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This story has been updated to reflect the fact that the VA removed the nurses from patient care. An earlier version incorrectly stated the nurses were fired. In the U.S., nurses must graduate from an approved one to four year LPN or RN nursing program which includes both classroom and hands-on training, pass the national exam, and meet any additional requirements of the state they want to be licensed in. Currently, 36 states participate in the Nursing Licensure Compact, which allows nurses licensed in one state to practice in others. The fragmentation creates problems for state regulators. For example, Maryland doesn't allow for-profit schools, but does allow graduates of other states' for-profit schools; 111 graduates of the Virginia mill were licensed by Maryland before it instituted new fraud controls in 2018.