The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Health Policy
BILL: SB 274
INTRODUCER: Senator Avila
SUBJECT: Nursing Education Pathway for Military Combat Medics
DATE: February 17, 2023
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Jahnke Bouck HE Favorable
2. Rossitto-Van
Winkle
Brown
HP
Pre-meeting
3. RC
Summary:
SB 274 creates the “Pathway for Military Combat Medics Act.” The bill expands the award of
postsecondary credit for military training and education courses to promote uniformity in the
application of military combat medic training and education toward postsecondary credit (credit)
or career education clock hours (clock hours) by public postsecondary educational institutions.
Specifically, the bill requires:
The Department of Education’s Articulation Coordinating Committee (ACC) to convene a
workgroup to establish a process for prioritizing and determining postsecondary course
equivalencies and the minimum credit or clock hours that must be awarded in an accredited
nursing education program for military training and education required for service in
specified positions. The process must be approved by the Board of Governors of the State
University System (BOG) and the State Board of Education (SBE).
The ACC to approve a list of postsecondary course equivalencies and credit and clock hours
awarded for such courses and training, which must be approved by the BOG and SBE in the
statewide articulation agreement.
State universities, Florida College System (FCS) institutions, and career centers to award
credit or clock hours based on the approved list.
Additionally, the bill revises a primary goal of the Florida Center for Nursing (Center) to provide
that, under its strategic statewide plan for nursing manpower, the encouragement and
coordination of the development of partnerships must include partnerships with hospitals that
provide opportunities for nursing students to obtain clinical experience.
The bill takes effect upon becoming law.
REVISED: BILL: SB 274 Page 2
Present Situation:
Postsecondary Credit for Military Training and Education Courses
The BOG and SBE, in consultation with the Florida Department of Veterans’ Affairs, are
required to adopt regulations and rules, respectively, to create a system for the uniform award of
credit or clock hours based on military training and education.
1
The ACC must approve a prioritized list of postsecondary course equivalencies and the
minimum credit or clock hours that must be awarded for courses taken or occupations held by
individuals during their service in the military. The list must then be adopted in the statewide
articulation agreement by the BOG and SBE. The list must be updated annually.
2
The current list includes credit or clock hour equivalencies for 46 military occupations, which
include Practical Nurse, Combat Medic Specialist, and Special Operations Combat Medic.
3
The
American Council on Education (ACE) Military Guide
4
was used as a foundation to determine
equivalences, including courses for military occupations. For example, military veterans that
served as a Combat Medic Specialist can currently receive a minimum of 29 credit hours for
courses in the system such as Medical Emergencies (3 credit hours), Advanced Pre-Hospital
Trauma (4 credit hours), and Fundamentals of Nursing (7 credit hours).
5
State universities, FCS institutions, and career centers operated by school districts must award
credit or clock hours, as applicable, for approved courses and occupations included in the list, if
the credit or clock hours are applicable to the student’s degree or certificate. Institutions may also
grant additional credit or clock hours, if appropriate. Credit awarded on these bases is guaranteed
to transfer to other public postsecondary institutions as if the credit was earned at the receiving
institution.
6
Articulation Coordinating Committee
The Commissioner of Education, in consultation with the Chancellor of the State University
System, establishes the ACC, whose primary role is to recommend statewide articulation
policies.
7
Specifically, the ACC must monitor articulation between education systems, propose
guidelines for articulation agreements, publish lists of general education and common
prerequisite courses, establish dual enrollment course equivalencies to high school credit, and
annually review the Statewide Articulation Agreement.
8
The Office of K-20 Articulation within
the Florida Department of Education provides administrative support to the ACC.
9
1
Section 1004.096, F.S.; see also Board of Governors Regulation 6.013 and Fla. Admin. Code R. 6A-10.024, (2022).
2
Id.
3
Articulation Coordinating Committee, Credit or Clock Hour for Military Experience Equivalency List (Sept. 2022),
available at https://www.fldoe.org/core/fileparse.php/5421/urlt/MilExpEquiv.pdf (last visited Feb. 14, 2023).
