Florida Senate - 2024                                    SB 1118
       
       
        
       By Senator Harrell
       
       
       
       
       
       31-00960A-24                                          20241118__
    1                        A bill to be entitled                      
    2         An act relating to nursing education programs;
    3         amending s. 464.019, F.S.; revising application
    4         requirements for nursing education program approval;
    5         requiring the Board of Nursing to deny an application
    6         under certain circumstances; authorizing the board to
    7         revoke a program’s approval under certain
    8         circumstances; revising requirements for annual
    9         reports approved programs are required to submit to
   10         the board; providing for the revocation of a program’s
   11         approval, and discipline of its program director,
   12         under certain circumstances; revising remediation
   13         procedures for approved programs with graduate passage
   14         rates that do not meet specified requirements;
   15         subjecting program directors of approved programs to
   16         specified disciplinary action under certain
   17         circumstances; deleting a provision authorizing the
   18         board to extend a program’s probationary status;
   19         authorizing agents of the Department of Health to
   20         conduct onsite evaluations and inspections of approved
   21         and accredited nursing education programs; authorizing
   22         the department to collect evidence as part of such
   23         evaluations and inspections; deeming failure or
   24         refusal of a program to allow such evaluation or
   25         inspection as a violation of a legal obligation;
   26         revising rulemaking authority of the board; deleting a
   27         provision authorizing approved nursing education
   28         programs to request an extension to meet the board’s
   29         accreditation requirements; providing an effective
   30         date.
   31          
   32  Be It Enacted by the Legislature of the State of Florida:
   33  
   34         Section 1. Subsections (1), (2), (3), (5), and (8) and
   35  paragraph (f) of subsection (11) of section 464.019, Florida
   36  Statutes, are amended to read:
   37         464.019 Approval of nursing education programs.—
   38         (1) PROGRAM APPLICATION.—An educational institution that
   39  wishes to conduct a program in this state for the prelicensure
   40  education of professional or practical nurses must submit to the
   41  department a program application and review fee of $1,000 for
   42  each prelicensure nursing education program to be offered at the
   43  institution’s main campus, branch campus, or other instructional
   44  site. The program application must include the legal name of the
   45  educational institution, the legal name of the nursing education
   46  program, the legal name of the nursing education program
   47  director, and, if such institution is accredited, the name of
   48  the accrediting agency. The application must also document that:
   49         (a)1. For a professional nursing education program, the
   50  program director and at least 50 percent of the program’s
   51  faculty members are registered nurses who have a master’s or
   52  higher degree in nursing or a bachelor’s degree in nursing and a
   53  master’s or higher degree in a field related to nursing.
   54         2. For a practical nursing education program, the program
   55  director and at least 50 percent of the program’s faculty
   56  members are registered nurses who have a bachelor’s or higher
   57  degree in nursing.
   58  
   59  The educational degree requirements of this paragraph must may
   60  be documented by an official transcript or by a written
   61  statement from the program director of the educational
   62  institution verifying that the institution conferred the degree.
   63  The program director shall certify the official transcript or
   64  written statement as true and accurate.
   65         (b) The program’s nursing major curriculum consists of at
   66  least:
   67         1. Fifty percent clinical training in the United States,
   68  the District of Columbia, or a possession or territory of the
   69  United States for a practical nursing education program, an
   70  associate degree professional nursing education program, or a
   71  professional diploma nursing education program.
   72         2. Forty percent clinical training in the United States,
   73  the District of Columbia, or a possession or territory of the
   74  United States for a bachelor’s degree professional nursing
   75  education program.
   76         (c) No more than 50 percent of the program’s clinical
   77  training consists of clinical simulation.
   78         (d) The program has signed agreements with each agency,
   79  facility, and organization included in the curriculum plan as
   80  clinical training sites and community-based clinical experience
   81  sites.
   82         (e) The program has written policies for faculty which
   83  include provisions for direct or indirect supervision by program
   84  faculty or clinical preceptors for students in clinical training
   85  consistent with the following standards:
   86         1. The number of program faculty members equals at least
   87  one faculty member directly supervising every 12 students unless
   88  the written agreement between the program and the agency,
   89  facility, or organization providing clinical training sites
   90  allows more students, not to exceed 18 students, to be directly
   91  supervised by one program faculty member.
