[Congressional Record Volume 148, Number 100 (Monday, July 22, 2002)]
[House]
[Pages H5053-H5059]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
NURSE REINVESTMENT ACT
Mr. BILIRAKIS. Mr. Speaker, I move to suspend the rules and concur in
the Senate amendment to the bill (H.R. 3487) to amend the Public
Service Act with respect to health professions programs regarding the
field of nursing.
The Clerk read as follows:
Senate amendment:
Strike out all after the enacting clause and insert:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Nurse Reinvestment Act''.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--NURSE RECRUITMENT
Sec. 101. Definitions.
Sec. 102. Public service announcements regarding the nursing
profession.
Sec. 103. National Nurse Service Corps.
TITLE II--NURSE RETENTION
Sec. 201. Building career ladders and retaining quality nurses.
Sec. 202. Comprehensive geriatric education.
Sec. 203. Nurse faculty loan program.
Sec. 204. Reports by General Accounting Office.
TITLE I--NURSE RECRUITMENT
SEC. 101. DEFINITIONS.
Section 801 of the Public Health Service Act (42 U.S.C.
296) is amended by adding at the end the following:
``(9) Ambulatory surgical center.--The term `ambulatory
surgical center' has the meaning applicable to such term
under title XVIII of the Social Security Act.
``(10) Federally qualified health center.--The term
`Federally qualified health center' has the meaning given
such term under section 1861(aa)(4) of the Social Security
Act.
``(11) Health care facility.--The term `health care
facility' means an Indian Health Service health center, a
Native Hawaiian health center, a hospital, a Federally
qualified health center, a rural health clinic, a nursing
home, a home health agency, a hospice program, a public
health clinic, a State or local department of public health,
a skilled nursing facility, an ambulatory surgical center, or
any other facility designated by the Secretary.
``(12) Home health agency.--The term `home health agency'
has the meaning given such term in section 1861(o) of the
Social Security Act.
``(13) Hospice program.--The term `hospice program' has the
meaning given such term in section 1861(dd)(2) of the Social
Security Act.
``(14) Rural health clinic.--The term `rural health clinic'
has the meaning given such term in section 1861(aa)(2) of the
Social Security Act.
``(15) Skilled nursing facility.--The term `skilled nursing
facility' has the meaning given such term in section 1819(a)
of the Social Security Act.''.
SEC. 102. PUBLIC SERVICE ANNOUNCEMENTS REGARDING THE 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.
``(c) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section such
sums as may be necessary for each of fiscal years 2003
through 2007.
``SEC. 852. STATE AND LOCAL PUBLIC SERVICE ANNOUNCEMENTS.
``(a) In General.--The Secretary may award grants to
eligible entities to support State and local advertising
campaigns through 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, or post information on
billboards or on the Internet in a manner intended to reach
as wide and diverse an audience as possible, in order to--
``(1) advertise and promote the nursing profession;
``(2) promote nursing education programs;
``(3) inform the public of financial assistance regarding
such education programs;
``(4) highlight individuals in the community who are
practicing nursing in order to recruit new nurses; or
``(5) provide any other information to recruit individuals
for the nursing profession.
``(c) Limitation.--An eligible entity that receives a grant
under subsection (a) shall not use funds received through
such grant to advertise particular employment opportunities.
``(d) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section such
sums as may be necessary for each of fiscal years 2003
through 2007.''.
SEC. 103. NATIONAL NURSE SERVICE CORPS.
(a) Loan Repayment Program.--Section 846(a) of the Public
Health Service Act (42 U.S.C. 297n(a)) is amended--
(1) in paragraph (3), by striking ``in an Indian Health
Service health center'' and all that follows to the semicolon
and inserting ``at a health care facility with a critical
shortage of nurses''; and
(2) by adding at the end the following: ``After fiscal year
2007, the Secretary may not, pursuant to any agreement
entered into under this subsection, assign a nurse to any
private entity unless that entity is nonprofit.''.
(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 ``loan
repayment program'' and inserting ``loan repayment 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 shall (for fiscal years
2003 and 2004) and may (for fiscal years thereafter) carry
out a program of entering into contracts with eligible
individuals under which such individuals agree to serve as
nurses for a period of not less than 2 years at a health care
facility with a critical shortage of nurses, in consideration
of the Federal Government agreeing to provide to the
individuals scholarships for attendance at schools of
nursing.
``(2) Eligible individuals.--In this subsection, the term
`eligible individual' means an individual who is enrolled or
accepted for enrollment as a full-time or part-time student
in a school of nursing.
``(3) Service requirement.--
``(A) In general.--The Secretary may not enter into a
contract with an eligible individual under this subsection
unless the individual agrees to serve as a nurse at a health
care facility with a critical shortage of nurses for a period
of full-time service of not less than 2 years, or for a
period of part-time service in accordance with subparagraph
(B).
``(B) Part-time service.--An individual may complete the
period of service described in subparagraph (A) on a part-
time basis if the individual has a written agreement that--
``(i) is entered into by the facility and the individual
and is approved by the Secretary; and
``(ii) provides that the period of obligated service will
be extended so that the aggregate amount of service performed
will equal the amount of service that would be performed
through a period of full-time service of not less than 2
years.
``(4) Applicability of certain provisions.--The provisions
of subpart III of part D of title III shall, except as
inconsistent with this section, apply to the program
established in paragraph (1) in the same manner and to the
same
[[Page H5054]]
extent as such provisions apply to the National Health
Service Corps Scholarship Program established in such
subpart.''.
