STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

SYLEM MAY FEARON, )

)

Petitioner, )

)

vs. ) Case No. 99-2121

)

DEPARTMENT OF HEALTH, )

BOARD OF NURSING, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, the Division of Administrative Hearings, by its duly-designated Administrative Law Judge, Mary Clark, conducted a formal administrative hearing in the above-styled case on August 19, 1999, by videoconference. Petitioner and court reporter were present at the videoconference site in Orlando, Florida; the Administrative Law Judge and Respondent's counsel and witness were present at the videoconference site in Tallahassee, Florida.

APPEARANCES

For Petitioner: Sylem May Fearon, pro se

7019 Hiawassee Oak Drive Orlando, Florida 32818

For Respondent: Lee Ann Gustafson, Esquire

Office of the Attorney General The Capitol, Plaza Level 01 Tallahassee, Florida 32399-1050

STATEMENT OF ISSUE

The issue for disposition in this proceeding is whether Petitioner, Ms. Fearon, is entitled to licensure by endorsement as a registered nurse in Florida. This requires a determination of whether her education is substantially equivalent to or more stringent than required in Florida, pursuant to Section 464.009, Florida Statutes, and Rule 64B9-3.008, Florida Administrative Code.

PROCEDURAL MATTERS

In response to an Order by the Board of Nursing denying her application, Ms. Fearon requested an administrative hearing, and the case was referred to the Division of Administrative Hearings where it proceeded as described above.

At the hearing Ms. Fearon testified in her own behalf and presented three documents in support of her application.

Petitioner's Exhibits nos. 1 and 3 were marked and received in evidence; Petitioner's Exhibit no. 2 was withdrawn at the Administrative Law Judge's suggestion as it was a duplicate document in Respondent's licensure file.

Respondent, the Board of Nursing, presented testimony of its executive director, Ruth Stiehi, Ph.D. and submitted a single exhibit, the licensure file for Ms. Fearon, which was received in evidence as Respondent's Exhibit no. 1 (composite exhibit).

The Transcript was filed on November 29, 1999; the court reporter also included Petitioner's Exhibit nos. 1 and 3, which

were apparently misplaced by the court reporter after the hearing. Copies of those exhibits will remain in the record; the originals are being returned to Ms. Fearon, as requested.

On December 2, 1999, counsel for the Board of Nursing filed a Proposed Recommended Order; on December 6, 1999, Ms. Fearon's letter requesting a result of her hearing was received.

FINDINGS OF FACT

1. Petitioner Sylem May Fearon (Ms. Fearon) was born in Jamaica, approximately 68 years ago. After being educated in Jamaica she emigrated to England to pursue an education for the practice of professional nursing.

2. Ms. Fearon took courses in geriatric nursing in England for two years, then proceeded to do a three-year general training program (1960-1963). After the general registered nursing education, she took courses in midwifery for two years, passed an examination, and was qualified as a certified nurse midwife in September 1965.

3. Approximately 32 years ago, Ms. Fearon responded to nursing recruiters from the United States; she emigrated to the United States and commenced working as a staff nurse in a hospital in Washington, D.C.

4. Since emigrating to the United States, Ms. Fearon has become a citizen. She took the examinations for nursing licensure in New York and Massachusetts and was successful in obtaining licensure in both states, as well as in Washington,

   D.C. She maintains current licensure as a registered nurse in Washington, D.C.

5. Approximately two years ago, Ms. Fearon moved to Florida and commenced application for licensure by endorsement as a registered nurse in this state.

6. Florida's and other states' nursing boards do not have reciprocity with each other in the sense that if you are licensed in one state you may also practice in others. Florida and other jurisdictions have licensure by endorsement which allows an applicant for licensure to demonstrate that he or she has passed an examination in another state and has the educational background that is substantially the same or more stringent than required by the state in which the applicant is seeking licensure. This allows an applicant to become licensed without having to take another examination but does not waive other requirements for licensure such as education.

7. After Ms. Fearon applied for licensure by endorsement in Florida, nursing board staff determined that she met all of the requirements except for some areas of her education. The Board of Nursing in Florida has developed guidelines to implement its broad rules on what specific education is required. When staff determines those guidelines are not met, the individual case is brought to the Board which then makes the ultimate decision. In Ms. Fearon's case, the Board accepted the deficiencies identified

   by its staff and entered the order which Ms. Fearon has challenged in this proceeding.

8. The staff and Board considered a transcript of

   
   

   Ms. Fearon's registered nursing education from the University of Sheffield School of Nursing and Midwifery, hereinafter referred to as the official transcript. Ms. Fearon also provided copies of a "Statement and Recommendation by Director of Nursing" dated July 20, 1967, hereinafter referred to as Petitioner's transcript, and a copy of correspondence from the Chesterfield School of Nursing dated May 2, 1968, which stated Ms. Fearon attended lectures in elementary psychology (8 hours), psychiatry (5 hours) and head injuries (2 hours), hereinafter referred to as the 1968 supplement. The official transcript includes coursework that is not listed on Petitioner's transcript, and there are discrepancies between the official transcript, Petitioner's transcript, and the 1968 supplement; however, these discrepancies did not prejudice Ms. Fearon, according to Dr. Stiehl, executive director of the Board.

