Congress Reaches Deal on FY 2014 Budget
On December 10, Representative Paul Ryan (R-WI) and Senator Patty Murray (D-WA), leaders of the bipartisan budget conference committee, announced an agreement on a two-year budget plan. While described as a modest step forward, the significance of the bipartisan budget deal, the first to emerge from a divided Congress in over a quarter of a century, should be noted. If passed by both chambers as expected, it will lift the threat of a second government shutdown, and just as importantly, the compromise may be a sign of some old partisan wounds beginning to heal.
The Bipartisan Budget Act of 2013 sets levels for overall spending for the next two fiscal years and replaces a large portion of the scheduled sequestration cuts, restoring almost two-thirds of the scheduled nondefense discretionary (NDD) cuts in 2014, but providing significantly less relief in 2015. In addition, the bill provides much needed certainty for FY 2014 and 2015 and paves the way for passage of appropriations bills through regular order, a welcome improvement over the more recent precedent of falling back on continuing resolutions and lurching from fiscal crisis to crisis.
The current law provides a NDD spending cap in 2014 of $469.391 billion and $483.130 billion in 2015. The Bipartisan Budget Act increases the NDD 2014 spending cap to $491.773 billion and $492.456 billion in 2015. The deal avoids tax increases, shrinks the sequester by $63 billion over the next two years, and modestly lowers the long-term deficit. The plan would set a $1.012 trillion discretionary spending level for 2013 - halfway between the $967 billion House sequester level and the Senate $1.014 trillion level for 2014. The additional spending now would come at the expense of more spending later - notably in pension benefits for federal workers and other items that have yet to be detailed. The long-term deficit would be cut by $23 billion.
If the deal fails, a full year continuing resolution with full sequestration will be the result. Some Democrats have indicated their displeasure that an extension of unemployment benefits was not included in the budget deal while some Republicans are unhappy with the overall level of spending as being too high. The leaders of the House and Senate Appropriations Committees began work immediately, and continued throughout the month of December, to set allocations for various programs and agencies.
HHS Awards $55.5 Million to Bolster America's Health Care Workforce
On December 5, 2013, Health and Human Services (HHS) Secretary Kathleen Sebelius announced $55.5 million in funding awarded in FY 2013 to strengthen training for health professionals and increase the size of the nation's health care workforce. "These grants and the many training programs they support have a real impact by helping to create innovative care delivery models and improving access to high-quality care," Secretary Sebelius said.
More than 270 grants will address health workforce needs in nursing, public health, behavioral health, health workforce development, and dentistry. The grants are managed by HHS' Health Resources and Services Administration (HRSA). A majority of the funding - $45.4 million - will support nursing workforce development in the following areas:
- Increasing the number of nurse faculty ($22.1 million): provides low-interest loans to nurses to train to become faculty and loan cancellation for service as faculty.
- Improving nursing diversity ($5.2 million): expands educational opportunities for students from disadvantaged backgrounds, including racial and ethnic minorities who are underrepresented among registered nurses.
- Increasing nurse anesthetist traineeships ($2.2 million): supports nurse anesthetist programs to provide traineeships to licensed registered nurses enrolled as full-time students in a master's or doctoral nurse anesthesia program.
- Promoting interprofessional collaborative practice ($6.7 million): brings together interprofessional teams of nurses and other health professionals to develop and implement innovative practice models for providing care.
- Supporting advanced nursing education ($9.2 million): funds advanced nursing programs that support registered nurses in becoming nurse practitioners, nurse midwives, and other advanced practice nurses.
For a list of grant awards, go to www.hrsa.gov/about/news/2013tables/healthprofessions
Back to the Future of Nursing: A Look Ahead Based on a Landmark IOM Report
The Institute of Medicine recently celebrated the three-year anniversary of The Future of Nursing: Leading Change, Advancing Health report, which was released on October 5, 2010. The event highlighted the impact of the report through implementation of recommendations at both the national and local levels, discussed the continued work of the Future of Nursing: Campaign for Action, and charted future directions and priorities for the nursing profession. Former Department of Health and Human Services Secretary Donna Shalala, PhD, FAAN, kicked off the event with a keynote address. Secretary Shalala discussed the report's influence three years later including how this report is part of nursing curriculum today.
