CS/CS/HB 1337

1	A bill to be entitled
2	An act relating to nursing; amending s. 456.014, F.S.;
3	authorizing the disclosure of certain confidential
4	information required of nursing license applicants to
5	certain persons; amending s. 464.003, F.S.; providing and
6	revising definitions; amending s. 464.008, F.S.; revising
7	requirements for graduation from certain nursing education
8	programs for nursing license applicants seeking to take
9	the licensing examination; amending s. 464.015, F.S.;
10	revising restrictions on nursing graduates who may use
11	certain titles and abbreviations; amending s. 464.019,
12	F.S.; revising requirements for the approval of nursing
13	education programs by the Board of Nursing, including
14	application requirements and procedures for the review and
15	approval or denial of applications; revising requirements
16	for the approval of nursing education programs meeting
17	certain requirements before a specified date; providing
18	for retroactive application; revising requirements for the
19	submission of annual reports by approved programs;
20	revising requirements for the information published on the
21	board's Internet website; revising accountability
22	requirements for an approved program's graduate passage
23	rates on a certain licensing examination; revising
24	procedures for placing programs on, and removing such
25	programs, from probationary status; requiring termination
26	of programs under certain circumstances; requiring certain
27	representatives of programs that fail to submit annual
28	reports to appear before the board; requiring the
29	Department of Health to disclose certain confidential
30	information about a program's graduates to the program
31	director under certain circumstances; requiring program
32	directors to maintain the confidentiality of such
33	information; providing penalties for unlawful disclosure
34	of confidential information; revising requirements for the
35	closure of programs; revising the board's authority to
36	adopt rules; exempting accredited programs from specified
37	requirements; providing requirements for an accredited
38	program that ceases to be accredited; conforming
39	provisions; deleting obsolete provisions; revising
40	requirements for the Florida Center for Nursing's
41	evaluation of the board's implementation of certain
42	accountability provisions; providing for the performance
43	of certain duties of the Florida Center for Nursing by the
44	Office of Program Policy Analysis and Government
45	Accountability under certain circumstances; conforming
46	cross-references; amending s. 464.022, F.S.; conforming
47	provisions; amending ss. 458.348, 459.025, 464.012, and
48	960.28, F.S.; conforming cross-references; providing an
49	effective date.
50
51	Be It Enacted by the Legislature of the State of Florida:
52
53	Section 1.  Subsection (1) of section 456.014, Florida
54	Statutes, is amended to read:
55	456.014  Public inspection of information required from
56	applicants; exceptions; examination hearing.-
57	(1)  All information required by the department of any
58	applicant shall be a public record and shall be open to public
59	inspection pursuant to s. 119.07, except financial information,
60	medical information, school transcripts, examination questions,
61	answers, papers, grades, and grading keys, which are
62	confidential and exempt from s. 119.07(1) and shall not be
63	discussed with or made accessible to anyone except the program
64	director of an approved program or accredited program as
65	provided in s. 464.019(7), members of the board, the department,
66	and staff thereof, who have a bona fide need to know such
67	information. Any information supplied to the department by any
68	other agency which is exempt from the provisions of chapter 119
69	or is confidential shall remain exempt or confidential pursuant
70	to applicable law while in the custody of the department or the
71	agency.
72	Section 2.  Section 464.003, Florida Statutes, is reordered
73	and amended to read:
74	464.003  Definitions.-As used in this part, the term:
75	(1)  "Accredited program" means a program for the
76	prelicensure education of professional or practical nurses that
77	is conducted in the United States at an educational institution,
78	whether in this state, another state, or the District of
79	Columbia, and that is accredited by a specialized nursing
80	accrediting agency that is nationally recognized by the United
81	States Secretary of Education to accredit nursing education
82	programs.
83	(13)(1)  "Department" means the Department of Health.
84	(5)(2)  "Board" means the Board of Nursing.
85	(20)(3)(a)  "Practice of professional nursing" means the
86	performance of those acts requiring substantial specialized
87	knowledge, judgment, and nursing skill based upon applied
88	principles of psychological, biological, physical, and social
89	sciences which shall include, but not be limited to:
90	(a)1.  The observation, assessment, nursing diagnosis,
91	planning, intervention, and evaluation of care; health teaching
92	and counseling of the ill, injured, or infirm; and the promotion
93	of wellness, maintenance of health, and prevention of illness of
94	others.
95	(b)2.  The administration of medications and treatments as
96	prescribed or authorized by a duly licensed practitioner
97	authorized by the laws of this state to prescribe such
98	medications and treatments.
99	(c)3.  The supervision and teaching of other personnel in
100	the theory and performance of any of the above acts described in
101	this subsection.
102
103	A professional nurse is responsible and accountable for making
104	decisions that are based upon the individual's educational
105	preparation and experience in nursing.
106	(19)(b)  "Practice of practical nursing" means the
107	performance of selected acts, including the administration of
108	treatments and medications, in the care of the ill, injured, or
109	infirm and the promotion of wellness, maintenance of health, and
110	prevention of illness of others under the direction of a
111	registered nurse, a licensed physician, a licensed osteopathic
112	physician, a licensed podiatric physician, or a licensed
113	dentist. A The professional nurse and the practical nurse is
114	shall be responsible and accountable for making decisions that
115	are based upon the individual's educational preparation and
116	experience in nursing.
