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

What I Want From Wisconsin State Senators and Representatives

According to their own web site the Wisconsin State Department of Regulation & Licensing (DRL) is ordinarily in charge of "enforcing occupational licensing laws" among other things.

Unfortunately, the DRL has actually entered into a "Special Agreement" with a private institution, Marquette University, that violates the very laws that they are supposed to be upholding. Let me be as clear as possible: the DRL is not authorized to allow Marquette's Direct Entry students to become licensed as registered nurses without graduating because state law requires RN's to have graduated from a nursing program.

Allowing students in Marquette's Direct Entry nursing program to become RN's in Wisconsin without graduating violates both the Wisconsin Nurse Practice Act 441.04 and the Wisconsin Administrative Code N 2.03 (1)(c).

Since the DRL has not yet responded to my requests that they bring their policies regarding Marquette's Direct Entry nursing program into compliance with state law, I am appealing to Wisconsin State Legislators to put pressure on the DRL to do what they are supposed to be doing on their own anyway: enforcing the law.

Now is a good time to reevaluate the "Special Agreement" between the DRL and Marquette University since there has been significant turnover in both organizations since 1999 when the agreement was made.

Discussed by the Wisconsin Board of Nursing

Apparently my letter to the members of the Board got someone's attention, because it looks like I was discussed at the most recent meeting of the Wisconsin Board of Nursing on May 17th. The meeting agenda can be found here. I was surprised to find myself on the agenda since I have not been contacted by anyone from the Wisconsin Board of Nursing.

The minutes for the May 17th meeting should be available on the web some time after the next meeting on June 21st. The minutes might contain more information than the agenda, which simply indicates that I was discussed.

Step #5: Letter to State Senators and State Assembly Representatives for the City of Milwaukee

This letter was sent to all of the state senators and state assembly representatives for districts in the City of Milwaukee:

State Senate:
District 3, Tim Carpenter
District 4, Lena Taylor
District 5, Jim Sullivan
District 6, Spencer Coggs
District 7, Jeffrey Plale
District 8, Alberta Darling

State Assembly:
District 7, Peggy Krusick
District 8, Pedro Colon
District 9, Josh Zepnick
District 10, Annette Polly Williams
District 11, Jason Fields
District 12, Frederick Kessler
District 13, David Cullen
District 14, Leah Vukmir
District 15, Tony Staskunas
District 16, Leon Young
District 17, Barbara Toles
District 18, Tamara Grigsby
District 19, Jon Richards
District 20, Christine Sinicki
District 21, Mark Honadel
District 22, Sheldon Wasserman
District 23, Jim Ott
___________________________________________________
Thursday May17, 2007

[name]
Room XXX
State Capitol
PO Box XXXX
Madison, WI 5370X

Dear [name]:

As a [state senator/state assembly representative] for a district in the City of Milwaukee, I would like to bring to your attention a problem with Marquette University’s Direct Entry Nursing program. 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’s Direct Entry nursing program 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 State Law (Wisconsin Nurse Practice Act 441.04) 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 in order to 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.

Continuing to allow Marquette to flagrantly disregard the law in this manner serves only to prevent qualified individuals from obtaining RN licensure in other states while the nation is in the midst of a nursing shortage crisis. When Celia M. Jackson, the Secretary of the DRL, was asked directly whether or not she supports Marquette University's absurd "interpretation" of the Nurse Practice Act, she did not respond.

I urge you to force Marquette University to bring its Direct Entry nursing program into compliance with Wisconsin State Law. If Marquette wishes to run a Direct Entry nursing program, then they must provide students with actual degrees and graduation dates before they can become RN’s - just like every other private university in Wisconsin that wishes to make its students eligible for RN licensure in Wisconsin must do. This is clearly what is required by the Wisconsin Nurse Practice Act.

Sincerely,

Lydia Bertrand

cc: Celia M. Jackson, Secretary, Wisconsin Department of Regulation & Licensing

Nursing Shortage In Mississippi

This article in the New York Times discusses the distressing increase in infant deaths in Mississippi. The article lists the nursing shortage as one of the many contributing factors to this problem.

The University of Wisconsin - Milwaukee's Direct Entry Nursing Program

The University of Wisconsin -Milwaukee (UWM) started a Direct Entry Nursing program shortly after Marquette University started theirs. Until recently I had not done much research on UWM's program since the legal basis for their program is not really relevant to my campaign with Marquette. I imagined that UWM probably had some kind of written "special agreement" with the Wisconsin Department of Regulation & Licensing (DRL) similar to the one that Marquette claims to have, possibly even in the form of a letter from Mr. Wayne Austin to the Dean of UWM's College of Nursing like Marquette's.

Since UWM's Direct Entry program does not meet the Wisconsin Nurse Practice Act by providing a degree to its students before they become RNs, it seems like there should be some kind of formal written documentation that acknowledges Wisconsin's acceptance of this program. When an open records review of all documents relating to Direct Entry nursing programs in Wisconsin was requested of Celia Jackson, the Secretary of the Wisconsin DRL, she responded:

Concerning your request . . . for documents authorizing a direct entry nursing program at the University of Wisconsin - Milwaukee, my staff has been unable to find such documents. Wayne Austin's personal drive and e-mail has also been searched for information concerning direct entry programs. Only the 1999 letter from Mr. Austin to the Marquette School of Nursing was found which is already attached.

So according to the DRL, there is apparently NO formal documentation whatsoever that UWM's Direct Entry program is considered valid by the State of Wisconsin, even though the program violates state law by not conferring degrees to its students before they become RN's.

Who Accredits the Marquette College of Nursing?

Marquette's web site says that they are accredited by a number of organizations, including:

"NLNAC, Commission on Collegiate Nursing Education, the North Central Association of Colleges and Secondary Schools and The Wisconsin State Board of Nursing."

But Marquette is not listed on the NLNAC website as being accredited by them.

A simple e-mail to NLNAC revealed that "Marquette University's Baccalaureate and Masters' degree programs last day of accreditation with NLNAC is December 2006." I hope Marquette plans to update their website at some point.


UPDATE: Marquette's web site was changed some time on Monday, April 30th so that it no longer mistakenly lists that the College of Nursing is accredited by NLNAC. It only took them four months.

Statement of Graduation

Click here for a larger image

In the last post the issue of what form of documentation is accepted by different states that require graduation from a school of nursing in order to become a registered nurse came up. Here is the "STATEMENT OF GRADUATION" form that was a part of my application for RN licensure in Wisconsin.

