Georgia rules block nursing students from critical clinical training

Tioney Thomas has wanted to become a nurse since she was 14. When she arrived in the United States from Jamaica four years later, she felt one step closer to achieving that goal.

Tioney began working as a grocery store cashier and then started her own lip gloss business, which brought in six figures in its first year. Despite her entrepreneurial prowess, she still felt called toward nursing. Perhaps it ran in her blood—her mother and aunts were nurses—or perhaps she just had an instinct toward helping others.

As a Jamaican immigrant and the eldest of seven siblings, Tioney had a lot of responsibilities at home; leaving all day every day to pursue her education wasn’t an option. But she eventually discovered Nightingale College, a private, accredited nursing school based in Utah that offers a range of nursing degrees in a distance-learning format. The program’s flexibility allowed her to take the first step toward pursuing a lifelong dream.

Clinical placements are a cornerstone of the program, which Nightingale arranges locally in each student’s area through partnerships with in-state facilities. The collaboration is mutually beneficial; students earn their degrees, and rural or remote communities retain trained healthcare professionals.

Unfortunately, in Tioney’s home state of Georgia, the Board of Nursing does not approve of any out-of-state or online pre-licensure nursing programs. Their website even states, “the [Board] is not approving, nor allowing out-of-state nor online pre-licensure nursing programs to complete clinical in Georgia.”

The ban on Nightingale’s clinical placements forces Tioney to travel on her own dime to complete her education. The Georgia resident spends up to a month at a time paying for airfare, hotels, and food to do her clinicals in a different state, something she describes as “almost a dealbreaker.”

Georgia’s discrimination against out-of-state programs bears no rational relation to public health. In effect, it constrains the ability of any nursing student enrolled in an online or out-of-state program to complete their clinicals in Georgia. Tioney is one such student; Carolyn Patchett is another.

Carolyn felt called to rural healthcare after growing up in a remote Alaska town where the nearest hospital was a four-hour plane ride away. Like Tioney, her path wasn’t traditional: She left college after a family emergency and then met her husband, who served as military police in the Air Force, and had three children. When she returned to school, she needed a program that would allow her to raise her kids and accommodate a military schedule, which brought her family to Washington, then Georgia, and finally Colorado.

While her family was stationed in Georgia, Carolyn had no options for clinical placements. Although she finally had time to pursue her degree—her children were older, and her husband’s schedule had become more predictable—her education was stalled by Georgia’s restriction.

Represented free of charge by Pacific Legal Foundation, Carolyn, Tioney, and Nightingale College have filed a complaint in the U.S. District Court for the Northern District of Georgia alleging that the state’s protectionist regulations violate the Dormant Commerce Clause, the Equal Protection Clause, and federal antitrust law.

Their complaint details how Georgia’s Board of Nursing imposes unique burdens on out-of-state institutions that in-state programs do not face, such as redundant vetting and disregard for Nightingale’s credentials.

Because the Georgia Board of Nursing is comprised almost entirely of nurses and nurse educators, Georgia’s restriction is effectively a restraint of trade by incumbent market participants against would-be competitors.

A victory for Carolyn and Tioney would protect the rights of nursing students to pursue their degrees without discriminatory state regulations getting in the way. For a nation facing a nursing shortage—especially acute in Georgia—policymakers should be expanding access to a nursing education, not restricting it.