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Statement
of the Tri-Council for Nursing
on
Fiscal Year 2000 Appropriations for Nursing Education
and Research
Before
the House Appropriations Committee
Subcommittee on Labor, Health and Human
Services,
Education and Related Agencies
April 23, 1999
The
four nursing associations that comprise The Tri-Council for Nursing appreciate
the opportunity to present this statement on Title VIII of the Public Health Service
Act (Nurse Education Act or NEA), that provides for Nursing Workforce Development
and the National Institute of Nursing Research. Ensuring a sufficient number of
qualified nurses is a critical issue in providing essential health care in this
nation. The
Tri-Council for Nursing collectively represents nurses in every sector of the
nursing profession. Its four major national nursing organizations include: The
American Association of Colleges of Nursing representing over 534 baccalaureate
and graduate nursing education programs in senior colleges and universities across
the United States; The
American Nurses Association with 174,000 registered nurse members in 53 constituent
state and territorial associations; The
American Organization of Nurse Executives representing 5,000 nurses in executive
practice in all types of healthcare settings; and The
National League for Nursing on behalf of 1,674 education agency members representing
all levels of nursing education, 42 constituent state leagues representing 40
states, 104 healthcare institutions, 67 academic nursing centers and non-academic
agencies, and 6,842 individual members, including consumers, nursing school faculty
and nurse practitioners in community nursing centers. The
Tri-Council for Nursing believes that the Fiscal Year 1999 figure of $67 million
for the Nurse Education Act begins to underscore the importance of nursing education
programs to the public health. For Fiscal Year 2000, The Tri-Council for Nursing
recommends an increase in NEA funding of 10 percent over FY 1999 funding. This
increase would fund the Nurse Education Act programs at approximately $74 million.
The
Tri-Council for Nursing expresses its appreciation for the fiscal year 1999 levels
of funding for the programs critical to nursing education and research such as
the Nurse Education Act and National Institute of Nursing Research at NIH. The
1999 level of funding will be spent to improve the public health, but even this
level of funding is insufficient to meet today's demand for nurses. The
Nurse Education Act The
Nurse Education Act was re-authorized in 1998. It is the key source of federal
financial support for nursing education programs and nursing students. The NEA
and its student loan program primarily seek to encourage preparation of undergraduate
nursing students and advance practice nurses that are in high demand for care
of under-served populations. Nursing
workforce issues are of paramount concern now and for the future. The shortfall
of registered nurses predicted by the year 2010 is already being evidenced today.
(Findings from the National Sample Survey of Registered Nurses, Division of Nursing,
DHHS, March 1996) A recent survey of Nurse Staffing concluded that there is a
critical shortage of nurses prepared in specialty areas of practice, in all types
of settings and in all geographic locations in the country. (Survey on Nursing
Staff Shortages: The American Organization of Nurse Executives, 1999) Information
about pending nursing shortages underscores the fact that nurses are integral
to effective health care delivery in this country. Having sufficient numbers of
qualified nurses to provide patient care is essential to accessible, quality patient
care. Nurses provide essential care in every type of care setting: primary care,
acute and long term care and care of the chronically ill, disabled and elderly
and those at the end of life in a variety of traditional and non-traditional settings.
Title VIII provides the essential support needed to ensure the nursing workforce
needed to serve the public's requirements for health. Early
warning signs portend a nursing shortage that is very different from previous
shortages. This shortage will be challenged by demographics in the nursing profession.
The average age of nurses has increased to a high today of 44 years, and will
continue to increase. In addition, the demand for nurses prepared for specialty
nursing practice will only increase, with the burgeoning patient care technology
and continued change in health care delivery. Also, enrollments in baccalaureate
nursing programs have declined for the past four years. This year, even Masters
program enrollments are down. ("1998-1999 Enrollment and Graduations in Baccalaureate
and Graduate Programs in Nursing," AACN, 1999). These changes compound what could
be a serious nurse shortage in the areas typically hard hit by shortages, such
as underserved populations and special patient populations. The
NEA provides support for nurse practitioners, nurse midwives, nurse anesthetists
and other advanced nursing programs. Nursing administration is now included in
recognition of the priority for talented nursing management in health care organizations.
Federal funding for these programs has had a significant impact on increasing
the supply of nurse practitioners, nurse midwives and clinical nurse specialists.
Yet the supply of these well-trained professionals continues to lag behind demand.
One of the biggest challenges facing health care organizations today is finding
sufficient numbers of qualified nurses for specialty practice. The
NEA provides modest stipends to master's and doctoral students and offers disadvantaged
students the help they need to attain nursing education. This essential student
support enables individuals who might not otherwise complete advanced education
to make major contributions to health care in their local communities and regions.
Emerging
unmet health care needs will increase the burden on the already over-extended
nursing workforce. Areas of emerging serious concern include child health, immune
compromised individuals, older persons, low-income individuals, people with mental
illness and with substance abuse problems. People in these specialized populations
have complex care demands. Their needs are intertwined with social and behavioral
issues that are not easily resolved. There is need for innovation to develop care
delivery approaches to better meet their special requirements. Interventions are
needed now, because there is evidence of ever-increasing demand for care by these
groups. In
today's health care delivery, nursing is not only being asked to expand its functions,
but also to innovate in care delivery. The scarce resources for care are being
experienced in every sector of health care. Nursing, at the core of the health
care system, is experiencing the profound effects of reduced resources. In response,
nurses are taking on increased responsibility for patient care to meet the challenges
of this dynamic health care environment. As the complexity of care continues to
increase, nurses and others must continue to stretch their capacity and the resources.