117	(7)(c)  "Clinical nurse specialist practice" means the
118	delivery and management of advanced practice nursing care to
119	individuals or groups, including the ability to:
120	(a)1.  Assess the health status of individuals and families
121	using methods appropriate to the population and area of
122	practice.
123	(b)2.  Diagnose human responses to actual or potential
124	health problems.
125	(c)3.  Plan for health promotion, disease prevention, and
126	therapeutic intervention in collaboration with the patient or
127	client.
128	(d)4.  Implement therapeutic interventions based on the
129	nurse specialist's area of expertise and within the scope of
130	advanced nursing practice, including, but not limited to, direct
131	nursing care, counseling, teaching, and collaboration with other
132	licensed health care providers.
133	(e)5.  Coordinate health care as necessary and appropriate
134	and evaluate with the patient or client the effectiveness of
135	care.
136	(2)(d)  "Advanced or specialized nursing practice" means,
137	in addition to the practice of professional nursing, the
138	performance of advanced-level nursing acts approved by the board
139	which, by virtue of postbasic specialized education, training,
140	and experience, are appropriately performed by an advanced
141	registered nurse practitioner. Within the context of advanced or
142	specialized nursing practice, the advanced registered nurse
143	practitioner may perform acts of nursing diagnosis and nursing
144	treatment of alterations of the health status. The advanced
145	registered nurse practitioner may also perform acts of medical
146	diagnosis and treatment, prescription, and operation which are
147	identified and approved by a joint committee composed of three
148	members appointed by the Board of Nursing, two of whom must be
149	advanced registered nurse practitioners; three members appointed
150	by the Board of Medicine, two of whom must have had work
151	experience with advanced registered nurse practitioners; and the
152	State Surgeon General or the State Surgeon General's designee.
153	Each committee member appointed by a board shall be appointed to
154	a term of 4 years unless a shorter term is required to establish
155	or maintain staggered terms. The Board of Nursing shall adopt
156	rules authorizing the performance of any such acts approved by
157	the joint committee. Unless otherwise specified by the joint
158	committee, such acts must be performed under the general
159	supervision of a practitioner licensed under chapter 458,
160	chapter 459, or chapter 466 within the framework of standing
161	protocols which identify the medical acts to be performed and
162	the conditions for their performance. The department may, by
163	rule, require that a copy of the protocol be filed with the
164	department along with the notice required by s. 458.348.
165	(17)(e)  "Nursing diagnosis" means the observation and
166	evaluation of physical or mental conditions, behaviors, signs
167	and symptoms of illness, and reactions to treatment and the
168	determination as to whether such conditions, signs, symptoms,
169	and reactions represent a deviation from normal.
170	(18)(f)  "Nursing treatment" means the establishment and
171	implementation of a nursing regimen for the care and comfort of
172	individuals, the prevention of illness, and the education,
173	restoration, and maintenance of health.
174	(22)(4)  "Registered nurse" means any person licensed in
175	this state to practice professional nursing.
176	(16)(5)  "Licensed practical nurse" means any person
177	licensed in this state to practice practical nursing.
178	(6)  "Clinical nurse specialist" means any person licensed
179	in this state to practice professional nursing and certified in
180	clinical nurse specialist practice.
181	(3)(7)  "Advanced registered nurse practitioner" means any
182	person licensed in this state to practice professional nursing
183	and certified in advanced or specialized nursing practice,
184	including certified registered nurse anesthetists, certified
185	nurse midwives, and nurse practitioners.
186	(4)(8)  "Approved program" means a nursing program for the
187	prelicensure education of professional or practical nurses that
188	is conducted in the state at an educational institution and that
189	is in a school, college, or university which is approved under
190	s. 464.019 for the education of nurses. The term includes such a
191	program placed on probationary status.
192	(10)(9)  "Clinical training" means direct nursing care
193	experiences with patients or clients which offer the student the
194	opportunity to integrate, apply, and refine specific skills and
195	abilities based on theoretical concepts and scientific
196	principles.
197	(8)(10)  "Clinical preceptor" means a registered nurse or
198	licensed practical nurse who is employed by a clinical training
199	facility to serve who serves as a role model and clinical
200	resource person for a specified period to students an individual
201	enrolled in an approved program.
202	(9)(11)  "Clinical simulation" means a strategy used to
203	replicate clinical practice as closely as possible to teach
204	theory, assessment, technology, pharmacology, and skills.
205	(11)(12)  "Community-based clinical experience" means
206	activities consistent with the curriculum and involving
207	individuals, families, and groups with the intent of promoting
208	wellness, maintaining health, and preventing illness.
209	(12)(13)  "Curriculum" means a planned sequence of course
210	offerings and learning experiences that comprise a nursing
211	education program.
212	(21)(14)  "Probationary status" means the status of an
213	approved a nursing education program that is placed on such
214	status pursuant subject to s. 464.019(2)(a)2. or (5)(a) or (b).
215	(14)  "Educational institution" means a school, college, or
216	university.
217	(15)  "Graduate passage rate" means the percentage of a
218	program's graduates who, as first-time test takers, pass the
219	National Council of State Boards of Nursing Licensing
220	Examination during a calendar year, as calculated by the
221	contract testing service of the National Council of State Boards
222	of Nursing.
