Update: license accepted in Louisiana without a hitch

I moved from Mississippi to Louisiana a few months ago, and had no problem whatsoever in obtaining a nursing license by endorsement in Louisiana. I sent a cover letter to the Louisiana Board of Nursing along with my application for RN licensure explaining Marquette's Direct Entry nursing program and explaining why my official school transcript would not contain a "graduation date." This was enough for Louisiana to issue me a license without delay.

I've heard through the grapevine that Marquette is now being very aggressive in telling Direct Entry students that there is no way that they can get a nursing license in any state other than Wisconsin and Mississippi if they leave at the completion of the pre-MSN phase of the program . . . . lies, lies, lies!

At the completion of the pre-MSN phase of Marquette's Direct Entry nursing program I have proven that you can get an RN license in Mississippi AND in Louisiana. By extension I expect that most, if not all, other states would also issue RN licenses to Direct Entry students as well.

If you would like to see the cover letter I sent to the Louisiana Board of Nursing with my application for licensure by endorsement, please email me -- I'd be more than happy to help you in any way I can!

lydiajoanne (at) yahoo (dot) com

Motions Passed by the Wisconsin Board of Nursing on October 4th

The minutes for the October 4th Wisconsin Board of Nursing meeting are up on line now. The exact motions passed by the board regarding Marquette's Direct Entry nursing program can be found on pages 8 and 9. Although technically the Board moved to deny my requests, their formal official affirmation that the "Certificate of Completion" of the pre-MSN phase actually legally IS a "diploma of graduation" is what won my case for me here in Mississippi - and would probably work in most states.

I don't anticipate any further posts to this blog, although I will leave the archives up in hopes that it may be helpful to others in the future. I would like to thank everyone who followed the blog, commented, offered support via email, linked to my blog, contacted the Marquette Tribune or came to a Wisconsin Board of Nursing meeting.

I can be contacted at: lydiajoanne (at) yahoo (dot) com

A Message for Marquette Direct Entry Nursing Students

Marquette wants you to think that the pre-MSN phase of the program will make you eligible for RN licensure only in Wisconsin. This is a lie, plain and simple.

Legally, there is no possible way for a school of nursing to make their students eligible for licensure in only one state. If Marquette wishes to make Direct Entry students eligible for licensure in Wisconsin, then they must meet the criteria for licensure in Wisconsin - and the criteria for licensure in Wisconsin is very similar, or even identical, to the criteria for licensure in most other states.

Once you have passed NCLEX (the state board exam) and get a Wisconsin RN license, you should be able to transfer this license to most, if not all, other states in the country. Of course I can not guarantee licensure at the completion of the pre-MSN phase in any state, even Wisconsin, and neither can Marquette. Becoming licensed as an RN requires that you must pass NCLEX among other things that Marquette can not control.

If you have completed the pre-MSN phase of Marquette's Direct Entry program, have become licensed in Wisconsin, did not complete an MSN at Marquette, and wish to get a nursing license in a state other than Wisconsin, these are my suggestions:

1. Apply to your new state's Board of Nursing for a "license by endorsement." This means transferring a license from one state to another. It may be helpful to submit a copy of your "Certificate of Completion" from Marquette with your application. Dr. Judith Miller may also be willing to send the Board a letter explaining the Direct Entry program a little bit and stating that you "completed the pre-MSN phase of the Direct Entry program."



2. If there are questions raised about your initial application and you are still told that you can't get a license without "graduation" from a school of nursing, try submitting the Memorandum produced by Colleen Baird, legal counsel for the Wisconsin Board of Nursing, that gives her legal interpretation of the "Certificate of Completion" to legally constitute a "Diploma of Graduation." I have a feeling that most, if not all, state Boards of Nursing would take this document very seriously. A pdf file of the memorandum can be found here, please feel free to print out a copy.



3. Find out the exact wording of your new state's Nurse Practice Act and their Board of Nursing Rules and Regulations (this may be called something else in some states - in Wisconsin it is the same thing as Chapter N of the Wisconsin Administrative Code). Look for the part that discusses issuing nursing licenses by endorsement. The full text of these documents for most states are available on the internet. In most states the Nurse Practice Act and the Board of Nursing Rules and Regulations are worded to require either "completion of a nursing program," "graduation from a nursing program" or "a degree or diploma from a school of nursing." Marquette has already issued you a "Certificate of Completion" and the Wisconsin Board of Nursing has issued a legal interpretation stating that this is the same thing as a "Diploma of Graduation." With any of these types of wording you should be able to get a license in that state.



