[Congressional Record Volume 152, Number 86 (Wednesday, June 28, 2006)]
[Senate]
[Pages S6635-S6637]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself and Ms. Mikulski):
  S. 3588. A bill to amend the Public Health Service Act to authorize 
capitation grants to increase the number of nursing faculty and 
students, and for other purposes; to the Committee on Health, 
Education, Labor, and Pensions.
  Mr. DURBIN. Mr. President, I would request the Chair to inform me 
when I have used 6 minutes of the 10 minutes I have requested.
  We have a lot of bipartisan battles in the Senate. I am going to try 
to bring an issue to the consideration of the Senate and to their 
attention which I believe is very bipartisan. It affects the State of 
Alaska, the State of North Dakota, the State of Illinois, and the State 
of Maine. It affects us all. What I am speaking to is the shortage of 
nurses in America.
  We face a critical shortage of nurses. The U.S. Department of Health 
and Human Services looked at all of the licensed nurses and found that 
in the year 2000, this country was 110,000 nurses short of what was 
necessary to provide adequate health care. By 2005, the shortage had 
doubled to 219,000 nurses. By 2020, we will be more than 1 million 
nurses short of what is necessary to maintain quality health care in 
America.
  To avoid this shortage which the Department of Health and Human 
Services projects, we have to substantially increase the number of 
nursing graduates and those entering the workforce each year. Just to 
replace the nurses who are retiring, we need to increase student 
enrollment by at least 40 percent. The baseline supply for nurses--as 
you can see on this chart--in our country, for the current time and 
through the year 2020, is on a steady downward flow, whereas demand 
goes up dramatically. If we had 90 percent more nursing graduates, we 
still would not reach the projected demand in America as baby boomers 
reach the point where they need help and many others need quality 
nursing.
  The problem is that there are not enough teachers at schools of 
nursing. That is what it comes down to. Last year, nursing schools 
across America denied admission to 35,000 qualified students because 
there just weren't enough teachers.
  In my home State of Illinois, schools of nursing are denying 
qualified students admittance because of the shortage of teachers. This 
is an indication

[[Page S6636]]

here. These are B.A. and graduate nursing programs in Illinois. These 
are the enrollees and these are the numbers turned away. As you can 
see, from the year 2002 to the present time, we are up to 2000 
potential nursing graduates who are turned away each year despite their 
qualifications because, sadly, we can't keep up with teaching them.
  The American Association of Colleges of Nursing surveyed more than 
400 schools of nursing this last year. Two-thirds of the schools, 
represented by the blue part of this pie chart--69 percent reported 
vacancies on their faculty. An additional 15 percent said that they 
were fully staffed but still needed more faculty.
  Statistics paint a bleak picture for the availability of nursing 
faculty now and into the future. Take a look at the age of full-time 
nursing faculty across America. Unfortunately, that reflects an older 
population now teaching in our nursing schools, soon to retire. The 
median age of a doctoral-prepared nursing faculty member in America is 
52. The average age of retirement for faculty is 62. It is expected 
that 200 to 300 doctorally prepared faculty will be eligible for 
retirement each year from 2005 to 2012, reducing even more the faculty 
available to train the nurses we need.
  We think help should be on the way, and it should start in the 
Senate. Our leader on the Democratic side of the aisle is Senator 
Barbara Mikulski of Maryland. She has been the strong voice for nurses 
as long as she has served in the Senate. I am happy today to join her 
in introducing the Nurse Education Expansion and Development Act. The 
Act would provide schools of nursing with grants to hire and retain new 
faculty, purchase educational equipment, enhance clinical laboratories 
and expand and repair infrastructure. This bill would also require the 
Government Accountability Office, the GAO, to report on ways to 
increase participation in the nurse faculty profession.
  Nurses care for our kids, our grandkids, our parents--people whom we 
love. We know the difference they make in everyone's life and 
increasingly we are noticing the difference when we do not have enough 
nurses, these dedicated men and women, when we need them the most. We 
must take deliberate action now to solve this critical health care 
problem. I urge all my colleagues on both sides of the aisle to support 
this Mikulski-Durbin legislation. I think this is an important step in 
the direction toward quality health care for generations to come.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 3588

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Nurse Education, Expansion, 
     and Development Act of 2006''.

     SEC. 2. FINDINGS.