(c) Preference.--Section 846(e) of the Public Health
Service Act (42 U.S.C. 297n(e)) is amended by striking
``under subsection (a)'' and all that follows through the
period and inserting ``under subsection (a) or (d), the
Secretary shall give preference to qualified applicants with
the greatest financial need.''.
(d) Reports.--Subsection (h) of section 846 of the Public
Health Service Act (42 U.S.C. 297n) (as redesignated by
subsection (b)(2)) is amended to read as follows:
``(h) Reports.--Not later than 18 months after the date of
enactment of the Nurse Reinvestment Act, and annually
thereafter, the Secretary shall prepare and submit to the
Congress a report describing the programs carried out under
this section, including statements regarding--
``(1) the number of enrollees, scholarships, loan
repayments, and grant recipients;
``(2) the number of graduates;
``(3) the amount of scholarship payments and loan
repayments made;
``(4) which educational institution the recipients
attended;
``(5) the number and placement location of the scholarship
and loan repayment recipients at health care facilities with
a critical shortage of nurses;
``(6) the default rate and actions required;
``(7) the amount of outstanding default funds of both the
scholarship and loan repayment programs;
``(8) to the extent that it can be determined, the reason
for the default;
``(9) the demographics of the individuals participating in
the scholarship and loan repayment programs;
``(10) justification for the allocation of funds between
the scholarship and loan repayment programs; and
``(11) an evaluation of the overall costs and benefits of
the programs.''.
(e) Funding.--Subsection (i) of section 846 of the Public
Health Service Act (42 U.S.C. 297n) (as redesignated by
subsection (b)(2)) is amended 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 fiscal years 2003 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).''.
TITLE II--NURSE RETENTION
SEC. 201. BUILDING CAREER LADDERS AND RETAINING QUALITY
NURSES.
Section 831 of the Public Health Service Act (42 U.S.C.
296p) is amended to read as follows:
``SEC. 831. NURSE EDUCATION, PRACTICE, AND RETENTION GRANTS.
``(a) Education Priority Areas.--The Secretary may award
grants to or enter into contracts with eligible entities
for--
``(1) expanding the enrollment in baccalaureate nursing
programs;
``(2) developing and implementing internship and residency
programs to encourage mentoring and the development of
specialties; or
``(3) providing education in new technologies, including
distance learning methodologies.
``(b) Practice Priority Areas.--The Secretary may award
grants to or enter into contracts with eligible entities
for--
``(1) establishing or expanding nursing practice
arrangements in noninstitutional settings to demonstrate
methods to improve access to primary health care in medically
underserved communities;
``(2) providing care for underserved populations and other
high-risk groups such as the elderly, individuals with HIV-
AIDS, substance abusers, the homeless, and victims of
domestic violence;
``(3) providing managed care, quality improvement, and
other skills needed to practice in existing and emerging
organized health care systems; or
``(4) developing cultural competencies among nurses.
``(c) Retention Priority Areas.--The Secretary may award
grants to and enter into contracts with eligible entities to
enhance the nursing workforce by initiating and maintaining
nurse retention programs pursuant to paragraph (1) or (2).
``(1) Grants for career ladder programs.--The Secretary may
award grants to and enter into contracts with eligible
entities for programs--
``(A) to promote career advancement for nursing personnel
in a variety of training settings, cross training or
specialty training among diverse population groups, and the
advancement of individuals including to become professional
nurses, advanced education nurses, licensed practical nurses,
certified nurse assistants, and home health aides; and
``(B) to assist individuals in obtaining education and
training required to enter the nursing profession and advance
within such profession, such as by providing career
counseling and mentoring.
``(2) Enhancing patient care delivery systems.--
``(A) Grants.--The Secretary may award grants to eligible
entities to improve the retention of nurses and enhance
patient care that is directly related to nursing activities
by enhancing collaboration and communication among nurses and
other health care professionals, and by promoting nurse
involvement in the organizational and clinical decisionmaking
processes of a health care facility.
``(B) Preference.--In making awards of grants under this
paragraph, the Secretary shall give a preference to
applicants that have not previously received an award under
this paragraph.
``(C) Continuation of an award.--The Secretary shall make
continuation of any award under this paragraph beyond the
second year of such award contingent on the recipient of such
award having demonstrated to the Secretary measurable and
substantive improvement in nurse retention or patient care.
``(d) Other Priority Areas.--The Secretary may award grants
to or enter into contracts with eligible entities to address
other areas that are of high priority to nurse education,
practice, and retention, as determined by the Secretary.
``(e) Preference.--For purposes of any amount of funds
appropriated to carry out this section for fiscal year 2003,
2004, or 2005 that is in excess of the amount of funds
appropriated to carry out this section for fiscal year 2002,
the Secretary shall give preference to awarding grants or
entering into contracts under subsections (a)(2) and (c).
``(f) Report.--The Secretary shall submit to the Congress
before the end of each fiscal year a report on the grants
awarded and the contracts entered into under this section.
Each such report shall identify the overall number of such
grants and contracts and provide an explanation of why each
such grant or contract will meet the priority need of the
nursing workforce.
``(g) Eligible Entity.--For purposes of this section, the
term `eligible entity' includes a school of nursing, a health
care facility, or a partnership of such a school and
facility.
