Florida Senate - 2014                             CS for SB 1036
       
       
        
       By the Committee on Health Policy; and Senator Grimsley
       
       
       
       
       
       588-02181-14                                          20141036c1
    1                        A bill to be entitled                      
    2         An act relating to nursing education programs;
    3         amending s. 464.003, F.S.; revising definitions;
    4         amending s. 464.013, F.S.; exempting nurses who are
    5         certified by an accredited program from continuing
    6         education requirements; amending s. 464.019, F.S.;
    7         specifying the location of clinical training; revising
    8         the limitation on the percentage of clinical training
    9         that consists of clinical simulation; deleting
   10         obsolete requirements; authorizing the Board of
   11         Nursing to adopt certain rules relating to documenting
   12         the accreditation of nursing education programs;
   13         deleting the requirement that the Office of Program
   14         Policy Analysis and Government Accountability
   15         participate in an implementation study and revising
   16         the terms of the study; requiring nursing education
   17         programs that prepare students for the practice of
   18         professional nursing to be accredited; providing an
   19         exception; amending s. 456.014, F.S.; conforming a
   20         cross-reference; providing an effective date.
   21          
   22  Be It Enacted by the Legislature of the State of Florida:
   23  
   24         Section 1. Subsections (10), (19), and (23) of section
   25  464.003, Florida Statutes, are amended to read:
   26         464.003 Definitions.—As used in this part, the term:
   27         (10) “Clinical training” means direct nursing care
   28  experiences with patients or clients, or clinical simulation of
   29  such experiences, which offer the student the opportunity to
   30  integrate, apply, and refine specific skills and abilities based
   31  on theoretical concepts and scientific principles.
   32         (19) “Practice of practical nursing” means the performance
   33  of selected acts, including the administration of treatments and
   34  medications, in the care of the ill, injured, or infirm; and the
   35  promotion of wellness, maintenance of health, and prevention of
   36  illness of others under the direction of a registered nurse, a
   37  licensed physician, a licensed osteopathic physician, a licensed
   38  podiatric physician, or a licensed dentist; and the teaching of
   39  general principles of health and wellness to the public and to
   40  students other than nursing students. A practical nurse is
   41  responsible and accountable for making decisions that are based
   42  upon the individual’s educational preparation and experience in
   43  nursing.
   44         (23) “Required passage rate” means the graduate passage
   45  rate required for an approved program pursuant to s.
   46  464.019(5)(a) 464.019(6)(a)1.
   47         Section 2. Subsection (3) of section 464.013, Florida
   48  Statutes, is amended to read:
   49         464.013 Renewal of license or certificate.—
   50         (3) The board shall by rule prescribe up to 30 hours of
   51  continuing education not to exceed 30 hours biennially as a
   52  condition for renewal of a license or certificate. A nurse who
   53  is certified by a health care specialty program accredited by
   54  the National Commission for Certifying Agencies or Accreditation
   55  Board for Specialty Nursing Certification is exempt from
   56  continuing education requirements. The criteria for programs
   57  shall be approved by the board.
   58         Section 3. Section 464.019, Florida Statutes, is amended to
   59  read:
   60         464.019 Approval of nursing education programs.—
   61         (1) PROGRAM APPLICATION APPLICATIONS.—An educational
   62  institution that wishes to conduct a program in this state for
   63  the prelicensure education of professional or practical nurses
   64  must submit to the department a program application and review
   65  fee of $1,000 for each prelicensure nursing education program to
   66  be offered at the institution’s main campus, branch campus, or
   67  other instructional site. The Each program application must
   68  include the legal name of the educational institution, the legal
   69  name of the nursing education program, and, if such institution
   70  program is accredited by an accrediting agency other than an
   71  accrediting agency described in s. 464.003(1), the name of the
   72  accrediting agency. The application must also document that:
   73         (a)1. For a professional nursing education program, the
   74  program director and at least 50 percent of the program’s
   75  faculty members are registered nurses who have a master’s or
   76  higher degree in nursing or a bachelor’s degree in nursing and a
   77  master’s or higher degree in a field related to nursing.
   78         2. For a practical nursing education program, the program
   79  director and at least 50 percent of the program’s faculty
   80  members are registered nurses who have a bachelor’s or higher
   81  degree in nursing.