       The Congress finds as follows:
       (1) While the Nurse Reinvestment Act (Public Law 107-205) 
     helped to increase applications to schools of nursing by 175 
     percent, schools of nursing have been unable to accommodate 
     the influx of interested students because they have an 
     insufficient number of nurse educators. It is estimated 
     that--
       (A) in the 2005-2006 school year--
       (i) 66 percent of schools of nursing had both 1 to 16 
     vacant faculty positions and needed additional faculty; and
       (ii) an additional 15.7 percent of schools of nursing 
     needed additional faculty, but lacked the resources needed to 
     add more positions; and
       (B) 41,683 eligible candidates were denied admission to 
     schools of nursing in 2005, primarily due to an insufficient 
     number of faculty members.
       (2) A growing number of nurses with doctoral degrees are 
     choosing careers outside of education. Over the last few 
     years, there has been a 12 percent increase in doctoral 
     nursing graduates seeking employment outside the education 
     profession.
       (3) The average age of nurse faculty at retirement is 62.5 
     years. With the average age of doctorally-prepared professors 
     currently at 57.5 years, a wave of retirements is expected 
     within the next 10 years.
       (4) Master's and doctoral programs in nursing are not 
     producing a large enough pool of potential nurse educators to 
     meet the projected demand for nurses over the next 10 years. 
     While graduations from master's and doctoral programs in 
     nursing rose by 10.5 percent and 1.5 percent, respectively, 
     in the 2005-2006 school year, projections still demonstrate a 
     shortage of nurse faculty. Given current trends, there will 
     be at least 2,616 unfilled faculty positions in 2012.
       (5) According to the November 2005 Monthly Labor Review 
     from the Bureau of Labor Statistics, more than 1,200,000 new 
     and replacement nurses will be needed by 2014.

     SEC. 3. CAPITATION GRANTS TO INCREASE THE NUMBER OF NURSING 
                   FACULTY AND STUDENTS.

       (a) Grants.--Part D of title VIII of the Public Health 
     Service Act (42 U.S.C. 296p) is amended by adding at the end 
     the following:

     ``SEC. 832. CAPITATION GRANTS.

       ``(a) In General.--For the purpose described in subsection 
     (b), the Secretary, acting through the Health Resources and 
     Services Administration, shall award a grant each fiscal year 
     in an amount determined in accordance with subsection (c) to 
     each eligible school of nursing that submits an application 
     in accordance with this section.
       ``(b) Purpose.--A funding agreement for a grant under this 
     section is that the eligible school of nursing involved will 
     expend the grant to increase the number of nursing faculty 
     and students at the school, including by hiring new faculty, 
     retaining current faculty, purchasing educational equipment 
     and audiovisual laboratories, enhancing clinical 
     laboratories, repairing and expanding infrastructure, or 
     recruiting students.
       ``(c) Grant Computation.--
       ``(1) Amount per student.--Subject to paragraph (2), the 
     amount of a grant to an eligible school of nursing under this 
     section for a fiscal year shall be the total of the 
     following, as determined by the Secretary:
       ``(A) Not to exceed $1,800 for each full-time or part-time 
     student who is enrolled at the school in a graduate program 
     in nursing that--
       ``(i) leads to a master's degree, a doctoral degree, or an 
     equivalent degree; and
       ``(ii) prepares individuals to serve as faculty through 
     additional course work in education and ensuring competency 
     in an advanced practice area.
       ``(B) Not to exceed $1,405 for each full-time or part-time 
     student who--
       ``(i) is enrolled at the school in a program in nursing 
     leading to a bachelor of science degree, a bachelor of 
     nursing degree, a graduate degree in nursing if such program 
     does not meet the requirements of subparagraph (A), or an 
     equivalent degree; and
       ``(ii) has not more than 3 years of academic credits 
     remaining in the program.
       ``(C) Not to exceed $966 for each full-time or part-time 
     student who is enrolled at the school in a program in nursing 
     leading to an associate degree in nursing or an equivalent 
     degree.
       ``(2) Limitation.--In calculating the amount of a grant to 
     a school under paragraph (1), the Secretary may not make a 
     payment with respect to a particular student--
       ``(A) for more than 2 fiscal years in the case of a student 
     described in paragraph (1)(A) who is enrolled in a graduate 
     program in nursing leading to a master's degree or an 
     equivalent degree;
       ``(B) for more than 4 fiscal years in the case of a student 
     described in paragraph (1)(A) who is enrolled in a graduate 
     program in nursing leading to a doctoral degree or an 
     equivalent degree;
       ``(C) for more than 3 fiscal years in the case of a student 
     described in paragraph (1)(B); or
       ``(D) for more than 2 fiscal years in the case of a student 
     described in paragraph (1)(C).
       ``(d) Eligibility.--For purposes of this section, the term 
     `eligible school of nursing' means a school of nursing that--
       ``(1) is accredited by a nursing accrediting agency 
     recognized by the Secretary of Education;
       ``(2) has a passage rate on the National Council Licensure 
     Examination for Registered Nurses of not less than 80 percent 
     for each of the 3 school years preceding submission of the 
     grant application; and
       ``(3) has a graduation rate (based on the number of 
     students in a class who graduate relative to, for a 
     baccalaureate program, the number of students who were 
     enrolled in the class at the beginning of junior year or, for 
     an associate degree program, the number of students who were 
     enrolled in the class at the end of the first year) of not 
     less than 80 percent for each of the 3 school years preceding 
     submission of the grant application.
       ``(e) Requirements.--The Secretary may award a grant under 
     this section to an eligible school of nursing only if the 
     school gives assurances satisfactory to the Secretary that, 
     for each school year for which the grant is awarded, the 
     school will comply with the following:
       ``(1) The school will maintain a passage rate on the 
     National Council Licensure Examination for Registered Nurses 
     of not less than 80 percent.
       ``(2) The school will maintain a graduation rate (as 
     described in subsection (d)(3)) of not less than 80 percent.
       ``(3)(A) Subject to subparagraphs (B) and (C), the first-
     year enrollment of full-time nursing students in the school 
     will exceed such enrollment for the preceding school year by 
     5 percent or 5 students, whichever is greater.
       ``(B) Subparagraph (A) does not apply to the first school 
     year for which a school receives a grant under this section.
       ``(4) Not later than 1 year after receipt of the grant, the 
     school will formulate and implement a plan to accomplish at 
     least 2 of the following:

