[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

[[Page S7131]]

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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