``(h) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section such
sums as may be necessary for each of fiscal years 2003
through 2007.''.
SEC. 202. COMPREHENSIVE GERIATRIC EDUCATION.
(a) Comprehensive Geriatric Education.--Title VIII of the
Public Health Service Act (42 U.S.C. 296 et seq.) (as amended
by section 102) is amended by adding at the end the
following:
``PART I--COMPREHENSIVE GERIATRIC EDUCATION
``SEC. 855. COMPREHENSIVE GERIATRIC EDUCATION.
``(a) Program Authorized.--The Secretary shall award grants
to eligible entities to develop and implement, in
coordination with programs under section 753, programs and
initiatives to train and educate individuals in providing
geriatric care for the elderly.
``(b) Use of Funds.--An eligible entity that receives a
grant under subsection (a) shall use funds under such grant
to--
``(1) provide training to individuals who will provide
geriatric care for the elderly;
``(2) develop and disseminate curricula relating to the
treatment of the health problems of elderly individuals;
``(3) train faculty members in geriatrics; or
``(4) provide continuing education to individuals who
provide geriatric care.
``(c) Application.--An eligible entity desiring a grant
under subsection (a) shall submit an application to the
Secretary at such time, in such manner, and containing such
information as the Secretary may reasonably require.
``(d) Eligible Entity.--For purposes of this section, the
term `eligible entity' includes a school of nursing, a health
care facility, a program leading to certification as a
certified nurse assistant, a partnership of such a school and
facility, or a partnership of such a program and facility.
``(e) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section such
sums as may be necessary for each of fiscal years 2003
through 2007.''.
(b) Technical Amendment.--Section 753(a)(1) of the Public
Health Service Act (42 U.S.C. 294c) is amended by striking
``, and section 853(2),'' and inserting ``, and section
801(2),''.
SEC. 203. NURSE FACULTY LOAN PROGRAM.
Part E of title VIII of the Public Health Service Act (42
U.S.C. 297a et seq.) is amended by inserting after section
846 the following:
``nurse faculty loan program
``Sec. 846A. (a) Establishment.--The Secretary, acting
through the Administrator of the Health Resources and
Services Administration, may enter into an agreement with any
school of nursing for the establishment and operation of a
student loan fund in accordance with this section, to
increase the number of qualified nursing faculty.
``(b) Agreements.--Each agreement entered into under
subsection (a) shall--
``(1) provide for the establishment of a student loan fund
by the school involved;
``(2) provide for deposit in the fund of--
``(A) the Federal capital contributions to the fund;
``(B) an amount equal to not less than one-ninth of such
Federal capital contributions, contributed by such school;
``(C) collections of principal and interest on loans made
from the fund; and
``(D) any other earnings of the fund;
``(3) provide that the fund will be used only for loans to
students of the school in accordance with subsection (c) and
for costs of collection of such loans and interest thereon;
``(4) provide that loans may be made from such fund only to
students pursuing a full-time course of study or, at the
discretion of the Secretary, a part-time course of study in
an advanced degree program described in section 811(b); and
``(5) contain such other provisions as are necessary to
protect the financial interests of the United States.
``(c) Loan Provisions.--Loans from any student loan fund
established by a school pursuant
[[Page H5055]]
to an agreement under subsection (a) shall be made to an
individual on such terms and conditions as the school may
determine, except that--
``(1) such terms and conditions are subject to any
conditions, limitations, and requirements prescribed by the
Secretary;
``(2) in the case of any individual, the total of the loans
for any academic year made by schools of nursing from loan
funds established pursuant to agreements under subsection (a)
may not exceed $30,000, plus any amount determined by the
Secretary on an annual basis to reflect inflation;
``(3) an amount up to 85 percent of any such loan (plus
interest thereon) shall be canceled by the school as follows:
``(A) upon completion by the individual of each of the
first, second, and third year of full-time employment,
required by the loan agreement entered into under this
subsection, as a faculty member in a school of nursing, the
school shall cancel 20 percent of the principle of, and the
interest on, the amount of such loan unpaid on the first day
of such employment; and
``(B) upon completion by the individual of the fourth year
of full-time employment, required by the loan agreement
entered into under this subsection, as a faculty member in a
school of nursing, the school shall cancel 25 percent of the
principle of, and the interest on, the amount of such loan
unpaid on the first day of such employment;
``(4) such a loan may be used to pay the cost of tuition,
fees, books, laboratory expenses, and other reasonable
education expenses;
``(5) such a loan shall be repayable in equal or graduated
periodic installments (with the right of the borrower to
accelerate repayment) over the 10-year period that begins 9
months after the individual ceases to pursue a course of
study at a school of nursing; and
``(6) such a loan shall--
``(A) beginning on the date that is 3 months after the
individual ceases to pursue a course of study at a school of
nursing, bear interest on the unpaid balance of the loan at
the rate of 3 percent per annum; or
``(B) subject to subsection (e), if the school of nursing
determines that the individual will not complete such course
of study or serve as a faculty member as required under the
loan agreement under this subsection, bear interest on the
unpaid balance of the loan at the prevailing market rate.
``(d) Payment of Proportionate Share.--Where all or any
part of a loan, or interest, is canceled under this section,
the Secretary shall pay to the school an amount equal to the
school's proportionate share of the canceled portion, as
determined by the Secretary.
``(e) Review by Secretary.--At the request of the
individual involved, the Secretary may review any
determination by a school of nursing under subsection
(c)(6)(B).
