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 program’s 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 program’s 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 program’s 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 board’s
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:
54 464.008 Licensure 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:
95 464.019 Approval 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 institution’s 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 program’s
109 faculty members are registered nurses who have a master’s or
110 higher degree in nursing or a bachelor’s degree in nursing and a
111 master’s 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 program’s faculty
114 members are registered nurses who have a bachelor’s 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 program’s 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 bachelor’s degree professional nursing
133 education program.
134 (c) No more than 50 percent of the program’s 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 program’s 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 department’s
241 receipt of the application. A program application is deemed
242 complete upon the department’s 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 department’s receipt of a complete
250 program application, the board may conduct an onsite evaluation
251 if necessary to document the applicant’s compliance with
252 subsection (1). Within 90 days after the department’s 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 board’s denial of the application. The board may
260 not deny a program application because of an educational
261 institution’s 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 board’s 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 program’s authorization to operate.
282 (3) ANNUAL REPORT.—By November 1 of each year, each
283 approved program’s 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 program’s 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 program’s retention rates for students tracked from
294 program entry to graduation.
295 (c) The program’s 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 program’s 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 program’s 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 program’s 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 program’s compliance
323 submitted under subsection (3).
324 3. The program’s accreditation status, including
325 identification of the accrediting agency.
326 4. The program’s probationary status.
327 5. The program’s graduate passage rates for the most recent
328 2 calendar years.
329 6. Each program’s 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 bachelor’s 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 program’s 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 program’s 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 program’s graduate passage rate by the National Council
389 of State Boards of Nursing, shall remove the program’s
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 program’s 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 board’s 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 program’s students and applicants. The notification must include
415 an explanation of the implications of the program’s 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 program’s 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 program’s 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 board’s 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.