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CS/HB 121 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to nursing education programs; 2
amending s. 464.019, F.S.; revising application 3
requirements for nursing education program approval; 4
requiring the Board of Nursing to deny an application 5
under certain circumstances; authorizing the board to 6
revoke a program's approval under certain 7
circumstances; authorizing the board to investigate 8
the nature of an adverse action and take specified 9
actions; revising requirements for annual reports 10
program directors of approved programs are required to 11
submit to the board; providing for the termination of 12
a program's approval, and discipline of its program 13
director, under certain circumstances; revising 14
remediation procedures for approved programs with 15
graduate passage rates that do not meet specified 16
requirements; deleting a provision authorizing the 17
board to extend a program's probationary status; 18
revising requirements for certain nursing education 19
programs placed on probationary status; providing 20
requirements for programs with certain graduate 21
passage rates; authorizing agents of the Department of 22
Health to conduct onsite evaluations and inspections 23
of approved and accredited nursing education programs; 24
authorizing the department to collect evidence as part 25
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of such evaluations and inspections; deeming failure 26
or refusal of a program to allow such evaluation or 27
inspection as a violation of a legal obligation; 28
revising and providing rulemaking authority of the 29
board; revising program-specific data the Florida 30
Center for Nursing evaluates for certain programs; 31
deleting a provision authorizing approved nursing 32
education programs to request an extension to meet the 33
board's accreditation requirements; providing an 34
effective date. 35
36
Be It Enacted by the Legislature of the State of Florida: 37
38
Section 1. Subsections (1), (2), (3), (5), (8), and (10) 39
and paragraph (f) of subsection (11) of section 464.019, Florida 40
Statutes, are amended to read: 41
464.019 Approval of nursing education programs.— 42
(1) PROGRAM APPLICATION.—An educational institution that 43
wishes to conduct a program in this state for the prelicensure 44
education of professional or practical nurses must submit to the 45
department a program application and review fee of $1,000 for 46
each prelicensure nursing education program to be offered at the 47
institution's main campus, branch campus, or other instructional 48
site. The program application must include the legal name of the 49
educational institution, the legal name of the nursing education 50
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program, the legal name of the nursing education program 51
director, the status and outcome of any disciplinary case 52
pending or closed against the applicant in another regulatory 53
jurisdiction in the United States, and, if such institution is 54
accredited, the name of the accrediting agency. The application 55
must also document that: 56
(a)1. For a professional nursing education program, the 57
program director and at least 50 percent of the program's 58
faculty members are registered nurses who have a master's or 59
higher degree in nursing or a bachelor's degree in nursing and a 60
master's or higher degree in a field related to nursing. 61
2. For a practical nursing education program, the program 62
director and at least 50 percent of the program's faculty 63
members are registered nurses who have a bachelor's or higher 64
degree in nursing. 65
66
The educational degree requirements of this paragraph may be 67
documented by an official transcript or by a written statement 68
from the program director of the educational institution 69
verifying that the institution conferred the degree. The program 70
director shall certify the official transcript or written 71
statement as true and accurate. 72
(b) The program's nursing major curriculum consists of at 73
least: 74
1. Fifty percent clinical training in the United States, 75
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the District of Columbia, or a possession or territory of the 76
United States for a practical nursing education program, an 77
associate degree professional nursing education program, or a 78
professional diploma nursing education program. 79
2. Forty percent clinical training in the United States, 80
the District of Columbia, or a possession or territory of the 81
United States for a bachelor's degree professional nursing 82
education program. 83
(c) No more than 50 percent of the program's clinical 84
training consists of clinical simulation. 85
(d) The program has signed agreements with each agency, 86
facility, and organization included in the curriculum plan as 87
clinical training sites and community-based clinical experience 88
sites. 89
(e) The program has written policies for faculty which 90
include provisions for direct or indirect supervision by program 91
faculty or clinical preceptors for students in clinical training 92
consistent with the following standards: 93
1. The number of program faculty members equals at least 94
one faculty member directly supervising every 12 students unless 95
the written agreement between the program and the agency, 96
