[Congressional Record Volume 148, Number 100 (Monday, July 22, 2002)]
[Senate]
[Pages S7127-S7132]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
NURSE REINVESTMENT ACT
Mr. REID. I ask unanimous consent the Senate proceed to the immediate
consideration of Calendar No. 306, H.R. 3487.
The PRESIDENT pro tempore. The clerk will report the bill by title.
The assistant legislative clerk read as follows:
The bill (H.R. 3487) to amend the Public Health Service Act
with respect to health professions programs regarding the
field of nursing.
There being no objection, the Senate proceeded to consider the bill.
Ms. MIKULSKI. Mr. President, I am proud to rise in support of final
passage of the Nurse Reinvestment Act. This bill addresses the critical
nursing shortage in our country by getting behind the nurses who take
care of us every day. It provides incentives to encourage people to
enter the nursing profession and make it a career. This legislation is
based on the Nurse Reinvestment Act, S. 1864, that I sponsored with
Senators Tim Hutchinson, John Kerry, and Jim Jeffords.
Since the Senate passed the Nurse Reinvestment Act in December of
last year, there is new information showing that the nursing shortage
has become even more severe. In Maryland, almost 16 percent of nursing
jobs are unfilled, up from 3.3 percent in 1997. There are over 2,000
registered nurse vacancies in Maryland hospitals. Since the average age
of a Maryland nurse is 47 years, we face the possibility that the
shortage will soon get worse if young nurses do not enter and stay in
the profession.
The nursing shortage is not unique to Maryland. It is nationwide. In
2001, the average American hospital vacancy rate was 13 percent for
registered nurses. The average age of an American nurse is 44 years,
with many retiring in their fifties or working part time due to the
physical demands of the job. At the same time, the labor force is
shrinking and baby boomers will soon retire and place additional
demands on our health care system.
The nursing shortage can have grave consequences on patient care. A
recent study published in the New England Journal of Medicine found
that nursing shortages in hospitals are associated with a higher risk
of complications and even death. It is our duty to take steps to make
sure our health care system is staffed with enough qualified nurses.
Nurses care for Americans from the cradle to the grave. We depend on
them to care for our parents, our children,
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our siblings and sometimes ourselves. We turn to them in hospitals,
nursing homes, community health centers, hospices, and for home health.
These organizations truly could not exist without nurses.
This bill is a significant step in addressing the nursing shortage.
It helps men and women obtain the education they need to become nurses,
provides training and career ladder programs to help nurses advance in
the profession, and helps ensure that there are enough nursing faculty
to teach more nursing students. Highlights of this bill include:
National Nurse Service Corps To Serve in Areas With Critical Nurse
Shortages:
The bill creates a scholarship program, which provides scholarships
for nursing education in exchange for at least two years of full time
service, or the equivalent amount of part time service, in a facility
with a critical shortage of nurses; and
The bill extends the Loan Repayment Program for nurses: nurses have
their nursing education loans paid back in exchange serving as a nurse
for at least two years in a facility with a critical shortage of
nurses.
Public Service Announcements To Recruit Nurses and Promote Nursing:
The legislation creates State and national public service
announcements to promote nursing, encourage people to enter the nursing
profession, and inform the public of financial assistance for nursing
education programs.
Building Career Ladders and Retaining Quality Nurses:
The bill provides grants to improve nurse education, practice, and
retention including:
Career ladder programs with schools of nursing and health care
facilities to encourage individuals to pursue additional education and
training to enter and advance within the nursing profession, including
certified nurse assistants, CNAs;
Internship and residency programs that encourage mentoring and the
development of specialties;
Retention programs that enhance collaboration among nurses and other
health care professionals and promote nurse involvement in
organizational and clinical decisionmaking.
Geriatric Education To Train Individuals To Care for the Elderly:
The bill creates a program to award grants to train and educate
individuals in providing geriatric care to the elderly.
Financial Help to Recruit Faculty To Teach in Nursing Schools:
The legislation provides loans for graduate-level education in
nursing--cancels up to 85 percent of the loan and interest, in exchange
for teaching at a school of nursing, to help ensure that we have enough
faculty at our nursing schools.
This bill is about nursing education, but it is also about
empowerment. We can empower people to improve their lives and go into a
career that saves lives.
The bill will empower the single mom stuck in a dead end retail job
to get a nursing degree at the local community college to forge a
better life for herself and her family. She can receive a scholarship
that enables her to work around the needs of her family by going to
nursing school either full or part-time. She would also have the
opportunity to receive additional training or assistance in getting her
bachelor's degree in nursing. A mentoring program could help her
advance in her profession and help keep her in the profession. She
could even get a master's degree and teach nursing at her local
community college, while most of her loans for her advanced degree are
cancelled.
