The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Health Policy
BILL: CS/SB 1296
INTRODUCER: Health Policy Committee and Senator Brodeur
SUBJECT: Nursing Programs
DATE: March 31, 2021 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rossitto Van-
Brown HP Fav/CS
Winkle
2. ED
3. RC
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 1296 redefines how Florida measures and evaluates approved nursing education and
training programs to determine whether the programs’ graduates are meeting national
performance standards to satisfy the state’s increasing demands for safe nursing services for the
public’s health, safety, and welfare. The bill:
 Amends terminology to expand the number and time frame over which a nursing education
and training program’s graduate passage rates of the Nursing Council Licensure Examination
(NCLEX) are measured, from the percentage of first-time test takers in a calendar year
passing the NCLEX, to:
o The program’s average graduate passage rate of test takers passing the NCLEX during
the two most recent calendar years, including those retaking the NCLEX but excluding
those who fail more than three consecutive times; or
o The program’s passage rate as calculated by the contract testing service of the National
Council of State Boards of Nursing if the average passage rate is 80 percent or greater on
the NCLEX for the prior calendar year;
 Defines “test takers” to include graduates who take the NCLEX within one year after
graduation and do not fail the NCLEX more than three consecutive times;
 Repeals the definition of “required passage rate” which, under current law, means the
graduate passage rate that an approved nursing education program is required to attain and
relies on a graduate passage rate of not more than ten percentage below the national average
BILL: CS/SB 1296 Page 2
for first-time test takers on the NCLEX during the same calendar year for graduates of
comparable degree programs who were educated in the U.S.;
 Requires an approved program to achieve an average graduate passage rate of 80 percent or
greater for the most recent average graduate passage rate on the NCLEX or be placed on
probation or terminated;
 Amends the requirements for an approved programs’ annual reports to the Board of Nursing
(BON) to change the due date and includes additional requirements;
 Requires an approved program to provide students who fail the NCLEX on the first attempt,
for at least one year after graduation, information about remediation programs designed to
assist the student in passing the NCLEX;
 Prohibits the BON from considering, in any manner, the average graduate passage rates of
any approved program for the calendar years 2020 and 2021 when determining whether to
take any adverse action against the program; and
 Provides Legislative intent for the bill’s provisions relating to probation and termination to
apply retroactively to January 1, 2021, to prevent the BON from placing or continuing an
approved program on probation or terminating an existing approved program that is already
on probation.
The bill provides an effective date of July 1, 2021.
II. Present Situation:
Part I of ch. 464, F.S., the Nurse Practice Act, governs the licensure and regulation of nurses in
Florida. Nurses are licensed by the Department of Health (DOH)1 and are regulated by the
BON.2 Currently a nurse desiring to practice nursing in the state of Florida must obtain a Florida
license by examination or endorsement.
Applicants for licensure by examination as a registered nurse (RN) or licensed practical nurse
(LPN) must, among other requirements:
 Graduate from an approved program or its equivalent as determined by the BON;3
 Submit an application to the DOH;
 Pay a fee;
 Submit information for a criminal background check;4 and
 Pass the NCLEX.5
Licensure by endorsement requirements include submitting an application and fee, passing a
criminal background screening, and:
 Holding a valid license to practice professional or practical nursing in another state or
territory of the U.S. which, when issued, met or exceeded those in Florida at that time;
1
Section 464.008, F.S.
2
The BON is composed of 13 members appointed by the Governor and confirmed by the Senate who serve four-year terms.
All members must be residents of the state. Seven members must be registered nurses who are representative of the diverse
areas of practice within the nursing profession. Three members must be licensed practical nurses and three members must be
laypersons. At least one member of the board must be 60 years of age or older. See Section 464.004, F.S.
3
Section 464.008(1)(c), F.S.
4
Section 464.008(1)(b), F.S.
5
Section 464.008(2), F.S.