The Wisconsin Nurse Practice Act requires graduation from a school of nursing, and this form (the "STATEMENT OF GRADUATION" form) is considered by the State to constitute official proof of graduation. I filled out the top half according to the instructions provided by Marquette staff members and turned it in to Marquette, and Marquette then filled in the bottom half and forwarded it to the Wisconsin Department of Regulation & Licensing so that I would become eligible to sit for the NCLEX-RN exam. (The Marquette seal does not show up on photocopies.) You may notice that it is signed by Dr. Judith Miller.

I remembered filling out this form, and brought it up in my first letter to Dr. Judith Miller. She had some interesting comments about it in her response letter:

Dr. Miller explained that on the "Statement of Graduation" form for Direct Entry students the box for "BSN" is checked and a graduation date is filled in because:

"This application document does not have a space for Direct Entry applicants . . . "

and

"We do not want our professional nurses to check LPN, or ADN on the application form."

Does this explanation make any sense to YOU? I may be a stickler here, but to me an official document required by an agency of the State of Wisconsin that says "STATEMENT OF GRADUATION" across the top, has "BSN" marked and lists a graduation date, is signed by the associate dean of the nursing program, and has the Marquette University seal at the bottom kind of looks like it is saying that I . . . y'know . . . GRADUATED.

Step #4: Letter to the Members of the Wisconsin Board of Nursing

I sent this letter out this morning to each member of the Wisconsin Board of Nursing. They should get it around Tuesday of next week.
___________________________________________________
Thursday April 19, 2007

[name]
Member, Wisconsin Board of Nursing
State of Wisconsin
Department of Regulation and Licensing
PO Box 8935
Madison, WI 53708-8935

Dear [name]:

As a member of the Wisconsin Board of Nursing, I would like to bring to your attention a problem with Marquette University’s Direct Entry Nursing program. 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/

I was a member of the 6th cohort of Marquette’s Direct Entry program in 2004-2005, but I left the program before the completion of an MSN degree. After I completed the pre-MSN portion of the Direct Entry program I passed NCLEX-RN and obtained licensure in Wisconsin. When I was unable to become licensed in Mississippi, where I am now living, I began to research licensure laws and procedures in the two states in order to find out how I could get a license in Mississippi. During this process I discovered the Wisconsin Nurse Practice Act 441.04, which lists requirements to sit for the NCLEX-RN 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.

As a Direct Entry Student at Marquette I was told that Marquette and the 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.

I urge you to reevaluate the Board’s "special agreement" with Marquette. I simply can not understand why a Wisconsin state agency would agree to a blatant misinterpretation of State Law that seems to serve only to facilitate the financial gain of a private institution. If Marquette wishes to run a Direct Entry nursing program, then they must be required to provide students with actual degrees and graduation dates before they can sit for NCLEX – just like every other private university in Wisconsin. This is clearly what is required by the Wisconsin Nurse Practice Act.

Sincerely,

Lydia Bertrand

cc: Jeff Scanlan, Director, Bureau of Health Services Professions
Colleen Baird, Legal Counsel for the Wisconsin Board of Nursing

Letter From the Director of the ADN Program

I asked the Director of Nursing Education at Pearl River Community College's ADN program to put the content of our conversation last week into writing for me, and I got her letter today. Here is an excerpt:
________________________________________________
Dear Ms. Bertrand:

After careful review of your transcript and syllabi from Wisconsin, we find that you have essentially completed everything in our curriculum. Our college catalog states that in order to receive a degree from the institution you must complete at least 25% of your final course work in residence. You would have to repeat numerous courses that you have completed already and have done extremely well in . . .

I wish I could do more . . . Good luck to you in your endeavors.

Sincerely,

Peggy Dease, M.S., R.N.
Director of Nursing Education, Pearl River Community College

Turned Away From an ADN Program

I don't usually read the daily newspaper, but I just happened to glance at the front page today and this article in the Clarion-Ledger, a Jackson Mississippi paper, grabbed my attention. I thought it was pretty interesting since just Tuesday I met with the director of a nearby ADN (Associate's Degree in Nursing) program - who actually turned me away from their program because I have already taken too many classes, including many classes more advanced that what they even offer at a community college.

Before I realized that there was a legal problem with Marquette's Direct Entry program I decided to apply to an ADN program. Marquette had indicated that the only way for me to get a degree would be to go through another school as a transfer student. I thought that a community college might be the fastest & least expensive way for me to get a degree, which I need to get a valid Mississippi nursing license. I knew that it would basically mean repeating material I've already done, but my focus was on speed and cost. I figured I should just go ahead and apply and see how many of my credits they would transfer, and then I could decide if it would be worth my time and money to get the ADN or not. So I applied to the nearest community college with an ADN program (which is 45 miles from where I live). The problem is that in order for them to grant a degree from their institution, you have to take at least 25% of the required nursing courses at their school - and I already took ALL of their required courses, plus many more advanced nursing courses, at Marquette. I thought maybe they would let me re-take 25% of the classes at their school, but the director of the program decided that the situation was too irregular and told me that they would not accept me as a student.

Second Letter To Father Wild

Tuesday April 3, 2007

Robert A. Wild, S.J.
Office of the President
Marquette University
P.O. Box 1881
Milwaukee, WI 53201

Dear Father Wild:

Thank you for your letter dated March 28, 2007. I had a lot to say in my last letter, and so perhaps my main point was not clear.

I am not asking Marquette University to influence any state authorities, or to fulfill the licensure requirements of any state other than Wisconsin. The only thing I am asking of Marquette is to bring the Direct Entry nursing program into compliance with Wisconsin State Law.

The Wisconsin Nurse Practice Act 441.04 lists requirements to sit for the licensure exam (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.

The Wisconsin Administrative Code N 2.03 also discusses requirements to sit for the RN licensure exam, and includes this requirement (emphasis mine):

Has graduated from a board-approved school of professional nursing.

Both the Wisconsin Nurse Practice Act and the Wisconsin Administrative Code both clearly require graduation. Although up to this time the State of Wisconsin has interpreted its licensing requirements to allow students who have completed the pre-MSN phase of Marquette’s Direct Entry Program to sit for the licensing exam, this interpretation is on shaky ground. I suspect that this absurd “interpretation” of the law may not hold up to legal scrutiny - and I am perfectly willing to find out if it will stand up to legal scrutiny if this problem is not resolved in another way.

