Florida Senate - 2026 SB 254
By Senator Harrell
31-00436B-26 2026254__
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 temporary provisional licenses to
5 graduate registered nurses and graduate licensed
6 practical nurses; providing requirements for the
7 temporary provisional license; establishing that such
8 graduate nurses may practice only under direct
9 supervision and subject to a written protocol with a
10 registered nurse or licensed practical nurse, as
11 applicable; requiring the Board of Nursing to adopt
12 rules; amending s. 464.019, F.S.; revising application
13 requirements for nursing education program approval;
14 specifying preceptorship requirements; requiring the
15 Florida Center for Nursing to develop graduate nursing
16 preceptorship standards by a specified date; requiring
17 the board to incorporate the standards into rule;
18 requiring the board to deny a program’s application
19 under certain circumstances; authorizing the board to
20 revoke an existing program’s approval under certain
21 circumstances; defining the term “adverse action”;
22 clarifying that an approved program’s director is
23 responsible for submitting certain annual reports to
24 the board; requiring the board to terminate a program
25 under certain circumstances; providing penalties for
26 program directors found to be in violation of
27 specified provisions; clarifying that the board must
28 publish the graduate average passage rate of each
29 approved nursing program on its website; revising
30 remediation procedures for approved programs with
31 graduate passage rates that do not meet specified
32 requirements; subjecting program directors of approved
33 programs to specified disciplinary action under
34 certain circumstances; deleting a provision
35 authorizing the board to extend a program’s
36 probationary status; authorizing agents or employees
37 of the department to conduct onsite evaluations and
38 inspections of approved and accredited nursing
39 education programs; authorizing the department to
40 collect evidence as part of such evaluations and
41 inspections; deeming the failure or refusal of a
42 program to allow such evaluation or inspection a
43 violation of a legal obligation; requiring the
44 department to disclose graduate average passage rates
45 to each program director; requiring program directors
46 to ensure that graduate average passage rates are
47 posted on their program’s website; revising rulemaking
48 authority of the board; deleting a provision
49 authorizing approved nursing education programs to
50 request an extension to meet the board’s accreditation
51 requirements; providing an effective date.
52
53 Be It Enacted by the Legislature of the State of Florida:
54
55 Section 1. Subsection (5) is added to section 464.008,
56 Florida Statutes, and subsection (1) of that section is
57 republished, to read:
58 464.008 Licensure by examination.—
59 (1) Any person desiring to be licensed as a registered
60 nurse or licensed practical nurse shall apply to the department
61 to take the licensure examination. The department shall examine
62 each applicant who:
63 (a) Has completed the application form and remitted a fee
64 set by the board not to exceed $150 and has remitted an
65 examination fee set by the board not to exceed $75 plus the
66 actual per applicant cost to the department for purchase of the
67 examination from the National Council of State Boards of Nursing
68 or a similar national organization.
69 (b) Has provided sufficient information on or after October
70 1, 1989, which must be submitted by the department for a
71 statewide criminal records correspondence check through the
72 Department of Law Enforcement.
73 (c) Is in good mental and physical health, is a recipient
74 of a high school diploma or the equivalent, and has completed
75 the requirements for:
76 1. Graduation from an approved program;
77 2. Graduation from a prelicensure nursing education program
78 that the board determines is equivalent to an approved program;
79 3. Graduation on or after July 1, 2009, from an accredited
80 program; or
81 4. Graduation before July 1, 2009, from a prelicensure
82 nursing education program whose graduates at that time were
83 eligible for examination.
84
85 Courses successfully completed in a professional nursing
86 education program that are at least equivalent to a practical
87 nursing education program may be used to satisfy the education
88 requirements for licensure as a licensed practical nurse.
89 (d) Has the ability to communicate in the English language,
90 which may be determined by an examination given by the
91 department.