4. At this point, don't bother arguing with low-level bureaucrats. You will likely need to go up the chain of command. I suggest going directly to the legal counsel for the Board of Nursing in your new state if your initial application was denied, although the exact job title for this person varies from state to state. (In Mississippi, for example, this person's job title is "Director of Discipline" because for the most part their job involves dealing with disciplinary actions.)



5. Good Luck!

Anyone out there who is having a problem getting a nursing license in a new state after attending a Direct Entry program is welcome to email me for more information. I have spent the last eight months doing in-depth research on all aspects of RN licensure policies and procedures in general - and in Wisconsin, Mississippi, Tennessee, and Louisiana specifically. I may not be able to answer specific questions about licensure in other states, but I could probably point you in the right direction.

My email address is: lydiajoanne (at) yahoo (dot) com

VICTORY!

Today the Mississippi Board of nursing reviewed my application for licensure by endorsement (transferring my RN license from Wisconsin) and voted to approve my license!!! They already have all of my application materials on file, so the paperwork should go through next week.

At the August 30th Wisconsin Board of Nursing meeting (which I was not able to attend in person) some people from the Wisconsin Board spoke with my parents (who were there) and told them that the Wisconsin Board and Marquette had both been in contact with the Mississippi Board of Nursing (MSBN) and had been advocating for Mississippi to review my application and grant me a license by endorsement. Until that time I had no idea that the Wisconsin Board of Nursing or Marquette had been in contact with the MSBN. Dr. Judith Miller from Marquette's College of Nursing had already written the MSBN at the time that I first applied for a nursing license here (almost two years ago) and her letter had not made any difference. Besides, the MSBN Rules and Regulations clearly require proof of graduation from a school of nursing, which I could not provide, so I did not see any benefit to appealing the MSBN's original decision on my application since I don't have proof of graduation.

Basically I made such a problem for both Marquette and the Wisconsin Board of Nursing that they will both do almost anything to make me just go away. This is not how I wanted the problem to be resolved, but at this point I'm counting it as a victory and planning to begin moving on with my life as a nurse some time soon!

I'll be leaving the blog up in perpetuity in hopes that it will be helpful to future generations of googlers.

Legal Interpretation of "Diploma of Graduation" Presented to the Wisconsin Board of Nursing Yesterday

Here are links to pdf files of the documents that Colleen Baird presented to the Wisconsin Board of Nursing yesterday with short explanations:

The Memorandum (10 pages)
This document basically says that since the phrase "Diploma of Graduation" is not defined in the law, then the generally accepted meaning of the words are to be used. She twists the dictionary definition of the words "diploma" and "graduation" to include the "Certificate of Completion" that Marquette's Direct Entry students are given at the end of the pre-MSN phase. She argues that it is legal for Direct Entry students to be licensed as RNs in Wisconsin under the Nurse Practice Act because they get this "Certificate of completion" from Marquette. It is very creative - you should check it out.

Although I completely disagree with this legal interpretation that the "Certificate of Completion" that Marquette gives to Direct Entry students at the completion of the pre-MSN phase of the program legally constitutes a "Diploma of Graduation" under the Wisconsin Nurse Practice Act, this document could help me to obtain licensure in states other than Wisconsin. You better bet I'll be holding on to it in case I move to another state in the future.

In fact, this document could also help other students who, like me, completed the pre-MSN phase of Marquette's Direct Entry program but moved out of Wisconsin before completion of an MSN degree. The document could help people in this situation to obtain RN licensure in their new state of residence. If you are one of these students, then please feel free to print off a copy of the pdf file and send it in to the Board of Nursing in your new state if you are having a problem with your licensure application!


Attachments:

Brochure about Marquette's Direct Entry Program (2 pages)
I don't have a pdf of this file, but it just gives some basic information about Marquette's Direct Entry program like the courses that are a part of the pre-MSN phase and things like that.

Direct Entry MSN Nursing Program (1 page)
This chart shows each cohort of Marquette's and UWM's Direct Entry programs and lists how many applications they got, how many students were accepted, and how many students dropped out.

I am very curious how they are defining "applied to the program" because there is a huge inconsistency between what this chart lists and what I was told by Marquette administrators when I was a student in the Direct Entry program. I was in the 6th cohort (04-05) and I was told at that time that there had been about 90 applicants for my class, yet this chart indicates that there were 672 applications for that year. I am also curious how they are defining "dropped out of the program" because only about half of my cohort actually went on to the MSN part of the program, and fewer than that graduated from the MSN program.

