[Congressional Record Volume 147, Number 177 (Wednesday, December 19, 2001)]
[House]
[Pages H10487-H10493]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         NURSE REINVESTMENT ACT

  Mr. BILIRAKIS. Madam Speaker, I move to suspend the rules and pass 
the bill (H.R. 3487) to amend the Public Health Service Act with 
respect to health professions programs regarding the field of nursing.
  The Clerk read as follows:

                               H.R. 3487

       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 ``Nurse Reinvestment Act''.

     SEC. 2. PUBLIC SERVICE ANNOUNCEMENTS REGARDING NURSING 
                   PROFESSION.

       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--PUBLIC SERVICE ANNOUNCEMENTS

     ``SEC. 851. PUBLIC SERVICE ANNOUNCEMENTS.

       ``(a) In General.--The Secretary shall develop and issue 
     public service announcements that advertise and promote the 
     nursing profession, highlight the advantages and rewards of 
     nursing, and encourage individuals to enter the nursing 
     profession.
       ``(b) Method.--The public service announcements described 
     in subsection (a) shall be broadcast through appropriate 
     media outlets, including television or radio, in a manner 
     intended to reach as wide and diverse an audience as 
     possible.

     ``SEC. 852. STATE AND LOCAL PUBLIC SERVICE ANNOUNCEMENTS.

       ``(a) In General.--The Secretary shall award grants to 
     eligible entities to support State and local advertising 
     campaigns via appropriate media outlets to promote the 
     nursing profession, highlight the advantages and rewards of 
     nursing, and encourage individuals from disadvantaged 
     backgrounds to enter the nursing profession.
       ``(b) Use of Funds.--An eligible entity that receives a 
     grant under subsection (a) shall use funds received through 
     such grant to acquire local television and radio time, place 
     advertisements in local newspapers, and post information on 
     billboards or on the Internet, in order to--
       ``(1) advertise and promote the nursing profession;
       ``(2) promote nursing education programs;
       ``(3) inform the public of public assistance regarding such 
     education programs;
       ``(4) highlight individuals in the community that are 
     presently practicing nursing in order to recruit new nurses; 
     and
       ``(5) provide any other information to recruit individuals 
     for the nursing profession.
       ``(c) Method.--The campaigns described in subsection (a) 
     shall be broadcast on television or radio, or placed in 
     newspapers as advertisements, or posted on billboards or the 
     Internet, in a manner intended to reach as wide and diverse 
     an audience as possible.''.

     SEC. 3. LOAN REPAYMENT PROGRAM; SCHOLARSHIPS.

       (a) Loan Repayment Program; Additional Assignment 
     Authorities.--Section 846(a) of the Public Health Service Act 
     (42 U.S.C. 297n(a)) is amended--
       (1) in paragraph (3)--
       (A) by striking ``in a public hospital,'' and inserting 
     ``in a public or private hospital (including a critical 
     access hospital or a rural hospital),''; and
       (B) by inserting after ``rural health clinic,'' the 
     following: ``in a State or local department of public health, 
     in a skilled nursing facility, in a home health agency, in a 
     hospice program (including home settings), in an ambulatory 
     surgical center,''; and
       (2) by adding at the end the following: ``In the case of a 
     private entity that is not a nonprofit entity and is pursuant 
     to paragraph (3) eligible for an assignment of a nurse, the 
     Secretary may not assign a nurse to such an entity after the 
     expiration of the three-year period beginning on the date of 
     the enactment of the Nurse Reinvestment Act.''.
       (b) Establishment of Scholarship Program.--Section 846 of 
     the Public Health Service Act (42 U.S.C. 297n) is amended--
       (1) in the heading for the section, by striking ``program'' 
     and inserting ``and scholarship programs'';
       (2) by redesignating subsections (d), (f), (g), and (h) as 
     subsections (f), (h), (i), and (g), respectively;
       (3) by transferring subsections (f) and (g) (as so 
     redesignated) from their current placements, by inserting 
     subsection (f) after subsection (e), and by inserting 
     subsection (g) after subsection (f) (as so inserted); and
       (4) by inserting after subsection (c) the following 
     subsection:
       ``(d) Scholarship Program.--
       ``(1) In general.--The Secretary may carry out a program of 
     entering into contracts with eligible individuals under which 
     such individuals agree to serve as nurses in designated 
     health facilities in consideration of the Federal Government 
     agreeing to provide to the individuals scholarships for 
     attendance at schools of nursing.
       ``(2) Eligible individuals; designated health facilities.--
     For purposes of this subsection:
       ``(A) The term `eligible individual' means an individual 
     who is enrolled or accepted for enrollment as a full-time 
     student in a school of nursing.
       ``(B) The term `designated health facility' means any 
     entity that is eligible under subsection (a) for an 
     assignment of a nurse, subject to the provisions of such 
     subsection relating to private entities that are not 
     nonprofit entities.
       ``(3) Applicability of certain provisions.--With respect to 
     the National Health Service Corps Scholarship Repayment 
     Program established in subpart III of part D of title III, 
     the provisions of such subpart shall, except as inconsistent 
     with this section, apply to the program established in 
     paragraph (1) in the same manner and to the same extent as 
     such provisions apply to the National Health Service Corps 
     Scholarship Program established in such subpart.''.
       (c) Preferences Regarding Participants.--Section 846(e) of 
     the Public Health Service Act (42 U.S.C. 297n(e)) is amended 
     in the matter preceding paragraph (1) by striking 
     ``subsection (a)'' and inserting ``subsection (a) or (d)''.
       (d) Definitions.--Section 846 of the Public Health Service 
     Act (42 U.S.C. 297n) is amended in subsection (h) (as 
     redesignated by subsection (b)(2) of this section) by 
     amending the subsection to read as follows:
       ``(h) Definitions.--For purposes of this section:
       ``(1) The term `ambulatory surgical center' has the meaning 
     applicable to such term under title XVIII of the Social 
     Security Act.
       ``(2) The term `community health center' has the meaning 
     applicable to such term under section 330.