``(f) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section such
sums as may be necessary for each of fiscal years 2003
through 2007.''.
SEC. 204. REPORTS BY GENERAL ACCOUNTING OFFICE.
(a) National Variations.--Not later than 4 years after the
date of the enactment of this Act, the Comptroller General of
the United States shall conduct a survey to determine
national variations in the nursing shortage at hospitals,
nursing homes, and other health care providers, and submit a
report, including recommendations, to the Congress on Federal
remedies to ease nursing shortages. The Comptroller General
shall submit to the Congress this report describing the
findings relating to ownership status and associated
remedies.
(b) 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 4 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.
(c) Nursing Scholarships.--The Comptroller General of the
United States shall conduct an evaluation of whether the
program carried out under section 846(d) of the Public Health
Service Act has demonstrably increased the number of
applicants to schools of nursing and, not later than 4 years
after the date of the enactment of this Act, submit a report
to the Congress on the results of such evaluation.
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. Mr. Speaker, I ask unanimous consent that all Members
may have 5 legislative days within which to revise and extend their
remarks on this legislation, and to insert extraneous material on the
bill.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Florida?
There was no objection.
Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I rise today in support of H.R. 3487, the Nurse
Reinvestment Act.
Over the past several weeks, both the Senate and the House have
worked to reach agreement on legislation that will help alleviate the
national nursing shortage. We have all heard about issues with
recruitment and retention of nursing staff across the nursing
continuum. Our health and long-term care systems rely heavily on the
services of these dedicated health care professionals. Nurses provide
critical medical services necessary to ensure quality health care. Our
legislation provides new authority to the Secretary of Health and Human
Services to ensure that we will have an adequate supply of qualified
nurses in our health care system.
{time} 2000
To address the nursing shortage, this legislation focuses on two key
areas. The first one pertains to the recruitment of new nurses, which
means we must encourage more young people to choose this challenging
and fulfilling career. This legislation directs the Secretary of Health
and Human Services to create public service announcements designed to
promote nursing and nursing education programs. Secondly, this
legislation focuses on the training of those in the profession by
building on the recruitment theme.
The compromise bill we are considering today expands title 8 of the
Public Health Service Act to include scholarships for students entering
the nursing profession. In exchange, students must enter a commitment
to serve in a health facility determined to have a critical shortage of
nurses.
Third, H.R. 3487 focuses on the retention of the talented workforce
that is in the system today. To aid in the retention of qualified
nurses, the legislation provides the HHS Secretary with authority to
expand on career ladder programs that promote career advancement of
nurses within the profession. The bill also allows grants to enhance
the nursing workforce by initiating and retaining nurse retention
programs. Moreover, this legislation authorizes grants for programs
that will train and educate individuals in providing care for elderly,
which may be critical with our aging baby boom population.
Our efforts to recruit and retain qualified nursing professionals
will be in vain if we do not also address our system for educating
nurses. If we are successful in recruiting nurses to the profession, we
will need to build up our Nation's capacity to educate nurses. To this
end, the bill establishes a faculty loan cancellation program to
encourage people to complete advanced education and treat future
nurses. Under this program, Ph.D. and master's nursing students will be
eligible to receive loans if they agree to teach in a nursing schooling
upon completion of their degree. For every year up to 4 years that a
loan recipient teaches, he or she will have an increasing portion of
their loan canceled.
Nurses are invaluable, Mr. Speaker, to the success and quality of our
health care system. The legislation helps ensure that our Nation will
have a well-trained supply of nurses on which to rely. Again, this
legislation, and I am very proud to say this, was put together with a
bipartisan effort of the House and the Senate. And I would certainly be
remiss if I did not mention the gentlewoman from California (Mrs.
Capps), who is a nurse herself who has lived these particular problems
and she has been a pusher, I guess is the best way I can put it, on
this; and we are very, very grateful to her for this and to her staff.
I would like to thank my colleagues for their hard work and
dedication to this issue, and I would also add thanks to the gentleman
from Maryland (Mr. Ehrlich), the gentleman from Kentucky (Mr.
Whitfield), the gentleman from Tennessee (Mr. Bryant), and the
gentlewoman from New York (Mrs. Kelly). There are so many from the
other side of the aisle and our side who have been so helpful because
of the great interest in trying to solve this particular problem.
I would like to take a moment to thank some of the staff who worked
on this bill. Please forgive me if I miss anyone in this process. I
would like to recognize a few people. First, Anne Esposito, who
recently left my staff, was instrumental in obtaining House passage of
the bill. John Ford, Jeremy
[[Page H5056]]
Sharp, and Katie Porter on the minority were also most helpful, as were
Steve Tilton, Erin Ockunzzi, Cheryl Jaeger, and Pat Morrisey from my
staff. I thank each of them for their hard work on this legislation. I
know that we all should feel awfully proud and awfully good about
having passed this or at least brought it to this particular point.
I urge my colleagues to join me in support of H.R. 3487, the Nurse
Reinvestment Act.
Mr. Speaker, I reserve the balance of my time.
Mr. BROWN of Ohio. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, there are three nurses in the House of Representatives,
the gentlewoman from New York (Mrs. McCarthy), the gentlewoman from
Texas (Ms. Eddie Bernice Johnson), and the gentlewoman from California
(Mrs. Capps).
