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 526
INTRODUCER: Senator Harrell
SUBJECT: Nursing Education Programs
DATE: March 3, 2025
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Smith Brown HP Pre-meeting
2. AHS
3. FP
I. Summary:
SB 526 amends s. 464.019, F.S., related to the approval of nursing education programs to:
• Revise program application requirements;
• Authorize the Board of Nursing (BON) to deny certain program applications;
• Revise annual reporting requirements and authorize the BON to terminate programs that do
not meet reporting requirements;
• Revise the criteria by which the BON may terminate a program for not meeting certain
graduate passage rates;
• Authorize the Department of Health to conduct onsite inspections to determine compliance;
• Revise the BON rule-making authority; and
• Repeal the BON’s rule-making authority to grant an extension of the accreditation deadline.
The bill has no fiscal impact on state expenditures.
The bill provides an effective date of July 1, 2025.
II. Present Situation:
Florida Postsecondary Nursing Education Programs
As of January 9, 2025, the Florida Board of Nursing (BON) has approved 314 Registered Nurse
(RN) programs, five Professional Diploma programs, and 194 Practical Nursing (LPN) programs
for pre-licensure education.
1
Pre-licensure nursing programs include pre-licensure programs
offered by Florida’s state universities, colleges, public school districts, private institutions
licensed by the Florida Commission for Independent Education (CIE), private institutions that
1
Department of Health, Senate Bill 526 Legislative Analysis (Feb. 28, 2025) (on file with the Senate Committee on Health
Policy).
REVISED: BILL: SB 526 Page 2
are members of the Independent Colleges and Universities of Florida (ICUF), and religious
institutions authorized by law to offer nursing programs.
2
Post-licensure nursing programs advance the training of licensed RNs and include Registered
Nurse to Bachelor of Science in Nursing (RN to BSN), Master of Science in Nursing (MSN),
Doctor of Nursing Practice (DNP), Doctor of Philosophy (Ph.D.) programs, and nursing
certificates. Upon completion of some master's and doctorate programs, RNs transition to an
advanced practice registered nurse (APRN) license. These roles include nurse practitioner (NP),
certified nurse midwife (CNM), clinical nurse specialist (CNS), psychiatric mental health nurse
practitioner, and certified registered nurse anesthetist (CRNA).
3
Pre-licensure Nursing Education Programs
Educational institutions that wish to conduct a program in Florida for the pre-licensure education
of RNs or LPNs must meet specific requirements to be approved by the BON.
4
The program
application must include the legal name of the educational institution, the legal name of the
nursing education program, and, if such institution is accredited, the name of the accrediting
agency. The application must also document:
5
• For an RN education program, the program director and that 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;
• 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 RN and LPN 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
2
Florida Center for Nursing (2025), The State of Nursing Education in Florida - 2025, Tampa, Fla., available at
https://issuu.com/flcenterfornursing/docs/newthestateofnursingeducationinflorida (last visited Feb. 28, 2025).
3
Id.
4
Section. 464.019, F.S. and Florida Board of Nursing, Education and Training Programs, available at
https://floridasnursing.gov/education-and-training-programs/ (last visited Feb. 28, 2025).
5
Section 464.019(1), F.S. BILL: SB 526 Page 3
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
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 RN or LPN nursing curriculum plan must document clinical experience and theoretical
instruction in medical, surgical, obstetric, pediatric, and geriatric nursing. An RN curriculum
plan 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
o Legal aspects of practice; and
• An RN nursing 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.
Program Approval Process
Upon receipt of a program application and the required fee, the Department of Health (DOH)
must examine the application to determine if it is complete. If the application is not complete, the
DOH must notify the educational institution in writing of any errors or omissions within 30 days
after the DOH’s receipt of the application. A program application is deemed complete upon the
DOH’s receipt of:
• The initial application, if the DOH does not notify the educational institution of any errors or
omissions within the initial 30-day period after receipt; or BILL: SB 526 Page 4
• Upon receipt of a revised application that corrects each error and omission that the DOH has
notified the applicant of within the initial 30-day period after receipt of the application.
6
Once a complete application is received, the BON may conduct an onsite evaluation if necessary
to document the applicant’s curriculum and staffing. Within 90 days after the DOH’s receipt of
the complete program application, the BON must:
• Approve the application; or
• Provide the educational institution with a Notice of Intent to Deny if information or
documents are missing.