My signing of the “Memorandum of Understanding” is meaningless because this document required me to agree to allow Marquette to do something that is not legal. I signed the Memorandum because I was required to do so in order to become a student in the Direct Entry program, and at the time that I signed it I was not aware that the contents of the Memorandum directly contradict the Nurse Practice Act and the Wisconsin Administrative Code. I assure you that I never would have decided to become a student in Marquette’s Direct Entry program if I had known that the program did not meet the legal requirements for RN licensure in the state of Wisconsin.

I asked to be granted a BSN for several reasons. [name], Graduate Program Assistant for the College of Nursing, told me in an e-mail on February 23, 2007 that the State of Wisconsin considers Direct Entry students to have earned a “BSN equivalent.” (Enclosed) Also, on the “Statement of Graduation” form that we fill out for the Department of Regulation & Licensing Direct Entry students are told to mark the box for “BSN.” (Enclosed) Dr. Judith Miller told me in her letter dated February 26, 2007 that this is because Marquette does not “want [its] professional nurses to check LPN, or ADN on the application form.” And as a University, I was under the impression that Marquette does not issue Associate’s degrees. The fact remains that the Law requires students to graduate from a nursing program of some kind in order to become licensed.

Although I already explained why the “Memorandum of Understanding” that I signed is invalid, I think you should know that this document was altered after I signed it. The “Memorandum of Understanding” that I signed states: “you will be eligible to take the professional licensing exam for nursing in the State of Wisconsin.” It does not address RN licensure in any other state one way or the other. After I signed the Memorandum someone added in handwriting the word “only” after the word “Wisconsin,” which completely changes the meaning of the sentence. You state in your letter dated March 28th that by signing the “Memorandum of Understanding” that I “agreed that . . . [I] would be eligible to take the licensing exam in the State of Wisconsin, but not in any other state.” This is not accurate. The “Memorandum of Understanding” that I signed did not say this, nor have I ever been told this verbally. Dr. Judith Miller told me verbally when I left the program that I “may not be able to become licensed in another state,” and that Marquette “could not guarantee licensure in another state.” I never signed a form, or was ever told verbally by Dr. Judith Miller or anyone else, that I definitely would not be able to become licensed in any other state. In any case, my acknowledgment of these verbal statements by Dr. Miller at the time that I left the program is irrelevant for the same reason that the “Memorandum of Understanding” is - these statements reflect a Marquette policy that directly contradicts Wisconsin State law.

Wisconsin State law requires registered nurses to graduate from a school of nursing. Any interpretation of the law that honors a program that does not graduate its students is ludicrous. The best solution to this problem, for all parties involved, is for Marquette University to bring the Direct Entry nursing program into compliance with Wisconsin State law by issuing a nursing degree and graduation date to students who complete the pre-MSN portion of the program.

Sincerely,

Lydia Bertrand

Um . . . Where Did This Come From???

Ya see that "only" penciled in after "Wisconsin"? That wasn't there when I signed the form. This is the copy of the "Memorandum of Understanding" that was included with Father Wild's letter dated March 28, 2007.

This is the unaltered copy of the "Memorandum of Understanding" that was included with the letter I received from Dr. Miller on February 26, 2007.

Response From Father Wild: Including a Doctored Document

March 28, 2007

Dear Lydia,

Thank you for your letter regarding your experience at Marquette. After receiving your letter and a letter from your father, I discussed your case with a number of colleagues. First, let me say that I do appreciate your situation. I certainly understand that your life plans changed and that you moved from Wisconsin to the Gulf Coast region as a result of your marriage and your husband's work as an Episcopal priest. I'm sure that you are making a positive difference in the lives of your parishioners and in your community. So I do appreciate your current circumstances.

Those things said, Marquette has a specific requirements outlined in the Graduate Bulletin that we must adhere to in terms of granting degrees. You yourself agreed to the terms outlined by the College of Nursing and in the Graduate Bulletin when you were a student. Specifically, you signed a Memorandum of Understanding dated April 1, 2004 (copy enclosed) where you acknowledged and agreed to the following:

"Please understand that the purpose of this program is to prepare you with a Master of Science degree in Nursing. You will not receive another bachelor's degree. At the completion of the pre-MSN phase, you will be eligible to take the professional licensing exam for nursing in the State of Wisconsin."

You agreed to these terms. If they were not acceptable to you, then you should not have signed the Memorandum of Understanding. Specifically, you agreed that you would not earn a bachelor's degree and that after the pre-MSN phase, you would be eligible to take the licensing exam in the State of Wisconsin, but not in any other state. Now you are asking Marquette to award you a bachelor's degree, and that is something that we did not promise and cannot do because you did not earn such a degree here at Marquette. In order to earn a bachelor's degree, Marquette requires completion of 53 credits of university core courses in addition to the nursing courses, plus a student must earn a total of 128 credits in order to receive a bachelor's degree. Since you did not meet these requirements, you cannot receive a BSN degree. Rather, you were required to take 50 credits of undergraduate nursing courses to be eligible to take the NCLEX examination in Wisconsin. The State of Wisconsin has interpreted its licensing requirements to allow students who have completed the pre-MSN phase of Marquette's Direct Entry Program to sit for the licensing exam. We do not control how other states interpret their own licensing requirements.

Professional licensing remains the jurisdiction of each individual state. Indeed, your letter states that you took the NCLEX examination at the conclusion of the pre-MSN phase of the program, as outlined in the materials you received from us, and you passed that exam which allowed you to be licensed in Wisconsin.

While I appreciate that you and your husband left Wisconsin, I must point out that in doing so, you were informed on multiple occasions what this would mean for your future career in nursing, namely that it would likely be necessary for you to take addition courses at another institution in order to become licensed outside of Wisconsin.

We have no direct influence over any state authorities. That said, I know that Dr. Judith Fitzgerald Miller, Associate Dean of the College of Nursing has been working with you with respect to the Mississippi licensing requirements (see enclosed letter from Dr. Miller to you dated February 26, 2007). My assessment of this is that Dr. Miller is going above and beyond in order to help you, which is what I would expect of faculty members at Marquette. While Dr. Miller is doing all that she can to help you, it is important to remember that what we can do with respect to Mississippi is limited.

The best advice that I can give is for you to continue working directly with Dr. Miller on possible solutions to this issue. I recognize that you and your family are not pleased with the current status, but the issue is beyond Marquette's control for the reasons explained above. You chose to move out of Wisconsin and unfortunately that decision complicated your nursing situation a great deal.

For the rest, please be assured of my prayers for you and your husband that our good and gracious God will bless your continued work in Mississippi.

