HB 1853

1
A bill to be entitled
2An act relating to increased production of nurses in
3Florida; amending s. 464.019, F.S.; authorizing the Board
4of Nursing to change faculty-to-student ratios only under
5certain circumstances; requiring a study to evaluate rules
6regarding clinical instruction; providing for assistance
7to approved nursing programs to expand capacity; amending
8s. 464.0195, F.S.; requiring the Florida Center for
9Nursing to develop and maintain an information system;
10requiring an implementation plan; creating s. 1004.09,
11F.S.; establishing a contract grant program for increasing
12the capacity of approved nursing programs; requiring the
13Department of Education to establish guidelines and
14procedures; specifying requirements for grant proposals;
15establishing priorities for receipt of grants; providing
16for review, approval, and funding of proposals; requiring
17the State Board of Education to submit a report on
18implementation status; amending s. 1009.66, F.S.; renaming
19the Nursing Student Loan Forgiveness Program and
20transferring administration of the program to the
21Department of Education; revising criteria for receiving
22funds under the program and for repayment of loans;
23requiring that certain nurses employed as faculty in an
24approved nursing program be given priority in receiving
25funds under the program; renaming the Nursing Student Loan
26Forgiveness Trust Fund and transferring administration of
27the trust fund to the Department of Education; authorizing
28the adoption of rules; amending s. 1009.67, F.S.; renaming
29the Nursing Scholarship Program and transferring
30administration of the program to the Department of
31Education; revising criteria for receiving funds under the
32program; revising repayment provisions; requiring the
33adoption of rules; amending s. 215.20, F.S.; conforming
34provisions relating to the trust fund; requiring the
35Department of Education to identify specified examinations
36for earning postsecondary credit for mastery of nursing
37course material; requiring a status report; providing for
38a type two transfer; providing an effective date.
39
40Be It Enacted by the Legislature of the State of Florida:
41
42     Section 1.  Subsection (2) of section 464.019, Florida
43Statutes, is amended, and subsection (8) is added to said
44section, to read:
45     464.019  Approval of nursing programs.--
46     (2)(a)  The board shall adopt rules, applicable to initial
47review and conditional approval of a program, regarding
48educational objectives, faculty qualifications, curriculum
49guidelines, administrative procedures, and clinical training. An
50applicant institution shall comply with such rules in order to
51obtain conditional program approval. No program shall be
52considered fully approved, nor shall any program be exempted
53from such rules, prior to the graduation of the program's first
54class.
55     (b)  The board shall adopt rules regarding educational
56objectives and curriculum guidelines as are necessary to grant
57full approval to a program and to ensure that fully approved
58programs graduate nurses capable of competent practice under
59this part. Rules regarding educational objectives shall consider
60student attrition rate standards, availability of qualified
61faculty, and appropriate clinical training facilities. However,
62the board shall adopt no rule that prohibits a qualified
63institution from placing a student in a facility for clinical
64experience, regardless of whether more than one nursing program
65is using the same facility for clinical experience.
66     (c)  The board shall adopt rules governing probation,
67suspension, and termination status of programs that fail to
68comply with the standards of this part.
69     (d)  The board shall not adopt any rule limiting the number
70of students admitted to a nursing program, provided appropriate
71faculty-to-student ratios are maintained, and provided the board
72shall not enact any changes to faculty-to-student ratios that
73have the effect of limiting capacity in approved nursing
74programs unless such changes are based in scientific research
75prior to 2004.
76     (e)  The board, in conjunction with the Florida Center for
77Nursing, shall conduct a study of research literature to
78evaluate existing rules regarding clinical instruction,
79including an assessment of expanding the use of qualified
80registered nurses as supervisors and simulation as effective
81ways to maximize the opportunities for clinical experiences.
82     (8)  The board shall work with the Department of Health,
83the Department of Education, and the Florida Center for Nursing
84to assist any approved nursing program with increasing capacity
85to produce more nurses to enter the workforce in the state. Such
86assistance may include, but is not limited to:
87     (a)  Facilitating the development of partnerships between
88the program and clinical facilities that maximize the
89opportunities for clinical experiences for the students,
90including the use of clinical personnel in teaching roles.
91     (b)  Identifying strategies for reducing the demands of
92nonclinical requirements on nursing faculty, including
93consolidating core requirements across nursing majors and tracks
94and identifying courses that are taught in other health and
95medical fields that could be jointly offered, taught by non-
96nurse faculty, or substituted for nursing courses.
