to Madeline Wake, then Dean of the Marquette College of Nursing, stating that they would interpret progression from the 15-month pre-MSN portion of the Direct Entry program into the MSN portion to be considered "graduation" so that it would meet the Nurse Practice Act's requirement for "graduation." The whole "Special Agreement" was a farce! Marquette is fiercely adamant that Direct Entry students do not graduate until they have earned an MSN degree.

Next I sent letters to the members of the Wisconsin Board of Nursing asking that they reevaluate the "Special Agreement." I never heard back from anyone at the Wisconsin Board of Nursing, so I thought they they had also blown me off. Several weeks after the fact, however, I discovered that my letter had been discussed at the Wisconsin Board of Nursing meeting on May 17th!

Now things are really getting ridiculous. The Wisconsin Board of Nursing is supposed to uphold the laws relating to the licensure of registered nurses, and here they are making unlawful exceptions to the very laws they should be upholding. I filed a formal complaint with Governor Doyle's office against Colleen M. Baird, legal counsel for the Board of Nursing charging her with two offences: not notifying me that my letter to the members of the Board would be brought up at a meeting so that I could participate in the meeting, and counseling the Board to continue with a policy that contradicts State Law. I have not yet heard back from the DRL regarding the formal complaint.

I was granted a personal appearance before the Wisconsin Board of Nursing on July 26th in Madison Wisconsin. In my presentation I asked the Board to immediately discontinue issuing nursing licenses to individuals who do not meet the criteria for licensure in the Wisconsin Nurse Practice Act 441.04; including students who have completed the 15-month pre-MSN portion of Marquette's Direct Entry program because they do not hold a "diploma of graduation." The presentation went well, and the Board seemed very surprised about the situation and perhaps interested in working out a compromise between Marquette and me. The Board wanted to hear from a representative of Marquette's Direct Entry program before making any decisions and so decided that they would revisit the issue at their next meeting on August 30th so that Dr. Judith Miller could attend.

Marquette was informed ahead of time about my appearance before the Board of Nursing, and submitted some materials of their own to the Board. One of the materials that they submitted was a copy of the 1999 letter from Wayne Austin to Madeline Wake (the "Special Agreement"). But this was not the same letter that the DRL had provided to me with several months earlier. It turns out there are two conflicting versions of the "Special Agreement." The version of the letter that was actually sent to Marquette does not say that Direct Entry students are eligible for RN licensure in Wisconsin at the completion of the pre-MSN phase. The letter simply states that graduates of the program are eligible for licensure - and Direct Entry students don't graduate until they have been awarded an MSN degree at the end of the three years.

Meanwhile, my parents (Wisconsin state residents) had contacted their state representatives and asked them to look into the RN licensure of Marquette Direct Entry students without having graduated. Debra Kraft, Interim General Counsel for the DRL, responded to my parents' state representatives with an August 2nd letter riddled with falsehoods. Since Ms. Kraft had sent this letter to many important individuals associated with the controversy, including the Wisconsin Board of Nursing, I responded with my own letter to make sure the individuals who got Ms. Kraft's letter had the facts before the next Board of Nursing meeting on August 30th.

The most important problem with Ms. Kraft's letter is that she based her stance on the licensure of Direct Entry students on the wrong version of the "Special Agreement." I do not know why the DRL had a version of this letter that directly contradicted what they actually sent to Marquette back in 1999.

Now I am waiting to see what happens at the Wisconsin Board of Nursing meeting on August 30th.

Agenda for Next Wisconsin Board of Nursing Meeting

The agenda for the next Wisconsin Board of Nursing meeting is up on line now. The meeting will be held on Thursday, August 30th at 1400 E. Washington Ave. in Madison, Wisconsin. The Board plans to address the licensure of Direct Entry students at around 9:45 a.m. but that is an estimate. These meetings are open to the public, so anyone who would like to attend is welcome.

It looks like the Board is allotting 45 minutes to address the issue, and I'm sure they will need at least that much time. I believe representatives from Marquette and UWM will be in attendance.