9. According to the official transcript, Ms. Fearon's education at the Royal Hospital of Chesterfield in Derbyshire, England, consisted of the following coursework in hours:

   Theory Hours

   Anatomy and Physiology 42

   Personal and Communal Health 21

   First Aid 15

   Nutrition 8

   History of Nursing 2

   Elementary Psychology 8

   Bacteriology and Principles of Asepsis 15

   Theory of Nursing		66
   Demonstration and Practical Classes		103
   Bandaging		13
   Principle of Surgery and Surgical
   Nursing		15
   Principle of Medicine and Medical
   Nursing		19
   Operating Theatre Technique		3
   Gynecology and Introduction to
   Obstetrics		10
   Diseases of Ear, Nose and Throat		5
   Genito-Urinary Diseases		4
   Diseases of the Eye		3
   Lecture by Anesthetist		1
   Orthopaedics		4
   Pharmacology		4
   Communicable Disease		6
   Venereal Disease		4
   Pediatrics and Nursing of Sick
   Children		8
   Psychiatry		5
   Social Services		4
   Disease of the Skin		4
   Radiography		2
   Revision and Coaching Classes		10
   Practical/Clinical		Hours
   Childrens		375
   Female Surgery		487.5
   Male Surgery		637.5
   Ear, Nose and Throat		150
   Opthalmic		300
   Female Orthopaedic		75
   Male Orthopaedic		300
   Male Medical		412.5
   Female Medical		187.5
   Gynecology		300
   Theatre		412.5
   Casualty		300
   Private Patient Unit		150
   Relief Night Duty		225
   Preliminary Training	School	450
   Study Blocks		225

   
   

10. A nursing license is issued by the Board of Nursing for a general practitioner, i.e. the licensee can work in any area of nursing. Therefore, to practice safely, the licensee needs a

    basic theoretical underpinning in all the basic areas of nursing: medical, surgical, obstetric, pediatric, and psychiatric nursing. Hours spent in patient care is not equivalent to didactic study. Study of theory provides the proper theoretical base to make good clinical decisions.

11. The Board's guidelines establish these minimum standards that must be demonstrated before its staff may approve an applicant (education in hours):

    Subject	Theory	Clinical
    Medical Nursing	35	150
    Surgical Nursing	35	150
    Obstetric Nursing	20	70
    Pediatric Nursing	20	70
    Psychiatric Nursing	20	70

    Community Health Nursing NO SPECIFIED

    MINIMUM

    
    

12. Ms. Fearon's official transcript met the minimum requirements in Medical Nursing (theory and clinical), Surgical Nursing (theory and clinical), Pediatric Nursing (clinical only), and Community Health Nursing.

13. The official transcript documents only 5 hours of theory in Obstetric Nursing and no clinical hours. The official Transcript demonstrates 300 hours of clinical experience in "Gynecology"; however, gynecology cannot be substituted for obstetrics training. Gynecology and obstetrics training are not interchangeable. In gynecology the training looks at the female patient in totality and at a different set of disease processes than in obstetrics; in obstetrics the training focuses not only on the mother but the growth of the fetus and the health of the

    child. However, Dr. Stiehl reviewed Petitioner's Exhibit no. 3 (the midwife certificate) and determined that this documents the necessary training in obstetrics.

14. The official transcript documents only 8 hours of theory in Pediatric Nursing and no clinical hours. Ms. Fearon testified that her midwifery training covered pediatrics; however, it does not meet the requirements for theory and clinical training in pediatrics. Midwifery training covers the child from birth to age one; pediatrics covers children from birth to age 18.

15. The official transcript documents only 5 hours of theory in Psychiatric Nursing. The 1968 supplement demonstrates

    5 hours in Psychiatric Nursing and 8 hours in Elementary Psychology. Psychology cannot be substituted for psychiatric training. Basic psychology training looks at normal behavior; psychiatric nursing training deals with comparing normal with abnormal and with disease processes such as manic depression. The course in head injuries is not identified as training in psychiatry. Petitioner's transcript documents 12 weeks of clinical training in psychiatry, and the Board staff reviewer gave her full credit for the needed hours. (See worksheet Respondent's Composite Exhibit no 1.) Although Ms. Fearon asserted that she had psychiatric training in her midwifery program, it would not provide the necessary minimum education in psychiatric theory.

16. Ms. Fearon's documentation demonstrates deficiencies in psychiatric theory, pediatrics theory, and clinical training. Even if the information on Petitioner's transcript regarding psychiatric clinical experience is accepted, Petitioner still has not demonstrated sufficient theoretical education.

