Deceit Allegations, Lawsuits Dog Florida For-Profit Nursing School

For-profit nursing colleges typically market their applications to individuals working in low-level jobs, individuals trying to enhance their life circumstances. Many promise a versatile, expedited training and a supportive surroundings, through which anybody who works onerous can succeed.

But too typically the colleges fail to ship on these guarantees. When that occurs, college students stand to lose tens of 1000’s of {dollars} in federal loans, the prospect to take a seat for his or her nursing licensure examination, and a profession many say they felt referred to as to since childhood.

This is the third story in our collection on for-profit nursing applications. As a part of our investigation, MedPage Today spoke with greater than a dozen present and former nursing college students, in addition to lecturers, nursing professors, and regulators.

In December 2019, Kim Bailey, a single mom working at an animal shelter, got here throughout an advert for HCI College’s accelerated affiliate diploma in nursing program on Facebook.

Bailey, a veteran, was fascinated by wounds and wished to turn out to be a wound care nurse.

She had accomplished her conditions for nursing at Palm Beach State College however utilized there and was rejected from its core nursing program twice. Wait lists should not uncommon at public and non-profit nursing colleges, however HCI’s accelerated program supplied rapid entry, accepted most of Bailey’s earlier credit, and would take solely 18 months to finish.

HCI College (initially Health Career Institute) was based in 1993 as a non-profit establishment to coach emergency medical service personnel, based on its website. It was reincorporated as a for-profit establishment in 2012, and bought by Florian Education Investors in 2013. That similar 12 months, the Florida Board of Nursing (BON) granted approval for HCI to open a nursing program.

On its website, the faculty at the moment advertises access to day and night lessons, monetary help for many who qualify, and 24/7 access to stay tutors. Importantly, for graduates, this system additionally offers eligibility to take the National Council Licensure Exam (NCLEX), which is required to turn out to be a registered nurse.

Bailey handed the doorway examination on her first strive. After utilizing her remaining G.I. Bill advantages and taking out a non-public mortgage, she enrolled and commenced lessons in HCI’s core program in August of 2020.

Rebecca Freeman, a former HCI pupil and contract help specialist, trying to make a “good quick profession change” was additionally drawn to the faculty for its comfort.

Because she had just lately earned a medical assistant certificates, she remembers being informed she might end the nursing program in simply 1 12 months.

“There was no ready record … You simply needed to take an entrance examination,” Freeman stated throughout a cellphone interview along with her lawyer’s public relations consultant current.

During her tour of the faculty, in September 2020, admissions officer Krystal Zimbaldi informed Freeman that the varsity’s cross charges on the NCLEX had been between 80% and 100%, and that it was accredited by the Accrediting Commission of Career Schools and Colleges (ACCSC) — a nationwide accrediting company.

After a cellphone name to her husband, Freeman enrolled that day.

Both Bailey and Freeman now say HCI crushed their goals of a nursing profession by not delivering what it promised. Freeman, Brittany Roberson, Bianca Viñas, and Tiffany King — all former HCI college students — sued the varsity on Dec. 2, 2022. Tresha Thompson, one other former HCI pupil, later joined them.

Their class action complaint charged HCI College, Florian Education Investors, and Steven Hart (chairman of HCI and CEO of Florian), with having “systematically imposed unfair and arbitrary obstacles” on college students to forestall them from graduating and taking the NCLEX.

In the meantime, Bailey “maxed out” her G.I. Bill credit; she nonetheless owes greater than $6,000 in personal loans and believes she owes $3,000 to the Department of Veterans Affairs for a housing stipend.

Bailey has not tried to sue the varsity or requested a refund. She put aside her dream of turning into a wound care nurse and continues to work at an animal shelter.

Freeman stated she has about $12,000 in out-of-pocket bills and owes about $20,000 in federal mortgage debt. She is at the moment repeating her total diploma from scratch at Indian River State College.

Both their tales are emblematic of the issues critics imagine underlie for-profit nursing applications.

Promises vs Reality

During her HCI orientation, one thing felt amiss, Freeman stated. She anticipated to listen to the “sport plan” by way of course expectations, and methods to use on-line task instruments, however “we weren’t actually oriented to something.”