BILL: CS/SB 1296 Page 3
 Meeting the requirements for licensure in Florida and having successfully completed an
examination in another state which is substantially equivalent to the examination in Florida;
or
 Having actively practiced nursing in another state, jurisdiction, or territory of the U.S. for
two of the preceding three years without having his or her license acted against by the
licensing authority of any jurisdiction.6
In 2016, the Legislature created s. 464.0095, F.S., – Florida’s entrance into the Nurse Licensure
Compact (NLC) – which took effect January 19, 2018, and adopts the revised NLC in its entirety
into state law. This allows for licensed practical and professional nurses to practice in all member
states by maintaining a single license in the nurse’s primary state of residence. To date, 34 states,
including Florida, have adopted the revised NLC.7
The National Council of State Boards of Nursing, Inc. (NCSBN)
The NCSBN is an independent, non-profit organization that was created in 1978 out of
recognition that in order to guard the safety of the public, the organization involved in the
regulation of nurses needs to be a separate entity from the American Nurses Association (ANA)
Council on State Boards of Nursing, which represents professional nurses. The NCSBN’s
membership is now composed of state boards of nursing and other nursing regulatory bodies that
are charged with the responsibility of providing regulatory excellence for public health, safety,
and welfare. To meet that goal, the NCSBN developed a psychometrically sound and legally-
defensible nurse licensure examination consistent with current nursing practice. NCSBN became
the first organization to implement computerized adaptive testing for nationwide licensure
examinations in 1994, – the NCLEX-RN and NCLEX-LPN.8
Nursing Education Program Approval and Accreditation
Section 464.019, F.S., requires an institution desiring to offer a pre-licensure nursing education
program to submit an application to the DOH and pay a program review fee for each campus or
instructional site. In addition to identifying information about the program, the application must
indicate the name of the accrediting agency.
The application must document compliance with the following program standards: faculty
qualifications; clinical training and clinical simulation requirements, including a requirement that
no more than 50 percent of the program’s clinical training consist of clinical simulation; faculty-
to-student supervision ratios; and curriculum and instruction requirements.
Once the DOH determines an application is complete, it forwards the application to the BON.
The BON may conduct an onsite evaluation if necessary to document the applicant’s compliance
with required program standards. Upon receipt, the BON has 90 days to approve the application
or to provide the applicant with notice of its intent to deny and the reasons for the denial. An
6
Section 464.009, F.S.
7
The National Council of State Boards of Nursing administers the NLC. They refer to it as the enhanced NLC. available at
https://www.nursecompact.com/Updated_onepaged_NLC.pdf (last visited on March 23, 2021).
8
National Council of State Boards of Nursing, Inc., History. available at https://www.ncsbn.org/history.htm (last visited
Mar. 28, 2021).
BILL: CS/SB 1296 Page 4
applicant may request a hearing under ch. 120, F.S., on a notice of intent to deny his or her
application.9
Chapter 464, F.S., recognizes and distinguishes between nursing education programs that are
approved by the BON and programs that are approved and accredited.10
An “accredited program” is accredited by a specialized nursing accrediting agency that is
nationally recognized by the U.S. Secretary of Education to accredit nursing education
programs.11 The specialized nursing accrediting agencies currently recognized by the U.S.
Department of Education include the Commission on Collegiate Nursing Education and the
Accreditation Commission for Education in Nursing.12
A BON-approved nursing education program13 is required to submit an annual report to the BON
which includes an affidavit certifying compliance with the program standards and documentation
for the previous academic year that sets forth data related to the number of students who applied,
were accepted, enrolled, and graduated; retention rates; and accreditation status.14
The BON posts the following information on its website:15
 A list of all accredited programs and graduation rates for the most recent two years;
 A list of all approved programs that are not accredited;
 All documentation submitted in a program’s application;
 A summary of the program’s compliance with program standards;
 A program’s accreditation status, probationary status, graduate passage rates for the most
recent two years, and retention rates.16
Approved programs must have a graduate passage rate not lower than ten percent below the
national average for two consecutive years. Programs are placed on probation for low
performance with NCLEX scores for two consecutive years and are subject to termination. The
program director is required to present a plan for remediation to the BON that includes specific
benchmarks to identify progress toward a graduate passage rate goal. The program must remain
on probationary status until it achieves a graduate passage rate that equals or exceeds the
required passage rate for any one calendar year. If the program does not achieve the required
passage rate in any one calendar year after a program has been placed on probationary status, the
9
Section 464.019(2)(c), F.S. If the BON does not act on a program application within the 90-day review period, the program
application is deemed approved. Id.