97     (c)  Developing alternative models of clinical education
98that reduce the burden on nursing faculty, including expanding
99the use of preceptors, providing more clinical instruction as a
100concentrated clinical experience later in the program, and
101increasing the use of simulators.
102     (d)  Providing master's programs at primary health care
103facilities to build faculties of onsite nursing instructors to
104help meet the nursing needs of those facilities.
105     Section 2.  Subsection (4) is added to section 464.0195,
106Florida Statutes, to read:
107     464.0195  Florida Center for Nursing; goals; information
108system.--
109     (4)  The Florida Center for Nursing, in collaboration with
110the Department of Health, the Agency for Health Care
111Administration, the Agency for Workforce Innovation, and the
112Department of Education, and in consultation with the Office of
113Program Policy Analysis and Government Accountability, shall
114develop and maintain an information system to assess the
115workforce needs of the nursing profession in the state. The
116information system shall be designed to enable the center to
117produce reliable, comparable, and comprehensive data on the
118nursing workforce in the state; identify potential nursing
119shortages and the areas in which they may occur; assess the
120productivity of approved nursing programs, especially in
121responding to identified workforce needs; and establish a
122registry to link approved nursing programs that need additional
123clinical sites or faculty to expand their capacity with licensed
124health care providers that may be able to assist in meeting such
125needs. Data to support the information system may be collected
126as part of the initial and renewal licensure process for both
127individuals and health care facilities and as part of the Board
128of Nursing program approval process. No later than November 1,
1292005, the Florida Center for Nursing shall submit to the
130President of the Senate and the Speaker of the House of
131Representatives an implementation plan for the information
132system, including projected cost and recommended rule changes
133that may be required to collect the information necessary for
134the system to be successful.
135     Section 3.  Section 1004.09, Florida Statutes, is created
136to read:
137     1004.09  Nursing education grant program.--The Department
138of Education shall establish a contract grant program for
139increasing the capacity of nursing programs approved by the
140Board of Nursing at postsecondary educational institutions to
141produce more nurses or nursing faculty to enter the workforce in
142the state. The department shall establish application
143procedures, guidelines, accountability measures, and timelines
144for implementation of the grant program and advise all Board of
145Nursing approved programs accordingly.
146     (1)  Proposals for a grant authorized pursuant to this
147section must:
148     (a)  Indicate the number of students to be served, the
149length of the proposed program, and the projected cost.
150     (b)  Document the workforce need to be addressed through
151the expanded capacity of the existing nursing program.
152     (c)  Demonstrate a pool of qualified applicants to fill the
153expanded capacity.
154     (2)  Funds for a grant provided pursuant to this section
155must be used to support new students and not to supplant current
156funding or students. An institution applying for a grant must
157certify to the department that it will not reduce funding or the
158current level of enrollment in its existing nursing program. Any
159such reduction shall result in a pro rata reduction in the grant
160awarded pursuant to this section.
161     (3)  Priority in the awarding of new grants authorized
162pursuant to this section shall be given to proposals that comply
163with three or more of the following:
164     (a)  Proposals that result in new nurses in the workforce
165or nurses moving to a higher level on the career ladder.
166     (b)  Proposals that could be implemented as early as the
167fall of 2005.
168     (c)  Proposals that include partnerships or collaborations
169with other institutions, programs, or health care providers.
170     (d)  Proposals for programs offered at the worksite or
171through distance learning that permit nurses to achieve a higher
172level of nursing licensure.
173     (e)  Proposals for accelerated programs that shorten the
174time required to receive a diploma, certificate, or degree;
175obtain licensure; and enter the workforce.
176     (f)  Proposals that target exiting military personnel or
177other persons interested in making career changes.
178     (g)  Proposals from nursing programs with demonstrated
179success as evidenced by graduation rates, licensure examination
180passage rates, and placement of graduates in nursing employment
181in the state.
182     (h)  Proposals for programs that would address the state's
183need for rapid production of highly skilled clinical nurses and
184qualified nursing faculty, such as the fast-track baccalaureate
185to doctoral program, the Clinical Nurse Leader Program, and the
186Doctor of Nursing Practice program.
187     (4)  Subsequent to the first year of funding for the grant
188program, priority for awarding grants shall be for renewal
189grants to nursing programs that are making adequate progress
190towards their contracted production.
