NLN Board Blankets Capitol Hill
The NLN Board of Governors once again demonstrated the innate ability of nurses to advocate for those who need us the most — our patients — during its foray to Capitol Hill on May 14. During the meetings with their congressional delegations, board members advocated for increased funding for Title VIII – Nursing Workforce Development Programs and the Health Professions Programs under Title VII. Also, discussed in their meetings were various aspects of health care reform. In their visits, they noted that:

Title VIII – Nursing Workforce Development Programs

  • An increase in funding for Title VIII programs to a minimum of $215 million in FY 2010 would put the federal investment in this health care capacity-building tool to only six hundred thousandths of the total estimated federal budget of $3.56 trillion.
  • With an estimated 3.4 million licensed RNs and APRNs, nurses represent the largest occupation of all health care workers in the United States and provide patient care in virtually all locations in which health care is delivered.
  • The Bureau of Labor Statistics reports that employment of RNs is expected to grow 23 percent from 2006 to 2016, much faster than the average for all occupations. During this time, the system is projected to generate 587,000 new RN jobs in addition to the hundreds of thousands of job openings resulting from the need to replace experienced nurses who will leave the occupation.
  • The Health Resources and Services Administration projects that, absent aggressive intervention, the RN workforce will fall 36 percent below requirements by the year 2020.
  • The present nurse faculty staffing deficit is expected to intensify as the existing nurse educator workforce reaches retirement age. With 48 percent of nurse faculty over the age of 55, fully one-half of today’s nurse faculty workforce is expected to retire by 2015, while more than one in five (21 percent) expect to retire within the next five years.
  • In 2006, the nurse faculty vacancies grew to 1,390 as the estimated number of budgeted, unfilled, full-time positions countrywide, representing a 7.9 percent vacancy rate in baccalaureate and higher degree programs. This was an increase of 32 percent since 2002, and a 5.6 percent vacancy rate in associate degree programs, which translated to a 10 percent rise in the same period. By 2007, just in one year, the unfilled full-time faculty positions nationwide rose to more than 1,900.
  • Title VII – Health Professions Programs

  • The Health Professions Programs under Title VII should be restored to a funding level of $330 million in FY 2010.
  • Title VII programs — $193.96 million in FY 2008 — are a cost-effective source of federal funding for the education of health care providers who are more likely to return to medically underserved areas where shortages occur.
  • A report recently released by the Institute of Medicine characterized the health professions programs as an “undervalued asset” and recommended that Congress “invest in programs with proven effectiveness.”
  • According to a National Conference of State Legislatures survey, federal funding of Title VII programs influences the allocation of funds from the states and other sources to these programs, which are viewed as fundamental to the states’ work-force goals.
  • According to HRSA's 2007 annual performance measures, the Title VII programs exceeded expectations — by as much as 17 percent — in three key areas: the percentage of graduates and program completers that are underrepresented minorities and/or from disadvantaged back-grounds; the proportion of participants training in medically underserved communities; and the percentage of health professionals entering practice in underserved areas.

        Volume 6, Issue 2
            May 2009

NLN Board Blankets Capitol Hill

Health Care Reform


Government Affairs Action Center
Health Care Reform
Building and supporting a quality health care system accessible to all is justified by the following:
  • In 2007, the United States spent a total of $2.2 trillion on health care, about $7,421 per person, nearly twice the per capita cost of other industrial nations, and yet the United States has worse health outcomes — shorter lifespan and higher infant mortality — than other developed nations.
  • In the last two years, approximately 87 million people were uninsured at some point, and nearly 160 million workers with employer-based health insurance are poised to lose coverage.
  • The US economy lost as much as $207 billion in 2007 due to the poor health and shorter lifespan of the uninsured.
  • When the uninsured cannot pay for the health care needed, health care providers shift costs to those who can pay. A recent study estimates that in 2009, premiums for family coverage were 8 percent higher — a national average of $1,100 — owing to the cost shift from the uninsured.
  • Disparity in health status — shorter life expectancy, higher rates of chronic health conditions, and disability — exist in communities and populations throughout the nation. According to the Agency for Healthcare Research and Quality, disparities also are observed in most aspects of health care, including care for chronic conditions such as mental health disorders and substance use, HIV/AIDS, cancer, diabetes, heart disease, oral health conditions, infant mortality and morbidity, respiratory disease, and end stage renal disease.
  • Delivering a cost-effective health model of coordinated care, health promotion, and consumer education and empowerment requires effective learning from well-prepared nurses, the predominant profession in health care, and the profession that relies on educating patients and communities and is guided by a holistic philosophy of care.

President Obama released his proposed budget for FY 2010 on May 7, 2009. To the welcome surprise of those nursing organizations that have DC-based advocacy programs, the president’s proposed budget would allocate $263.4 million for the Title VIII programs, which are currently funded at $171 million. The two programs that would receive the increase are the Nursing Faculty Loan Program and Nurse Education Loan Repayment & Nurse Scholarships.