Sincerely,

Robert A. Wild, S.J.
___________________________________________________
This letter included a copy of the "Memorandum of Understanding" in which someone had hand-written in the word "only" in this passage:

At the completion of the pre-MSN phase, you will be eligible to take the professional licensing exam for nursing in the state of Wisconsin only.

The word "only" was not on the original document at the time that I signed it. The insertion of the word "only" completely changes the meaning of the sentence. The document that I signed stated that I could become licensed in Wisconsin, but said nothing about licensure in other states.

Frequently Asked Questions

Q: What is the Direct Entry Nursing program?

A: It is an accelerated three-year program for individuals who have a bachelor's degree in a field unrelated to nursing to get an RN and a master's degree in a nursing specialty (for example to become a nurse-midwife, pediatric nurse practitioner, etc.) At the end of the first 15 months students become registered nurses, then spend the next two years working on their MSN (Master's of Science in Nursing). Students must be able to become licensed as registered nurses before beginning the master's degree part of the program so that they can participate in the clinical courses that are required. The intent of the program is for people to stay through the completion of the master's degree.

Q: You knew when you began the program that it did not offer a Bachelor's of Science in Nursing (BSN), so why are you upset about this now?

A: I agreed to attend the Direct Entry program even though I knew that I would not get a BSN because I was not aware that Wisconsin State Law requires graduation from a school of nursing in order to become an RN. We were told that Marquette had a "special agreement" with Wisconsin in order to allow us to become RNs without BSNs. Marquette is a reputable institution, and they had already been running the Direct Entry program for several years, so I assumed that this "special agreement" must be legitimate.

After I moved to Mississippi and I was unable to obtain a license here I began to research the nursing laws and licensure procedures in Wisconsin and Mississippi to find out how it happened that I was able to get licensed there, but not here. This research revealed that the "special agreement" between Marquette and the State directly conflicts with the Nurse Practice Act (441.04) in Wisconsin, which clearly requires graduation in order to become licensed as an RN.

The bottom line: it does not matter what I agreed to when I began the Direct Entry program at Marquette if what they are doing is not legal. Marquette can't force its students to sign a form allowing them to break the law. I have not been able to find any official evidence that the "special agreement" that Marquette has with Wisconsin is legal.

Step #3: Letter to Each Member of Marquette's Board of Trustees

I have not gotten a response from Father Wild or from the second letter I sent to Judith Miller that requested a copy of the 'special agreement.' It has been over two weeks, so I'm moving on to the next step. These letters should arrive at Marquette around next Wednesday - since there are 35 letters I can't afford to send them priority. It's hard to say when the individual board members will actually get their letters - it looks like many of them don't live in Milwaukee. Over three weeks ago I requested a copy of the "Statement of Graduation" that is part of my file at the Department of Regulation & Licensing because I had wanted to include a copy of it with this letter, but I have not received it yet.
___________________________________________________
Friday, March 23, 2007

[NAME]
Member, Marquette University Board of Trustees
Marquette University
P.O. Box 1881
Milwaukee, WI 53201

Dear [NAME]:

I would like to bring to your attention some irregularities relating to Marquette University’s Direct Entry nursing program. I will give an overview of the problem here, but additional details and documents can be found on my website: lydiaslicense.blogspot.com.

Let me begin by briefly telling you my story. I graduated from Chatham College in 1999 with a B.A. in Mathematics and English Literature, Cum Laude, Phi Beta Kappa. I was a member of the 6th cohort of the Direct Entry nursing program at Marquette University (2004-2005). When I began the program I fully intended to complete the full three years. About half way through the first 15 months, the RN portion of the program, I became engaged. At that time my fiancé was in his last year at an Episcopal seminary, and he was obligated to return to serve in his home state of Louisiana in June of 2005. He was assigned to a large parish in New Orleans and I stayed in Milwaukee until August to complete my RN, with plans to move to New Orleans with him directly after our wedding. On August 13, 2005 I completed the RN portion of the Direct Entry program at Marquette, on August 20th I got married, and on August 29th my husband and I lost nearly everything in Hurricane Katrina - including my husband’s parish. In November I took state boards and received my nursing license in Wisconsin. My husband took the first job he was offered, which did not happen until March of 2006. This job happened to be in Mississippi.

When I applied for a nursing license in Mississippi my application was denied for one reason: because my Marquette transcript does not contain a graduation date. I am now in repayment of over $35,000 in student loans that I took out in order to attend Marquette although I am now unable to work as a nurse. My husband is an Episcopal priest in rural Mississippi and is currently supporting our family of three on only a few thousand dollars a year more than the amount of my outstanding student loans. The area we live in is also experiencing a severe nursing shortage crisis.

Mississippi state law regulating nurses states that one must graduate from an accredited nursing program in order to hold a license. The same is true in Wisconsin (Nurse Practice Act: 441.04). How can the Direct Entry program qualify its students to become registered nurses, yet not award us degrees? When I applied to take the state board examination (NCLEX-RN) I filled out a "Statement of Graduation" form for the Wisconsin State Board of Regulation & Licensing. On this form my classmates and I were instructed by Marquette staff members to check the box for "BSN" and to list August 13, 2005 as a graduation date - yet there is no graduation date listed on my official Marquette transcript.

Dr. Judith Miller, Associate Dean of Graduate Programs & Research, College of Nursing, has informed me that Marquette University negotiated with the State of Wisconsin to allow Direct Entry students to sit for the state board exam without holding a degree. I fail to see how an agreement of this kind can possibly be valid. The Nurse Practice Act clearly states that in order to sit for the licensure exam individuals must hold "a diploma of graduation."

I requested a copy of the formal written agreement between the State of Wisconsin and Marquette University relating to the licensure of Direct Entry students from Dr. Judith Miller on May 5, 2007, but I did not receive a response. When I requested the same information from the Department of Regulation & Licensing under the Wisconsin Public Records Law I was provided with two letters. (A pdf file containing these documents is available on my web site for your convenience.) The first letter is from Madeline Wake, then Dean of the College of Nursing, to Wayne Austin, then Legal Counsel for the Board of Nursing, and is dated December 15, 1998. The second letter is from Mr. Austin to Dr. Wake and is dated February 1, 1999. In this exchange of letters Mr. Austin and Dr. Wake agree to interpret the intent of the Wisconsin Administrative Code N 2.03 to include progression from the pre-MSN phase of the Direct Entry program into the MSN phase to qualify as "graduation": yet Marquette does not actually graduate these students. This interpretation is absurd. The Wisconsin Administrative Code (N 2.03) and Wisconsin State Law (Nurse Practice Act 441.04) are both quite clear that graduation from an approved school of nursing is required for RN licensure in Wisconsin. It is obvious to any person who does not have an ulterior motive that the only appropriate interpretation of the word "graduation" in this context is "graduation." If Marquette University wishes to run a Direct Entry nursing program, then it is obligated to provide degrees and graduation dates for the students who complete the first 15 months of the program.