The
NEA will continue to encourage programs that link training to the delivery of
primary care for underserved people. The Tri-Council for Nursing supports funding
for programs that provide repayment for academic loans for nurses who agree to
practice in areas of nurse shortage. These areas include public hospitals, community
health centers, American Indian facilities and public health services. Having
adequate numbers of nurses caring for patients in these underserved areas is critical
to the nation's goals for health. Through
the support of NEA funding, nurses have achieved innovations that have extended
the capacity to provide care for people in special population groups. Care provided
by nurses in more non-traditional type care settings such as community based health
care centers and primary care sites have made care more accessible to the public.
NEA funding that has supported these efforts includes both the programs to educate
APNs and future nurse faculty. Nursing
is one of the key health professions, working with others to provide care, a point
that will be further clarified by the next National Sample Survey of Registered
Nurses, scheduled for March, 2000 . This survey is expected to provide essential
information on integrated practice, which is critical in today's environment.
We are encouraged by joint efforts by the Council of Graduate Medical Education
and the National Advisory Council on Nurse Education and Practice, the Bureau
of Health Professions in this regard. Another
area of particular importance is the technologic advances that engender innovation
in providing both patient care and education for nurses. The ever-evolving patient
care technology allows access to nursing care by patients in a different delivery
modes. Many patients obtain their first line care information from telehealth
provided by nurses. This nursing care improves both access to care and improves
use of health care resources. Technology also allows sharing of professional expertise
across settings, thereby closing the gap between care settings in geographically
distant locations. Additionally, the technology increases the opportunity for
patient and family self-care, which requires corresponding patient education,
consultation and support. The new NEA could support projects that allow nurses
to design, manage and facilitate these new types of patient care and to best utilize
of the available resources. The
NEA provides for increasing the diversity of the nursing workforce. Although the
number of nurses from minority backgrounds increased at a somewhat faster rate
between 1992 and 1998, they only comprise ten percent of the nation's registered
nurse population. Funding for this important focus is critical to achieving the
goal of increasing the number of nurses who are representative of the populations
they serve. The NEA also helps disadvantaged students become nurses. The
new NEA also provides for strengthening the capacity for basic nursing education
and practice. The leverage provided through federal influence helps focus critical
areas for study and development, essential now that the nation faces the possibility
of a critical shortage of nurses. Bold steps must be taken to meet workforce demands
in the face of rapid change in demand for care and in the nursing workforce. The
importance of information for present and future planning is recognized in the
NEA. The Tri-Council for Nursing strongly supports Division of Nursing initiatives
to assess the practice choices made by nurses who have benefited from NEA funding.
The estimates on the projected supply and distribution of nurses and work on improved
forecasting models could impact readiness for patient care in significant ways
Informatics
is a key aspect of future practice and is important to the Tri-Council for Nursing.
Work on the National Nursing Informatics Agenda is of continuing value in addressing
interdisciplinary patient care planning and interventions. Future care will be
not only interdisciplinary but also across settings in new and different ways.
The
National Institute of Nursing Research The
purpose of the National Institute of Nursing Research at the National Institutes
of Health is to support clinical and basic research and to answer complex and
difficult questions in patient care delivery. NINR funds projects that deal with
care of individuals across the life span. The scope of NINR issues encompasses
promotion of healthy lifestyles, care during illness, reducing risks for disease
and disability and to provide care for the at-risk and undeserved populations.
Research
programs supported by the NINR address a number of critical public health and
patient care issues and questions. NINR research has added significantly to the
science of patient care and has contributed to improved public health and has
helped to lower the cost of care, through new ways to meet patient demand for
health care. NINR studies have addressed diabetes in Hispanic populations and
cardiovascular disease in African American children and youth. A hospital discharge
planning and care study using advanced practice nurses has improved health outcomes
and decreased readmission rates for low birth weight babies and elderly patients
at risk. This year the nursing community is seeking a $20.9 million funding increase
for the NINR for Fiscal Year 2000. This increase would provide more adequate funding
for the scope of NINR programs at $90.7 million. NINR
has supported research, important to key issues in health care today. Among the
topics of this research are health and risk behaviors, pain management which is
a key aspect for patients and families in end-of-life care, care of patients with
immune and infectious diseases, care of patients with cancer, with renal and urinary
diseases; trauma care; wound healing and mental health. Studies in the area of
healthcare delivery include acute care hospital nursing practices, accountability
for patient care outcomes, long term care practices, women's health, neuro-function
and cognition and musculoskeletal diseases, metabolic and diabetes and long term
care. The
Tri-Council for Nursing appreciates the opportunity to present its fiscal 2000
recommendations for nursing education and research. We look forward to working
with the subcommittee to achieve these funding levels. American
Association of Colleges of Nursing
One Dupont Circle, Suite 530
Washington,
DC 20036
202/463-6930
FAX: 202/785-8320 American
Nurses Association
600 Maryland Avenue, SW- Suite 100W
Washington,
DC 20024
202/651-7001 American
Organization of Nurse Executives
One North Franklin
Chicago, IL 60606
312/422-2800
FAX: 312/422-4503 National
League for Nursing
61 Broadway, 33rd Floor
New York, NY 10006
212/363-5555
FAX: 212/812-0393
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