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Establishes Nurse Scholarships

• Provides educational scholarships in exchange for commitment to serve in a public or private non-profit health facility determined to have a critical shortage of nurses.

Establishes Nurse Retention and Patient Safety Enhancement Grants

• Assists health care facilities to retain nurses and improve patient care delivery through more collaboration between nurses and other health care professionals and more involvement by nurses in the decision-making process.

Establishes Comprehensive Geriatric Training Grants for Nurses

• Provides for programs to train and educate individuals in providing geriatric care for the elderly.

Establishes Faculty Loan Cancellation Program

• Provides for loan cancellation to nurses to allow full-time study and rapid completion of advanced degree studies. For cancellation of a set amount of loan, recipients would be obligated to spend a certain amount of time in a faculty position at a school of nursing.

Establishes Career Ladder Grant Program

• Assists individuals in the nursing workforce to obtain more education.
  
• Establishes partnerships between Health Care Providers and Schools of Nursing for advanced training.
  

Establishes Public Service Announcements

• Advertises and promotes the nursing profession.
  
• Educates the public about the rewards of a nursing career

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AACN BILL ANALYSIS: NURSE REINVESTMENT ACT

The Nurse Reinvestment Act (H.R. 3487) was passed by unanimous consent first in the Senate, and then House of Representatives on July 22, 2002. On August 1, 2002, President George W. Bush signed the bill into law creating P.L. 107-205. Below is an analysis of the new law.

TITLE I---NURSE RECRUITMENT

SEC. 101. DEFINITIONS.

• Amends Section 801 of the Public Health Service Act (PHSA) by adding definitions of Ambulatory Surgical Center, Federally Qualified Health Center, Home Health Agency, Hospice Program, Rural Health Clinic, and Skilled Nursing Facility to expand practice sites so that nurses may fulfill their service requirements for the Nursing Education Loan Repayment Program and new Scholarship Program in Section 846. In a statement of congressional intent, Nurse-Managed Health Centers are added to the list. The definition of ‘Health Care Facility’ is expanded to include the above-mentioned sites in addition to Indian Health Service Health Center, Native Hawaiian Health Center, Public Health Clinic, and State or Local Health Department, and also replaces ‘public hospital’ with ‘hospital.’

SEC. 102. PUBLIC HEALTH SERVICE ANNOUNCEMENTS REGARDING THE NURSING PROFESSION.
Amends the following sections of Title VIII of the PHSA by adding new sections:

• Section 851 Public Service Announcements
  Directs the Secretary of Health and Human Services to develop a national public service announcement campaign that advertises and promotes the nursing profession. Funds may be used for broadcast through television, radio and other appropriate media outlets. Authorizes ‘such sums as necessary’ for FY 2003 to 2007.
  
  
• Section 852 State and Local Public Service Announcements
  Establishes authority for the Secretary to award grants to schools of nursing, nursing centers, academic health centers, state or local governments, and other public or private nonprofit entities to support state and local advertising campaigns promoting the nursing profession and encouraging students from disadvantaged backgrounds to enter the nursing profession. Funds may be used for local television, radio, newspaper, billboard, or internet advertisements to promote the nursing profession; promote nursing education programs; inform the public of financial assistance available for nursing education; and recruit individuals into nursing. Funds may not be used to advertise specific employment opportunities. Authorizes ‘such sums as necessary’ for FY 2003 to 2007.

SEC. 103. NATIONAL NURSE SERVICE CORPS.
Amends Title VIII of the PHSA by expanding Section 846:

• Loan Repayment Program-Expands practice sites for the Nursing Education Loan Repayment Program and new Scholarship Program (see below) defined as a Health Care Facility with a critical shortage of nurses. After FY 2007, nurses may not be assigned to for-profit private facilities.
  
  
• Scholarship Program-Establishes a Scholarship Program for FY 2003 and FY 2004. The Scholarship Program may be continued at the discretion of the Secretary thereafter. Individuals who are enrolled or accepted for enrollment as a full-time or part-time student are eligible. Preference is given to students with the greatest financial need. Students agree to serve as nurses in a Health Care Facility with a critical shortage of nurses upon graduation for not less than two years or on a part-time basis equivalent to full-time service of not less than two years.

  A report to Congress is due no later than 18 months after enactment of the law that evaluates the number and demographics of recipients of scholarships and loan repayments; amount of scholarships and loans; number of graduates; schools the recipients attended; placement of the recipients; default rate; amount of outstanding default funds and reason for default; justification for allocation of funds between Scholarship and Loans Repayment Programs; and overall costs and benefits of the program. Authorizes ‘such sums as necessary’ for FY 2003 to 2007. The Secretary may determine the allocation between the Scholarship Program and the Loan Program.