223	(23)  "Required passage rate" means the graduate passage
224	rate required for an approved program pursuant to s.
225	464.019(6)(a)1.
226	Section 3.  Subsection (1) of section 464.008, Florida
227	Statutes, is amended to read:
228	464.008  Licensure by examination.-
229	(1)  Any person desiring to be licensed as a registered
230	nurse or licensed practical nurse shall apply to the department
231	to take the licensure examination. The department shall examine
232	each applicant who:
233	(a)  Has completed the application form and remitted a fee
234	set by the board not to exceed $150 and has remitted an
235	examination fee set by the board not to exceed $75 plus the
236	actual per applicant cost to the department for purchase of the
237	examination from the National Council of State Boards of Nursing
238	or a similar national organization.
239	(b)  Has provided sufficient information on or after
240	October 1, 1989, which must be submitted by the department for a
241	statewide criminal records correspondence check through the
242	Department of Law Enforcement.
243	(c)  Is in good mental and physical health, is a recipient
244	of a high school diploma or the equivalent, and has completed
245	the requirements for:
246	1.  Graduation from an approved program;
247	2.  Graduation from a prelicensure nursing education
248	program that the board determines is, or its equivalent to an
249	approved program;
250	3.  Graduation on or after July 1, 2009, from an accredited
251	program; or
252	4.  Graduation before July 1, 2009, from a prelicensure
253	nursing education program whose graduates at that time were
254	eligible for examination as determined by the board, for the
255	preparation of registered nurses or licensed practical nurses,
256	whichever is applicable.
257
258	Courses successfully completed in a professional nursing
259	education program that which are at least equivalent to a
260	practical nursing education program may be used to satisfy the
261	education requirements for licensure as a licensed practical
262	nurse.
263	(d)  Has the ability to communicate in the English
264	language, which may be determined by an examination given by the
265	department.
266	Section 4.  Subsections (3) and (4) of section 464.015,
267	Florida Statutes, are amended to read:
268	464.015  Titles and abbreviations; restrictions; penalty.-
269	(3)  Only persons who are graduates of prelicensure nursing
270	education approved programs listed in s. 464.008(1)(c) or the
271	equivalent may use the term "Graduate Nurse" and the
272	abbreviation "G.N.," pending the results of the first licensure
273	examination for which they are eligible.
274	(4)  Only persons who are graduates of prelicensure nursing
275	education approved programs listed in s. 464.008(1)(c) or the
276	equivalent may use the term "Graduate Practical Nurse" and the
277	abbreviation "G.P.N.," pending the results of the first
278	licensure examination for which they are eligible.
279	Section 5.  Section 464.019, Florida Statutes, is reordered
280	and amended to read:
281	464.019  Approval of nursing education programs.-
282	(1)  PROGRAM APPLICATIONS.-An educational institution that
283	wishes to conduct a program in this state for the prelicensure
284	education of professional or practical nurses must shall submit
285	to the department a program application and a program review fee
286	of $1,000 for each prelicensure nursing education program to be
287	offered at the institution's main campus, branch campus, or
288	other instructional site the department. Within 90 days after
289	receipt of a program application and program review fee, the
290	board shall approve the program application if it documents
291	compliance with the standards in paragraphs (a)-(h). If the
292	program application is incomplete or does not document
293	compliance, the board shall follow the procedures in subsection
294	(3). a program application is deemed approved by the board if
295	the board does not act on the application within the timeframes
296	specified in subsection (3) or this subsection. Each program
297	application must include the legal name of the educational
298	institution, the legal name of the nursing education program,
299	and, if such program is accredited by an accrediting agency
300	other than an accrediting agency described in s. 464.003(1), the
301	name of the accrediting agency. The application must also
302	document that:
303	(a)1.  For a professional nursing education program, the
304	program director and at least 50 percent of the program's
305	faculty members are registered nurses who have, at a minimum, a
306	master's or higher bachelor's degree in nursing or a bachelor's
307	and a master's degree in nursing and a master's or higher degree
308	in a field or a related to nursing field.
309	2.(b)  For a practical nursing education program, the
310	program director and at least 50 percent of the program's
311	faculty members are registered nurses who have, at a minimum, a
312	bachelor's or higher degree in nursing.
313
314	The educational degree requirements of this paragraph may be
315	documented by an official transcript or by a written statement
316	from the educational institution verifying that the institution
317	conferred the degree.
318	(b)(c)  The program's nursing major curriculum consists of
319	at least:
320	1.  Fifty percent clinical training for a practical nursing
321	education program, an associate degree professional nursing
322	education program, or a professional diploma nursing education
323	program.
324	2.  Forty percent clinical training for a bachelor's degree
325	professional nursing education program.
326	(c)(d)  No more than 25 percent of the program's clinical
327	training consists of clinical simulation.
328	(d)(e)  The program has signed agreements with each agency,
329	facility, and organization included in the curriculum plan as
330	clinical training sites and community-based clinical experience
331	sites.
332	(e)(f)  The program has written policies for faculty which
333	include provisions for direct or indirect supervision by program
334	faculty or clinical preceptors for students in clinical training
335	consistent with the following standards:
336	1.  The number of program faculty members equals at least
337	one faculty member directly supervising every 12 students unless
338	the written agreement between the program and the agency,
339	facility, or organization providing clinical training sites
340	allows more students, not to exceed 18 students, to be directly
341	supervised by one program faculty member.