Other panelists included:
In their opening remarks and subsequent discussion, the panelists highlighted similar thoughts and issues including the importance of modifying scope of practice laws to ensure that the full health care team can provide care, that all pathways to the nursing profession are important and the need to recognize nursing students coming through community college and LPN programs in addition to four-year baccalaureate programs, and that education of health professionals must be team-based in addition to the team-based approach for patients.
- Carmen Alvarez, PhD, RN, NP-C, CNM, Julio Bellber Postdoctoral Fellow, Department of Health Policy, George Washington University
- Linda Burnes Bolton, DrPH, RN, FAAN, vice president and chief nursing officer, Cedars-Sinai Medical Center; vice-chair, Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing
- Susan Hassmiller, PhD, RN, FAAN, senior adviser for nursing, Robert Wood Johnson Foundation; study director, Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing
- Darrell Kirch, MD, president and chief executive officer, Association of American Medical Colleges
- David Vlahov, PhD, RN, FAAN, dean and endowed professor of nursing education, School of Nursing, University of California, San Francisco
An archived webcast of the event can be found at http://www.iom.edu/rosenthal2013.
Coalition Building: The Key to Effective Advocacy
"Coalition building" draws on a rich skill set that can be developed in the classroom through techniques such as cooperative learning. "Coalition building" also is an indispensable professional strategy for nurses to employ outside the classroom. The complexity, depth, and scope of today's problems make coalition building a basic skill for nursing, regardless of whether the context is empowering family members for health care of a loved one, fostering team cohesion in the workplace, networking for community trauma-informed care, or shaping a "health in all policies" tactic using collaborative approaches to improve population health by embedding health considerations into decision-making processes across a broad array of sectors.
The National League for Nursing is no stranger to coalition building. On the national level the NLN participates as a member or a facilitator in the following collaborations:
ANSR Alliance (Americans for Nursing Shortage Relief)
The NLN serves as ANSR's co-facilitator. Since 2001, ANSR has identified and promoted creative approaches for addressing the nursing and nurse faculty shortages. The alliance was instrumental in securing new and expanded initiatives to sustain and boost HRSA's Nursing Workforce Development Programs of the Public Health Service Act's Title VIII. ANSR, comprising 54 national organizations, develops and submits letters to congressional appropriations committees urging appropriate funding of Title VIII programs. It writes and delivers testimony to the committees and plans and conducts congressional briefings. ANSR also seeks to empower nurses and students by developing web-based resources that aid in building advocacy knowledge, skills, and abilities.
Coalition for Patients' Rights (CPR)
More than 35 organizations representing a variety of licensed health care providers counter efforts by the American Medical Association's Scope of Practice initiative designed to limit patients' choice of health practitioners. By working to level the playing field among authorized health care providers, CPR ensures that legislation and regulation not discriminate among types of health care providers.
Mental Health Liaison Group (MHLG)
Membership in MHLG enhances the NLN's public policy work addressing mental health issues. The MHLG is a coalition of some 80-plus national member organizations. MHLG's operations cover developing a consensus document of recommended appropriation levels for various programs of the Substance Abuse and Mental Health Services Administration and NIH, monitoring federal developments, and preparing letters and testimony that best reflect consensus within the community.
National Violence Prevention Network (NVPN)
This coalition of health providers, anti-violence organizations, and law enforcement groups, builds awareness and support for the National Violent Death Reporting System (NVDRS), a database that underpins practice and policy to abate violence as a public health phenomenon.
Friends of HRSA (FHRSA)
FHRSA is a non-partisan alliance of more than 175 national organizations dedicated to improving health through high-quality primary and preventive services and a well-prepared health care workforce. The coalition advocates that HRSA's programs receive adequate funding in order to reach individuals and families who are medically vulnerable, low-income, and geographically isolated.
Health Professions and Nursing Education Coalition (HPNEC)
HPNEC is an informal alliance of more than 60 national organizations representing schools, programs, health professionals, and students committed to ensuring the health care workforce is educated to meet the needs of the country's growing, aging, and diverse population. HPNEC focuses on the HRSA Title VIII and VII (Health Professions) programs.
Nursing Alliance for Quality Care (NAQC)
This partnership among the nation's leading nursing organizations, consumers, and stakeholders advances safe, high-quality, patient-centric care for all. NAQC resources include information on policy and health care quality leadership.