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Florida Senate - 2025 CS for CS for SB 526 By the Appropriations Committee on Health and Human Services; the Committee on Health Policy; and Senators Harrell and Sharief 603-03600-25 2025526c2 1 A bill to be entitled 2 An act relating to nursing education programs; 3 amending s. 464.008, F.S., requiring the Department of 4 Health to issue provisional licenses to graduate 5 licensed practical nurses and graduate registered 6 nurses under the supervision of clinical preceptors; 7 amending s. 464.019, F.S.; revising application 8 requirements for nursing education program approval; 9 providing preceptorship requirements; requiring the 10 Florida Center for Nursing to develop graduate nursing 11 preceptorship standards by a specified date; requiring 12 the Board of Nursing to incorporate the standards into 13 rule; clarifying that the Board of Nursing must 14 publish the graduate average passage rate of each 15 approved nursing program on its website; requiring the 16 board to deny an application under certain 17 circumstances; requiring the board to revoke an 18 existing programs approval under certain 19 circumstances; defining the term adverse action; 20 revising requirements for annual reports approved 21 programs are required to submit to the board; 22 requiring the board to terminate a program under 23 certain circumstances; providing penalties for program 24 directors found to be in violation of specified 25 provisions; revising remediation procedures for 26 approved programs with graduate passage rates that do 27 not meet specified requirements; subjecting program 28 directors of approved programs to specified 29 disciplinary action under certain circumstances; 30 deleting a provision authorizing the board to extend a 31 programs probationary status; authorizing agents or 32 employees of the department to conduct onsite 33 evaluations and inspections of approved and accredited 34 nursing education programs; authorizing the department 35 to collect evidence as part of such evaluations and 36 inspections; deeming failure or refusal of a program 37 to allow such evaluation or inspection as a violation 38 of a legal obligation; requiring the department to 39 disclose graduate average passage rates to each 40 program director; providing that program directors are 41 responsible for ensuring that graduate average passage 42 rates are posted on the programs website; revising 43 rulemaking authority of the board; deleting a 44 provision authorizing approved nursing education 45 programs to request an extension to meet the boards 46 accreditation requirements; providing an effective 47 date. 48 49 Be It Enacted by the Legislature of the State of Florida: 50 51 Section 1.Subsection (5) is added to section 464.008, 52 Florida Statutes, and subsection (1) of that section is 53 republished, to read: 54 464.008Licensure by examination. 55 (1)Any person desiring to be licensed as a registered 56 nurse or licensed practical nurse shall apply to the department 57 to take the licensure examination. The department shall examine 58 each applicant who: 59 (a)Has completed the application form and remitted a fee 60 set by the board not to exceed $150 and has remitted an 61 examination fee set by the board not to exceed $75 plus the 62 actual per applicant cost to the department for purchase of the 63 examination from the National Council of State Boards of Nursing 64 or a similar national organization. 65 (b)Has provided sufficient information on or after October 66 1, 1989, which must be submitted by the department for a 67 statewide criminal records correspondence check through the 68 Department of Law Enforcement. 69 (c)Is in good mental and physical health, is a recipient 70 of a high school diploma or the equivalent, and has completed 71 the requirements for: 72 1.Graduation from an approved program; 73 2.Graduation from a prelicensure nursing education program 74 that the board determines is equivalent to an approved program; 75 3.Graduation on or after July 1, 2009, from an accredited 76 program; or 77 4.Graduation before July 1, 2009, from a prelicensure 78 nursing education program whose graduates at that time were 79 eligible for examination. 80 81 Courses successfully completed in a professional nursing 82 education program that are at least equivalent to a practical 83 nursing education program may be used to satisfy the education 84 requirements for licensure as a licensed practical nurse. 85 (d)Has the ability to communicate in the English language, 86 which may be determined by an examination given by the 87 department. 88 (5)Pursuant to s. 464.019(1)(k) establishing graduate 89 nursing preceptorships, the department shall issue a provisional 90 license to such graduates who also meet the criteria in 91 paragraphs (1)(b), (c), and (d). 92 Section 2.Subsections (1) through (6) and (8) and 93 paragraph (f) of subsection (11) of section 464.019, Florida 94 Statutes, are amended to read: 95 464.019Approval of nursing education programs. 96 (1)PROGRAM APPLICATION.An educational institution that 97 wishes to conduct a program in this state for the prelicensure 98 education of professional or practical nurses must submit to the 99 department a program application and review fee of $1,000 for 100 each prelicensure nursing education program to be offered at the 101 institutions main campus, branch campus, or other instructional 102 site. The program application must include the legal name of the 103 educational institution, the legal name of the nursing education 104 program, the legal name of the nursing education program 105 director, and, if such institution is accredited, the name of 106 the accrediting agency. The application must also document that: 107 (a)1.For a professional nursing education program, the 108 program director and at least 50 percent of the programs 109 faculty members are registered nurses who have a masters or 110 higher degree in nursing or a bachelors degree in nursing and a 111 masters or higher degree in a field related to nursing. 