facility, or organization providing clinical training sites 97
allows more students, not to exceed 18 students, to be directly 98
supervised by one program faculty member. 99
2. For a hospital setting, indirect supervision may occur 100
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only if there is direct supervision by an assigned clinical 101
preceptor, a supervising program faculty member is available by 102
telephone, and such arrangement is approved by the clinical 103
facility. 104
3. For community-based clinical experiences that involve 105
student participation in invasive or complex nursing activities, 106
students must be directly supervised by a program faculty member 107
or clinical preceptor and such arrangement must be approved by 108
the community-based clinical facility. 109
4. For community-based clinical experiences not subject to 110
subparagraph 3., indirect supervision may occur only when a 111
supervising program faculty member is available to the student 112
by telephone. 113
114
A program's policies established under this paragraph must 115
require that a clinical preceptor who is supervising students in 116
a professional nursing education program be a registered nurse 117
or, if supervising students in a practical nursing education 118
program, be a registered nurse or licensed practical nurse. 119
(f) The professional or practical nursing curriculum plan 120
documents clinical experience and theoretical instruction in 121
medical, surgical, obstetric, pediatric, and geriatric nursing. 122
A professional nursing curriculum plan must shall also document 123
clinical experience and theoretical instruction in psychiatric 124
nursing. Each curriculum plan must document clinical training 125
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experience in appropriate settings that include, but are not 126
limited to, acute care, long-term care, and community settings. 127
(g) The professional or practical nursing education 128
program provides theoretical instruction and clinical 129
application in personal, family, and community health concepts; 130
nutrition; human growth and development throughout the life 131
span; body structure and function; interpersonal relationship 132
skills; mental health concepts; pharmacology and administration 133
of medications; and legal aspects of practice. A professional 134
nursing education program must also provide theoretical 135
instruction and clinical application in interpersonal 136
relationships and leadership skills; professional role and 137
function; and health teaching and counseling skills. 138
(h) The professional or practical nursing education 139
program has established evaluation and standardized admission 140
criteria. The admission criteria must, at a minimum, identify 141
those students who are likely to need additional educational 142
support to be successful program graduates. The program must 143
maintain documentation of the individualized student academic 144
support plan for those students identified as in need of 145
additional preparation and educational support. 146
(i) The professional or practical nursing education 147
program has an established comprehensive examination, known as 148
an exit examination, or a full preparation course incorporating 149
multiple comprehensive examinations, known as a preparation 150
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course, to prepare students for the National Council of State 151
Boards of Nursing Licensing Examination. The exit examination or 152
preparation course must be administered to all students before 153
program completion. Successful completion of the exit 154
examination or preparation course may not be required for 155
graduation unless students are notified of such requirement in 156
writing upon enrollment in the program. The program director is 157
responsible for posting the average exit examination results of 158
the program on the program's website. 159
(j) The professional or practical nursing education 160
program has submitted to the board the established criteria for 161
remediation that will be available for students who do not pass 162
the exit examination or preparation course. 163
(2) PROGRAM APPROVAL.— 164
(a) Upon receipt of a program application and review fee, 165
the department shall examine the application to determine if it 166
is complete. If the application is not complete, the department 167
must shall notify the educational institution in writing of any 168
errors or omissions within 30 days after the department's 169
receipt of the application. A program application is deemed 170
complete upon the department's receipt of: 171
1. The initial application, if the department does not 172
notify the educational institution of any errors or omissions 173
within the 30-day period; or 174
2. A revised application that corrects each error and 175
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omission of which the department notifies the educational 176
institution within the 30-day period. 177
(b) Following the department's receipt of a complete 178
program application, the board may conduct an onsite evaluation 179
if necessary to document the applicant's compliance with 180
subsection (1). Within 90 days after the department's receipt of 181
a complete program application, the board shall: 182