Bailey stated that regardless of the promise of tutors and individualized help, when she began to wrestle along with her programs, nobody was available to assist. The one teacher who did provide help was solely ever free throughout Bailey’s work hours. Bailey remembers that that very same professor later refused to offer her an extension on a key task when she was within the hospital with COVID in a single day.

In her first semester, Bailey had been impressed with the simulated clinicals, and had drawn real-looking blood from a pretend arm. But after a number of weeks of simulated clinicals in her second semester, she arrived to seek out the teacher was on depart. Yet for almost a month, college students had been nonetheless required to point out up one full day every week for necessary research corridor, she stated.

“I used to be going loopy,” stated Bailey. “We’re paying a lot money … and there is not any teacher!”

Tuition was roughly $10,000 per semester, and the course was anticipated to take 5 semesters.

In early 2021, Bailey dropped out of this system.

Freeman, nonetheless, stated she was fortunate to land a medical rotation on the Weston, Florida department of the Cleveland Clinic, however that ended prematurely when the hospital terminated its relationship with HCI in the summertime of 2021. (A spokesperson for the Cleveland Clinic declined to touch upon any relationship with HCI on account of pending litigation.)

Also in the summertime of 2021, HCI applied what was referred to as “the 50% rule,” Freeman stated. On each proctored examination, college students needed to rating 50% or extra questions proper in every class along with scoring 80% or greater total on the examination, she stated. The catch: some classes had solely two or three questions. So a pupil might get one or two questions fallacious and fail the entire examination, she stated. And due to the brand new guidelines, a lot of her fellow college students had been “sliced out” of this system.

By December 2021, Freeman had survived the 50% rule, accomplished the required credit, scored 80% or greater within the core nursing curriculum, 70% or greater within the normal training programs, and handed the Assessment Technologies Institute predictor examination. In different phrases, she met all of HCI’s graduation requirements. Then, in the course of the “Capstone” portion of her remaining semester, the scholars had been required to take an exit examination. They had been informed neither the kind of examination nor the benchmark for passing. The examination was given at 7 p.m., after a full day of sophistication, Freeman stated.

A couple of hours later, an e-mail from the assistant dean of nursing popped up in her inbox, telling her she had failed the take a look at and wanted to repeat the semester. Freeman and some different college students who refused to repeat the course tried to enchantment the choice. According to the student handbook, she ought to have been allowed to retake the examination, Freeman stated.

They met with directors, however “it was the identical stone wall wherever you went,” Freeman stated. “‘Oh, we’re sorry about your luck.'”

Institutions submit names to the BON confirming particular person pupil’s commencement and their eligibility to take the licensure examination — in Freeman’s case, the NCLEX-RN. HCI gave no such permission to Freeman. It did ultimately enable her to take the NCLEX-PN and turn out to be a licensed practical nurse.

Pedro De Guzman, president and CEO of HCI College, disputes the claims made by former college students like Freeman and Bailey.

Regarding the shock nature of the exit examination format, that was a step the varsity took to “shield the integrity of our program,” and forestall dishonest, he stated.

As for the medical rotations, De Guzman stated the one time HCI had issue inserting college students was in the course of the pandemic, and he had no information of any rotations being changed into research halls.

Asked concerning the 50% rule, he wrote in a follow-up e-mail that “[a]ny idea taught within the semester or program could seem on any examination, whatever the course … The college students get 4 possibilities by the tip of the semester to display mastery (rating 50% or higher) on the ideas.”

Finally, with regard to complaints a few lack of help, he famous that the varsity provides on-line tutoring “24 hours a day, 7 days every week.”

“Sometimes the scholars aren’t pleased with the toughness of this system, however we do not make apologies for that,” De Guzman stated. “Because if … we made it simple as they acquired by way of and no one might cross [the NCLEX], then we would have a distinct drawback.”

Standards Plummet, Schools Multiply

The issues Bailey, Freeman, and different college students encountered could have resulted partly from coverage actions taken greater than a decade earlier.