Analysis of 60 DE schools AACN list (10 pages)
Marquette has been claiming that their are 59 other Direct Entry MSN programs other than theirs across the country to make it look like programs like Marquette's Direct Entry program are widely accepted. (AACN stands for the American Association of Colleges of Nursing, and they list of 60 Direct Entry MSN type programs in the U.S.) The only problem with this is that most of these other programs are not run the same way as Marquette's program, and thus these other programs follow the Nurse Practice Acts of their own states for a number of reasons. The Board of Nursing researched all 60 of these programs and how they are run.

Some of these programs do award a BSN or another kind of degree or diploma at the completion of the pre-MSN phase, and some programs require students to already be registered nurses in order to apply to the program in the first place. One thing that was left off of this chart was whether or not the state that the program is in legally requires graduation or a degree or diploma in order to become licensed. Some states' Nurse Practice Acts are worded in such a way that they do not actually require graduation in order to be legally eligible for licensure in their state - so a program run like Marquette's would be legal in a state like that. Wisconsin state law, on the other hand, clearly requires graduation.

The "Special Agreement" (4 pages)
They included the version that was altered after it was approved by the Board. I explain more about the two versions of the "Special Agreement" here.

Affidavit (1 page)
I posted about the Affidavit signed by Madeline Wake and how the "Special Agreement" was altered after it was approved by the Board of Nursing here.

Today's Wisconsin Board of Nursing Meeting

I was not able to attend today's Wisconsin Board of Nursing meeting in person, but my Mother attended and told me what happened. Representatives from Marquette were also in attendance.

Today the Board voted on and passed a motion in closed session that basically stated that the Board will consider my "Certificate of Completion" of the pre-MSN phase of Marquette's Direct Entry nursing program to legally constitute a "diploma of graduation" so that Marquette's Direct Entry students are legally eligible for RN licensure in Wisconsin under the Wisconsin Nurse Practice Act. (The Wisconsin Nurse Practice Act 441.04 requires one to hold a "diploma of graduation" from a school of nursing in order to be eligible for RN licensure in Wisconsin.) It does not matter that this makes absolutely no sense whatsoever, or that Marquette is very clear that Direct Entry students do not graduate or earn any kind of degree or diploma at the completion of the pre-MSN phase.

Representatives from Marquette stood before the Board today and called the "Certificate of Completion" that is given to Direct Entry students at the end of the pre-MSN part of the Direct Entry program nothing more than a "celebratory piece of paper." Very interesting that the DRL is considering this "celebratory piece of paper" a "diploma of graduation."

Unfortunately I do not have a copy of the exact wording of the motion that was passed by the Board today, and I won't have it until the minutes for today's meeting are approved at their next meeting on November 8th.

Debra Kraft, interim legal counsel for the Wisconsin Department of Regulation & Licensing, presented to the Board a lengthy document that gives her legal interpretation of the term "diploma of graduation" and an explanation of how she interprets Marquette's "Certificate of Completion" to actually be a form of a "diploma of graduation." I will have a copy of this document tomorrow and will post more about it then.

[Update: turns out the "legal interpretation" I mentioned above was actually written and presented by Colleen Baird, legal counsel for the Wisconsin Board of Nursing, not Debra Kraft.]

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.

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.

Marquette Promised Me Eligibility for Licensure in *Wisconsin*

One issue that came up several times during the discussion following my presentation before the Wisconsin Board of Nursing last Thursday was whether or not Marquette had ever indicated to me that my nursing license would be transferable to other states, and whether or not the Direct Entry program must make its students eligible for licensure in other states.

To put it simply: Marquette never falsely led me to believe that I could become licensed as an RN in any state other than Wisconsin at the end of the pre-MSN part of the Direct Entry program, and they are in fact not required by anybody to make their students eligible for RN licensure in any state other than Wisconsin.

My problem with Marquette's Direct Entry program is that they indicate in the "Memorandum of Understanding" that must be signed by every student before they begin the program that they will be eligible to sit for NCLEX and for RN licensure in Wisconsin. But this is not true: unless Marquette starts issuing a "diploma of graduation" at the end of the pre-MSN phase of the program, these individuals are not in fact eligible for RN licensure in Wisconsin at that time. For the last 8 years the Wisconsin Board of Nursing has been issuing nursing license to Marquette's Direct Entry students illegally.