This bill also addresses the health care needs of a growing
population in our country: the elderly. This bill provides training for
individuals involved in caring for the elderly by funding schools of
nursing, health care facilities, programs leading to CNA certification,
and partnerships of these to provide education and training in
geriatric care for the elderly. Our population is aging--more than 70
million Americans will be over age 65 by 2030. Their care will be
improved by nurses and other health care professionals who are
specifically trained to care for the unique health needs of older
Americans.
As a senior member of the Appropriations Committee, I will fight for
funding for the Nurse Reinvestment Act. We are putting these important
programs on our law books to address the nursing shortage. We must put
these same priorities in our federal checkbook.
This bill gets behind our Nation's nurses. It will improve patient
care by bringing more nurses to communities across the country. I thank
my colleagues for their support of this important legislation. I also
want to acknowledge and thank Senators Kennedy, Gregg, Hutchinson,
Kerry, Jeffords, Frist, and Clinton for their hard work in moving this
legislation. I ask unanimous consent that the accompanying statement of
managers be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
The following is a statement of congressional intent with
respect to the Nurse Reinvestment Act.
I. funding methodology
During the last reauthorization of Title VIII in 1998,
Congress required the Secretary of Health and Human Services
to determine a funding methodology to be used for fiscal year
2003 and thereafter to determine the appropriate amounts to
be allocated to three important programs within the Nursing
Workforce Development activities--advanced nursing education,
workforce diversity, and nurse education and practice. In
developing this methodology, Congress outlined a series of
factors that should be considered and required a report
describing the new methodology as well as the effects of the
new methodology on the current allocations between those
three important programs.
Given that the new funding methodology was to take effect
in fiscal year 2003, Congress requested that the contract for
the funding methodology be completed by February 1, 2002, and
that the report to Congress regarding that methodology arrive
no later than 30 days after the completion of the development
of the methodology. Although Congress has not yet received
the report, George Mason University has been working on this
contract, and they have described the new funding methodology
on their website. This methodology states that advanced
nursing education should receive 31.5 percent of the funds (a
46 percent decrease from fiscal year 2001 allocations),
workforce diversity should receive 31.5 percent of the funds
(a 25% increase over fiscal year 2001 allocations), and nurse
education and practice should receive 37 percent of the funds
(a 20 percent increase over fiscal year 2001 allocations).
Because Congress expected the funding methodology to be
completed by the beginning of fiscal year 2003, current law
does not state how the funds should be allocated if no
funding methodology was available. Therefore, the discretion
is left to the Secretary. Due to that discretion, it is the
Congress' intent that the Secretary allocate funds in a
manner that would most appropriately address any current or
impending nursing shortage while minimizing disruption and
report such allocations to the appropriate committees of
Congress, along with a justification for those allocations.
Further, given that Congress has requested a new funding
methodology for fiscal year 2003, the Secretary is now
requested to provide an update on the development of that
methodology and the expected timeline for implementation.
ii. authorizations under the nurse reinvestment act
Throughout the bill, the legislation authorizes the
appropriation of such sums as may be necessary to accomplish
the objective of the legislation. It is Congress' belief that
the current nursing shortage is a significant national
problem that has a major negative impact on the delivery of
high-quality health care in the United States. It is
Congress' belief that funds should be appropriated for the
initiatives authorized by this legislation at a lever that is
commensurate with the significance of this problem.
The legislation authorizes the appropriation of such sums
as may be necessary in order to accomplish the objectives of
the legislation to allow flexibility in providing funding to
respond to the ongoing needs of the programs authorized by
the legislation. Although the legislation does not
authorize the appropriation of specific dollar amounts, it
is Congress' belief that the investment of significant new
resources, beyond those already provided under Title VIII
of the Public Health Service Act, will be required in
order to alleviate the current nursing shortage.
iii. loan repayment and scholarships
The Congress intends that nurses fulfilling their service
requirement under the Loan Repayment Program or the
Scholarship Program under section 846 be able to fulfill
their service requirement in a nurse-managed health center
with a critical shortage of nurses.
The Congress further intends that, in determining the
placement of nurses under section 103 of the bill, the Health
Resources and Services Administration is not expected to
follow the placement requirements outlined under the National
Health Service Corps.