About 5 years in the past in Florida, “you could not throw a stone with out hitting a nursing faculty, as a result of the requirements, the laws, had been so poor that nursing colleges had been popping up in all places,” Maria Flores-Harris, DNP, RN, president of Academic Partners Consulting, who labored within the state up till 2022, informed MedPage Today.

The story behind the explosion of nursing colleges in Florida, a lot of them for-profit, dates again to 2009, when the Florida legislature began making changes to the state’s Nurse Practice Act that made it simpler for brand spanking new nursing applications to open.

Previously, the regulation directed the Florida BON to “adopt rules” round, for instance, the minimal college {qualifications} or medical coaching required for a program to obtain preliminary approval from the board. It additionally allowed the BON to conduct web site visits to applications to evaluate high quality firsthand.

Under the brand new regulation, though the state’s BON nonetheless decided which colleges to open, which to watch, and which to shut, the Florida BON might now not set the factors for making such choices.

“It took away all of the tooth of the Board of Nursing,” stated Patricia “Polly” Pittman, PhD, professor of well being coverage and administration on the Milken Institute School of Public Health at George Washington University, whose research linked for-profit ownership of nursing schools to lower pass rates on nursing board exams.

The board accredited 231 new nursing applications from 2009 to 2013, almost doubling their numbers, based on a 2014 report from the Office of Program Policy Analysis and Government Accountability (OPPAGA).

The variety of nursing program graduates additionally shot up greater than 25% — from almost 12,000 in 2008-2009 to greater than 15,000 in 2012-2013, the report famous. But that was the purpose: lawmakers wished to mitigate the nursing scarcity, in addition to quiet complaints of bias from for-profit applications.

But there was an issue — NCLEX cross charges fell as increasingly nursing colleges opened, recalled Willa Fuller, BSN, RN, government director of the Florida Nurses Association. (To turn out to be a registered nurse within the U.S. or Canada, a nursing faculty graduate should first cross the NCLEX examination.)

In 2015, roughly 42% of all nursing applications in Florida had cross charges under required state requirements, based on a 2016 OPPAGA report. And nearly all of these applications opened after 2009.

Perhaps extra worrisome, based on Jessie Colin, PhD, RN, who served on the Florida BON from 2005 to 2015, was that the BON appeared to Colin to be unable to right the issue.

It would shut one failing program, solely to have it reapply below one other title or tackle. And the BON had no avenue below the laws to disclaim the appliance if this system met the legislature’s standards, Colin stated.

As a board member, it felt to her like “our fingers had been tied behind our backs.”

At the BON’s urging, the legislature in 2017 passed changes to the Nurse Practice Act, requiring {that a} terminated program wait a minimal of three years to once more search program approval “below its unique title or a brand new program title” — however different issues emerged.

For instance, having so many new nursing applications put strain on medical websites to serve increasingly nursing college students.

“There’s solely so many college students you possibly can burden nurses with once they’re making an attempt to work, and nonetheless be secure,” Fuller stated.

Not way back, Fuller stated, she acquired a name from a nurse involved a few recent graduate who had “by no means touched a affected person” and “by no means been in a hospital.” Fuller acknowledged that she and her colleagues additionally had studies of non-nurses, emergency medical technicians, and faculty directors educating nursing lessons.

“It can be like me going and educating a course to air site visitors controllers,” she stated.

Florida’s first-time NCLEX cross fee for 2022 was 63.9%, incomes it the final spot within the nation’s rankings for the sixth 12 months in a row.

Asked what would possibly reverse this decline, Fuller stated she hopes lawmakers will rethink the adjustments lawmakers made to the BON greater than a decade in the past, she stated.

When the legislature threw open the doorways to nursing program approval in 2009, Fuller believes the purpose was to churn out extra college students to answer an anticipated nursing scarcity.

“Imagine in the event that they stated that about docs,” Fuller stated. “Let’s simply open a medical faculty on each nook … People would discover that alarming.”

But advancing the sorts of reforms many nurse leaders suppose are wanted would require a significant shift within the picture the general public, and notably lawmakers, have of nurses and nursing faculty, she stated.

