[Congressional Record Volume 147, Number 49 (Thursday, April 5, 2001)]
[Senate]
[Pages S3546-S3552]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. HUTCHINSON (for himself, Ms. Mikulski, Mr. Warner, Mr. 
        Enzi, Mr. Bingaman, Mr. Roberts, Mr. Frist, and Ms. Collins):
  S. 721. A bill to amend the Public Health Service Act to establish a 
Nurse Corps and recruitment and retention strategies to address the 
nursing shortage, and for other purposes; to the Committee on Health, 
Education, Labor, and Pension.
  Mr. HUTCHINSON. Mr. President, today, I am pleased to introduce the 
Nurse Employment and Education Development--or NEED Act--critical 
legislation to address the current and impending nursing shortages in 
our country. I am joined by Senators Mikulski, Warner, Enzi, Bingaman, 
Roberts, Frist and Collins.
  This year, the first order of business of the Aging Subcommittee, of 
which I am Chairman, was to hold a hearing on the nursing shortage and 
its impact on our health care delivery system. Recent nursing 
statistics paint a grim picture for the future of the nursing 
workforce, when millions of Baby Boomers will retire and place an 
unprecedented strain on the health care system. By the year 2020, it is 
projected that nursing needs will be unmet by at least 20 percent.
  This is in large part due to a shrinking pipeline. The average age of 
Registered Nurses is 43.3 years. Nurses under age 30 comprise less than 
10 percent of today's nurse workforce. Minorities, including men, 
remain a minuscule percentage of the workforce.

[[Page S3547]]

The cumulative effect of all this is that nurses and nurse faculty are 
retiring or leaving the profession at a rapid rate, and only a small 
number of nurses and nurse educators are taking their place.
  In my home state of Arkansas, 153 eligible nursing students were 
turned away in 1999 because of the lack of faculty to teach them. In 
the meantime, over 750 nursing vacancies have been reported by Arkansas 
hospitals, and I know that this trend is being experienced by many more 
health care providers across the state. What is happening in Arkansas 
is becoming a major issue across the country.
  The NEED Act builds on the programs currently in the Nurse Education 
Act and adds several new, innovative approaches to alleviate the 
nursing shortage. In the area of recruitment, the NEED Act establishes 
a Nurse Corps, which is essential to attracting able individuals into 
the nurse workforce to fill current and future health needs. In 
particular, the NEED Act expands the existing nurse loan repayment 
program under the Nurse Education Act and by adding scholarships for 
which nursing students can qualify in exchange for at least 2 years of 
service in a critical nurse shortage area or in a variety of health 
care facilities determined to have a shortage in nursing. In addition, 
the NEED Act adds nursing homes, home health agencies, public health 
departments and nurse management health centers to the list of eligible 
entities to fulfill this service requirement.
  Changing the image of nursing and promoting workforce diversity is 
another key recruiting factor to get people, especially young people, 
interested in nursing careers. The NEED Act provides funding for multi-
media campaigns at the federal and state level to reach out to 
individuals to encourage them to consider nursing as they make career 
choices.
  The NEED Act also provides grants for community partnerships to 
develop innovative nurse recruiting and retention strategies tailored 
to a particular community, and authorizes additional funding for 
workforce diversity grants already provided for under the Nurse 
Education Act.

  In order to strengthen the existing workforce, the NEED Act provides 
grant funding for: career ladder programs to facilitate educational 
advancement for individuals with existing nursing degrees or health 
care training; long-term care training for nurses who will inevitably 
be dealing with an older patient population; and nursing internships 
and residencies to meet the current demand for nurses with specialty 
training, be it in the ER or the labor and delivery room
  Finally, the NEED Act provides for a fast-track faculty development 
program, which seeks to encourage master's and doctoral students to 
rapidly complete their studies through loans and scholarships. We must 
realize that getting people into the pipeline will mean very little if 
we do not have the teachers to teach them. Individuals receiving 
financial assistance through the fast-track faculty program must agree 
to teach at an accredited school of nursing in exchange for this 
assistance.
  This is a bipartisan issue and it is becoming a nationwide concern. I 
hope that we can work together to successfully secure passage of the 
NEED Act and other meaningful solutions.
  I ask unanimous consent that the text of the Nurse Employment and 
Education Development (NEED Act) be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 721

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Nursing Employment and 
     Education Development Act'' or the ``NEED Act''.

     SEC. 2. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.

       (a) Nurse Corps Loan Repayment Program.--Section 846 of the 
     Public Health Service Act (42 U.S.C. 297n) is amended by--
       (1) in subsection (a)(3), by inserting ``in a skilled 
     nursing facility, in a home health agency, in a public health 
     department, in a nurse-managed health center,'' after ``in a 
     public hospital,''; and
       (2) in subsection (g), by striking ``$5,000,000'' and all 
     that follows to the period and inserting ``$10,000,000 for 
     fiscal year 2002 and $15,000,000 in 2003''.
       (b) Grant Programs.--Title VIII of the Public Health 
     Service Act (42 U.S.C. 296 et seq.) is amended by adding at 
     the end the following:

               ``PART H--NURSE CORPS SCHOLARSHIP PROGRAM

     ``SEC. 851. NURSE CORPS SCHOLARSHIP PROGRAM.

