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Testimony
of the American Association of Colleges of Nursing
on Fiscal Year 2002 Appropriations
For the National Institute of Nursing
Research and
the Bureau of Health Professions, Nursing Division and other
Programs
for the Senate Appropriations Subcommittee on Labor, Health and Human
Services, Education
The
American Association of Colleges of Nursing (AACN) respectfully submits this testimony
to the Subcommittee with our requested funding priorities for nursing research
and education programs. This federal support will be a critical piece in the nation's
effort to overcome the nursing shortage. AACN represents over 550 baccalaureate
and graduate nursing education programs in senior colleges and universities across
the United States. The
country is in the midst of an emerging nursing shortage unlike any that the nation
has experienced over the past 30 years. Since 1994, AACN has noted declining enrollments
in baccalaureate nursing programs. Increasingly, employers are reporting dramatic
and crisis level shortages of nurses in their health care settings. Hospitals
are forced to close entire patient care units; ambulances are being diverted to
other overcrowded facilities; and surgeries are being canceled due to the lack
of appropriately educated and skilled registered nurses (RNs). Nurse vacancy rates
are noted in all practice settings including long-term care, home care, and public
health. In addition, an aging workforce, with the average age of RNs up to 45.2
years, compounds the shortage. Although
employers are seeking a more highly educated nursing workforce for today's complex
health care environment, only 41% of nurses have a baccalaureate or higher degree.
The growing shortage and the decline in enrollments are accompanied by a number
of other factors that will affect the ability of the nursing profession to meet
the demand for professional nursing care. The longitudinal American Freshman Study
indicates that an extremely small percentage of freshman college students are
choosing a nursing career. A recent national assessment of children's career aspirations
by the J. W. Thompson Company has found that young children, particularly those
who plan to seek a college education, also do not see nursing as an attractive
career option. A
lack of nursing faculty has had an impact on the shortage. The majority of AACN
member nursing programs report great difficulty filling budgeted faculty positions.
The small one percent of doctorally prepared nurses in this country and the lengthy
completion time of a doctoral degree have limited the availability of nurses prepared
to function in a faculty role. Doctoral nursing students also are more often part-time
students and have maintained their full-time clinical or other positions. Expansion
of doctoral enrollments as full-time students would facilitate greatly the production
of available faculty. AACN members also report difficulty recruiting master's
prepared nursing personnel for faculty roles because of the great disparity between
clinical salaries and the salaries available as a faculty member. Schools would
benefit from support initiatives that provide resources to augment salaries for
specialized faculty needed to support the entire program. AACN
recognizes that strategies to meet the growing nursing shortage must encompass
private and public sector initiatives. Local communities and health care employers
are utilizing creative programs to recruit middle school students into the nursing
profession. States are introducing legislation funding scholarships and studies
to assess statewide workforce need. We are asking the Subcommittee to graciously
consider these requests and the effect that an unresolved RN shortage of this
magnitude will have on the future of health care in America. National
Institute of Nursing Research (NINR) We
thank you and respectfully request a Fiscal Year 2002 funding level of $144.37
million, which reflects an increase of $40 million for the National Institute
of Nursing Research. At this funding level, NINR will support significant
new research on health disparities in diseases such as diabetes and cardiovascular
disease, self management of chronic pain, end-of-life research to address weight
loss, muscle wasting, fatigue, and caregiver issues. Most critical to enhancing
research within the nursing profession is infrastructure development that increases
the pool of nurse investigators, expands programs to develop partnerships between
research-intensive environments and smaller colleges and universities, and promotes
career development for minority researchers. In
an effort to develop the pool of nurse faculty and researchers, NINR directs 8%
of its budget to research training. Research training dollars supported approximately
190 pre-doctoral nurse researchers and 70 post-doctoral researchers this year.
