HB 1853CS

CHAMBER ACTION



1The Education Appropriations Committee recommends the following:
2
3     Council/Committee Substitute
4     Remove the entire bill and insert:
5
A bill to be entitled
6An act relating to increased production of nurses in
7Florida; amending s. 464.019, F.S.; authorizing the Board
8of Nursing to change faculty-to-student ratios only under
9certain circumstances; requiring a study to evaluate rules
10regarding clinical instruction; providing for assistance
11to approved nursing programs to expand capacity; amending
12s. 464.0195, F.S.; requiring the Florida Center for
13Nursing to develop and maintain an information system;
14requiring an implementation plan; creating s. 1004.09,
15F.S.; establishing a contract grant program for increasing
16the capacity of approved nursing programs; requiring the
17Department of Education to establish guidelines and
18procedures; specifying requirements for grant proposals;
19establishing priorities for receipt of grants; providing
20for review, approval, and funding of proposals; requiring
21the State Board of Education to submit a report on
22implementation status; amending s. 1009.66, F.S.; renaming
23the Nursing Student Loan Forgiveness Program and
24transferring administration of the program to the
25Department of Education; revising criteria for receiving
26funds under the program and for repayment of loans;
27requiring that certain nurses employed as faculty in an
28approved nursing program be given priority in receiving
29funds under the program; renaming the Nursing Student Loan
30Forgiveness Trust Fund and transferring administration of
31the trust fund to the Department of Education; authorizing
32the adoption of rules; amending s. 1009.67, F.S.; renaming
33the Nursing Scholarship Program and transferring
34administration of the program to the Department of
35Education; revising criteria for receiving funds under the
36program; revising repayment provisions; requiring the
37adoption of rules; amending s. 215.20, F.S.; conforming
38provisions relating to the trust fund; requiring the
39Department of Education to identify specified examinations
40for earning postsecondary credit for mastery of nursing
41course material; requiring a status report; providing for
42a type two transfer; providing an effective date.
43
44Be It Enacted by the Legislature of the State of Florida:
45
46     Section 1.  Subsection (2) of section 464.019, Florida
47Statutes, is amended, and subsection (8) is added to said
48section, to read:
49     464.019  Approval of nursing programs.--
50     (2)(a)  The board shall adopt rules, applicable to initial
51review and conditional approval of a program, regarding
52educational objectives, faculty qualifications, curriculum
53guidelines, administrative procedures, and clinical training. An
54applicant institution shall comply with such rules in order to
55obtain conditional program approval. No program shall be
56considered fully approved, nor shall any program be exempted
57from such rules, prior to the graduation of the program's first
58class.
59     (b)  The board shall adopt rules regarding educational
60objectives and curriculum guidelines as are necessary to grant
61full approval to a program and to ensure that fully approved
62programs graduate nurses capable of competent practice under
63this part. Rules regarding educational objectives shall consider
64student attrition rate standards, availability of qualified
65faculty, and appropriate clinical training facilities. However,
66the board shall adopt no rule that prohibits a qualified
67institution from placing a student in a facility for clinical
68experience, regardless of whether more than one nursing program
69is using the same facility for clinical experience.
70     (c)  The board shall adopt rules governing probation,
71suspension, and termination status of programs that fail to
72comply with the standards of this part.
73     (d)  The board shall not adopt any rule limiting the number
74of students admitted to a nursing program, provided appropriate
75faculty-to-student ratios are maintained, and provided the board
76shall not enact any changes to faculty-to-student ratios that
77have the effect of limiting capacity in approved nursing
78programs unless such changes are based in scientific research
79prior to 2004.
80     (e)  The board, in conjunction with the Florida Center for
81Nursing, shall conduct a study of research literature to
82evaluate existing rules regarding clinical instruction,
83including an assessment of expanding the use of qualified
84registered nurses as supervisors and simulation as effective
85ways to maximize the opportunities for clinical experiences.
86     (8)  The board shall work with the Department of Health,
87the Department of Education, and the Florida Center for Nursing
88to assist any approved nursing program with increasing capacity
89to produce more nurses to enter the workforce in the state. Such
90assistance may include, but is not limited to:
91     (a)  Facilitating the development of partnerships between
92the program and clinical facilities that maximize the
93opportunities for clinical experiences for the students,
94including the use of clinical personnel in teaching roles.