If Marquette started issuing graduation dates for Direct Entry students at the end of the pre-MSN phase of the program, they would probably be able to transfer their RN licenses to more states than they can now, but that is just a side effect. The real issue here is that Marquette University is located in Wisconsin, and promises their students eligibility for RN licensure in Wisconsin. That means issuing a "diploma of graduation" at the end of the pre-MSN phase of the Direct Entry program.

Success at the Board of Nursing Meeting This Morning

My presentation at the Wisconsin Board of Nursing meeting this morning went as well as I could have realistically expected. No decisions were made today, but the members of the Board listened to what I had to say and it seemed like they are interested helping to find a reasonable resolution to the problem with the RN licensure of Marquette University's Direct Entry nursing students.

Dr. Judith Miller, the Associate Dean for Graduate Programs at Marquette's College of Nursing, was not able to attend today's meeting. The Board would like to give her the opportunity to address the issue at a meeting, so the Board will be again addressing the licensure of Marquette's Direct Entry students at the next board meeting on August 30th.

I don't have time to give all the details about what happened at the meeting right now, but for now I will post the content of my presentation:
__________________________________________________

– My name is Lydia Bertrand. I would like to thank the members of the Board for allowing me to make a personal appearance at this meeting today.

– Before I get started I would like to give everyone a copy of some materials relevant to my presentation. [Distribute handouts]

– I was a member of the 6th cohort of Marquette’s Direct Entry nursing program from 2004 to 2005, but left the program at the end of the 15-month pre-MSN portion because my family was forced to move to another state for my husband’s work. The state of Mississippi, where I am now living, has been unable to issue me a nursing license by endorsement even though I was granted a Wisconsin license. But even worse, having attended Marquette’s Direct Entry program has actually made it even more difficult for me to get a nursing license in Mississippi than it would have been if I had never taken a nursing class before. Because of this, my husband is currently supporting our family of three on only a few thousand dollars per year more than the amount of my outstanding student loans that I took in order to attend the Marquette University Direct Entry program.

– Back in 1999 the Wisconsin Board of Nursing made a terrible mistake. The Board OK’d a letter from Wayne Austin, then legal counsel for the Board of Nursing, to Madeline Wake, then Dean of Marquette’s College of Nursing. Both the DRL and Marquette seem to believe that this letter gives permission for students in Marquette University’s Direct Entry nursing program to sit for NCLEX and to become licensed as RN s at the end of the 15-month pre-MSN portion of the program even though students do not graduate from the program at that time.

– I call this arrangement between the Board of Nursing and Marquette University the "Special Agreement" because that is what the administrators at Marquette called it when I was a student in the Direct Entry program.

– There are two problems with this interpretation of the "Special Agreement." The first problem is that the letter from Wayne Austin does not say that Direct Entry students can sit for NCLEX and become licensed as RN s at the end of the pre-MSN part of the program without graduating.

– I have highlighted the pertinent section of the letter on page 5 of your handout. Wayne Austin says in the letter that: "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 is it indicated that students who have not graduated from the program are eligible for licensure in Wisconsin.

– The second problem with the "Special Agreement" is that even if Wayne Austin and the Board of Nursing had stated that Marquette’s Direct Entry students could become licensed as RN s at the end of the pre-MSN phase of the program without graduating, the agreement would be invalid because it is outside of their scope of authority to make such exceptions to Wisconsin State Law.

– The Wisconsin Nurse Practice Act 441.04 and the Wisconsin Administrative Code N 2.03 (1)(c) both require graduation from a nursing program - but Marquette’s Direct Entry students don’t graduate at the end of the pre-MSN portion of the program, so they do not meet the legal criteria for RN licensure in WI at that time.

– On page 2 of your handout I have printed out the relevant text of the Nurse Practice Act and the Wisconsin Administrative Code. The Wisconsin Nurse Practice Act 441.04 reads:
"Any person who has graduated from a high school or its equivalent as determined by the board, does not have an arrest or conviction record, subject to ss. 111.321, 111.322 and 111.335, holds a diploma of graduation from an accredited school of nursing and, if the school is located outside this state, submits evidence of general and professional educational qualifications comparable to those required in this state at the time of graduation may apply to the department for licensure by the board as a registered nurse, and upon payment of the fee specified under s. 440.05 (1) shall be entitled to examination."

– The Wisconsin Administrative Code N 2.03 (1) reads:
"An applicant is eligible for the examination for registered nurses if the applicant:
(a) Does not have an arrest or conviction record, subject to ss. 111.321, 111.322 and 111.335, Stats.;
(b) Has graduated from high school or its equivalent; and,
(c) Has graduated from a board-approved school of professional nursing."