17. Ms. Fearon testified that she completed two years of geriatric nursing training. No documentation has been provided of what the content of the course was. Education for a lower level of licensure would not be considered as meeting the requirements for licensure as a registered nurse. Ms. Fearon also testified that she completed courses in order to sit

    for her U.S. licensing examination. However, the courses were not identified, and no documentation of the courses has been submitted.

18. Ms. Fearon did not document the requirements for licensure in New York in 1973, when she was first licensed in the United States. Instead she has responded to the staff's inquires with an effort to provide documentation of her education, most of which occurred over 35 years ago in a program which no longer exists.

    CONCLUSIONS OF LAW

    
    

19. The Division of Aministrative Hearings has jurisdiction of this action pursuant to Sections 120.569, 120.57 and 120.60, Florida Statutes.

20. Section 464.009, Florida Satutes, provides that in order to be licensed by endorsement in Florida as a nurse, the applicant must demonstrate either that she:

    1. Holds a valid license to practice professional or practical nursing in another state of the United States, provided that, when the applicant secured his or her original license, the requirements for licensure were substantially equivalent to or more stringent than those existing in Florida at that time; OR

       
       

    2. Meets the qualifications for licensure in Section 464.008 and has successfully completed a state, regional, or national examination which is substantially equivalent to or more stringent than the examination given by the department.

       
       

21. Ms. Fearon attempted to demonstrate eligibility for licensure under Section 464.009(1)(b), Florida Statutes. The Board agrees that she successfully completed a state examination substantially equivalent to or more stringent than the examination approved by the Board, but she must also demonstrate graduation from an approved nursing program. (See Section 464.008(2), Florida Statutes, and Rule 64B90-3.008, Florida Administrative Code.)

22. The Board defines an "approved nursing program equivalent" as a "nursing program conducted in a school, college or university outside the State of Florida which has been approved by the Board of Nursing in the jurisdiction in which it is located, if such Board exists, and which demonstrates that it

    meets the education criteria in Chapter 64B9-2 Rules." Rule 64B9-3.001(2), Florida Administrative Code.

23. The evidentiary basis for the Board's guidelines was explained briefly at the hearing by Dr. Steihl, as reflected in the findings of fact above. The evidence presented at hearing in Ms. Fearon's testimony, Dr. Steihl's testimony, the licensure file, and Ms. Fearon's documents, establishes that Ms. Fearon's documentation of her education still has deficiencies in pediatric nursing theory (lacks 12 hours of coursework) and psychiatric nursing (lacks 15 hours of coursework).

24. Ms. Fearon is understandably frustrated at the process of proving her fitness for licensure in Florida after a long successful career in nursing in the United States and a rich and varied educational background. She simply has been unable to sustain her burden of demonstrating that her education meets the Board's specific guidelines in two areas only.

25. Ms. Fearon now has the option of continuing to provide documentation regarding her hours of coursework in pediatric nursing and psychiatric nursing or seeking endorsement under Section 464.009(1)(a), Florida Statutes. Board staff is urged to assist Ms. Fearon in determining which option she should pursue. There is precedent for the Board's determination that a registered nurse licensed in New York State has met the requirements of Section 464.009(1)(a), Florida Statutes. In the case Jacinth E. Brown v. Board of Nursing, DOAH Case No. 82-0754,

Final Order entered February 22, 1983, the Board determined that in 1969 the requirements for registered nurse licensure in

New York were equivalent to or more stringent than Florida's requirements. Ms. Fearon's relevant year is apparently four years later, 1973, and it is possible that the same requirements were in effect in both states, with the same felicitious result.

RECOMMENDATION

Based on the foregoing, it is hereby RECOMMENDED:

That the Board of Nursing enter its Final Order denying Petitioner's application for licensure by endorsement without prejudice to her right to pursue her application as described above.

DONE AND ENTERED this 22nd day of December, 1999, in Tallahassee, Leon County, Florida.

MARY CLARK

Administrative Law Judge

Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

(850) 488-9675 SUNCOM 278-9675

Fax Filing (850) 921-6847 www.doah.state.fl.us

Filed with the Clerk of the Division of Administrative Hearings this 22nd day of December, 1999.

COPIES FURNISHED:

Lee Ann Gustafson, Esquire Office of the Attorney General The Capitol, Plaza Level 01 Tallahassee, Florida 32399-1050 Sylem May Fearon

7019 Hiawassee Oak Drive Orlando, Florida 32818

Ruth Stiehl, Executive Director Board of Nursing

Department of Health

4080 Woodcock Drive, Suite 202

Jacksonville, Florida 32207

Pete Peterson, General Counsel Department of Health

Bin A02

2020 Capital Circle, Southeast Tallahassee, Florida 32399-1701

Angela T. Hall, Agency Clerk Department of Health

Bin A02

2020 Capital Circle, Southeast Tallahassee, Florida 32399-1701

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within 15 days from the date of this Recommended Order. Any exceptions to this Recommended Order should be filed with the agency that will issue the final order in this case.

Docket for Case No: 99-002121

Orders for Case No: 99-002121