95     (b)  Identifying strategies for reducing the demands of
96nonclinical requirements on nursing faculty, including
97consolidating core requirements across nursing majors and tracks
98and identifying courses that are taught in other health and
99medical fields that could be jointly offered, taught by non-
100nurse faculty, or substituted for nursing courses.
101     (c)  Developing alternative models of clinical education
102that reduce the burden on nursing faculty, including expanding
103the use of preceptors, providing more clinical instruction as a
104concentrated clinical experience later in the program, and
105increasing the use of simulators.
106     (d)  Providing master's programs at primary health care
107facilities to build faculties of onsite nursing instructors to
108help meet the nursing needs of those facilities.
109     Section 2.  Subsection (4) is added to section 464.0195,
110Florida Statutes, to read:
111     464.0195  Florida Center for Nursing; goals; information
112system.--
113     (4)  The Florida Center for Nursing, in collaboration with
114the Department of Health, the Agency for Health Care
115Administration, the Agency for Workforce Innovation, and the
116Department of Education, and in consultation with the Office of
117Program Policy Analysis and Government Accountability, shall
118develop and maintain an information system to assess the
119workforce needs of the nursing profession in the state. The
120information system shall be designed to enable the center to
121produce reliable, comparable, and comprehensive data on the
122nursing workforce in the state; identify potential nursing
123shortages and the areas in which they may occur; assess the
124productivity of approved nursing programs, especially in
125responding to identified workforce needs; and establish a
126registry to link approved nursing programs that need additional
127clinical sites or faculty to expand their capacity with licensed
128health care providers that may be able to assist in meeting such
129needs. Data to support the information system may be collected
130as part of the initial and renewal licensure process for both
131individuals and health care facilities and as part of the Board
132of Nursing program approval process. No later than November 1,
1332005, the Florida Center for Nursing shall submit to the
134President of the Senate and the Speaker of the House of
135Representatives an implementation plan for the information
136system, including projected cost and recommended rule changes
137that may be required to collect the information necessary for
138the system to be successful.
139     Section 3.  Section 1004.09, Florida Statutes, is created
140to read:
141     1004.09  SUCCEED, Florida ? Crucial Professionals Nursing
142Education Grant Program.--The SUCCEED, Florida ? Crucial
143Professionals Nursing Education Grant Program is established as
144a contract grant program within the Department of Education to
145increase the capacity of nursing programs approved by the Board
146of Nursing at postsecondary educational institutions to produce
147more nurses or nursing faculty to enter the workforce in the
148state. The department shall establish application procedures,
149guidelines, accountability measures, and timelines for
150implementation of the grant program and advise all Board of
151Nursing approved programs accordingly.
152     (1)  Proposals for a grant authorized pursuant to this
153section must:
154     (a)  Indicate the number of students to be served, the
155length of the proposed program, and the projected cost.
156     (b)  Document the workforce need to be addressed through
157the expanded capacity of the existing nursing program.
158     (c)  Demonstrate a pool of qualified applicants to fill the
159expanded capacity.
160     (2)  Funds for a grant provided pursuant to this section
161must be used to support new students and not to supplant current
162funding or students. An institution applying for a grant must
163certify to the department that it will not reduce funding or the
164current level of enrollment in its existing nursing program. Any
165such reduction shall result in a pro rata reduction in the grant
166awarded pursuant to this section.
167     (3)  Priority in the awarding of new grants authorized
168pursuant to this section shall be given to proposals that comply
169with three or more of the following:
170     (a)  Proposals that result in new nurses in the workforce
171or nurses moving to a higher level on the career ladder.
172     (b)  Proposals that could be implemented as early as the
173fall of 2005.
174     (c)  Proposals that include partnerships or collaborations
175with other institutions, programs, or health care providers.
176     (d)  Proposals for programs offered at the worksite or
177through distance learning that permit nurses to achieve a higher
178level of nursing licensure.
179     (e)  Proposals for accelerated programs that shorten the
180time required to receive a diploma, certificate, or degree;
181obtain licensure; and enter the workforce.
182     (f)  Proposals that target exiting military personnel or
183other persons interested in making career changes.
184     (g)  Proposals from nursing programs with demonstrated
185success as evidenced by graduation rates, licensure examination
186passage rates, and placement of graduates in nursing employment
187in the state.
188     (h)  Proposals for programs that would address the state's
189need for rapid production of highly skilled clinical nurses and
190qualified nursing faculty, such as the fast-track baccalaureate
191to doctoral program, the Clinical Nurse Leader Program, and the
192Doctor of Nursing Practice program.