Mr. Speaker, I yield 5 minutes to the gentlewoman from California
(Mrs. Capps), who, as a registered nurse and a member of the
Subcommittee on Health of the Committee on Energy and Commerce, has
been the driving force and turned this dream into a reality and, as the
gentleman from Florida (Mr. Bilirakis) has said, has simply not let up
on this issue.
Mrs. CAPPS. Mr. Speaker, I thank my colleague for yielding me time.
Mr. Speaker, I rise in strong support of the Nurse Reinvestment Act,
and I urge my colleagues to vote for this important legislation.
Mr. Speaker, I want to thank the gentleman from Florida (Mr.
Bilirakis) for putting up with me, the gentleman from Louisiana (Mr.
Tauzin), and especially ranking members, the gentleman from Michigan
(Mr. Dingell) and the gentleman from Ohio (Mr. Brown), and all of the
staff for the hard work put into this bill. I will mention by name as
well: Katie Porter, John Ford, Steve Tilton, Cheryl Yaeger, and from my
office, Jeremy Sharp.
Together we have crafted good legislation that will help us deal with
the nursing shortage.
This bill marks a major commitment by the Congress to end the
shortage of nurses. The bill is based on legislation that I introduced
in April of last year, H.R. 1436, and represents a major step forward
in nursing education. I am grateful for the support of 238 co-sponsors
of that bill and the nursing and public health groups that helped us
move it forward.
The Nurse Reinvestment Act will authorize new scholarships for
prospective nurses to complete their education more quickly and join
the workforce. These scholarships will enable a broader range of people
to find their way into a very rewarding career, one that will always be
in demand, no matter the strength or weakness of the economy.
The bill also authorizes grants to train all levels of the nursing
workforce in geriatric care. This will better prepare our nurses to
deal with the coming retirement of the baby boom generation. And the
bill addresses the shortages of nursing faculty by providing loan
assistance to nurses who want to teach.
It also expands current nursing programs to include career ladder
grant programs and nursing retention programs. These new programs will
help make the nursing profession more attractive to potential nurses
and to provide for more upward mobility.
And, finally, the legislation will authorize public service
announcements to educate the public about the need for more nurses, the
opportunities available for educational assistance, and the rewards of
this kind of care-giving career. One of the major problems nursing
faces is the perception that it is an unappealing career and women's
work. These PSA's will help us counter that impression and explain the
value and the benefits of a career in nursing.
Mr. Speaker, I am, as my colleague mentioned, one of three nurses
currently serving in Congress. Before I was elected to the House of
Representatives, I served the people of Santa Barbara County as a
public health nurse for 20 years. I do know first hand the challenges
facing our hospitals and health care providers and the consequences if
we fail to meet them. Nurses are the backbone of our public health
system. As we struggle to prepare our Nation for everyday public health
emergencies, and extraordinary events like bio-terrorism, we certainly
cannot afford to be without enough nurses. September 11 and the anthrax
letters remind us that our safety and well-being depends in part on the
ability of our hospitals to care for us and our loved ones. Having
enough nurses is a critical component of that care. Nurses are the
first line of defense in all these scenarios. They will be the ones
treating the victims of biological and conventional terror attacks, and
right now we do not have enough of them.
Data on the nursing workforce shows that staffing shortages are
increasing and recruiting new registered nurses is becoming
progressively more difficult. We already today need 125,000 RN's to
fill existing vacancies according to the American Hospitals
Association; and by 2010, 40 percent of the RN workforce will be over
50 years old. In contrast, the number of RN's under 35 has fallen to
just a little over 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, and then we need to appropriate sufficient
funds to the program it creates. This bill represent several good steps
toward a comprehensive solution toward the nursing shortage; but if we
do not fund it, it will be of little help.
Funding for nursing education programs right now is around $100
million. We certainly have to increase our commitment to nursing. To be
sure, there is much more that we will need to do. But this is an
excellent start, and I am pleased that we have finally come to this
point. So I urge all of my colleagues to support nurses and vote for
the Nurse Reinvestment Act.
Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I must say that last evening, late last night about
11:15, 11:30, my favorite uncle, my wife's and mine, passed away with
leukemia. And during these last few weeks when he was in the hospital
in Tarpon Springs, Florida, my hometown; and afterwards with the
hospice people at his home for 3 or 4 days, well, the dedication of
nurses was just there and I do not think I told any of them; but I
wanted to tell them about this piece of legislation, but they were
awfully busy.
Mr. Speaker, I yield such time as he may consume to the gentleman
from Maryland (Mr. Ehrlich), who is a member of the committee.
Mr. EHRLICH. Mr. Speaker, I rise in support of H.R. 3487, as amended.
We have already heard this bill is absolutely critical. In Maryland,
our health care facilities are now reporting a shortage of 2,000 nurses
statewide. This shortage directly affects the quality of care
Marylanders receive in hospitals, in community health centers, in
doctors' offices, and even their homes. This act spurs both nurse
recruitment to attract more young people into the profession, as well
as nurse retention to hold on to experienced nurses.
As we have heard, this legislation contains provisions for public
service announcements to advertise and promote the nursing profession,
highlight the advantages and rewards of nursing, and encourage
individuals to enter this critical profession. It also establishes a
scholarship program for students who want to become nurses but may not
be able to afford nursing school.
