Federal nursing student loan

There are three problems causing the current nursing shortage, according to Georges C. Benjamin, MD, secretary of the Maryland Department of Health and Mental Hygiene--nurses are not entering the profession, they are not staying in the profession; and they are not happy when they are there. (1) Dr Benjamin gave this testimony before the US Senate Health, Education, Labor, and Pensions Subcommittee on Aging, which was charged with investigating the nursing shortage and its effect on the US health care delivery system, in February 2001. At the same meeting, Sen Hillary Rodham Clinton (D-NY) noted the direct link between nursing care and patient outcomes. Sen Clinton urged Congress to address nurse staffing, whistle blower protections for nurses who register complaints about inadequate patient care, stagnant wage growth, and mandatory overtime. (2) Similar hearings were held before the Senate Health, Education, Labor, and Pensions Committee to investigate staffing changes in the last decade and before the Senate Veterans Affairs Committee to investigate the effect of the nursing shortage on the Department of Veterans Affairs.

UNDERSTANDING THE SHORTAGE

Two federal reports shed light on the nursing shortage issue. One report, issued by the Congressional Research Service (CRS), states that the nurse staffing crisis may be attributed to a maidistribution of labor rather than an actual shortage of RNs. The report implies that the shortage may be the result of recent poor personnel decisions. The report also states that more significant nursing shortages will be evident by 2010 unless corrective actions are taken now to increase the supply of RNs. (3)

The second report was issued by the General Accounting Office (GAO) after Rep Nancy Johnson (R-Conn), chair of the House Ways and Means Subcommittee on Health, requested the GAO study the challenges facing nurses today. The GAO concluded that data are not available currently to assess the nursing shortage adequately. Like the CRS report, however, the GAO report concludes that demographic pressures on supply and demand for RNs will result in a further shortage if steps are not taken immediately to correct the problem. (4) The report indicates that job satisfaction plays a key role in retention of RNs who are employed currently. The report states that the following factors are responsible for growing dissatisfaction in the nursing profession:

* inadequate staffing,

* heavy workloads,

* increased use of overtime,

* lack of sufficient support staff members, and

* inadequate wages. (5)

AORN JOINS THE DISCUSSION

AORN has joined approximately 30 other nursing organizations in a consensus statement that identifies factors contributing to the nursing crisis. Titled Assuring Quality Health Care for the United States: Supporting Nurse Education and Training, Building an Adequate Supply of Nurses, this statement addresses the need for increased capacity in the following areas. (6)

* Increase funding for programs of the Health Professions Education Partnership Act of 1998. A minimum $25 million increase in general appropriations funding over fiscal year (FY) 2001 is requested for FY 2002.

* Increase funding for the Nursing Education Loan Repayment Program. At least $10 million in appropriations is requested for FY 2002.

* Provide authority for and appropriations of at least $10 million in FY 2002 for the Nursing Student Loan Program. This program has operated on a $2 million revolving account funded through loan repayments, and new funding has not been authorized since the 1980s.

* Expand the Health Professions Education Partnerships Act of 1998 to ensure an adequate, highly trained nurse workforce. This expansion includes minority nurse initiatives, internship residency programs, scholarships, faculty member development (eg, a fast-track nursing faculty scholarship and loan program), a National Nurse Corps, and tax incentives.

* Promote quality patient care through initiatives in the Department of Labor and the Office of Minority Health that recognize the nursing shortage as a national issue that needs recruitment and retention strategies for minorities and through grants to support information systems that enhance the clinical education of nurses in all fields.

* Encourage community-based solutions, including the development of community-nurse outreach grants; expansion of Area Health Education Centers (AHECs), especially in rural areas; expansion of AHEC nurse-mentoring programs; and expansion of the Public Health Service to allow federal recognition of nurse-managed health centers.

* Incorporate research by the Agency for Healthcare Research and Quality on nurse staffing and education preparation, the National Institute of Nursing Research on the cost-effectiveness of different nursing practices on patient outcomes, and the Health Resources and Services Administration (HRSA) on increasing the timeliness and frequency of data collection to develop a national nursing workforce model. Data collection efforts and state and regional workforce planning efforts should be coordinated through HRSA.

AORN members and staff members also participated in "The Call to the Nursing Profession," an invitational meeting of national nursing organization leaders held in Washington, DC, in September 2001. Key issues of concern to nurses and their profession were addressed, including work environment; economic value; education; legislation, regulation, and policy; delivery systems and nursing practice models; diversity; recruitment and retention; professional and nursing culture; public relations and communications; and leadership and planning.

FEDERAL LEGISLATION

Many bills have been introduced in Congress to address the nursing shortage. Three particular bills are of special interest and are more likely than other bills to move through the legislative process. (7)

House resolution 1436. Rep Lois Capps (R-Calif), a former school nurse and a sponsor of HR 822, is the original sponsor of the Nurse Reinvestment Act, which had 187 cosponsors by mid-September 2001. This bill directs the Department of Health and Human Services to

* develop public service announcements that advertise and promote the nursing profession, highlight the rewards of nursing, and encourage individuals from diverse communities and backgrounds to enter the profession;

* provide grants to increase the number of nurses;

* establish a fast-track nursing school faculty training program;

* create a national Nurse Service Corps scholarship program that provides education in exchange for service in underserved areas;

* exclude money received from the National Nurse Service Corps Scholarship program from Internal Revenue Service gross income statements;

* provide Medicare payments to qualified entities for nurse education and training; and

* increase the Medicaid matching rate for Medicaid nurse aide training and competency evaluations.

The bill was referred to the House Ways and Means Committee Subcommittee on Health and the House Energy and Commerce Committee Subcommittee on Health. Sen John Kerry (D-Mass) has introduced a similar bill, S 706, in the Senate Finance Committee.

House resolution 1897. The Nurse of Tomorrow Act of 2001, HR 1897, was introduced by Rep Eliot Engel (D-NY) and was referred to the House Ways and Means Committee Subcommittee on Health. At press time, the bill had 57 cosponsors. This legislation authorizes Department of Health and Human Services grants for nurse recruitment and retention, basic nurse education, and encouragement of nurse education. In addition, the bill provides a refundable tax credit for nurses who work in hospitals, hospice programs, and other defined facilities and provides nurses deductions for monies received through the Nursing Education Loan Repayment Program.

Senate bill 721. The Nursing Employment and Education Development Act, S 721, was introduced by Sen Kay Bailey Hutchison (R-Tex) and referred to the Senate Health, Education, Labor, and Pensions Committee. With 19 cosponsors at press time, the bill funds the nursing workforce development student loan repayment program and permits nurses in this program to work in skilled nursing facilities, home health care agencies, public health departments, and nurse-managed health centers. The bill also calls for

* a Nurse Corps Scholarship program that provides individuals with nursing education in exchange for service in critical nursing shortage areas;

* a public awareness campaign to encourage individuals to enter the nursing profession;

* models of excellence for nurses;

* community nurse outreach grants;

* education assistance for nurses from diverse or disadvantaged backgrounds;

* career program grants for nurses;

* nurse training, internships, and residency grants;

* a fast-track nursing faculty loan program;

* a stipend and scholarship program to encourage individuals to seek advanced nursing degrees; and