112 2.For a practical nursing education program, the program 113 director and at least 50 percent of the programs faculty 114 members are registered nurses who have a bachelors or higher 115 degree in nursing. 116 117 The educational degree requirements of this paragraph must may 118 be documented by an official transcript or by a written 119 statement from the program director of the educational 120 institution verifying that the institution conferred the degree. 121 The program director shall certify the official transcript or 122 written statement as true and accurate. 123 (b)The programs nursing major curriculum consists of at 124 least: 125 1.Fifty percent clinical training in the United States, 126 the District of Columbia, or a possession or territory of the 127 United States for a practical nursing education program, an 128 associate degree professional nursing education program, or a 129 professional diploma nursing education program. 130 2.Forty percent clinical training in the United States, 131 the District of Columbia, or a possession or territory of the 132 United States for a bachelors degree professional nursing 133 education program. 134 (c)No more than 50 percent of the programs clinical 135 training consists of clinical simulation. 136 (d)The program has signed agreements with each agency, 137 facility, and organization included in the curriculum plan as 138 clinical training sites and community-based clinical experience 139 sites. 140 (e)The program has written policies for faculty which 141 include provisions for direct or indirect supervision by program 142 faculty or clinical preceptors for students in clinical training 143 consistent with the following standards: 144 1.The number of program faculty members equals at least 145 one faculty member directly supervising every 12 students unless 146 the written agreement between the program and the agency, 147 facility, or organization providing clinical training sites 148 allows more students, not to exceed 18 students, to be directly 149 supervised by one program faculty member. 150 2.For a hospital setting, indirect supervision may occur 151 only if there is direct supervision by an assigned clinical 152 preceptor, a supervising program faculty member is available by 153 telephone, and such arrangement is approved by the clinical 154 facility. 155 3.For community-based clinical experiences that involve 156 student participation in invasive or complex nursing activities, 157 students must be directly supervised by a program faculty member 158 or clinical preceptor and such arrangement must be approved by 159 the community-based clinical facility. 160 4.For community-based clinical experiences not subject to 161 subparagraph 3., indirect supervision may occur only when a 162 supervising program faculty member is available to the student 163 by telephone. 164 165 A programs policies established under this paragraph must 166 require that a clinical preceptor who is supervising students in 167 a professional nursing education program be a registered nurse 168 or, if supervising students in a practical nursing education 169 program, be a registered nurse or licensed practical nurse. 170 (f)The professional or practical nursing curriculum plan 171 documents clinical experience and theoretical instruction in 172 medical, surgical, obstetric, pediatric, and geriatric nursing. 173 A professional nursing curriculum plan must shall also document 174 clinical experience and theoretical instruction in psychiatric 175 nursing. Each curriculum plan must document clinical training 176 experience in appropriate settings that include, but are not 177 limited to, acute care, long-term care, and community settings. 178 (g)The professional or practical nursing education program 179 provides theoretical instruction and clinical application in 180 personal, family, and community health concepts; nutrition; 181 human growth and development throughout the life span; body 182 structure and function; interpersonal relationship skills; 183 mental health concepts; pharmacology and administration of 184 medications; and legal aspects of practice. A professional 185 nursing education program must also provide theoretical 186 instruction and clinical application in interpersonal 187 relationships and leadership skills; professional role and 188 function; and health teaching and counseling skills. 189 (h)The professional or practical nursing education program 190 has established evaluation and standardized admission criteria. 191 The admission criteria must, at a minimum, identify those 192 students who are likely to need additional educational support 193 to be successful program graduates. The program must maintain 194 documentation of the individualized student academic support 195 plan for those students identified as in need of additional 196 preparation and educational support. 197 (i)For each student, the professional or practical nursing 198 education program administers an exit examination that is a 199 national, standardized, and comprehensive predictor exam 200 designed to help nursing students assess their readiness for the 201 National Council of State Boards of Nursing Licensing 202 Examination (NCLEX) by identifying areas needing further study 203 and remediation. The exit examination may not be the sole 204 exclusion to graduation if the student has otherwise 205 successfully completed all coursework required by the program. 