1. Approve the application if it documents compliance with 183
subsection (1); or 184
2. Provide the educational institution with a notice of 185
intent to deny the application if it does not document 186
compliance with subsection (1). The notice must specify written 187
reasons for the board's denial of the application. The board may 188
not deny a program application because of an educational 189
institution's failure to correct an error or omission that the 190
department failed to provide notice of to the institution within 191
the 30-day notice period under paragraph (a). The educational 192
institution may request a hearing on the notice of intent to 193
deny the program application pursuant to chapter 120. 194
(c) A program application is deemed approved if the board 195
does not act within the 90-day review period provided under 196
paragraph (b). 197
(d) Upon the board's approval of a program application, 198
the program becomes an approved program. 199
(e) The board may consider adverse actions taken against a 200
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nursing education program by another regulatory jurisdiction in 201
the United States in determining program approval. The program 202
director of an approved program must notify the board within 15 203
days after any adverse action taken against the program by 204
another regulatory jurisdiction in the United States. 205
1. The board shall deny an application from an applicant 206
if another regulatory jurisdiction in the United States has 207
terminated or otherwise revoked its authority to operate a 208
nursing education program. 209
2. The board may investigate the nature of an adverse 210
action. In instances of adverse action other than termination or 211
revocation of a program's authority to operate, the board may: 212
a. Approve the application; 213
b. Approve the application with conditions; or 214
c. Deny the application. 215
3. The board may impose disciplinary remedies on an 216
approved program against which an adverse action has been taken 217
by another regulatory jurisdiction in the United States. The 218
board may impose remedies up to and including revocation of a 219
program's approval pursuant to rules adopted under this section. 220
(f) The board may deny an application for approval if the 221
board determines that the applicant is owned by any individual, 222
group of individuals, or entity who directly or indirectly 223
owned, controlled, or held a 25 percent or greater financial or 224
ownership interest in a nursing education program that was on 225
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probationary status at the time of its closure. 226
(3) ANNUAL REPORT.—By November 1 of each year, the program 227
director of each approved program shall submit to the board an 228
annual report comprised of an affidavit certifying continued 229
compliance with subsection (1), a summary description of the 230
program's compliance with subsection (1), and documentation for 231
the previous academic year that, to the extent applicable, 232
describes: 233
(a) The number of student applications received, qualified 234
applicants, applicants accepted, accepted applicants who enroll 235
in the program, students enrolled in the program, and program 236
graduates. 237
(b) The program's retention rates for students tracked 238
from program entry to graduation. 239
(c) The program's accreditation status, including 240
identification of the accrediting agency. 241
(d) The program's average exit examination or preparation 242
course results. 243
244
The board must terminate the program if the requirements of this 245
subsection are not met. The program director is also subject to 246
discipline under s. 456.072(1)(k) for such failure. 247
(5) ACCOUNTABILITY.— 248
(a)1. An approved program must achieve a graduate passage 249
rate for first-time test takers which is not more than 10 250
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percentage points lower than the average passage rate during the 251
same calendar year for graduates of comparable degree programs 252
who are United States educated, first-time test takers on the 253
National Council of State Boards of Nursing Licensing 254
Examination, as calculated by the contract testing service of 255
the National Council of State Boards of Nursing. For purposes of 256
this subparagraph, an approved program is comparable to all 257
degree programs of the same program type from among the 258
following program types: 259
a. Professional nursing education programs that terminate 260
in a bachelor's degree. 261
b. Professional nursing education programs that terminate 262
in an associate degree. 263
c. Professional nursing education programs that terminate 264
in a diploma. 265
d. Practical nursing education programs. 266
2. If an approved program's graduate passage rates do not 267
equal or exceed the required passage rates for 2 consecutive 268
calendar years, the board must shall place the program on 269
probationary status pursuant to chapter 120 and the program 270
director must submit a written remediation plan to the board. 271
The program director must shall appear before the board to 272
present the a plan for remediation, which must shall include 273
specific nationally recognized benchmarks to identify progress 274
toward a graduate passage rate goal. The board must terminate a 275
