[Congressional Record Volume 148, Number 103 (Thursday, July 25, 2002)]
[Extensions of Remarks]
[Pages E1378-E1379]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         NURSE REINVESTMENT ACT

                                 ______
                                 

                               speech of

                         HON. MICHAEL BILIRAKIS

                               of florida

                    in the house of representatives

                         Monday, July 22, 2002

  Mr. BILIRAKIS. Mr. Speaker, as the sponsor or H.R. 3487, 1 would like 
to revise and extend my remarks in support of passage of H.R. 3487, and 
I would like to note that this intent language is supported by all the 
members involved in reaching agreement on the final bill which passed 
the House and Senate on July 22, 2002. These members include myself, 
Senator Barbara A. Mikulski, Congresswoman Lois Capps, Senator Tim 
Hutchinson, Congressman W.J. ``Billy'' Tauzin, Senator John F. Kerry, 
Congressman John D. Dingell, Senator James M. Jeffords, Congressman 
Richard Burr, Senator Judd Gregg, Congressman Sherrod Brown, Senator 
Bill Frist, M.D., Congressman Ed Whitfield, Senator Edward M. Kennedy, 
Congressman Eliot Engel, Senator Susan Collins, Congressman Robert L. 
Ehrlich, Senator Hillary Rodham Clinton, and Congressman Henry Waxman.


                         1. 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 appropriate 
funding methodology on their website. This methodology states that 
advanced nursing education should receive 31.5% of the funds (a 46% 
decrease from fiscal year 2001 allocations), workforce diversity should 
receive 31.5% of the funds (a 25% increase over fiscal year 2001 
allocations), and nurse education and practice should receive 37% of 
the funds (a 20% 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 objectives of the 
legislation. It is the 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 the Congress' belief that funds should be appropriated 
for the initiatives authorized by this legislation at a level that is 
commensurate with the significance of this problem.
  The legislation authorizes the appropriations 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 
the 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

[[Page E1379]]

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.


                       IV. Basic Nurse Education

                        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 that 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 Development

  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.

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