191     (5)  Grant recipients must enter into a contract between
192the postsecondary educational institution and the state to
193produce a specific number of nursing graduates within a specific
194time period.
195     (6)  Nursing programs receiving grants pursuant to this
196section must submit periodic reports to the department
197documenting compliance with the accountability measures
198established by the department. Award amounts in subsequent years
199shall be tied to student retention; the production of degrees,
200certificates, or diplomas; and the number of graduates placed in
201a nursing position in the state.
202     (7)  Proposals submitted pursuant to this section shall be
203reviewed by the Board of Nursing and the State Board of
204Education. Final approval and level of funding shall be
205determined by the State Board of Education with consideration
206given to comments submitted to the State Board of Education by
207the Board of Nursing.
208     (8)  The State Board of Education shall monitor compliance
209with accountability requirements.
210     (9)  By February 1, 2006, the State Board of Education
211shall submit a report to the President of the Senate and the
212Speaker of the House of Representatives on the status of
213implementation of the grant program.
214     Section 4.  Section 1009.66, Florida Statutes, is amended
215to read:
216     1009.66  Nursing Student Loan Reimbursement Forgiveness
217Program.--
218     (1)  To encourage qualified personnel to seek employment in
219areas of this state in which critical nursing shortages exist,
220there is established the Nursing Student Loan Reimbursement
221Forgiveness Program. The primary function of the program is to
222increase employment and retention of registered nurses and
223licensed practical nurses in nursing homes and hospitals in the
224state and in state-operated medical and health care facilities,
225public schools, birth centers, federally sponsored community
226health centers, family practice teaching hospitals, and
227specialty children's hospitals and the employment and retention
228of instructional faculty in nursing programs approved by the
229Board of Nursing by making repayments toward loans received by
230students from federal or state programs or commercial lending
231institutions for the support of postsecondary study in
232accredited or approved nursing programs or for the support of
233study in a preparatory course for foreign-trained nurses offered
234by an approved nursing program.
235     (2)  To be eligible, a candidate must have graduated from
236an accredited or approved nursing program or have successfully
237completed a preparatory course for foreign-trained nurses
238offered by an approved nursing program and have received a
239Florida license as a licensed practical nurse or a registered
240nurse or a Florida certificate as an advanced registered nurse
241practitioner.
242     (3)  Only loans to pay the costs of tuition, books, and
243living expenses shall be covered, at an amount not to exceed
244$4,000 for each year of education toward the degree obtained.
245     (4)  From the funds available, the Department of Education
246Health may make loan principal repayments of up to $4,000 a year
247for up to 4 years on behalf of eligible candidates pursuant to
248subsection (2) selected graduates of an accredited or approved
249nursing program. All repayments shall be contingent upon
250continued proof of employment in the designated facilities in
251this state and shall be made directly to the holder of the loan
252or the lending institution for loans held by a lending
253institution. The state shall bear no responsibility for the
254collection of any interest charges or other remaining balance.
255In the event that the designated facilities are changed, a nurse
256shall continue to be eligible for loan reimbursement forgiveness
257as long as he or she continues to work in the facility for which
258the original loan repayment was made and otherwise meets all
259conditions of eligibility.
260     (5)  There is created the Nursing Student Loan
261Reimbursement Forgiveness Trust Fund to be administered by the
262Department of Education Health pursuant to this section and s.
2631009.67 and department rules. The Chief Financial Officer shall
264authorize expenditures from the trust fund upon receipt of
265vouchers approved by the Department of Education Health. All
266moneys collected from the private health care industry and other
267private sources for the purposes of this section shall be
268deposited into the Nursing Student Loan Reimbursement
269Forgiveness Trust Fund. Any balance in the trust fund at the end
270of any fiscal year shall remain therein and shall be available
271for carrying out the purposes of this section and s. 1009.67.
272     (6)  In addition to licensing fees imposed under part I of
273chapter 464, there is hereby levied and imposed an additional
274fee of $5, which fee shall be paid upon licensure or renewal of
275nursing licensure. Revenues collected from the fee imposed in
276this subsection shall be deposited in the Nursing Student Loan
277Reimbursement Forgiveness Trust Fund of the Department of
278Education Health and will be used solely for the purpose of
279carrying out the provisions of this section and s. 1009.67. Up
280to 50 percent of the revenues appropriated to implement this
281subsection may be used for the nursing scholarship loan program
282established pursuant to s. 1009.67.