[[Page H10488]]

       ``(3) The term `home health agency' has the meaning given 
     such term in section 1861(o) of the Social Security Act.
       ``(4) The term `hospice program' has the meaning given such 
     term in section 1861(dd)(2) of the Social Security Act.
       ``(5) The term `migrant health center' has the meaning 
     applicable to such term under section 330.
       ``(6) The term `rural health clinic' has the meaning given 
     such term in section 1861(aa)(2) of the Social Security Act.
       ``(7) The term `rural hospital' means a hospital located in 
     a rural area, as defined in section 1886(d)(2)(D) of the 
     Social Security Act.
       ``(8) The term `skilled nursing facility' has the meaning 
     given such term in section 1819(a) of the Social Security 
     Act.''.
       (e) Funding.--Section 846 of the Public Health Service Act 
     (42 U.S.C. 297n) is amended in subsection (i) (as 
     redesignated by subsection (b)(2) of this section) by 
     amending the subsection to read as follows:
       ``(i) Funding.--
       ``(1) Authorization of appropriations.--For the purpose of 
     payments under agreements entered into under subsection (a) 
     or (d), there are authorized to be appropriated such sums as 
     may be necessary for each of the fiscal years 2002 through 
     2007.
       ``(2) Allocations.--Of the amounts appropriated under 
     paragraph (1), the Secretary may as determined appropriate by 
     the Secretary allocate amounts between the program under 
     subsection (a) and the program under subsection (d).''.

     SEC. 4. STUDIES BY GENERAL ACCOUNTING OFFICE.

       (a) Hiring Differences Among Certain Private Entities.--The 
     Comptroller General of the United States shall conduct a 
     study to determine differences in the hiring of nurses by 
     nonprofit private entities as compared to the hiring of 
     nurses by private entities that are not nonprofit. In 
     carrying out the study, the Comptroller General shall 
     determine the effect of the inclusion of private entities 
     that are not nonprofit in the program under section 846 of 
     the Public Health Service Act. Not later than two years after 
     the date of the enactment of this Act, the Comptroller 
     General shall submit to the Congress a report describing the 
     findings of the study.
       (b) Nurse Faculty.--
       (1) Determination regarding shortage of faculty.--The 
     Comptroller General of the United States shall conduct a 
     study to determine whether and to what extent there is a 
     shortage of faculty for schools of nursing. Not later than 
     June 30, 2002, the Comptroller General shall submit to the 
     Congress a report describing the findings of the study.
       (2) Recommendations.--If the Comptroller General determines 
     pursuant to paragraph (1) that there is or will be a shortage 
     of faculty for schools of nursing, the Comptroller General 
     shall, not later than September 30, 2002, submit to the 
     Congress a report providing the recommendations of the 
     Comptroller General for developing scholarship programs, loan 
     repayment programs, private-public partnerships, or other 
     programs through the Department of Health and Human Services 
     to provide for an increase in the number of such faculty, 
     including recommendations on appropriate incentives for 
     nurses to become such faculty.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Florida (Mr. Bilirakis) and the gentleman from Ohio (Mr. Brown) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Florida (Mr. Bilirakis).


                             General Leave

  Mr. BILIRAKIS. Madam Speaker, I ask unanimous consent that all 
Members may have 5 legislative days within which to revise and extend 
their remarks and include extraneous material on H.R. 3487.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.
  Mr. BILIRAKIS. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, I rise today in support of H.R. 3487, the Nurse 
Reinvestment Act. Recently we have all read about and heard about 
issues with recruitment and retention of nursing staff, including both 
nurses and nurse aides. Our health and long-term care systems rely 
heavily on the services of these health care professionals.
  I would like to thank my colleague, the gentlewoman from California 
(Mrs. Capps), for being such a strong advocate in this field, and I 