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iv. nurse education, practice, and retention grants
A. Intent of Legislation
The legislation adds a number of new programs to section
831, and it is Congress' intent to ensure that these programs
are actually funded and implemented. Therefore, Congress
expects that the Secretary will seek to fund worthy
applications received under the Section 831 authorities that
have been added, while assuring the existing priorities
indicated under section 831 also continue.
Congress anticipates that the use of funds under 831(c)(2)
will directly affect nurses in their workplaces and will be
monitored for demonstrable improvement in the areas of nurse
retention and patient care.
B. Background
In authorizing section 831(c)(2), Congress did so with the
evidence of the efficacy of magnet hospitals in mind. The
concept of magnet hospitals dates back to the country's last
nursing shortage in the 1980's. At the time, nursing
professional organizations and other experts noticed that
despite the nationwide nurse shortage, certain hospitals were
able to successfully attract and retain professional nurses,
behaving as nursing ``magnets.'' A study of these hospitals
showed that they shared a number of characteristics, each of
which contributed to making these ``magnet hospitals''
attractive workplaces for nurses. Many of these attributes
have been mentioned in section 831(c)(2). Currently hospitals
can receive a magnet designation from the American Nurse
Credentialing Center, and extensive research on magnet-
designated facilities shows that nurses in these hospitals
show an average length of employment twice that of nurses in
non-magnet hospitals, and magnet hospital nurses consistently
report greater job satisfaction. Research has demonstrated
that magnet hospitals also show lower mortality rates,
shorter lengths of stay, and higher patient satisfaction.
v. nurse faculty loan program
The purpose of the nurse faculty loan program is to
encourage individuals to pursue a master's or doctoral degree
to teach at a school of nursing in exchange for cancellation
of educational loans to these individuals.
Michael Bilirakis, Lois Capps, Billy J. Tauzin, John D.
Dingell, Richard Burr, Sherrod Brown, Ed Whitfield,
Eliot L. Engel, Robert L. Ehrlich, Henry A. Waxman,
Barbara A. Mikulski, Tim Hutchinson, John F. Kerry,
James M. Jeffords, Judd Gregg, Bill Frist, M.D., Edward
M. Kennedy, Susan M. Collins, Hilliary Rodham Clinton.
Mr. KENNEDY. Mr. President, today the Senate considers long-needed
legislation to address the worsening crisis in nursing care across the
country. We all know the importance of nurses in delivering good health
care. A nurse is often the first person that patients see after waking
in the morning and the last person they see at night. Nurses are the
backbone of an effective health care system--yet the nation now faces a
crisis in nursing due to the shortages of trained nurses. The Nurse
Reinvestment Act we are considering today takes significant steps to
address the shortage by improving nurse training, reducing the barriers
to a nursing education through loan repayment programs and
scholarships, and improving working conditions.
The bill we consider today owes much to the skill and dedication of
many of our colleagues on both sides of the aisle and on both sides of
the Capitol. The legislation contains major provisions to improve nurse
training sponsored by our colleague from Maryland, Senator Mikulski,
who has been tireless in her support for nurses. Her energy and skill
were indispensable in the Senate's approval of this important
legislation earlier this year. She is a champion for nurses, and this
bill is a fitting tribute to her dedication.
The legislation we consider today also owes a great deal to the
commitment of our colleagues, Senator Kerry and Senator Jeffords. In
the legislation they introduced in the Senate last year, they outlined
a vision for a National Nurse Service Corps to serve in areas with a
nursing shortage. This proposal is part of the legislation we are
considering today. The provisions on the National Nurse Service Corps
will provide scholarships and loan repayment agreements for nursing
students who agree to practice nursing in areas with a critical
shortage of nurses. This corps of nurses can be effective in easing the
most critical shortages that exist in so many communities.
The challenge we face is clear. It is becoming increasingly difficult
for hospitals and other health facilities to obtain the nurses they
need to properly care for patients. Today, about 125,000 nurse
positions remain vacant. This shortage will become more severe in the
years ahead as nurses reach retirement and as the demand for nursing
care increases because of the nation's aging population. A major part
of the problem is that nurses often leave the practice of nursing
because of poor working conditions.
Senator Clinton has sponsored important provisions in the bill to
improve working conditions for nurses and improve the retention of
trained nurses. Her proposals will provide effective incentives for
hospitals to involve nurses in clinical decision-making and to improve
communication among nurses and other health professionals. A clear
example of the benefits of these programs is shown by the success of
hospitals designated as ``magnets'' for quality nurses. These leading
institutions provide higher quality patient care because they are
successful in retaining trained nurses. The source of their success is
very clear--they value the professional role of nurses in patient care.
