[Congressional Record Volume 155, Number 81 (Tuesday, June 2, 2009)]
[Senate]
[Pages S5945-S5947]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself and Mrs. Lincoln):
  S. 1161. A bill to amend the Public Health Service Act to authorize 
programs to increase the number of nurse faculty and to increase the 
domestic nursing and physical therapy workforce, and for other 
purposes; to the Committee on Health, Education, Labor, and Pensions.
  Mr. BINGAMAN. Mr. President, I rise today with my colleague Senator 
Lincoln to introduce the Nurse Faculty and Physical Therapist Education 
Act of 2009. This legislation will help to address the critical 
shortage of nurse faculty and physical therapists that is facing our 
Nation. The nationwide nursing shortage is growing rapidly, because the 
average age of the nursing workforce is near retirement and because the 
aging population has increased health care needs. The shortage is one 
that affects the entire Nation. A 2006 Health Resources and Services 
Administration, HRSA, report estimated that the national nursing 
shortage would more than triple, to more than one million nurses, by 
the year 2020. The report also predicts that all 50 States will 
experience nursing shortages by 2015. Quite simply, we need to educate 
more nurses, or we, as a Nation, will not have enough trained nurses to 
meet the needs of our aging society.
  One of the biggest constraints to educating more nurses is a shortage 
of nursing faculty. Almost three-quarters of nursing programs surveyed 
by the American Association of Colleges of Nursing cited faculty 
shortages as a reason for turning away qualified applicants. Although 
applications to nursing programs have surged 59 percent over the past 
decade, the National League for Nursing estimates that 147,000 
qualified applications were turned away in 2004. This represents a 27 
percent decrease in admissions over the previous year, indicating the 
need to scale up capacity in nursing programs is more critical than 
ever.
  I know that in my home State of New Mexico, nursing programs turned 
down almost half of qualified applicants, even though HRSA predicts 
that New Mexico will only be able to meet 64 percent of its demand for 
nurses by 2020. With a national nurse faculty workforce that averages 
53.5 years of age, and an average nurse faculty retirement age of 62.5 
years, we cannot and must not wait any longer to address nurse faculty 
shortages.
  Nursing faculty are not the only segment of the population that is 
aging. As the baby boom generation ages, there will be an increased 
need for nurses to care for the elderly. However, less than one percent 
of practicing nurses have a certification in geriatrics.
  The Nurse Faculty and Physical Therapist Education Act will amend the 
Public Health Service Act, to help alleviate the faculty shortage by 
providing funds to help nursing schools increase enrollment and 
graduation from nursing doctoral programs. The act will increase 
partnering opportunities between academic institutions and medical 
practices, enhance cooperative education, support marketing outreach, 
and strengthen mentoring programs. The bill will increase the number of 
nurses who complete nursing doctoral programs and seek employment as 
faculty members and nursing leaders in academic institutions. In 
addition, the bill authorizes awards to train nursing faculty in 
clinical geriatrics, so that more nursing students will be equipped for 
our aging population.
  By addressing the faculty shortage, we are addressing the nursing 
shortage.
  The aging population will also require additional health workers in 
other fields. Physical therapy was listed as one of the fastest growing 
occupations by the U.S. Department of Labor, with a projected job 
growth of greater than 36 percent between 2004 and 2014. The need for 
physical therapists is particularly acute in rural and urban 
underserved areas, which have three to four times fewer physical 
therapists per capita than suburban areas. To address this need, the 
bill also authorizes a distance education pilot program to improve 
access to educational opportunity for both nursing and physical therapy 
students. Finally, the bill calls for a study by the Institute of 
Medicine at the National Academy of Sciences which will recommend how 
to balance education, labor, and immigration policies to meet the 
demand for qualified nurses and physical therapists.
  The provisions of the Nurse Faculty and Physical Therapist Education 
Act are vital to overcoming workforce challenges. By addressing nurse 
faculty and physical therapist shortages, we will enhance both access 
to care and the quality of care.
  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. 1161

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

     SECTION 1. SHORT TITLE; FINDINGS.