342	2.  For a hospital setting, indirect supervision may occur
343	only if there is direct supervision by an assigned clinical
344	preceptor, a supervising program faculty member is available by
345	telephone, and such arrangement is approved by the clinical
346	facility.
347	3.  For community-based clinical experiences that involve
348	student participation in invasive or complex nursing activities,
349	students must be directly supervised by a program faculty member
350	or clinical preceptor and such arrangement must be approved by
351	the community-based clinical facility.
352	4.  For community-based clinical experiences not subject to
353	subparagraph 3., indirect supervision may occur only when a
354	supervising program faculty member is available to the student
355	by telephone.
356
357	A program's policies established under this paragraph must
358	require a clinical preceptor, if supervising students in a
359	professional nursing education program, to be a registered nurse
360	or, if supervising students in a practical nursing education
361	program, to be a registered nurse or licensed practical nurse.
362	(f)(g)  The professional or practical nursing curriculum
363	plan documents clinical experience and theoretical instruction
364	in medical, surgical, obstetric, pediatric, and geriatric
365	nursing. A professional nursing curriculum plan shall also
366	document clinical experience and theoretical instruction in
367	psychiatric nursing. Each curriculum plan must document clinical
368	training experience in appropriate settings that include, but
369	are not limited to, acute care, long-term care, and community
370	settings.
371	(g)(h)  The professional or practical nursing education
372	program provides theoretical instruction and clinical
373	application in personal, family, and community health concepts;
374	nutrition; human growth and development throughout the life
375	span; body structure and function; interpersonal relationship
376	skills; mental health concepts; pharmacology and administration
377	of medications; and legal aspects of practice. A professional
378	nursing education program shall also provide theoretical
379	instruction and clinical application in interpersonal
380	relationships and leadership skills; professional role and
381	function; and health teaching and counseling skills.
382
383	Upon the board's approval of a program application, the program
384	becomes an approved program under this section.
385	(3)(2)  STATUS OF CERTAIN PROGRAMS.-
386	(a)  A professional or practical nursing education program
387	becomes an approved program if that, as of June 30, 2009, the
388	program:
389	(a)1.  Has full or provisional approval from the board or,
390	except as provided in paragraph (b), is on probationary status,
391	except as provided in subparagraph 2., becomes an approved
392	program under this section. In order to retain approved program
393	status, such program shall submit the report required under
394	paragraph (c) to the board by November 1, 2009, and annually
395	thereafter.
396	(b)2.  Is on probationary status because the program did
397	not meet the board's requirement for program graduate passage
398	rates. Such program on the National Council of State Boards of
399	Nursing Licensing Examination, shall remain on probationary
400	status until it the program achieves a graduate passage rate for
401	calendar year 2009 or 2010 that equals or exceeds the required
402	passage rate for the respective calendar year and compliance
403	with the program graduate passage rate requirement in paragraph
404	(5)(a). A program that is subject to this subparagraph must
405	disclose its probationary status in writing to the program's
406	students and applicants submit the report required under
407	paragraph (c) to the board by November 1, 2009, and annually
408	thereafter and must comply with paragraph (5)(c). If the program
409	does not achieve the required passage rate compliance by July 1,
410	2011, the board shall terminate the program pursuant to chapter
411	120 as provided in paragraph (5)(d).
412	(b)  Each professional or practical nursing program that
413	has its application approved by the board under subsection (1)
414	on or after July 1, 2009, shall annually submit the report
415	required under paragraph (c) to the board by November 1 of each
416	year following initial approval of its application.
417	(4)  ANNUAL REPORT.-By November 1 of each year, each
418	approved program shall submit to the board an
419	(c)  The annual report comprised of required by this
420	subsection must include an affidavit certifying continued
421	compliance with paragraphs (1)(a)-(g) subsection (1), must
422	provide a summary description of the program's compliance with
423	paragraphs (1)(a)-(g) with subsection (1), and documentation
424	must document for the previous academic year that, to the extent
425	applicable, sets forth for each professional and practical
426	nursing program:
427	(a)1.  The number of student applications received, the
428	number of qualified applicants, applicants and the number of
429	students accepted, accepted applicants who enroll in the
430	program, students enrolled in the program, and.
431	2.  the number of program graduates.
432	3.  The program's graduate passage rate on the National
433	Council of State Boards of Nursing Licensing Examination.
434	(b)4.  The program's retention rates for students tracked
435	from program entry to graduation.
436	(c)5.  The program's accreditation status, including
437	identification of the accrediting agency if such agency is not
438	an accrediting agency described in s. 464.003(1) body.
439	(2)(3)  PROGRAM APPROVAL.-
440	(a)  Upon receipt of a If an institution's program
441	application and review fee, the department shall examine the
442	application to determine whether it is complete. If a program
443	application is not complete incomplete, the department board
444	shall notify the educational institution in writing of any
445	apparent errors or omissions within 30 days after the
446	department's receipt of the application and follow the
447	procedures in s. 120.60. A program application is deemed
448	complete upon the department's receipt of:
449	1.  The initial application, if the department does not
450	notify the educational institution of any errors or omissions
451	within the 30-day period; or
452	2.  A revised application that corrects each error and
453	omission of which the department notifies the educational
454	institution within the 30-day period.