       ``(a) Program Authorized.--The Secretary shall establish a 
     Nurse Corps Scholarship program (referred to in this section 
     as the `program') to provide scholarships to individuals 
     seeking nursing education in exchange for service from such 
     individuals in a critical nursing shortage area upon 
     completion of such education.
       ``(b) Purpose.--The purpose of the program is to assure 
     that--
       ``(1) an adequate supply of nurses, at all preparation 
     levels up to the doctoral level, are available to meet the 
     nursing needs in critical nursing shortage areas;
       ``(2) an adequate supply of nurse educators are available 
     to meet the nursing education needs of the Nation; and
       ``(3) preference will be given to the preparation of 
     minority nurses and individuals who demonstrate greatest 
     financial need for nursing and nurse faculty scholarships.
       ``(c) Critical Nursing Shortage Area.--
       ``(1) In general.--The term `critical nursing shortage 
     area' means--
       ``(A) an urban or rural area that the Secretary determines 
     is experiencing a nursing shortage;
       ``(B) a population that the Secretary determines has such a 
     shortage; or
       ``(C) a medical facility or other public or private 
     facility that the Secretary determines has a shortage.
       ``(2) Factors to consider.--In making a determination 
     regarding a critical nursing shortage area, the Secretary 
     shall the criteria in section 846 for not more than 12 
     months, and after such period, the following:
       ``(A) The ratio of available nurses to the number of 
     individuals in the area or population group.
       ``(B) The demonstrated need of a medical facility or other 
     public health facility in the area.
       ``(C) The presence of innovative retention strategies 
     utilized by eligible facilities.
       ``(d) Eligibility.--To be eligible for the program an 
     individual shall--
       ``(1) be accepted for enrollment, or be enrolled, as a 
     full- or part-time student in an accredited nursing program; 
     and
       ``(2) submit an application for the program; and
       ``(3) submit a written contract, at the time of submitting 
     the application, accepting payment of a scholarship in 
     exchange for providing the required service in a critical 
     nursing shortage area.
       ``(e) Preference.--In selecting individuals to participate 
     in the program, the Secretary shall give priority to any 
     application submitted by an individual--
       ``(1) who has characteristics that increase the probability 
     that the individual will continue to serve in a critical 
     nursing shortage area after the period of obligated service 
     is complete;
       ``(2) who has an interest in a practice area of nursing, 
     including teaching nursing, that has unmet needs; and
       ``(3) who is from a disadvantaged background or 
     demonstrates the greatest financial need.
       ``(f) Application.--The Secretary shall create an 
     application form for any individual desiring to participate 
     in the program, and include in such form--
       ``(1) a summary of the rights and liabilities of an 
     individual whose application is approved (and whose contract 
     is accepted) by the Secretary;
       ``(2) information respecting meeting a service obligation 
     through private practice under an agreement; and
       ``(3) any other information that the individual needs to 
     understand the program, including a statement of all factors 
     considered in approving applications for the program.
       ``(g) Contract.--
       ``(1) In general.--The Secretary shall prepare a written 
     contract for the program that shall be provided to any 
     individual desiring to participate in the program at the time 
     that an application is provided to such individual.
       ``(2) Content.--The contract described in paragraph (1) 
     shall be an agreement between the Secretary and individual 
     that states that, subject to paragraph (3)--
       ``(A) the Secretary agrees to--
       ``(i) provide the individual with a scholarship in each 
     such school year or years for a period of years (not to 
     exceed 4 school years) determined by the individual, during 
     which period the individual is pursuing a course of study; 
     and
       ``(ii) accept the individual into the Corps (or for 
     equivalent service as otherwise provided in this section); 
     and
       ``(B) the individual agrees to--
       ``(i) accept provision of such a scholarship to the 
     individual;
       ``(ii) maintain enrollment in a course of study until the 
     individual completes the course of study;
       ``(iii) while enrolled in such course of study, maintain an 
     acceptable level of academic standing (as determined under 
     regulations of the Secretary by the educational institution 
     offering such course of study); and
       ``(iv) serve for required period of service equal to--

[[Page S3548]]

       ``(I) 1 year for each school year for which the individual 
     was provided a scholarship under the program, or
       ``(II) 2 years,