I don't understand why they keep calling Marquette "UW-Marquette." Marquette is just called Marquette, although UWM is sometimes called UW-Milwaukee for clarity.

Response From Dr. Miller

I got this today in response to my August 2nd letter to Dr. Miller at Marquette University. The gist of the letter is: "go bug somebody else."
__________________________________________________
August 14, 2007

Dear Ms. Bertrand:

I received your letter of August 2, 2007 in which you request Marquette University to grant you an Associate Degree. Marquette is an institution of higher learning which issues Baccalaureate and higher degrees. Marquette University does not award associate degrees in nursing.

If you have not already appealed to the Mississippi Board of Nursing to grant you a license to practice as a professional nurse in their state, I urge you to do so. Dr. Mary Ware, Director of the Institute for Higher Learning in the state of Mississippi indicated some time ago that if you appealed to the state of Mississippi Board of Nursing, she felt certain they would grant you licensure in Mississippi.

Good luck with this.

Judith Fitzgerald Miller, Phd, RN, FAAN

cc. Ellen Rudy, Interim Dean

Step #8: Refutation of DRL's Misinformation

I have not posted much recently, but there has been quite a bit going on behind the scenes in the last couple of weeks. A couple of months ago my parents contacted their state representatives (Since they are Wisconsin state residents) asking them to look into the legal status of the RN licensure of Direct Entry students in Wisconsin without holding a "diploma of graduation" as is required by the Wisconsin Nurse Practice Act 441.04. They did make inquiries of the Wisconsin Department of Regulation & Licensing (DRL) on our behalf, but unfortunately did not act as advocates for us as we had hoped.

In any event our letters, and the letter from my parent's state representatives, did cause the DRL to investigate Marquette's Direct Entry program and their procedures for licensing these students without graduation dates. Debra Kraft (Interim General Counsel for the DRL) responded to my parents' State Representatives with this letter dated August 2, 2007. The letter contains several serious factual errors, and was cc'd to a wide range of individuals: including the Chair of the Wisconsin Board of Nursing, the Wisconsin Attorney General's Office, lawyers at Marquette and Lawyers at the DRL among others.

I want to make sure that the individuals who have received this letter from Ms. Kraft become aware of the falsehoods and misrepresentations in the letter before the next Wisconsin Board of Nursing meeting which will be held on August 30, so I mailed out this letter this morning:
__________________________________________________

August 18, 2007

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

RE: RN LICENSURE OF MARQUETTE DIRECT ENTRY NURSING STUDENTS

Dear Ms. Kraft:

I would like to correct some misinformation that was contained in your August 2nd letter to Senator Mark Miller and Representative Joseph Parisi regarding the licensure of Marquette University’s Direct Entry nursing students. (Enclosed)

First, there is a serious problem with the 1999 letter from Wayne Austin to Madeline Wake that you discussed and attached with your letter. The version of the letter from Mr. Austin to Ms. Wake that you attached, the version provided by the Department of Regulation & Licensing (DRL), is not the same letter that was actually sent to Ms. Wake. Marquette University has produced a different letter of the same date in which Mr. Austin comes to the exact opposite conclusion about Marquette’s Direct Entry students’ eligibility for RN licensure in the State of Wisconsin. Please notice that the version of the letter produced by the DRL, the version that you are basing your stance on, does not contain Mr. Austin’s signature. The version of the letter produced by Marquette University, which does not advocate for the RN licensure of Direct Entry students in Wisconsin at the completion of the pre-MSN portion of the Direct Entry program without graduating, does contain Mr. Austin’s signature. I have enclosed both versions of this 1999 letter from Mr. Austin to Ms. Wake.

At the bottom of the second page of the real version of the 1999 letter from Wayne Austin to Madeline Wake, Mr. Austin states (emphasis mine):

If graduates of the new program will also have completed education and training which conform with the curriculum standards cited above, it is our opinion that graduates of the program would qualify both to sit for NCLEX and for licensure to practice professional nursing.

