The
American Association of Colleges of Nursing (AACN) respectfully submits this written
statement to the subcommittee highlighting funding priorities for nursing education
and research programs. Federal support has and will continue to play a critical
role in the nation's effort to address the nursing shortage. AACN represents over
570 senior colleges and universities across the U.S. with baccalaureate and graduate
nursing education programs. These institutions are responsible for educating approximately
half of our nation's registered nurses (RNs) and all of the nurse faculty and
researchers.
The
nation is in the midst of a long-term nursing shortage that began in 1998. This
shortage is expected to intensify over the coming years. According to the U.S.
Bureau of Labor Statistics, there is projected demand for 1.1 million new and
replacement nurses by 2012. For the first time, the U.S. Department of Labor has
identified RNs as the top occupation in terms of job growth. Though particularly
intense in hospitals across the nation, all sectors of health care, including
long-term care, home care, and public health, are reporting nurse vacancies. Alarming
predictions show little change in the multitude of contributing factors such as
the aging of America's population, a total population of RNs growing at the slowest
rate in over 20 years, high RN retirements, the aging nurse workforce, and the
increasing demand for more intensive health services.
AACN's
2003 nationwide survey noted that enrollments in entry-level baccalaureate nursing
programs increased by 16.6% over the previous year. 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 nurse loan repayment programs. Though this
increase is welcome, it is insufficient to meet the projected demand for nurses.
Dr. Peter Buerhaus, in the November 2003 issue of Health Affairs, stated "because
the number of young RNs has decreased so dramatically over the past two decades,
enrollments of young people in nursing programs would have to increase at least
40% annually to replace those expected to leave the workforce through retirement."
Now
qualified students are being turned away or placed on waiting lists at colleges
of nursing across the nation. According to AACN's latest annual survey, U.S. colleges
of nursing turned away 18,105 qualified applicants in 2003 due to insufficient
numbers of faculty, clinical sites, classroom space, clinical preceptors, and
budget constraints. Moreover, 64.8% of the nursing colleges responding to the
survey pointed to faculty shortages as a reason for not accepting all qualified
applicants.
Nationwide,
AACN member colleges report increasing difficulty filling budgeted faculty positions
with both doctoral and master's prepared nurses, which limit our colleges' ability
to expand capacity to educate the new and growing nursing workforce. Budget constraints,
length of educational trajectory, an aging faculty, and increasing job competition
have contributed to this emerging crisis. Results from a special AACN survey conducted
in 2003 show a nurse faculty vacancy rate of 8.6%, an increase from 7.4% reported
in 2000. In addition, the number of graduates from master's and doctoral programs
declined in 2003 by 2.5% and 9.9% respectively. The impact of age and retirements
coupled with an inadequate number of younger faculty for replacement are the primary
influences on the availability of future faculty. It is projected that half of
the current nurse faculty will retire by 2012 creating an even greater faculty
shortage over the next 10 to 15 years.
AACN
recognizes that strategies to educate the future nursing workforce to meet the
health care needs of the nation 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 effect that an unresolved
shortage of this magnitude is having and will continue to have on the future of
health care in America.
NURSING
WORKFORCE DEVELOPMENT
Nursing
Workforce Development (Public Health Service Act, Title VIII) is the authority
that gives federal focus to the supply and distribution of qualified nurses to
meet our nation's health care needs. Enacted in August 2002, the Nurse Reinvestment
Act (P.L. 107-205) expanded existing programs and added new authorities for
nursing education. Nursing Workforce Development provides financial assistance
for nursing education programs as well as individual students. Programs favor
institutions that train nurses for practice in medically underserved communities
including nursing shortage areas and support nursing education from entry-level
preparation through graduate study. Nursing Workforce Development is the largest
source of federal funding targeted to nursing education. In FY 2003, these programs
supported the recruitment, education, and retention of 24,000 nurses and nursing
students. The appropriation for FY 2004 is $141.92 million. AACN gratefully
requests $205 million for Nursing Workforce Development in FY 2005, an additional
$63 million over FY 2004 funding. New funds would go to support the following
programs that address education, recruitment, and retention of the nursing workforce
and will assist in resolving the nursing shortage.
Advanced
Education Nursing (Sec. 811) - These grants support the majority of
programs that prepare graduate-level nurses for faculty positions and work as
primary care providers. They 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. In FY 2003, applications were submitted
and 36 grants were awarded. Advanced Education received $58.65 million in FY
2004.
Workforce
Diversity (Sec. 821) - 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 looking 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. In FY 2003, 122 applications were submitted
and 20 grants were awarded. Workforce Diversity received $16.40 million in
FY 2004.
Nurse
Education, Practice and Retention (Sec. 831) - These grants help schools
of nursing, academic health centers, nurse-managed health centers, state and local
governments, and health care facilities strengthen programs that provide nursing
education. Three primary areas of focus are education, practice, and retention.
Education Grant Areas include expanding enrollments in baccalaureate nursing
programs, developing internship and residency programs, and providing new technologies
in education. In FY 2003, there were 52 applications approved and 14 grants awarded
for the internship and residency program. Practice Grant Areas include
expanding practice arrangements in non-institutional settings to improve primary
health care in medically underserved communities, providing care for underserved
populations, and developing cultural competencies. Retention Grant Areas
include the Career Ladder program which supports education to assist individuals
in entering the nursing profession and to promote career advancement. In FY 2003,
301 applications were submitted and 12 grants were awarded. The program entitled
Enhancing Patient Care Delivery Systems provides grants to facilities for enhancing
collaboration and communication among nurses and other health care professionals.
These "best practices" double nurse retention rates and improve patient
care. In FY 2003, 122 applications were submitted and 14 grants were awarded.
