ALBANY, N.Y. (AP) — Medical licensing officials in multiple states are scrambling to stop nurses with fraudulent academic credentials from caring for patients, after three Florida schools were accused of selling thousands of bogus diplomas.

New York regulators told 903 nurses in recent weeks to either surrender their licenses or prove they were properly educated. Delaware and Washington state officials have yanked dozens of nursing licenses. Texas filed administrative charges against 23 nurses. More actions in additional states are expected.

In some cases, lawyers for the nurses contend states are questioning the credentials of caregivers who earned diplomas legitimately. But there’s wide agreement in the industry that nurses with fraudulent degrees need to be rooted out.

“The public needs to know that when they’re the most fragile, when they’re sick, when they’re in a hospital bed, that the individual who is at their bedside has gone through the required training,” said Jennifer Mensik Kennedy, president of the American Nurses Association union.

States are acting in the wake of Operation Nightingale, a federal investigation into what officials say was a wire fraud scheme in which several now-closed Florida nursing schools sold phony nursing diplomas and transcripts from 2016 to 2022. Twenty-five defendants, including school owners and alleged recruiters, have been charged, U.S. Attorney for the Southern District of Florida Markenzy Lapointe announced in late January. Those cases are pending.

About 7,600 students paid an average of $15,000 for bogus diplomas, according to prosecutors. Around 2,400 of those people then passed a licensing exam to obtain jobs as registered nurses and licensed practical nurses or vocational nurses in multiple states, prosecutors say.

How did so many test takers pass without the required classroom and clinical work? In some cases, they were experienced L.P.N.s seeking to become R.N.s. Some had been health care providers in other countries.

The nurses got jobs across the country, including at a hospital in Georgia, Veterans Affairs medical centers in Maryland and New York, a skilled nursing facility in Ohio, and an assisted living facility in New Jersey, according to court filings.

Students came not only from Florida, but also New York, New Jersey, Pennsylvania, Texas and Delaware. Many of the students took their licensing exam in New York, where they can sit it multiple times, according to investigators.

Investigators identified the Florida nursing schools as the Palm Beach School of Nursing; Siena College, a school in Broward County that wasn’t related to the college of the same name in New York; and the Sacred Heart International Institute, which was also based in Broward County and had no relation to a university with a similar name in Connecticut.

It was not entirely clear how many of the roughly 2,400 nurses with credentials from these schools are currently employed, or where.

Federal officials shared information so states could pursue nurses with phony academic credentials. Some states have taken action.

The Washington State Nursing Care Quality Assurance Commission rescinded the R.N. licenses of 17 people and denied license applications for four. The Delaware Board of Nursing annulled 26 licenses. The Georgia Board of Nursing asked 22 nurses to voluntarily surrender their licenses.

The 23 nurses facing possible license revocations in Texas can continue working while their disciplinary cases are pending. Texas Board of Nursing general counsel James “Dusty” Johnston said more charges could come as officials develop “the necessary information for each individual.”

A spokesperson for Veterans Affairs said it removed 89 nurses “from patient care” nationwide last year immediately after being notified by federal officials. The agency has not found any instances of patients being harmed.

New York’s Office of the Professions posted on the state education department’s website that it expects some of the 903 licensees who attended the schools “did, in fact, attend required hours and clinicals and are properly licensed.” Those people are being asked to have a qualified nursing program submit verification.

Attorneys for some of the nurses in New York and Georgia say nurses who legitimately earned diplomas are getting caught up in the investigation.

“There are obviously people who bought transcripts who are fraudulent and should not be practicing nursing under any circumstances,” said Atlanta attorney Hahnah Williams. “But there are also people who went to those schools legitimately and did nothing wrong. And they are somehow being lumped together with the fraudulent nurses.”

Williams said her clients are hardworking immigrants who went to schools that were accredited at the time and have since worked for many years without incident.

Similarly, attorney Jordan Fensterman in New York said he has clients who attended classes at one of the schools to finish up their R.N. degrees and then worked during the pandemic. He said those nurses deserve due process now.

The state board actions are taking place as hospitals across the nation try to deal with chronic staffing challenges.

“Hopefully, the number is smaller once the authorities sort things out,” said Kennedy, the American Nurses Association president.

