STORAGE NAME: h0919e.HHS
DATE: 4/17/2025
1
FLORIDA HOUSE OF REPRESENTATIVES
BILL ANALYSIS
This bill analysis was prepared by nonpartisan committee staff and does not constitute an official statement of legislative intent.
BILL #: CS/HB 919
TITLE: Nursing Education Programs
SPONSOR(S): Overdorf
COMPANION BILL: CS/SB 526 (Harrell)
LINKED BILLS: None
RELATED BILLS: None
Committee References
Health Professions & Programs
15 Y, 0 N
Careers & Workforce
18 Y, 0 N
Health & Human Services
22 Y, 0 N, As CS
SUMMARY
Effect of the Bill:
CS/HB 919 establishes new requirements for nursing education programs to be approved by the Board of Nursing,
including the adoption of standardized evaluation and admission criteria, a comprehensive exit exam, and a
remediation program. The bill allows the Board of Nursing to address adverse actions taken against an approved
nursing education program in another U.S. jurisdiction.
The bill revises existing accountability measures by reducing the number of years an approved nursing education
program can fail to meet statutory requirements before being placed on probation from two years to one year. The
bill also reduces the length of time a program can spend on probation from up to three years to two years. The bill
also removes the Board of Nursing’s authority to extend the deadline to obtain accreditation for professional
nursing education programs.
Fiscal or Economic Impact:
The Department of Health will incur an insignificant, negative fiscal impact implementing the provisions of this bill
which current resources are adequate to absorb.
JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
ANALYSIS
EFFECT OF THE BILL:
Nursing Education Program Requirements
Before a potential nurse can be licensed to practice, they must first graduate from a board-approved nursing
education program and pass the National Council of State Boards of Nursing Licensing Exam (NCLEX). While
Florida’s nursing education programs graduate more potential nurses than almost any other state in the nation,
Florida’s first-time NCLEX test-takers are also more likely to fail the NCLEX than test-takers in any other state.
Florida currently ranks last in the nation for NCLEX passage rates. The bill raises the standards for nursing
education programs in Florida.
CS/HB 919 revises existing accountability measures and imposes new requirements on pre-licensure nursing
education programs for practical nurses (LPN) and professional nurses (RN). In addition to the application
requirements in current law, the bill requires an educational institution seeking to operate a nursing education
program to include in its application for approval from the Board of Nursing (Board) the legal name of the program
director and documentation of the following program components:
Standardized evaluation and admission criteria that identifies students who are likely to need additional
educational support and the program must maintain individualized student academic support plans for
these students; JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
2
A comprehensive exit examination, or a preparation course including multiple comprehensive
examinations, to prepare students for the NCLEX; and
Remediation to be offered to students who do not pass the exit examination.
A nursing education program must demonstrate that it meets all statutory requirements in its application for
approval. Approved nursing education programs must certify continued compliance with statutory requirements
annually through an affidavit submitted with the program’s annual report. Accredited nursing education programs
are exempt from submitting an annual report. The bill reduces the grace period for a program to submit its annual
report from six months after the due date
1 to 30 days after the due date. The bill requires the Board to terminate a
nursing education program for failing to adhere to the annual reporting requirements.
The bill authorizes DOH staff to conduct on-site inspections or evaluations of nursing education programs during
regular hours of operation to assess compliance with statutory requirements. A nursing education program is
subject to disciplinary action by the Department if the program fails to allow such an inspection or evaluation
during reasonable hours.
Program Director Responsibilities
Current law requires nursing education programs to be administered by a program director who is a registered
nurse; as such, the program director may be subject to licensure discipline for failure to perform a statutory or
legal obligation placed upon them as a licensee.
2 Program directors are required to appear before the Board when
a program is failing to meet statutory requirements,
3 but current law does not expressly impose any disciplinary
actions against a program director for failing to comply with these requirements.