283     (7)  Funds contained in the Nursing Student Loan
284Reimbursement Forgiveness Trust Fund which are to be used for
285loan reimbursement forgiveness for those nurses employed by
286hospitals, birth centers, and nursing homes and for those nurses
287employed as instructional faculty in an approved nursing program
288must be matched on a dollar-for-dollar basis by contributions or
289tuition reductions from the employing institutions, except that
290this provision shall not apply to state-operated medical and
291health care facilities, community colleges, state universities,
292public schools, county health departments, federally sponsored
293community health centers, teaching hospitals as defined in s.
294408.07, family practice teaching hospitals as defined in s.
295395.805, or specialty hospitals for children as used in s.
296409.9119. An estimate of the annual trust fund dollars shall be
297made at the beginning of the fiscal year based on historic
298expenditures from the trust fund. Applicant requests shall be
299reviewed on a quarterly basis, and applicant awards shall be
300based on the following priority of employer until all such
301estimated trust funds are awarded: nursing programs approved by
302the Board of Nursing if the employer and the award recipient
303agree that the award recipient will spend a minimum of 75
304percent of his or her time providing instruction, developing
305curriculum, or advising or mentoring students for the duration
306of the award; state-operated medical and health care facilities;
307public schools; county health departments; federally sponsored
308community health centers; teaching hospitals as defined in s.
309408.07; family practice teaching hospitals as defined in s.
310395.805; specialty hospitals for children as used in s.
311409.9119; and other hospitals, birth centers, and nursing homes.
312     (8)  The Department of Health may solicit technical
313assistance relating to the conduct of this program from the
314Department of Education.
315     (8)(9)  The Department of Education Health is authorized to
316recover from the Nursing Student Loan Reimbursement Forgiveness
317Trust Fund its costs for administering the Nursing Student Loan
318Reimbursement Forgiveness Program.
319     (9)(10)  The State Board of Education Department of Health
320may adopt rules necessary to administer this program.
321     (10)(11)  This section shall be implemented only as
322specifically funded.
323     (11)(12)  Students receiving a nursing scholarship loan
324pursuant to s. 1009.67 are not eligible to participate in the
325Nursing Student Loan Reimbursement Forgiveness Program.
326     Section 5.  Section 1009.67, Florida Statutes, is amended
327to read:
328     1009.67  Nursing Scholarship Loan Program.--
329     (1)  There is established within the Department of
330Education Health a scholarship loan program for the purpose of
331attracting capable and promising students to the nursing
332profession.
333     (2)  A scholarship loan applicant shall be enrolled in an
334approved nursing program leading to the award of an associate
335degree, a baccalaureate degree, or a graduate degree in nursing
336or enrolled in a preparatory course for foreign-trained nurses
337offered by an approved nursing program.
338     (3)  A scholarship loan may be awarded for no more than 2
339years, in an amount not to exceed $8,000 per year. However,
340registered nurses pursuing a graduate degree for a faculty
341position or to practice as an advanced registered nurse
342practitioner may receive up to $12,000 per year. These amounts
343shall be adjusted by the amount of increase or decrease in the
344consumer price index for urban consumers published by the United
345States Department of Commerce.
346     (4)  Credit for repayment of a scholarship loan shall be as
347follows:
348     (a)  For each full year of scholarship loan assistance, the
349recipient agrees to work for 12 months in a faculty position in
350a college of nursing or community college nursing program in
351this state and spend a minimum of 75 percent of his or her time
352providing instruction, developing curriculum, or advising or
353mentoring students or agrees to work for 12 months at a health
354care facility in a medically underserved area as approved by the
355Department of Health. Scholarship loan recipients who attend
356school on a part-time basis shall have their employment service
357obligation prorated in proportion to the amount of scholarship
358loan payments received.
359     (b)  Eligible health care facilities include nursing homes
360and hospitals in this state, state-operated medical or health
361care facilities, public schools, county health departments,
362federally sponsored community health centers, colleges of
363nursing in universities in this state, and community college
364nursing programs in this state, family practice teaching
365hospitals as defined in s. 395.805, or specialty children's
366hospitals as described in s. 409.9119. The recipient shall be
367encouraged to complete the service obligation at a single
368employment site. If continuous employment at the same site is
369not feasible, the recipient may apply to the department for a
370transfer to another approved health care facility.