193     (4)  Subsequent to the first year of funding for the grant
194program, priority for awarding grants shall be for renewal
195grants to nursing programs that are making adequate progress
196towards their contracted production.
197     (5)  Grant recipients must enter into a contract between
198the postsecondary educational institution and the state to
199produce a specific number of nursing graduates within a specific
200time period.
201     (6)  Nursing programs receiving grants pursuant to this
202section must submit periodic reports to the department
203documenting compliance with the accountability measures
204established by the department. Award amounts in subsequent years
205shall be tied to student retention; the production of degrees,
206certificates, or diplomas; and the number of graduates placed in
207a nursing position in the state.
208     (7)  Proposals submitted pursuant to this section shall be
209reviewed by the Board of Nursing and the State Board of
210Education. Final approval and level of funding shall be
211determined by the State Board of Education with consideration
212given to comments submitted to the State Board of Education by
213the Board of Nursing.
214     (8)  The State Board of Education shall monitor compliance
215with accountability requirements.
216     (9)  By February 1, 2006, the State Board of Education
217shall submit a report to the President of the Senate and the
218Speaker of the House of Representatives on the status of
219implementation of the grant program.
220     Section 4.  Section 1009.66, Florida Statutes, is amended
221to read:
222     1009.66  Nursing Student Loan Reimbursement Forgiveness
223Program.--
224     (1)  To encourage qualified personnel to seek employment in
225areas of this state in which critical nursing shortages exist,
226there is established the Nursing Student Loan Reimbursement
227Forgiveness Program. The primary function of the program is to
228increase employment and retention of registered nurses and
229licensed practical nurses in nursing homes and hospitals in the
230state and in state-operated medical and health care facilities,
231public schools, birth centers, federally sponsored community
232health centers, family practice teaching hospitals, and
233specialty children's hospitals and the employment and retention
234of instructional faculty in nursing programs approved by the
235Board of Nursing by making repayments toward loans received by
236students from federal or state programs or commercial lending
237institutions for the support of postsecondary study in
238accredited or approved nursing programs or for the support of
239study in a preparatory course for foreign-trained nurses offered
240by an approved nursing program.
241     (2)  To be eligible, a candidate must have graduated from
242an accredited or approved nursing program or have successfully
243completed a preparatory course for foreign-trained nurses
244offered by an approved nursing program and have received a
245Florida license as a licensed practical nurse or a registered
246nurse or a Florida certificate as an advanced registered nurse
247practitioner.
248     (3)  Only loans to pay the costs of tuition, books, and
249living expenses shall be covered, at an amount not to exceed
250$4,000 for each year of education toward the degree obtained.
251     (4)  From the funds available, the Department of Education
252Health may make loan principal repayments of up to $4,000 a year
253for up to 4 years on behalf of eligible candidates pursuant to
254subsection (2) selected graduates of an accredited or approved
255nursing program. All repayments shall be contingent upon
256continued proof of employment in the designated facilities in
257this state and shall be made directly to the holder of the loan
258or the lending institution for loans held by a lending
259institution. The state shall bear no responsibility for the
260collection of any interest charges or other remaining balance.
261In the event that the designated facilities are changed, a nurse
262shall continue to be eligible for loan reimbursement forgiveness
263as long as he or she continues to work in the facility for which
264the original loan repayment was made and otherwise meets all
265conditions of eligibility.
266     (5)  There is created the Nursing Student Loan
267Reimbursement Forgiveness Trust Fund to be administered by the
268Department of Education Health pursuant to this section and s.
2691009.67 and department rules. The Chief Financial Officer shall
270authorize expenditures from the trust fund upon receipt of
271vouchers approved by the Department of Education Health. All
272moneys collected from the private health care industry and other
273private sources for the purposes of this section shall be
274deposited into the Nursing Student Loan Reimbursement
275Forgiveness Trust Fund. Any balance in the trust fund at the end
276of any fiscal year shall remain therein and shall be available
277for carrying out the purposes of this section and s. 1009.67.
278     (6)  In addition to licensing fees imposed under part I of
279chapter 464, there is hereby levied and imposed an additional
280fee of $5, which fee shall be paid upon licensure or renewal of
281nursing licensure. Revenues collected from the fee imposed in
282this subsection shall be deposited in the Nursing Student Loan
283Reimbursement Forgiveness Trust Fund of the Department of
284Education Health and will be used solely for the purpose of
285carrying out the provisions of this section and s. 1009.67. Up
286to 50 percent of the revenues appropriated to implement this
287subsection may be used for the nursing scholarship loan program
288established pursuant to s. 1009.67.
