Title VIII Nursing Workforce Development
Creates Opportunities to Develop a Highly Educated Nursing Workforce.
Nursing Workforce Development (Public Health
Service Act, Title VIII), formerly known as the Nurse Education
Act (NEA), is the authority that gives federal focus to the
supply and distribution of qualified nurses to meet our nation's
health care needs. It provides financial support for nursing
education programs as well as individual student support.
It favors programs in institutions that train nurses for practice
in medically underserved communities and nursing shortage
areas. Nursing Workforce Development supports nursing education
programs through the continuum, from entry-level preparation
through graduate study. It is the major source of funding
for nursing education.
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.
This act amends Title VIII 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 scholarship and loan programs: Nurse Education Loan
Repayment and Scholarship Programs and the Nursing Student
Loan (NSL) Program.
RECOMMENDATION: In FY 2004, AACN
recommends $175 million in funding for Nursing Workforce Development
programs. In FY 2003, Congress provided Nursing Workforce
Development with $113.5 million, yet the demand for nurses
will continue to rise with the aging of America's population
and its need for more intensive medical services. By bolstering
federal support, programs will prepare more nurse faculty
and educate registered nurses to meet the nation's health
care needs.
A Closer Look at Nursing Workforce Development
Grant Programs.
Advanced
Education Nursing Grants support the majority of programs
that prepare graduate-level nurses for faculty positions and
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.
Workforce
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 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. Workforce Diversity received $10 million for
FY 2003.
Nurse
Education, Practice and Retention 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 in obtaining 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 Authorized by the Nurse Reinvestment Act
Comprehensive
Geriatric Education Grants
The Nurse Reinvestment Act created Section 855 of the Public
Health Service Act to award grants to train and educate individuals
to provide geriatric care for the elderly. This 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
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 Student Support
Loan
Repayment and Scholarship Programs
The Nurse Reinvestment Act expanded Section 846, the Nurse
Education Loan Repayment Program, to include a scholarship
program. The new program offers individuals who are enrolled
or accepted for enrollment as a 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 repays up to 85% of nursing student
loans in return for at least two years of practice in a designated
nursing shortage area. For the first two years of service,
the program pays 60% of the RN's student loan balance, up
to $30,000. If the participant elects to stay for another
year, an additional 25% of the loan will is repaid, up to
an additional $7,500. Within three years, a nurse can pay
off approximately 85% of his or her student loans. In FY 2002,
564 students received awards. This expanded program received
$20 million for FY 2003.
Nursing
Student Loan (NSL)
In 1964, Congress created the NSL program (Public Health Service
Act, Title VIII, Section 836) 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.
Updated
March 19, 2003
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