Nowhere in the letter does Mr. Austin state that "completion of the pre-MSN portion of the Direct Entry program" is to be considered a "diploma of graduation" under the Wisconsin Nurse Practice Act 441.04. Nor does the letter indicate that completion of the pre-MSN portion of the program is sufficient for RN licensure in the State of Wisconsin. The letter clearly states that only graduates of the Direct Entry MSN program are eligible for RN licensure in Wisconsin. Marquette University is quite adamant that Direct Entry students do not graduate until they have earned an MSN degree. Mr. Austin’s letter simply confirms that they would be eligible for RN licensure in Wisconsin at the time that they have graduated with an MSN degree, not at the completion of the pre-MSN phase of the program.

You state in your August 2nd letter that "the Department [of Regulation & Licensing] has again concluded that it will continue to recognize the conclusions reached by Mr. Austin in his 1999 letter." If this is the case, then the DRL has already concluded that Marquette Direct Entry students are legally eligible for RN licensure in Wisconsin not at the completion of the pre-MSN phase of the program, but only upon graduation from the MSN program. This is the conclusion that was reached by Wayne Austin in the letter that was actually sent to Madeline Wake back in 1999.

Second, your letter states that in my July 26th presentation before the Wisconsin Board of Nursing that I asked the Board to "dissolve the Marquette Direct Entry MSN Program." This is not true. I asked the Board to dissolve the "Special Agreement" with Marquette’s Direct Entry MSN program under which students are being granted Wisconsin nursing licenses without holding a "diploma of graduation" as is required by the Wisconsin Nurse Practice Act 441.04. I have no desire for the program to end: I ask only that the program be held to the same standards and legal procedures as every other school of nursing in the State of Wisconsin. A complete transcript of my presentation is available on my website: http://lydiaslicense.blogspot.com/2007/07/success-at-board-of-nursing-meeting.html

Third, the second footnote on the bottom of page two of your letter says: "The document used to verify completion of the pre-MSN phase is DRL form #259, a standard internal administrative form used to process all nursing student applications." It was not mentioned in your letter that the #259 form is also called the "Statement of Graduation" form. Marquette University lied on the #259 "Statement of Graduation" portion of my licensure application by falsely indicating that I had actually been awarded a BSN degree from their institution - and the DRL knowingly accepted this fraudulent document. (Enclosed)

In conclusion, it is vital for the Wisconsin Department of Regulation & Licensing to again re-examine the original conclusions that were drawn by Wayne Austin in 1999. I do not know why there are two conflicting versions of the letter in circulation, but the version of the letter that was signed by Mr. Austin and was actually sent to Marquette University does not in any way indicate that Marquette’s Direct Entry students are eligible for RN licensure in Wisconsin at the completion of the pre-MSN portion of the program.

Sincerely,

Lydia Bertrand

cc: Senator Mark Miller, 16th Senate District
Representative Joseph Parisi, 48th Assembly District
Celia Jackson, Secretary, Wisconsin Department of Regulation & Licensing
Larry Martin, Executive Assistant, Wisconsin Department of Regulation & Licensing
Kimberly Nania, Division Administrator, Wisconsin Department of Regulation & Licensing
Marilyn Kaufmann, Chair, Wisconsin Board of Nursing
Colleen Baird, Legal Counsel, Wisconsin Board of Nursing
Thomas J. Balistreri, Assistant Attorney General, Wisconsin Department of Justice
Jeffrey Kipfmueller, Associate General Counsel, Marquette University
Richard Sweet, Senior Staff Attorney, Wisconsin Legislative Council

Two Versions of the "Special Agreement"?

Early on in this campaign, I requested a copy of the written official agreement between Marquette and the Wisconsin Department of Regulation & Licensing (DRL) regarding the licensure of Direct Entry students who do not hold a "diploma of graduation" as is required by the Wisconsin Nurse Practice Act. I requested this document, which I am calling the "Special Agreement," from both Marquette and from the DRL, but only the DRL responded (the DRL is legally required to provide this of information under the Wisconsin Public Records Law).