Under the bill, the program director is directly responsible for submitting the required annual report to the Board,
as well as a written remediation plan in the case of a program that has failed to meet the required NCLEX graduate
passage rates. The program director must also certify the accuracy of the program faculty credentials reported to
the Board and ensure that the program’s average exit examination results are posted on the program’s website. A
program director’s failure to comply with requirements under this section constitute grounds for discipline.
4
Accountability Requirements
Current law establishes minimum graduate NCLEX passage rate requirements for approved and accredited nursing
education programs.
5 Programs that fail to meet these requirements for two consecutive years are subject to a
probationary process. A program may remain on probation for two years, and the Board has the authority to grant
an extension for a third year. Programs that fail to meet the required passage rate during the probationary period
are terminated by the Board.
Under the bill, a nursing education program that fails to meet the statutorily required NCLEX passage rates for a
single calendar year, compared to two calendar years under current law, must be placed on probationary status.
The bill requires the program director to submit a written remediation plan to the Board, in addition to the oral
presentation of a remediation plan that is required under current law. The remediation plan must include specific,
nationally-recognized benchmarks to identify progress toward a passage rate goal. The Board must terminate the
program if the program director fails to submit and present a remediation plan within six months of the program’s
placement on probation.
1 S. 464.019(3), F.S.; Current law establishes November 1 of each year as the due date for nursing education program annual reports.
2 See, s. 456.072(k)(1), F.S.; Under current law, every licensee is subject to discipline for failure to perform a statutory or legal obligation
placed upon a licensee.
3 s. 464.019(5), F.S.
4 Supra, note 2.
5 See, s. 464.019(5), F.S.; Approved nursing education programs must achieve graduate passage rates that are no more than ten percentage
points lower than the average passage rate for the same calendar year for graduates of comparable degree programs who are U.S. educated,
first-time NCLEX test takers. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
3
The bill allows for a nursing education program to stay on probation under the remediation plan for two years. If
the program meets the required graduate passage rate then they are taken off of probation. The Board must
terminate the program if it does not achieve the required passage rate during the two years on probation.
Under the framework proposed by the bill, a nursing educational program may only fail to meet the required
NCLEX passage rate for three consecutive years before facing termination. This is a significantly shorter timeframe
than under current law, which allows a nursing education program to fail to meet the required passage rate for up
to five consecutive years before the program is terminated.
Additionally, the bill requires nursing education programs with an NCLEX passage rate below 30 percent in a given
year to reimburse the total cost of tuition and fees paid by each program graduate who failed to pass the NCLEX as
a first-time test taker in that calendar year.
The bill allows the Board to deny an application for approval if the Board determines that the applicant is owned
by any individual, group of individuals, or entity who directly or indirectly held 25 percent or greater financial or
ownership interest in a nursing education program that was on probationary status at the time of the program’s
closure.
Adverse Action in Other Jurisdictions
The bill establishes processes allowing the Board to respond to adverse actions taken in another US jurisdiction
against a nursing education program that is operating or seeks to operate in Florida. The bill allows the Board to
consider such actions, as well as conduct investigations into the nature of an adverse action.
Under the bill, an application for program approval must include the status and outcome of any disciplinary case
pending or closed against the applicant in another regulatory jurisdiction. The Board must deny an application if
the applicant has been terminated or otherwise had its authority to operate in another US jurisdiction revoked. For
less serious actions against a program, the Board is authorized to approve the application, approve the application
with conditions, or deny the application.
Approved nursing education programs must notify the Board of any adverse actions taken against the program in
another US jurisdiction within 15 days. The bill allows the Board to impose disciplinary remedies on an approved
program up to and including revocation of the program’s approval, pursuant to rules adopted by the Board.
Student Remediation
The bill requires all nursing education programs to establish criteria for remediation programs to be offered to
students who fail the program’s exit exam in order to obtain Board approval. Additionally, nursing education
programs that are on probation must provide remediation at no cost, or otherwise pay for the student to obtain
remediation from a different Board-approved remediation course, to students who have failed the program’s exit
exam, or have failed the NCLEX.