4
American Council on Education, The ACE Military Guide, available at https://www.acenet.edu/Programs-
Services/Pages/Credit-Transcripts/Military-Guide-Online.aspx (last visited Feb. 3, 2023).
5
Board of Governors, 2023 Legislative Bill Analysis for SB 274 (Feb. 1, 2023).
6
Supra note 3.
7
Section 1007.01(3), F.S.
8
Section 1007.01(3)(a) and (b), F.S.
9
Section 1007.01(3), F.S.; s. 20.15(3)(h), F.S. BILL: SB 274 Page 3
Statewide Articulation Agreement
The SBE and the BOG are required to enter into a statewide articulation agreement, which the
SBE must adopt by rule.
10
The agreement must preserve Florida’s “2+2” system of articulation
and facilitate the seamless articulation of student credit across and among Florida’s educational
entities. Specifically, the statewide articulation agreement includes provisions that govern:
Articulation between secondary and postsecondary education;
The admission of associate in arts degree graduates to the upper division of a state university;
Articulation of career credit to academic credit programs;
The application of acceleration mechanisms to postsecondary credit; and
General education requirements.
Florida Postsecondary Nursing Education Programs
Florida’s postsecondary education institutions offer a variety of nursing education programs that
prepare students for varying levels of licensure. Licensed practical nurse (LPN) clock-hour
programs are offered at 28 career centers and 13 FCS institutions, while all 28 FCS institutions
offer associate of science in nursing (ASN) and bachelor of science in nursing (BSN) programs.
Ten state universities offer 20 pre-licensure nursing education programs. Seventeen of the 30
Independent Colleges and Universities of Florida (ICUF) member institutions offer nursing
education programs.
11
Approved versus Accredited Nursing Education Programs
Educational institutions that wish to conduct a program in the state of Florida for the prelicensure
education of professional or practical nurses must meet specified requirements to be approved by
the Florida Board of Nursing (BON).
12
An “approved” nursing education program is a program for the prelicensure education of
professional or practical nurses which is conducted in the state of Florida at an educational
institution and which is approved and regulated by the state of Florida.
13
An “accredited” nursing education program is a program for the prelicensure education of
professional or practical nurses that is conducted in the United States at an educational
institution, whether in Florida, another state, or the District of Columbia, and that is accredited
by a specialized nursing accrediting agency that is nationally recognized by the United States
Secretary of Education to accredit nursing education programs.
14
Accredited programs do not
10
Section 1007.23(1), F.S. See also Rule 6A-10.024, F.A.C.
11
Staff of the Florida House of Representatives, Legislative Bill Analysis for CS/HB 5201 (2022).
12
Section. 464.019, F.S. and Florida Board of Nursing, Education and Training Programs,
https://floridasnursing.gov/education-and-training-programs/ (last visited Feb. 2, 2023).
13
Section 464.019, F.S. and s. 464.003(4), F.S.
14
Section 464.003(1), F.S. Eligible nursing associations are: Accreditation Commission for Education in Nursing (ACEN),
Commission on Collegiate Nursing Education (CCNE)) or National League for Nursing Commission for Nursing Education
Accreditation (NLN CNEA). Florida Board of Nursing, What is the difference between an “approved” and an “accredited”
prelicensure nursing education program in Florida? https://floridasnursing.gov/help-center/what-is-the-difference-between-
an-approved-and-an-accredited-pre-licensure-nursing-education-program-in-florida/ (last visited Feb. 3. 2023). BILL: SB 274 Page 4
have to meet requirements related to program application, approval, or submission of annual
reports to the BON.
15
All approved and accredited programs must meet accountability requirements related to graduate
passage rate on the National Council of State Boards of Nursing Licensing Examination.
All approved nursing programs, except those specifically excluded,
16
must seek accreditation
within five years of enrolling the program’s first students.