371     (c)  Any recipient who does not complete an appropriate
372program of studies, who does not become licensed, who does not
373accept employment as a nurse at an approved health care
374facility, or who does not complete 12 months of approved
375employment for each year of scholarship loan assistance received
376shall repay to the Department of Education Health, on a schedule
377to be determined by the department, the entire amount of the
378scholarship loan plus 18 percent interest accruing from the date
379of the scholarship payment. Repayment schedules and applicable
380interest rates shall be determined by rules of the State Board
381of Education. Moneys repaid shall be deposited into the Nursing
382Student Loan Reimbursement Forgiveness Trust Fund established in
383s. 1009.66. However, the department may provide additional time
384for repayment if the department finds that circumstances beyond
385the control of the recipient caused or contributed to the
386default.
387     (5)  Scholarship loan payments shall be transmitted to the
388recipient upon receipt of documentation that the recipient is
389enrolled in an approved nursing program. The Department of
390Education Health shall develop a formula to prorate payments to
391scholarship loan recipients so as not to exceed the maximum
392amount per academic year.
393     (6)  The State Board of Education Department of Health
394shall adopt rules, including rules to address extraordinary
395circumstances that may cause a recipient to default on either
396the school enrollment or employment contractual agreement, to
397implement this section.
398     (7)  The Department of Education Health may recover from
399the Nursing Student Loan Reimbursement Forgiveness Trust Fund
400its costs for administering the nursing scholarship loan
401program.
402     Section 6.  Paragraphs (h) and (l) of subsection (4) of
403section 215.20, Florida Statutes, are amended to read:
404     215.20  Certain income and certain trust funds to
405contribute to the General Revenue Fund.--
406     (4)  The income of a revenue nature deposited in the
407following described trust funds, by whatever name designated, is
408that from which the appropriations authorized by subsection (3)
409shall be made:
410     (h)  Within the Department of Education:
411     1.  The Educational Certification and Service Trust Fund.
412     2.  The Phosphate Research Trust Fund.
413     3.  The Nursing Student Loan Reimbursement Trust Fund.
414     (l)  Within the Department of Health:
415     1.  The Administrative Trust Fund.
416     2.  The Brain and Spinal Cord Injury Program Trust Fund.
417     3.  The Donations Trust Fund.
418     4.  The Emergency Medical Services Trust Fund.
419     5.  The Epilepsy Services Trust Fund.
420     6.  The Florida Drug, Device, and Cosmetic Trust Fund.
421     7.  The Grants and Donations Trust Fund.
422     8.  The Medical Quality Assurance Trust Fund.
423     9.  The Nursing Student Loan Forgiveness Trust Fund.
424     9.10.  The Planning and Evaluation Trust Fund.
425     10.11.  The Radiation Protection Trust Fund.
426
427The enumeration of the foregoing moneys or trust funds shall not
428prohibit the applicability thereto of s. 215.24 should the
429Governor determine that for the reasons mentioned in s. 215.24
430the money or trust funds should be exempt herefrom, as it is the
431purpose of this law to exempt income from its force and effect
432when, by the operation of this law, federal matching funds or
433contributions or private grants to any trust fund would be lost
434to the state.
435     Section 7.  By July 1, 2006, the Department of Education,
436with input from public and private postsecondary educational
437institutions, shall identify national standardized or licensure
438examinations by which secondary and postsecondary students may
439demonstrate mastery of postsecondary nursing course material and
440earn postsecondary credit for such courses. The examinations and
441corresponding minimum scores required for an award of credit
442shall be delineated by the State Board of Education in the
443statewide articulation agreement. The delineation of such
444examinations shall not preclude community colleges and
445universities from awarding credit by examination based on
446student performance on examinations developed within and
447recognized by the individual postsecondary educational
448institutions. By February 1, 2006, the Department of Education
449shall provide a status report on implementation of this section
450to the Governor, the President of the Senate, and the Speaker of
451the House of Representatives.
452     Section 8.  All statutory powers, duties, functions,
453records, positions, property, and unexpended balances of
454appropriations, allocations, or other funds of the Department of
455Health relating to the Nursing Student Loan Reimbursement
456Program and the Nursing Student Loan Reimbursement Trust Fund as
457created in s. 1009.66, Florida Statutes, and the Nursing
458Scholarship Loan Program as created in s. 1009.67, Florida
459Statutes, are transferred by a type two transfer as provided for
460in s. 20.06(2), Florida Statutes, from the Department of Health
461to the Department of Education.
462     Section 9.  This act shall take effect July 1, 2005.


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