Accreditation
Under current law, nursing education programs for professional nurses
6 must obtain accreditation within five
years of enrolling its first students, or face termination for failing to do. However, a program may apply to the
Board and receive a deadline extension of up to two years, for a total of seven years until a program must be
accredited.
7
The bill eliminates the Board’s authority to grant an extension of the accreditation deadline, thereby limiting
programs to only five years between enrolling students and obtaining accreditation. (Section 1).
6 Also known as Registered Nurses, or RNs; see. S. 464.003, F.S.
7 S. 464.019(11), F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
4
The bill provides an effective date of July 1, 2025. (Section 2).
RULEMAKING:
The Board has limited rulemaking authority regarding the regulation of nursing education programs. The bill
expands the Board’s rulemaking authority to expressly include the enforcement and administration of
accountability provisions of this bill.
Lawmaking is a legislative power; however, the Legislature may delegate a portion of such power to executive
branch agencies to create rules that have the force of law. To exercise this delegated power, an agency must
have a grant of rulemaking authority and a law to implement.
FISCAL OR ECONOMIC IMPACT:
STATE GOVERNMENT:
Current resources are adequate to absorb the increase in workload that the Department of Health will experience
relating to enforcement and rulemaking under the provisions of this bill.
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RELEVANT INFORMATION
SUBJECT OVERVIEW:
Nursing Practice and Regulation
The Board of Nursing (Board), within the Department of Health (DOH), oversees the licensure and regulation of the
nursing profession, as well as the pre-licensure nursing education programs that prepare individuals to practice
nursing in the state. The Board is composed of 13 members appointed by the Governor and approved by the
Senate. The Board membership includes:
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Seven professional nurses who have been practicing for at least four years, including one advanced practice
registered nurse, one nurse educator from an approved nursing education program, and one nurse
executive;
Three licensed practical nurses who have been practicing for at least four years; and
Three Florida residents who have never been licensed as nurses and who are in no way connected with the
practice of nursing.
There are two categories of nurse licensure:
Professional nurses; often referred to as “registered nurses,” (RNs), professional nurses perform acts
requiring substantial specialized knowledge, judgement, and nursing skill based on applied principles of
psychological, biological, physical, and social sciences. Advanced Practice Registered Nurses (APRNs) are a
subcategory of professional nurses who have completed additional education and training.
Practical nurses; a licensed practical nurse (LPN) performs selected acts, including the administration of
treatments and medications, in the care of the ill, injured, or infirm; the promotion of wellness,
maintenance of health, and prevention of illness of others under the direction of a registered nurse, a
licensed physician, a licensed osteopathic physician, a licensed podiatric physician, or a licensed dentist.
To be licensed as either an RN or LPN, an individual must, among other requirements, have graduated from an
approved
10 prelicensure nursing education program and passed the national licensure examination, the National
Council of State Boards of Nursing Licensure Exam (NCLEX), for the level of nursing the applicant is seeking to
8 Department of Health, 2025 Agency Legislative Bill Analysis for HB 919 (2025). On file with the Health & Human Services Committee.
9 S. 464.004, F.S.
10 Or a program that the Board has determined to be equivalent to an approved program; see, s. 464.008(1)(c), F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
5
practice.
11 The number of test-takers passing the NCLEX can indicate approximately the number of new nurses
entering the nursing workforce.
Nursing Education Programs
Pre-licensure nursing education programs prepare students to safely practice nursing as an RN or LPN. A key
component of this preparation is ensuring that students are ready and able to pass the NCLEX, which is a
requirement for licensure as a nurse in all 50 states. In Florida, nursing education programs are offered by state
universities, Florida colleges, public school districts, private institutions licensed by the Commission for
Independent Education (CIE), private institutions that are members of the Independent Colleges and Universities
of Florida (ICUF), and religious institutions authorized by law to offer nursing education programs.
