Florida’s Nurse Education Expansion Creates Failing Programs

Former nurse Anna Small says predictions of a nurse shortfall in Florida haven’t materialized. (Photo by Julie Branaman/FCIR)

Former nurse Anna Small says predictions of a nurse shortfall in Florida haven’t materialized. (Photo by Julie Branaman/FCIR)

By Steve Miller
Florida Center for Investigative Reporting

Laws passed in recent years to boost the number of nurses in Florida have resulted in more nursing education programs on probation and more nursing graduates failing the national competency examination.

Measures passed unanimously by the Florida Legislature in 2009 and 2010 allowed colleges and trade schools to open nursing programs without the scrutiny of the state’s 13-member Board of Nursing, which for years has assessed and approved proposed nurse education programs.


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The bills increased the number of shorter-term nursing education programs, adding 100 new programs through the end of last year, from 181 to 281. These two-year and certificate programs are aimed at getting nurses out of school and into the system. Meanwhile, the percentage of bachelor’s programs for nurses dropped.

Many of the lower-level programs were added by for-profit, private schools that advertise degrees and certifications for a set price.

Today, 11 of the programs on probation went online in 2011 or later, an analysis of state records by the Florida Center for Investigative Reporting found. Eighteen of the programs are run by for-profit schools, and all of them are two-year and certificate programs.

The state’s Department of Health declined to identify the number of programs on probation or whose licenses have been removed since 2006, before the legislation was passed. It claims it doesn’t keep the data.

The legislative retooling beginning in 2009 allowed less-accomplished education programs to open, often exposing students to an educational system that has an increasingly unsavory reputation.

“The universities lack the resources to handle that many more students, and the for-profit schools take them,” said Ann-Lynn Denker, a member of the state Board of Nursing. “And they tend to take students that don’t always have good potential, or didn’t have the grades to make these other schools.”

Legislation to revamp the nursing school licensing process was fueled by a perception that the board was too deliberate and bureaucratic.

“We were getting complaints that people wanting to get into nursing school weren’t able to get in,” said state Sen. Denise Grimsley, who was a state representative when she sponsored both the 2009 and 2010 bills. Prior to the new laws, the Board of Nursing was blocking private and community colleges from adding nursing programs for “silly things like the director’s office being painted the wrong color,” Grimsley said.

Now, though, there is a fear that students may not be getting the best education as they take out large students loans to pay for what may end up being a worthless degree.

“Florida doesn’t need more associates degree nurses,” Denker said. “These people don’t have to go $100,000 into debt. Community colleges offer programs that are cheaper and offer a way for a student to move on into a bachelor’s program if they want to down the line.”

Some operators of older for-profit schools, which often fail to meet state standards, blame the new law for some of their own troubles.

“The new laws hurt the ability of more established schools to get students,” said Rosemarie Solomon, who since 2003 has run a series of nursing schools called Rose Training Institute, with locations in Kissimmee, Jacksonville and Winter Park. “And the students we could get were not always the best.”

The state shuttered three of Solomon’s medical services schools in 2012 after she failed to file the requisite paperwork to keep them updated. The Rose Training Institute in Kissimmee remains open, although it has no website and is on probation because its graduates aren’t passing the national nursing exam at a satisfactory rate.

Late last month, Ernesto Perez, chief executive officer and co-founder of the for-profit Dade Medical College, resigned after Miami-Dade County prosecutors charged him with perjury for allegedly failing to disclose prior arrests in an application for a government appointment. The school’s operations in Hollywood and Miami are both on probation, and Perez is also being investigated by the state in connection to land deals he obtained for some of his campuses.

The operator of the Health Education Training School in Miami, Luc Gayot, said his school is doing fine and denied that it is on probation, although the state lists it as so. Through September, five graduates of the training school have taken the state nursing test to be a certified nursing assistant. None of the graduates have passed.

Several other schools that are currently on probation declined to comment for this story.

Grimsley, who is also a certified nurse, said that the fact that these schools are on probation means the system is working: “There are always going to be bad players, and the probation aspect gives us an ability to weed out those bad players.”

State law requires nursing schools to have passing rates close to the 89 percent national average. The state Board of Nursing places programs on probation if the school’s average examination scores fall 10 percent below the national average for two consecutive calendar years. The laws passed in 2009 and 2010 made it easier for a program to get off probation; it previously took two years of acceptable test passage rates, but now one year is enough.

Advocates of the changes claim the board of nursing was saddled by bureaucracy as more nurses were needed and took too long to approve applications for new programs.

“The Board of Nursing wasn’t keeping up with the applications to the degree that the nursing shortage needed to be addressed,” said Mark Anderson, a consultant and lobbyist. His clients incl`1ude Education Management Corp., which operates nursing schools in its South University locations in Tampa and Royal Palm Beach.

Last year a former recruiting manager at Education Management Corporation filed a federal whistle-blower suit alleging the company, along with South University, routinely misled students about tuition costs and future job prospects. The suit specified alleged fabrications about the accreditation level of South University’s nursing program. The company has denied the allegations.

Since 2009, the pass rate for graduates in Florida on the national test for nurses has dropped from 88 to 85 percent as the national average passage rate has increased from 88 to 91 percent.

“Everyone is aware of that,” said Martha DeCastro, vice president of the Florida Hospital Association. “It’s clearly an issue that needs to be addressed, and I think it will be in the next session.”

Some believe the drop in test scores is due to a watered-down nursing education system in Florida that is not preparing students for their jobs.

“The premise behind the legislation was that if a program was successful, it will survive and that everyone has the right to offer all types of programs,” said Mary Lou Brunell, head of the Florida Center for Nursing, which was created by the Legislature in 2001 to analyze the state’s alleged nursing shortage. “What was missing is the impact on students as well as a shortage of faculty to teach these new students.”

The bills, supported by lobbying money and lawmakers with campaign contributions from the education industry, claimed to address a dramatic need for more nursing education curriculums in Florida.

“There is…no shortage of potential nurses in Florida,” a legislative analysis announced in 2010.  Instead, the report cited figures from the Florida Center for Nursing that showed Florida nursing programs turned away over 12,000 applicants because programs were at capacity.

But for years, the Florida Center for Nursing has been predicting shortages, claims that are repeated in news reports. Instead, nursing levels tend to be cyclical, said Anna Small, a Tampa lawyer and past vice president of the Florida Nurses Association. “Actually, if you look at the numbers right now, I don’t think this shortage is bad, because there are many people in the workforce who don’t want to be,” said Small, herself a licensed nurse. Many nurses stop working as they age due to the strain of floor duty and 12-hour shifts.

With the still-struggling economy, which has hit Florida substantially more than many other states, nurses are carrying households hobbled by out-of-work spouses and other economic factors.

“When I graduated from nursing school in the late 90s, you could name the place you wanted to work. You could pick your floor,” Small said.

Grimsley promised follow-up legislation that could address the issue of poorly performing – and sometimes exploitative – for-profit schools by requiring federal accreditation of nursing programs.

Accreditation will be the centerpiece of that new legislation, mandating that all nursing programs are certified by a nationally recognized endorser, an often expensive requirement that could weed out some of the lesser programs.

Anderson, the lobbyist, said most rules as far reaching as the earlier measures requires tweaking down the line.

“As with anything when you pass a piece of legislation there will be follow-ups and some glitches,” he said.

Small, the former VP of the Florida Nursing Association, said “when you are looking the problem, something may sound great in theory, but in practice, you may end up turning out some nurses that aren’t that well educated.”

The Florida Center for Investigative Reporting is a nonprofit news organization supported by foundations and individual contributions. For more information, visit fcir.org.