206 (j)The professional or practical nursing education program 207 has submitted to the board the established criteria for 208 remediation that will be offered to students who do not 209 successfully pass the exit examination. 210 (k)Beginning August 1, 2026, a program with more than 10 211 percentage points lower than the average passage rate during the 212 same calendar year for graduates of comparable degree programs 213 who are United States-educated, first-time test takers on the 214 NCLEX, as calculated by the contract testing service of the 215 National Council of State Boards of Nursing, shall offer a 216 graduate nursing preceptorship to its graduates. All programs 217 are encouraged to offer a graduate nursing preceptorship to 218 their graduates to provide opportunities for job shadowing, 219 clinical training, nonclinical training, and patient care in a 220 hospital setting. A graduate nursing preceptorship must last for 221 3 months, with the expectation that graduates will take the 222 NCLEX at the conclusion of the preceptorship. Graduate 223 registered nurses and graduate licensed practical nurses must be 224 supervised by clinical preceptors. The department shall issue 225 temporary provisional registered nurse licenses to a graduate of 226 a registered nursing program. The department shall issue 227 temporary provisional licensed practical nurse licenses to a 228 graduate of a licensed practical nursing program. If the 229 examination, professional or practical nursing education program 230 must offer remediation to the graduate for free. By January 1, 231 2026, the Florida Center for Nursing shall establish standards 232 for graduate nursing preceptorships, including supervision 233 requirements. The board shall incorporate the standards into 234 rule. 235 (2)PROGRAM APPROVAL. 236 (a)Upon receipt of a program application and review fee, 237 the department shall examine the application to determine if it 238 is complete. If the application is not complete, the department 239 must shall notify the educational institution in writing of any 240 errors or omissions within 30 days after the departments 241 receipt of the application. A program application is deemed 242 complete upon the departments receipt of: 243 1.The initial application, if the department does not 244 notify the educational institution of any errors or omissions 245 within the 30-day period; or 246 2.A revised application that corrects each error and 247 omission of which the department notifies the educational 248 institution within the 30-day period. 249 (b)Following the departments receipt of a complete 250 program application, the board may conduct an onsite evaluation 251 if necessary to document the applicants compliance with 252 subsection (1). Within 90 days after the departments receipt of 253 a complete program application, the board shall: 254 1.Approve the application if it documents compliance with 255 subsection (1); or 256 2.Provide the educational institution with a notice of 257 intent to deny the application if it does not document 258 compliance with subsection (1). The notice must specify written 259 reasons for the boards denial of the application. The board may 260 not deny a program application because of an educational 261 institutions failure to correct an error or omission that the 262 department failed to provide notice of to the institution within 263 the 30-day notice period under paragraph (a). The educational 264 institution may request a hearing on the notice of intent to 265 deny the program application pursuant to chapter 120. 266 (c)A program application is deemed approved if the board 267 does not act within the 90-day review period provided under 268 paragraph (b). 269 (d)Upon the boards approval of a program application, the 270 program becomes an approved program. 271 (e)The board shall deny an application from a program that 272 has had adverse action taken against it by another regulatory 273 jurisdiction in the United States. The board may also revoke the 274 approval of an existing approved program that has had adverse 275 action taken against it by another regulatory jurisdiction in 276 the United States. For purposes of this paragraph, the term 277 adverse action means any administrative, civil, or criminal 278 action imposed by a licensing board or other state authority 279 against a program. The term includes actions such as revocation, 280 suspension, probation, or any other encumbrance affecting the 281 programs authorization to operate. 282 (3)ANNUAL REPORT.By November 1 of each year, each 283 approved programs director program shall submit to the board an 284 annual report consisting comprised of an affidavit certifying 285 continued compliance with subsection (1), a summary description 286 of the programs compliance with subsection (1), and 287 documentation for the previous academic year that, to the extent 288 applicable, describes: 289 (a)The number of student applications received, qualified 290 applicants, applicants accepted, accepted applicants who enroll 291 in the program, students enrolled in the program, and program 292 graduates. 293 (b)The programs retention rates for students tracked from 294 program entry to graduation. 295 (c)The programs accreditation status, including 296 identification of the accrediting agency. 297 298 The board must terminate the program pursuant to chapter 120 if 299 the requirements of this subsection are not met. Upon request, 300 the board may give an extension for good cause not to exceed 60 301 days for a program to meet the requirements of this subsection. 302 If a program director is found to be in violation of this 303 subsection, the board may impose a penalty listed in s. 304 456.072(2). 