The DRL provided this document. It is a 1999 letter from Wayne Austin (then legal counsel for the Wisconsin Board of Nursing) to Madeline Wake (then Dean of Marquette University's College of Nursing). I never followed up with trying to get this information from Marquette as well since, as a private institution, they are not legally required to provide me with this information, and I thought that they would just produce the same document.

The most important sentence in the copy of the "Special Agreement" produced by the DRL can be found at the bottom of the second page (emphasis mine):

"If participants in the new program will also complete educational and training which conform to the curriculum standards cited above, it is our opinion that persons completing the basic nursing education phase of the program would qualify both to sit for NCLEX and for licensure to practice professional nursing."

Marquette University provided a copy of this 1999 letter from Wayne Austin to Madeline Wake to the Wisconsin Board of Nursing for review at the July 26th meeting, presumably in defense of the licensure of their Direct Entry students. But the most important sentence in the letter provided by Marquette is significantly different, in fact it completely changes the entire meaning of the letter. The text of the "Special Agreement" provided by Marquette is exactly the same as the one provided by the DRL except for that the sentence quoted above is replaced with this sentence (emphasis mine):

"If graduates of the new program will also have completed education and training which conform with the curriculum standards cited above, it is our opinion that graduates of the program would qualify both to sit for NCLEX and for licensure to practice professional nursing."

[I'm sorry I don't have a pdf of this version of the "Special Agreement" that I can link to yet]

The version of the "Special Agreement" provided by the DRL seems to answer Marquette's question (does "completion of the pre-MSN part of the Direct Entry program legally constitute "graduation" for the purposes of licensure in Wisconsin?) by indicating that, yes, this would be sufficient for licensure in Wisconsin.

The version of the "Special Agreement" provided by Marquette answers the same question exactly the opposite way: it clearly states that only graduates of the program will be eligible for licensure. I don't quite understand why Marquette is interpreting this letter as "permission" for Direct Entry students to become licensed at the end of the pre-MSN phase of the program without graduating.

There was one other small difference between the "Special Agreement" provided by the DRL and the one provided by Marquette. The letter provided by the DRL is not signed by Wayne Austin, and the one provided by Marquette is. It seems most likely to me that the version of the "Special Agreement" produced by Marquette, the one that specifically requires graduation and has Wayne Austin's signature on it, is the real document.

I would be interested to know why there are two versions of the "Special Agreement," and which one is real? Why does the DRL apparently not have on file the same letter as the one that Marquette has produced? Was the document tampered with at the DRL, or are they just being sloppy?

In any event, it really does not matter which version was actually sent to Marquette back in 1999. Either way the the licensure of Marquette's Direct Entry students who do not hold a "diploma of graduation" from a school of nursing is against Wisconsin State Law:

1. If Marquette's version is the real one, then it clearly states that only graduates of the program are eligible for licensure. This is exactly what is required by the Wisconsin Nurse Practice Act 441.04 and the Wisconsin Administrative Code N 2.03 (1)(c). Marquette's Direct Entry program is operating in direct violation of this letter, which clearly requires graduation.



2. If the DRL's version is the real one then Wayne Austin and the Wisconsin Board of Nursing were acting outside of their scope of authority to make such an exception to state law to allow the licensure of Direct Entry students who do not hold a "diploma of graduation" from a school of nursing. The letter is invalid because it violates Wisconsin State Law.

Step #7: Third Letter To Dean Miller

August 2, 2007

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

RE: RN LICENSURE OF MARQUETTE DIRECT ENTRY STUDENTS

Dear Dr. Miller:

I am sorry that you were not able to attend the Wisconsin Board of Nursing meeting on July 26th in Madison. I am hopeful, and I think you may be as well, that the issue of the legality of the RN licensure of Marquette’s Direct Entry students can be finally resolved at the Board of Nursing meeting on August 30th. I will not be able to attend the August meeting myself.

There is a strong case for requesting BSN degrees for Direct Entry students, particularly because Marquette has been marking the box for "BSN" on the licensure applications of its Direct Entry students for the last 8 years, and because Direct Entry students complete all of the nursing theory and practical coursework required of their regular BSN students.

