Testimony of the American Association of Colleges of Nursing on Fiscal Year 2004 Appropriations For the National Institute of Nursing Research and the Bureau of Health Professions, Nursing Division and other Programs for the House Appropriations Subcommittee on Labor, Health and Human Services and Education (May 23, 2003) The American Association of Colleges of Nursing (AACN) respectfully submits this written statement to the subcommittee highlighting our funding priorities for nursing research and education programs. Federal support has and will continue to play a crucial role in the nation's effort to address the nursing shortage. AACN represents over 570 baccalaureate and graduate nursing education programs offered at universities and four-year colleges across the United States. The nation is in the grips of a long-term nursing shortage that began in 1998. The shortage is particularly intense in hospitals across the nation that employs 59% of the nation's 2.2 million practicing nurses. Yet all sectors of health care including long-term care, home care, and public health are reporting nursing vacancies. Alarming predictions show little change in the multitude of contributing factors such as the aging nursing workforce, diminished enrollments in colleges of nursing, and the demand for highly complex nursing care over the coming decades. In fact, demographics indicate that this demand for registered nurses (RNs) will only increase due to the aging of America's population and its growing need for more intensive health services. Since 1995, AACN noted declining enrollments in baccalaureate nursing programs that reached a low point of 21.1% in 2000. Despite slight increases in enrollments over the past two years, enrollments in 2002 still have 10,000 fewer students than in 1995. These increases are attributed to intensive marketing by the private sector, public-private partnerships providing additional resources to expand capacity of nursing programs, and state legislation targeting funds to scholarships and nursing loan repayment programs. But, it is inadequate to address the projected need of over one million new and replacement RNs by 2010, according to the Bureau of Labor Statistics. Many of the nation's colleges of nursing are enduring budget cuts due to declining revenues in state budgets. The National Conference of State Legislatures projected combined state revenue shortfalls of $68 billion for FY 2003. Just when colleges of nursing need increasing state support to expand their capacity, they are being asked to cut faculty positions, cut need classes, and cut creative off-campus programs. AACN is receiving reports that students are being turned away or placed on waiting lists at colleges of nursing across the nation. In fall 2002, AACN's Enrollments and Graduations survey shows that 5,283 students were turned away from colleges of nursing due to lack of faculty, classroom space, and clinical practice sites. Despite the need to expand the nursing workforce, a lack of nursing faculty has had a tremendous impact on the shortage. The majority of AACN member schools report great difficulty filling budgeted faculty positions with both doctorally and master's prepared nurses. The small percentage 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. Expanding the number of full-time doctoral students would greatly facilitate the production of available faculty. AACN recognizes that strategies to meet the evolving nursing shortage must encompass state support, increased federal funding, and public-private sector initiatives. We are asking the subcommittee to graciously consider these federal requests and the affect that an unresolved shortage of this magnitude is having and will continue to have on the future of health care in America. NATIONAL INSTITUTE OF NURSING RESEARCH (NINR) We greatly appreciate your visionary work to complete the doubling of the budget of the National Institutes of Health (NIH) over five years in FY 2003. AACN supports the recommendation of the Ad Hoc Group for Medical Research Funding to add a 10% increase to the doubled budget of NIH, bringing the total to $30 billion. Further, we thank you for your support of the National Institute for Nursing Research (NINR). AACN respectfully requests an FY 2004 funding level of $160 million for NINR, an increase of $30 million. The stated mission of NINR is to support the science that advances the knowledge-base of the nation's largest profession of health care providers-2.7 million registered nurses-key to the health of the public. NINR's research is the evidence base for nursing practice and the practice of other health care providers to: understand and ease the symptoms of acute and chronic illness; prevent or delay the onset of disease or disability, or slow its progression; find effective approaches to achieving and sustaining optimal health; and improve the clinical settings in which care is provided. Nursing research improves quality of life and patient outcomes. It defines the health choices that prevent disease and promote health. Nursing research designs and tests cost-effective models of care