–Both the Nurse Practice Act and the Administrative Code specifically list graduation as a requirement for taking the licensure exam. The only reasonable interpretation of the intent of these passages is that they actually require graduation.

– Since the Wisconsin Nurse Practice Act is clear about requiring graduation from a nursing program, it might seem surprising that The American Association of Colleges of Nursing lists 60 schools that offer graduate entry programs for people who hold non-nursing bachelor’s degrees similar to the one at Marquette. [it's on page 4 of the pdf file]

– I have not had time to research every one of these programs, but I randomly chose 12 programs from the list that are outside of Wisconsin to look into further. I found that very few of the programs are run the same way as Marquette’s Direct Entry program. Most of them do not have the same legal problem with the RN licensure of their students at the end of the pre-MSN phase for one of four reasons:

1) One of the programs I researched, the one at the University of South Alabama, confers a BSN degree at the end of the pre-MSN phase so that their students are legally eligible to sit for NCLEX and to become licensed as RN’s at that time.

2) Another program through the Medical College of Georgia, does not have its students sit for NCLEX or become RN s until they graduate from the program with an MSN degree, which makes them legally eligible for RN licensure at that time.

3) At three of the institutions I researched, San Francisco State University, The University of South Florida, and the University of Tampa, having an RN license is a prerequisite for entering the "graduate entry" program, so there is no need for the program to make its students legally eligible for RN licensure.

4) And lastly: four of the programs I looked at, the ones at Vanderbilt, Yale, the University of Southern Maine, and the University of Minnesota, are in states where their Nurse Practice Act does not require graduation from a school of nursing in order to become licensed as an RN. For this reason their students can become legally eligible to sit for NCLEX and to become licensed as RN s even though these programs do not confer a degree or diploma at the end of the pre-MSN phase.

– Marquette never led me to believe that I would be granted a BSN degree at the end of the pre-MSN portion of the Direct Entry program. They did lead me to believe that I would be legally eligible to sit for NCLEX and to become licensed as an RN in Wisconsin at the end of the pre-MSN portion of the program - and that was simply not true. The only way I became eligible to sit for NCLEX and became licensed as an RN in Wisconsin is because Marquette filed a fraudulent "259" or "Statement of Graduation" form with the DRL as a part of my licensure application that falsely indicated I had in fact been awarded a BSN. I have included a photocopy of this "Statement of Graduation" form on page 7 of your handout.

– I am not the only person who has been hurt by the "Special Agreement" between the Wisconsin Board of Nursing and Marquette University. There are other students who continued with the MSN portion of the program but did not graduate from it. These students - many of them experienced nurses - could be unable to obtain licensure in another state if they ever leave Wisconsin. Also, I know of a student who has been threatened with losing her job unless she goes back to school to get a BSN – even while working on her MSN.

– This is the bottom line: The Wisconsin Board of Nursing never gave permission for Marquette’s Direct Entry students to become licensed as RN s without graduating from a nursing program. The 1999 letter from Wayne Austin to Marquette states that graduates of the program would be eligible to sit for NCLEX and to become licensed as RNs.

– And even if they had given permission for Marquette’s Direct Entry students to become licensed at the end of the pre-MSN part of the program without holding a "diploma of graduation," the agreement would be invalid because the Board of Nursing does not hold the authority to make such an exception to a State Law.

– I traveled all the way from my home in Mississippi to be here today to ask the Board to fix the mistake that was made 8 years ago – by immediately dissolving the "Special Agreement" with the Marquette University Direct Entry nursing program, and any other similar programs in Wisconsin.

– I believe that the Board has no alternative but to immediately stop issuing nursing licenses to individuals who do not hold a true "diploma of graduation" from a school of nursing, as is required by the Wisconsin Nurse Practice Act.

– Are there any questions for me?

Heading To the Dairy State

I'm leaving for Wisconsin later today! I will be giving updates from Wisconsin later this week.

Board of Nursing Agenda for July 26th Meeting

The agenda for the July 26th meeting of the Wisconsin Board of Nursing went up on-line today. Marquette University is aware of my appearance at the meeting and has submitted some materials of their own for the discussion.

DRL Changes "Statement of Graduation" Form

I was doing some research for my presentation today, and I happened to notice that just this month (the date of revision is on the bottom left corner of the form) the Department of Regulation & Licensing changed its "Statement of Graduation" form into a "Statement of Graduation or Completion of Pre-MSN Registered Nursing Program Requirements (Direct Entry)" form.