The act creates a scholarship program to help individuals who agree
to serve at least 2 years at a health care facility in a nurse shortage
area. To improve retention, the bill gives the Secretary of Health and
Human Services the authority to provide grants for nurse education
practices and retention grants. These grants may go to programs to help
train nurses in specialty areas, serve underserved populations such as
the elderly and substance abusers, and work for a higher nursing
degree, among other nurse-retention programs.
Mr. Speaker, this act gives the Health Resources and Services
Administration the authority to offer loan repayment opportunities for
nurses to gain advance degrees in order to become nursing faculty.
Faculty who serve 4 years in nurse-shortage areas
[[Page H5057]]
will have 85 percent of their school loans repaid for them.
I would like to thank the chairman. We could not do this without the
gentleman from Florida (Mr. Bilirakis). His leadership has been
terrific, and he has been as dogged as the gentlewoman from California
(Mrs. Capps). I also want to thank the gentlewoman from New York (Mrs.
Kelly), my colleague and friend, for her hard work on this; the
gentleman from Ohio (Mr. Brown); and, of course, the man who makes it
all possible, the chairman of the committee, the gentleman from
Louisiana (Mr. Tauzin). But without the gentleman from Florida (Mr.
Bilirakis), we would not be standing here today. I know the gentlewoman
from California (Mrs. Capps) agrees with that thought.
Mr. Speaker, this investment in the nursing workforce improves our
Nation's health delivery system, and it is crucial to the health and
public safety of all Americans. I congratulate everybody associated
with the bill. It will be signed by the President. It is good policy.
It is a bipartisan bill. I look forward to its enactment into law.
Mr. BROWN of Ohio. Mr. Speaker, I yield 3 minutes to the gentlewoman
from New York (Mrs. McCarthy), who also is a registered nurse.
Mrs. McCARTHY of New York. Mr. Speaker, I was a nurse for over 30
years before I came to Congress and the gentlewoman from California
(Mrs. Capps) and I talk about it. We are still nurses. We just happen
to have a side job as being a Congressperson. That is the way we look
at it here. That is why I take the nursing shortage very personally;
and also why, last December when we passed a version of the Nurse
Reinvestment Act, I was happy that we started looking at the issue
because it is an important issue to all of us. But we still need to do
more for our nurses. That is why I and the gentlewoman from California
(Mrs. Bono) introduced H.R. 4654, the Nurse Retention and Quality of
Care Act. This is a bill that provides $20 million in grant monies to
hospitals to help them become magnet hospitals.
On Long Island where I live, we have an RN vacancy rate of 8 percent
and an 16 percent LPN vacancy rate. In addition, 126,000 nurses are
needed nationwide.
One solution to keep and retain nurses immediately would be to help
hospitals obtain magnet hospital status. Magnet hospitals are hospitals
that have reorganized care to be more hands-on, team-oriented, patient-
centered, and as a result are attracting more nurses.
I and the gentlewoman from California (Mrs. Bono) wanted to give
hospitals a chance to become better workplaces for health care
professionals. Even in times of nursing shortages, magnet hospitals
enjoy low turn-over and job satisfaction. The average length of
employment for registered nurses in magnet hospitals is 8 years, twice
the length of employment in nonmagnet hospitals. Magnet hospitals give
our nurses the ability to make their own schedules, which, by the way,
is one of the biggest contentions with nurses in hospitals today. In
addition, nurses are on all administration boards and continued
education for all levels of nursing are provided.
As a result, magnet hospitals report lower mortality rates, higher
patient satisfaction and greater cost efficiency.
{time} 2015
The patients experience shorter stays in hospital and intensive care
units. Best of all, nurses are enjoying their jobs again.
The nurses I spoke to at my Long Island magnet hospitals say that
their quality of life has dramatically improved due to the changes
made, and I think this is something that we are starting to really
address now. With this particular bill, we are looking at all of the
aspects of what our nurses are facing on a daily basis. We have sicker
patients in the hospitals today. The job has gotten harder and harder.
Higher tech has come in, but yet there is one thing all nurses have in
common, and this is the compassion to take care of the people. That is
why we went into nursing in the first place.
Mr. Speaker, I rise today thrilled that the Nurse Reinvestment Act
now includes our magnet hospital language, and it has truly become a
bill that will help all nurses, but this is a win-win situation. Not
only is it good for our nurses and our hospitals, but it really is good
for our patients, and again, that comes back down to those that need us
the most, especially when they are sick.
I commend my colleagues in both Houses for their diligent work
negotiating for a better bill and urge all Members to support this
important piece of legislation.
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. This is a substantial step in addressing the growing
shortage of nurses currently being experienced by health care
facilities nationwide. I thank the gentleman from Florida (Mr.
Bilirakis), the Subcommittee on Health chairman, and the gentlewoman
from California (Mrs. Capps), for their hard work in bringing this
legislation to the floor.
As a professional patient advocate, I hope that this measure will
increase the number of health professionals available to care for the
growing number of patients we have, the growing number, as well as
being more ill when they are in the hospital.
The bill contains practical and creative solutions to eliminating the
nursing shortage. It focuses on recruitment, retention, career
enhancement and faculty development. The Nurse Reinvestment Act will
provide a framework for increasing awareness about opportunities in the
nursing profession, growing enrollment in nursing schools, and
providing staff coverage for areas experiencing acute shortages.
Funding for outreach and public awareness campaigns will help us tap
into new communities, seeking those people who may not traditionally
have considered health care as a career. The National Nurse Service
Corps expanded loan repayment assistance and a scholarship program
contained in this bill will further entice prospective students to
serve in areas where the need is the greatest.