[[Page S6637]]

       ``(A) Establishing or significantly expanding an 
     accelerated baccalaureate degree nursing program designed to 
     graduate new nurses in 12 to 18 months.
       ``(B) Establishing cooperative intradisciplinary education 
     among schools of nursing with a view toward shared use of 
     technological resources, including information technology.
       ``(C) Establishing cooperative interdisciplinary training 
     between schools of nursing and schools of allied health, 
     medicine, dentistry, osteopathy, optometry, podiatry, 
     pharmacy, public health, or veterinary medicine, including 
     training for the use of the interdisciplinary team approach 
     to the delivery of health services.
       ``(D) Integrating core competencies on evidence-based 
     practice, quality improvements, and patient-centered care.
       ``(E) Increasing admissions, enrollment, and retention of 
     qualified individuals who are financially disadvantaged.
       ``(F) Increasing enrollment of minority and diverse student 
     populations.
       ``(G) Increasing enrollment of new graduate baccalaureate 
     nursing students in graduate programs that educate nurse 
     faculty members.
       ``(H) Developing post-baccalaureate residency programs to 
     prepare nurses for practice in specialty areas where nursing 
     shortages are most severe.
       ``(I) Increasing integration of geriatric content into the 
     core curriculum.
       ``(J) Partnering with economically disadvantaged 
     communities to provide nursing education.
       ``(K) Expanding the ability of nurse managed health centers 
     to provide clinical education training sites to nursing 
     students.
       ``(5) The school will submit an annual report to the 
     Secretary that includes updated information on the school 
     with respect to student enrollment, student retention, 
     graduation rates, passage rates on the National Council 
     Licensure Examination for Registered Nurses, the number of 
     graduates employed as nursing faculty or nursing care 
     providers within 12 months of graduation, and the number of 
     students who are accepted into graduate programs for further 
     nursing education.
       ``(6) The school will allow the Secretary to make on-site 
     inspections, and will comply with the Secretary's requests 
     for information, to determine the extent to which the school 
     is complying with the requirements of this section.
       ``(f) Reports to Congress.--The Secretary shall evaluate 
     the results of grants under this section and submit to the 
     Congress--
       ``(1) not later than 18 months after the date of the 
     enactment of this section, an interim report on such results; 
     and
       ``(2) not later than the end of fiscal year 2009, a final 
     report on such results.
       ``(g) Application.--To seek a grant under this section, a 
     school nursing shall submit an application to the Secretary 
     at such time, in such manner, and containing such information 
     and assurances as the Secretary may require.
       ``(h) Authorization of Appropriations.--
       ``(1) In general.--For the costs of carrying out this 
     section (except the costs described in paragraph (2)), there 
     are authorized to be appropriated $75,000,000 for fiscal year 
     2007, $85,000,000 for fiscal year 2008, and $95,000,000 for 
     fiscal year 2009.
       ``(2) Administrative costs.--For the costs of administering 
     this section, including the costs of evaluating the results 
     of grants and submitting reports to the Congress, there are 
     authorized to be appropriated such sums as may be necessary 
     for each of fiscal years 2007, 2008, and 2009.''.
       (b) GAO Study.--
       (1) In general.--Not later than 1 year after the date of 
     the enactment of this Act, the Comptroller General of the 
     United States shall conduct a study and submit a report to 
     the Congress on ways to increase participation in the nurse 
     faculty profession.
       (2) Contents of report.--The report required by paragraph 
     (1) shall include the following:
       (A) A discussion of the master's degree and doctoral degree 
     programs that are successful in placing graduates as faculty 
     in schools of nursing.
       (B) An examination of compensation disparities throughout 
     the nursing profession and compensation disparities between 
     higher education instructional faculty generally and higher 
     education instructional nursing faculty.
                                 ______