305 (4)INTERNET WEBSITE.The board shall publish the following 306 information on its Internet website: 307 (a)A list of each accredited program conducted in the 308 state and the programs graduate passage rates for the most 309 recent 2 calendar years, which the department shall determine 310 through the following sources: 311 1.For a programs accreditation status, the specialized 312 accrediting agencies that are nationally recognized by the 313 United States Secretary of Education to accredit nursing 314 education programs. 315 2.For a programs graduate passage rates, the contract 316 testing service of the National Council of State Boards of 317 Nursing. 318 (b)The following data for each approved program, which 319 includes, to the extent applicable: 320 1.All documentation provided by the program in its program 321 application. 322 2.The summary description of the programs compliance 323 submitted under subsection (3). 324 3.The programs accreditation status, including 325 identification of the accrediting agency. 326 4.The programs probationary status. 327 5.The programs graduate passage rates for the most recent 328 2 calendar years. 329 6.Each programs retention rates for students tracked from 330 program entry to graduation. 331 (c)The average passage rates for United States educated, 332 first-time test takers on the National Council of State Boards 333 of Nursing Licensing Examination for the most recent 2 calendar 334 years, as calculated by the contract testing service of the 335 National Council of State Boards of Nursing. The average passage 336 rates shall be published separately for each type of comparable 337 degree program listed in subparagraph (5)(a)1., and individually 338 for each approved nursing program. 339 340 The information required to be published under this subsection 341 shall be made available in a manner that allows interactive 342 searches and comparisons of individual programs selected by the 343 website user. The board shall update the Internet website at 344 least quarterly with the available information. 345 (5)ACCOUNTABILITY. 346 (a)1.An approved program must achieve a graduate passage 347 rate for first-time test takers which is not more than 10 348 percentage points lower than the average passage rate during the 349 same calendar year for graduates of comparable degree programs 350 who are United States educated, first-time test takers on the 351 National Council of State Boards of Nursing Licensing 352 Examination, as calculated by the contract testing service of 353 the National Council of State Boards of Nursing. For purposes of 354 this subparagraph, an approved program is comparable to all 355 degree programs of the same program type from among the 356 following program types: 357 a.Professional nursing education programs that terminate 358 in a bachelors degree. 359 b.Professional nursing education programs that terminate 360 in an associate degree. 361 c.Professional nursing education programs that terminate 362 in a diploma. 363 d.Practical nursing education programs. 364 2.If an approved programs graduate passage rates do not 365 equal or exceed the required passage rates for 2 consecutive 366 calendar years, the board must shall place the program on 367 probationary status pursuant to chapter 120 and the program 368 director must submit a written remediation plan to the board. 369 The program director must shall appear before the board to 370 present the a plan for remediation, which must shall include 371 specific nationally recognized benchmarks to identify progress 372 toward a graduate passage rate goal. The board must terminate a 373 program pursuant to chapter 120 if the program director fails to 374 submit a written remediation plan or fails to appear before the 375 board and present the remediation plan no later than 6 months 376 after the date of the program being placed on probation. The 377 board may impose a penalty listed in s. 456.072(2) on the 378 program director for such failure. The program must remain on 379 probationary status until it achieves a graduate passage rate 380 that equals or exceeds the required passage rate for any 1 381 calendar year. The board must shall deny a program application 382 for a new prelicensure nursing education program submitted by an 383 educational institution if the institution has an existing 384 program that is already on probationary status. 385 3.Upon the programs achievement of a graduate passage 386 rate that equals or exceeds the required passage rate, the 387 board, at its next regularly scheduled meeting following release 388 of the programs graduate passage rate by the National Council 389 of State Boards of Nursing, shall remove the programs 390 probationary status. If the program, during the 2 calendar years 391 following its placement on probationary status, does not achieve 392 the required passage rate for any 1 calendar year, the board 393 must may extend the programs probationary status for 1 394 additional year, provided the program has demonstrated adequate 395 progress toward the graduate passage rate goal by meeting a 396 majority of the benchmarks established in the remediation plan. 397 If the program is not granted the 1-year extension or fails to 398 achieve the required passage rate by the end of such extension, 399 the board shall terminate the program pursuant to chapter 120. 