   82  
   83  The educational degree requirements of this paragraph may be
   84  documented by an official transcript or by a written statement
   85  from the educational institution verifying that the institution
   86  conferred the degree.
   87         (b) The program’s nursing major curriculum consists of at
   88  least:
   89         1. Fifty percent clinical training at a health care
   90  facility in the United States, the District of Columbia, or a
   91  possession or territory of the United States for a practical
   92  nursing education program, an associate degree professional
   93  nursing education program, or a professional diploma nursing
   94  education program.
   95         2. Forty percent clinical training at a health care
   96  facility in the United States, the District of Columbia, or a
   97  possession or territory of the United States for a bachelor’s
   98  degree professional nursing education program.
   99         (c) No more than 50 25 percent of the program’s clinical
  100  training consists of clinical simulation.
  101         (d) The program has signed agreements with each agency,
  102  facility, and organization included in the curriculum plan as
  103  clinical training sites and community-based clinical experience
  104  sites.
  105         (e) The program has written policies for faculty which
  106  include provisions for direct or indirect supervision by program
  107  faculty or clinical preceptors for students in clinical training
  108  consistent with the following standards:
  109         1. The number of program faculty members equals at least
  110  one faculty member directly supervising every 12 students unless
  111  the written agreement between the program and the agency,
  112  facility, or organization providing clinical training sites
  113  allows more students, not to exceed 18 students, to be directly
  114  supervised by one program faculty member.
  115         2. For a hospital setting, indirect supervision may occur
  116  only if there is direct supervision by an assigned clinical
  117  preceptor, a supervising program faculty member is available by
  118  telephone, and such arrangement is approved by the clinical
  119  facility.
  120         3. For community-based clinical experiences that involve
  121  student participation in invasive or complex nursing activities,
  122  students must be directly supervised by a program faculty member
  123  or clinical preceptor and such arrangement must be approved by
  124  the community-based clinical facility.
  125         4. For community-based clinical experiences not subject to
  126  subparagraph 3., indirect supervision may occur only when a
  127  supervising program faculty member is available to the student
  128  by telephone.
  129  
  130  A program’s policies established under this paragraph must
  131  require that a clinical preceptor who is, if supervising
  132  students in a professional nursing education program, to be a
  133  registered nurse or, if supervising students in a practical
  134  nursing education program, to be a registered nurse or licensed
  135  practical nurse.
  136         (f) The professional or practical nursing curriculum plan
  137  documents clinical experience and theoretical instruction in
  138  medical, surgical, obstetric, pediatric, and geriatric nursing.
  139  A professional nursing curriculum plan shall also document
  140  clinical experience and theoretical instruction in psychiatric
  141  nursing. Each curriculum plan must document clinical training
  142  experience in appropriate settings that include, but are not
  143  limited to, acute care, long-term care, and community settings.
  144         (g) The professional or practical nursing education program
  145  provides theoretical instruction and clinical application in
  146  personal, family, and community health concepts; nutrition;
  147  human growth and development throughout the life span; body
  148  structure and function; interpersonal relationship skills;
  149  mental health concepts; pharmacology and administration of
  150  medications; and legal aspects of practice. A professional
  151  nursing education program must shall also provide theoretical
  152  instruction and clinical application in interpersonal
  153  relationships and leadership skills; professional role and
  154  function; and health teaching and counseling skills.
  155         (2) PROGRAM APPROVAL.—
  156         (a)  Upon receipt of a program application and review fee,
  157  the department shall examine the application to determine if
  158  whether it is complete. If the a program application is not
  159  complete, the department shall notify the educational
  160  institution in writing of any errors or omissions within 30 days
  161  after the department’s receipt of the application. A program
  162  application is deemed complete upon the department’s receipt of:
  163         1. The initial application, if the department does not
  164  notify the educational institution of any errors or omissions
  165  within the 30-day period; or
  166         2. A revised application that corrects each error and
  167  omission of which the department notifies the educational
  168  institution within the 30-day period.