I also commend the distinguished ranking member of our committee,
Senator Gregg, and the distinguished ranking member of our
subcommittee, Senator Frist, as well as many other members of our
committee for their contributions to this legislation. This legislation
will also attract more students to the practice of nursing through
public service announcements, advertisements and outreach programs to
demonstrate the value of a career in nursing to young persons in all
parts of the country.
Nurses have an indispensable role in our health care system. They are
the ones who provide much of the direct care to patients and monitor
how patients are recovering. Studies confirm that nursing care is
critical to improving patient outcomes, and that a shortage of nurses
can hurt patient care.
We cannot have a quality health care system without quality care by
nurses. The legislation the Senate considers today will alleviate the
severe shortage the nation faces in trained nurses. It will improve the
quality of care for millions of patients in communities throughout the
Nation. I thank my colleagues for their dedication to this important
issue, and I urge the Senate to approve this needed legislation.
Mr. KERRY. Mr. President, I am extremely pleased that the Senate is
considering final passage of the Nurse Reinvestment Act, a bill I
originally introduced with my colleague, Senator Jeffords, in April of
2001. I commend the chairman of the Senate Health, Education, Labor and
Pensions Committee, my colleague from Massachusetts, Senator Kennedy,
for his efforts in seeing this legislation through the Senate. In
addition, I wish to recognize the invaluable contributions Senators
Mikulski, Hutchinson, Frist, Gregg and Clinton made to the final
version of the legislation that is before us today. This legislation is
important for nurses and patients, and essential to ensuring that our
health care system can function at its best. Upon passage, the Nurse
Reinvestment Act will increase the number of nurses in our country, and
also ensure that every nurse in the field has the skills he or she
needs to provide the quality care patients deserve. I congratulate all
of my colleagues for their work on this measure and for the
contribution it will inevitably make to the health our nation.
The Nurse Reinvestment Act is long overdue. Our country is facing a
severe nursing workforce shortage. Every type of community--urban,
suburban and rural--is touched by it. No sector of our health care
system is immune to it. Across the country, hospitals, nursing homes,
home health care agencies and hospices are struggling to find nurses to
care for their patients. Patients seeking care have been denied
admission to facilities and told that there were ``no beds'' for them.
Often there are beds, just not the nurses to care for the patients who
would occupy them.
Our nation has suffered from nursing shortages in the past. However,
this shortage is particularly severe because we are losing nurses at
both ends of the pipeline. Over the past five years, enrollment in
entry-level nursing programs has declined by 20 percent. Lured to the
lucrative jobs of the new economy, high school graduates are not
pursuing careers in nursing in the numbers they once had. Consequently,
nurses under the age of 30 represent only 10 percent of the current
workforce. By 2010, 40 percent of the nursing
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workforce will be over the age of 50, and nearing retirement. If these
trends are not reversed, we stand to lose vast numbers of nurses at the
same time that they will be needed to care for the millions of baby
boomers enrolling in Medicare.
The Nurse Reinvestment Act will support the recruitment of new
students into America's nursing programs by funding national and local
public service announcements to enhance the profile of the nursing
profession and encourage students to commit to a career in nursing. In
addition to recruiting new nurses, our legislation will reinvest in
nurses who are already practicing by providing them with education and
training at every step of the career ladder and at every health care
facility in which they work. It will ensure that nurses can obtain
advanced degrees, from a B.S. in Nursing to a PhD in Nursing. It will
place nurses in internships and residencies where they can receive the
specialized clinical training they need to respond to the complex
health care needs of today's patients. Our bill will also help train
nurses in geriatrics to ensure that our health care providers are
prepared to care for the needs of our nation's growing senior
population.
Finally, the Nurse Reinvestment Act will create, for the first time
in history, a National Nurse Service Corps. Like the National Health
Service Corps, the NNSC will administer scholarships to and repay the
loans of students who commit to working in a health care facility that
is experiencing a shortage of nurses. In urban, suburban and rural
communities across the country, where facilities turn away patients due
to staff shortages, the NNSC will send qualified nurses to serve and
provide the care that patients deserve.
Our country boasts the best health care system in the world. But,
that health care system is being jeopardized by the shortage plaguing
our nursing workforce. Indeed, state-of-the-art medical facilities are
no use if their beds go unfilled and their floors remain empty because
the nurses needed to staff them are not available. The Nurse
Reinvestment Act will not only increase the numbers of new nurses in
our country, but also ensure that every nurse has the skills he or she
needs to provide the high quality care that makes our health care
system the best in the world. I urge my colleagues to join me and the
bill's cosponsors in supporting final passage of this important
legislation.