10
The program application and approval process, the annual report requirement, the data submission requirements and the
pass rate requirements are not applicable to accredited programs.
11
Section 464.003(1), F.S.
12
United States Department of Education, Accreditation in the United States: Specialized Accrediting Agencies, available at
https://www2.ed.gov/admins/finaid/accred/accreditation_pg7.html (last visited Mar. 25, 2021).
13
Section 464.003(4), F.S., defines an “approved program” as “a program for the pre-licensure education of professional or
practical nurses that is conducted in the state at an educational institution and that is approved under s. 464.019, F.S. The
term includes such a program placed on probationary status.”
14
Section 464.019(3), F.S.
15
Florida Department of Health, Board of Nursing, Education and Training Programs, available at
https://floridasnursing.gov/education-and-training-programs/ (last visited Mar. 28, 2021).
16
Section 464.019(4), F.S.
BILL: CS/SB 1296 Page 5
BON is authorized to terminate the program or may extend the probation for one additional
year.17
An approved program which has been placed on probation must disclose its probationary status
in writing to the program’s students and applicants.18
If an accredited program ceases to be accredited, the educational institution conducting the
program must provide written notice to that effect to the BON, the program’s students and
applicants, and each entity providing clinical training sites or experiences. It may then apply to
be an approved program.19
An approved program graduate who does not take the licensure examination within six months
after graduation must enroll in, and successfully complete, a licensure examination preparatory
course pursuant to s. 464.008, F.S.
The BON does not have rulemaking authority for the approval of nursing education programs,
except as to the format for submitting applications, the format for the annual report required to
be submitted by each approved program, and to administer the documentation of the
accreditation of nursing education programs.20 The BON may adopt rules relating to the nursing
curriculum, including rules relating to the uses and limitations of simulation technology and rules
relating to the criteria to qualify for an extension of time to meet accreditation requirements.21
The BON may not impose any condition or requirement on an educational institution submitting
a program application, an approved program, or an accredited program.22
Florida Nurse Education Program Graduate Passage Rates - 201923
In 2001 the Legislature created The Florida Center for Nursing (FCN) to establishing and
maintaining a database on nursing supply and demand and evaluate nursing program-specific
data for each approved program and accredited nursing education program to determine each
program’s student populations and NCLEX passage rates.
The FCN found that Florida’s NCLEX passage rates varied by program type, and by the
program’s classification as public or private. According to the FCN in 2019, “For the third year
in a row, Florida’s NCLEX passage rates for RN and LPN programs were at or near the
bottom of the United States and Territories.”(emphasis original).24 RN programs include
graduates of bachelor’s degree nurse (BSN) programs and associate degree nurse (AARN)
programs. As a group, BSN graduates performed the best, followed by licensed practical nurse
(LPN) graduates. AARN graduates collectively performed at the lowest level.
17
Section. 464.019(5), F.S.
18
Id.
19
Section 464.019(9)(b), F.S.
20
Section 464.019(8), F.S.
21
Id.
22
Id.
23
This is the most recent Florida Center for Nursing report available, as of this writing.
24
Florida Center for Nursing, Review of Florida Nurse Education Program Graduate Passage Rates on the National Council
of State Boards of Nursing Licensure Examination: Calendar Year 2019, April 2020, available at
https://floridasnursing.gov/forms/2019-nclex-pass-rates.pdf (last visited Mar. 28, 2021) (emphasis original).
BILL: CS/SB 1296 Page 6
Florida’s performance standard requires each program’s passage rate to be no more than 10
percentage points below than national passage rates of comparable degree programs in the same
calendar year. Nearly half of all Florida programs scored below the state’s performance standard,
including 89 AARN (54 percent), 66 LPN (47 percent), and 18 BSN (31 percent) programs.
In total, 364 nursing programs in Florida had graduates that took the NCLEX in 2019 for the first
time, including 98 public programs and 266 private programs. Among AARN and BSN
programs, the NCLEX passage rates of public programs were above the national totals. Public
LPN programs were below the national passage rate but above the state’s performance standard.
In contrast, the total passage rate for private programs in each category (e.g. LPN, AARN, BSN)
were below national rates with the LPN and AARN passage rates falling well below the state’s
10-percen