     whichever is greater, as a provider of nursing services in a 
     critical nursing shortage area to which he or she is assigned 
     by the Secretary as a member of the program, or as otherwise 
     provided in this section.
       ``(3) Limitation.--The contract described in paragraph (1) 
     shall contain a provision that any financial obligation of 
     the United States arising out of a contract entered into 
     under this section and any obligation of the individual which 
     is conditioned thereon, is contingent upon funds being 
     appropriated for scholarships under this section.
       ``(h) Payment.--
       ``(1) In general.--A scholarship provided to a student for 
     a school year under a written contract under the program 
     shall consist of--
       ``(A) payment to, or (in accordance with paragraph (2)) on 
     behalf of, the student of the amount of--
       ``(i) the tuition of the student in such school year; and
       ``(ii) all other reasonable educational expenses, including 
     fees, books, and laboratory expenses, incurred by the student 
     in such school year; and
       ``(B) payment to the student of a stipend of $400 per month 
     (adjusted in accordance with paragraph (3)) for each month 
     the student is enrolled.
       ``(2) Contract.--The Secretary may contract with an 
     educational institution, in which a participant in the 
     program is enrolled, for the payment to the educational 
     institution of the amounts of tuition and other reasonable 
     educational expenses described in paragraph (1)(A).
       ``(3) Monthly stipend.--The amount of the monthly stipend, 
     specified in paragraph (1)(B) and as previously adjusted (if 
     at all) in accordance with this paragraph, shall be increased 
     by the Secretary as the Secretary determines to be 
     reasonable.
       ``(i) Breach of Agreement.--
       ``(1) In general.--Subject to paragraph (2), if an 
     individual participates in the program under this section and 
     agrees to provide health services for a period of time in 
     consideration for receipt of an award of Federal funds for 
     education as a nurse, the following applies:
       ``(A) Failure regarding education.--The individual is 
     liable to the Federal Government for the amount of such award 
     (including amounts provided for expenses related to such 
     attendance), and for interest on such amount at the maximum 
     legal prevailing rate, if the individual--
       ``(i) fails to maintain an acceptable level of academic 
     standing in the nursing program (as indicated by the program 
     in accordance with requirements established by the 
     Secretary);
       ``(ii) is dismissed from the nursing program for 
     disciplinary reasons; or
       ``(iii) voluntarily terminates the nursing program.
       ``(B) Failure regarding service.--The individual is liable 
     to the Federal Government for the amount of such award 
     (including amounts provided for expenses related to such 
     attendance), and for interest on such amount at the maximum 
     legal prevailing rate, if the individual fails to provide 
     health services in accordance with the program for the 
     required time period.
       ``(2) Waiver or suspension of liability.--The Secretary 
     shall waive liability under paragraph (1) if compliance by 
     the individual with the agreement involved is impossible, or 
     would involve extreme hardship to the individual, and if 
     enforcement of the agreements with respect to the individual 
     or facility would be unconscionable.
       ``(j) Information of the Program.--The Secretary shall 
     distribute material regarding the program to junior and 
     senior high schools, community colleges, universities, and 
     schools of nursing. The Secretary shall encourage such 
     schools to disseminate such material to the students of such 
     schools.
       ``(k) Service Information.--The Secretary shall provide to 
     an individual who has participated in the program and is 
     nearing the conclusion of his or her service obligation, 
     information regarding other opportunities for nursing in 
     critical nursing shortage areas.
       ``(l) Report.--Not later than 18 months after the first 
     loan cycle, and annually thereafter, the Secretary shall 
     prepare and submit to Congress a report describing the 
     program, including statements regarding--
       ``(1) the number of enrollees, scholarship, and grant 
     recipients by year of study;
       ``(2) the number of graduates;
       ``(3) the amount of scholarship payments made for each of 
     tuition, stipends, and other expenses;
       ``(4) which educational institutions the scholar attended;
       ``(5) the number and placement location of the scholars;
       ``(6) the default rate and actions required;
       ``(7) the amount of outstanding default funds;
       ``(8) to the extent that can be determined, the reason for 
     the default;
       ``(9) the demographics of the individuals participating in 
     the scholarship program; and
       ``(10) recommendations for future modifications of the 
     scholarship program.
       ``(m) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $10,000,000 for 
     fiscal year 2002 and $15,000,000 for fiscal years 2003 and 
     2004.

                      ``PART I--NURSE RECRUITMENT

     ``SEC. 855. PUBLIC AWARENESS AND EDUCATION CAMPAIGN.

       ``(a) National Campaign.--
       ``(1) In general.--The Secretary shall develop and 
     administer a comprehensive national multi-media public 
     education campaign to enhance the image of the nursing 
     profession, promote diversity in the workforce, encourage 
     individuals to enter the nursing profession, and encourage 
     career development for individuals in the nursing profession.
       ``(2) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this subsection, $5,0000,000 
     for fiscal year 2002, and such sums as may be necessary for 
     fiscal years 2003 and 2004.
       ``(b) State Campaigns.--
       ``(1) In general.--The Secretary shall award grants to 
     eligible entities to establish the multi-media campaigns 
     described in subsection (a) at a State level.
       ``(2) Definitions.--
       ``(A) Eligible entity.--The term `eligible entity' means a 
     professional State nursing association, State health care 
     provider association, school of nursing, and any other entity 
     that provides similar services or serves a like function.
       ``(B) State health care provider association.--The term 
     `State health care provider association' means a professional 
     association of hospitals, nursing homes, home health care 
     agencies, hospices, consortia of said associations, or other 
     such entities deemed eligible by the Secretary.
       ``(3) Limitation.--An eligible entity that receives a grant 
     under this subsection shall not use funds received through 
     such grant to advertise particular employment opportunities 
     or recruit members or affiliates of such entity.
       ``(4) Application.--Each eligible entity that desires a 
     grant under this subsection shall submit an application to 
     the Secretary at such time, in such manner, and containing 
     such information as the Secretary may reasonably require.
       ``(5) Equitable broadcasting.--The campaigns described in 
     paragraph (1) shall be broadcast in such a manner as to 
     inform diverse populations throughout the State of nursing 
     opportunities, including rural populations.
       ``(c) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $5,000,000 for 
     fiscal year 2002, and such sums as may be necessary for 
     fiscal years 2003 and 2004.

     ``SEC. 856. AREA HEALTH EDUCATION CENTERS PROGRAM.

       ``(a) Program Authorized.--The Secretary shall award grants 
     to schools of nursing to expand the operation of area health 
     education centers under section 751 to work in communities to 
     develop models of excellence for school nurses, public health 
     nurses, perinatal outreach nurses, and other community-based 
     nurses, or to expand any junior and senior high school 
     mentoring programs to include a nurse mentoring program.
       ``(b) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $5,000,000 for 
     fiscal year 2002, and such sums as may be necessary for 
     fiscal years 2003 and 2004.