mean strong advocate in this field. We worked together with the 
gentleman from Louisiana (Mr. Tauzin); the ranking member, the 
gentleman from Michigan (Mr. Dingell); the gentleman from Ohio (Mr. 
Brown); the gentleman from Maryland (Mr. Ehrlich); the gentleman from 
Kentucky (Mr. Whitfield); and the gentlewoman from New York (Mrs. 
Kelly) to craft this bipartisan legislation that addresses the nursing 
shortage.
  Nurses provide the critical medical services necessary to ensure 
comfortable quality health care. A nurse shortage could seriously 
diminish the level of medical care in health care facilities. Experts 
and providers are reporting a current shortage of nurses, partly as a 
result of patients' increasingly complex care needs.
  Unfortunately, young Americans today are not entering the nursing 
profession. To encourage young people to choose this challenging and 
fulfilling career, this legislation directs the Secretary of Health and 
Human Services to create public service announcements, PSAs, designed 
to promote nursing and nursing education programs and to highlight the 
benefits and rewards of a career in nursing.
  Furthermore, H.R. 3487 expands Title VIII of the Public Health 
Service Act to include scholarships for students entering the nursing 
profession. In exchange for a commitment to serve in a health care 
facility determined to have a critical shortage of nurses, students 
will receive scholarships to nursing schools.
  This bill includes a sunset, to take place after 3 years, on the 
inclusion of private facilities in this scholarship and loan repayment 
program. A Government Accounting Office study required under the bill 
to examine the hiring practices of private and nonprofit facilities is 
due prior to this sunset. The goal of this legislation is to ensure a 
strong pool of talented nurses throughout the country for years to 
come.
  Again, Madam Speaker, I would like to recognize the work of the 
gentlewoman from California (Mrs. Capps) in this legislation and thank 
her for her dedication and persistence on this issue. As a nurse, the 
gentlewoman from California (Mrs. Capps) understands the importance of 
nurses in our health care system and recognizes the dangers patients 
could encounter without proper nursing care.
  I would also like to thank, in no little way, the gentlewoman from 
New York (Mrs. Kelly) for taking a leadership role on this issue, 
particularly on this side of the aisle. Many times, many times, she has 
talked to me about the need to do something to help solve this problem.
  I would like to also mention legislative counsel, Pete Goodloe, for 
his efforts to work with the Committee on Energy and Commerce on this 
issue and so many others on the floor possibly today, but at other 
times. His dedication and service should be not overlooked and 
certainly deserve more than a brief mention.
  I would also like to thank staff who worked so hard on this issue, 
including Anne Esposito, Jeremy Sharp, John Ford, Katie Porter, and 
Erin Ockunzzi on our side.
  Nurses are invaluable to the success and quality of our health care 
delivery system. This legislation helps ensure that the Nation will 
have a well-trained supply of nurses on which to rely. I urge my 
colleagues to join me and the gentlewoman from California (Mrs. Capps) 
and the gentlewoman from New York (Mrs. Kelly) in support of H.R. 3487, 
the Nurse Reinvestment Act.
  Madam Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Madam Speaker, I yield myself 3 minutes.
  Madam Speaker, I want to thank both the gentleman from Louisiana (Mr. 
Tauzin) and the gentleman from Florida (Mr. Bilirakis) for their 
commitment to work with the gentleman from Michigan (Mr. Dingell) and 
with the gentlewoman from California (Mrs. Capps), whose idea this bill 
was, and for the particularly good work she did, and to work with me on 
this modest but important legislation.
  The gentlewoman from California (Mrs. Capps) has particularly led the 
charge on an omnibus, more comprehensive bill to deal with the nursing 
shortage, and this is a very important step we hope we can address in 
more detail later.
  Special thanks to staff members Anne Esposito and Jeremy Sharp for 
their hard work on this legislation. Anne has been terrific to work 
with on this bill and many others. Jeremy's father I served with my 
first term in the legislature, and he was one of the most hard-working, 
decent people I have had the pleasure to know in my 9 years in this 
institution.