I thank the Chair.
Mr. JEFFORDS. Mr. President, I am especially pleased on this day that
we are considering final passage of a long-awaited Nurse Reinvestment
Act. When we pass this measure, it will represent a good day for the
future of the nursing profession in America and an equally good day for
the future of quality patient care. I want to take this opportunity to
speak about this legislation, and to congratulate and complement my
fellow Members of Congress who worked so hard to see this effort
through. Back in April of 2001, together with my good friend from
Massachusetts, Senator Kerry, I was proud to sponsor the innovative set
of solutions to the nursing shortage set out in our Nurse Reinvestment
Act. Since that time, with extraordinary contributions on behalf of
Senator Hutchinson and Senator Mikulski, as well as the cooperative
spirit of our colleagues in the House, I believe that we have produced
a piece of legislation that we can all be proud of. Today we have
before us a measure that represents a truly bipartisan and bicameral
effort to address a very serious nursing shortage in the United States.
As I have stated before, we are facing a looming crisis in this
country. The size of our nursing workforce remains stagnant, while the
average age of the American nurse is on the rise. Over the past 5
years, enrollment in entry-level nursing programs has declined by 20
percent. Nurses under the age of 30 represent only 10 percent of the
current workforce. By 2010, 40 percent of the nursing workforce will be
over the age of 50, and nearing retirement. In Vermont, we are facing
an even greater crisis. Only 28 percent of nurses are under the age of
40 and Vermont schools and colleges are producing 31 percent fewer
nurses today than they did just 5 years ago.
We have a compelling need to encourage more Americans to enter the
nursing profession and to strengthen it so that more nurses choose to
stay in the profession. All facets of the health care system will have
a role to play in ensuring a strong nursing workforce. Nurses,
physicians, hospitals, nursing homes, academia, community organizations
and State and Federal Governments all must accept responsibility and
work towards a solution. Part of the responsibility to launch that
effort begins with us today as we vote affirmatively for this
legislation.
The Nurse Reinvestment Act expands and improves the Federal
Government's support of ``pipeline'' programs, which will maintain a
strong talent pool and develop a nursing workforce that can address the
increasingly diverse needs of America's population. The Nurse
Reinvestment Act provides for a comprehensive public awareness and
education campaign on a national, State and local level. The campaign
will help to bolster the image of the profession and highlight the
advantages and rewards of nursing, attract more nurses to the
workforce, and lead current nurses to take advantage of career
development opportunities.
This legislation creates a National Nursing Service Corps Scholarship
Program that will provide scholarships to individuals to attend schools
of nursing in exchange for a commitment to serve 2 years in a health
care facility determined to have a critical shortage of nurses. This
scholarship program is designed to recruit both full-time and part-time
nursing students, and to complement the existing loan repayment
program.
The Nurse Reinvestment Act also provides for nurse education,
practice, and retention grants. Specifically, the grants will be
focused on internship and residency programs that encourage mentoring,
development of specialties, and increased education in the area of new
technologies like distance learning. It provides for career ladder
grants to promote advancement for nursing personnel, including
professional nurses, advanced education nurses, licensed practical
nurses, certified nurse assistants, and home health aides. In addition,
these grants aim to improve retention by enhancing collaboration among
nurses and other health care professionals and by promoting nurse
involvement in organizational and clinical decision-making.
The legislation before us today goes even further by emphasizing
preparation for the aging baby boomer population. With this
legislation, we create a new program that provides for grants to train
and educate individuals in providing geriatric care for the elderly. We
also create a nurse faculty loan program in order to ensure that we
have enough faculty to teach the nurses that we will so direly need in
the years to come. The faculty loan program will allow for up to 85
percent loan cancellation for students in advanced degree programs who
agree to serve as a faculty member at a school of nursing.
Once again, I want to applaud my colleagues Senator Kerry, Senator
Mikulski and Senator Hutchinson for their tireless work on the Nurse
Reinvestment Act and for the work of their staffs. In particular, I
want to recognize the efforts of Kelly Bovio in Senator Kerry's office,
Kate Hull in Senator Hutchinson's office and Rhonda Richards with
Senator Mikulski. This effort was also advanced with the help of Sarah
Bianchi, Jackie Gran, Brian Hickey, and David Bowen who are members of
Senator Kennedy's staff, Christina Ho of Senator Clinton's staff, Steve
Irizarry with Senator Gregg and Shana Christrup with Senator Frist.