     ``SEC. 857. COMMUNITY NURSE OUTREACH GRANTS.

       ``(a) Program Authorized.--The Secretary, acting through 
     the Director of the Office of Rural Health Policy (of the 
     Health Resources and Services Administration) shall award 
     grants to community-based partnerships to establish programs 
     to recruit and retain nurses.
       ``(b) Community-based Partnerships.--The term `community-
     based partnerships' means a health care provider and a 
     community partner, such as a school, nursing program, faith-
     based organization, university, community college, public 
     health department, State health care provider association, 
     professional State nursing association, hospice care program 
     or other entity deemed eligible by the Secretary, that forms 
     a partnership with not less than 2 other entities in the 
     community to develop a network to recruit and retain nurses 
     in the community.
       ``(c) Priority.--In awarding grants under subsection (a), 
     the Secretary shall give priority to--
       ``(1) community-based partnerships seeking to recruit and 
     retain nurses in rural communities and medically underserved 
     urban communities, and other communities experiencing a 
     nursing shortage; and
       ``(2) community-based partnerships seeking to address such 
     needs as dependent care, transportation, or others as deemed 
     appropriate by the Secretary.
       ``(d) Application.--A community-based partnership seeking a 
     grant under this section shall submit an application to the 
     Secretary at such time, in such manner, and containing such 
     information as the Secretary may reasonably require.
       ``(e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $10,000,000 for 
     fiscal year 2002, and such sums as may be necessary for 
     fiscal years 2003 and 2004.

[[Page S3549]]

     ``SEC. 858. EDUCATIONAL ASSISTANCE IN NURSING REGARDING 
                   INDIVIDUALS FROM DIVERSE OR DISADVANTAGED 
                   BACKGROUNDS.

       ``(a) Program Authorized.--The Secretary shall award grants 
     to eligible entities to assist individuals from disadvantaged 
     backgrounds to pursue nursing education opportunities and 
     nursing career positions.
       ``(b) Eligible Entity.--In this section, the term `eligible 
     entity' has the same meaning given such term in section 
     801(1).
       ``(c) Use of Funds.--An eligible entity that receives a 
     grant under subsection (a) shall use funds received under 
     such grant to increase nursing education opportunities for 
     individuals from disadvantaged backgrounds, including by 
     providing student scholarships, stipends, pre-entry 
     preparation, and retention activities.
       ``(d) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $10,000,000 for 
     fiscal year 2002, and such sums as may be necessary for 
     fiscal years 2003 and 2004.

              ``PART J--STRENGTHENING THE NURSE WORKFORCE

     ``SEC. 861. GRANTS FOR CAREER LADDER PROGRAMS.

       ``(a) Program Authorized.--The Secretary shall award grants 
     to eligible entities to develop programs that aid and 
     encourage individuals in nursing programs to pursue 
     additional nursing education and training.
       ``(b) Definitions.--
       ``(1) Eligible Entity.--The term `eligible entity' means a 
     school of nursing or a health care facility, or a partnership 
     of such school and facility.
       ``(2) Health care facility.--The term `health care 
     facility' means a hospital, nursing home, home health care 
     agency, hospice, federally qualified health center, federally 
     qualified community health center, rural health clinic, or 
     public health clinic.
       ``(c) Use of Funds.--An eligible entity that receives a 
     grant under subsection (a) shall use such funds received 
     through such grant to--
       ``(1) provide career counseling to individuals seeking to 
     advance within the nursing profession;
       ``(2) promote career mobility for nursing personnel by 
     providing training in a variety of settings and specialty 
     training; and
       ``(3) develop programs to facilitate educational 
     advancement for individuals with existing degrees or health 
     care training.
       ``(d) Application.--An eligible entity seeking a grant 
     under subsection (a) shall submit an application to the 
     Secretary at such time, in such a manner, and containing such 
     information as the Secretary may reasonably require.
       ``(e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $10,000,000 for 
     fiscal year 2002, and such sums as may be necessary for 
     fiscal years 2003 and 2004.

     ``SEC. 862. GRANTS FOR NURSE TRAINING.

       ``(a) Program Authorized.--The Secretary shall award grants 
     to eligible entities to encourage individuals to enter the 
     nursing profession with a focus on providing long-term care.
       ``(b)(1) Eligible entity.--The term `eligible entity' means 
     a school of nursing or a health care facility, or a 
     partnership of such school and facility.
       ``(2) Health care facility.--The term `health care 
     facility' means a hospital, nursing home, home health care 
     agency, hospice, federally qualified health center, federally 
     qualified community health center, rural health clinic, or 
     public health clinic.
       ``(c) Use of Funds.--An eligible entity that receives a 
     grant under subsection (a) shall use such funds received 
     through such grant to--
       ``(1) provide education and training to individuals who 
     will provide long-term care; and
       ``(2) expand the enrollment in nursing programs, especially 
     programs that focus on training individuals in the provision 
     of long-term care.
       ``(d) Application.--An eligible entity seeking a grant 
     under subsection (a) shall submit an application to the 
     Secretary at such time, in such a manner, and containing such 
     information as the Secretary may reasonably require.
       ``(e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $10,000,000 for 
     fiscal year 2002, and such sums as may be necessary for 
     fiscal years 2003 and 2004.

     ``SEC. 863. GRANTS FOR INTERNSHIP AND RESIDENCY PROGRAMS.