Nursing faculty is about greater than studying to do duties and take exams; it is about role-modeling and instilling a code of ethics. Nurses are additionally typically the primary to note critical issues and to intervene — by calling a doctor or springing to motion themselves. That particular person has to have the information and the medical judgment to know “what to do and when to do it,” Fuller stated.

This is not Nineteenth-century nursing, Fuller stated. “We’re not roaming the halls with a lamp simply making individuals really feel good.”

HCI College: Missing Clinicals, High-Stakes Exams

By law in Florida, if a program’s cross charges by first-time U.S. educated take a look at takers on the NCLEX fall greater than 10 share factors under the nationwide common for two consecutive years, this system is positioned on probation. Once on probation, a program has 1 12 months to satisfy minimal requirements or be “terminated,” though colleges that present progress could get an extension of 1 extra 12 months.

In their lawsuit, Freeman and the opposite plaintiffs allege that HCI allowed solely these college students with the best likelihood of passing the NCLEX to graduate in an effort to “artificially inflate” its NCLEX cross charges and forestall this system from being shut down.

As of February 2023, solely 9 graduates out of the 100 college students who had been anticipated to finish this system in December 2021 had taken the NCLEX, based on the lawsuit.

According to Freeman and the opposite plaintiffs, that wasn’t the faculty’s solely failing. Students really feel that HCI allegedly gamed the BON’s guidelines in a distinct method as nicely.

HCI has two Florida campuses: one in West Palm Beach and one in Fort Lauderdale. Curiously, in May 2018, HCI utilized to open a “new” program at its West Palm Beach campus, itemizing the identical instructors, curriculum, amenities, course catalog, and nursing director as an present program that had been granted BON-approval 5 years earlier. According to the scholars’ grievance, HCI didn’t acknowledge its present program — which had been positioned on probation in 2018 — in its software for the brand new one.

Adding yet another wrinkle to the story, based on the students’ complaint, in March 2018 — 2 months previous to making use of for approval of its new program — HCI introduced an administrative problem to the BON, arguing that the board had “improperly calculated” its cross charges. Had the board used HCI’s “most well-liked calculation methodology,” it could nonetheless have been positioned on probation, the scholar’s grievance asserted.

In October 2018, maybe unknowingly, the BON accredited HCI’s “new” program on the West Palm Beach campus, regardless of a 2012 law that requires the board to disclaim approval of any program if the applicant has an present program that’s already on probation. Less than a 12 months later, on Aug. 7, 2019, based on the student’s complaint, the BON pressured the unique program to shut for failing to acquire accreditation from a specialised nurse accrediting company by the deadline — basically a 5-year window — established below a 2014 law. Why the BON accredited HCI’s new program regardless of its old program having been on probation, and arguably on the street to closure, is unclear.

Eileen Connor, JD, president and director of the Project on Predatory Student Lending, who represents the scholars suing HCI, stated the board seems to have the “energy and duty” to watch applications however lacks the assets to take action successfully.

Importantly, as soon as HCI’s “new” program was accredited, its West Palm Beach campus acquired a brand new NCLEX code. This purchased the faculty time — 5 extra years — to earn programmatic accreditation, the grievance famous.

Then, within the spring of 2019, HCI College — then referred to as the Health Career Institute — requested a reputation change. The Florida Commission for Independent Education accredited the request.

In September 2019, HCI started to enroll college students in its “new” program below its new title: HCI College. Each newly enrolled pupil at HCI College was given a state-mandated disclosure type evaluating HCI’s cross charges to the nationwide cross fee for the NCLEX in 2018, which was 85.11%. That similar 12 months, there have been zero college students from HCI who took the licensure examination, the shape famous. HCI additionally indicated that in 2018, this system was “not on probation.”

With its new NCLEX code, Connor informed MedPage Today, HCI was given “a clear slate once they truly had horrible passage charges, horrible completion charges, and so they did not have to inform anybody that.”