400 (b)If an approved program fails to submit the annual 401 report required in subsection (3), the board must shall notify 402 the program director and president or chief executive officer of 403 the educational institution in writing within 15 days after the 404 due date of the annual report. The program director must shall 405 appear before the board at the boards next regularly scheduled 406 meeting to explain the reason for the delay. The board must 407 shall terminate the program pursuant to chapter 120 if the 408 program director fails to appear before the board, as required 409 under this paragraph, or if the program does not submit the 410 annual report within 6 months after the due date. 411 (c)A nursing education program, whether accredited or 412 nonaccredited, which has been placed on probationary status must 413 shall disclose its probationary status in writing to the 414 programs students and applicants. The notification must include 415 an explanation of the implications of the programs probationary 416 status on the students or applicants. 417 (d)If students from a program that is terminated pursuant 418 to this subsection transfer to an approved or an accredited 419 program under the direction of the Commission for Independent 420 Education, the board must shall recalculate the passage rates of 421 the programs receiving the transferring students, excluding the 422 test scores of those students transferring more than 12 credits. 423 (e)Duly authorized agents or employees of the department 424 may conduct onsite evaluations or inspections at any time during 425 business hours to ensure that approved programs or accredited 426 programs are in full compliance with this chapter, or to 427 determine whether this chapter or s. 456.072 is being violated. 428 The department may collect any necessary evidence needed to 429 ensure compliance with this chapter or for prosecution as deemed 430 necessary. A failure of a program to refuse or allow an onsite 431 evaluation or inspection is deemed a violation of a legal 432 obligation imposed by the board or the department. 433 (6)DISCLOSURE OF GRADUATE PASSAGE RATE DATA. 434 (a)For each graduate of the program included in the 435 calculation of the programs graduate passage rate, the 436 department shall disclose to the program director, upon his or 437 her written request, the name, examination date, and 438 determination of whether each graduate passed or failed the 439 National Council of State Boards of Nursing Licensing 440 Examination, if such information is provided to the department 441 by the contract testing service of the National Council of State 442 Boards of Nursing. The department shall disclose to the program 443 director the average passage rate for graduates from its program 444 written request must specify the calendar years for which the 445 information is requested. 446 (b)A program director to whom confidential information 447 exempt from public disclosure pursuant to s. 456.014 is 448 disclosed under this subsection must maintain the 449 confidentiality of the information and is subject to the same 450 penalties provided in s. 456.082 for department employees who 451 unlawfully disclose confidential information. 452 (c)The program director is responsible for ensuring that 453 the graduate average passage rate, as reported by the 454 department, is posted on the programs website. 455 (8)RULEMAKING.The board does not have rulemaking 456 authority to administer this section, except that the board 457 shall adopt rules that prescribe the format for submitting 458 program applications under subsection (1) and annual reports 459 under subsection (3), to implement graduate nursing 460 preceptorships as established in paragraph (1)(k), to enforce 461 and administer subsection (5), and to administer the 462 documentation of the accreditation of nursing education programs 463 under subsection (11). The board may adopt rules relating to the 464 nursing curriculum, including rules relating to the uses and 465 limitations of simulation technology, and rules relating to the 466 criteria to qualify for an extension of time to meet the 467 accreditation requirements under paragraph (11)(f). The board 468 may not impose any condition or requirement on an educational 469 institution submitting a program application, an approved 470 program, or an accredited program, except as expressly provided 471 in this section. 472 (11)ACCREDITATION REQUIRED. 473 (f)An approved nursing education program may, no sooner 474 than 90 days before the deadline for meeting the accreditation 475 requirements of this subsection, apply to the board for an 476 extension of the accreditation deadline for a period which does 477 not exceed 2 years. An additional extension may not be granted. 478 In order to be eligible for the extension, the approved program 479 must establish that it has a graduate passage rate of 60 percent 480 or higher on the National Council of State Boards of Nursing 481 Licensing Examination for the most recent calendar year and must 482 meet a majority of the boards additional criteria, including, 483 but not limited to, all of the following: 484 1.A student retention rate of 60 percent or higher for the 485 most recent calendar year. 486 2.A graduate work placement rate of 70 percent or higher 487 for the most recent calendar year. 488 3.The program has applied for approval or been approved by 489 an institutional or programmatic accreditor recognized by the 490 United States Department of Education. 491 4.The program is in full compliance with subsections (1) 492 and (3) and paragraph (5)(b). 493 5.The program is not currently in its second year of 494 probationary status under subsection (5). 495 496 The applicable deadline under this paragraph is tolled from the 497 date on which an approved program applies for an extension until 498 the date on which the board issues a decision on the requested 499 extension. 500 Section 3.This act shall take effect July 1, 2025.
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