       ``(a) Program Authorized.--The Secretary shall award grants 
     to an eligible entity to develop internship and residency 
     programs that encourage mentoring and the development of 
     specialties.
       ``(b) Definitions.--
       ``(1) Eligible Entity.--The term `eligible entity' means a 
     health care facility, or a partnership of a school of nursing 
     and health care facility.
       ``(2) Health care facility.--The term `health care 
     facility' means a hospital, nursing home, home health care 
     agency, hospice, federally qualified health center, federally 
     qualified community health center, rural health clinic, or 
     public health clinic.
       ``(c) Use of Funds.--An eligible entity that receives a 
     grant under subsection (a) shall use such funds received 
     through such grant to--
       ``(1) develop internship and residency programs and 
     curriculum and training programs for graduates of a nursing 
     program;
       ``(2) provide funding for faculty and mentors; and
       ``(3) provide funding for nurses participating in 
     internship and residency programs on both a full-time and 
     part-time basis.
       ``(d) Application.--An eligible entity seeking a grant 
     under subsection (a) shall submit an application to the 
     Secretary at such time, in such a manner, and containing such 
     information as the Secretary may reasonably require.
       ``(e) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $10,000,000 for 
     fiscal year 2002, and such sums as may be necessary for 
     fiscal years 2003 and 2004.

                  ``PART K--NURSE FACULTY DEVELOPMENT

     ``SEC. 865. FAST-TRACK NURSING FACULTY LOAN PROGRAM.

       ``(a) Program Authorized.--
       ``(1) In general.--The Secretary is authorized to enter 
     into an agreement for the establishment and operation of a 
     student loan fund with any public or nonprofit private school 
     of nursing to aid masters or doctoral level students.
       ``(2) Limitation.--Assistance provided under paragraph (1) 
     for a part-time masters degree program shall be provided for 
     not more than 6 years and for a part-time doctoral degree 
     program for not more than 7 years.
       ``(b) Agreement.--Each agreement entered into under this 
     section shall--
       ``(1) provide for the establishment of a student loan fund 
     by the school;
       ``(2) provide for the deposit in the fund of Federal 
     contributions, additional amounts received from other 
     sources, collections of principal and interest on loans made 
     from the fund, and any other earnings of the fund;
       ``(3) provide that the fund shall only be used for loans to 
     students of the school in accordance with the agreement and 
     for costs of collection of such loans and interest thereon; 
     and
       ``(4) provide that the loan shall only be used to meet the 
     costs of projects that help individuals seek a masters degree 
     or a doctoral degree.
       ``(c) Limitations.--The total of the loans for any academic 
     year made by schools of nursing from loan funds established 
     pursuant to agreements under this section may not exceed 
     $35,000 in the case of any student. In the granting of such 
     loans, a school shall give preference to persons with 
     exceptional financial need.
       ``(d) Terms and Conditions of Loans.--Loans from any 
     student loan fund by any school shall be made on such terms 
     and conditions as the school may determine, subject to 
     limitations the Secretary may prescribe (by regulation or in 
     the agreement with the school) to prevent the impairment of 
     the capital of such fund while enabling the student to 
     complete his course of study, except that--
       ``(1) such a loan may be made only to a student who--
       ``(A) is in financial need of the amount of the loan to 
     pursue a full- or part-time course of study at the school to 
     obtain a masters degree with a concentration in education or 
     a doctoral degree; and
       ``(B) is capable, in the opinion of the school, of 
     maintaining good standing in such course of study;
       ``(2) such a loan shall be repayable in equal or graduated 
     periodic installments (with the right of the borrower to 
     accelerate repayment) over the 10-year period which begins 9 
     months after the student ceases to pursue a full- or part-
     time course of study at a school of nursing, excluding from 
     such 10-year period all--
       ``(A) periods (up to 3 years) of--
       ``(i) active duty performed by the borrower as a member of 
     a uniformed service; or
       ``(ii) service as a volunteer under the Peace Corps Act; 
     and
       ``(B) periods (up to 10 years) during which the borrower is 
     pursuing a full-time or half-time course of study in advanced 
     nursing education at a school of nursing;
       ``(3) the liability to repay the unpaid balance of such 
     loan and accrued interest thereon shall be canceled upon the 
     death of the borrower, or if the Secretary determines that 
     the borrower has become permanently and totally disabled;
       ``(4) such a loan shall bear interest on the unpaid balance 
     of the loan, computed only for periods during which the loan 
     is repayable, at the rate of 5 percent per annum;
       ``(5) such a loan shall be made without security or 
     endorsement, except that if the borrower is a minor and the 
     note or other evidence of obligation executed by the borrower 
     would not, under the applicable law, create a binding 
     obligation, either security or endorsement may be required;
       ``(6) no note or other evidence of any such loan may be 
     transferred or assigned by the school making the loan except 
     that, if the borrower transfers to another school 
     participating in the program, such note or other evidence of 
     a loan may be transferred to such other school;
       ``(7) any student receiving a loan shall agree to teach at 
     an accredited school of nursing for each year of assistance 
     after the masters or doctoral degree has been obtained; and
       ``(8) pursuant to uniform criteria established by the 
     Secretary, the repayment period established under paragraph 
     (2) for any student borrower who during the repayment period 
     failed to make consecutive payments