Finally, in my own office, I want to note the efforts of Philo Hall,
Angela Mattie, Eric Silva and Sean Donohue for their work throughout
this process.
Adequate health care services cannot survive any further diminishing
of the nursing workforce. Today, we are taking a positive step forward
to address the problem before us. I urge my colleagues to join me and
the bill's cosponsors in support of this measure, and I trust that this
Nurse Reinvestment Act will be given top priority when it comes time to
adequately fund the programs set out in it.
Thank you, Mr. President.
Mr. HUTCHINSON. Mr. President, today is a day of great significance
and a turning point for the future of nursing in our country. We are
about to
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pass the final version of the Nurse Reinvestment Act, after months of
negotiations between the House of Representatives and the Senate.
Eighteen months ago, I held the first hearings in the Senate examining
the severity of the nursing shortage and its impact on our health care
delivery system. I subsequently worked with Senator Mikulski to
introduce S. 721, the Nurse Education and Employment Development Act,
which served as a basis for the legislation the Senate is about to pass
today.
Nurses are the foundation of our Nation's health care system. Our
nation has one of the best health care systems in the world the quality
of health care that we have come to expect is a direct result of the
hard work and commitment of nurses. However, the profession as a whole
is shrinking. Nurses and nurse faculty are retiring or leaving the
profession, perhaps for a better paying job, and fewer new nurses are
there to replace them. According to recent surveys, working nurses are
on average 45 years old. Less than 10 percent of the nurse workforce is
under age 30, and just about 5 percent of the workforce consists of
men.
The Bureau of Labor Statistics predicts that over 560,000 new nursing
jobs will be created in the next decade due to continued demand for
health care services and the retirement of the Baby Boomers. During
this same time period, over 440,000 nursing jobs will open due to
nurses retiring from the profession. Despite this incredible need,
overall enrollments in Registered Nurse programs reached a high of
nearly 270,000 in 1993, and have declined by over 50,000 by 1999. In
Arkansas, nursing enrollments have declined by over 40 percent over the
last decade. Unless this trend is reversed by encouraging more people
to enter the field of nursing and developing a diverse workforce,
studies indicate that by the year 2020, 20 percent of nursing needs
will go unmet.
The provisions of the Nurse Reinvestment Act, all of which reflect
those contained in the original legislation introduced by Senator
Mikulski and myself, aim to attract and retain more nurses and to
ensure quality care.
First, the legislation establishes a National Nurse Service Corps,
which consists of scholarships and expanded loan repayments for nurses
who agree to serve for at least two years in a health care facility
with a critical shortage of nurses. Hospitals, nursing homes, home
health agencies, and health centers are all experiencing shortages of
qualified health care personnel. Up to 168,000 hospital positions are
unfilled today, and 75 percent, or 126,000, of those vacancies are
Registered Nurse positions. Of the 106,982 direct care nursing
positions now vacant in nursing homes, 16,196 are Registered Nurse
jobs. The goal of the National Nurse Service Corps is to inspire
individuals to obtain nursing education at all levels and to fill the
need.
Compassion, intellect and courage are all terms that come to mind
when I think of the nursing profession. Unfortunately, negative
stereotypes, that nursing is only for women, or that nursing just
involves changing bedpans, have invaded our culture. The Nurse
Reinvestment Act provides for a national awareness campaign, through
public service announcements, to show all Americans, men, women, and
young children, how rewarding and noble a career in nursing can be and
about opportunities for assistance in obtaining a nursing education.
In the areas of training and recruitment, the Nurse Reinvestment Act
compromise retains the Senate provision relating to geriatric training
for nurses, a critical provision in light of the growing number of
older patients with complex medical histories and multiple chronic
conditions. Provisions to encourage mentoring and specialty training
through internships and residencies, career ladder programs to
encourage nursing professionals of all levels to seek further education
and professional development, and grants for nurse retention
activities, all have been incorporated into the existing structure of
Title VIII in the Public Health Service Act.
With all of the new measures in the Nurse Reinvestment Act to recruit
and train nurses, it is essential to have adequate nurse faculty to
teach these students. The shortage of nurse faculty is especially
evident in my home state of Arkansas and the surrounding southern
region. In 1999, 153 eligible nursing students in Arkansas were turned
away because of inadequate faculty to teach them. Eighty-six schools of
nursing in the southern region have reported insufficient faculty.