455	(b)  Within 90 days after the department's receipt of a
456	complete program application, the board shall:
457	1.  Approve the If an institution's program application if
458	it documents does not document compliance with paragraphs
459	(1)(a)-(g); or the standards in subsection (1), within 90 days
460	after the board's receipt of the program application, the board
461	shall
462	2.  Provide the educational institution with a notice of
463	intent to deny the program application if it does not document
464	compliance with paragraphs (1)(a)-(g) that sets forth written
465	reasons for the denial. The notice must set forth written
466	reasons for the board's denial of the application. The board may
467	not deny a program application because of an educational
468	institution's failure to correct any error or omission of which
469	the department does not notify the institution within the 30-day
470	notice period under paragraph (a). The educational institution
471	may request a hearing on the notice of intent to deny the
472	program application pursuant to chapter 120.
473	(c)  A program application is deemed approved if the board
474	does not act within the 90-day review period provided under
475	paragraph (b).
476	(d)  Upon the board's approval of a program application,
477	the program becomes an approved program.
478	(5)(4)  INTERNET WEBSITE.-By October 1, 2010, the board
479	shall publish the following information on its Internet website:
480	(a)  A list of each accredited program conducted in the
481	state and the program's graduate passage rates for the most
482	recent 2 calendar years, which the department shall determine
483	through the following sources:
484	1.  For a program's accreditation status, the specialized
485	accrediting agencies that are nationally recognized by the
486	United States Secretary of Education to accredit nursing
487	education programs.
488	2.  For a program's graduate passage rates, the contract
489	testing service of the National Council of State Boards of
490	Nursing.
491	(b)  The following data for each approved program, which on
492	nursing programs located in the state. The data shall include,
493	to the extent applicable:
494	1.(a)  All documentation provided by the program in its
495	applicant for each approved nursing program application if
496	submitted on or after July 1, 2009.
497	2.(b)  The summary description of the each program's
498	compliance as submitted under subsection (4) paragraph (2)(c).
499	(c)  A comprehensive list of each practical and
500	professional nursing program in the state.
501	3.(d)  The program's accreditation status for each program,
502	including identification of the accrediting agency if such
503	agency is not an accrediting agency described in s. 464.003(1)
504	body.
505	4.(e)  The Each program's approval or probationary status.
506	5.(f)  The Each program's graduate passage rates for the
507	most recent 2 calendar years rate on the National Council of
508	State Boards of Nursing Licensing Examination.
509	(g)  The national average for passage rates on the National
510	Council of State Boards of Nursing Licensing Examination.
511	6.(h)  Each program's retention rates for students tracked
512	from program entry to graduation.
513	(c)  The average passage rates for United States educated
514	first-time test takers on the National Council of State Boards
515	of Nursing Licensing Examination for the most recent 2 calendar
516	years, as calculated by the contract testing service of the
517	National Council of State Boards of Nursing. The average passage
518	rates shall be published separately for each type of comparable
519	degree program listed in sub-subparagraphs (6)(a)1.a.-d.
520
521	The information data required to be published under this
522	subsection shall be made available in a manner that allows
523	interactive searches and comparisons of individual specific
524	nursing education programs selected by the website user. The
525	board shall publish the data by December 31, 2009, and update
526	the Internet website at least quarterly with the available
527	information data.
528	(6)(5)  ACCOUNTABILITY.-
529	(a)1.  An approved program must achieve a graduate passage
530	rate that is not lower than 10 percentage points less than the
531	average passage rate for graduates of comparable degree programs
532	who are United States educated first-time test takers on the
533	National Council of State Boards of Nursing Licensing
534	Examination during a calendar year, as calculated by the
535	contract testing service of the National Council of State Boards
536	of Nursing. For purposes of this subparagraph, an approved
537	program is comparable to all degree programs of the same program
538	type from among the following program types:
539	a.  Professional nursing education programs that terminate
540	in a bachelor's degree.
541	b.  Professional nursing education programs that terminate
542	in an associate degree.
543	c.  Professional nursing education programs that terminate
544	in a diploma.
545	d.  Practical nursing education programs.
546	2.  Beginning with graduate passage rates for calendar year
547	2010, if an approved a professional or practical nursing
548	program's average graduate passage rates do not equal or exceed
549	the required passage rates rate for first-time test takers on
550	the National Council of State Boards of Nursing Licensing
551	Examination falls 10 percent or more below the national average
552	passage rate for first-time test takers educated in the United
553	States, as annually published by the contract testing service of
554	the National Council of State Boards of Nursing, for 2
555	consecutive calendar years, the board shall place the program on
556	probationary status pursuant to chapter 120 probation and the
557	program director must shall be required to appear before the
558	board to present a plan for remediation. The program shall
559	remain on probationary status until it achieves a compliance
560	with the graduate passage rate that equals or exceeds the
561	required passage rate for any one calendar year.
562	3.  Upon the program's achievement of a graduate passage
563	rate that equals or exceeds the required passage rate,
564	requirement and shall be terminated by the board, at its next
565	regularly scheduled meeting following release of the program's
566	graduate passage rate by the National Council of State Boards of
567	Nursing, shall remove the program's probationary status.
568	However, under paragraph (d) if the program, during the 2
569	calendar years following its placement on probationary status,
570	does not achieve the required passage rate for any one
571	compliance within 2 calendar year, the board shall terminate the
572	program pursuant to chapter 120 years.