[[Page H10489]]

  There is, Madam Speaker, a nursing shortage in this country. It is 
jeopardizing health care access and quality, and it is getting worse. 
It is not a theoretical problem; it is a fact.
  We especially, as I said earlier, owe a debt of gratitude to the 
gentlewoman from California (Mrs. Capps), the top health care expert in 
Congress, a registered nurse, a valuable member of the Subcommittee on 
Health Care, for making sure that this body finally is doing something 
about it.
  The problem is easy to define: There are not enough nurses in the 
workforce to replace those expected to retire in the next 10 years. But 
the problem is difficult to address. A host of factors, ranging from 
working conditions to competing professional opportunities, have 
contributed to the current shortage.
  This bill is not intended to provide all the answers. Its modest but 
crucial purpose is to get the ball rolling. To alleviate the nursing 
shortage, we must jump-start recruitment and foster retention.
  Key provisions of the bill would establish a nursing degree 
scholarship program and a major public awareness and recruitment 
campaign. These strategies make sense. They can be deployed quickly and 
they will make a difference.
  I want to again thank my friend, the gentlewoman from California 
(Mrs. Capps) as well as the gentlewoman from New York (Mrs. Kelly) for 
raising the profile of the nursing shortage issue.
  I urge my colleagues to support this legislation.
  Madam Speaker, I ask unanimous consent to yield the balance of my 
time to the author of this bill, the gentlewoman from California (Mrs. 
Capps), and I ask that she be permitted to yield time.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Ohio?
  There was no objection.
  Mr. BILIRAKIS. Madam Speaker, I yield such time as he may consume to 
the gentleman from Maryland (Mr. Ehrlich), who, along with the 
gentleman from Kentucky (Mr. Whitfield), has really been just so very 
strongly in support of doing something regarding this shortage.

                              {time}  1930

  Mr. EHRLICH. Mr. Speaker, I rise to commend this Congress for 
bringing to this floor important legislation to address the national 
nursing shortage.
  This bill, which the gentlewoman from California (Mrs. Capps) has 
worked so hard to pass, will assist the Secretary of HHS in addressing 
the nursing shortage around the country.
  As we have heard, the bill amends the Public Health Service act to 
empower the Secretary to develop and issue public service announcements 
to advertise and promote the nursing profession. The bill allows for 
national public service announcements, as well as authorizes the 
Secretary to provide grants to State and local communities to promote 
nursing, highlight the advantages and rewards of nursing, and encourage 
individuals from disadvantaged backgrounds to enter the profession.
  Second, the legislation establishes a scholarship program to allow 
the Secretary to enter into contracts with individuals to serve in 
medically underserved areas. In return for service to those in need, 
sometimes in dire need, the Federal Government will provide to these 
nurses scholarships to pay for the cost of their education.
  The third provision of the bill instructs the GAO to conduct a study 
of the shortage of highly trained nurse faculty who are charged with 
educating bedside nurses. The study has two parts: the first, due by 
June 30, 2002, will address whether and to what extent there is a 
shortage of nursing faculty; the second part, due by September 30, 
2002, will report on recommendations to address a potential shortage of 
nursing faculty through the Department of Health and Human Services.
  I have been pleased to work with many Members on this bill, and the 
names have been mentioned. Our terrific chairman, the gentleman from 
Florida (Mr. Bilirakis), his work speaks for itself. I really 
appreciate his willingness and his attitude and everything he has done 
to bring this bill to the floor. The gentlewoman from California (Mrs. 
Capps), we could not get it done without her. The gentleman from 
Kentucky (Mr. Whitfield) and the gentlewoman from New York (Mrs. 
Kelly), who I believe is going to speak, and the gentleman from Ohio 
(Mr. Brown) as well. Finally, the gentleman from Louisiana (Mr. 
Tauzin), of course. Everybody talks about staff, and the American 
public should know that these bills do not get done without bipartisan 
cooperation, not just between Members, but also with regard to staff as 
well. So I congratulate staff on both sides of the aisle. Also, the 
gentleman from Michigan (Mr. Dingell), of course, the ranking member of 
the full committee and, as I said, the gentleman from Louisiana (Mr. 
Tauzin), the full committee chairman.
  Mr. Speaker, I thank the gentleman from Florida (Mr. Bilirakis) very 
much for bringing this bill to the floor. I mean that. I have bugged 
him time and time again, and I know it is a friendly bug and I was 
preaching to the choir; and the gentleman from Florida, in turn, went 
to the leadership and got this done. So I congratulate the gentleman.
  This bipartisan legislation puts patients first by investing in high 
quality, highly trained nurses. I urge all of my colleagues to support 
it.
  Mrs. CAPPS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in strong support of the Nurse Reinvestment Act, 
and I urge my colleagues to vote for this important legislation, H.R. 
3487. I want to thank the gentleman from Florida (Mr. Bilirakis) and 
the gentleman from Louisiana (Mr. Tauzin) for their hard work on this 
issue and their willingness to help us get this legislation to the 
floor this year. The staff members Ann Esposito and Jeremy Sharp have 
been mentioned, and I want to add two others, John Ford and Katie 
Porter. I also particularly want to thank the gentleman from Michigan 
(Mr. Dingell), the ranking member of the full committee, and the 
gentleman from Ohio (Mr. Brown), the ranking member of the 
subcommittee, for their unswerving support for this effort. They have 
made this bill a priority, and I doubt if we would have seen this 
action so quickly without their dedication. They and their staff have 
made the effort to see that this legislation could move in the waning 
days of this session.
  This bill is based on legislation that I introduced in April, H.R. 
1436. That bill was the product of a lot of hard work of the gentleman 
from Michigan (Mr. Dingell) and the gentleman from Ohio (Mr. Brown), 
and a variety of nursing and health care groups, including the American 
Nurses Association, the American Organization of Nurse Executives, and 
the American Association of Colleges of Nursing. H.R. 1436 now has 228 
bipartisan cosponsors.
  The bill before us will authorize new scholarships to help 
prospective nurses complete their education more quickly. These 
scholarships will help a broader range of people to find their way into 
a very rewarding career, one that will be in much great demand, no 
matter the strength or weaknesses of the economy. It will also 
authorize public service announcements to educate the public about the 
need for more nurses, the opportunities available for educational 
assistance, and the rewards of a care-giving career.
  Our profession needs the positive and accurate description within 
this PR campaign. One of the major problems we face is the 
misperception that nursing is an unappealing career and that it is 
women's work. These PSAs will help us counter that impression and 
explain the value and benefits of a career in nursing. These benefits 
have been brought to sharp relief for us by the events of September 11.
  The bill will direct the General Accounting Office to study the 
faculty needs of our nursing schools and education programs. As my 
colleagues know, I am one of three nurses currently serving in the 
Congress. Before I was elected to this House, I served the people of 
Santa Barbara County in California as a public health nurse for 20 
years. I know firsthand the challenges facing our hospitals and our 
health care providers and the consequences if we fail to meet them.
  One of the most important difficulties we face is a shortage of 
nurses, especially registered nurses. Current