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program if the program director fails to submit a written 276
remediation plan that complies with this section or fails to 277
appear before the board and present the remediation within 6 278
months after the program is placed on probation. The program's 279
director is also subject to discipline under s. 456.072(1)(k) 280
for such failure. The program must remain on probationary status 281
until it achieves a graduate passage rate that equals or exceeds 282
the required passage rate for any 1 calendar year. The board 283
must shall deny a program application for a new prelicensure 284
nursing education program submitted by an educational 285
institution if the institution has an existing program that is 286
already on probationary status. 287
3. Upon the program's achievement of a graduate passage 288
rate that equals or exceeds the required passage rate, the 289
board, at its next regularly scheduled meeting following release 290
of the program's graduate passage rate by the National Council 291
of State Boards of Nursing, shall remove the program's 292
probationary status. If the program, during the 2 calendar years 293
following its placement on probationary status, does not achieve 294
the required passage rate for any 1 calendar year, the board 295
must may extend the program's probationary status for 1 296
additional year, provided the program has demonstrated adequate 297
progress toward the graduate passage rate goal by meeting a 298
majority of the benchmarks established in the remediation plan. 299
If the program is not granted the 1-year extension or fails to 300
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achieve the required passage rate by the end of such extension, 301
the board shall terminate the program pursuant to chapter 120. 302
(b) If an approved program fails to submit the annual 303
report required in subsection (3), the board must 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 must shall 307
appear before the board at the board's next regularly scheduled 308
meeting to explain the reason for the delay. The board must 309
shall terminate the program pursuant to chapter 120 if the 310
program director fails to appear before the board, as required 311
under this paragraph, or if the program does not submit the 312
annual report within 30 days 6 months after the due date. 313
(c) A nursing education program, whether accredited or 314
nonaccredited, which has been placed on probationary status 315
must: 316
1. shall Disclose its probationary status in writing to 317
the program's students and applicants. The notification must 318
include an explanation of the implications of the program's 319
probationary status on the students or applicants. 320
2. Offer remediation at no additional cost or pay for 321
remediation from a board-approved remedial program for: 322
a. Students who do not pass the program's exit examination 323
or preparation course. 324
b. Each program graduate who fails to pass the National 325
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Council of State Boards of Nursing Licensing Examination as a 326
first-time test taker within 1 calendar year after graduation. 327
(d) If students from a program that is terminated pursuant 328
to this subsection transfer to an approved or an accredited 329
program under the direction of the Commission for Independent 330
Education, the board must shall recalculate the passage rates of 331
the programs receiving the transferring students, excluding the 332
test scores of those students transferring more than 12 credits. 333
(e) If an approved program's graduate passage rate is 334
below 30 percent in a calendar year, the program must reimburse 335
the total cost of tuition and fees paid by each student who 336
failed to pass the National Council of State Boards of Nursing 337
Licensing Examination as a first-time test taker in that 338
calendar year. The program must outline its plan for meeting 339
this requirement in its written remediation plan under 340
subparagraph (a)2. 341
(f) Duly authorized agents or employees of the department 342
may conduct onsite evaluations or inspections at all regular 343
hours of operation to verify that approved programs or 344
accredited programs are in full compliance with this chapter, or 345
to determine whether this chapter or s. 456.072 is being 346
violated. The department may collect any necessary evidence 347
needed to verify compliance with this chapter or for prosecution 348
as deemed necessary. The failure of a program to allow an onsite 349
evaluation or inspection is deemed a violation of a legal 350
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obligation imposed by the board or the department. 351
(8) RULEMAKING.—The board does not have rulemaking 352
authority to administer this section, except that the board 353
shall adopt rules that prescribe the format for submitting 354
program applications under subsection (1) and annual reports 355
under subsection (3), and to administer the documentation of the 356
accreditation of nursing education programs under subsection 357
(11). By December 31, 2026, the board shall adopt rules to 358
conduct investigations and take actions consistent with 359
subsection (2) and to enforce and administer subsection (5). The 360
board may adopt rules relating to the nursing curriculum, 361