  169         (b) Within 90 days after the department’s receipt of a
  170  complete program application, the board shall:
  171         1. Approve the application if it documents compliance with
  172  subsection (1) paragraphs (1)(a)-(g); or
  173         2. Provide the educational institution with a notice of
  174  intent to deny the application if it does not document
  175  compliance with subsection (1) paragraphs (1)(a)-(g). The notice
  176  must specify set forth written reasons for the board’s denial of
  177  the application. The board may not deny a program application
  178  because of an educational institution’s failure to correct an
  179  any error or omission that of which the department failed to
  180  provide notice of to does not notify the institution within the
  181  30-day notice period under paragraph (a). The educational
  182  institution may request a hearing on the notice of intent to
  183  deny the program application pursuant to chapter 120.
  184         (c) A program application is deemed approved if the board
  185  does not act within the 90-day review period provided under
  186  paragraph (b).
  187         (d) Upon the board’s approval of a program application, the
  188  program becomes an approved program.
  189         (3) STATUS OF CERTAIN PROGRAMS.—A professional or practical
  190  nursing education program becomes an approved program if, as of
  191  June 30, 2009, the program:
  192         (a) Has full or provisional approval from the board or,
  193  except as provided in paragraph (b), is on probationary status.
  194         (b) Is on probationary status because the program did not
  195  meet the board’s requirement for graduate passage rates. Such
  196  program shall remain on probationary status until it achieves a
  197  graduate passage rate for calendar year 2009 or 2010 that equals
  198  or exceeds the required passage rate for the respective calendar
  199  year and must disclose its probationary status in writing to the
  200  program’s students and applicants. If the program does not
  201  achieve the required passage rate, the board shall terminate the
  202  program pursuant to chapter 120.
  203         (3)(4) ANNUAL REPORT.—By November 1 of each year, each
  204  approved program shall submit to the board an annual report
  205  comprised of an affidavit certifying continued compliance with
  206  subsection (1) paragraphs (1)(a)-(g), a summary description of
  207  the program’s compliance with subsection (1) paragraphs (1)(a)
  208  (g), and documentation for the previous academic year that, to
  209  the extent applicable, describes sets forth:
  210         (a) The number of student applications received, qualified
  211  applicants, applicants accepted, accepted applicants who enroll
  212  in the program, students enrolled in the program, and program
  213  graduates.
  214         (b) The program’s retention rates for students tracked from
  215  program entry to graduation.
  216         (c) The program’s accreditation status, including
  217  identification of the accrediting agency if such agency is not
  218  an accrediting agency described in s. 464.003(1).
  219         (4)(5) INTERNET WEBSITE.—By October 1, 2010, The board
  220  shall publish the following information on its Internet website:
  221         (a) A list of each accredited program conducted in the
  222  state and the program’s graduate passage rates for the most
  223  recent 2 calendar years, which the department shall determine
  224  through the following sources:
  225         1. For a program’s accreditation status, the specialized
  226  accrediting agencies that are nationally recognized by the
  227  United States Secretary of Education to accredit nursing
  228  education programs.
  229         2. For a program’s graduate passage rates, the contract
  230  testing service of the National Council of State Boards of
  231  Nursing.
  232         (b) The following data for each approved program, which
  233  includes shall include, to the extent applicable:
  234         1. All documentation provided by the program in its program
  235  application if submitted on or after July 1, 2009.
  236         2. The summary description of the program’s compliance
  237  submitted under subsection (3) (4).
  238         3. The program’s accreditation status, including
  239  identification of the accrediting agency if such agency is not
  240  an accrediting agency described in s. 464.003(1).
  241         4. The program’s probationary status.
  242         5. The program’s graduate passage rates for the most recent
  243  2 calendar years.
  244         6. Each program’s retention rates for students tracked from
  245  program entry to graduation.
  246         (c) The average passage rates for United States educated
  247  first-time test takers on the National Council of State Boards
  248  of Nursing Licensing Examination for the most recent 2 calendar
  249  years, as calculated by the contract testing service of the
  250  National Council of State Boards of Nursing. The average passage
  251  rates shall be published separately for each type of comparable
  252  degree program listed in subparagraph (5)(a)1. sub-subparagraphs
  253  (6)(a)1.a.-d.
  254  
  255  The information required to be published under this subsection
  256  shall be made available in a manner that allows interactive
  257  searches and comparisons of individual programs selected by the
  258  website user. The board shall update the Internet website at
  259  least quarterly with the available information.
