Congress Getting the Message about Need for Highly Skilled Nurses

Health care advocates have long warned about a looming shortage of nurses that threatens to undermine the health and health care of all Americans. Now, as Congress debates an overhaul of the nation's health care system, it appears that lawmakers are getting the message.

    • August 31, 2009

Health care advocates have long warned about a looming shortage of nurses that threatens to undermine the health and health care of all Americans.

Now, as Congress debates an overhaul of the nation’s health care system, it appears that lawmakers are getting the message.

Both the House of Representatives and the Senate are considering legislation that would reauthorize funding for the Nursing Workforce Development programs under Title VIII of the Public Health Service Act, the primary source of federal funding for nurse education programs. The Act has not been fully reauthorized in more than a decade.

One bill under consideration in both chambers would also modernize existing law to expand the numbers of advanced practice nurses, and the pending appropriations bill would help to increase all levels of the nursing workforce. Still, consumer advocates say pending legislation in both chambers could go further in curbing the looming shortage.

“As they work to reform our health care system, House and Senate lawmakers are taking some key steps to curb the coming nursing workforce shortage,” said Winifred Quinn, M.A., Ph.D., senior legislative representative at the Center to Champion Nursing in America, a joint initiative of the Robert Wood Johnson Foundation, AARP and the AARP Foundation. “More than just addressing a shortage of nurses, these provisions would prepare nurses with the advanced skills they need to meet America’s health care needs.” The shortage looms as our population ages and more patients require complex health care.

Nursing Shortage on Horizon

The current economic climate has mitigated the effects of the nursing shortage. Because of the recession, more nurses are postponing retirement or adding more hours to their schedule—making jobs for nurses in some parts of the country harder to find.

But as the recession lifts, nurses—who are graying along with the rest of the population—will begin to retire en masse, leaving an aging population without enough nurses to meet its health needs. In short, demand for nurses will far outstrip supply in coming years. And when nurses are stretched too thin, the quality of patient care suffers.

Exacerbating the situation is the fact that there are not enough nurse educators in place to prepare the next generation of nurses. Practicing nurses are reluctant to move into academia, where education requirements are higher than in clinical settings but where salaries are lower. And those who do make the switch often find themselves at institutions that lack the resources needed to accommodate aspiring nurses. Nursing schools, in fact, are turning away tens of thousands of qualified applicants every year—rejecting the very people who are capable of ending the shortage.

Pending Bills Could Help Improve Access to Highly Skilled Nursing Workforce

Health care reform legislation pending in Congress could go a long way toward remedying the problem, nursing advocates say.

Three House committees approved legislation in July that would create a mandatory funding stream over 10 years to provide money for health care professionals, including Nursing Workforce Development programs. Along with annual appropriations funding, authorization levels for the programs would total $271 million in the first year after passage and would increase annually over the following decade.

The House bill—called America’s Affordable Health Choices Act—would also change the Public Health Services Act so that it would increase loan repayment benefits for nursing students and faculty; remove the cap on awards for nursing students pursuing a doctoral degree; and make nurse-led health centers eligible for government funding.

In the Senate, the Health, Education, Labor and Pensions Committee approved its own version of health care reform legislation on July 15. The Senate bill would authorize $338 million for Nursing Workforce Development programs, but does not create a mandatory funding stream. Like the House bill, the Senate bill includes new legislative language designed to curb the looming nursing shortage.

Both bills would also lift a 10 percent cap on the amount of money that can be spent to support doctoral nursing students.

The House version of the bill has clearer language expanding the role nurse practitioners can take in leading roles in providing primary care and increases the payment rate for nurse midwives for covered services.

“We are just ecstatic that lawmakers are taking notice of the important role nurses play in the health care delivery system,” said Suzanne Begeny, Ph.D, R.N., director of government affairs at the American Association of Colleges of Nursing.

But both bills could go do more to address the looming nursing workforce shortage, Begeny said. As the measures move through the legislative process, she hopes lawmakers will adopt more provider-neutral language to ensure that nurse practitioners and other advanced practice registered nurses can practice to the full extent of their ability.

She would also like to see the addition of two provisions to pending health care legislation: a measure that would authorize formula grants to nursing schools and one that would modernize the way Medicare funds nursing education to provide more federal dollars for graduate nursing education in clinical settings. Neither provision is included in either the House or Senate versions of health reform bills, but both items would go far in addressing the shortage of nurse faculty, she said.

Congress Sets Aside New Funding for Nurse Education Programs

Despite uncertainty over the outcome of the health care debate, nursing and consumer advocates are thrilled with actions taken by Congress so far this year to bolster the nursing workforce.

In February, President Obama signed into law an economic stimulus package that included $200 million for nursing and other health care workforce development programs and $250 million for job training and placement programs in high growth jobs like nursing, according to the Center to Champion Nursing in America.

Some of that money has already been put to use. On July 28, the Department of Health and Human Services released the $200 million in health care training funding, $39 million of which is targeted at nurses and nurse faculty. And on August 12, the Department announced the release of $13.4 million for loan repayments to nurses who agree to practice in facilities with critical shortages and for schools of nursing to provide loans to students who will become nurse faculty.

After enacting the stimulus package, Obama signed into law the fiscal year 2009 budget, which included increases of nearly 10 percent for nursing education programs and 46 percent for nurse faculty loan-repayment programs, according to the Center. He also submitted a budget proposal for fiscal year 2010 that included more funding for programs designed to expand the nursing workforce.

Congress appears to agree with Obama’s funding plans. In July, the House approved an appropriations bill providing $263.4 million for nurse education programs, representing a 54 percent increase over the $171 million spent in fiscal 2009. The Senate Appropriations Committee passed its version of the bill on July 30. It included $217 million for nurse education programs. The bill awaits action on the Senate floor. House and Senate lawmakers will negotiate differences in conference committee.

“Congress in general has gotten the message that nurses are important to health care reform,” said Polly Bednash, Ph.D., R.N., F.A.A.N., chief executive officer and executive director of the American Association of Colleges of Nursing.

For more information on legislation affecting the nursing workforce, visit the Center to Champion Nursing in America and the American Association of Colleges of Nursing.