and best practices that promote quality care. NINR provides translational research, taking many basic scientific discoveries achieved at NIH, and applying them to clinical practice at the bedside or wherever nursing care is provided. NINR supports investigators who conduct a broad range of clinical research, develop and test interventions to improve patient care, treat disease, manage chronic conditions, and address many compelling public health problems which affect the physical and mental well-being of a diverse American public. In addition, NINR collaborates with other Institutes and Centers at NIH to promote the translational aspects of biomedical and behavioral research inherent in the NIH Roadmap. Nursing research funds are also combined with other Department of Health and Human Services agencies such as the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention to provide a more comprehensive approach to outcomes based research and quality patient care. This new funding will support the following new research: Develop and test new approaches to self-management of chronic diseases like high blood pressure and diabetes as well as conditions such as dementia and developmental disabilities. Outcomes of these studies will improve the quality of life for many of the 100 million individuals with chronic disease conditions, allowing them to remain productive members of society. Improve the care of more than 1.6 million residents of nursing homes and many others in assisted living facilities and board-and-care homes. NINR will fund studies that focus on residents' functional mobility, their adjustment to loss of independent living, and prevention of falls and depression. Partner with communities to design ways to eliminate health disparities in those communities. Focus on end-of-life care and research to address the public's concern with issues at the end-of-life, including symptom management, family caregiver burden, and decision-making. Directions for this research include developing palliative care models and are coordinated with the recommendations of a recent Institute of Medicine report on pediatric end-of-life care. Enhance health promotion among minority men who have a higher mortality rate and a shorter life expectancy compared to all women. Such factors as smoking; diet; exercise; and the influence of families, social networks, and communities; are examined to design interventions that improve the health of minority men. As the primary sponsor of nursing research in the country, NINR attracts new students to the profession by providing opportunities for nurse researchers to solve important clinical problems. Clearly, nursing research makes a difference in patients' lives and provides the visible link between the effects of basic research and patient outcomes. NINR emphasizes early entry into doctoral training and career development programs culminating in an increase in the number of nursing faculty. With a nationwide shortage of nursing faculty preventing schools of nursing from significantly increasing enrollments, NINR assists by directing 8% of its budget to research training that increases the pool of investigators available to conduct nursing research and to teach. FY 2003 research training dollars support approximately 193 pre-doctoral nurse researchers and 70 post-doctoral researchers. A $30 million funding increase would substantially increase the pool of pre- and post-doctoral researchers to 380. However, under the Administration's proposed budget for FY 2004, the number of funded nurse researchers would be reduced from FY 2003 levels. These numbers must be increased in the future to meet the recommendations of the National Research Council to recruit nurses into the research track earlier in their careers and address the critical shortage of nursing faculty. The Subcommittee's investment in NINR is well justified since nursing research contributes extensively to wellness and health choices that prevent disease and enhance health outcomes. Through NINR, the National Institutes of Health will continue to expand its emphasis on clinical research, the means by which basic findings relating to behavior, molecules, and genes can be tested and translated into 'best biomedical and biobehavioral practices' and improvements in public health. NURSING WORKFORCE DEVELOPMENT (Title VIII, Public Health Service Act) In August 2002, the Nurse Reinvestment Act (P.L. 107-205) was signed into law, demonstrating a federal commitment to addressing the nation's nursing shortage. AACN is grateful for the $20 million in new funding that the Committee appropriated for these programs. Since the enactment of FY 2003 appropriations in February 2003, the Health Resources and Services Administration (HRSA) has worked tirelessly to set up these new programs to begin the process of addressing the nursing shortage. With this start-up funding and a structural framework in place, AACN requests $175 million for Nursing Workforce Development Programs in FY 2004. In light of the significant shortage of RNs, AACN believes that this 54% increase of $62 million over current funding