289     (7)  Funds contained in the Nursing Student Loan
290Reimbursement Forgiveness Trust Fund which are to be used for
291loan reimbursement forgiveness for those nurses employed by
292hospitals, birth centers, and nursing homes and for those nurses
293employed as instructional faculty in an approved nursing program
294must be matched on a dollar-for-dollar basis by contributions or
295tuition reductions from the employing institutions, except that
296this provision shall not apply to state-operated medical and
297health care facilities, community colleges, state universities,
298public schools, county health departments, federally sponsored
299community health centers, teaching hospitals as defined in s.
300408.07, family practice teaching hospitals as defined in s.
301395.805, or specialty hospitals for children as used in s.
302409.9119. An estimate of the annual trust fund dollars shall be
303made at the beginning of the fiscal year based on historic
304expenditures from the trust fund. Applicant requests shall be
305reviewed on a quarterly basis, and applicant awards shall be
306based on the following priority of employer until all such
307estimated trust funds are awarded: nursing programs approved by
308the Board of Nursing if the employer and the award recipient
309agree that the award recipient will spend a minimum of 75
310percent of his or her time providing instruction, developing
311curriculum, or advising or mentoring students for the duration
312of the award; state-operated medical and health care facilities;
313public schools; county health departments; federally sponsored
314community health centers; teaching hospitals as defined in s.
315408.07; family practice teaching hospitals as defined in s.
316395.805; specialty hospitals for children as used in s.
317409.9119; and other hospitals, birth centers, and nursing homes.
318     (8)  The Department of Health may solicit technical
319assistance relating to the conduct of this program from the
320Department of Education.
321     (8)(9)  The Department of Education Health is authorized to
322recover from the Nursing Student Loan Reimbursement Forgiveness
323Trust Fund its costs for administering the Nursing Student Loan
324Reimbursement Forgiveness Program.
325     (9)(10)  The State Board of Education Department of Health
326may adopt rules necessary to administer this program.
327     (10)(11)  This section shall be implemented only as
328specifically funded.
329     (11)(12)  Students receiving a nursing scholarship loan
330pursuant to s. 1009.67 are not eligible to participate in the
331Nursing Student Loan Reimbursement Forgiveness Program.
332     Section 5.  Section 1009.67, Florida Statutes, is amended
333to read:
334     1009.67  Nursing Scholarship Loan Program.--
335     (1)  There is established within the Department of
336Education Health a scholarship loan program for the purpose of
337attracting capable and promising students to the nursing
338profession.
339     (2)  A scholarship loan applicant shall be enrolled in an
340approved nursing program leading to the award of an associate
341degree, a baccalaureate degree, or a graduate degree in nursing
342or enrolled in a preparatory course for foreign-trained nurses
343offered by an approved nursing program.
344     (3)  A scholarship loan may be awarded for no more than 2
345years, in an amount not to exceed $8,000 per year. However,
346registered nurses pursuing a graduate degree for a faculty
347position or to practice as an advanced registered nurse
348practitioner may receive up to $12,000 per year. These amounts
349shall be adjusted by the amount of increase or decrease in the
350consumer price index for urban consumers published by the United
351States Department of Commerce.
352     (4)  Credit for repayment of a scholarship loan shall be as
353follows:
354     (a)  For each full year of scholarship loan assistance, the
355recipient agrees to work for 12 months in a faculty position in
356a college of nursing or community college nursing program in
357this state and spend a minimum of 75 percent of his or her time
358providing instruction, developing curriculum, or advising or
359mentoring students or agrees to work for 12 months at a health
360care facility in a medically underserved area as approved by the
361Department of Health. Scholarship loan recipients who attend
362school on a part-time basis shall have their employment service
363obligation prorated in proportion to the amount of scholarship
364loan payments received.
365     (b)  Eligible health care facilities include nursing homes
366and hospitals in this state, state-operated medical or health
367care facilities, public schools, county health departments,
368federally sponsored community health centers, colleges of
369nursing in universities in this state, and community college
370nursing programs in this state, family practice teaching
371hospitals as defined in s. 395.805, or specialty children's
372hospitals as described in s. 409.9119. The recipient shall be
373encouraged to complete the service obligation at a single
374employment site. If continuous employment at the same site is
375not feasible, the recipient may apply to the department for a
376transfer to another approved health care facility.
