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.

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.

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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.

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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:
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– 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?

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.

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.
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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

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.
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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