TITLE II---NURSE RETENTION

SEC. 201. BUILDING CAREER LADDERS AND RETAINING QUALITY NURSES.
Amends Title VIII of the PHSA by expanding Section 831:

• Nurse Education, Practice, and Retention Grants- Reorganizes and expands grant areas for which the Secretary may award grants to a school of nursing, Health Care Facility, or a partnership of a school and a facility.

  Reprioritizes Education Grant Areas to: a) expand enrollments in baccalaureate nursing programs; b) develop internship and residency programs to enhance mentoring and specialty training; and c) provide new technologies in education including distance learning.

  Reprioritizes Practice Grant Areas to: a) expand practice arrangements in non-institutional settings to improve primary health care in medically underserved communities; b) provide care for underserved populations such as the elderly, HIV/AIDS patients, substance abusers, homeless, and domestic abuse victims; c) provide skills to practice in existing and emerging health systems; and d) develop cultural competencies.

• Creates Retention Grant Areas to enhance the nursing workforce through two retention programs. Career Ladder Programs-Creates a grant program to promote career advancement for nursing personnel from home health aide to certified nursing assistant, licensed practical nurse, registered nurse, and advanced education nurse. Assists individuals to obtain career counseling, mentoring, and education required to enter the nursing profession.

Enhancing Patient Care Delivery Systems-Establishes a grant program to enhance collaboration and communication among nurses and other health care providers by promoting nurse involvement in organizational and clinical decision-making processes. Preference is given to applicants that have not received past awards from this program, but the Secretary can make exceptions based on substantial improvement in nurse retention or patient care.

An annual report is due to Congress identifying the number of grants and how these grants meet the needs of the nursing workforce. Authorizes ‘such sums as necessary’ for FY 2003 to 2007. In FY 2003 through FY 2005, funds appropriated for Section 831 in excess of FY 2002 levels will be given preference by the Secretary to developing internship and residency programs, new retention grant areas, and other priority areas determined by the Secretary.

SEC. 202. COMPREHENSIVE GERIATRIC EDUCATION.
Amends Title VIII of the PHSA by adding a new section:

• Section 855 Comprehensive Geriatric Education
  Establishes authority for the Secretary to award grants to a school of nursing, Health Care Facility, program leading to certification as a certified nursing assistant, or a partnership of a school or program and facility to train and educate individuals in providing geriatric care for the elderly. This program is to coordinate with the geriatric education program in Section 753 of the PHSA that provides geriatric training for physicians and dentists. Funds may be used to train individuals who will provide geriatric care for the elderly, develop and disseminate geriatric curriculum, train faculty members, and provide continuing education. Authorizes ‘such sums as necessary’ for FY 2003 to 2007.
  

SEC. 203. NURSE FACULTY LOAN PROGRAM.
Amends Title VIII of the PHSA by adding a new sections:

• Section 846A Nurse Faculty Loan Program
  Establishes authority for the Secretary, acting through the Administrator of the Health Resources and Services Administration, to enter into agreements with a school of nursing to establish a student loan fund to increase the number of qualified faculty. Agreements include the creation of a student loan fund by the school taking a federal contribution; an amount equal to not less than one-ninth of the federal contribution contributed by the school; and providing for collection of principal, interest and any other earnings on loans made by the fund. The student loan fund may only be used for loans to students and costs of collection of loans and interest.

  Students must be pursuing full-time study or, at the discretion of the Secretary, part-time study in an advanced degree program for Advanced Education Nurses as described in Section 811b of the PHSA. A statement of congressional intent clarifies that the student may pursue a master’s or doctoral degree. The maximum loan made by the school is $30,000 per student in an academic year.

  Students must agree to teach at the 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. An interest rate 3% for the student pursuing the faculty role begins accruing three months after graduation. If the school of nursing determines that the student will not complete the course of study or serve as a faculty member as required under the agreement, the interest rate on the unpaid balance of the loan will be at the prevailing market rate. The Secretary will pay the school of nursing an amount equal to the proportionate share of the canceled loan. Authorizes ‘such sums as necessary’ for FY 2003 to 2007.
  

SEC. 204. REPORTS BY GENERAL ACCOUNTING OFFICE.
Directs the GAO to study three issues not later than four years after enactment of the law:

• National Variations in the nursing shortage at hospitals, nursing homes, and other practice sites. A report will be submitted to Congress identifying federal remedies to resolve the shortage.
  
  
• Hiring Differences Among Certain Private Entities specifically the hiring patterns of nonprofit private facilities versus for-profit private facilities. A report will be submitted to Congress citing the effect of inclusion of for-profit private facilities on implementing the law.
  
  
• Nursing Scholarships to ascertain whether the addition of scholarships to Section 846 of the PHSA has increased the number of applicants to schools of nursing. A report will be submitted to Congress on the results.

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