As a member of the Marquette University Board of Trustees I am requesting your assistance in procuring BSN degrees and graduation dates for Direct Entry nursing students who successfully complete, or have completed, the first 15 months of the program. Direct Entry students complete all of the nursing theory and practical courses required of Marquette’s regular BSN students. I contacted Dr. Judith Miller regarding this discrepancy on February 22, 2007, but she did not resolve the problem satisfactorily. Father Wild has not yet responded to the letter I sent to him on March 5, 2007. As you know, Marquette University is a highly regarded institution in the community. Intentionally engineering a questionable loophole in order to obtain RN licensure for its Direct Entry students without providing a degree or a graduation date for them is not in line with the Catholic values of the University.

Sincerely,

Lydia Bertrand

Documents Provided by the DRL

Link to the letters referenced by Colleen Baird in the previous post.

Response From DRL (Email)

Date: Friday, March 9
To: Lydia Bertrand
From: Colleen Baird

Dear Ms. Bertrand: This is a follow-up to my email response on March 5,2007, regarding the Graduate Nursing Direct-Entry Program and your letter to Secretary Celia Jackson, dated March 6, 2007. You sent the following question:

I am looking for some information about Marquette's Direct Entry Nursing program. I have been told that Marquette has a special agreement with the state of Wisconsin allowing their Direct Entry students to become RN's without obtaining a BSN degree. I would like a copy of this formal agreement. Thank you.
Lydia Bertrand

I stated that I did not believe that we had a copy of a formal agreement and recommended that you contact the school for a copy. I apologize, but unfortunately, I was not familiar with the history or documentation for this program. The individual who handled such matters had just retired. However,with the assistance of staff, two documents were located which should satisfy your request. These documents are attached for your convenience. I will also send a hard copy by U.S. Mail. The first document is a letter dated February 1, 1999, from Wayne Austin, former legal counsel for the Board of Nursing. The second document is a letter dated December 15, 1998, from Madeline Wake, Dean of Marquette University. These letters constitute the "agreement" between the Department, the Board of Nursing and Marquette University for the direct-entry advance three year advance nursing program.

The letter from Dean Wake inquires whether students who have completed the basic nursing education and progress to the MSN phase of the program would meet the intent of Chapter N.03 "has graduated from a board-approved school of professional nursing. " The letter from Attorney Wayne Austin confirms this interpretation; that participants in the direct-entry for graduate nursing program who complete the basic nursing education phase of the program would qualify both to sit for the NCLEX and for licensure to practice professional nursing. Mr. Austin states that the Board's approval was made pursuant to its authority to establish minimum standards for schools of professional nurses and approve new nursing programs under sec. N1.06, Wis. Admin. Code. It further confirms that Marquette University had an existing approved nursing program.

The statutory authority for licensure and approval of schools of professional nursing is found in secs. 441. 04 and 441.01(3), Wis. Stats. (Nurse Practice Act). The administrative rules in Chapter N 1, Wis. Admin Code, codify the process for approval of schools of nursing and nursing programs. I am not aware of any other statutes which are pertinent to RN licensure of individuals who do not hold a "diploma of graduation." The basis upon which Wisconsin determined that you were eligible to sit for the NCLEX, and to obtain a professional nursing license, was the receipt of a statement from Marquette University verifying that you had completed the basic nursing education phase of the three year graduate (master's level) nursing program.

I trust that this is the information you were seeking and it is helpful in your efforts to obtain licensure in Mississippi. If we can be of further assistance, please do not hesitate to contact us.

Colleen M. Baird
Legal Counsel
Wisconsin Board of Nursing
___________________________________________________
I will post the letters that were attached to this e-mail as soon as I figure out how to put up pdf files.

Freedom of Information

I know I just said I wouldn't be posting for a few days, but the baby is sleeping a little longer than usual and I couldn't help myself . . .

Of course I have heard of the Freedom of Information Act (FOIA) before, but I didn't know much about exactly what it meant or how it works. It only took about 5 minutes of research on the Internet to find out that the FOIA only applies to federal agencies. The State of Wisconsin, however, has a similar law, the Wisconsin Public Records Law (WPRL) that requires disclosure of information from State agencies unless the information falls into certain specific exemptions. Requests for information from The Wisconsin Department of Regulation & Licensing would be covered by the WPRL. The Department of Justice recommends that requests for information should be filled within 10 business days if possible. This page has some good general information on the WPRL that I found interesting.

Out of town for a few days

I won't be posting for a few days because I'll be out of town. There is not much to post now anyway since all I'm doing is waiting to get responses from Judith Miller, Father Wild, and Celia Jackson from the DRL. See you in a few days!

Letter to Celia M. Jackson, Secretary of the DRL

March 6, 2007

Celia M. Jackson
Secretary
Wisconsin Department of Regulation & Licensing
PO Box 8935
Madison, WI 53708-8935

Secretary Jackson:

I was a student in Marquette University’s Direct-Entry Nursing program. I have been told that there is some kind of ‘special agreement’ between Marquette and the State of Wisconsin that allows their Direct-Entry students to become Registered Nurses without having degree or graduating from their program. This appears to be in conflict with the Nurse Practice Act (441.04), which requires "a diploma of graduation" before one can sit for NCLEX-RN.

On Tuesday, February 27th I e-mailed the Department of Regulation & Licensing at web@drl.state.wi.us to ask for a copy of this formal agreement. On March 5th I got a response from Colleen Baird, who identified herself as Legal Counsel for the Wisconsin Board of Nursing. Her e-mail stated:

This is in response to your question about the Marquette Nursing Program. I do not believe that we have a copy of this formal agreement. You should contact the school directly.

A complete transcript of the e-mail exchange is available on my web site: http://lydiaslicense.blogspot.com/2007/03/email-exchange-with-wi-department-of.html

Frankly, I find it hard to believe that if an agreement exists between Marquette University and the Department of Regulation & Licensing allowing Direct-Entry students to sit for NCLEX and become RNs without holding a degree (as I have been repeatedly assured is the case), that the DRL literally does not have an actual copy of this formal agreement present somewhere in their files.

1. Does the Wisconsin Department of Regulation & Licensing in fact have an agreement with Marquette University which allows Direct-Entry students to become RNs without graduating or holding a degree?