[[Page H10490]]

events, as I have said, have highlighted the importance of having a 
strong and effective public health system. September 11 and the recent 
spate of anthrax letters reminds us that our safety and our well-being 
depend on the ability of our hospitals to care for us and our loved 
ones, and having enough nurses is a critical component, both in the 
hospital and in many public health settings.
  Nurses are the first line of defense in our health care system. They 
will be the ones treating victims of biological or conventional terror 
attacks; and right now, we do not have enough of them, not enough of 
them even for our daily needs.
  Last week, we passed legislation to address many of our Nation's 
needs in terms of bioterrorism, and now it is time to make sure we have 
the workforce necessary to carry out that bill's provisions. Data on 
the nursing workforce show that staffing shortages are increasing, and 
recruiting new registered nurses is becoming progressively more 
difficult. We already need 125,000 registered nurses to fill the 
existing vacancies of today, according to the American Hospital 
Association; and by 2010, less than 9 years from now, 40 percent of the 
RN workforce will be over 50 years old. In contrast, the number of RNs 
under 35 has fallen to 18 percent. Simply put, there are not enough new 
nurses joining the workforce to replace those expected to retire in the 
next 10 years, and this problem will be compounded by the 78 million 
baby boomers retiring and needing more health care.
  Congress needs to act on this problem quickly. We need to pass the 
Nurse Reinvestment Act. This bill represents several good steps toward 
a comprehensive solution to the nursing shortage and, to be sure, as 
has been mentioned, there is much more we will need to do, including 
increasing funding for nurse education programs; but this is an 
excellent start. I will be pleased if we can move it forward. I urge 
all of my colleagues to support nurses and vote for the Nurse 
Reinvestment Act.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BILIRAKIS. Mr. Speaker, I yield such time as she may consume to 
the gentlewoman from New York (Mrs. Kelly).
  Mrs. KELLY. Mr. Speaker, I rise in strong support of the Nurse 
Reinvestment Act, which is a substantial first step in addressing the 
growing shortage of nurses currently being experienced by health care 
facilities nationwide.
  Today we are working on both short- and long-term solutions to the 
problem, and I thank the gentleman from Florida (Mr. Bilirakis) and the 
gentlewoman from California (Mrs. Capps) for their hard work in 
bringing the legislation to the floor. It is my hope that this is the 
first of many steps that Congress will take to make sure there are 
enough health care professionals to care for a growing number of 
patients.
  Let us think about what nurses do for a minute. They are there at our 
birth; they are more than likely there at our death. And in between, 
nurses are apt to be there to support and care for us during every 
single serious medical crisis that we face, helping us through good 
news and bad. They care for patients, they advocate for patients, they 
are there for our long-term care, and those who are nurse anesthetists 
make us comfortable during surgery and during medical stress.
  Now more than ever, attention needs to be focused on the ability of 
our health care personnel to respond to critical situations, and we 
have a crisis on our hands. The shortage of nurses in our Nation's 
hospitals and the pending retirement of many nurses should be worrisome 
to all of us. Hospitals cannot run without nurses. Without adequate 
nursing staff, hospitals are forced to close units, turn away patients, 
and redirect emergency cases. This results in long waits and reduced 
quality of care. In critical situations, time is everything; and when 
patients have to travel farther or wait longer for care, they are less 
likely to have a positive recovery.
  So let us consider this bill. It focuses on attracting students to 
nursing by educating them about the benefits of a nursing career. Its 
outreach and public awareness campaigns should help ensure stronger 
registration at nursing schools so that we have a steady supply of 
well-trained nurses to replace the retiring RNs; and, believe me, they 
are retiring very rapidly. In New York, the average age of a nurse is 
48 years old. We need to attract new people, people who may not 
traditionally have considered a career in health care. The bill expands 
loan repayment assistance to encourage nurses to serve after graduation 
in an area that is experiencing a shortage.
  This bill will not only facilitate the entry of students into nursing 
schools, it also anticipates additional issues that we may encounter. 
It requires the GAO to evaluate the need for nursing faculty 
recruitment. In New York State, our faculty average age is somewhere 
around 52 to 53 years old. We need to raise the consciousness of nurses 
that they can enhance their skills and become a part of faculty.
  This provision particularly is important, since we need qualified 
educators to train those who want to enter the field and seek to expand 
their expertise into the advanced practice of nursing specialties.
  In short, the bill does a simple thing. It sets forth a method to get 
more nurses into the field. This should give relief to the nursing 
staff that are already stretched too thin and provide much-needed care 
to patients. It is a small step, but it is a necessary beginning. There 
is much more to be done.
  Mr. Speaker, I look forward to the passage of this legislation and to 
continuing to explore new innovative solutions to relieve America's 
nursing shortage. I urge my colleagues to support America's nurses and 
support this bill and strengthen our Nation's health care in the 
workforce.
  Mrs. CAPPS. Mr. Speaker, I am very pleased to yield 3 minutes to the 
distinguished gentleman from Michigan (Mr. Dingell), the ranking member 
of the Committee on Commerce.
  (Mr. DINGELL asked and was given permission to revise and extend his 
remarks.)
  Mr. DINGELL. Mr. Speaker, I thank the distinguished gentlewoman from 
California for yielding me this time.
  I rise in support of the Nurse Reinvestment Act, a solid piece of 
legislation, one which does great credit to the gentlewoman from 
California and one which is a solid down payment on our effort to 
address severe shortages in the nursing professions. We need to do 
more, and we must do more. But for a variety of reasons, this is about 
as good as we can do today. It is, however, a valuable bill.
  As with any bill of importance, this is a very important bill and 
much of the credit goes to the colleagues of ours who are willing to do 
the hard work. No one has worked harder for the nursing profession than 
my distinguished friend and colleague from California (Mrs. Capps). She 
has been tireless and, today, that effort bears fruit. I congratulate 
her and salute her for a job well done. Of course, we would not be here 
without bipartisan support and cooperation; and I thank the gentleman 
from Florida (Mr. Bilirakis), the chairman of the Subcommittee on 
Health, and the gentleman from Ohio (Mr. Brown), the subcommittee 
ranking member, and, of course, the gentleman from Louisiana (Mr. 
Tauzin), the chairman of the full committee, for their support of this 
undertaking.
  The bill will help us recruit more nurses through public service 
announcements and other educational programs. These will inform the 
public about the nursing profession as a career and will tell potential 
nurses about resources available to them if they choose to enter this 
wonderful, caring, and giving profession. This legislation mandates the 
study of the shortage in the nursing faculty and requests an analysis 
of the methods by which we may address effectively the faculty 
shortages and other shortages in the industry.
  Finally, the bill has educational scholarships to the loan repayment 
program for nurse education. This is an important new tool, and it is a 
significant step in the right direction. Educational assistance in the 
form of scholarships reaches a new pool of applicants, and it also pays 
additional dividends in delivering quality health care to underserved 
areas as aspiring nurses work off their scholarship commitments.
  The types of facilities that can accept nurses through this program 
have expanded, which will add to the appeal of the programs, both for 
nurses and