Education, Practice and Retention received a total of $31.77 million in FY
2004.
Nurse
Faculty Loan Program (Sec. 846A) - This 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 in an advanced nursing education program. Students must commit 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. 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.
In FY 2003, 65 applications were submitted by schools of nursing and 55 grants
were awarded at an average of $51,266 per school. The Nurse Faculty Loan Program
received $4.87 million in FY 2004.
Comprehensive
Geriatric Education (Sec. 855) - This program awards grants to train
and educate individuals to provide geriatric care for the elderly. It coordinates
with the geriatric education program (Section 753) that funds 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. These grants allow RN participants
to use their knowledge and skills to develop and strengthen the skills of other
nursing care providers in the care of the elderly. In FY 2003, 92 applications
were submitted and 17 grants were awarded. These grants reached 12 universities
and five health care facilities and organizations. It is projected that over 3,000
RNs will be trained with this funding. Comprehensive Geriatric Education received
$3.48 million in FY 2004.
Nurse
Loan Repayment and Scholarship Programs (Sec. 846) - The loan repayment
program repays up to 85% of nursing student loans in return for at least three
years of practice in a designated nursing shortage area. For the first two years
of practice, the program will pay 60% of up to $30,000 in loans. With an additional
year of service, another 25% of the loan will be repaid, up to $7,500. In FY 2003,
16,000 applications were submitted and 602 students received awards. The scholarship
program offers individuals who are enrolled as full-time undergraduate 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. In FY 2003, 8,000 applications were submitted and 81 scholarships
were awarded. The average award amount was $40,840. The loan repayment and
scholarship programs received a combined $26.74 million in FY 2004.
Nursing
Student Loan (NSL) (Sec. 836) - In 1964, Congress created the NSL program
to address nursing workforce shortages. The program loans up to $13,000 per nursing
student and is open to undergraduate and graduate students with a preference for
those in financial need. 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. The interest rate is 5% and the repayment period is 10 years. These
funds are disbursed to new students as loans and must be repaid by those graduating
or otherwise leaving school. In FY 2003, there were 10,447 awards distributed.
This program has not received additional appropriations since 1983.
NATIONAL
INSTITUTE OF NURSING RESEARCH
We
greatly appreciate your increases in funding for the National Institutes of Health
(NIH). AACN supports the recommendation of the Ad Hoc Group for Medical Research
Funding to increase the budget of NIH by 10%, bringing the total to $30 billion
in FY 2005. Further, we thank you for your support of the National Institute of
Nursing Research (NINR) at $134.76 million this year. AACN respectfully
requests funding of $160 million for NINR in FY 2005. These additional funds will
support significant translational research, training of nurse researchers, and
provide the research base important to the health of the public.
NINR
supports basic and clinical research to establish the scientific knowledge for
the care of individuals across the life span. The Institute emphasizes translational
research, the means by which basic findings relating to behavior, molecules, and
genes can be tested in the clinical setting and translated into medical practice
and improvements in public health. This research is important to the future of
the health care system and its ability to deliver safe, cost-effective, and high
quality care. It provides outcomes-based findings for the nation's largest profession
of health care providers-2.7 million registered nurses (RNs)--but also for the
practice of other health care providers who care for our nation's citizens in
the community, the home, long-term care facilities, and hospitals. With additional
funding, NINR will target new research in the following areas:
In
2003, the NIH created a visionary framework called the NIH Roadmap for Medical
Research to target resources at evolving public health challenges such as
acute to chronic conditions, aging population, health disparities, emerging diseases,
and biodefense. The Roadmap promises a trans-Institute effort focusing on three
areas including establishing next-generation research tools and procedures, creation
of an interdisciplinary research workforce, and emphasis on a clinical research
enterprise. NINR and nurse researchers are well-prepared to address the development
of new research teams and enhanced clinical research moving the NIH's social,
behavioral, and medical research forward in this coordinated and cohesive effort.
Of
further note, NINR's research training mechanisms produce highly educated nurses
who are needed for vacant faculty positions across the country. NINR directs 8%
of its budget to research training to help develop the pool of nurse researchers
who become faculty. Training dollars support approximately 266 pre-doctoral and
post-doctoral researchers this year. The additional requested funding would support
a total of 405 pre- and post-doctoral researchers in FY 2005.
AGENCY
FOR HEALTHCARE RESEARCH AND QUALITY
The
Agency for Healthcare Research and Quality (AHRQ) focuses on quality, patient
safety, and ways to reduce medical errors. AHRQ conducts and supports health services
research on clinical outcomes, quality, cost, use of resources and access to care.
Organized around their five centers on Outcomes and Evidence; Primary Care, Prevention,
and Clinical Partnerships; Delivery, Organization, and Markets; Financing, Access
and Cost Trends; and Quality Improvement and Patient Safety, AHRQ is developing
a body of knowledge for evidence-based practice that will change health care delivery
and nursing practice.
Preserving
patient safety by ensuring good patient care results is fundamental to nurses
and the care they provide. Nurses work in a variety of settings, monitor patients'
status, coordinate patient care, educate patients and their families, and provide
essential therapeutic care. Nurses are the healthcare providers patients spend
the greatest amount of time with and depend upon for recovery, providing protection
at the most vulnerable moments. In FY 2004, this program received $301.91 million.
AACN supports health services research at AHRQ and joins the Friends of
AHRQ in recommending a funding level of $443 million for FY 2005.
In
summary, AACN respectfully recommends the following appropriations for FY 2005:
| National
Institute of Nursing Research | $160.00
million |
| National
Institutes of Health | $
30.00 billion |
| Nursing
Workforce Development | $205.00
million |
| Agency
for Healthcare Research and Quality | $443.00
million |
