How Does This Happen?

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Many of you have read about the more than 7,600 fake RN and LPN nursing diplomas issued by three South Florida-based nursing schools: Siena College in Broward County, Fla., Palm Beach School of Nursing in Palm Beach County, Fla., and Sacred Heart International Institute in Broward County. Up to 2800 students receiving these degrees could have successfully passed their licensing exams and may be working. Some states are beginning to take action and are revoking licenses.

The bigger question is, how does this happen? As a long-time resident of the State of Florida and graduate of the University of Florida, I have watched the impact of a change in state statutes in 2014 that ultimately has led to limited oversight of nursing programs in the state. Before the passage of this legislation, the Florida Board of Nursing had complete oversight over both new and existing nursing programs. Board members asked tough questions of anyone wanting to start a program. They reviewed curriculum and faculty credentials. The Board required letters of commitment from health systems about giving students clinical space. Programs were quickly placed on probation when passage rates on NCLEX dropped below national averages, and action plans were required. This oversight was felt too restrictive by for-profit schools anxious to set up shop in the state.  Legislators then passed new state statutes.

The Florida Board of Nursing now advises consumers on its website that it is not authorized to conduct site visits, and oversight of approved nursing education program quality measures is limited by Florida law. All concerns or complaints about approved nursing education programs in Florida should be directed to the Commission for Independent Education at: www.fldoe.org/cie

The outcomes have been alarming. Florida has the country’s lowest pass rate on NCLEX at 64.7%. There is a striking difference with school types, as 83.77 percent passed the exam at state public schools, compared to the 54.82 percent pass rate in private institutions. Many of these private programs, despite multiple attempts, never achieve accreditation. They are run like businesses and cycle through program directors and faculty.

Most health systems in the state have been reluctant to hire new graduates from unaccredited programs. But with the shortage of nurses, there is less focus on where the nurse graduated from and more on whether they have a current license. To complicate the situation further, Florida is part of the multistate licensure compact.

At the time of the legislation, Florida nurse leaders testified and aggressively fought against changes to the law to no avail. The leaders worried about scenarios such as the one happening now. You can follow the money in exploring how things like this happen with the campaign donations made to legislators by parties with vested interests in seeing the law changed. What happened in Florida is a cautionary tale for other states – education matters and oversight matters.