Compounding this problem is the increasing number of nurse faculty
retirements. In the 2000, 2001 academic year, 144 nurse educators
retired in the southern region alone, 784 more nurse educators are
expected to retire in this region between 2002 and 2006.
Our schools of nursing must have the capacity to teach new nurses in
order to overcome the nursing shortage. I am therefore extremely
pleased that the Nurse Reinvestment Act final compromise includes a
modified nurse faculty development provision which provides loans to
nurses pursuing their masters and doctoral degrees and provides for
loan cancellation up to 85 percent upon service as a nurse educator at
a school of nursing.
In all, the Nurse Reinvestment Act is a solid step forward in
addressing the nursing shortage in our country. I urge my colleagues to
support this legislation, so we can send it to President Bush for
signature.
Mr. FRIST. Mr. President, I rise today to applaud the passage of the
``Nurse Reinvestment Act''--the culmination of work to directly address
the nursing shortage. This bill, which has combined portions of S.
726--the ``Nursing Employment and Education Development, NEED, Act''
and S. 706--the ``Nurse Reinvestment Act'' outlines a comprehensive
approach to the nursing shortage by focusing on recruitment, education
and retention of nurses. I want to thank Senators Hutchinson, Kerry,
Jeffords, and Mikulski for their leadership in this issue.
This crucial legislation provides for public service announcements at
both the State and Federal level to educate the public about the
advantages and rewards of nursing. Additionally, this important
legislation assists us with training future nurses and future nursing
needs by establishing a focus on geriatric nursing, establishing a
faculty loan program, and focusing on nursing mobility through the
development of career ladders. Finally, this bill focus as new
resources on retaining nurses to the profession by establishing a
National Nurse Service Corps and by increasing the emphasis on
retention within basic nurse education grants.
We are in the midst of a nursing shortage. Not only are fewer people
entering and staying in the nursing profession, but we are losing
experienced nurses at a time of growing need. Today, nurses are needed
in a greater number of settings, such as nursing homes, extended care
facilities, community and public health centers, professional
education, and ambulatory care centers. Nationwide, health care
providers, ranging from hospitals and nursing homes to home health
agencies and public health departments, are struggling to find
qualified nurses to provide safe, efficient, quality care for their
patients.
Though we have faced nursing shortages in the past, this looming
shortage is particularly troublesome because it reflects two trends
that are occurring simultaneously: (1) a shortage of people entering
the profession and (2) the retirement of nurses who have been working
in the profession for many years. Over the past 5 years, enrollment in
entry-level nursing programs has declined by 20 percent, mirroring the
declining awareness of the nursing profession among high school
graduates. Consequently, nurses under the age of 30 represent only 10%
of the current workforce. By 2010, 40 percent of the nursing workforce
will be older than 50 and nearing retirement. If these trends are not
reversed, we stand to lose vast numbers of nurses at the very time they
will be needed to care for the millions of baby boomers reaching
retirement age. Therefore, we need to focus on both recruitment to and
retention within the nursing profession.
Further, greater efforts must be made to recruit more men and
minorities to this noble profession. Currently, only 10 percent of the
registered nurses in the United States are from racial or ethnic
minority backgrounds, even though these individuals comprise 28 percent
of the total United States population. In 2000, only 5.9 percent of the
registered nurses were men. We must
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work to promote diversity in the workforce, not only to increase the
number of individuals within the profession, but also to promote
culturally competent and relevant care.
Even if nursing schools could recruit more students to deal with the
shortage, many schools could not accommodate higher enrollments because
of faculty shortages. There are nearly 400 faculty vacancies at nursing
schools in this country. And, an even greater faculty shortage looms in
the next 10-15 years as many current nursing faculty approach
retirement and fewer nursing students pursue academic careers.
Therefore, the faculty develop piece within this legislation is crucial
to dealing with this shortage.
Further, in examining any nursing shortage, we must recognize the
potential effects of this looming shortage on patient outcomes. A
recent study by Jack Needleman, Peter Buerhaus, and others, found a
direct link between nurse staffing levels and five inpatient outcomes--
urinary tract infections, pneumonia, length of stay, upper
gastrointestinal bleeding, and shock. To provide an appropriate
emphasis on patient outcomes, we have increased the emphasis on
examining patient outcomes within this legislation.
Additionally, shortages of nurse aides parallel the trends seen in
relationship to nurses. Nurse aides are primarily employed in nursing
home settings, and some studies have suggested that the average
turnover rate for nurse aides is 100 percent. This high turnover rate
directly affects both health care costs and patient care quality.