These numbers must be increased in the future to address recent recommendations
of the National Research Council. Additionally, AACN's 2000 Survey of Institutional
Data Systems claims 3,338 nurses in doctoral programs, indicating that NINR supports
less than 6% of those nurses in doctoral study. In view of the national nurse
faculty shortage of 500 unfilled positions in teaching and research, we recommend
this significant increase in appropriations for additional stipends and training
for pre- and post-doctoral researchers. NINR
provides research findings for the nation's largest profession of health care
providers: 2.7 million RNs. In light of the increasing shortage of qualified professional
nurses, the NINR requires a significant funding increase for the following reasons:
- To provide clinically-based
research findings that make a difference in the lives of all Americans, from our
youth whose health needs must be addressed to our nation's aging population of
which many experience chronic, debilitating diseases.
- To
establish the role of nurse researcher, which attracts bright young women and
men into a field that provides opportunities to both conduct meaningful research
and use important research findings that make a difference in people's lives.
NINR's
FY 2001 funding is at $104.37 million. This is $14.83 million or 16.6% more than
the FY 2000 level. Nurses from across the nation are thankful for this increase.
It has provided resources for 81 new multi-year research grants beginning in FY
2000 and an estimated 60 new studies, which begin in FY 2001. The
increase in appropriation for FY 2000 enabled NINR's success rate to reach the
NIH mean success rate of 32% for competing research projects for the first time
in its 15-year history. This is a significant improvement over FY 1999 when the
success rate was only 14.4%. Because of NINR's ability to attract important applications
for research studies, the success rate for FY2001, despite a good increase in
appropriation, is estimated to be only 20%. The
FY 2000 research findings from NINR-funded studies include 17 reports related
to aging, long-term care, or Alzheimer's and care giving. More studies are reported
in dozens of scientific articles in: HIV/AIDS patient care, cardiovascular disease
prevention and care, child and adolescent health, critical care, diabetes, mental
health, and the utilization of nurses in the health care system. In addition,
NINR-funded investigators across the country produced scientific advances in maternal-infant
care, pain and other symptom management, and women's health. These findings together
form the research base to establish evidence-based practice for registered nurses
providing direct patient care 24-hours a day, seven days a week, all across the
country. In
addition, NINR is the lead institute at NIH to coordinate research on end-of-life
care, addressing the public's disappointment with the current status of care at
the end of life. Other groups such as the Institute of Medicine, the Robert Wood
Johnson Foundation, and the Hartford Foundation recognizing this need especially
in light of our aging population. End-of-life care utilizes many of the skills
of nurses such as pain and other symptom management, clinical management to promote
quality of life, and family teaching and counseling. This focus helps families
to identify and use resources to better cope with the stresses at this critical
time. The
Subcommittee investment in NINR is well justified as nursing research contributes
extensively to wellness and health choices that prevent disease. The NINR supports
investigators who conduct a broad range of clinical research, developing and testing
interventions to improve patient care, treat disease, manage chronic conditions
and address the physical and emotional concerns that are important to the diverse
American public. There is growing evidence of advances made possible by NINR research,
but I will highlight just four recent success stories. AACN believes that based
on these and numerous other examples, it is clear that nursing research is making
a difference in health outcomes. For example, NINR research has made a difference
by identifying interventions or other studies to:
- Enhance the independence
and reduce signs of distress among severely cognitively impaired nursing home
residents.
- Develop
new methodologies for investigating ways to reduce breast cancer risk in women
who have a genetic predisposition.
- Reduce
the extremely high stress levels experienced by family members who were involved
with decisions to stop life-sustaining support for a terminally ill loved.
- Reduce
the risk of cardiovascular disease in children from minority backgrounds who are
living in rural areas.
The
Nurse Education Act (NEA) We
also ask for increased funding of $25 million for the Nurse Education Act and
additional funding for the nursing student loan programs. AACN recommends an
increase in the NEA for FY 2002 to $103.1 million and an additional $20 million
directed to student loan programs. NEA appropriations for FY01 were $78.1
million. Central to increasing the availability of a well-trained nursing workforce
is the availability of educational grants and scholarships. Current demand for
nursing student loan support exceeds significantly the resources available. In
addition, scholarship support is a major incentive to enter the profession and
facilitates full-time study. Title
VIII of the Public Health Service Act (PHSA), the NEA, is the major federal statute
providing authority for the Department of Health and Human Services to fund initiatives
to expand or improve nursing education. Authorities under Title VIII provide for
support of advanced practice nursing education, special initiatives for nursing
clinics, support of innovations in the delivery of nursing care, expansion of
enrollments in baccalaureate nursing programs, and development of initiatives
to expand minority nursing enrollments. Several of the programs assist schools
with their efforts to bring more students into baccalaureate nursing programs.