92 (5)(a) The department shall issue a temporary provisional
93 license to an applicant who is eligible to take the licensure
94 examination under subsection (1) and who seeks to practice as a
95 graduate registered nurse or licensed practical nurse, as
96 applicable.
97 (b) A temporary provisional license issued under this
98 subsection:
99 1. Is valid for a period not to exceed 180 days after the
100 date of issuance.
101 2. Is nonrenewable.
102 3. Automatically expires upon the applicant passing the
103 licensure examination and the department issuing of a full
104 license, or upon the applicant’s failure to pass the
105 examination.
106 (c) A temporary provisional licensee may practice only
107 under the direct supervision of a registered nurse or licensed
108 practical nurse, as applicable, who has filed a written protocol
109 with the department. The board shall adopt rules to implement
110 this paragraph.
111 Section 2. Subsections (1) through (6) and (8) and
112 paragraph (f) of subsection (11) of section 464.019, Florida
113 Statutes, are amended to read:
114 464.019 Approval of nursing education programs.—
115 (1) PROGRAM APPLICATION.—An educational institution that
116 wishes to conduct a program in this state for the prelicensure
117 education of professional or practical nurses must submit to the
118 department a program application and review fee of $1,000 for
119 each prelicensure nursing education program to be offered at the
120 institution’s main campus, branch campus, or other instructional
121 site. The program application must include the legal name of the
122 educational institution, the legal name of the nursing education
123 program, the legal name of the nursing education program
124 director, and, if such institution is accredited, the name of
125 the accrediting agency. The application must also document that:
126 (a)1. For a professional nursing education program, the
127 program director and at least 50 percent of the program’s
128 faculty members are registered nurses who have a master’s or
129 higher degree in nursing or a bachelor’s degree in nursing and a
130 master’s or higher degree in a field related to nursing.
131 2. For a practical nursing education program, the program
132 director and at least 50 percent of the program’s faculty
133 members are registered nurses who have a bachelor’s or higher
134 degree in nursing.
135
136 The educational degree requirements of this paragraph must may
137 be documented by an official transcript or by a written
138 statement from the program director of the educational
139 institution verifying that the institution conferred the degree.
140 The program director shall certify the official transcript or
141 written statement as true and accurate.
142 (b) The program’s nursing major curriculum consists of at
143 least:
144 1. Fifty percent clinical training in the United States,
145 the District of Columbia, or a possession or territory of the
146 United States for a practical nursing education program, an
147 associate degree professional nursing education program, or a
148 professional diploma nursing education program.
149 2. Forty percent clinical training in the United States,
150 the District of Columbia, or a possession or territory of the
151 United States for a bachelor’s degree professional nursing
152 education program.
153 (c) No more than 50 percent of the program’s clinical
154 training consists of clinical simulation.
155 (d) The program has signed agreements with each agency,
156 facility, and organization included in the curriculum plan as
157 clinical training sites and community-based clinical experience
158 sites.
159 (e) The program has written policies for faculty which
160 include provisions for direct or indirect supervision by program
161 faculty or clinical preceptors for students in clinical training
162 consistent with the following standards:
163 1. The number of program faculty members equals at least
164 one faculty member directly supervising every 12 students unless
165 the written agreement between the program and the agency,
166 facility, or organization providing clinical training sites
167 allows more students, not to exceed 18 students, to be directly
168 supervised by one program faculty member.
169 2. For a hospital setting, indirect supervision may occur
170 only if there is direct supervision by an assigned clinical
171 preceptor, a supervising program faculty member is available by
172 telephone, and such arrangement is approved by the clinical
173 facility.
174 3. For community-based clinical experiences that involve
175 student participation in invasive or complex nursing activities,
176 students must be directly supervised by a program faculty member
177 or clinical preceptor and such arrangement must be approved by
178 the community-based clinical facility.
179 4. For community-based clinical experiences not subject to
180 subparagraph 3., indirect supervision may occur only when a
181 supervising program faculty member is available to the student
182 by telephone.