12
Application for Board Approval
Nursing education programs are overseen by the Board in conjunction with DOH. An educational institution
seeking to conduct a nursing education program must apply to DOH for approval, DOH reviews the application for
completion, and then forwards the complete application to the Board for final approval.
13 As of January 9, 2025,
there are 319 approved RN education programs and 194 approved LPN education programs.
14
The application must include the legal name of the educational institution, the legal name of the nursing education
program, and, if the institution is accredited, the name of the accrediting agency. The application must also
document:
15
For an RN education program, the program director and at least 50 percent of the program’s faculty
members must be RNs who have a master’s degree or higher in nursing or a bachelor’s degree in nursing
and a master’s or higher degree in a field related to nursing;
For an LPN education program, the program director and at least 50 percent of the program’s faculty
members must be RNs who have a bachelor’s degree or higher in nursing;
Faculty educational degree requirements may be documented by an official transcript or by a written
statement from the educational institution verifying that the institution conferred the degree;
The program must have signed agreements with each agency, facility, and organization included in the
curriculum plan as clinical training sites and community-based clinical experience sites;
The program must have written policies for faculty which include provisions for direct or indirect
supervision by faculty or clinical preceptors for students in clinical training consistent with the following
standards:
o The number of program faculty members must equal at least one faculty member directly
supervising every 12 students unless the written agreement between the program and the agency,
facility, or organization providing clinical training sites allows more students, not to exceed 18, to
be directly supervised by one program faculty member;
o For a hospital setting, indirect supervision may occur only if there is direct supervision by an
assigned clinical preceptor and a supervising program faculty member is available by telephone,
and such arrangement is approved by the clinical facility;
o For community-based clinical experiences that involve student participation in invasive or complex
nursing activities, students must be directly supervised by a program faculty member or clinical
preceptor and such arrangement must be approved by the community-based clinical facility;
o For community-based clinical experiences not involving student participation in invasive or
complex nursing activities, indirect supervision may occur only when a supervising program faculty
member is available to the student by telephone; and
11 s. 464.008(1), F.S.
12 Florida Center for Nursing, The State of Nursing Education in Florida (2025). Available at https://www.flcenterfornursing.org/research-
data/nursing-education-reports/the-state-of-nursing-education-in-florida-2025/ (last visited March 15, 2025).; see also, s. 1005.06, F.S.
13 S. 464.019(2), F.S.
14 Department of Health, 2025 Agency Legislative Bill Analysis for HB 919 (2025). On file with the Health & Human Services Committee.
15 S. 464.019(1), F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
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o A program’s clinical training policies must require that a clinical preceptor who is supervising
students in an RN education program be an RN or, if supervising students in an LPN education
program, be an RN or LPN;
The program’s nursing major curriculum consists of at least:
o Fifty percent clinical training in the U.S., the District of Columbia (D.C.), or a possession or territory
of the U.S. for an LPN, ARN, or a diploma RN;
o Forty percent of clinical training in a U.S. state, D.C., or a possession or territory of the U.S. for a B.S.
degree RN education program, and no more than 50 percent of the program’s clinical training may
consist of clinical simulation;
The nursing curriculum plan documenting clinical experience and theoretical instruction in medical,
surgical, obstetric, pediatric, and geriatric nursing. The curriculum plan for an RN education program must
also document clinical experience and theoretical instruction in psychiatric nursing. Each curriculum plan
must document clinical training experience in appropriate settings that include, but are not limited to,
acute care, long-term care, and community settings;
An RN or LPN education program must provide theoretical instruction and clinical application in the
following:
o Personal, family, and community health concepts;
o Nutrition;
o Human growth and development throughout the lifespan;
o Body structure and function;
o Interpersonal relationship skills;
o Mental health concepts;
o Pharmacology and administration of medications; and Legal aspects of practice; and
An RN education program must also provide theoretical instruction and clinical experience in:
o Interpersonal relationships and leadership skills;
o Professional role and function; and
o Health teaching and counseling skills.
DOH has 30 days after receiving an application to notify the applicant of any errors or omissions in the application.