17
Florida Center for Nursing
The Center was established by the Legislature in 2001, to address the issues of supply and
demand for nursing, including the recruitment, retention, and utilization of nurse workforce
resources.
18
The Center’s primary goals are to:
19
Develop a strategic statewide plan for nursing manpower in this state by:
o Conducting a statistically valid biennial data-driven gap analysis of the supply and
demand of the healthcare workforce. Demand must align with the Labor Market
Estimating Conference.
o Developing recommendations to increase nurse faculty and clinical preceptors, support
nurse faculty development, and promote advanced nurse education.
o Developing best practices in the academic preparation and continuing education needs of
qualified nurse educators, nurse faculty, and clinical preceptors.
o Collecting data on nurse faculty, employment, distribution, and retention.
o Piloting innovative projects to support the recruitment, development, and retention of
qualified nurse faculty and clinical preceptors.
o Encouraging and coordinating the development of academic-practice partnerships to
support nurse faculty employment and advancement.
o Developing distance learning infrastructure for nursing education and advancing faculty
competencies in the pedagogy of teaching and the evidence-based use of technology,
simulation, and distance learning techniques.
Enhance and promote recognition, reward, and renewal activities for nurses in the state by:
o Promoting nursing excellence programs such as magnet recognition by the American
Nurses Credentialing Center.
o Proposing and creating additional reward, recognition, and renewal activities for nurses.
o Promoting media and positive image-building efforts for nursing.
University of South Florida V-CARE Program
In 2013 the University of South Florida (USF) College of Nursing received a grant from Health
Resources and Services Administration of the U.S. Department of Health and Human Services to
create the Veteran to Bachelor of Science in Nursing (VBSN). Originally, VBSN was an
15
Section 464.019(9), F.S.
16
Excluded institutions are those exempt from licensure by the Commission of Independent Education under s. 1005.06(1),
F.S. Section 464.019(11)(d), F.S.
17
Section 464.019(11)(a)-(d), F.S.
18
Chapter 2001-277, s. 97, Laws of Fla. and s. 464.0195, F.S.
19
Section 464.0195, F.S. BILL: SB 274 Page 5
accelerated four-semester program that shortened the time needed for degree completion while
maintaining the academic rigor, clinical quality, and high National Council Licensure
Examination (NCLEX)
20
pass rates. In 2019, when the grant ended, USF continued the program
and funded it through different revenue sources.
The VBSN program gradually evolved into the current V-CARE program which is a highly
selective program for military medics and corpsmen that builds upon their military health care
education, training, and experience, and provides a more efficient pathway and education ladder
from veteran, to student, to baccalaureate prepared nursing professional. The pathway is a
student-centered program tailored to each veteran that fills a gap in the education needs of
veterans who are serving or have served as medics or corpsmen in the Armed Forces and who
wish to pursue BSN coursework and continue their health care careers as nurses.
To date, 138 veteran students have enrolled in the V-CARE pathway, and 132 have graduated.
Currently, 22 veteran students are enrolled. Upon graduation, approximately 37 percent of
graduates have returned to active duty and been commissioned as officers in their respective
nurse corps (Army, Navy, Air Force, and Coast Guard), 42 percent have accepted positions in
hospitals in the civilian sector, and 21 percent have accepted positions in Veteran Administration
Hospitals. Roughly one-fourth of the graduates have earned master’s and/or doctoral degrees in
nursing at USF, as well as other universities across the country. Almost 50 percent of all V-
CARE graduates have remained in Florida at least one year post graduation. The V-CARE
pathway NCLEX pass rate is 92 percent. As of December 16, 2022, the national benchmark is
82.95 percent, and the Florida pass rate is 83.16 percent.
21
Effect of Proposed Changes:
Postsecondary Credit for Military Training and Education Courses
SB 274 creates the “Pathway for Military Combat Medics Act.” The bill expands s. 1004.096,
F.S., to promote uniformity in the application of military combat medic training and education
toward creditor clock hours by public postsecondary educational institutions. The bill establishes
a process similar to those established for the award of postsecondary credit for military training
and education and for law enforcement training.