2. If an agreement does exist, then I demand a copy of the written formal agreement, and any other documents pertinent to the licensure of Direct-Entry students who do not hold a "diploma of graduation."

3. I would like references to any state statues pertinent to the RN licensure of individuals who do not hold a "diploma of graduation" in addition to the one I referenced above (the Nurse Practice Act 441.04)

Thank you,

Lydia Bertrand

cc: Barbara Wyatt Sibley, Deputy Secretary
Larry Martin, Executive Assistant

An Email Exchange With The WI Department of Regulation & Licensing

Date: Tuesday, February 27
To: web@drl.state.wi.us [the generic DRL email address]
From: Lydia Bertrand

I am looking for some information about Marquette's Direct Entry Nursing program. I have been told that Marquette has a special agreement with the state of Wisconsin allowing their Direct Entry students to become RN's without obtaining a BSN degree. I would like a copy of this formal agreement.

Thank you

Lydia Bertrand
___________________________________________________
Date: Saturday, March 3
To: Lydia Bertrand
From: [name]

Lydia

Marquette's direct entry masters program is recognized by the board of nursing. The portion of the program that prepares for the license has been approved by the board. When students complete that portion, the school verifies it to the board, and the student can take the exam and get the license.

You are right that the student does not get a degree at that point. The student would need to complete the masters to get a degree. Students with non-nursing bachelors degrees may prefer that, if they go back to school, they get a masters, rather than another bachelors degree. That need is what the program addresses.

[name]
___________________________________________________
Date: Saturday, March 3
To: [name]
From: Lydia Bertrand

[name]

Thank you for returning my email.

This agreement appears to be in conflict with the Nurse Practice Act (441.04) which requires individuals to obtain a "degree of graduation" before they may sit for NCLEX. Was there an amendment, or another part of the law that I am missing that makes an exception for Marquette's Direct Entry program?

There must be a written formal agreement between the State and Marquette. How may I obtain a copy of this agreement?

Thank you,

Lydia Bertrand
___________________________________________________
Date: Monday, March 5
To: Lydia Bertrand
From: Colleen Baird

This is in response to your question about the Marquette Nursing Program. I do not believe that we have a copy of this formal agreement. You should contact the school directly.

Colleen M. Baird
Legal Counsel
Wisconsin Board of Nursing
___________________________________________________

Does anyone else think this is a tad strange? It is hard to tell if this is suspicious or just ordinary incompetence.

I didn't think that I was going to get a response to my first email, so last week I also mailed a paper letter to the "Credentialing Administrator" at the DRL asking for a copy of the formal written agreement, but they won't get the letter for several more days.

Step #2: Letter to President of Marquette University, Father Wild

March 5, 2007

Robert A. Wild, S.J.
Office of the President
Marquette University
P.O. Box 1881
Milwaukee, WI 53201

Dear Father Wild:

I would like to bring to your attention some irregularities relating to Marquette University’s Direct-Entry nursing program.

Let me begin by briefly telling you my story. I graduated from Chatham College in 1999 with a B.A. in Mathematics and English Literature, Cum Laude, Phi Beta Kappa. I was a member of the 6th cohort of the Direct-Entry nursing program at Marquette University (2004-2005). When I began the program I fully intended to complete the full three years. About half way through the first 15 months, the RN portion of the program, I became engaged. At that time my fiancé was in his last year at an Episcopal seminary, and he was obligated to return to serve in his home state of Louisiana in June of 2005. He was assigned to a large parish in New Orleans and I stayed in Milwaukee until August to complete my RN, with plans to move to New Orleans with him directly after our wedding. On August 13, 2005 I completed the RN portion of the Direct-Entry program at Marquette, on August 20th I got married, and on August 29th my husband and I lost nearly everything in Hurricane Katrina - including my husband’s parish. In November I took state boards and received my nursing license in Wisconsin. My husband took the first job he was offered, which did not happen until March of 2006. This job happened to be in Mississippi.

When I applied for a nursing license in Mississippi my application was denied for one reason: because my Marquette transcript does not contain a graduation date. I am now in repayment of over $35,000 in student loans that I took out in order to attend Marquette although I am now unable to work as a nurse. My husband is an Episcopal priest in rural Mississippi and is currently supporting our family of three on only a few thousand dollars a year more than the amount of my outstanding student loans. The area we live in is also experiencing a severe nursing shortage crisis.

Mississippi state law regulating nurses states that one must graduate from an accredited nursing program in order to hold a license. The same is true in Wisconsin (Nurse Practice Act: 441.04). How can the Direct-Entry program qualify its students to become registered nurses, yet not award them degrees? When I applied to take the state board examination (NCLEX-RN) I filled out a "Statement of Graduation" form for the Wisconsin State Board of Regulation & Licensing. On this form my classmates and I were instructed by Marquette staff members to check the box for "BSN" and to list August 13, 2005 as a graduation date - yet there is no graduation date listed on my official Marquette transcript.

Either my Direct-Entry classmates and I hold BSNs with Marquette University, or we do not. It is unethical for Marquette to provide evidence of graduation only to those parties for whom it is to Marquette’s advantage. If my fellow Direct-Entry students and I have earned BSNs with Marquette University then our transcripts should list graduation dates. If we have not obtained BSNs from Marquette University then it appears as though the University is intentionally forging falsified "Statement of Graduation" forms for the Wisconsin Department of Regulation & Licensing every year for each Direct-Entry student.

Dr. Judith Miller, Associate Dean of Graduate Programs & Research, College of Nursing, has informed me that Marquette University has negotiated with the State of Wisconsin to allow Direct-Entry students to sit for the state board exam without holding a degree. I fail to see how an agreement of this kind can possibly be valid. The Nurse Practice Act clearly states that in order to sit for the licensure exam individuals must hold "a diploma of graduation" (441.04). Even the State itself is not authorized to make exceptions to this law without actually changing the law.

Marquette University should be ashamed for engineering this loophole to obtain RNs for its Direct-Entry students without providing a graduation date on their transcripts. I would have expected a Catholic University to behave with integrity. I contacted Dr. Judith Miller regarding this discrepancy, but she was unable to resolve the problem satisfactorily. If Direct-Entry students who successfully complete, or have completed, the first 15 months of the program are not granted BSNs with graduation dates placed on their official Marquette transcripts, I will take further action.