[[Page H10491]]

for the health care facilities in which they serve.
  Mr. Speaker, we are looking at a severe shortage of nurses which we 
can anticipate will get worse because of lack of adequate pay, because 
of lack of adequate responsibility, because of excessive hours, and a 
wide array of other things. This will be a small step forward towards 
ending those unfortunate situation; but we hope that we will shortly be 
moving forward on other legislation which will continue and in new ways 
address the concerns which we confront in this area of providing 
adequate nursing care to the people of this country.

                              {time}  1945

  I would note that the nurses are a wonderful group of public servants 
to whom we owe a great debt.
  I again thank my distinguished colleague, the gentlewoman from 
California (Mrs. Capps), and my other colleagues who have brought us 
this far.
  I urge my colleagues to join us in support of this bill.
  Mr. BILIRAKIS. Mr. Speaker, I reserve the balance of my time.
  Mrs. CAPPS. Mr. Speaker, I am very pleased to yield 2\1/2\ minutes to 
my colleague, the gentleman from Illinois (Mr. Davis).
  (Mr. DAVIS of Illinois asked and was given permission to revise and 
extend his remarks.)
  Mr. DAVIS of Illinois. Mr. Speaker, first of all, let me commend and 
congratulate all of the members of the Committee on Commerce, 
especially its leadership, the gentleman from Louisiana (Chairman 
Tauzin); the dean of the House, the gentleman from Michigan (Mr. 
Dingell); both the chairman and the ranking member of the subcommittee; 
and especially my colleague, the gentlewoman from California (Mrs. 
Capps).
  They have all put their fingers on a most severe problem in our 
country, and I was just sitting there thinking how much of a Christmas 
present this is going to be for all of the hospitals.
  I represent a district that has 23 hospitals, four university medical 
centers, nine nurses' training programs, 25 community health centers. 
Health for my district is one of the most important elements of it.
  I just finished meeting with the deans of our nursing schools. Every 
one of them recognizes this shortage. I just finished meeting with the 
owners of nursing homes, and they all point out the problem that they 
have. As a matter of fact, we have even had hospitals seek waivers so 
that they could import nurses from other countries.
  So we thank the gentleman for America, but especially do I want to 
thank this committee for the people of the Seventh Congressional 
District in Illinois. They have given us a tremendous Christmas 
present.
  Mrs. CAPPS. Mr. Speaker, I am very pleased to yield 2\1/2\ minutes to 
my distinguished colleague, the gentlewoman from Connecticut (Ms. 
DeLauro).
  Ms. DeLAURO. Mr. Speaker, I rise in strong support of the bipartisan 
Nurse Reinvestment Act; and I thank the gentlewoman from California 
(Mrs. Capps), the gentleman from Ohio (Mr. Brown), the gentleman from 
Florida (Mr. Bilirakis), and the gentlewoman from New York (Mrs. Kelly) 
for their commitment to addressing our Nation's nursing shortage.
  They have worked so hard to ensure this body could take the first 
steps in addressing the concerns of nurses and the issues which have 
plagued the nursing profession.
  In Connecticut, more than 3,200 nurses have left the State or given 
up their licenses since 1996. Nurse vacancy rates are up 50 percent 
since 1996, and the number of newly licensed nurses is down 25 percent 
from 4 years ago.
  Further, the average age of licensed nurses in my State is 45, 
compared to the national average of 42. There is a widening gap between 
the increasing need for nursing care and the number of women and men 
who will be there to provide the care that their patients need.
  This year I sat down with a group of nurses in my district to discuss 
the shortage and the effect it is having on patient care. One nurse 
shared with me the critical nature of her work and the difficulty of 
providing care to all patients with so few nurses.
  Another spoke to me of how difficult working conditions are, driving 
women and men away from the profession. If allowed to persist, the 
nursing shortage will have grave effects on the quality of life for 
America's nurses and the quality of care they are able to provide to 
their patients.
  Substandard conditions must change. Nurses must feel valued, working 
conditions must improve, and we must recruit the next generation of 
nurses to care for our loved ones and ourselves. Nurses play a critical 
role and are often underappreciated in our health care system. Anyone 
who has spent time in any hospital knows how hard nurses work and the 
high quality of care that they provide.
  I spent several months in the hospital a number of years ago; and 
while I applaud what the medical profession did for me and the 
wonderful doctors, it was the care, the feeding, the constant attention 
that I received from nurses that carried me through those months.
  Congress needs to support nurses, just as they support us and our 
loved ones when we need it the most. The Nurse Reinvestment Act is that 
first step to achieve these goals. I am proud that nurses have been the 
driving force behind this bill. Together, they played a large role in 
developing the legislation and fighting for its passage. They were out 
on the front lines. They know better than anyone the challenges that 
nurses face day in and day out, and their experience and ideas informed 
this bipartisan effort and built a strong piece of legislation.
  This much-needed legislation will provide for educational 
scholarships in exchange for a commitment to serve in health care 
facilities that are experiencing a critical shortage of nurses. The 
bill provides for public service announcements to educate the public 
about the nursing profession and the rewards of a nursing career.
  Finally, it would require the GAO to study the nursing faculty work 
force to determine if there is a shortage. I strongly support the Nurse 
Investment Act. I thank my colleagues who spent so many hours in making 
this a reality. It is an investment that will build a strong force of 
nurses and improve the quality of health care in America.
  Mr. BILIRAKIS. Mr. Speaker, I yield such time as he may consume to 
the gentleman from Kansas (Mr. Moran).
  Mr. MORAN of Kansas. Mr. Speaker, I rise tonight in strong support 
and admiration of the cosponsors, the lead sponsors of this 
legislation. There is perhaps no more important issue that we face than 
the one of health care, certainly in Kansas, with the demographics of 
an aging population and our desire to make certain that all of our 
citizens across the country have access to adequate and affordable 
health care.
  As I talked to hospital administrators, hospital trustees across the 
State of Kansas, the greatest concern they have is the lack of health 
care professionals. At the top of the list is the front line providers 
of health care service, our nurses. That nursing profession is so 
important.
  I recently visited the school of nursing at Emporia State University, 
where I met with students who wanted to be nurses. I asked them the 
question, Why do you want to be a nurse? The answers were wonderful. 
They were about, when I was a young girl my grandmother was ill, and in 
the hospital the nurse took care of her. I watched how she cared for my 
grandmother and our family, and all my life I wanted to be a nurse. 
Today I am in nursing school so I can fulfill that ambition.
  They were the kind of stories about human care and alleviating human 
suffering, and it made me very proud to know that there were still 
people who want to enter a profession to care for others.
  Unfortunately, we have had a number of nurses retire, we have had a 
number of nurses change professions, and we have a number of people who 
still want to meet the needs of other citizens, meet their health care 
needs.
  I think it is so appropriate that we step forward tonight to create 
the incentives and the environment for our schools of nursing and for 
potential nursing students to fulfill their life ambition to help other 
people.
  It is important that we do things in the long run to make the nursing 
profession one that is rewarding and enjoyable, and we have issues of 
reimbursement and salaries that come from

[[Page H10492]]

