[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.
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