7
The notice must specify in writing the reasons for the BON’s denial of the application, and the
BON may not deny an application because an educational institution failed to correct an error or
omission that the DOH failed to notify the institution of within the 30-day notice period. The
educational institution may request a hearing on the Notice of Intent to Deny the application
pursuant to ch. 120, F.S. A program application is deemed approved if the BON does not act
within the 90-day review period. Upon the BON’s approval of a program application, the
program becomes an “approved” program.
8
Approved Nursing Pre-licensure Education Programs Annual Report
Each approved pre-licensure education program must submit to the BON an annual report by
November 1, which must include:
• An affidavit certifying continued compliance with s. 465.019(1), F.S;
• A summary description of the program’s compliance with s. 465.019(1), F.S; 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
o The program’s accreditation status, including identification of the accrediting agency.
9
If an approved program fails to submit the required annual report, the BON must notify the
program director and president or chief executive officer of the institution in writing within 15
days after the due date. The program director must appear before the BON 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 BON must terminate the program.
10
6
Sections 464.019(2) and 464.003(4), F.S.
7
Id.
8
Id.
9
Section 464.019(3), F.S.
10
Section 464.019(5). F.S. BILL: SB 526 Page 5
Approved Nursing Pre-licensure Education Programs Accountability
Graduate Passage Rates
An approved nursing pre-licensure education program must achieve a graduate National Council
of State Boards of Nursing Licensing Examination (NCLEX) passage rate of first-time test takers
which is not more than ten percentage points lower than the average passage rate during the same
calendar year for graduates of comparable degree programs who are U.S. educated, first-time test
takers, as calculated by the contracted testing service of the National Council of State Boards of
Nursing.
11
For purposes of s. 464.019(5), F.S., an approved program is comparable to all degree programs
of the same program type from among the following program types:
12
• 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.
If an approved program’s graduate passage rates do not equal or exceed the required passage
rates for two consecutive calendar years, the BON must place the program on probationary status
and the program director must appear before the BON to present a remediation plan, which must
include specific benchmarks to identify progress toward a graduate passage rate goal. The
program must remain on probationary status until it achieves a graduate passage rate that equals
or exceeds the required passage rate for any one calendar year.
13
The BON must deny a program application for a new pre-licensure nursing education program
submitted by an educational institution if the institution has an existing program that is already
on probationary status. Upon the program’s achievement of a graduate passage rate that equals or
exceeds the required passage rate, the BON must remove the program’s probationary status.
If the program, during the two calendar years following its placement on probation, does not
achieve the required passage rate for any one calendar year, the BON may extend the program’s
probationary status for one additional year if certain criteria are met. If the program is not
granted the one-year extension or fails to achieve the required passage rate by the end of the
extension, the BON must terminate the program. If students from a program that is terminated
transfer to an approved or accredited program under the direction of the Commission for
Independent Education, the BON must recalculate the passage rates of the programs receiving
the transfer students and exclude the test scores of those students transferring more than 12
credits.
14
An “accredited” nursing education program is a program for the pre-licensure education of RNs
or LPNs that is conducted at a U.S. educational institution, whether in Florida, another state, or
D.C., and that is accredited by a specialized nursing accrediting agency that is nationally
11
Section 464.019(5). F.S.
12
Id.
13
Id.
14
Id. BILL: SB 526 Page 6
recognized by the U.S. Secretary of Education to accredit nursing education programs.
15
Accredited programs do not have to meet requirements related to program application, approval,
or submission of annual reports to the BON.
16
All approved and accredited programs must meet accountability requirements related to the
graduate passage rate on the NCLEX.
All approved nursing programs, except those specifically excluded,
17
must seek accreditation
within five years of enrolling the program’s first students.
18
An approved program that has been
placed on probation must disclose its probationary status in writing to the program’s students and
applicants.
19
If an accredited program ceases to be accredited, the educational institution
conducting the program must provide written notice to that effect to the BON, the program’s
students and applicants, and each entity providing clinical training sites or experiences. It may
then apply to be an approved program.
20
The BON does not have rulemaking authority to administer s. 464.019, F.S., except:
• The BON must adopt rules that prescribe the format for submitting program applications and
annual reports, and to administer the documentation of the accreditation of nursing education
programs.
21
• The board may adopt rules relating to the nursing curriculum, including rules relating to the
uses and limitations of simulation technology, and rules relating to the criteria to qualify for
an extension of time to meet the accreditation requirements.
22
Under these rulemaking requirements and authority, the BON may not impose any condition or
requirement on an educational institution submitting a program application, an approved
program, or an accredited program, except as expressly provided in s. 464.019, F.S.