  260         (5)(6) ACCOUNTABILITY.—
  261         (a)1. An approved program must achieve a graduate passage
  262  rate that is not more lower than 10 percentage points lower less
  263  than the average passage rate during the same calendar year for
  264  graduates of comparable degree programs who are United States
  265  educated, first-time test takers on the National Council of
  266  State Boards of Nursing Licensing Examination during a calendar
  267  year, as calculated by the contract testing service of the
  268  National Council of State Boards of Nursing. For purposes of
  269  this subparagraph, an approved program is comparable to all
  270  degree programs of the same program type from among the
  271  following program types:
  272         a. Professional nursing education programs that terminate
  273  in a bachelor’s degree.
  274         b. Professional nursing education programs that terminate
  275  in an associate degree.
  276         c. Professional nursing education programs that terminate
  277  in a diploma.
  278         d. Practical nursing education programs.
  279         2. Beginning with graduate passage rates for calendar year
  280  2010, if an approved program’s graduate passage rates do not
  281  equal or exceed the required passage rates for 2 consecutive
  282  calendar years, the board shall place the program on
  283  probationary status pursuant to chapter 120 and the program
  284  director shall must appear before the board to present a plan
  285  for remediation. The program must shall remain on probationary
  286  status until it achieves a graduate passage rate that equals or
  287  exceeds the required passage rate for any 1 calendar year. The
  288  board shall deny a program application for a new prelicensure
  289  nursing education program submitted by an educational
  290  institution if the institution has an existing program that is
  291  already on probationary status.
  292         3. Upon the program’s achievement of a graduate passage
  293  rate that equals or exceeds the required passage rate, the
  294  board, at its next regularly scheduled meeting following release
  295  of the program’s graduate passage rate by the National Council
  296  of State Boards of Nursing, shall remove the program’s
  297  probationary status. However, if the program, during the 2
  298  calendar years following its placement on probationary status,
  299  does not achieve the required passage rate for any 1 calendar
  300  year, the board shall terminate the program pursuant to chapter
  301  120.
  302         (b) If an approved program fails to submit the annual
  303  report required in subsection (3) (4), the board shall notify
  304  the program director and president or chief executive officer of
  305  the educational institution in writing within 15 days after the
  306  due date of the annual report. The program director shall must
  307  appear before the board at the board’s next regularly scheduled
  308  meeting to explain the reason for the delay. The board shall
  309  terminate the program pursuant to chapter 120 if it does not
  310  submit the annual report within 6 months after the due date.
  311         (c) An approved program on probationary status shall
  312  disclose its probationary status in writing to the program’s
  313  students and applicants.
  314         (6)(7) DISCLOSURE OF GRADUATE PASSAGE RATE DATA.—
  315         (a) For each graduate of the program an approved program’s
  316  or accredited program’s graduates included in the calculation of
  317  the program’s graduate passage rate, the department shall
  318  disclose to the program director, upon his or her written
  319  request, the name, examination date, and determination of
  320  whether each graduate passed or failed the National Council of
  321  for State Boards of Nursing Licensing Examination, if to the
  322  extent that such information is provided to the department by
  323  the contract testing service of the National Council of for
  324  State Boards of Nursing. The written request must specify the
  325  calendar years for which the information is requested.
  326         (b) A program director to whom confidential information
  327  exempt from public disclosure pursuant to s. 456.014 is
  328  disclosed under this subsection must maintain the
  329  confidentiality of the information and is subject to the same
  330  penalties provided in s. 456.082 for department employees who
  331  unlawfully disclose confidential information.
  332         (7)(8) PROGRAM CLOSURE.—
  333         (a) An educational institution conducting an approved
  334  program or accredited program in this state, at least 30 days
  335  before voluntarily closing the program, shall notify the board
  336  in writing of the institution’s reason for closing the program,
  337  the intended closure date, the institution’s plan to provide for
  338  or assist in the completion of training by the program’s
  339  students, and the arrangements for storage of the program’s
  340  permanent records.
  341         (b) An educational institution conducting a nursing
  342  education program that is terminated under subsection (5) (6) or
  343  closed under subparagraph (9)(b)3. (10)(b)3.:
  344         1. May not accept or enroll new students.
  345         2. Shall Must submit to the board within 30 days after the
  346  program is terminated or closed a written description of how the
  347  institution will assist in completing the completion of training
  348  of by the program’s students and the institution’s arrangements
  349  for storage of the program’s permanent records.