including rules relating to the uses and limitations of 362
simulation technology, and rules relating to the criteria to 363
qualify for an extension of time to meet the accreditation 364
requirements under paragraph (11)(f). The board may not impose 365
any condition or requirement on an educational institution 366
submitting a program application, an approved program, or an 367
accredited program, except as expressly provided in this 368
section. 369
(10) IMPLEMENTATION STUDY.—The Florida Center for Nursing 370
shall study the administration of this section and submit 371
reports to the Governor, the President of the Senate, and the 372
Speaker of the House of Representatives annually by January 30. 373
The annual reports shall address the previous academic year; 374
provide data on the measures specified in paragraphs (a) and 375
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(b), as such data becomes available; and include an evaluation 376
of such data for purposes of determining whether this section is 377
increasing the availability of nursing education programs and 378
the production of quality nurses. The department and each 379
approved program or accredited program shall comply with 380
requests for data from the Florida Center for Nursing. 381
(a) The Florida Center for Nursing shall evaluate program-382
specific data for each approved program and accredited program 383
conducted in the state, including, but not limited to: 384
1. The number of programs and student slots available. 385
2. The number of student applications submitted, the 386
number of qualified applicants, and the number of students 387
accepted. 388
3. The number of program graduates. 389
4. Program retention rates of students tracked from 390
program entry to graduation. 391
5. Program exit examination results. 392
6. The number of students offered remediation due to exit 393
examination performance and the number of students who completed 394
remediation. 395
7. The impact of exit examinations and remediation on 396
graduation rates and graduate passage rates on the National 397
Council of State Boards of Nursing Licensing Examination. 398
8.5. Graduate passage rates on the National Council of 399
State Boards of Nursing Licensing Examination. 400
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9.6. The number of graduates who become employed as 401
practical or professional nurses in the state. 402
(b) The Florida Center for Nursing shall evaluate the 403
board's implementation of the: 404
1. Program application approval process, including, but 405
not limited to, the number of program applications submitted 406
under subsection (1), the number of program applications 407
approved and denied by the board under subsection (2), the 408
number of denials of program applications reviewed under chapter 409
120, and a description of the outcomes of those reviews. 410
2. Accountability processes, including, but not limited 411
to, the number of programs on probationary status, the number of 412
approved programs for which the program director is required to 413
appear before the board under subsection (5), the number of 414
approved programs terminated by the board, the number of 415
terminations reviewed under chapter 120, and a description of 416
the outcomes of those reviews. 417
(c) The Florida Center for Nursing shall complete an 418
annual assessment of compliance by programs with the 419
accreditation requirements of subsection (11), include in the 420
assessment a determination of the accreditation process status 421
for each program, and submit the assessment as part of the 422
reports required by this subsection. 423
(11) ACCREDITATION REQUIRED.— 424
(f) An approved nursing education program may, no sooner 425
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than 90 days before the deadline for meeting the accreditation 426
requirements of this subsection, apply to the board for an 427
extension of the accreditation deadline for a period which does 428
not exceed 2 years. An additional extension may not be granted. 429
In order to be eligible for the extension, the approved program 430
must establish that it has a graduate passage rate of 60 percent 431
or higher on the National Council of State Boards of Nursing 432
Licensing Examination for the most recent calendar year and must 433
meet a majority of the board's additional criteria, including, 434
but not limited to, all of the following: 435
1. A student retention rate of 60 percent or higher for 436
the most recent calendar year. 437
2. A graduate work placement rate of 70 percent or higher 438
for the most recent calendar year. 439
3. The program has applied for approval or been approved 440
by an institutional or programmatic accreditor recognized by the 441
United States Department of Education. 442
4. The program is in full compliance with subsections (1) 443
and (3) and paragraph (5)(b). 444
5. The program is not currently in its second year of 445
probationary status under subsection (5). 446
447
The applicable deadline under this paragraph is tolled from the 448
date on which an approved program applies for an extension until 449
the date on which the board issues a decision on the requested 450
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extension. 451
Section 2. This act shall take effect July 1, 2026. 452