Arkansas Expands Nurse Loan Program

Through Act 9 — passed by the Legislature this session, signed into law February 3 by Governor Mike Beebe (D), and immediately effective — Arkansas now provides nursing student loans of up to $20,000 a year. In addition, the program has been extended to include nurses seeking postgraduate degrees to qualify them as nurse educators. Previously, the Nursing Student Loan Program limited the loans to $6,000 and was available only to students in RN or LPN programs.

Representative Tracy Pennartz (D-Fort Smith), who spearheaded the legislation, said she learned from Arkansas Nursing Board executive director Faith Fields that the lack of qualified nurses to fill nursing school educator positions is contributing to the state’s nursing shortage. Therefore, she suggested revamping the loan program to include educating faculty.

Carolyn Mosley, dean of the University of Arkansas at Forth Smith (UAFS) College of Health Sciences and a member of the NLN Board of Governors, also was instrumental in bringing the issue to the forefront. When the Legislature’s Health and Safety Committee met at UAFS, Mosley testified about the difficulty in recruiting faculty. In her testimony she said, “Arkansas is in a unique situation because few people are available because there are few nurses with degrees above associate degrees, and at a minimum, a master’s degree is required for teaching, and preferably a doctorate.” Mosley noted that UAFS has more applicants than it can accept into its nursing program due to limited faculty. She praised the loan program’s expansion, saying it “. . . will enable us to train more educators so we can increase enrollment.”

Under the program’s loan terms, students will have their loans forgiven at the rate of one year’s loan for each year they work in Arkansas as a nurse or in a state nursing education program. The loan program is administered by the Arkansas State Board of Nursing and funded through state and federal appropriations, gifts, grants, bequests, and donations.

Nurse Education Bill Introduced in Ohio

On April 2, Ohio State Senator and RN Sue Morano (D-13) introduced a Comprehensive Nurse Education bill to address the state’s shortage of nursing educators. Incorporating recommendations of the General Assembly’s Nursing Education Study Committee, chaired by Morano, Senate Bill 89 directs the Ohio Board of Regents to encourage universities to share ideas about how best to recruit instructors and to funnel more money to help nurses wanting to teach pay for advanced degrees. The bill also changes requirements for APRNs. The bill does not address the pay of nursing faculty in Ohio (the average annual salary of an entry-level nursing professor is $50,000), but Morano said the Legislature cannot force schools to pay higher salaries. She said that, even with lower salaries, better marketing could make the teaching profession more attractive, and added, “I believe this bill is a big step in the right direction for solving a nursing education crisis.”

Rhode Island Proposes Tax Credit for Nurse Educators

A special legislative commission in Rhode Island formed in May 2008 has come up with a proposal designed to counter a looming shortage of nurses in the state. To retain/recruit nursing faculty and thereby expand the number of nursing school graduates, the commission recommends that the state’s nurse educators be given a $3,500 tax credit annually.

At a news conference unveiling the proposal on April 22, commission members cited projections indicating that Rhode Island will have a shortfall of 1,800 RNs by next year, growing to 6,500 by 2020. They stressed that the state’s nursing schools cannot handle the demand. For example, in 2004, nearly 3,900 people applied to nursing schools in Rhode Island, but only 737 were accepted. According to the commission’s report, “Most of the schools of nursing reported faculty shortages as the primary reason why they cannot admit more nursing students.”

Despite its conclusion that the state’s faculty shortages are due to low pay, the commission opted to recommend the tax credit rather than an increase in school salaries. An increase, commission leaders said, would not be practical because, first, the state is in the midst of a budget crisis. Second, according to commission co-chair Senator James E. Doyle (D-Pawtucket), contractual issues at state nursing schools would prevent nursing faculty from receiving larger pay hikes than those teaching other disciplines.

Doyle acknowledged that if the tax credit is passed, the state could lose as much as $500,000 a year in revenue. However, he added, that would be offset by the economic benefits to health-care facilities that hire the graduates, saving millions of dollars in overtime pay, recruitment costs, and temporary help.

In addition to the tax credit, the commission recommends that in subsequent years the state should give priority to nursing programs, including the expansion, replacement, or renovation of existing facilities. The benefits accruing from the commission’s recommendations are described in its report as follows: “Increasing funding and nursing educational capacity within Rhode Island is a win-win for all — the state economy gains knowledge-based, better-paying jobs which add significantly to the tax base, and the increasingly aging population of Rhode Island receives quality, efficient, and potentially less costly health care with the full inclusion of an educated nursing workforce.”

Because the nurse shortage figures cited by the commission at its news conference raised a number of questions from nurses, particularly new graduates, who are having trouble finding work, the panel spent a good part of its conference explaining why local hospitals are not hiring. In essence, the commission members blamed the economy — the current lack of jobs for new graduates represents an anomaly that will change once the economy turns around.

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