Provider costs related to high turnover include recruitment, selection,
and training of new staff; use of temporary staff; overtime for current
staff; initial reduction of efficiency of new staff; and decrease in
nurse aide moral and group productivity. A recent report from the
Centers for Medicare and Medicaid Services found a direct relationship
between nurse aid staffing levels and quality of resident care. To
ensure the appropriate emphasis on nurse aides, we ensured that, where
feasible, these facilities and providers were covered within the bill.
It has been an honor and a pleasure to work closely with my
distinguished colleagues in both the House and Senate, and I look
forward to continuing to working with them as we advocate for funding
for these particular provisions and ensure that they are appropriately
implemented.
Mrs. CLINTON. Mr. President, I am proud that the House and the Senate
have worked out the differences between the two versions of the Nurse
Reinvestment Act that we passed last year. I am also proud that today,
the Senate will pass this agreed-upon legislation with unanimous
support, and I look forward to subsequent action by the House so that
this bill can be swiftly signed into law. I thank Senators Mikulski,
Hutchinson, Kerry, Jeffords, and Kennedy for their leadership. Many on
the House side have also worked hard on this legislation, including
Representatives Bilirakis, Capps, and others.
We have all heard a great deal about the workforce shortage from
nurses in New York and across the Nation. Around the country, nurses
are facing an emergency of their own.
The number of undergraduate nursing program graduates in New York
State has dropped each academic year since 1996, and this pattern is
evident everywhere.
The Nurse Reinvestment Act we are passing today contains
scholarships, public service announcements, and other provisions to
encourage people to enter the profession, as well as nurse faculty
provisions too, so that colleges of nursing have the personnel equipped
to help train new nurses entering the pipeline.
But the current nursing shortage problem exists not only because
fewer individuals are entering the nursing profession, but also because
the healthcare industry is having trouble retaining the nurses already
on staff. Fifty percent of nurses say that they have recently
considered leaving their jobs for reasons other than retirement, and
approximately half a million licenses nurses are not currently
practicing nursing. Many of the nurses who have considered leaving the
profession cite their low level of overall job satisfaction.
But there are some health care facilities that are taking action and
having an effect on retention and nurse satisfaction.
During the last nursing shortage, researchers found some hospitals
experienced low turnover and low vacancies. They found these hospitals
shared certain characteristics. They were structured along
participatory, collaborative, and patient-centered lines and, as a
result, act as ``magnets'' that attract and retain nurses.
The American Nurse Credentialing Center developed a credentialing
program to designate facilities as magnet facilities if they met
certain criteria. And over the years, these magnet facilities have
continued to demonstrate results. The average length of employment for
registered nurses in magnet hospitals is 8.35 years, which is twice the
length of employment in hospitals generally, and magnet hospital nurses
consistently report greater job satisfaction, fewer needlestick
injuries, and lower burnout rates than other nurses.
But the beneficiaries of this legislation are not just hospitals and
nurses, but patients as well. Magnet hospitals report lower mortality
rates, higher patient satisfaction, and greater cost-efficiency, with
patients experiencing shorter stays in hospitals and intensive care
units.
That is why last year I introduced the bipartisan Nurse Retention and
Quality Care Act with my colleague, Senator Gordon Smith of Oregon, to
provides grants to health care organizations to implement these magnet
hospital principles that improve nurse retention.
The Nurse Reinvestment Act, which we are passing today, adds for the
first time some recognition of the importance of retention in
addressing nursing issues, as well, and specifically mentions the
magnet principles of collaboration, nurse involvement in
decisionmaking, and orientation toward patient outcomes. I look forward
to action by the House and the President to assure that this bill
becomes law.
On September 11, and since, our nurses have been on the front lines
of the battle against terrorism and bioterrorism. Today, they continue
to defend America. I am pleased to be celebrating our work together to
help hospitals, nurses, and patients, through this bill, which we will
work together to fund.
Mr. REID. Senators Mikulski, Hutchinson of Arkansas, and others have
a substitute amendment at the desk, and I ask that the amendment be
considered and agreed to; the motion to reconsider be laid upon the
table; the bill, as amended, be read the third time and passed; the
motion to reconsider be laid upon the table; and that any statements be
printed in the Record, with no intervening action or debate.
The PRESIDENT pro tempore. Without objection, it is so ordered.
The amendment (No. 4312) was agreed to.
(The amendment is printed in today's Record under ``Text of
Amendments.'')
The bill (H.R. 3487), as amended, was read the third time and passed.
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