ELIMINATE BORDER WARS: A Call for Action

Abstract

COLLEGES OF NURSING that provide students' clinical experiences across state lines must have their programs approved in all states in which they operate. Since the United States Constitution gives each state the right to regulate education and licensure of all licensed professionals, requirements are not uniform among the states. Thus, each board of nursing regulates the practice of nursing, licensure qualifications, and the approval of nursing programs, including clinical experiences (Crawford, 2004). In 2004, Crawford surveyed a total of 378 nursing programs regarding state board regulations. The majority of respondents felt there was too much regulation involved in the approval of educational programs. Surprisingly, the National Council of State Boards of Nursing (NCSBN) identified varying nursing education and practice regulations among the states as one of several barriers to nursing education innovation (NCSBN, 2008). Some states use the Nurse Licensure Compact (NLC) program to break down practice barriers. The NLC refers to an agreement among states that allow a common professional license for nurses. A nurse licensed in one of the compact states may practice in any other compact state without a separate license (Roberts, 2008). Nurses must continue to comply with the rules and regulations of their home state to keep their license current. The NLC agreement has broken down some border barriers faced by traveling nurses and other nurses who cross state lines. However, the compact agreement does not extend to schools of nursing or to nursing students in the compact states. ACCEL BSN Option Overview and Outcome Data In May 2003, in response to the increasing demand for accelerated nursing education programs, the University of Wisconsin Oshkosh (UWO) College of Nursing (CON) launched the UWO ACCEL BSN option. The program's prelicensure bachelor's to baccalaureate degree was developed in response to repeated inquiries from potential students who already held a minimum of a bachelor's degree in a field other than nursing. Since 2004, two cohorts have been offered every year. Each cohort contains 24 to 30 second-degree students from various parts of the United States. Students spend time on campus only three times during the program. There is a two-day orientation prior to the beginning of the online course work; a two-week "boot camp" consisting of rigorous lab and clinical experiences about four months into the program; and a weeklong capstone experience during the last week of the program. All theory courses are available online only. Students begin working on clinical experiences with an agency BSN-prepared nurse preceptor approximately one month after boot camp and continue through all five clinical rotations. The program requires a total of 728 hours of clinical instruction. In 2003, the UWO ACCEL BSN option (ACCEL option) was fully accredited by the Commission on Collegiate Nursing Education (CCNE). The CON received a full 10-year accreditation in October 2010 for all its programs. Since its inception, more than 325 BSN-prepared nurses have graduated from the ACCEL option. Obtaining Out-of-State Board Approval In the first year of the ACCEL option, there were no clinical placement problems since all students were from the university's home state. As the program grew in popularity, students applied from different areas of the United States. Seeking 50 different approvals for one nursing program is a daunting task. As ACCEL option administrators began dealing with out-of-state boards of nursing, they encountered different regulations and requirements for each state. It was impossible to put together a "State Board Packet" that could be sent to all 50 states since boards requested different information. Some boards were willing to look at written proposals, while others required in-person attendance at their meetings. Some state boards readily granted approval in a reciprocity-like agreement. …