23
15
Section 464.003(1), F.S. Eligible institutional and accrediting Agencies available to Florida Nursing Programs are:
Accreditation Commission for Education in Nursing (ACEN), Inc., formerly, National League for Nursing Accrediting
Commission; Commission on Collegiate Nursing Education (CCNE)); National League for Nursing Commission for
Nursing Education Accreditation (NLN CNEA); National Nurse Practitioner Residency and Fellowship Training
Consortium;. and Florida Board of Nursing, See U.S. Department of Education, Accreditation in the U.S., available at
https://www.ed.gov/laws-and-policy/higher-education-laws-and-policy/college-accreditation/college-accreditation-united-
states/college-accreditation-in-the-united-states--pg-4#National_Institutional#National_Institutional (last visited
Feb. 28, 2025); and Florida Board of Nursing, What is the difference between an “approved” and an “accredited” pre-
licensure nursing education program in Florida? available at 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. 28, 2025).
16
Section 464.019(9), F.S.
17
Excluded institutions are those exempt from licensure by the Commission of Independent Education under ss. 1005.06(1)
and 464.019(11)(d), F.S.
18
Section 464.019(11)(a)-(d), F.S.
19
Id.
20
Section 464.019(9)(b), F.S.
21
Section 464.019(8), F.S.
22
Id.
23
Id. BILL: SB 526 Page 7
III. Effect of Proposed Changes:
The bill adds the following requirements to the application process for nursing education
program approval:
• The legal name of the nursing education program director must be included;
• The nursing educational program’s annual report to the Board of Nursing (BON) must be
submitted by the program director;
• The nursing education program must have evaluation and standardized admission criteria that
identify students who are likely to need additional educational support and a student
academic support plan; and
• The nursing education program must have a comprehensive examination to prepare nursing
students for the National Council of State Boards of Nursing Licensing Examination
(NCLEX);
o This type of comprehensive examination:
▪ Must be termed an “exit examination” that all nursing education programs will
administer;
▪ May not be the sole exclusion to graduation if the student has otherwise completed all
coursework required by the program; and
▪ The program director must be responsible for ensuring that the program’s average
exit exam results are placed on the program’s website and reported to the BON along
with the annual report.
The nursing education program must submit to the BON established criteria for remediation that
will be offered to students who do not successfully pass the exit examination. A program with
NCLEX passage rates at least ten percentage points below the average passage rate for the most
recent calendar year must offer remediation at no additional cost or refer the student to an
approved remedial program and pay for that program for the student.
The bill requires the BON to deny an application from a nursing education program that has had
adverse action taken against it by another regulatory jurisdiction in the U.S. The BON may also
revoke the approval of an existing approved program that has had adverse action taken against it
by another regulatory jurisdiction in the U.S.
The bill reduces the period for which an approved nursing education program’s graduate passage
rates are permitted to go below the required passage rates before the BON must place the
program on probation, from two consecutive calendar years to one calendar year.
The bill requires the program director to submit to the BON a written remediation plan with
specific nationally-recognized benchmarks to identify progress toward a graduate passage rate
goal, and to present that plan to the BON. If the program director fails to submit the required
written remediation plan, or fails to appear before the BON to present the remediation plan no
later than six months after the date of the program being placed on probation, the bill requires the
BON to terminate the nursing education program and the program director is subject to
professional discipline for failing to perform any statutory or legal obligation placed upon a
licensee.
BILL: SB 526 Page 8
The bill requires that if a nursing education program, during the calendar year following being
placed on probation, does not achieve the required passage rate, the BON must terminate the
program.
The bill authorizes agents or employees of the DOH to conduct onsite evaluations or inspections
at reasonable hours to ensure that approved programs or accredited programs are in full
compliance with ch. 464, F.S., or to determine whether ch. 464, F.S., or s. 456.072, F.S., is being
violated. The DOH may collect any evidence necessary or as required to ensure compliance with
ch. 464, F.S. or for prosecution. A refusal by a nursing education program to allow an onsite
evaluation or inspection is deemed a violation of a legal obligation imposed by the BON and the
DOH.
The bill grants rulemaking authority to the BON to enforce and administer s. 464.019(5), F.S.;
and repeals the BON rulemaking authority to establish the criteria for nursing education
programs to qualify for an extension of time to meet the accreditation requirements under
s. 464.019(11), F.S., and repeals s. 464.019(11)(f), F.S., which gives the BON authority to grant
an extension of the accreditation deadline.
The bill provides an effective date of July 1, 2025.
IV. 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.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None. BILL: SB 526 Page 9
B. Private Sector Impact:
None.
C. Government Sector Impact:
The bill does not have a fiscal impact on state expenditures.
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends section 464.019 of the Florida Statutes.
IX. 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.