DOH forwards complete applications to the Board who may then conduct an onsite evaluation if necessary to
document the applicant’s compliance with staffing and curriculum requirements. Within 90 days of DOH’s receipt
of the complete application, the Board must either:
16
Approve the application; or
Provide the educational institution with a notice of intent to deny citing specific reasons for the denial.
The applicant may request may request a hearing on the notice of intent to deny pursuant to the Administrative
Procedures Act.
17
Required Annual Report
Approved nursing education programs are required to submit an annual report to the Board by November 1
st of
each year. The annual report must include:
An affidavit certifying continued compliance with the requirements for initial program approval;
18
A summary description of the program’s compliance with such requirements; and
Documentation for the previous academic year that describes:
o The number of student applications received, qualified applicants, applicants accepted, accepted
applicants who enroll in the program, students enrolled in the program, and program graduates;
o The program’s retention rates for students tracked from program entry to graduation; and
16 S. 464.019(2), F.S.
17 Id. See also, Ch. 120, F.S.
18 See, s. 464.019(1), F.S., for program approval requirements. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
7
o The program’s accreditation status, including identification of the accrediting agency.
19
If an approved nursing education program fails to submit the required annual report, the Board must notify the
program director and president or chief executive officer of the educational institution in writing within 15 days
after the due date. The program director must appear before the Board to explain the delay. If the program director
fails to appear, or if the program does not submit the annual report within six months after the due date, the Board
must terminate the program.
20 In 2024, the Board terminated 31 programs for failing to submit their annual
report.
21
Accredited nursing education programs are not required to submit an annual report.
22
NCLEX Passage Rate Requirements
Approved nursing education programs are required to meet accountability requirements related to graduate
passage rates on the NCLEX. The NCLEX is developed by the National Council of State Boards of Nursing (NCSBN)
to test the competency of nursing education program graduates in the United States and Canada. The NCSBN is a
non-profit organization whose membership is composed of state boards of nursing and other nursing regulatory
bodies that are charged with regulating public health, safety, and welfare.
23 The NCLEX-RN and NCLEX-PN are
variable-length, valid, and reliable computerized adaptive tests designed to measure nursing competence
according to the intended practice level of the test-taker.
A nursing education program’s graduate passage rate reflects the percentage of a program’s graduates who pass
the NCLEX in a given calendar year as first-time test-takers.
24 Approved nursing education programs must achieve
graduate passage rates that are no more than ten percentage points lower than the average passage rate for the
same calendar year for graduates of comparable degree programs who are U.S. educated, first-time NCLEX test
takers.
25 The national passage rates for 2024 are 91.16 percent for the NCLEX-RN and 88.38 percent for the
NCLEX-PN.; compared to Florida’s passage rates of 84.9 percent for the NCLEX-RN and 80.78 percent for the
NCLEX-PN.
26 These scores place Florida last among all 50 states for NCLEX passage rates in 2024.
27
19 S. 464.019(3), F.S.
20 s. 464.019(5), F.S.
21 Supra, note 14.
22 S. 464.019(9), F.S.
23 National Council of State Boards of Nursing, History. Available at https://www.ncsbn.org/about/history.page (last visited March 15,
2025).
24 S. 464.003(14), F.S.
25 s. 464.019(5), F.S.
26 Supra, note 12.
27 Supra, note 14. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
8
28
Each nursing education program is compared to other programs based on level of nursing and degree type.
Programs are categorized according to the following program types:
29
RN nursing education programs that terminate in a bachelor’s degree;
RN nursing education programs that terminate in an associate degree;
RN nursing education programs that terminate in a diploma; and
LPN nursing education programs.
Probation
Nursing education programs that fail to meet the required passage rates for two consecutive years are placed on
probation by the Board. The program director of a program placed on probation must appear before the Board to
present a remediation plan including specific benchmarks to identify progress toward a graduate passage rate goal.