377     (c)  Any recipient who does not complete an appropriate
378program of studies, who does not become licensed, who does not
379accept employment as a nurse at an approved health care
380facility, or who does not complete 12 months of approved
381employment for each year of scholarship loan assistance received
382shall repay to the Department of Education Health, on a schedule
383to be determined by the department, the entire amount of the
384scholarship loan plus 18 percent interest accruing from the date
385of the scholarship payment. Repayment schedules and applicable
386interest rates shall be determined by rules of the State Board
387of Education. Moneys repaid shall be deposited into the Nursing
388Student Loan Reimbursement Forgiveness Trust Fund established in
389s. 1009.66. However, the department may provide additional time
390for repayment if the department finds that circumstances beyond
391the control of the recipient caused or contributed to the
392default.
393     (5)  Scholarship loan payments shall be transmitted to the
394recipient upon receipt of documentation that the recipient is
395enrolled in an approved nursing program. The Department of
396Education Health shall develop a formula to prorate payments to
397scholarship loan recipients so as not to exceed the maximum
398amount per academic year.
399     (6)  The State Board of Education Department of Health
400shall adopt rules, including rules to address extraordinary
401circumstances that may cause a recipient to default on either
402the school enrollment or employment contractual agreement, to
403implement this section.
404     (7)  The Department of Education Health may recover from
405the Nursing Student Loan Reimbursement Forgiveness Trust Fund
406its costs for administering the nursing scholarship loan
407program.
408     Section 6.  Paragraphs (h) and (l) of subsection (4) of
409section 215.20, Florida Statutes, are amended to read:
410     215.20  Certain income and certain trust funds to
411contribute to the General Revenue Fund.--
412     (4)  The income of a revenue nature deposited in the
413following described trust funds, by whatever name designated, is
414that from which the appropriations authorized by subsection (3)
415shall be made:
416     (h)  Within the Department of Education:
417     1.  The Educational Certification and Service Trust Fund.
418     2.  The Phosphate Research Trust Fund.
419     3.  The Nursing Student Loan Reimbursement Trust Fund.
420     (l)  Within the Department of Health:
421     1.  The Administrative Trust Fund.
422     2.  The Brain and Spinal Cord Injury Program Trust Fund.
423     3.  The Donations Trust Fund.
424     4.  The Emergency Medical Services Trust Fund.
425     5.  The Epilepsy Services Trust Fund.
426     6.  The Florida Drug, Device, and Cosmetic Trust Fund.
427     7.  The Grants and Donations Trust Fund.
428     8.  The Medical Quality Assurance Trust Fund.
429     9.  The Nursing Student Loan Forgiveness Trust Fund.
430     9.10.  The Planning and Evaluation Trust Fund.
431     10.11.  The Radiation Protection Trust Fund.
432
433The enumeration of the foregoing moneys or trust funds shall not
434prohibit the applicability thereto of s. 215.24 should the
435Governor determine that for the reasons mentioned in s. 215.24
436the money or trust funds should be exempt herefrom, as it is the
437purpose of this law to exempt income from its force and effect
438when, by the operation of this law, federal matching funds or
439contributions or private grants to any trust fund would be lost
440to the state.
441     Section 7.  By July 1, 2006, the Department of Education,
442with input from public and private postsecondary educational
443institutions, shall identify national standardized or licensure
444examinations by which secondary and postsecondary students may
445demonstrate mastery of postsecondary nursing course material and
446earn postsecondary credit for such courses. The examinations and
447corresponding minimum scores required for an award of credit
448shall be delineated by the State Board of Education in the
449statewide articulation agreement. The delineation of such
450examinations shall not preclude community colleges and
451universities from awarding credit by examination based on
452student performance on examinations developed within and
453recognized by the individual postsecondary educational
454institutions. By February 1, 2006, the Department of Education
455shall provide a status report on implementation of this section
456to the Governor, the President of the Senate, and the Speaker of
457the House of Representatives.
458     Section 8.  All statutory powers, duties, functions,
459records, positions, property, and unexpended balances of
460appropriations, allocations, or other funds of the Department of
461Health relating to the Nursing Student Loan Reimbursement
462Program and the Nursing Student Loan Reimbursement Trust Fund as
463created in s. 1009.66, Florida Statutes, and the Nursing
464Scholarship Loan Program as created in s. 1009.67, Florida
465Statutes, are transferred by a type two transfer as provided for
466in s. 20.06(2), Florida Statutes, from the Department of Health
467to the Department of Education.
468     Section 9.  This act shall take effect July 1, 2005.


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