   92         2. For a hospital setting, indirect supervision may occur
   93  only if there is direct supervision by an assigned clinical
   94  preceptor, a supervising program faculty member is available by
   95  telephone, and such arrangement is approved by the clinical
   96  facility.
   97         3. For community-based clinical experiences that involve
   98  student participation in invasive or complex nursing activities,
   99  students must be directly supervised by a program faculty member
  100  or clinical preceptor and such arrangement must be approved by
  101  the community-based clinical facility.
  102         4. For community-based clinical experiences not subject to
  103  subparagraph 3., indirect supervision may occur only when a
  104  supervising program faculty member is available to the student
  105  by telephone.
  106  
  107  A program’s policies established under this paragraph must
  108  require that a clinical preceptor who is supervising students in
  109  a professional nursing education program be a registered nurse
  110  or, if supervising students in a practical nursing education
  111  program, be a registered nurse or licensed practical nurse.
  112         (f) The professional or practical nursing curriculum plan
  113  documents clinical experience and theoretical instruction in
  114  medical, surgical, obstetric, pediatric, and geriatric nursing.
  115  A professional nursing curriculum plan shall also document
  116  clinical experience and theoretical instruction in psychiatric
  117  nursing. Each curriculum plan must document clinical training
  118  experience in appropriate settings that include, but are not
  119  limited to, acute care, long-term care, and community settings.
  120         (g) The professional or practical nursing education program
  121  provides theoretical instruction and clinical application in
  122  personal, family, and community health concepts; nutrition;
  123  human growth and development throughout the life span; body
  124  structure and function; interpersonal relationship skills;
  125  mental health concepts; pharmacology and administration of
  126  medications; and legal aspects of practice. A professional
  127  nursing education program must also provide theoretical
  128  instruction and clinical application in interpersonal
  129  relationships and leadership skills; professional role and
  130  function; and health teaching and counseling skills.
  131         (h)The professional or practical nursing education program
  132  has established evaluation and standardized admission criteria.
  133  The admission criteria must, at a minimum, identify those
  134  students who are likely to need additional educational support
  135  to be successful program graduates. The program shall maintain
  136  documentation of the individualized student academic support
  137  plan for those students identified as in need of additional
  138  preparation and educational support.
  139         (i)The professional or practical nursing education program
  140  has an established comprehensive examination to prepare students
  141  for the National Council of State Boards of Nursing Licensing
  142  Examination (NCLEX). This type of comprehensive examination must
  143  be termed an exit examination that all programs will administer
  144  and may not be the sole exclusion to graduation if the student
  145  has otherwise successfully completed all coursework required by
  146  the program. The program director is responsible for ensuring
  147  that the average exit exam results of the program are placed on
  148  the program’s website and reported to the board along with the
  149  annual report required in subsection (3).
  150         (j)The program shall submit to the board established
  151  criteria for remediation that will be offered to students who do
  152  not successfully pass the exit examination. A program with NCLEX
  153  passage rates at least 10 percentage points below the average
  154  passage rate for the most recent calendar year must offer
  155  remediation at no additional cost or refer the student to an
  156  approved remedial program and pay for that program for the
  157  student.
  158         (2) PROGRAM APPROVAL.—
  159         (a) Upon receipt of a program application and review fee,
  160  the department shall examine the application to determine if it
  161  is complete. If the application is not complete, the department
  162  shall notify the educational institution in writing of any
  163  errors or omissions within 30 days after the department’s
  164  receipt of the application. A program application is deemed
  165  complete upon the department’s receipt of:
  166         1. The initial application, if the department does not
  167  notify the educational institution of any errors or omissions
  168  within the 30-day period; or
  169         2. A revised application that corrects each error and
  170  omission of which the department notifies the educational
  171  institution within the 30-day period.