It's sure interesting that they decided to change the form at this particular time, since Marquette University has been marking the box for "BSN" for it's Direct Entry students on the old "Statement of Graduation" form for the last eight years. This is how Marquette filled out my own "Statement of Graduation" form that Marquette submitted to the DRL as a part of my licensure application in 2005. I did a whole post about it back in April, including pictures.

The fact that they added a "Direct Entry" box on this form does not really matter though - the Wisconsin Nurse Practice Act specifically requires graduation from an approved school of nursing. "Completion of a Direct Entry program" is not sufficient for RN licensure in Wisconsin under the law.

Formal Confirmation of Appearance Before the Board of Nursing

I got this letter in the mail today. I'm not sure why they keep referring to it as the "UW-Marquette Direct Entry program." As far as I know the Marquette Direct Entry program and the UWM Direct Entry program are two separate programs - and I will only be directly addressing Marquette's program. I suppose they are lumping them together because whatever decision is made about Marquette's program will also affect UWM's program.
______________________________________________
July 9, 2007

SUBJECT: APPEARANCE REQUEST REGARDING UW-MARQUETTE DIRECT ENTRY PROGRAM - LYDIA BERTRAND

Dear Ms. Bertrand:

An appearance has been scheduled for you to appear before the Wisconsin Board of Nursing regarding your request to discuss the UW-Marquette Direct Entry Program. Please report on July 26, 2007 at 8:45 a.m., in Room 121A, 1400 E. Washington Avenue, Madison, WI. You will be allowed 15 minutes for your presentation.

Please acknowledge receipt of the scheduled time.

Sincerely,

Kimberly Nania, Ph.D.
Division Administrator
Bureau of Health Service Professions

Clarification of Typo

July 9, 2007

RE: Correction to Prior Correspondence

Dear Ms. Bertrand:

This is to clarify there was an inadvertent clerical error in my prior correspondence dated July 6, 2007. I unintentionally omitted the word "not" which may have led you to believe that the Board had taken action in regard to your request for reevaluation of the Marquette University Direct Entry Graduate Nursing Program.

Instead, the third full sentence in the first paragraph should correctly read as follows:

"I can confirm that the members briefly discussed the issues which you have raised, however, they did not decide on any course of action."

Also, I understand that you have requested a personal appearance before the Board and that Ms. Nania is scheduling that for the July 26th meeting. We look forward to meeting you then.

Sincerely,

Colleen M. Baird
Legal Counsel
Wisconsin Board of Nursing

Update

I have received confirmation that I will be on the agenda for the Wisconsin Board of Nursing Meeting on July 26th. This is great news, but I'm still waiting for a response from the Department of Regulation & Licensing regarding the formal complaint.

Step #6: Request to Appear Before the Wisconsin Board of Nursing

I spoke with Ms. Nania on the phone this morning, and it looks like it is very likely that they will put me on the agenda for the meeting on July 26. This is wonderful news because it means that I will be able to present my case to the Board in person. I submitted my request to her via email a few moments ago.
_________________________________________________
Dear Ms. Nania:

I would like to schedule a personal appearance before the Wisconsin Board of Nursing. The reason I am requesting an appearance is in order to discuss the Board’s "Special Agreement" with Marquette University under which Marquette’s Direct Entry nursing students are eligible for RN licensure. I plan to ask the Board to immediately dissolve this "Special Agreement" because it violates both the Wisconsin Nurse Practice Act 441.04 and the Wisconsin Administrative Code N 2.03 (1)(c).

If possible, I would like to appear before the Board of Nursing at the July 26th meeting because I am making a special trip from my home in Mississippi to Madison specifically in to attend that meeting in person. If another date is necessary, then I give permission for [NAME] to appear before the board in my place.

Thank you for your help.

Sincerely,

Lydia Bertrand

Letter From Colleen Baird Regarding Meeting That Discussed My Correspondence

On June 7, 2007 I sent a letter to Marilyn Kaufmann, chair of the Wisconsin Board of Nursing, that I did not post on this blog. In this letter I asked her for more information about what happened at the May board meeting at which my letter to the members of the board was discussed. I got this response from Colleen Baird, legal counsel for the Wisconsin Board of Nursing:
_____________________________________________
July 6, 2007

RE: Correspondence with the Wisconsin Board of Nursing

Dear Ms. Bertrand:

I am writing in response to your letter dated June 7, 2007, to Marilyn Kaufmann, the Chair of the Wisconsin Board of Nursing. You indicated that you would like to know about the discussion of your correspondence regarding the Marquette University Direct Entry Graduate Nursing Program and whether the Board has decided to reevaluate the program. I can confirm that the members briefly discussed the issues which you have raised, however, they did decide on any course of action. [sic]

For your information, correspondence to Board members is typically reviewed and discussed in open session at the next available meeting. Members of the public may attend the open session. The meeting agendas are publicly posted on the Department's website at least 24 hours in advance of a meeting. Individual notices of specific agenda items are only provided if there is a written request or a scheduled appearance before the Board.