is well justified. The appropriation for FY 2003 is $113 million. The Nurse Reinvestment Act amends Title VIII of the Public Health Service Act (PHSA) by adding new authorities including Public Service Announcements, Comprehensive Geriatric Training Grants, and a Nurse Faculty Loan Program. It also expands existing programs in Title VIII to include a Scholarship Program, Career Ladder Programs, and Retention Grants for Enhancing Patient Care Delivery Systems. In addition to the new Faculty and Geriatrics authorities, Nursing Workforce Development contains three major grant programs: Advanced Education Nursing, Nursing Workforce Diversity, and Nurse Education, Practice, and Retention. It also provides individual student support through the Nurse Loan Repayment and Scholarship Programs and the Nursing Student Loan Program. EXISTING AND EXPANDED GRANT PROGRAMS Advanced Education Nursing Grants (Sec. 811) - These grants support the majority of programs that prepare graduate-level nurses for faculty positions and to work as primary care providers. These grants help schools of nursing, academic health centers, and other nonprofit entities improve the education and practice of nurse practitioners, nurse-midwives, nurse anesthetists, nurse educators, nurse administrators, public health nurses, and clinical nurse specialists. Advanced Education received $50.5 million for FY 2003. Nursing Workforce Diversity Grants (Sec. 821) - Diversity grants prepare disadvantaged students to become nurses. This program awards grants and contract opportunities to schools of nursing, nurse-managed health centers, academic health centers, state or local governments, and nonprofit entities to increase access to nursing education for disadvantaged students including racial and ethnic minorities under-represented among registered nurses. The program provides scholarships or stipends, pre-entry preparation, and retention activities to enable students to complete nursing education programs. Workforce Diversity received $10 million for FY 2003. Nurse Education, Practice and Retention Grants (Sec. 831) - These grants help schools of nursing, academic health centers, nurse-managed health centers, state and local governments, and other health care facilities to strengthen programs that provide nursing education. Formerly known as Basic Nurse Education and Practice, Section 831 was expanded and reorganized by the Nurse Reinvestment Act. Education Grant Areas were reorganized to include: a) expanding enrollments in baccalaureate nursing programs; b) developing internship and residency programs to enhance mentoring and specialty training; and c) providing new technologies in education including distance learning. Practice Grant Areas now include: a) expanding practice arrangements in non-institutional settings to improve primary health care in medically underserved communities; b) providing care for underserved populations such as the elderly, HIV/AIDS patients, substance abusers, the homeless, and domestic abuse victims; c) providing skills to practice in existing and emerging health systems; and d) developing cultural competencies. A new Retention Grant Area was authorized to enhance the nursing workforce. The Career Ladders provision supports education programs designed to assist individuals to obtain the education required to enter the nursing profession and to promote career advancement. A second program, Enhancing Patient Care Delivery Systems, provides grants to facilities to enhance collaboration and communication among nurses and other health care professionals and to promote nurse involvement in the organizational and clinical decision-making processes of a health care facility. These best practices have been shown to double nurse retention rates and improve patient care. Education, Practice, and Retention received $27 million for FY 2003. NEW GRANT PROGRAMS Comprehensive Geriatric Education Grants (Sec. 855) - The Nurse Reinvestment Act created this program to award grants to train and educate individuals to provide geriatric care for the elderly. The program coordinates with the geriatric education program (Section 753) that funds geriatric training for physicians and dentists. Grants may be used to train individuals who will provide direct care for the elderly, develop and disseminate geriatric curriculum, train faculty members, and provide continuing education. Geriatric Grants received $3 million for FY 2003. Nurse Faculty Loan Program (Sec. 846A) - This new program establishes a student loan fund administered by schools of nursing to increase the number of qualified nurse faculty. Students may pursue a master's or doctoral degree in full-time study or, at the discretion of the Secretary, part-time study in an advanced degree program for Advanced Education Nurses. Students must agree to teach at a school of nursing in exchange for cancellation of up to 85% of their educational loans, plus interest, over a four-year period at a rate of 20% per year for three years and 25% in the final year. Student loans may cover the costs of tuition, fees, books, laboratory expenses, and other reasonable