  350         (c) If an educational institution does not comply with
  351  paragraph (a) or paragraph (b), the board shall provide a
  352  written notice explaining the institution’s noncompliance to the
  353  following persons and entities:
  354         1. The president or chief executive officer of the
  355  educational institution.
  356         2. The Board of Governors, if the program is conducted by a
  357  state university.
  358         3. The district school board, if the program is conducted
  359  by an educational institution operated by a school district.
  360         4. The Commission for Independent Education, if the program
  361  is conducted by an educational institution licensed under
  362  chapter 1005.
  363         5. The State Board of Education, if the program is
  364  conducted by an educational institution in the Florida College
  365  System or by an educational institution that is not subject to
  366  subparagraphs 2.-4.
  367         (8)(9) RULEMAKING.—The board does not have any rulemaking
  368  authority to administer this section, except that the board
  369  shall adopt rules a rule that prescribe prescribes the format
  370  for submitting program applications under subsection (1) and
  371  annual reports under subsection (3), and to administer the
  372  documentation of the accreditation of nursing education programs
  373  under subsection (11) (4). The board may not impose any
  374  condition or requirement on an educational institution
  375  submitting a program application, an approved program, or an
  376  accredited program, except as expressly provided in this
  377  section. The board shall repeal all rules, or portions thereof,
  378  in existence on July 1, 2009, that are inconsistent with this
  379  subsection.
  380         (9)(10) APPLICABILITY TO ACCREDITED PROGRAMS.—
  381         (a) Subsections (1)-(3) (1)-(4), paragraph (4)(b) (5)(b),
  382  and subsection (5) (6) do not apply to an accredited program. An
  383  accredited program on probationary status before July 1, 2010,
  384  ceases to be subject to the probationary status.
  385         (b) If an accredited program ceases to be accredited, the
  386  educational institution conducting the program:
  387         1. Within 10 business days after the program ceases to be
  388  accredited, must provide written notice of the date that the
  389  program ceased to be accredited to the board, the program’s
  390  students and applicants, and each entity providing clinical
  391  training sites or community-based clinical experience sites for
  392  the program. The educational institution must continue to
  393  provide the written notice to new students, applicants, and
  394  entities providing clinical training sites or community-based
  395  clinical experience sites for the program until the program
  396  becomes an approved program or is closed under subparagraph 3.
  397         2. Within 30 days after the program ceases to be
  398  accredited, must submit an affidavit to the board, signed by the
  399  educational institution’s president or chief executive officer
  400  which, that certifies the institution’s compliance with
  401  subparagraph 1. The board shall notify the persons and
  402  applicable entities listed in paragraph (7)(c) subparagraph
  403  (8)(c)1. and the applicable entities listed in subparagraphs
  404  (8)(c)2.-5. if an educational institution does not submit the
  405  affidavit required by this subparagraph.
  406         3. May apply to become an approved program under this
  407  section. If the educational institution:
  408         a. Within 30 days after the program ceases to be
  409  accredited, submits a program application and review fee to the
  410  department under subsection (1) and the affidavit required under
  411  subparagraph 2., the program shall be deemed an approved program
  412  from the date that the program ceased to be accredited until the
  413  date that the board approves or denies the program application.
  414  The program application must be denied by the board pursuant to
  415  chapter 120 if it does not contain the affidavit. If the board
  416  denies the program application under subsection (2) or if
  417  because the program application does not contain the affidavit,
  418  the program shall be closed and the educational institution
  419  conducting the program must comply with paragraph (7)(b) (8)(b).
  420         b. Does not apply to become an approved program pursuant to
  421  sub-subparagraph a., the program shall be deemed an approved
  422  program from the date that the program ceased to be accredited
  423  until the 31st day after that date. On the 31st day after the
  424  program ceased to be accredited, the program shall be closed and
  425  the educational institution conducting the program must comply
  426  with paragraph (7)(b) (8)(b).
