[Congressional Record Volume 155, Number 34 (Thursday, February 26, 2009)]
[Senate]
[Pages S2567-S2569]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN:
  S. 497. 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. As we prepare to tackle the many challenges of our health 
care system, let's take the time to make sure that nursing schools are 
in a position to teach and train a new generation of nurses and nurse 
educators. Today, I am introducing the Nurse Education, Expansion, and 
Development (NEED) Act to provide schools of nursing with grants for 
faculty, equipment, and clinical laboratories. The proposed grants give 
colleges of nursing the flexibility to use federal funds to address the 
very problems that keep nursing schools from hiring more teachers 
today.
  The healthcare crisis is complicated and the challenges are immense, 
but the runaway costs and inefficiencies in our health care system are 
no longer sustainable. So as we begin to look at healthcare reform in 
this Congress, let's keep in mind one lesson we learned from 
Massachusetts' recent experience. After a landmark healthcare reform 
law to extend healthcare coverage to every person in the State, the 
sudden demand for primary care professionals outpaced the supply.
  Nurses can help fill that primary care gap. Today, nurse 
practitioners are already taking over at the helm of primary care in 
many areas that don't have any primary care physicians. Nurses are 
staffing health care clinics, and many are opening their own practices. 
Increased standards of training have opened new doors for nurses who 
want to further their careers but do not want to attend medical school. 
The numbers tell the story. In 2000 there were roughly 90,000 nurse 
practitioners in the U.S. By 2015, it is estimated there will be as 
many as 135,000.
  Unfortunately, the number of nurses is not keeping pace with the 
growing health care needs of our Nation. In 2000, the U.S. Department 
of Health and Human Services found that the U.S. is 110,000 short of 
the number of nurses we need. By 2005, the shortage had doubled to 
219,000. By 2020, it is expected we will be more than 1 million nurses 
short of the need.
  Contributing to this shortage is a lack of faculty to teach and train 
future nurses. In a survey of more than 400 schools of nursing last 
year, the American Association of Colleges of Nursing found that 63 
percent of the schools reported vacancies on their faculty. An 
additional 17.8 percent said

[[Page S2568]]

they were fully staffed, but still needed more faculty to handle the 
number of students who want to be trained. Last year, nursing colleges 
across the Nation denied admission to 49,948 qualified applicants 
because there were not enough faculty members to teach the students.
  Statistics paint a bleak picture for the availability of nursing 
faculty now and into the future. The median age of a doctorally 
prepared nursing faculty member is 56 years old. The average age of 
retirement for faculty at schools of nursing is 65 years. It is 
expected that 200 to 300 doctorally prepared faculty will be eligible 
for retirement each year from 2005 through 2012, reducing faculty even 
though more than 1 million replacement nurses will be needed.
  The number of qualified students turned away from nursing schools in 
Illinois reflects the national trend and continues to grow. In 2002-
2003, 502 qualified students were rejected from Illinois nursing 
schools. In 2008, 2,523 students were turned away because of lack of 
faculty and resources--over 1600 more students than in 2007. To avoid 
the vast shortage HHS is projecting, we have to figure out how to make 
a significant increase that we can sustain in the number of nurses 
graduating and entering the workforce each year.
  My hope is that the bill I am introducing today can be part of the 
answer. Nursing schools need the resources to teach and train a new 
generation of nurses and nurse educators. Let's not take on health care 
reform without considering the more than 2.9 million nurses in our 
country today who are critical to our health care system. And as we 
look at improving our health care system, let's start by investing in 
the nursing pipeline today for the health care needs of tomorrow.
  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. 497

       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 2009''.

     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 125 
     percent, schools of nursing have been unable to accommodate 
     the influx of interested students because they have an 
     insufficient number of nurse educators. The American 
     Association of Colleges of Nursing estimates that--
       (A) in the 2008-2009 school year--
       (i) 62.8 percent of schools of nursing had from 1 to 16 
     vacant faculty positions; and
       (ii) an additional 17.8 percent of schools of nursing 
     needed additional faculty, but lacked the resources needed to 
     add more positions; and
       (B) 49,948 eligible candidates were denied admission to 
     schools of nursing in 2008, 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, 20.7 percent of doctoral nursing graduates reported 
     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 nurse 
     faculty at 55.6 years in 2007, 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 12.8 percent (or 1,918 graduates) and 4.5 
     percent (or 24 graduates), respectively, in the 2008-2009 
     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 2007 Monthly Labor Review of 
     the Bureau of Labor Statistics, more than 1,000,000 new and 
     replacement nurses will be needed by 2016.

     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:
       ``(A) $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) $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) $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.
       ``(C) With respect to any school year, the Secretary may 
     waive application of subparagraph (A) if--
       ``(i) the physical facilities at the school involved limit 
     the school from enrolling additional students; or
       ``(ii) the school has increased enrollment in the school 
     (as described in subparagraph (A)) for each of the 2 
     preceding school years.
       ``(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:
       ``(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,

[[Page S2569]]

     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 2010, 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 
     2010, $85,000,000 for fiscal year 2011, and $95,000,000 for 
     fiscal year 2012.
       ``(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 2010, 2011, and 2012.''.
       (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.
                                 ______