education expenses. The maximum loan made by the school is $30,000 per student in an academic year. Faculty Loan Program received $3 million for FY 2003. EXPANDED INDIVIDUAL SUPPORT Nurse Loan Repayment and Scholarship Programs (Sec. 846) - The Nurse Reinvestment Act expanded the Nurse Education Loan Repayment Program, to include a scholarship program. The new program offers individuals who are enrolled as full-time or part-time nursing students the opportunity to apply for scholarship funds. Upon graduation, a nurse is required to work in a health care facility with a critical shortage of nurses for no less than two years. Preference is given to students with the greatest financial need. The loan repayment program pays up to 85% of a nursing student's loans in return for at least three years of practice in a designated nursing shortage area. For the first two years of service, the program pays 60% of up to $30,000 in loans. If the participant elects to stay for another year, an additional 25% of the loan is paid, up to $7,500. In FY 2002, 564 students received awards. This expanded program received $20 million for FY 2003. Nursing Student Loan Program (NSL) (Sec. 836) - In 1964, Congress created the NSL program to address nursing workforce shortages. The program loans up to a total of $13,000 per nursing student and is open to undergraduate and graduate students with a preference for those in financial need. The interest rate is 5% and the default rate for NSL loans is 2.87%. The repayment period is 10 years. The NSL program may provide $2,500 in non-taxable loans to nursing students in their first two years of study, and $4,000 in their last two years. These funds are loaned out to new students as loans are repaid by those graduating or otherwise leaving school. In FY 2002, there were 8,188 awards distributed. This program has not received additional appropriations since 1983. OTHER PROGRAMS OF IMPORTANCE TO NURSING EDUCATION AND RESEARCH Scholarships for Disadvantaged Students (SDS) AACN recommends a funding level of $60 million for FY 2004. Currently, funding is at $48.10 million. SDS is a PHSA, Title VII (Sec. 737) program, administered by the Division of Health Careers Diversity and Development, that provides funds to disadvantaged and minority health professions students. The statute directs at least 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 increasing funds for the NHSC to $222.20 million for FY 2004. Currently, funding is at $172.2 million The National Health Service Corps Scholarship and Loan Repayment programs (PHSA, Title II) seek to attract health professionals to practice in Health Professions Shortage Areas that lack such providers. Many of those areas are rural and have difficulty attracting and retaining caregivers. Nursing has a minimum 10% set-aside that provides funding for certified nurse-midwives, nurse practitioners, physician assistants, and psychiatric clinical nurse specialists. There are approximately 1,170 loan repayment awards granted to all health professionals in FY 2003. Agency for Healthcare Research and Quality (AHRQ) AACN recommends an AHRQ funding level of $390 million for FY 2004. AHRQ's mission is to support health services research to improve the health care outcomes and quality of health care, reduce its costs, and address patient safety and medical errors. In 2003, AHRQ unveiled a new web-based patient safety journal designed to be a forum for sharing patient safety and health care quality information. The site features expert analysis of medical errors reported anonymously by readers, interactive learning modules on patient safety, and forums for online discussion. At their Center for Patient Safety, AHRQ is developing a body of knowledge for evidence-based practice that will change health care delivery and nursing practice. AHRQ received $303.69 million in FY 2003. Bioterrorism Training and Curriculum Development AACN support the President's FY 2004 recommended funding level of $60 million, a $32 million increase. Newly authorized, the Bioterrorism Training and Curriculum Development program is administered through the State, Community, and Public Health Division in HRSA. This program funds continuing education and training for health care providers and curriculum enhancement in health professions schools. These grants ensure that the healthcare workforce is prepared to meet the acute care needs of patients in a safe and appropriate manner and participate in a coordinated and multidisciplinary response to terrorist events. This new program received $28 million in FY 2003. In summary, AACN respectfully recommends the following appropriations for FY 2004: National Institute of Nursing Research $160.00 million Nursing Workforce Development $175.00 million Scholarships for Disadvantaged Students $60.00 million National Health Service Corps Scholarship/Loan $222.20 million Agency for Healthcare Research and Quality $390.00 million Bioterrorism Training and Curriculum Development $60.00 million Top | Government Affairs | AACN Home Copyright © 2004 by the American Association of Colleges of Nursing. All rights reserved.