[[Page S3550]]

     and who, during the last 12 months of the repayment period, 
     has made at least 12 consecutive payments may be extended for 
     a period not to exceed 10 years.
       ``(e) Canceled Loan.--Where all or any part of a loan, or 
     interest, is canceled under this section, the Secretary shall 
     pay to the school an amount equal to the school's 
     proportionate share of the canceled portion, as determined by 
     the Secretary.
       ``(f) Payments.--Any loan for any year by a school from a 
     student loan fund established pursuant to an agreement under 
     this section shall be made in such installments as the 
     Secretary determines, and, upon notice to the Secretary by 
     the school that any recipient of a loan is failing to 
     maintain satisfactory standing, any or all further 
     installments of the loans shall be withheld, as may be 
     appropriate.
       ``(g) Charges.--Subject to regulations of the Secretary and 
     in accordance with this section, a school shall assess a 
     charge with respect to a loan from the loan fund established 
     pursuant to an agreement under this section for failure of 
     the borrower to pay all or any part of an installment when it 
     is due and, in the case of a borrower who is entitled to 
     deferment of the loan under subsection (d)(2), for any 
     failure to file timely and satisfactory evidence of such 
     entitlement. No such charge may be made if the payment of 
     such installment or the filing of such evidence is made 
     within 60 days after the date on which such installment or 
     filing is due. The amount of any such charge may not exceed 
     an amount equal to 6 percent of the amount of such 
     installment. The school may elect to add the amount of any 
     such charge to the principal amount of the loan as of the 
     first day after the day on which such installment or evidence 
     was due, or to make the amount of the charge payable to the 
     school not later than the due date of the next installment 
     after receipt by the borrower of notice of the assessment of 
     the charge.
       ``(h) Repayment.--Upon application by a person who received 
     and is under an obligation to repay, any loan made under this 
     section, the Secretary may repay (without liability to the 
     applicant) all or a part of such loan, and any interest or 
     portion outstanding, if the applicant--
       ``(1) failed to complete the nursing studies with respect 
     to which such loan was made;
       ``(2) is in exceptionally needy circumstances; and
       ``(3) has not resumed, or cannot reasonably be expected to 
     resume, such nursing studies within 2 years following the 
     date upon which the applicant terminated the studies with 
     respect to which such loan was made.
       ``(i) Applications.--The Secretary shall from time to time 
     set dates by which schools of nursing must file applications 
     for Federal capital contributions.
       ``(j) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $10,000,000 for 
     fiscal year 2002 and $15,000,000 for fiscal years 2003 and 
     2004.

     ``SEC. 866. STIPEND AND SCHOLARSHIP PROGRAM.

       ``(a) Program Authorized.--
       ``(1) In general.--The Secretary shall establish a 
     scholarship and stipend program to encourage individuals to 
     seek a masters degree or a doctoral degree at a school of 
     nursing.
       ``(2) Limitation.--Assistance provided under paragraph (1) 
     for a part-time masters degree program shall be provided for 
     not more than 6 years and for a part-time doctoral degree 
     program not more than 7 years.
       ``(b) Eligibility.--To be eligible to receive a scholarship 
     or stipend under this section, an individual shall--
       ``(1) submit an application to the Secretary at such time, 
     in such manner, and containing such information as the 
     Secretary may reasonably require;
       ``(2) enter into an agreement with the Secretary to accept 
     the scholarship in consideration for remaining enrolled in a 
     nursing school and teaching at an accredited school of 
     nursing for 1 year for each year of assistance with a course 
     load determined by the school of nursing where the teaching 
     will take place.
       ``(c) Application.--The Secretary shall disseminate 
     application forms to individuals and in such forms, include--
       ``(1) a summary of the rights and liabilities of an 
     individual whose application is approved by the Secretary; 
     and
       ``(2) information respecting meeting the service obligation 
     described in subsection (b)(2).
       ``(d) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $10,000,000 for fiscal year 2002 and $15,000,000 for fiscal 
     years 2003 and 2004.

            ``PART L--NATIONAL COMMISSION ON NURSING CRISIS

     ``SEC. 871. NATIONAL COMMISSION ON NURSING CRISIS.