In addition, the program for loans to nursing students allows students to acquire
low interest rate loans that can be repaid through service in high need areas.
- Advanced
Education Nursing Grants
(Sec.811) -
The initiative provides grants to schools to train advanced practice primary care
nurse practitioners and nurse midwives. It also provides grants to educate master's
and doctoral students as clinical nurse specialists, public health nurses, nurse
administrators, faculty, nurse anesthetists, and non-primary care nurse practitioners.
It includes traineeships for master's and doctoral students with a limit of 10%
of appropriations for doctoral traineeships.
- Nursing
Workforce Diversity Grants
(Sec.821) - To increase opportunities for nursing education for disadvantaged
students, including underrepresented minorities, this initiative furnishes scholarships,
stipends, pre-entry preparation, and retention activities. Grantees are responsible
for accomplishing the objectives of their grants.
- Basic
Nurse Education and Practice Grants
(Sec.831) - This
initiative disseminates grants to schools of nursing to strengthen basic nurse
education and practice with seven priority areas. The areas are: expanding nursing
practice in non-institutional settings to increase access to primary health care,
training for care of underserved and high risk populations, education for managed
care, developing cultural competency, expanding baccalaureate enrollments, increasing
nursing career mobility, and nursing education in informatics and use of distance
learning.
Nursing
Student Loan Program (NSLP) (Sec. 836) - AACN recommends an appropriation
of at least $10.3 million for the NSLP for FY 2002. Administered by the Division
of Student Assistance, this program was created to address nursing workforce shortages.
Academic institutions select students enrolled in nursing programs for participation
in the program based on financial need. The program operates on revolving funds
received through student loan paybacks and returned funding received from nursing
schools that closedown. In FY 2001, only 291 out of 1,500 eligible collegiate
schools of nursing participate in the program because of reluctance to compete
for the limited funding. This loan program has received no new funding since 1983.
Nursing
Education Loan Repayment Program (NELRP) (Sec. 846) - AACN requests at
least an additional $10 million for this program in FY 2002. The NELRP, administered
by the Bureau of Primary Health Care, provides loans to registered nurses, nurse
anesthetists, and nurse practitioners in exchange for practicing in designated
Health Profession Shortage Areas. Due to funding limitations in FY 2000, the Bureau
provided loans of 60% of the amount authorized to only 50% of the nurses applying
for program participation. The NELRP has $2 million in FY 2001 funding. Scholarships
for Disadvantaged Students (SDS) AACN
recommends that SDS be funded at $55.63 million for FY02, a 25% increase. FY
2001 funding is at $44.5 million. Scholarships for Disadvantaged Students is a
PHSA Title VII Program (Sec .737) that provides funds to disadvantaged
and minority health professions students. The statute directs 16% of the funds
appropriated to nursing students. This program is the major federal scholarship
source for undergraduate nursing students and eliminates or reduces the financial
barriers that may prevent these students from enrolling. The majority of SDS recipients
are minority students. National
Health Service Corps (NHSC) AACN
recommends maintaining the 10% set aside and increasing funds for the NHSC to
$300 million. The National Health Service Corps Scholarship and Loan Repayment
programs (PHSA Title III) seek to attract health professionals to practice in
Health Professional Shortage Areas that lack such providers. Many of those areas
are rural, and have difficulty attracting and retaining caregivers. Nursing has
a 10% set aside that provides funding for certified nurse midwives, nurse practitioners,
and psychiatric clinical nurses specialists. Conclusion In
summary, AACN respectfully recommends the following appropriations
for FY2002: National
Institute of Nursing Research $144.37 million
Nurse Education Act $103.1 million
Nursing Student Loan Program $ 10.3 million
Nursing Education Loan Repayment
Program $ 12 million
Scholarships for Disadvantaged Students $ 55.63 million
National Health Service Corps Scholarship/Loan $300 million | 