De Guzman, HCI’s president, disagrees with Connor’s assertions. De Guzman defined that when a program is given a brand new NCLEX code, “you solely can disclose what you will have as a historical past of that quantity”; nonetheless, cross charges for the unique program below the prior NCLEX code “are nonetheless a matter of file,” he stated.

“We did disclose our total historical past to the scholars once they got here in [and] enrolled,” he informed MedPage Today in a cellphone interview throughout which a press consultant was current.

(Zimbaldi, HCI’s admissions officer at the moment, didn’t reply to interview requests from MedPage Today.)

For 2018, the “old NCLEX” cross fee for the West Palm Beach campus was 54.93%, De Guzman wrote in a follow-up e-mail. The 2018 NCLEX cross fee for Florida was 67.52%, he famous. Even whereas on probation, HCI’s cross charges “weren’t embarrassingly low in comparison with loads of different colleges within the state,” De Guzman stated over the cellphone.

“Nursing colleges are robust, and we’re happy with what we have been capable of obtain this previous 12 months with an 89% cross fee,” which “places us within the prime 10% within the state” throughout all program varieties — whether or not for-profit, non-profit, or public, he informed MedPage Today.

The BON has not responded to a number of requests from MedPage Today to debate its oversight of nursing applications or its interactions with HCI.

Can Florida Ever Recover?

The story of HCI represents only one for-profit nursing program. However, for-profit establishments in Florida have had their share of difficulties. For one factor, greater than half of the nursing colleges alleged to be concerned within the pretend diploma scheme dubbed Operation Nightingale are for-profit establishments.

In 2022, the gap in first-attempt NCLEX pass rates between for-profit RN applications and non-profit RN applications within the state was greater than 25 share factors — 52.71% versus 78.94% — based on a Florida Center for Nursing report revealed in January.

While these are “very low” numbers, stated Rayna Letourneau, PhD, RN, government director of the Center for Nursing, not each for-profit establishment is low-performing, she pressured.

In northwest Florida, for instance, for-profit applications had first-time cross charges considerably greater than these within the south and south-east components of the state. Notably, the regions with the greatest number of nursing programs also had the lowest pass rates.

But NCLEX cross charges inform just one a part of the story, stated Connor, of the Project on Predatory Student Lending.

To focus solely on test-takers is to have a look at the fallacious denominator, Connor informed MedPage Today. Pass charges exclude college students who do not graduate or take the NCLEX, however are nonetheless left with debt, she stated. Connor stated regulators must also observe and make use of total completion and dropout charges when evaluating a program’s efficiency.

Specialized nursing accreditation is an indicator of a program’s total efficiency that includes a extra rigorous evaluation than board approval and even another kinds of accreditation. Nursing accrediting companies, of which there are three, share the purpose of creating constant requirements throughout all applications.

There isn’t any “blanket” rule that every one for-profit colleges are underperforming colleges, Fuller stated. Longstanding for-profit establishments carry out nicely, notably these with specialised nursing accreditation, stated Fuller, as a result of they “observe these requirements that we adopted up to now.”

It seems it was the dearth of specialised accreditation that pressured HCI’s unique nursing program to shut in 2019. To date, neither HCI campus has acquired specialised nursing accreditation.

Data from 2020 by way of 2022 present cross charges for these accredited applications which are persistently greater than these with out this distinction, Letourneau stated.

However, as our MedPage Today investigation has proven, even accredited applications generally fail.

Connor helps the concept of requiring programmatic accreditation however stated there needs to be a “stricter timeline for attaining it.”

Some colleges are unlikely to acquire accreditation however apply anyway, then slow-walk the precise evaluation course of. In the interim, they take in giant quantities of scholars’ tuition and federal mortgage {dollars}. “And it is that point that’s actually hurting the [student] inhabitants that is getting lured into these colleges,” she stated.

For Fuller, rebuilding the career means rethinking previous errors. “We wish to see the regulation simply put again in place the best way it was,” she stated, referring to the Nurse Practice Act legislation in place previous to 2009, including that she would additionally wish to see an incorporation of necessities for accreditation.

Letourneau agreed that one thing wants to alter. “We want extra certified nurses. That does not essentially imply that we’d like extra nursing teaching programs,” she stated.