Sincerely,

Lydia Bertrand

Second Letter To Judith Miller

March 5, 2007

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

Dear Dr. Miller:

Thank you for your prompt and thorough response to my previous letter. I still do not understand how an agreement between Marquette and Wisconsin can be valid since it appears to be in direct conflict with the Nurse Practice Act (441.04) which lists requirements before sitting for NCLEX:

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.

I would like to request a copy of the formal written agreement between Marquette University and the State of Wisconsin regarding the licensure of Direct-Entry students. I would also like references to any state statutes that are applicable to this agreement other than the one I have quoted above.

Sincerely,

Lydia Bertrand

Email Exchange With MU Nursing Secretary

To: Secretary A
From: Lydia Bertrand
Date: Friday, February 23

Secretary A,

I’m wondering if you can help explain something to me about the DE program. I remember people talking about some kind of "special agreement" that Marquette made with the state in order for us to get RNs without us having a degree. Do you know anything more about this agreement and how it works?

Mississippi has denied my application for a license because my MU transcript does not contain a graduation date. When I started researching it, I found that the WI Nurse Practice Act requires evidence of graduation just like the MS law. I am very confused.

Lydia Bertrand
_________________________________________________
Secretary A was not really the best person to answer my question, so she forwarded my email to Secretary B, who promptly responded.
_________________________________________________
To: Lydia Bertrand
From: Secretary B
Date: Friday, February 23

Hi Lydia,

The special agreement is that you can work as an RN at the BSN level as long as you continue to complete the MSN program.

Some states choose to honor the fact that you have completed a BSN "equivalent" while others will not.

We can write a letter stating that you have completed an equivalent if they will accept it. The fact that you received RN licensure here could help.

Otherwise, all you can do is go to a university, have them evaluate your transcripts and do what they require for you to receive a BSN with them.

Let me know if you need anything or have other questions.

Secretary B
_________________________________________________
To: Secretary B
From: Lydia Bertrand
Date: Friday, February 23

Secretary B,

Thanks for getting back to me. I have some more questions about your response.

1. You said that people could work as an RN as long as they continue to complete the MSN program - but I know of individuals from my cohort that left the program, but became RN’s in WI and are still working there as nurses.

2. The WI nurse practice act states that you have to show proof of graduation in order to become an RN. Was there some kind of amendment, or another law that makes an exception for Marquette’s DE program? I don’t understand how some ‘special agreement’ is sufficient to override a state law.

Thanks for your help.

Lydia Bertrand
_________________________________________________
To: Lydia Bertrand
From: Secretary B
Date: Friday, February 23

It would be better to speak with Dr. Miller about this. You can call me or (414) xxx-xxxx and [Secretary C] or I will transfer you.

I guess I would say there has been a loophole on this one. WI has chosen to honor the equivalency.

But the fact that other states do not honor this is one reason why we need students to complete the program.

We can state what you’ve completed, but you have not received a degree since you did not finish the program. It is up to other states whether they will recognize your accomplishments or not. _________________________________________________

Let me recap some issues that were brought up in this email exchange:

1. The secretary lied to me about the content of this "special agreement." There are no restrictions on the WI nursing licenses of Direct-Entry students - even if they do not continue on to the MSN portion of the program. However, it is in Marquette’s best interests for Direct-Entry students to think that there is a restriction like this.




2. She admits that the Direct-Entry program is operating under a loophole.




3. The Nurse Practice Act says nothing about accepting a "BSN equivalent." The law clearly states that one must actually graduate. Period.




4. She implies that the reason Marquette is using this loophole in the Direct-Entry program is in order to attempt to keep students at Marquette for the MSN part of the program. They could award Direct-Entry students BSNs if they wanted to (we do all the work that regular BSN students do, and pay even more per credit than they do) but they choose not to.

Response From Dr. Miller

February 26, 2007

Dear Ms. Bertrand:

I received your letter today dated February 22, 2007 in which you express dismay abut not being able to become licensed as a professional nurse in Mississippi when in fact your previous classmates are able to be licensed in Wisconsin after completing the pre-MSN phase of the Direct Entry MSN program. Please recall that we negotiated with the State of Wisconsin to allow students in the Direct Entry program to take the NCLEX exam in Wisconsin after completing the pre-MSN portion of this program. We justify this in terms of meeting the nursing portion of the program objectives expected for the BSN here at Marquette. States have their own separate jurisdiction over professional nurse licensure. If students leave the program prior to completing the MSN phase, there is not guarantee that they will be licensed in any other state since no nursing degree has been conferred. You did not receive a BSN from Marquette. This was made clear to you and all students upon accepting admission and you signed the memorandum of understanding indicating so (see enclosed).

Regarding your comments about the State Board application, this application document does not have a space for Direct Entry applicants. Our accompanying documentation to the state of Wisconsin indicates the exact student status, having completed the pre-MSN portion of the MSN program. The State of Wisconsin is totally aware of this and the status of each NCLEX applicant. We do not want our professional nurses to check LPN, or ADN on the application form.

In trying to help you over the past months, I have written the State of Mississippi and have enclosed a copy of the Certificate of completion of the pre-MSN program, dated May 23, 2006 (enclosed). I have written Pearl River Community College as you requested January 16, 2007 (enclosed) with your e-mail response "This should be just fine!" Apparently there are no other Direct Entry MSN programs in the state of Mississippi. I called the Mississippi state board on your behalf today and talked to a Ms Carolyn Owens who was emphatic about Mississippi laws indicating a degree in nursing is required to sit for licensure. She indicated that the Mississippi Institute for Higher Learning approves all programs (degrees) for NCLEX applicants in Mississippi. When I explored with Ms. Owens the plan of your completing the NCLEX exam to be licensed in the state of Wisconsin and then transferring your license to Mississippi, she indicated a degree in nursing would still be required. I have a call in to Dr. Mary Ware (601-xxx-xxxx) who is the Chief of the Institute. I will continue to advocate for you. When you decided to leave the program in 2005, prior to completing the MSN, potential consequences were reviewed.

Any time a student decides to leave this Direct Entry MSN program, I am clear that being able to obtain a license in any other state until the MSN is completed is not a given. I recall this one-on-one session with you as well when you expressed your plans to marry and move to the South and not complete the program. Our commitment to our students is that students will be able to be licensed in the State of Wisconsin after the pre-MSN phase. The intent is to complete the degree of MSN. This negotiation was carefully completed 10 years ago with the State of Wisconsin prior to admitting our first students.

What happened to your plan to complete the ADN in Mississippi? I will inform you of any progress with the Mississippi Institute of Higher Learning.