  172         (b) Following the department’s receipt of a complete
  173  program application, the board may conduct an onsite evaluation
  174  if necessary to document the applicant’s compliance with
  175  subsection (1). Within 90 days after the department’s receipt of
  176  a complete program application, the board shall:
  177         1. Approve the application if it documents compliance with
  178  subsection (1); or
  179         2. Provide the educational institution with a notice of
  180  intent to deny the application if it does not document
  181  compliance with subsection (1). The notice must specify written
  182  reasons for the board’s denial of the application. The board may
  183  not deny a program application because of an educational
  184  institution’s failure to correct an error or omission that the
  185  department failed to provide notice of to the institution within
  186  the 30-day notice period under paragraph (a). The educational
  187  institution may request a hearing on the notice of intent to
  188  deny the program application pursuant to chapter 120.
  189         (c) A program application is deemed approved if the board
  190  does not act within the 90-day review period provided under
  191  paragraph (b).
  192         (d) Upon the board’s approval of a program application, the
  193  program becomes an approved program.
  194         (e)The board shall deny an application from a program that
  195  has had adverse action taken against it by another regulatory
  196  jurisdiction in the United States. The board may also revoke the
  197  approval of an existing approved program that has had adverse
  198  action taken against it by another regulatory jurisdiction in
  199  the United States.
  200         (3) ANNUAL REPORT.—By November 1 of each year, each
  201  approved program’s director program shall submit to the board an
  202  annual report comprised of an affidavit certifying continued
  203  compliance with subsection (1), a summary description of the
  204  program’s compliance with subsection (1), and documentation for
  205  the previous academic year that, to the extent applicable,
  206  describes:
  207         (a) The number of student applications received, qualified
  208  applicants, applicants accepted, accepted applicants who enroll
  209  in the program, students enrolled in the program, and program
  210  graduates.
  211         (b) The program’s retention rates for students tracked from
  212  program entry to graduation.
  213         (c) The program’s accreditation status, including
  214  identification of the accrediting agency.
  215  
  216  The board shall terminate the program pursuant to chapter 120 if
  217  the requirements of this subsection are not met. The program
  218  director is also subject to discipline under s. 456.072(1)(k).
  219         (5) ACCOUNTABILITY.—
  220         (a)1. An approved program must achieve a graduate passage
  221  rate for first-time test takers which is not more than 10
  222  percentage points lower than the average passage rate during the
  223  same calendar year for graduates of comparable degree programs
  224  who are United States educated, first-time test takers on the
  225  National Council of State Boards of Nursing Licensing
  226  Examination, as calculated by the contract testing service of
  227  the National Council of State Boards of Nursing. For purposes of
  228  this subparagraph, an approved program is comparable to all
  229  degree programs of the same program type from among the
  230  following program types:
  231         a. Professional nursing education programs that terminate
  232  in a bachelor’s degree.
  233         b. Professional nursing education programs that terminate
  234  in an associate degree.
  235         c. Professional nursing education programs that terminate
  236  in a diploma.
  237         d. Practical nursing education programs.
  238         2. If an approved program’s graduate passage rates do not
  239  equal or exceed the required passage rates for 1 calendar year 2
  240  consecutive calendar years, the board shall place the program on
  241  probationary status pursuant to chapter 120 and the program
  242  director shall submit a written remediation plan to the board.
  243  The program director shall appear before the board to present
  244  the a plan for remediation, which shall include specific
  245  nationally recognized benchmarks to identify progress toward a
  246  graduate passage rate goal. The board shall terminate a program
  247  pursuant to chapter 120 if the program director fails to submit
  248  a written remediation plan or fails to appear before the board
  249  and present the remediation plan no later than 6 months after
  250  the date of the program being placed on probation. The program’s
  251  director is also subject to discipline under s. 456.072(1)(k)
  252  for such failure. The program must remain on probationary status
  253  until it achieves a graduate passage rate that equals or exceeds
  254  the required passage rate for any 1 calendar year. The board
  255  shall deny a program application for a new prelicensure nursing
  256  education program submitted by an educational institution if the
  257  institution has an existing program that is already on
  258  probationary status.
  259         3. Upon the program’s achievement of a graduate passage
  260  rate that equals or exceeds the required passage rate, the
  261  board, at its next regularly scheduled meeting following release
  262  of the program’s graduate passage rate by the National Council
  263  of State Boards of Nursing, shall remove the program’s
  264  probationary status. If the program, during the 2 calendar year
  265  years following its placement on probationary status, does not
  266  achieve the required passage rate for any 1 calendar year, the
  267  board must may extend the program’s probationary status for 1
  268  additional year, provided the program has demonstrated adequate
  269  progress toward the graduate passage rate goal by meeting a
  270  majority of the benchmarks established in the remediation plan.