We hope that nurses currently practicing will find this legislation
provides funding for the development of internships, residency and
mentoring programs, and education and new emerging technologies. Nurses
also should be encouraged to seek specialty training and other
opportunities to enhance their skills as a result of this bill.
An especially important component of the bill is a provision to
ensure that nursing schools have adequate faculty. A loan forgiveness
program will be available for nurses pursuing advanced education who
will teach in nursing schools.
In short, the bill will help make sure that the classroom seats in
our Nation's nursing schools are filled and that practicing nurses
remain in the field and pursue higher skill levels. This will help
relieve the nursing shortage that we are experiencing. Nurses are
stretched too thin, and we need to get more nurses on the hospital
floors to provide much-needed care for patients.
It is a good step. It is a first step in helping America continue to
have caring and outstanding medical nursing care. I urge all of my
colleagues to support this measure and help strengthen our Nation's
health care workforce.
Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman
from Illinois (Mr. Davis).
Mr. DAVIS of Illinois. Mr. Speaker, I want to first of all commend
and congratulate the gentleman from Florida (Mr. Bilirakis) and the
gentleman from Ohio (Mr. Brown) for their outstanding leadership on
health issues, and I also want to commend the gentleman from Louisiana
(Mr. Tauzin) and the gentleman from Michigan (Mr. Dingell) for the
leadership that they provide. I could not let this opportunity go by
without coming over to congratulate and commend the gentlewoman from
California (Mrs. Capps) for the outstanding leadership she has provided
on this issue as well as so many others.
I was listening to the debate and was thinking of Loyola University,
Rush-Presbyterian St. Luke's, University of Illinois, Cook County
Hospital, Mount Sinai Hospital, Westside Veterans Administration,
Heinz, Northwestern, Mercy Hospital, Malcolm X College,
[[Page H5058]]
the Chicago Rehabilitation Institute, all of which have nursing schools
and nursing programs in my congressional district, all who lament the
fact that we do not have enough nurses, in many instances, to fill some
of the classes.
This deal will create an opportunity for many institutions not to
find it necessary to import nurses. There is a wealth of talent,
individuals around who with a little nudging and a little help will
choose nursing as a career. This is an opportunity. It is a great one.
Again, I commend the gentlewoman from California (Mrs. Capps) and all
of those who have made it happen.
Mr. BROWN of Ohio. Mr. Speaker, I yield myself 4 minutes.
I want to thank the gentleman from Louisiana (Mr. Tauzin) and the
gentleman from Florida (Mr. Bilirakis) for their fine work and for
working with the gentleman from Michigan (Mr. Dingell), the gentlewoman
from California (Mrs. Capps) and with me on the issue of the nurse
shortage and their commitment to send a bill to the President's desk.
Special thanks to staff members Steve Tilton and Cheryl Jaeger, and
Katie Porter in my office and John Ford, and Jeremy Sharp for the work
they did on this legislation.
Nurses are the heart of our health care system. They have the most
contact with patients. With the threat and reality of bioterrorism,
they are on the front lines treating exposure to biological and
chemical agents as well as a surge of ``worried well'' patients. They
make a functioning health care system an effective health care system,
and to be sure, they do not receive nearly enough gratitude.
There is not a Member in this House or Senate who does not recognize
the severity of the nursing shortage. While the facts to substantiate
the shortage are glaring, the solutions are far less clear. The House
and Senate each passed legislation that reflected their sincere and
strong commitment to tackling the problem. Both bodies put in a
tremendous amount of work to reach a compromise between the two bills,
and I am pleased in joining with my colleagues with the end result.
This bill is not intended to provide all the answers. Its modest but
critical purpose is to alleviate the nursing shortage by jump-starting
recruitment and fostering retention.
Under recruitment, our bill will establish public service
announcements and expands the current loan repayment programs to
include scholarships.
Under retention, our bill will help schools of nursing to train
nurses in geriatric care. It also establishes a career ladder grant
program and a faculty loan cancellation program. It provides resources
to health care facilities to improve their staff management.
While this bill will not cure the shortage, it is also much more than
a bandaid. The bill will provide substantial authority and ultimately
resources to interest men and women in becoming nurses and furthering
their careers in nursing and improving the quality of their work
environment. It sends a strong message to nurses that we value their
hard work, we recognize their inherent value in the delivery of quality
health care in this country, and we are committed to helping them in
their efforts to help others.
Mr. Speaker, I ask the House to support this legislation.
Mr. BENTSEN. Mr. Speaker, I rise today in strong support of the
conference report for H.R. 3487, the Nurse Reinvestment Act. As the
representative for Texas Medical Center, the home of four nursing
schools, I strongly believe that we need to provide sufficient federal
funding for nursing education and retention programs. In a time when
many of our nation's hospitals are facing nursing shortages, this
legislation is an important first step in our effort to recruit and
train more nurses to meet patient needs.
This bill will expand a nurse loan repayment program to include
scholarship for needy students. In exchange for this scholarship
assistance, nurses will be required to serve for a period of time in
health care facilities that face a critical shortage of nurses. The
requirement to serve will vary according to the amount of assistance
each nursing student receives.
This legislation will also provide resources to nursing schools to
train nurses of all levels to care for an aging population. As a larger
portion of our population reaches retirement age, there will be an
increased need for skilled nurses. Nursing schools will be allowed to
develop new curricula, faculty development, and offer continuing
education classes.