If you would like to make a personal appearance before the Board you should submit a written request. If you are granted an appearance, you will be notified of the date and time for your appearance. Also, if someone else is authorized to appear on your behalf, please let us know. Please contact Ms. Kimberly Nania, the Bureau Director for the Board of Nursing, and she will assist you in requesting an appearance. The next Board meeting dates are July 26 and August 30, 2007.

Sincerely,

Colleen M. Baird
Legal Counsel
Wisconsin Board of Nursing

A Little Humor

I thought you might enjoy a little Onion-style humor while we wait to get a response from the DRL.

Customer's Attempt To Complain To Manager Thwarted By Employee

ELGIN, IL-A customer's repeated attempts to complain to the store manager about Mama Z's Pizza employee Matt Wheaton were successfully thwarted by Wheaton, restaurant sources confirmed Monday.

DRL Needs More Time to Respond to Complaint

It has been over two weeks since the Department of Regulation & Licensing (DRL) was notified by the Governor's office of the formal complaint I registered with them against Colleen Baird, legal counsel for the Wisconsin Board of Nursing. Although complaints of this kind are usually handled within two weeks, the DRL is still working on a response and will need an additional week or two.

I'm hoping this process does not take too long, because I would like to see the matter addressed at the next Wisconsin Board of Nursing board meeting on July 26th. If that were to happen then I could present my case to the Board in person.

Wisconsin Board of Nursing Meeting Minutes

The minutes from the May 17th meeting of the Wisconsin Board of Nursing, the meeting where my letter to the board was discussed, went up on the web today. It does not give a whole lot of information, but here it is.

Formal Complaint Filed Against Legal Counsel for the Wisconsin Board of Nursing

Formal complaints of this nature are handled through the Governor's office. They should receive my letter tomorrow, and I should hear back from them within two weeks.
________________________________________________
Thursday June 14, 2007

Governor Jim Doyle
c/o Nick Coenen, Constituent Services
P.O. Box 7863
Madison, WI 53707

Dear Governor Doyle:

With this letter I would like to file a formal complaint against Colleen Baird, legal counsel for the Wisconsin Board of Nursing.

In her capacity as legal counsel for the Wisconsin Board of Nursing, Ms. Baird has advised the Board to issue RN licenses to individuals who do not meet the legal criteria for licensure set forth in Wisconsin Nurse Practice Act. Specifically, she has counseled them to license as registered nurses students who have completed the first 15 months of Marquette University’s Direct Entry nursing program. Students in this program do not graduate at that time, and thus are not eligible for licensure. The Wisconsin Nurse Practice Act 441.04 clearly requires graduation from a school of nursing in order to become licensed as an RN in Wisconsin. Neither Ms. Baird, nor the Wisconsin Board of Nursing hold the authority to override the law in this matter, and yet this is exactly what they are doing.

On April 19, 2007 I sent a letter to each member of the Wisconsin Board of Nursing, cc’d to Colleen Baird, asking them to reevaluate the Board’s "Special Agreement" with Marquette University under which the Board has been illegally issuing RN licenses to Direct Entry students who have not graduated from a school of nursing (enclosed). I was never notified that my correspondence with the Board would be discussed at the Wisconsin Board of Nursing meeting on May 17, 2007, and so I was not able to attend the meeting myself or present my case more fully directly to the Board. After the board meeting I was not notified that my correspondence had been discussed or what, if any, decisions had been made by the Board.

Not only has Ms. Baird been advising the Wisconsin Board of Nursing to continue with a policy that directly violates Wisconsin State Law, but she has prevented me from presenting my case directly to the Board itself. My participation was precluded because I was not notified beforehand about the board meeting that discussed my correspondence, nor was I notified about the Board’s decision after the meeting. I demand to have the opportunity to present my case directly to the Board.

Sincerely,

Lydia Bertrand

Agenda for June 21 Meeting Up Today

The Agenda for the next Wisconsin Board of Nursing meeting that will be held on Thursday, June 21 went up on the web today. Here it is. I'm not on it.

