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Testimony
of Janet D. Allan, PhD, RN,
on Behalf of the
American Association of Colleges of Nursing
On Fiscal Year 2001 Appropriations forNursing
Research and Education April
5, 2000
Before
the House Appropriations Subcommittee
on Labor, Health and Human Services,
Education and Related Agencies Good
afternoon, Mr. Chairman and members of the Subcommittee. I am Janet D. Allan,
PhD, RN, Dean of the School of Nursing at the University of Texas, Health Sciences
Center - San Antonio. On behalf of the American Association of Colleges of Nursing
(AACN), I greatly appreciate this opportunity to present AACN's funding recommendations
for nursing research and education programs within the jurisdiction of the Subcommittee.
AACN represents over 540 baccalaureate and graduate nursing education programs
in senior colleges and universities across the United States. Mr.
Chairman, I thank the members of this Subcommittee for supporting fiscal year
2000 funding for the National Institute of Nursing Research (NINR) at NIH at the
full Professional Judgment Budget level. AACN also greatly appreciates the leadership
of Congressman Henry Bonilla and this subcommittee over the years for funding
nursing and health professions education programs to benefit the health and well
being of the Nation. Our
appreciation extends to the Subcommittee's leadership regarding the Health Resources
and Services Administration's (HRSA) Health Profession Programs, particularly
the Nurse Education Act (NEA) (Public Health Service Act Title VIII) and Scholarships
for Disadvantaged Students (SDS) programs (in PHSA Title VII). A
table containing AACN's funding priorities for FY 2001 is at the end of this statement.
National
Institute of Nursing Research Mr.
Chairman, I thank you and the Subcommittee for supporting NINR with a significant
funding increase for Fiscal Year 2000 at an adjusted level of $89.522 million.
This is $19.734 million or 28% more than the FY 1999 level. The entire nursing
community is grateful for this increase. The estimated success rate for NINR research
project grants for FY2000 rose to 24%, compared to the projected average of 31%
for NIH overall. Nevertheless, the 24% success rate for FY 2000 is an enormous
improvement over FY 1999 when the success rate was only 14%. Mr.
Chairman, unfortunately the excellent progress made by the Subcommittee last year
is threatened by the Administration's FY 2001 request of $92.524 million, an increase
of only $3 million or 3.3% for NINR. This is the lowest proposed increase of all
NIH Institutes and Centers. The FY 2001 request, if approved by the Subcommittee,
would continue NINR's disproportionately slow growth rate compared to NIH in general.
For example, since 1986 NINR has received only $75.5 million, or 0.6% of the total
NIH growth of $12.3 billion. In fact, the entire FY 2000 total for NINR is less
than the increase provided by the Subcommittee in FY 2000 for 10 NIH Institutes
and Centers. Finally, the funding level proposed by the Administration would plunge
NINR's projected research project grant success rate for FY2001 to 14% compared
to the 26% success rate projected for NIH overall. Clearly this would result in
missing a significant amount of important scientific opportunities. Mr.
Chairman, the American Association of Colleges of Nursing, supported by the Tri
Council for Nursing and the 33 members of the Coalition for Nursing Research Funding,
urges that for the Fiscal Year 2001 the NINR be funded at $110 million or $17.476
million more than the Administration's request. At this funding level, NINR could
conduct significant new research recommended by its Professional Judgment Budget
such as: research on health disparities in ethnic groups, self management of chronic
illness, expanding end of life research to address pain, nausea, weight loss and
caregiver issues, and studying telehealth interventions in rural/underserved populations.
NINR is the lead
institute at NIH to coordinate research on end-of-life care that is critically
important to our aging population. End-of-life care utilizes many of the skills
of nursing such as management of pain, handling of chronic conditions, and family
counseling. As the American population continues to age, the importance of this
research both to reduce morbidity and health system cost continues to grow. While
13% of the current U.S. population is 65 years of age or older, by the year 2030
this proportion is projected to be 20%. The
Subcommittee investment in NINR is well justified as nursing research contributes
extensively to wellness and health outcomes. The NINR performs a wide span of
clinical research, developing and testing interventions to improve patient care,
treat disease, manage chronic conditions and address other concerns. There is
growing evidence of advances made possible by NINR research, but I will highlight
just five recent success stories. AACN believes that based on these and numerous
other examples, there is broad agreement that nursing research is making a difference
in health outcomes. For example, NINR research has made a difference by identifying
interventions to: - Facilitate
early hospital discharges of high risk elderly patients, reducing the length of
stays, the hospital re-admission rate and Medicare costs;
- Reduce
the rate of low birth weight babies among high risk women, as well a reducing
the rate of subsequent emergency room admissions of the mothers and their babies;
- Estimate
the (often fatal) improper insertion of feeding tubes with the use of a low cost
bedside chemical test;
- Reduce
high blood pressure in young urban African-American men at high risk for cardiovascular
disease and reduce cholesterol levels in minority children; and
- Avoid
the need for nursing home care of elderly women by controlling urinary incontinence.
The
Nurse Education Act The
Nurse Education Act (Public Health Service Act Title VIII) helps schools of nursing
and nursing students prepare for a changing health care delivery system. Reauthorized
in 1998, the NEA offers flexibility through expanding specific program initiatives,
including Advanced Education Nurse Grants, Work Force Diversity Grants, Basic
Nurse Education and Practice Grants, and an education loan repayment program to
attract nurses to practice in shortage areas. Advanced
Education Nurse Grants to schools help educate advanced practice primary care
nurse practitioners and nurse midwives. The program also provides grants to educate
master's and doctoral students as clinical nurse specialists, public health nurses,
nurse administrators, faculty (a major shortage exists), nurse anesthetists, and
non-primary care nurse practitioners and includes traineeships for master's and
doctoral students with a limit of 10 percent of appropriations for doctoral traineeships.