  271  If the program is not granted the 1-year extension or fails to
  272  achieve the required passage rate by the end of such extension,
  273  the board shall terminate the program pursuant to chapter 120.
  274         (b) If an approved program fails to submit the annual
  275  report required in subsection (3), the board must shall notify
  276  the program director and president or chief executive officer of
  277  the educational institution in writing within 15 days after the
  278  due date of the annual report. The program director shall appear
  279  before the board at the board’s next regularly scheduled meeting
  280  to explain the reason for the delay. The board shall terminate
  281  the program pursuant to chapter 120 if the program director
  282  fails to appear before the board, as required under this
  283  paragraph, or if the program does not submit the annual report
  284  within 6 months after the due date.
  285         (c) A nursing education program, whether accredited or
  286  nonaccredited, which has been placed on probationary status
  287  shall disclose its probationary status in writing to the
  288  program’s students and applicants. The notification must include
  289  an explanation of the implications of the program’s probationary
  290  status on the students or applicants.
  291         (d) If students from a program that is terminated pursuant
  292  to this subsection transfer to an approved or an accredited
  293  program under the direction of the Commission for Independent
  294  Education, the board must shall recalculate the passage rates of
  295  the programs receiving the transferring students, excluding the
  296  test scores of those students transferring more than 12 credits.
  297         (e)Duly authorized agents or employees of the department
  298  may conduct onsite evaluations or inspections at all reasonable
  299  hours to ensure that approved programs or accredited programs
  300  are in full compliance with this chapter, or to determine
  301  whether this chapter or s. 456.072 is being violated. The
  302  department may collect any necessary evidence needed to ensure
  303  compliance with this chapter or for prosecution as deemed
  304  necessary. A failure of a program to refuse or allow an onsite
  305  evaluation or inspection is deemed as violating a legal
  306  obligation imposed by the board or the department.
  307         (8) RULEMAKING.—The board does not have rulemaking
  308  authority to administer this section, except that the board
  309  shall adopt rules that prescribe the format for submitting
  310  program applications under subsection (1) and annual reports
  311  under subsection (3), to enforce and administer subsection (5),
  312  and to administer the documentation of the accreditation of
  313  nursing education programs under subsection (11). The board may
  314  adopt rules relating to the nursing curriculum, including rules
  315  relating to the uses and limitations of simulation technology,
  316  and rules relating to the criteria to qualify for an extension
  317  of time to meet the accreditation requirements under paragraph
  318  (11)(f). The board may not impose any condition or requirement
  319  on an educational institution submitting a program application,
  320  an approved program, or an accredited program, except as
  321  expressly provided in this section.
  322         (11) ACCREDITATION REQUIRED.—
  323         (f) An approved nursing education program may, no sooner
  324  than 90 days before the deadline for meeting the accreditation
  325  requirements of this subsection, apply to the board for an
  326  extension of the accreditation deadline for a period which does
  327  not exceed 2 years. An additional extension may not be granted.
  328  In order to be eligible for the extension, the approved program
  329  must establish that it has a graduate passage rate of 60 percent
  330  or higher on the National Council of State Boards of Nursing
  331  Licensing Examination for the most recent calendar year and must
  332  meet a majority of the board’s additional criteria, including,
  333  but not limited to, all of the following:
  334         1. A student retention rate of 60 percent or higher for the
  335  most recent calendar year.
  336         2. A graduate work placement rate of 70 percent or higher
  337  for the most recent calendar year.
  338         3. The program has applied for approval or been approved by
  339  an institutional or programmatic accreditor recognized by the
  340  United States Department of Education.
  341         4. The program is in full compliance with subsections (1)
  342  and (3) and paragraph (5)(b).
  343         5. The program is not currently in its second year of
  344  probationary status under subsection (5).
  345  
  346  The applicable deadline under this paragraph is tolled from the
  347  date on which an approved program applies for an extension until
  348  the date on which the board issues a decision on the requested
  349  extension.
  350         Section 2. This act shall take effect July 1, 2024.