However, in the interests of resolving the problem in a timely manner, I propose a compromise. A dual purpose would be served if Marquette University were to issue ADN degrees to Direct Entry students (past, present, and future) who successfully complete, or have completed, the 15-month pre-MSN portion of the program.

If Marquette’s Direct Entry nursing students were awarded ADN degrees at the end of the pre-MSN phase, these students would then be legally eligible for RN licensure in Wisconsin: which is what Marquette promises in the "Memorandum of Understanding." Clearing up this loophole would prevent Marquette University from facing liability around this issue from former, current or future Direct Entry students.

In addition, if Direct Entry students were issued ADN degrees, it would discourage students from intentionally misusing the Direct Entry program by planning to only stay through the first 15 months of the program. The pre-MSN portion of Marquette’s Direct Entry program is significantly more expensive, more competitive to enter, and requires much more work and more advanced work (including 9 graduate credits) than would ever be expected at a regular ADN program. For these reasons it is unlikely that issuing ADNs to Direct Entry students would significantly increase the drop-out rate at the end of the pre-MSN phase.

In order for this plan to make Marquette’s Direct Entry students legally eligible for RN licensure under the Wisconsin Nurse Practice Act 441.04 and the Wisconsin Administrative Code N 2.03 (1)(c), Marquette will need to become accredited and board-approved to issue ADN degrees. I am sure this can be accomplished since Marquette is already accredited and board-approved to issue BSN degrees.

Sincerely,

Lydia Bertrand

cc: Dr. Kerry Kosmoski-Goepfert, Associate Dean, Marquette University College of Nursing
Madeline Wake, Provost, Marquette University
Father Wild, President, Marquette University
Marquette University Board of Trustees
Wisconsin Board of Nursing
Colleen Baird, Legal Counsel, Wisconsin Board of Nursing
Celia M. Jackson, Secretary, Wisconsin Department of Regulation & Licensing

More Good Questions From the Board of Nursing Meeting

There were many good questions and issues that were brought up at the Board of Nursing meeting on July 26th that I was not able to fully address at the meeting, so I will attempt to do so here.

_____________________________________________
Isn't Mississippi a Compact State?

I think what they mean is: does Mississippi participate in the Nurse Licensure Compact (NLC)? The NLC allows nurses who hold a license in the state that they reside in to practice nursing in another state without getting a second license; as long as both states participate in the NLC. Since Wisconsin and Mississippi both participate in the NLC and I hold a valid Wisconsin nursing license, I would be able to practice nursing in Mississippi if I were still a Wisconsin resident.

Most of the people who make use of the NLC live near the border between two states: they live in one state but commute to a job in another state. Since Mississippi and Wisconsin do not border each other, I don't think anyone would believe that I actually still live in Wisconsin and commute to a job in Mississippi. This means that even though Wisconsin and Mississippi both participate in the NLC and I have a Wisconsin nursing license, since my permanent residence at this time is Mississippi I will need to get a Mississippi nursing license to practice nursing here.

__________________________________________________
There is a program just like Marquette's Direct Entry program in Tennessee, and Wisconsin accepts RN's from their program.

It is true that Vanderbilt University in Nashville, Tennessee has a program very similar to Marquette's Direct Entry program. Students in Vanderbilt's program do not get a degree or diploma at the end of the pre-MSN portion of the program and are still able to become RNs in Tennessee at that time.

The difference is the Tennessee Nurse Practice Act. The Tennessee Nurse Practice Act does not specifically require graduation from a school of nursing in order to become licensed as an RN in that state: so it is perfectly fine for them to run their program in this way and to still have their students become legally eligible for licensure. The Wisconsin Nurse Practice Act does specifically require a "diploma of graduation" in order to become licensed as a nurse in Wisconsin: so if Marquette wants its Direct Entry students to become licensed as RN's in Wisconsin at the end of the pre-MSN portion of the program they must supply their students with a "diploma of graduation" at that time.

I did a whole post on this very issue back in February.