Another important provision included in this bill will provide grants
to nursing schools for Faculty Loan Programs. Nursing schools will
offer loans to advanced degree students with the expectation that these
advanced trained nurses will join the faculty to teach new nurses. In
our local area, there is shortage of both trained nurses and trained
faculty members. I believe we need both more nursing teachers and
students in order to increase the supply of nurses.
This measure would also expand current basic nursing training
programs to provide grants to establish career ladder programs. With
these programs, health care facilities would be able to offer new
opportunities for nurses to increase their responsibilities and career
opportunities. If nurses believe that they can achieve advancement in
their careers, they will be more likely to be attracted to this
profession.
Finally, this bill provides for public service announcements to
promote the nursing professions. With more information, it is hoped
that more people will enter the nursing field when they realize that it
is a vital part of our health care profession. With nurses, our health
care facilities can provide quality care to patients. All of these
programs are necessary to ensure that tomorrow's nurses will be trained
to care for all Americans.
Mr. Speaker, I urge my colleagues to support this effort to increase
nursing education and recruitment programs.
Ms. DeLAURO. Mr. Speaker, I rise in strong support of the bipartisan
Nurse Reinvestment Act, and I thank the gentlewoman from California for
her commitment to addressing our Nation's nursing shortage. She has
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 my home state of 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 that time, 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. These
statistics only begin to indicate the severity of our nursing shortage,
one that mirrors what is happening nationally.
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.
Congress needs to support nurses, just as they support our loved ones
and us when we need it the most. The Nurse Reinvestment Act is that
first step to achieve these goals.
This bill would establish nurse scholarships in exchange for
requiring those nurses to serve facilities with critical shortages. It
would provide resources to schools of nursing to train nurses of all
levels to care for an older population. The Nursing Reinvestment Act
would also provide incentives and grant programs to ensure that nurses
stay in the profession and have opportunities to move up the career
ladder. It establishes public service announcements to change age-old
stereotypes about the nursing profession and improve recruiting.
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.
Again, I would like to thank my colleague, Mrs. Capps, for all of her
hard work on this bill, and I urge my colleagues to support this bill
so that we may meet this urgent need as soon as possible.
Mr. DINGELL. Mr. Speaker, I rise in support of the Nurse Reinvestment
Act. This bill is a solid down payment in our effort to address severe
shortages in the nursing profession. This is not the first nursing
shortage we have seen, but I am dedicated to finding a real solution so
that it may be our last. Nurses are the unsung heroes in health care,
and today they need our help.
As is the case with any bill of importance, much of the credit goes
to our colleagues who are willing to do the hard work. None has worked
harder on behalf of the nursing professions than my friend and
colleague, Representative Capps. She has been tireless and today her
efforts pay off. I congratulate her on a job well done. Of course, we
would not be here without bipartisan support and cooperation. I thank
the Chairman of the Health Subcommittee, Representative Bilirakis,
Subcommittee Ranking Member Brown, and Chairman Tauzin.
[[Page H5059]]
The national nursing shortage reached crisis level in 1999 and
experts are predicting that by 2008, the nation will be short 450,000
nurses. This shortage of nurses has dramatic detrimental repercussions
for American citizens. When there are too few nurses at bedsides,
patients are significantly more likely to suffer serious complications,
according to one study published recently in the New England Journal of
Medicine.
So far, my home state of Michigan has fared better than many other
states against the national nursing shortage because so many Canadian
nurses have crossed the Ambassador Bridge and Detroit-Windsor Tunnel
for U.S. nursing jobs. Metro Detroit hospitals import 15 to 20 percent
of their nursing staff from Canada. A study by the University of
Detroit-Mercy, however, reports that by 2008, Michigan will need 1.4
million registered nurses, but only 656,000 will be available.
The bill before us today seeks to rectify these problems and reverse
their implications. The Nurse Reinvestment Act establishes nurse
scholarships to provide educational scholarships in exchange for
commitment to serve in a public or private non-profit health facility
determined to have a critical shortage of nurses. H.R. 3487 further
establishes nurse retention and patient safety enhancement grants to
assist health care facilities to retain nurses and improve patient care
delivery through more collaboration between nurses and other health
care professionals.
H.R. 3487 establishes comprehensive geriatric training grants for
nurses, it establishes faculty loan cancellation programs to allow
nurses full-time study and rapid completion of advanced degree studies,
and it establishes a career ladder grant program to assist individuals
in the nursing workforce to obtain more education. Finally, the Nurse
Reinvestment Act will help us recruit more nurses through public
service announcements and other educational programs. These will inform
the public about nursing as a profession and career and will tell
potential nurses about the resources available to them if they choose
to enter this wonderful profession.
I salute the efforts of Representative Capps and my other colleagues
that have brought us this far and I urge my colleagues to join me in
support of this bill.
Mr. BROWN of Ohio. Mr. Speaker, I yield back the balance of my time.
Mr. BILIRAKIS. Mr. Speaker, I, too, have no further requests for
time, and I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Grucci). The question is on the motion
offered by the gentleman from Florida (Mr. Bilirakis) that the House
suspend the rules and concur in the Senate amendment to the bill, H.R.
3487.
The question was taken; and (two-thirds having voted in favor
thereof) the rules were suspended and the Senate amendment was
concurred in.
A motion to reconsider was laid on the table.
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