What I Want From The Wisconsin Board of Nursing

This one is pretty simple: I want the Wisconsin Board of Nursing to immediately stop providing RN licenses to individuals who do not meet the legal criteria for licensure set forth in the Wisconsin Nurse Practice Act. Since students in Marquette University's Direct Entry program do not graduate at the end of the first 15 months (the pre-MSN portion of the program), they are not legally eligible for RN licensure at that time.

Neither the Board, nor anyone else, has the authority to override the law in this matter. The Wisconsin Nurse Practice Act 441.04 and the Wisconsin Administrative Code N 2.03 (1)(c) both require individuals to graduate from a nursing program before sitting for NCLEX, the licensure exam.

The Wisconsin Board of Nursing must immediately stop issuing RN licenses to Marquette University's Direct Entry students at the end of the pre-MSN portion of the program before they have graduated from an approved school of nursing.

Step #5b: Letter to WI Legislators on Health Committees

I sent this slightly revised letter to each member of the State Senate Committee on Health & Human Services and the State Assembly Committee on Health & Healthcare Reform today. In this letter I tried to be more clear about exactly what I am asking of them.
___________________________________________________
Thursday June 7, 2007

Senator/Representative [name]
Committee on Health & Human Services/ Committee on Health & Healthcare Reform
Room XXX
State Capitol
PO Box XXXX
Madison, WI 5370X

Dear Senator/Representative [name]:

As a member of the Wisconsin State [Senate Committee for Health & Human Services/ Assembly Committee on Health & Healthcare Reform] I would like to bring your attention to a problem with the Wisconsin Department of Regulation & Licensing's relationship with Marquette University. I will give an overview of the problem here, but further details and documents can be found on my web site:

http://lydiaslicense.blogspot.com

Marquette University runs a Direct Entry nursing program that is designed for individuals who hold a bachelor's degree in an area unrelated to nursing. Students become RN's after the first 15 months of the program (the pre-MSN phase), and then move directly into master's studies. At the end of the 3-year program students are awarded a master's degree (MSN) in a nursing specialty.

As a Direct Entry nursing student at Marquette University I was told that Marquette and the Wisconsin Department of Regulation & Licensing (DRL) hold a "Special Agreement" that allows Direct Entry students to gain RN licensure in Wisconsin without holding a degree. When I requested a copy of this "Special Agreement" from the DRL under the Wisconsin Public Records Law I was provided with documents indicating that Wisconsin would consider completion of the pre-MSN phase of Marquette's Direct Entry program to constitute "graduation" for the purposes of RN licensure, even though Marquette is adamant that Direct Entry students do not actually graduate at that time.

This is a problem because the Wisconsin Nurse Practice Act requires individuals to graduate from a school of nursing in order to become licensed as an RN. Section 441.04 of the Wisconsin Nurse Practice Act lists requirements to sit for the licensure exam in Wisconsin (emphasis mine):

Any person who has graduated from a high school or its equivalent as determined by the board, does not have an arrest or conviction record . . . holds a diploma of graduation from an accredited school of nursing, and if the school is located outside this state, submits evidence of general and professional educational qualifications comparable to those required in this state at the time of graduation may apply to the department for licensure by the board as a registered nurse, and upon payment of the fee . . . shall be entitled to examination.

One of the forms required by the DRL before individuals can take the licensure exam is a "Statement of Graduation" form. Marquette fills out this "Statement of Graduation" form for Direct Entry nursing students; complete with a graduation date filled in, the signature of Dr. Judith Miller, associate dean for graduate programs & research in Marquette's College of Nursing, and the Marquette University seal. At the same time Marquette refuses to certify graduation to any other party. For your convenience I have enclosed a copy of the "Statement of Graduation" form that Marquette filed with the DRL for me, although the Marquette seal is not visible on this photocopy.

It is the DRL's job to enforce occupational licensing laws, and yet they have entered into an agreement with Marquette University that violates the very laws they should be enforcing. The DRL has not yet responded to my requests that they require Marquette's Direct Entry students to hold a degree before they may become licensed as RN's in Wisconsin (as is clearly required by the Wisconsin Nurse Practice Act) so I am appealing to you to become an advocate for my cause. Any "Special Agreement" between the DRL and a private university that allows for individuals to become licensed as RN's in Wisconsin without holding a degree is not legal, and must be immediately stopped.

Sincerely,

Lydia Bertrand