573	(b)  If an approved a program fails to submit the annual
574	report required in subsection (4) (2), the board shall notify
575	the program director and president or chief executive officer of
576	the educational institution in writing within 15 days after the
577	due date of the annual report. The program director must appear
578	before the board at the board's next regularly scheduled meeting
579	to explain the reason for the delay place the program on
580	probation. The board program shall terminate the program
581	pursuant to chapter 120 remain on probationary status until it
582	submits the annual report and shall be terminated by the board
583	under paragraph (d) if it does not submit the annual report
584	within 6 months after the report's due date.
585	(c)  An approved A program placed on probationary status
586	shall disclose its probationary status in writing to the
587	program's students and applicants.
588	(d)  The board shall terminate a program that fails to
589	comply with subparagraph (2)(a)2., paragraph (a), or paragraph
590	(b) pursuant to chapter 120.
591	(7)  DISCLOSURE OF GRADUATE PASSAGE RATE DATA.-
592	(a)  For each of an approved program's or accredited
593	program's graduates included in the calculation of the program's
594	graduate passage rate, the department shall disclose to the
595	program director, upon his or her written request, the name,
596	examination date, and determination of whether each graduate
597	passed or failed the National Council for State Boards of
598	Nursing Licensing Examination, to the extent that such
599	information is provided to the department by the contract
600	testing service of the National Council for State Boards of
601	Nursing. The written request must specify the calendar years for
602	which the information is requested.
603	(b)  A program director to whom confidential information
604	exempt from public disclosure pursuant to s. 456.014 is
605	disclosed under this subsection must maintain the
606	confidentiality of the information and is subject to the same
607	penalties provided in s. 456.082 for department employees who
608	unlawfully disclose confidential information.
609	(8)(6)  PROGRAM CLOSURE.-
610	(a)  An educational institution conducting an approved
611	program or accredited a nursing program in this state, at least
612	30 days before voluntarily closing the program, that closes
613	shall notify the board in writing of the institution's reason
614	for closing the program, the intended closure date, the
615	institution's plan to provide for or assist in the completion of
616	training by the program's students, and advise the board of the
617	arrangements for storage of the program's permanent
618	(b)  An educational institution conducting a nursing
619	education program that is terminated under subsection (6) or
620	closed under subparagraph (10)(b)3.:
621	1.  May not accept or enroll new students.
622	2.  Must submit to the board within 30 days after the
623	program is terminated or closed a written description of how the
624	institution will assist in the completion of training by the
625	program's students and the institution's arrangements for
626	storage of the program's permanent records.
627	(c)  If an educational institution does not comply with
628	paragraph (a) or paragraph (b), the board shall provide a
629	written notice explaining the institution's noncompliance to the
630	following persons and entities:
631	1.  The president or chief executive officer of the
632	educational institution.
633	2.  The Board of Governors, if the program is conducted by
634	a state university.
635	3.  The district school board, if the program is conducted
636	by an educational institution operated by a school district.
637	4.  The Commission for Independent Education, if the
638	program is conducted by an educational institution licensed
639	under chapter 1005.
640	5.  The State Board of Education, if the program is
641	conducted by an educational institution in the Florida College
642	System or by an educational institution that is not subject to
643	subparagraphs 2.-4.
644	(9)(7)  RULEMAKING.-The board does not have any rulemaking
645	authority to administer this section, except that the board
646	shall adopt a rule that prescribes the format for submitting
647	program applications under subsection (1) and annual reports
648	submitting summary descriptions of program compliance under
649	subsection (4) paragraph (2)(c). The board may not impose any
650	condition or requirement on an educational institution
651	submitting a program application, an approved program, or an
652	accredited program, a program on probationary status except as
653	expressly provided in this section. The board shall repeal all
654	rules, or portions thereof, in existence on July 1, 2009, that
655	are inconsistent with this subsection.
656	(10)  APPLICABILITY TO ACCREDITED PROGRAMS.-
657	(a)  Subsections (1)-(4), paragraph (5)(b), and subsection
658	(6) do not apply to an accredited program. An accredited program
659	on probationary status before July 1, 2010, ceases to be subject
660	to the probationary status.
661	(b)  If an accredited program ceases to be accredited, the
662	educational institution conducting the program:
663	1.  Within 10 business days after the program ceases to be
664	accredited, must provide written notice of the date that the
665	program ceased to be accredited to the board, the program's
666	students and applicants, and each entity providing clinical
667	training sites or community-based clinical experience sites for
668	the program. The educational institution must continue to
669	provide the written notice to new students, applicants, and
670	entities providing clinical training sites or community-based
671	clinical experience sites for the program until the program
672	becomes an approved program or is closed under subparagraph 3.
673	2.  Within 30 days after the program ceases to be
674	accredited, must submit an affidavit to the board, signed by the
675	educational institution's president or chief executive officer,
676	that certifies the institution's compliance with subparagraph 1.
677	The board shall notify the persons listed in subparagraph
678	(8)(c)1. and the applicable entities listed in subparagraphs
679	(8)(c)2.-5. if an educational institution does not submit the
680	affidavit required by this subparagraph.