  427         (10)(11) IMPLEMENTATION STUDY.—The Florida Center for
  428  Nursing and the education policy area of the Office of Program
  429  Policy Analysis and Government Accountability shall study the
  430  implementation 5-year administration of this section and submit
  431  reports to the Governor, the President of the Senate, and the
  432  Speaker of the House of Representatives in January of each year
  433  following the effective date of this act by January 30, 2011,and
  434  annually thereafter through January 30, 2015. The annual reports
  435  shall address the previous academic year; provide set forth data
  436  on the measures specified in paragraphs (a) and (b), as such
  437  data becomes available; and include an evaluation of such data
  438  for purposes of determining whether this section is increasing
  439  the availability of nursing education programs and the
  440  production of quality nurses. The department and each approved
  441  program or accredited program shall comply with requests for
  442  data from the Florida Center for Nursing and the education
  443  policy area of the Office of Program Policy Analysis and
  444  Government Accountability.
  445         (a) The Florida Center for Nursing education policy area of
  446  the Office of Program Policy Analysis and Government
  447  Accountability shall evaluate program-specific data for each
  448  approved program and accredited program conducted in the state,
  449  including, but not limited to:
  450         1. The number of programs and student slots available.
  451         2. The number of student applications submitted, the number
  452  of qualified applicants, and the number of students accepted.
  453         3. The number of program graduates.
  454         4. Program retention rates of students tracked from program
  455  entry to graduation.
  456         5. Graduate passage rates on the National Council of State
  457  Boards of Nursing Licensing Examination.
  458         6. The number of graduates who become employed as practical
  459  or professional nurses in the state.
  460         (b) The Florida Center for Nursing shall evaluate the
  461  board’s implementation of the:
  462         1. Program application approval process, including, but not
  463  limited to, the number of program applications submitted under
  464  subsection (1); the number of program applications approved and
  465  denied by the board under subsection (2); the number of denials
  466  of program applications reviewed under chapter 120; and a
  467  description of the outcomes of those reviews.
  468         2. Accountability processes, including, but not limited to,
  469  the number of programs on probationary status, the number of
  470  approved programs for which the program director is required to
  471  appear before the board under subsection (5) (6), the number of
  472  approved programs terminated by the board, the number of
  473  terminations reviewed under chapter 120, and a description of
  474  the outcomes of those reviews.
  475         (c) For any state fiscal year in which the Florida Center
  476  for Nursing does not receive legislative appropriations, the
  477  education policy area of the Office of Program Policy Analysis
  478  and Government Accountability shall perform the duties assigned
  479  by this subsection to the Florida Center for Nursing.
  480         (11) ACCREDITATION REQUIRED.—
  481         (a) A nursing education program that prepares students for
  482  the practice of professional nursing, that was approved under
  483  this section before July 1, 2014, and that enrolled students
  484  before July 1, 2014, must become an accredited program by July
  485  1, 2019.
  486         (b) A nursing education program that prepares students for
  487  the practice of professional nursing, that was approved under
  488  this section before July 1, 2014, but did not enroll students
  489  before that date, must become an accredited program within 5
  490  years after the date of enrolling the program’s first students.
  491         (c) A nursing education program that prepares students for
  492  the practice of professional nursing and that is approved by the
  493  board after June 30, 2014, must become an accredited program
  494  within 5 years after the date of enrolling the program’s first
  495  students.
  496         (d) This subsection does not apply to a nursing education
  497  program provided by an institution that is exempted from
  498  licensure by the Commission for Independent Education under s.
  499  1005.06(1)(e).
  500         Section 4. Subsection (1) of section 456.014, Florida
  501  Statutes, is amended to read:
  502         456.014 Public inspection of information required from
  503  applicants; exceptions; examination hearing.—
  504         (1) All information required by the department of any
  505  applicant shall be a public record and shall be open to public
  506  inspection pursuant to s. 119.07, except financial information,
  507  medical information, school transcripts, examination questions,
  508  answers, papers, grades, and grading keys, which are
  509  confidential and exempt from s. 119.07(1) and shall not be
  510  discussed with or made accessible to anyone except the program
  511  director of an approved program or accredited program as
  512  provided in s. 464.019(6) 464.019(7), members of the board, the
  513  department, and staff thereof, who have a bona fide need to know
  514  such information. Any information supplied to the department by
  515  any other agency which is exempt from the provisions of chapter
  516  119 or is confidential shall remain exempt or confidential
  517  pursuant to applicable law while in the custody of the
  518  department or the agency.
  519         Section 5. This act shall take effect July 1, 2014.