Sincerely,

Judith Fitzgerald Miller, PhD, RN, FAAN
Associate Dean of Graduate Programs & Research,
Professor
Marquette University College of Nursing

Nursing Laws in Other States

I was curious to find out how Direct-Entry nursing programs operate in states other than Wisconsin, so I randomly chose another program similar to Marquette's and did some research on it.

Vanderbilt University is located in Nashville, Tennessee, and offers a 3 year program similar to Marquette's. Vanderbilt's web site says that the pre-MSN portion of their program prepares "students for the NCLEX exam to become a Registered Nurse (RN) and provides the foundation equivalent to the bachelor's degree in nursing." I don't know for certain, but I would guess that this implies that they do not grant a degree to their students when they complete the first portion of the program although they are able to become RNs.

Let me preface this by saying that I am not a lawyer, and I don't know much about the law. This is totally new territory for me. As a pretty much completely uninformed layperson I was able to find the Tennessee Nurse Practice Act on the web. The section related to the licensing of nurses states that it is required that an RN applicant:

has successfully completed a course of study in an approved school of nursing, as defined by the board, and the applicant holds a diploma or degree from an approved school of nursing, or the approved school has certified to the board that the applicant has met all requirements for a diploma or degree.

(Emphasis mine) It looks like it is perfectly legal for Vanderbilt students to become RNs even though they are not issued BSNs.

Compare this to the portion of the Wisconsin Nurse Practice Act that deals with requirements to sit for NCLEX:

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.

(Emphasis mine again) To me it appears as though the procedure that Vanerbilt and Marquette follow with their Direct-Entry programs (having students become RNs without issuing them a degree) is perfectly legal in Tennessee but not in Wisconsin.

My Demands

There is only one way for Marquette University to ethically resolve the conundrum of the Direct-Entry program:

Grant a degree & provide a graduation date for every student (past, present and future) who successfully completes, or has completed, the first 15 months of the Direct Entry program.

The only other option would be to immediately shut down the Direct-Entry program and revoke the nursing licenses of all of the students who have been a part of it. If these students do not have a degree, then they are not eligible to sit for the NCLEX-RN exam, which is required for licensure. If Direct-Entry students are not registered nurses then they cannot complete the graduate portion of the program because they must be RNs in order to participate in graduate level clinical courses. Therefore Marquette can not run the Direct-Entry program unless they grant degrees to students after the first 15 months of the program. (I got an A in logic.)

I have a feeling that Marquette would prefer not to have to shut down the Direct-Entry program. I'm willing to bet that they would also prefer to avoid the bad press that would result from retroactively revoking the licenses of many nurses - some of whom have been practicing for years. Especially since Direct-Entry students complete all of the nursing theory and practical courses that Marquette requires of their regular BSN students.

Step #1: Letter to the Associate Dean for Graduate Programs, Marquette College of Nursing

February 22, 2007

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

Dear Dr. Miller:

I believe that you are already aware that I was a member of the 6th cohort of the Direct-Entry program, and that I have been unable to obtain a valid nursing license in the state of Mississippi where I am currently living.

Mississippi state law regulating nurses states that one must graduate from an accredited nursing program in order to hold a license. The same is true in Wisconsin (Nurse Practice Act: 441.04) . How can the Direct-Entry program qualify people to obtain a nursing license in Wisconsin, but not in other states? When I applied to take NCLEX I filled out a "graduation statement" for the Wisconsin State Board of Regulation & Licensing. On this form my classmates and I were told by Marquette staff members to check the box for "BSN" and to list August 13, 2005 as a graduation date - yet there is no graduation date listed on my official Marquette transcript.

Either my Direct-Entry classmates and I hold BSNs with Marquette University, or we do not. It is unethical for Marquette to choose when, and to whom, it is to their advantage to provide proof of graduation. If I have earned a BSN with Marquette University then my transcript should list a graduation date so that I can obtain a license in other states. If I have not obtained a BSN from Marquette University then I should not have been eligible for a license in the state of Wisconsin, and neither should any other students who have gone through the Direct-Entry program.

When I tried to obtain a nursing license in Mississippi I was denied solely because my Marquette transcript does not contain a graduation date. I am now in repayment of over $35,000 in student loans that I took out in order to attend Marquette although I am now unable to work as a nurse. My husband is an Episcopal priest in rural Mississippi and is currently supporting our family of three on only a few thousand dollars a year more than the amount of my outstanding student loans.

Marquette University should be ashamed for engineering this loophole in the legal regulation of registered nurses for its own purposes. I would have expected a Catholic University to behave with integrity. If the issue of whether or not individuals who have completed the Direct-Entry program have earned BSNs at Marquette University is not resolved, I will be forced to take further action.

Sincerely,

Lydia Bertrand

Some Backround Information

I was in the 6th cohort of the Direct Entry nursing program at Marquette University. This program is designed for individuals who have a bachelor's degree in an unrelated field to get an RN and a master's degree in a nursing specialty in an accelerated 3 year program. The program seemed perfect for me at the time: I already had a B.A. in Mathematics and English Literature, and my dream was to become a Certified Nurse-Midwife (CNM). Going through a more traditional path would mean starting from scratch to earn a BSN (bachelor's of science in nursing) and then working for two years as an RN before I could even apply to a CNM program.

There was no way for me to have known at the time that I was applying to Marquette that I had just met the man who would become my husband. We got engaged about half way through the RN portion of my program. He was in seminary, and the following summer was obligated to head down to Louisiana to serve there in his home state. I decided to complete the RN portion of the Direct-Entry program at Marquette, and then move to Louisiana after our wedding in August.

My husband had been assigned to a church in New Orleans, which was destroyed with our home in Hurricane Katrina only 9 days after our wedding. We were stranded in Wisconsin so I went ahead and passed NCLEX and got my nursing license in Wisconsin. We were homeless until March of 2006 when he was called to serve two small parishes in southern Mississippi.

This is where the problems with my nursing license began. I applied for a nursing licence in Mississippi as soon as we moved. In June, just a few weeks before I gave birth to our first child, I received a letter notifying me that my application for a license had been denied. The only reason that they cannot grant me a license is because my official Marquette transcript does not contain a graduation date. Mississippi state law states that in order to be eligible for an RN, one must graduate from an accredited nursing program.

But what about Wisconsin? As it turns out, a similar law is part of the Nurse Practice Act in Wisconsin (check out the pdf in the links section). So how on Earth did I get an RN in Wisconsin?

Well, Marquette University provided the Wisconsin Department of Regulation & Licensing with a "Statement of Graduation" for me, but they will not put a graduation date on my transcript.