183
184 A program’s policies established under this paragraph must
185 require that a clinical preceptor who is supervising students in
186 a professional nursing education program be a registered nurse
187 or, if supervising students in a practical nursing education
188 program, be a registered nurse or licensed practical nurse.
189 (f) The professional or practical nursing curriculum plan
190 documents clinical experience and theoretical instruction in
191 medical, surgical, obstetric, pediatric, and geriatric nursing.
192 A professional nursing curriculum plan must shall also document
193 clinical experience and theoretical instruction in psychiatric
194 nursing. Each curriculum plan must document clinical training
195 experience in appropriate settings that include, but are not
196 limited to, acute care, long-term care, and community settings.
197 (g) The professional or practical nursing education program
198 provides theoretical instruction and clinical application in
199 personal, family, and community health concepts; nutrition;
200 human growth and development throughout the life span; body
201 structure and function; interpersonal relationship skills;
202 mental health concepts; pharmacology and administration of
203 medications; and legal aspects of practice. A professional
204 nursing education program must also provide theoretical
205 instruction and clinical application in interpersonal
206 relationships and leadership skills; professional role and
207 function; and health teaching and counseling skills.
208 (h) The professional or practical nursing education program
209 has established evaluation and standardized admission criteria.
210 The admission criteria must, at a minimum, identify those
211 students who are likely to need additional preparation and
212 educational support to be successful program graduates. The
213 program must maintain documentation of the individualized
214 student academic support plan for those students identified as
215 in need of additional preparation and educational support.
216 (i) For each student, the professional or practical nursing
217 education program administers an exit examination that is a
218 national, standardized, and comprehensive predictor exam
219 designed to help nursing students assess their readiness for the
220 National Council of State Boards of Nursing Licensing
221 Examination (NCLEX) by identifying areas needing further study
222 and remediation. A student may not be excluded from graduation
223 on the sole basis of the exit examination if the student has
224 otherwise successfully completed all coursework required by the
225 program.
226 (j) The professional or practical nursing education program
227 has submitted to the board the established criteria for
228 remediation that will be offered to students who do not
229 successfully pass the exit examination.
230 (k) Beginning August 1, 2027, a program with a passage rate
231 more than 10 percentage points lower than the average national
232 passage rate during the same calendar year for graduates of
233 comparable degree programs who are United States-educated,
234 first-time test takers on the NCLEX, as calculated by the
235 contract testing service of the National Council of State Boards
236 of Nursing, offers a graduate nursing preceptorship to its
237 graduates. If a graduate from such a program does not pass the
238 NCLEX at the conclusion of his or her preceptorship, the
239 professional or practical nursing education program must offer
240 remediation to the graduate for free.
241 1. All programs are encouraged to offer a graduate nursing
242 preceptorship to their graduates to provide opportunities for
243 job shadowing, clinical training, nonclinical training, and
244 patient care in a hospital setting. Graduates who have been
245 issued a temporary provisional license under s. 464.008(5) may
246 participate in such preceptorships. A graduate nursing
247 preceptorship must last for 3 months, with the expectation that
248 graduates will take the NCLEX at the conclusion of the
249 preceptorship. Clinical preceptors shall oversee the
250 preceptorship programs.
251 2. By January 1, 2027, the Florida Center for Nursing shall
252 establish standards for graduate nursing preceptorships,
253 including supervision requirements. The board shall incorporate
254 the standards into rule.
255 (2) PROGRAM APPROVAL.—
256 (a) Upon receipt of a program application and review fee,
257 the department shall examine the application to determine if it
258 is complete. If the application is not complete, the department
259 must shall notify the educational institution in writing of any
260 errors or omissions within 30 days after the department’s
261 receipt of the application. A program application is deemed
262 complete upon the department’s receipt of:
263 1. The initial application, if the department does not
264 notify the educational institution of any errors or omissions
265 within the 30-day period; or
266 2. A revised application that corrects each error and
267 omission of which the department notifies the educational
268 institution within the 30-day period.