RALEIGH, N.C. (AP) — Lynette Hardaway, a zealous supporter of former President Donald Trump whose death had prompted widespread speculation over its cause, died earlier this month of a heart condition, according to a death certificate obtained Monday by The Associated Press.

Known by the moniker “Diamond” of the conservative political commentary duo Diamond and Silk, Hardaway, 51, died Jan. 8 of heart disease due to chronic high blood pressure.

Hardaway and her sister, Rochelle “Silk” Richardson, found internet stardom as Black women who ardently backed Trump during his 2016 presidential campaign. After making several campaign appearances with the former president, the two leveraged their notoriety to land regular commentator roles at Fox News. Their promotion of coronavirus falsities eventually got them dropped, but they landed at the far-right cable and digital media platform Newsmax.

The cause of Hardaway’s death, which was not released by the family, had become a topic of widespread speculation. A torrent of social media users suggested COVID-19 was to blame.

Many of the posts were based on an unsourced, and since-deleted, online report from November that claimed Hardaway had been hospitalized with COVID-19. Both Diamond and Silk vehemently denied that the virus had put Hardaway in the hospital.

COVID-19 was not listed as a cause or contributing factor on her death certificate, which was provided to the AP by the Hoke County Register of Deeds and was signed by a local doctor. No autopsy was performed.

A memorial ceremony held in Fayetteville, North Carolina, and streamed online Saturday renewed speculation when Richardson suggested her sister’s death was somehow linked to the COVID-19 vaccine. She insinuated Hardaway may have been “poisoned” by another person who had been vaccinated, amplifying the false notion that recipients can affect those around them.

At the memorial, Richardson mentioned people “dying suddenly,” a reference that has become shorthand among some anti-vaccine activists for deaths they say were caused by COVID-19 shots, despite studies showing the vaccines are safe and effective.

Joined on stage at the memorial by Trump, Richardson said her sister died after returning to her North Carolina home from a relative’s birthday celebration. Richardson noticed her sister looking strange and Hardaway suddenly said: “I can’t breathe,” Richardson recalled. She and her husband performed CPR on the kitchen floor as they waited for emergency services.

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Hannah Schoenbaum is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

WASHINGTON (AP) — U.S. health officials want to make COVID-19 vaccinations more like the annual flu shot.

The Food and Drug Administration on Monday proposed a simplified approach for future vaccination efforts, allowing most adults and children to get a once-a-year shot to protect against the mutating virus.

This means Americans would no longer have to keep track of how many shots they’ve received or how many months it’s been since their last booster.

The proposal comes as boosters have become a hard sell. While more than 80% of the U.S. population has had at least one vaccine dose, only 16% of those eligible have received the latest boosters authorized in August.

The FDA will ask its panel of outside vaccine experts to weigh in at a meeting Thursday. The agency is expected to take their advice into consideration while deciding future vaccine requirements for manufacturers.

In documents posted online, FDA scientists say many Americans now have “sufficient preexisting immunity” against the coronavirus because of vaccination, infection or a combination of the two. That baseline of protection should be enough to move to an annual booster against the latest strains in circulation and make COVID-19 vaccinations more like the yearly flu shot, according to the agency.

For adults with weakened immune systems and very small children, a two-dose combination may be needed for protection. FDA scientists and vaccine companies would study vaccination, infection rates and other data to decide who should receive a single shot versus a two-dose series.

FDA will also ask its panel to vote on whether all vaccines should target the same strains. That step would be needed to make the shots interchangeable, doing away with the current complicated system of primary vaccinations and boosters.

The initial shots from Pfizer and Moderna — called the primary series — target the strain of the virus that first emerged in 2020 and quickly swept across the world. The updated boosters launched last fall were also tweaked to target omicron relatives that had been dominant.

Under FDA’s proposal, the agency, independent experts and manufacturers would decide annually on which strains to target by the early summer, allowing several months to produce and launch updated shots before the fall. That’s roughly the same approach long used to select the strains for the annual flu shot.

Ultimately, FDA officials say moving to an annual schedule would make it easier to promote future vaccination campaigns, which could ultimately boost vaccination rates nationwide.

The original two-dose COVID shots have offered strong protection against severe disease and death no matter the variant, but protection against mild infection wanes. Experts continue to debate whether the latest round of boosters significantly enhanced protection, particularly for younger, healthy Americans.