[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.
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