681	3.  May apply to become an approved program under this
682	section. If the educational institution:
683	a.  Within 30 days after the program ceases to be
684	accredited, submits a program application and review fee to the
685	department under subsection (1) and the affidavit required under
686	subparagraph 2., the program shall be deemed an approved program
687	from the date that the program ceased to be accredited until the
688	date that the board approves or denies the program application.
689	The program application must be denied by the board pursuant to
690	chapter 120 if it does not contain the affidavit. If the board
691	denies the program application under subsection (2) or because
692	the program application does not contain the affidavit, the
693	program shall be closed and the educational institution
694	conducting the program must comply with paragraph (8)(b).
695	b.  Does not apply to become an approved program pursuant
696	to sub-subparagraph a., the program shall be deemed an approved
697	program from the date that the program ceased to be accredited
698	until the 31st day after that date. On the 31st day after the
699	program ceased to be accredited, the program shall be closed and
700	the educational institution conducting the program must comply
701	with paragraph (8)(b).
702	(8)  The Florida Center for Nursing and the Office of
703	Program Policy Analysis and Government Accountability shall
704	each:
705	(a)  Monitor the administration of this section and
706	evaluate the effectiveness of this section in achieving quality
707	nursing programs with a higher production of quality nursing
708	graduates.
709	(b)  Report its findings and make recommendations, if
710	warranted, to improve the effectiveness of this section to the
711	Governor, the President of the Senate, and the Speaker of the
712	House of Representatives by February 1, 2010.
713	(11)(9)  IMPLEMENTATION STUDY.-The Florida Center for
714	Nursing and the education policy area of the Office of Program
715	Policy Analysis and Government Accountability shall study the 5-
716	year administration of this section and submit reports to the
717	Governor, the President of the Senate, and the Speaker of the
718	House of Representatives by January 30, 2011, and annually
719	thereafter through January 30, 2015. The annual reports shall
720	address the previous academic year; set forth data on the
721	measures specified in paragraphs (a) and (b) for each
722	prelicensure practical and professional nursing program in the
723	state, as such data becomes available; and include an evaluation
724	of such data for purposes of determining whether this section is
725	increasing the availability of nursing education programs and
726	the production of quality nurses. The department and each
727	approved program or accredited program shall comply with
728	requests for data from the Florida Center for Nursing and the
729	education policy area of the Office of Program Policy Analysis
730	and Government Accountability.
731	(a)  The education policy area of the Office of Program
732	Policy Analysis and Government Accountability shall evaluate
733	program-specific data for each approved program and accredited
734	program conducted in the state, including, but not limited to:
735	1.  The number of nursing education programs and student
736	slots available.
737	2.  The number of student applications submitted, the
738	number of qualified applicants, and the number of students
739	accepted.
740	3.  The number of program graduates.
741	4.  Program retention rates of students tracked from
742	program entry to graduation.
743	5.  Graduate passage rates on the National Council of State
744	Boards of Nursing Licensing Examination.
745	6.  The number of graduates who become employed as
746	practical or professional nurses in the state.
747	(b)  The Florida Center for Nursing shall evaluate the
748	board's implementation of the:
749	1.  Program application approval process, including, but
750	not limited to, the number of program applications submitted
751	under subsection (1); the number of program applications
752	approved and denied by the board under subsection (2)
753	subsections (1) and (3); the number of denials of program
754	applications reviewed under chapter 120; and a description of
755	the outcomes of those reviews.
756	2.  Accountability Probation and termination processes,
757	including, but not limited to, the number of programs placed on
758	probationary status, the number of approved programs for which
759	the program director is required to appear before the board
760	under subsection (6), the number of approved programs terminated
761	by the board under paragraph (5)(d), the number of terminations
762	reviewed under chapter 120, and a description of the outcomes of
763	those reviews.
764	(c)  For any state fiscal year in which the Florida Center
765	for Nursing does not receive legislative appropriations, the
766	education policy area of the Office of Program Policy Analysis
767	and Government Accountability shall perform the duties assigned
768	by this subsection to the Florida Center for Nursing.
769	Section 6.  Subsection (4) of section 464.022, Florida
770	Statutes, is amended to read:
771	464.022  Exceptions.-No provision of this part shall be
772	construed to prohibit:
773	(4)  The practice of nursing by graduates of prelicensure
774	nursing education approved programs listed in s. 464.008(1)(c)
775	or the equivalent, pending the result of the first licensing
776	examination for which they are eligible following graduation,
777	provided they practice under direct supervision of a registered
778	professional nurse. The board shall by rule define what
779	constitutes direct supervision.
780	Section 7.  Paragraph (a) of subsection (1) and subsection
781	(2) of section 458.348, Florida Statutes, are amended to read:
782	458.348  Formal supervisory relationships, standing orders,
783	and established protocols; notice; standards.-
784	(1)  NOTICE.-
785	(a)  When a physician enters into a formal supervisory
786	relationship or standing orders with an emergency medical
787	technician or paramedic licensed pursuant to s. 401.27, which
788	relationship or orders contemplate the performance of medical
789	acts, or when a physician enters into an established protocol
790	with an advanced registered nurse practitioner, which protocol
791	contemplates the performance of medical acts identified and
792	approved by the joint committee pursuant to s. 464.003(2)(3)(d)
793	or acts set forth in s. 464.012(3) and (4), the physician shall
794	submit notice to the board. The notice shall contain a statement
795	in substantially the following form:
796	I, ...(name and professional license number of
797	physician)..., of ...(address of physician)... have hereby
798	entered into a formal supervisory relationship, standing orders,
799	or an established protocol with ...(number of persons)...