269 (b) Following the department’s receipt of a complete
270 program application, the board may conduct an onsite evaluation
271 if necessary to document the applicant’s compliance with
272 subsection (1). Within 90 days after the department’s receipt of
273 a complete program application, the board shall:
274 1. Approve the application if it documents compliance with
275 subsection (1); or
276 2. Provide the educational institution with a notice of
277 intent to deny the application if it does not document
278 compliance with subsection (1). The notice must specify written
279 reasons for the board’s denial of the application. The board may
280 not deny a program application because of an educational
281 institution’s failure to correct an error or omission that the
282 department failed to provide notice of to the institution within
283 the 30-day notice period under paragraph (a). The educational
284 institution may request a hearing on the notice of intent to
285 deny the program application pursuant to chapter 120.
286 (c) A program application is deemed approved if the board
287 does not act within the 90-day review period provided under
288 paragraph (b).
289 (d) Upon the board’s approval of a program application, the
290 program becomes an approved program.
291 (e) The board shall deny an application from a program that
292 has had adverse action taken against it by another regulatory
293 jurisdiction in the United States. The board may also revoke the
294 approval of an existing approved program that has had adverse
295 action taken against it by another regulatory jurisdiction in
296 the United States. For purposes of this paragraph, the term
297 “adverse action” means any administrative, civil, or criminal
298 action imposed by a licensing board or other state authority
299 against a program. The term includes actions such as revocation,
300 suspension, probation, or any other encumbrance affecting the
301 program’s authorization to operate.
302 (3) ANNUAL REPORT.—By November 1 of each year, each
303 approved program’s director program shall submit to the board an
304 annual report consisting comprised of an affidavit certifying
305 continued compliance with subsection (1), a summary description
306 of the program’s compliance with subsection (1), and
307 documentation for the previous academic year that, to the extent
308 applicable, describes:
309 (a) The number of student applications received, qualified
310 applicants, applicants accepted, accepted applicants who enroll
311 in the program, students enrolled in the program, and program
312 graduates.
313 (b) The program’s retention rates for students tracked from
314 program entry to graduation.
315 (c) The program’s accreditation status, including
316 identification of the accrediting agency.
317
318 The board must terminate the program pursuant to chapter 120 if
319 the requirements of this subsection are not met. Upon request,
320 the board may give an extension for good cause not to exceed 60
321 days for a program to meet the requirements of this subsection.
322 If a program director is found to be in violation of this
323 subsection, the board may impose a penalty listed in s.
324 456.072(2).
325 (4) INTERNET WEBSITE.—The board shall publish the following
326 information on its Internet website:
327 (a) A list of each accredited program conducted in the
328 state and the program’s graduate passage rates for the most
329 recent 2 calendar years, which the department shall determine
330 through the following sources:
331 1. For a program’s accreditation status, the specialized
332 accrediting agencies that are nationally recognized by the
333 United States Secretary of Education to accredit nursing
334 education programs.
335 2. For a program’s graduate passage rates, the contract
336 testing service of the National Council of State Boards of
337 Nursing.
338 (b) The following data for each approved program, which
339 includes, to the extent applicable:
340 1. All documentation provided by the program in its program
341 application.
342 2. The summary description of the program’s compliance
343 submitted under subsection (3).
344 3. The program’s accreditation status, including
345 identification of the accrediting agency.
346 4. The program’s probationary status.
347 5. The program’s graduate passage rates for the most recent
348 2 calendar years.
349 6. Each program’s retention rates for students tracked from
350 program entry to graduation.
351 (c) The average passage rates for United States educated,
352 first-time test takers on the National Council of State Boards
353 of Nursing Licensing Examination for the most recent 2 calendar
354 years, as calculated by the contract testing service of the
355 National Council of State Boards of Nursing. The average passage
356 rates shall be published separately for each type of comparable
357 degree program listed in subparagraph (5)(a)1., and individually
358 for each approved nursing program.