A program is taken off of probation once it achieves a graduate passage rate that meets the statutory requirement
in a calendar year. A program’s probationary status is automatically carried over for a second year if the program
does not meet the required passage rate in the first year on probation.
30
28 Monti, J & Dugan, J. (2024). States with the Highest NCLEX Pass Rates. NurseJournal. Available at
https://nursejournal.org/resources/nclex/states-with-highest-nclex-pass-rates/ (last visited April 11, 2025).
29 Id.
30 s. 464.019(5), F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
9
The Board may grant a program a third year of probation if the program still does not meet the required passage
rate, but is able to demonstrate improvement. If the program is not granted the one-year extension of probation, or
if the program fails to meet the required passage rates after the third year of probation, the Board must terminate
the program.
31 The current probationary process allows nursing education programs to have up to five consecutive
years of unsatisfactory NCLEX passage rates, including three years of probation, before the program is terminated.
In 2024, three LPN education programs and 13 RN education programs were placed on probation. Of the 16
programs placed on probation, 12 were for-profit programs.
32
Accreditation
An accredited nursing education program is a program that is operated in the U.S. and accredited by a specialized
nursing accrediting agency that is nationally recognized by the United States Secretary of Education to accredit
nursing education programs.
33 The specialized nursing accreditors are the:
34
Accreditation Commission for Education in Nursing;
Commission on Collegiate Nursing Education; and
National League for Nursing Commission for Nursing Education Accreditation.
Board-approved RN education programs are required to obtain accreditation within five years of enrolling its first
students.
35 However, a program may apply to the Board and receive an extension of the deadline for up to two
years. In order to be eligible for an extension, a program must meet NCLEX graduate passage rate, student
retention, and graduate work placement requirements, among others.
36
Due to the stringent criteria required to maintain accreditation, accredited nursing education programs are exempt
from the reporting requirements that are used to monitor approved nursing education programs’ compliance with
requirements, however they are still required to meet the statutory requirements for graduate passage rates on
the NCLEX.
37
If an accredited nursing education program ceases to be accredited, the educational institution conducting the
program must provide written notice to that effect to the Board, the program’s students and applicants, and each
entity providing clinical training sites or experiences. It may then apply to be an approved program.
38
OTHER RESOURCES:
Florida Center for Nursing, The State of Nursing Education in Florida: 2025
31 S. 464.019(5), F.S.
32 Supra, note 14.
33 S. 464.003(1), F.S.
34 Supra, note 12.
35 S. 464.019(11), F.S.
36 Supra, note 14; see also, s. 464.019(11)(f), F.S.
37 S. 464.019(9)(a), F.S.
38 S. 464.019(9)(b), F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
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BILL HISTORY
COMMITTEE REFERENCE ACTION DATE
STAFF
DIRECTOR/
POLICY CHIEF
ANALYSIS
PREPARED BY
Health Professions & Programs
Subcommittee
15 Y, 0 N 3/13/2025 McElroy Osborne
Careers & Workforce
Subcommittee
18 Y, 0 N 3/19/2025 Kiner Dixon
Health & Human Services
Committee
22 Y, 0 N, As CS 4/15/2025 Calamas Osborne
THE CHANGES ADOPTED BY THE
COMMITTEE:
Allowed nursing education programs to use either an exit exam or a
comprehensive preparation course to measure student NCLEX
preparedness.
Increased the time a program can be on probation from 1 year to 2 years.
Reduced the grace period to submit annual reports from 6 months to 30
days after the due date.
Granted the Board discretion in acting on certain adverse actions taken
against a program in another jurisdiction.
Required the Board to deny an application from a program that it
determines is owned by a person or persons who owned, directly or
indirectly, a 25% or greater share of a nursing education program that
was on probationary status at the time of closing.
Required the Board to adopt rules to implement the bill by December 31,
2025.
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THIS BILL ANALYSIS HAS BEEN UPDATED TO INCORPORATE ALL OF THE CHANGES DESCRIBED ABOVE.
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