The growing number of elderly, increasing number of individuals with chronic diseases,
high infant mortality rates, and rising number of uninsured and underserved individuals
all drive the demand for affordable, cost-effective health care. This need is
successfully met by nurses with advanced nursing education. The
Work Diversity Grants program provides funds to increase opportunities for nursing
education for disadvantaged students including underrepresented minorities by
providing scholarships, stipends, pre-entry preparation, and retention activities.
In addition to contributing to the preparation of a racially and ethnically diverse
nursing workforce, this program contributes to the basic preparation of disadvantaged
and minority nurses for leadership positions within nursing and the health care
community. The minority enrollment in schools of nursing supported by this program
is 46 percent compared to the national average of 19 percent. The
Basic Nurse Education and Practice Grants can support nursing centers as training
and care delivery sites, increase undergraduate enrollments (a nursing shortage
looms), provide entry level training for practice within underserved populations,
managed care facilities, to develop cultural competence and for other purposes.
AACN recommends $78 million for Title VIII Nurse Education Act programs in Fiscal
Year 2001, $10.2 million or 15% more than requested by the Administration. Scholarships
for Disadvantaged Students (SDS) Scholarships
for Disadvantaged Students (SDS) is a PHSA Title VII program that provides funds
to disadvantaged and minority health professions students. Federal law directs
16% of the funds appropriated to nursing students in the program -- making this
the major federal scholarship source for undergraduate nursing students. The
goals of the SDS Program are to increase diversity in the health professions and
nursing workforce and improve access to health care. The program provides scholarships
to financially needy students from disadvantaged backgrounds who are enrolled
in schools of nursing, and in programs of allopathic medicine, osteopathic medicine,
dentistry, veterinary medicine, optometry, podiatry, pharmacy, chiropractic, behavioral
and mental health, public health, allied health, and physician assistants. The
SDS program allows eligible students the opportunity to pursue health professions
or nursing education by eliminating or reducing financial barriers that might
otherwise prevent these students from enrolling. AACN
recommends that SDS be funded at $43.7 million for FY 2001, a $5.61 million or
14.7% increase over the FY 2000 level. AACN is a member of and supports the Health
Professions and Nursing Education Coalition's recommendation of $335 million for
Public Health Service Act Titles VII and VIII, that support health professions
and nursing education programs. Agency
for Healthcare Research and Quality (AHRQ) The
mission of the Agency for Healthcare Research and Quality (AHRQ) is to support,
conduct, and disseminate research that improves the outcomes, quality, access
to, and cost and use of health care services. This mission, which focuses on the
effectiveness and value of health care in daily practice, is unique and complements
the biomedical and behavioral research responsibilities of the National Institutes
of Health. The products of the Agency include knowledge that supports decision
making to improve health care, as well as tools that can help improve quality
and reduce costs. In
view of the significant contributions made by AHRQ research to health outcomes,
the AACN recommends appropriate increases for the AHRQ budget in Fiscal Year 2001.
National
Institutes of Health The
AACN applauds the leadership of Chairman Porter and the Subcommittee in the continuing
campaign to double the NIH budget in 5 years. The investment in biomedical and
behavioral research has propelled a remarkable transformation in our understanding
of the life sciences and has given us a bounty of new ways to prevent, treat,
and cure disease. Major threats to public health have been reduced, quality of
life has improved, and life expectancy has continued to rise. A child born in
the United States today can be expected to live 76.5 years, 3.9 years longer than
a child born in 1975. AACN joins the Ad Hoc Group for Medical Research Funding
in recommending a FY 2001 funding level of $20.47 billion for the NIH, a 15% increase
over the FY 2000 level. Indian
Health Service Mr.
Chairman, the Indian Health Services (IHS) provides vital health services to our
Native American populations and nursing professionals have been a central component
of the IHS health delivery system since the agency's inception. The
IHS provides direct health care services in 37 hospitals, 61 health centers, 4
school health centers, and 48 health stations. Tribes and tribal groups, through
contracts with the IHS, operate 12 hospitals, 134 health centers, 4 school health
centers, and 241 health stations (including 168 Alaska village clinics.) The IHS,
tribes and tribal groups also operate 7 regional youth substance abuse treatment
centers. AACN recommends appropriate increases for the Indian Health Service for
FY 2001. Higher
Education Act Programs - Student Financial and General Assistance There
are several student financial and general assistance programs that have been particularly
important to the nursing community over the years. The Pell Grant Program helps
ensure access to post secondary education for low and middle income undergraduate
students by providing grants that, in combination with other sources of student
aid, help meet post secondary education costs. The Federal Work Study Program
ensures access by assisting needy undergraduates and graduate students in financing
post secondary education costs through part time employment. The TRIO Programs
fund post secondary education outreach and student support services designed to
encourage individuals from disadvantaged backgrounds to enter and complete college.
AACN recommends appropriate increases for each of these programs over the levels
provided in FY 2000. Summary
of AACN Highest Priority FY2001 Funding Recommendations | AACN
Highest Priority Recommendation | FY2000 | FY2001
Admin. Proposal | FY2001
AACN Recommendation |
|---|
| National
Institute of Nursing Research | $89.5M | $92.524M | $110M |
| Nurse Education Act | $67.8M | $65.576M | $78M |
| Scholarships for
Disadvantaged Students | $38.09M | $38.09M | $43.7M |
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