359
360 The information required to be published under this subsection
361 shall be made available in a manner that allows interactive
362 searches and comparisons of individual programs selected by the
363 website user. The board shall update the Internet website at
364 least quarterly with the available information.
365 (5) ACCOUNTABILITY.—
366 (a)1. An approved program must achieve a graduate passage
367 rate for first-time test takers which is not more than 10
368 percentage points lower than the average passage rate during the
369 same calendar year for graduates of comparable degree programs
370 who are United States educated, first-time test takers on the
371 National Council of State Boards of Nursing Licensing
372 Examination, as calculated by the contract testing service of
373 the National Council of State Boards of Nursing. For purposes of
374 this subparagraph, an approved program is comparable to all
375 degree programs of the same program type from among the
376 following program types:
377 a. Professional nursing education programs that terminate
378 in a bachelor’s degree.
379 b. Professional nursing education programs that terminate
380 in an associate degree.
381 c. Professional nursing education programs that terminate
382 in a diploma.
383 d. Practical nursing education programs.
384 2. If an approved program’s graduate passage rates do not
385 equal or exceed the required passage rates for 2 consecutive
386 calendar years, the board must shall place the program on
387 probationary status pursuant to chapter 120 and the program
388 director must submit a written remediation plan to the board.
389 The program director must shall appear before the board to
390 present the a plan for remediation, which must shall include
391 specific nationally recognized benchmarks to identify progress
392 toward a graduate passage rate goal. The board must terminate a
393 program pursuant to chapter 120 if the program director fails to
394 submit a written remediation plan or fails to appear before the
395 board and present the remediation plan no later than 6 months
396 after the date of the program being placed on probation. The
397 board may impose a penalty listed in s. 456.072(2) on the
398 program director for such failure. The program must remain on
399 probationary status until it achieves a graduate passage rate
400 that equals or exceeds the required passage rate for any 1
401 calendar year. The board must shall deny a program application
402 for a new prelicensure nursing education program submitted by an
403 educational institution if the institution has an existing
404 program that is already on probationary status.
405 3. Upon the program’s achievement of a graduate passage
406 rate that equals or exceeds the required passage rate, the
407 board, at its next regularly scheduled meeting following release
408 of the program’s graduate passage rate by the National Council
409 of State Boards of Nursing, shall remove the program’s
410 probationary status. If the program, during the 2 calendar years
411 following its placement on probationary status, does not achieve
412 the required passage rate for any 1 calendar year, the board
413 must may extend the program’s probationary status for 1
414 additional year, provided the program has demonstrated adequate
415 progress toward the graduate passage rate goal by meeting a
416 majority of the benchmarks established in the remediation plan.
417 If the program is not granted the 1-year extension or fails to
418 achieve the required passage rate by the end of such extension,
419 the board shall terminate the program pursuant to chapter 120.
420 (b) If an approved program fails to submit the annual
421 report required in subsection (3), the board must shall notify
422 the program director and president or chief executive officer of
423 the educational institution in writing within 15 days after the
424 due date of the annual report. The program director must shall
425 appear before the board at the board’s next regularly scheduled
426 meeting to explain the reason for the delay. The board must
427 shall terminate the program pursuant to chapter 120 if the
428 program director fails to appear before the board, as required
429 under this paragraph, or if the program does not submit the
430 annual report within 6 months after the due date.
431 (c) A nursing education program, whether accredited or
432 nonaccredited, which has been placed on probationary status must
433 shall disclose its probationary status in writing to the
434 program’s students and applicants. The notification must include
435 an explanation of the implications of the program’s probationary
436 status on the students or applicants.