       ``(a) In General.--There is established a commission known 
     as the National Commission on the Nursing Crisis (referred to 
     in this section as the `Commission').
       ``(b) Duties.--The Commission shall meet at least four 
     times and shall study and make recommendations to the 
     appropriate committees of Congress regarding--
       ``(1) agency initiatives and legislative actions that are 
     necessary to address the nursing shortage in the short and 
     long term;
       ``(2) nurse training, nurse recruitment, retention of 
     nurses, workplace issues for nurses, funding for nursing 
     programs in this Act and the Social Security Act, and 
     infrastructure issues;
       ``(3) the facilitation of career advancement within the 
     nursing profession;
       ``(4) attracting middle and high school students into 
     nursing careers;
       ``(5) nurse education issues; and
       ``(6) the effectiveness of current nursing recruitment and 
     retention programs, and what changes might be needed.
       ``(c) Membership.--Not later than 3 months after the date 
     of enactment of this section, the Comptroller General shall 
     appoint members of the Commission (taking into account rural 
     and urban areas, geographic diversity, and the diversity of 
     the patient population within such areas) which shall be 
     composed of 19 members of whom--
       ``(1) at least \2/3\ of such members shall be nurses and 
     nursing assistants with different levels of education, and a 
     significant portion of such shall be currently practicing as 
     nurses; and
       ``(2) the other portion of such members shall be--
       ``(A) representatives of schools of nursing;
       ``(B) nursing students;
       ``(C) representatives of primary and secondary schools;
       ``(D) representatives of the Departments of Health and 
     Human Services and Education;
       ``(E) representatives of public health departments;
       ``(F) representatives of employers and facilities, such as 
     hospitals, long term care facilities, and home health 
     agencies;
       ``(G) patients and representatives of patients;
       ``(H) representatives of professional nursing associations;
       ``(I) representatives of health plans or health insurance 
     issuers;
       ``(J) union representatives who are nurses; and
       ``(K) representatives of other health care provider groups.
       ``(d) Chairperson.--The Secretary shall serve as the 
     chairperson of the Commission.
       ``(e) Subcommittees.--The Chairperson shall have the 
     authority to create subcommittees as the Chairperson 
     determines is necessary.
       ``(f) Staff.--The Secretary shall provide any staff that 
     the Commission shall require.
       ``(g) Quorum.--Nine members of the Commission shall 
     constitute a quorum.
       ``(h) Vacancies.--Any vacancy in the Commission shall not 
     affect the powers of the Commission, but shall be filled in 
     the same manner as the original appointment and shall be made 
     not later than 30 days after the date on which the Commission 
     is given notice of such vacancy.
       ``(i) Compensation.--Members of the Commission shall 
     receive no additional compensation by reason of their service 
     to the Commission. Each member shall be allowed travel 
     expenses, including per diem in lieu of subsistence, at rates 
     authorized for employees of agencies under subchapter I of 
     chapter 57 of title 5, United States Code, while away from 
     their homes or regular places of business in the performance 
     of services for the Commission.
       ``(j) Report.--Not later than 15 months after the date of 
     enactment of this section, the Commission shall prepare and 
     submit to Congress and the Secretary, a report that makes the 
     recommendations described in subsection (b) and reports on 
     any best practices that such Commission determines.
       ``(k) Sunset.--This section shall be effective for 15 
     months from the date of enactment of this section.
       ``(l) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $500,000 for fiscal year 2002.''.

  Mr. FRIST. Mr. President, we are in the midst of a nursing workforce 
shortage. Not only are fewer people entering and staying in the nursing 
profession, but we are losing nurses at a time of growing need. Today, 
nurses are needed in a greater number of settings, such as nursing 
homes, extended care facilities, community and public health settings, 
nursing education, and ambulatory care settings. Nationally, health 
care providers, ranging from hospitals and nursing homes to home health 
agencies and public health departments are struggling to find qualified 
nurses to provide safe, efficient quality care for their patients.
  Though we have faced nursing shortages in the past, this shortage is 
particularly troublesome because it reflects two trends that are 
occurring simultaneously: (1) a shortage of people entering the 
profession and (2) the retirement of nurses who have been working in 
the profession for many years. Over the past 5 years, enrollment in 
entry-level nursing programs has declined by 20%, mirroring the 
declining awareness of the nursing profession among high school 
graduates. Consequently, nurses under the age of 30 represent only 10% 
of the current workforce; and by 2010, 40% of the nursing workfoce will 
be over the age of 50 and nearing retirement. If these trends are not 
reversed, we stand to lost vast numbers of nurses at the vert time that 
they will be needed to care for the millions of baby boomers reach 
retirement age.

[[Page S3551]]

  Further, greater efforts must be made to recruit more men and 
minorities to this noble profession. Currently, only 10% of the 
registered nurses in the United States are from racial or ethnic 
minority backgrounds, even though these individuals comprise 28% of the 
total United States population. In 2000, only 5.9% of the registered 
nurses were men. We must work to promote diversity in the workforce, 
not only to increase the number of individuals within the profession 
but also to promote culturally competent and relevant care.
  Even if nursing schools could recruit more students to deal with the 
shortage, many schools could not accommodate higher enrollments because 
of faculty shortages. There are nearly 400 faculty vacancies at nursing 
schools in this country. And, an even greater faculty shortage looms in 
the next 10-15 years as many current nursing faculty approach 
retirement and fewer nursing students pursue academic careers.
  Therefore, I am pleased to join Senator Hutchinson in introducing the 
Nursing Employment and Education Development (NEED) Act to expand 
current programs addressing the increasing number of settings which 
rely on nurses to provide care, to attract young people to the nursing 
profession, and to promote career mobility. The NEED Act complements 
legislation that I am developing as Chairman of the Subcommittee on 
Public Health--the reauthorization of the National Health Service Corps 
(NHSC). The NHSC, a program designed to address the geographic 
maldistribution of health professionals, cannot be the only solution 
sought to deal with our nursing shortage. Initiatives like the NEED Act 
are also a critical component of a comprehensive strategy to address 
this growing problem.
  Specifically, the NEED Act will develop a national Nurse Corps 
Program that will allow nurses to receive scholarships and loan 
repayment assistance for agreeing to serve at least two years in 
nursing homes, home health agencies, public health departments, health 
centers, public hospitals, or rural health clinics. This program 
expansion more accurately address the number of settings affected by 
the nursing shortage and allows for stronger recruitment efforts for 
disadvantaged students.
  The bill will also help to attract young people to the profession by 
funding a multi-media, public campaign to enhance the image of the 
nursing profession, promote diversity in the workforce, and encourage 
career development for those already in the profession. The NEED Act 
further promotes community involvement by providing community outreach 
grants to providers and community partners to develop and implement 
creative strategies for nurse recruitment and retention. The bill also 
expands the Area Health Education Centers program to enhance 
recruitment and retention of nurses in rural areas.
  The NEED Act promotes career mobility by expanding career ladder 
programs and encouraging individuals to pursue advanced education 
through available scholarships and stipends. The bill also authorizes a 
Fast-Track Nursing Faculty Scholarships and Loan Program--a program 
providing scholarships, loans, and monthly stipends to college 
graduates and master's students to allow full-time study and faster 
completion of doctoral studies. To assist nursing schools in preparing 
those students, the NEED Act provides needed funding for long-tern care 
training and for internship or residency programs to encourage 
mentoring and the development of subspecialists.
  The NEED Act will help assure a strong and vibrant nursing workfoce, 
allowing us to avoid the harmful effects of a long-term nursing 
shortage. I appreciate Senator Hutchinson's work on this issue, and I 
am pleased to join him to day to introduce a bill that represents an 
important and thoughtful response to this pressing issue.
  Ms. MIKULSKI. Mr. President, I rise to join with my colleague, 
Senator Tim Hutchinson, today to introduce the Nursing Employment and 
Education Development or ``NEED'' Act. This bill is sorely needed, 
because we have a nursing shortage. In Maryland, 15% of the nursing 
jobs are vacant. Last year, it took an average of 68 days to fill a 
nurse vacancy, and we need about 1,600 more full-time nurses to fill 
those vacancies. There were 2,000 fewer nurses in Maryland in 1999 than 
there were in 1998. The shortage exists across the United States, and 
will get worse in the future. Nationwide, we will need 1.7 million 
nurses by the year 2020, but only about 600,000 will be available.
  We depend on nurses every day to care for millions of Americans, 
whether in a hospital, nursing home, health center, hospice, or through 
home health. They are the backbone of our health care system. If we 
don't effectively address the crisis in nursing, those hospitals, 
nursing homes and clinics will soon be on life support.
  This bill is a downpayment. It doesn't address the fact that nurses 
are underpaid, overworked, and undervalued, but it does focus on 
education. The NEED Act seeks to help bring men and women into the 
nursing profession, and help them advance within it. The bill does this 
under five major approaches:

       Nurse Corps: Creates a Nurse Corps Scholarhip Program, 
     which provides scholarships in exchange for at least 2 years 
     of service in a critical nurse shortage area, authorizes 
     increased funding for the nursing education loan repayment 
     program,
       Nurse Recruitment and Retention:
       Creates a public awareness and education campaign, to be 
     carried out on the state and national level, to enhance the 
     image of nursing, promote diversity in the nursing workforce, 
     and encourage people to enter the nursing profession, enables 
     Area Health Education Centers (AHECs) to expand their junior 
     and senior high school mentoring programs for nurses and 
     develop ``models of excellence'' for community-based nurses, 
     creates networks between health care facilities and community 
     organizations that will recruit and retain nurses in the 
     community.
       Nurse Training: Creates ``career ladder'' programs that 
     will encourage nurses and nursing students to pursue 
     additional education and training and advance within the 
     profession, encourages students to enter the nursing 
     profession with a focus on long-term care develops internship 
     and residency programs that encourage mentoring and the 
     development of specialties such as labor and delivery and 
     emergency room nursing.
       Nursing Faculty Development: Provides scholarships and 
     loans for graduate-level education in nursing, to help ensure 
     that we have enough teachers at our nursing schools.
       National Commission on the Nursing Crisis: Creates a 
     National Commission on the Nursing Crisis, modeled after the 
     Maryland Commission on the Crisis in Nursing, which will 
     study and make recommendations to Congress within 1 year on 
     how to address the nursing shortage in the short and long 
     term.

  This bill is about nursing education, but it's also about 
empowerment. We can empower people to have a better life and go into a 
career to save lives.
  The bill will empower the single mom who has been working in a dead-
end retail job to forge a better life for herself and her family. It 
will help her get a scholarship to help pay for tuition, books, and lab 
fees, and by funding child care programs to help her balance work and 
family.
  The bill empower the nurse who has a baccalaureate degree, but wants 
to get a Master's degree so she can teach nursing at a community 
college. It will help her get loans, scholarships, and living stipends 
to pursue that degree.
  This bill also will fund partnerships between schools and health care 
providers to inspire the next generation of nurses. For example, a 12-
year old boy or girl in Suitland, Maryland who is interested in 
nursing, could like up with a ``buddy'' or mentor at the local 
hospital. That mentor could help the student with science homework, or 
even let the student ``shadow'' the mentor at work.
  It is important that we add these programs to the federal law books. 
But as a member of the Appropriations Committee, I know how important 
it is that we fund them and our existing programs in the federal 
checkbook. That's why I was disturbed to read in the newspaper 
yesterday that President Bush plans to cut funding for education and 
training programs for doctors, nurses, pharmacists, and other health 
professionals from $353 million to just $140 million. That's a cut of 
$213 million! Such a move would be penny-wise and pound-foolish.
  President Bush wants to slow the growth of federal spending, but he 
can't slow the growth of illness, or of our aging population. He adds 
money for community health centers, which I support. But who will staff 
them? Without nurses, more community health centers are a hollow 
opportunity. He adds more money for medical research at the National 
Institutes of Health, which I support. But he

[[Page S3552]]

doesn't fund the programs that will train the pharmacists who will 
dispense the medicines that come from that medical research, or a real 
Medicare prescription drug benefit so that seniors can afford them. 
Again, this is a hollow opportunity. I urge the President to 
reconsider, and the Congress to reject his approach.
  I hope to work with my colleagues on both sides of the aisle to 
enhance opportunity for nurses and recruit new nurses into the 
profession by enacting this bill into law this year. Thank you.
                                 ______