concerns we all share about Medicare reimbursement to local health care 
providers.
  We have certainly bureaucratic and paperwork issues that our nurses 
face. We want to make certain that our nurses do not spend their days 
charting results, filling out paperwork, and that they really are 
involved in patient care. While we work on those more long-term 
solutions to our health care challenges in our country, we must take 
the steps forward that this legislation represents in providing an 
opportunity for young men and women to move forward in their 
profession, to seek that opportunity to help other people, and to save 
lives.
  I strongly support and encourage the enactment of this legislation 
and again commend our primary sponsors for their help in bringing this 
very critical issue to us. It is about saving lives, it is about 
fulfilling lifetime goals, and it is about taking the young person or 
even the middle-aged or elderly person who wants to change careers or 
move up the nursing ladder to a different aspect of nursing.
  So tonight we have that opportunity, and I urge its passage.
  Mrs. CAPPS. Mr. Speaker, I am pleased to yield 3 minutes to my 
colleague, the gentleman from Oregon (Mr. Blumenauer).
  Mr. BLUMENAUER. Mr. Speaker, I appreciate the gentlewoman's courtesy 
in allowing me to speak on this legislation.
  I am not going to join in the parade in acknowledging all the leaders 
who have stepped forward to make this possible. I will, however, say 
that I salute the gentlewoman from California (Mrs. Capps) for being 
the conscience of the House on this issue.
  I think this would be a better institution if we had more nurses who 
were Members of this body. But frankly, we cannot afford them because 
they are needed in the field, and we really probably need the three 
that are here now out there caring for people.
  Yes, it is true that nursing is a great profession, with caring, 
rewarding work that makes people really light up, which they really 
enjoy. It takes a special person, and they get special rewards. But we 
ought to acknowledge that it is also difficult work. It is demanding 
work, while it is more important than ever before, more critical, we 
have seen with actions that have taken place in recent months.
  We are learning some hard lessons at home in my community with an 
unpleasant labor dispute that is taking place between a teaching 
hospital and a nurses' association.
  It is not just the demographics that are working against us today. 
Frankly, I hear from friends of mine in the nursing profession and 
other health care professionals that the management of the health care 
system today is increasingly a negative factor. We are going to have to 
fight harder to keep these professionals, and we are going to have to 
work to make sure that the system works for them.
  I think this legislation is a small step in the right direction. It 
is not quite the legislation that some of us signed onto. Frankly, I 
hope before it wends its way through the legislative process, as it 
comes back from the Senate, that we will have stronger legislation, 
because frankly, I like the provisions that expand the nurse education 
loan repayment program. That is great. But it is also going to take 
more than public service announcements and more studies. We know how 
important it is. We know that there is a need. We know that there needs 
to be a greater Federal commitment if we are going to have the nursing 
professionals we need when we need them.
  I commend the members of the committee for bringing this legislation 
forward. I hope that it starts the momentum towards the Federal 
commitment that the public and the nursing profession demand.
  Mr. BILIRAKIS. Mr. Speaker, in the spirit of bipartisanship, I am 
glad to yield 3 minutes to the gentleman from Ohio (Mr. Strickland).
  Mr. STRICKLAND. Mr. Speaker, I rise in support of the Nurse 
Reinvestment Act, and I thank my friend and colleague, the gentleman 
from Florida (Mr. Bilirakis), for yielding me the time.
  Mr. Speaker, I am a cosponsor of this legislation, which will help to 
ensure that we have enough nurses to care for our increasingly older 
population. The nursing shortage hits my rural congressional district, 
where it is difficult to attract and retain almost all health care 
professionals.
  Statistics indicate that my State of Ohio is licensing fewer and 
fewer nurses. According to the Ohio Hospital Association, in 1995, 
6,875 new Ohio licenses were issued through the exam process. This 
number has dropped each year through the year 2000, when only 4,662 
licenses were issued. And recently, the Ohio Bureau of Employment 
Services estimated that Ohio will have 2,800 openings for registered 
nurses by the year 2002 which will probably go unfilled.
  Inadequate staffing that is the result of our nursing workforce 
shortage in our nursing homes and other long-term care facilities 
contributes to poor feeding, malnutrition, dehydration, and the 
hospitalization of nursing home residents. Studies show that there is a 
direct correlation between higher nurse staffing levels and better 
outcomes of nursing home care.
  This bill addresses these problems by expanding the nurse education 
loan repayment program to include scholarships if a nurse is willing to 
commit to serving in an area with a critical shortage of nurses. Like 
the National Health Service Corps, this provision gives nurses the 
incentives they may need to work in an area suffering from a critical 
workforce shortage, such as southern Ohio.
  The provision also gives nurses a longer list of facilities at which 
a nurse can complete his or her service commitment, including 
departments of public health, home health agencies, and long-term care 
facilities.

                              {time}  2000

  In addition, the bill authorizes public service announcements to 
educate the public regarding the nursing profession. Ensuring a strong 
workforce of health professionals would be particularly important in 
the events of a bioterrorist attack, when trained nurses would be 
critical to our Nation's effective identification of and response to 
the dissemination of a biological or chemical weapon.
  I want to thank my friend, the gentlewoman from California (Mrs. 
Capps). She is a nurse. I am a psychologist. Others in this body are 
physicians. There was a time when most of us who served here were 
attorneys. And I think what the gentlewoman from California (Mrs. 
Capps) and the other nurses in this body have accomplished with this 
legislation is a testament to the strength that we have and the current 
diversity of those of us who make up this wonderful House of 
Representatives.
  Mrs. CAPPS. Mr. Speaker, I yield 2 minutes to the gentleman from New 
York (Mr. Towns).
  Mr. TOWNS. Mr. Speaker, let me thank the gentlewoman from California 
(Mrs. Capps) for yielding me time. I would like to thank the gentleman 
from Florida (Mr. Bilirakis) and the gentlewoman from California (Mrs. 
Capps) for moving this legislation forward.
  We have been doing a lot of talk about the nursing situation but we 
have not done very much. So I am happy to come tonight in terms of the 
fact and be supportive of the Nurse Investment Act. I think that the 
time is here to take action.
  People are living longer now, so the fact that people are living 
longer we need more nursing personnel. We, right now, are 100,000 short 
nationwide in our nursing homes. And, of course, this is a small step 
in the right direction. Sure it is not a solution to the total problem, 
but it sure begins to move us in the right direction.
  In my earlier life, I was on the administrative staff of Beth-Israel 
Hospital in New York and I had the opportunity to work very closely 
about nurses. And I know in terms of the kind of job that they do on 
behalf of patients. But then it became very close to me. On September 
11, I had the opportunity to visit a few hospitals in New York during 
the crisis there. And to watch to see in terms of the functions, the 
way the nurses carried themselves, and I tell you it is very difficult 
work; but I want you to know that they were performing in grand style.
  I think that we need to do everything that we can to encourage people 
to stay in nursing, encourage people to