437 (d) If students from a program that is terminated pursuant
438 to this subsection transfer to an approved or an accredited
439 program under the direction of the Commission for Independent
440 Education, the board must shall recalculate the passage rates of
441 the programs receiving the transferring students, excluding the
442 test scores of those students transferring more than 12 credits.
443 (e) Duly authorized agents or employees of the department
444 may conduct onsite evaluations or inspections at any time during
445 business hours to ensure that approved programs or accredited
446 programs are in full compliance with this chapter, or to
447 determine whether this chapter or s. 456.072 is being violated.
448 The department may collect any necessary evidence needed to
449 ensure compliance with this chapter or for prosecution, as
450 deemed necessary. A program that refuses or fails to allow an
451 onsite evaluation or inspection is deemed in violation of a
452 legal obligation imposed by the board or the department.
453 (6) DISCLOSURE OF GRADUATE PASSAGE RATE DATA.—
454 (a) For each graduate of the program included in the
455 calculation of the program’s graduate passage rate, the
456 department shall disclose to the program director, upon his or
457 her written request, the name, examination date, and
458 determination of whether each graduate passed or failed the
459 National Council of State Boards of Nursing Licensing
460 Examination, if such information is provided to the department
461 by the contract testing service of the National Council of State
462 Boards of Nursing. The department shall disclose to the program
463 director the average passage rate for graduates from its program
464 written request must specify the calendar years for which the
465 information is requested.
466 (b) A program director to whom confidential information
467 exempt from public disclosure pursuant to s. 456.014 is
468 disclosed under this subsection must maintain the
469 confidentiality of the information and is subject to the same
470 penalties provided in s. 456.082 for department employees who
471 unlawfully disclose confidential information.
472 (c) The program director shall ensure that the graduate
473 average passage rate, as reported by the department, is posted
474 on the program’s website.
475 (8) RULEMAKING.—The board does not have rulemaking
476 authority to administer this section, except that the board
477 shall adopt rules that prescribe the format for submitting
478 program applications under subsection (1) and annual reports
479 under subsection (3), to implement graduate nursing
480 preceptorships as established in paragraph (1)(k), to enforce
481 and administer subsection (5), and to administer the
482 documentation of the accreditation of nursing education programs
483 under subsection (11). The board may adopt rules relating to the
484 nursing curriculum, including rules relating to the uses and
485 limitations of simulation technology, and rules relating to the
486 criteria to qualify for an extension of time to meet the
487 accreditation requirements under paragraph (11)(f). The board
488 may not impose any condition or requirement on an educational
489 institution submitting a program application, an approved
490 program, or an accredited program, except as expressly provided
491 in this section.
492 (11) ACCREDITATION REQUIRED.—
493 (f) An approved nursing education program may, no sooner
494 than 90 days before the deadline for meeting the accreditation
495 requirements of this subsection, apply to the board for an
496 extension of the accreditation deadline for a period which does
497 not exceed 2 years. An additional extension may not be granted.
498 In order to be eligible for the extension, the approved program
499 must establish that it has a graduate passage rate of 60 percent
500 or higher on the National Council of State Boards of Nursing
501 Licensing Examination for the most recent calendar year and must
502 meet a majority of the board’s additional criteria, including,
503 but not limited to, all of the following:
504 1. A student retention rate of 60 percent or higher for the
505 most recent calendar year.
506 2. A graduate work placement rate of 70 percent or higher
507 for the most recent calendar year.
508 3. The program has applied for approval or been approved by
509 an institutional or programmatic accreditor recognized by the
510 United States Department of Education.
511 4. The program is in full compliance with subsections (1)
512 and (3) and paragraph (5)(b).
513 5. The program is not currently in its second year of
514 probationary status under subsection (5).
515
516 The applicable deadline under this paragraph is tolled from the
517 date on which an approved program applies for an extension until
518 the date on which the board issues a decision on the requested
519 extension.
520 Section 3. This act shall take effect July 1, 2026.