The bill requires the ACC to, by July 15, 2023, convene a workgroup to establish a process for
determining postsecondary course equivalencies and the minimum credit or clock hours that
must be awarded in an accredited nursing education program for military training and education
required for service in as an Army Combat Medic Specialist, a Navy or Fleet Marine Force
Hospital Corpsman, an Air Force or Space Force Aerospace Medical Service Technician, or a
Coast Guard Health Services Technician.
The workgroup must consist of the following 13 members:
The chair of the ACC, or his or her designee, serving as chair;
20
The National Council of State Boards of Nursing develops the NCLEX exam to test the competency of nursing school
graduates in the U.S. and Canada.
21
University of South Florida, College of Nursing, USF V- CARE Pathway Program Overview (on file with the Senate
Committee on Health Policy). BILL: SB 274 Page 6
Four members representing academic affairs administrators and faculty from state
universities, appointed by the chair of the BOG;
Four members representing academic affairs administrators and faculty from FCS
institutions, appointed by the chair of the SBE;
Two members representing faculty from career centers, appointed by the SBE; and
Two members representing veterans, appointed by the executive director of the Florida
Department of Veterans Affairs.
The Office of K-20 Articulation must provide administrative support for the workgroup.
The workgroup must ensure that the award of credit or clock hours does not impair an accredited
program’s ability to comply with requirements relating to the state approval of nursing education
programs. The workgroup must provide recommendations regarding the determination process
for awarding credit or clock hours to the BOG and the SBE by December 1, 2023, for approval at
each board’s next meeting that allows for adequate public notice.
Upon the BOG and the SBE approval of the workgroup’s process recommendations, the ACC
must facilitate a review of military training and education for the specified military occupations
to determine postsecondary course equivalencies and the minimum credit or clock hours that
must be awarded.
Within one year after BOG and SBE approval of the ACC workgroup recommended process, the
ACC must approve a prioritized list of postsecondary course equivalencies and the minimum
credit or clock hours that must be awarded in an accredited program for such military training
and education. The list must then be adopted in the statewide articulation agreement by the BOG
and SBE at the next meeting of each board allowing for adequate public notice. The list must be
updated annually.
The bill requires state universities, FCS institutions, and career centers to award credit or clock
hours, as applicable, for such military training and education based on the adopted list, if the
credit or clock hours are applicable to the student’s degree or certificate. Institutions may also
grant additional credit or clock hours, if appropriate. Credit or clock hours awarded on these
bases are guaranteed to transfer from one state university, FCS institution, or career center to
another.
Florida Center for Nursing
The bill modifies s. 464.0195, F.S., by revising a primary goal of the Center to provide that,
under its strategic statewide plan for nursing manpower, the encouragement and coordination of
the development of academic-practice partnerships must include partnerships with hospitals that
provide opportunities for nursing students to obtain clinical experience.
The bill takes effect upon becoming law. BILL: SB 274 Page 7
Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
Should the workgroup process result in identifying additional equivalencies for military
training and experience, students may be eligible to receive postsecondary credit toward
an accredited pre-licensure nursing program. Credits from this experience may save the
student time and the cost of receiving a nursing degree at a state university.
22
C. Government Sector Impact:
None.
Technical Deficiencies:
None.
Related Issues:
Section 2 of the bill relating to the Florida Center of Nursing could be viewed as a different
subject than the rest of the bill or the bill’s title (which is an act relating to nursing education
pathway for military combat medics). Section 2 directs the Center to facilitate partnerships with
22
Board of Governors, 2023 Legislative Bill Analysis for SB 274 (Feb. 1, 2023). BILL: SB 274 Page 8
hospitals to provide opportunities for all nursing students, in general, to obtain clinical
experience, not specifically for students who are or were military combat medics.
Statutes Affected:
This bill substantially amends the following sections of the Florida Statutes: 464.019 and
1004.096.
Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
None.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.