[[Page H10493]]

 come into nursing. And I think this has to be a greater Federal 
commitment. I think that we have to begin to look at the salary scale, 
look at the kind of training they have and to see what we can do. Look 
at a situation that we might be able to provide scholarships in large 
way, a loan forgiveness. We need to find ways to make certain that we 
are being very friendly to that profession.
  I think it has not been treated fairly. I think that this legislation 
helps us to begin to look at it in a way that we should look at it. But 
the point is do not think this legislation is a solution. Let us look 
at what we can do with this now and then come back and do more.
  I want to thank my friend, the gentlewoman from California (Mrs. 
Capps) for staying there and working on this, and, of course, my 
friend, the gentleman from Florida (Mr. Bilirakis) and saying that we 
must stop talking about it and begin to do something. And now we are 
doing something.
  Mr. BILIRAKIS. Mr. Speaker, I would say amen to that.
  Mr. Speaker, I have no further requests for time, and I yield back 
the balance of my time.
  Mrs. CAPPS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I want to take a minute to again thank the chairman of 
the Subcommittee on Health, the gentleman from Florida (Mr. Bilirakis) 
for his excellent leadership in this legislation. I also keep in mind 
the many nurses across this country with whom I have worked closely and 
who have supported this legislation who know firsthand the importance 
of it and their patients who will benefit from it.
  Ms. PELOSI. Mr. Speaker, I rise in support of H.R. 3487, the Nurse 
Reinvestment Act, and commend my colleague Representative Capps for her 
leadership in addressing the current nursing shortage.
  Today, health care institutions across the nation are experiencing a 
crisis in nurse staffing. In my district, hospital emergency 
departments divert patients to other hospitals over 75 percent of the 
time because of inadequate nurses to staff the critical care units 
where most emergency admissions are transferred for care. In a recent 
meeting with San Francisco's emergency response leaders, the Director 
of Emergency Health Services cited inadequate nurse staffing for 
emergency departments, critical care units, and surgical units as a 
major problem.
  The shortage of educated, licensed Registered Nurses poses a 
significant threat to our nation's health care system, and we must act. 
The Nurse Reinvestment Act responds to this shortage by advertising and 
promoting the nursing profession to young people making career choices, 
broadening critical loan repayment programs and increasing the number 
of scholarships available for nursing students.
  Employers in hospitals, long-term care facilities are having 
difficulty finding experienced nurses, especially in emergency room and 
long term care. The safety and quality of care provided in the nation's 
health care facilities is directly related to the number and mix of 
direct care nursing staff. Studies show that when there are more 
nurses, there are lower mortality rates, shorter lengths of stay, lower 
costs, and fewer complications. The Institute of Medicine has 
documented that increased mortality and morbidity in long term 
facilities, where our most frail spend their final months, is directly 
related to inadequate nurse staffing.
  This shortage is compounded by the lack of young people entering the 
nursing profession, the rapid aging of the nursing workforce, and the 
impending health care needs of the baby boom generation.
  As new opportunities have opened up for young women and new stresses 
have been added to the profession of nursing, fewer people have opted 
to choose nursing as a career. For the past six years, new admissions 
into nursing schools have consistently dropped. Without sufficient 
numbers of young people entering nursing, the average age of nurses has 
increased steadily. As a result, the average working RN is over 43 
years old and large numbers of nurses are expected to retire over the 
next decade. At the same time, the need for complex nursing services 
will only increase due to the aging of the population.
  Now is the time to begin to address this impending public health 
crisis. I urge my colleagues to vote yes on the Nurse Reinvestment Act.
  Mr. TAUZIN. Mr. Speaker, I rise in support of H.R. 3487, the Nurse 
Reinvestment Act. The United States health care system relies heavily 
on the services provided by nurses who are essential for ensuring 
comfortable and quality care for all patients. Unfortunately, health 
care providers and recent media reports have reported rising vacancy 
rates in the nursing profession.
  Due to the lack of young people entering the nursing profession, the 
average age of the working nurse has increased to over 43 years old. If 
we do not encourage more young people to choose a career in nursing, 
the nursing workforce may reach dangerously low levels. This is taking 
place during a time when our demand for nursing services is growing, 
and will continue to grow into the future.
  To combat this problem and encourage more young people to enter the 
nursing profession, this legislation provides for public service 
announcements that highlight the rewards of a career in nursing. 
Additionally, the bill expands Title 8 of the Public Health Service Act 
to provide scholarships for nursing students. Students receiving these 
loans and scholarships will be required to serve in a health care 
facility that has a shortage of nurses.
  H.R. 3487 also provides for a study on nursing faculty. As more and 
more people enter nursing school, it is necessary to ensure there will 
be an adequate number of faculty to train them.
  I commend Chairman Bilirakis and Mrs. Capps for working in a truly 
bipartisan manner to craft this legislation to ensure our nation will 
have enough nursing professionals to ensure quality patient care. I 
urge my colleagues to join me in supporting the Nurse Reinvestment Act.
  Mr. TOWNS. Mr. Speaker, I rise today in support of H.R. 3487, the 
Nurse Reinvestment Act.
  While today's bill is a start toward the Nation's nursing shortage 
problems, we still have a series of outstanding issues which have not 
been addressed in this bill. Chief among them is the 100,000 nursing 
personnel shortage for long-term care facilities. The shortages include 
RNs, Licensed Practical Nurses (LPNs) and Certified Nurse Assistants 
(CNAs). Recent General Accounting Office (GAO) report indicates that 
``With the aging of the population, demand for nurse aides is expected 
to grow dramatically, with the supply of workers who have traditionally 
filled these jobs will remain virtually unchanged.'' Other reports 
suggest that the current nurse workforce issues are part of a larger 
healthcare workforce shortage that includes a shortage of Nurse Aides.
  Additionally, we must address the lack of minority representation in 
the nursing profession as well as resources to ensure that we have 
sufficient Advance Practice Nurses to provide primary preventative care 
in underserved communities. I look forward to working with my 
colleagues to address these concerns as part of the Reauthorization of 
the Health Professions Act next session. None of the above issues can 
be solved simply by ``Market Forces.'' If it was a question of simple 
economics, then we would not have a 100,000 personnel shortage. The 
Healthcare Industry needs our intervention to make sure that our 
Nation's patients have workers who are sufficiently trained to their 
health care needs. Let's support the Reinvestment Act today with the 
acknowledgement that much more remains to be done.
  Mrs. CAPPS. Mr. Speaker, I have no further requests for time, and I 
yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Shimkus). The question is on the motion 
offered by the gentleman from Florida (Mr. Bilirakis) that the House 
suspend the rules and pass the bill, H.R. 3487.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds of 
those present have voted in the affirmative.
  Mrs. CAPPS. Mr. Speaker, I object to the vote on the ground that a 
quorum is not present and make the point of order that a quorum is not 
present.
  The SPEAKER pro tempore. Pursuant to clause 8, rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.
  The point of no quorum is considered withdrawn.

                          ____________________