800	emergency medical technician(s), ...(number of persons)...
801	paramedic(s), or ...(number of persons)... advanced registered
802	nurse practitioner(s).
803	(2)  ESTABLISHMENT OF STANDARDS BY JOINT COMMITTEE.-The
804	joint committee created under s. 464.003(2)(3)(d) shall
805	determine minimum standards for the content of established
806	protocols pursuant to which an advanced registered nurse
807	practitioner may perform medical acts identified and approved by
808	the joint committee pursuant to s. 464.003(2)(3)(d) or acts set
809	forth in s. 464.012(3) and (4) and shall determine minimum
810	standards for supervision of such acts by the physician, unless
811	the joint committee determines that any act set forth in s.
812	464.012(3) or (4) is not a medical act. Such standards shall be
813	based on risk to the patient and acceptable standards of medical
814	care and shall take into account the special problems of
815	medically underserved areas. The standards developed by the
816	joint committee shall be adopted as rules by the Board of
817	Nursing and the Board of Medicine for purposes of carrying out
818	their responsibilities pursuant to part I of chapter 464 and
819	this chapter, respectively, but neither board shall have
820	disciplinary powers over the licensees of the other board.
821	Section 8.  Paragraph (a) of subsection (1) of section
822	459.025, Florida Statutes, is amended to read:
823	459.025  Formal supervisory relationships, standing orders,
824	and established protocols; notice; standards.-
825	(1)  NOTICE.-
826	(a)  When an osteopathic physician enters into a formal
827	supervisory relationship or standing orders with an emergency
828	medical technician or paramedic licensed pursuant to s. 401.27,
829	which relationship or orders contemplate the performance of
830	medical acts, or when an osteopathic physician enters into an
831	established protocol with an advanced registered nurse
832	practitioner, which protocol contemplates the performance of
833	medical acts identified and approved by the joint committee
834	pursuant to s. 464.003(2)(3)(d) or acts set forth in s.
835	464.012(3) and (4), the osteopathic physician shall submit
836	notice to the board. The notice must contain a statement in
837	substantially the following form:
838	I, ...(name and professional license number of osteopathic
839	physician)..., of ...(address of osteopathic physician)... have
840	hereby entered into a formal supervisory relationship, standing
841	orders, or an established protocol with ...(number of
842	persons)... emergency medical technician(s), ...(number of
843	persons)... paramedic(s), or ...(number of persons)... advanced
844	registered nurse practitioner(s).
845	Section 9.  Paragraph (c) of subsection (3) of section
846	464.012, Florida Statutes, is amended to read:
847	464.012  Certification of advanced registered nurse
848	practitioners; fees.-
849	(3)  An advanced registered nurse practitioner shall
850	perform those functions authorized in this section within the
851	framework of an established protocol that is filed with the
852	board upon biennial license renewal and within 30 days after
853	entering into a supervisory relationship with a physician or
854	changes to the protocol. The board shall review the protocol to
855	ensure compliance with applicable regulatory standards for
856	protocols. The board shall refer to the department licensees
857	submitting protocols that are not compliant with the regulatory
858	standards for protocols. A practitioner currently licensed under
859	chapter 458, chapter 459, or chapter 466 shall maintain
860	supervision for directing the specific course of medical
861	treatment. Within the established framework, an advanced
862	registered nurse practitioner may:
863	(c)  Perform additional functions as may be determined by
864	rule in accordance with s. 464.003(2)(3)(d).
865	Section 10.  Subsection (2) of section 960.28, Florida
866	Statutes, is amended to read:
867	960.28  Payment for victims' initial forensic physical
868	examinations.-
869	(2)  The Crime Victims' Services Office of the department
870	shall pay for medical expenses connected with an initial
871	forensic physical examination of a victim of sexual battery as
872	defined in chapter 794 or a lewd or lascivious offense as
873	defined in chapter 800. Such payment shall be made regardless of
874	whether the victim is covered by health or disability insurance
875	and whether the victim participates in the criminal justice
876	system or cooperates with law enforcement. The payment shall be
877	made only out of moneys allocated to the Crime Victims' Services
878	Office for the purposes of this section, and the payment may not
879	exceed $500 with respect to any violation. The department shall
880	develop and maintain separate protocols for the initial forensic
881	physical examination of adults and children. Payment under this
882	section is limited to medical expenses connected with the
883	initial forensic physical examination, and payment may be made
884	to a medical provider using an examiner qualified under part I
885	of chapter 464, excluding s. 464.003(16)(5); chapter 458; or
886	chapter 459. Payment made to the medical provider by the
887	department shall be considered by the provider as payment in
888	full for the initial forensic physical examination associated
889	with the collection of evidence. The victim may not be required
890	to pay, directly or indirectly, the cost of an initial forensic
891	physical examination performed in accordance with this section.
892	Section 11.  This act shall take effect July 1, 2010.

CODING: Words stricken are deletions; words underlined are additions.