       (a) Short Title.--This Act may be cited as the ``Nurse 
     Faculty and Physical Therapist Education Act of 2009''.
       (b) Findings.--Congress makes the following findings:
       (1) The Nurse Reinvestment Act (Public Law 107-205) has 
     helped to support students preparing to be nurse educators. 
     Yet, nursing schools nationwide are forced to deny admission 
     to individuals seeking to become nurses and nurse educators 
     due to the lack of qualified nurse faculty.
       (2) The American Association of Colleges of Nursing 
     reported that 42,866 qualified applicants were denied 
     admission to nursing baccalaureate and graduate programs in 
     2006, with faculty shortages identified as a major reason for 
     turning away students.
       (3) Seventy-one percent of schools have reported 
     insufficient faculty as the primary reason for not accepting 
     qualified applicants. The primary reasons for lack of faculty 
     are lack of funds to hire new faculty, inability to identify, 
     recruit and hire faculty in the competitive job market as of 
     May 2007, and lack of nursing faculty available in different 
     geographic areas.
       (4) Despite the fact that in 2006, 52.4 percent of 
     graduates of doctoral nursing programs enter education roles, 
     the 103 doctoral programs nationwide produced only 437 
     graduates, which is only an additional 6 graduates from 2005. 
     This annual graduation rate is insufficient to meet the needs 
     for nurse faculty. In keeping with other professional 
     academic disciplines, nurse faculty at colleges and 
     universities are typically doctorally prepared.
       (5) The nursing faculty workforce is aging and will be 
     retiring.
       (6) With the average retirement age of nurse faculty at 
     62.5 years of age, and the average age of doctorally prepared 
     faculty, as of May 2007, that hold the rank of professor, 
     associate professor, and assistant professor is 58.6, 55.8, 
     and 51.6 years, respectively, the health care system faces 
     unprecedented workforce and health access challenges with 
     current and future shortages of deans, nurse educators, and 
     nurses.
       (7) Research by the National League of Nursing indicates 
     that by 2019 approximately 75 percent of the nursing faculty 
     population (as of May 2007) is expected to retire.

[[Page S5946]]

       (8) A wave of nurses will be retiring from the profession 
     in the near future. As of May 2007, the average age of a 
     nurse in the United States is 46.8 years old. The Bureau of 
     Labor Statistics estimates that more than 1,200,000 new and 
     replacement registered nurses will be needed by 2014.
       (9) By 2030, the number of adults age 65 and older is 
     expected to double to 70,000,000, accounting for 20 percent 
     of the population. As the population ages, the demand for 
     nurses and nursing faculty will increase.
       (10) Despite the need for nurses to treat an aging 
     population, few registered nurses in the United States are 
     trained in geriatrics. Less than 1 percent of practicing 
     nurses have a certification in geriatrics and 3 percent of 
     advanced practice nurses specialize in geriatrics.
       (11) Specialized training in geriatrics is needed to treat 
     older adults with multiple health conditions and improve 
     health outcomes. Approximately 80 percent of Medicare 
     beneficiaries have 1 chronic condition, more than 60 percent 
     have 2 or more chronic conditions, and at least 10 percent 
     have coexisting Alzheimer's disease or other dementias that 
     complicate their care and worsen health outcomes. Two-thirds 
     of Medicare spending is attributed to 20 percent of 
     beneficiaries who have 5 or more chronic conditions. Research 
     indicates that older persons receiving care from nurses 
     trained in geriatrics are less frequently readmitted to 
     hospitals or transferred from nursing facilities to hospitals 
     than those who did not receive care from a nurse trained in 
     geriatrics.
       (12) The Department of Labor projected that the need for 
     physical therapists would increase by 36.7 percent between 
     2004 and 2014.
       (13) The need for physical therapists is particularly acute 
     rural and urban underserved areas, which have 3 to 4 times 
     fewer physical therapists per capita than suburban areas.

                 TITLE I--GRANTS FOR NURSING EDUCATION

     SEC. 101. NURSE FACULTY EDUCATION.

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

     ``SEC. 832. NURSE FACULTY EDUCATION.

       ``(a) Establishment.--The Secretary, acting through the 
     Health Resources and Services Administration, shall establish 
     a Nurse Faculty Education Program to ensure an adequate 
     supply of nurse faculty through the awarding of grants to 
     eligible entities to--
       ``(1) provide support for the hiring of new faculty, the 
     retaining of existing faculty, and the purchase of 
     educational resources;
       ``(2) provide for increasing enrollment and graduation 
     rates for students from doctoral programs; and
       ``(3) assist graduates from the entity in serving as nurse 
     faculty in schools of nursing;
       ``(b) Eligibility.--To be eligible to receive a grant under 
     subsection (a), an entity shall--
       ``(1) be an accredited school of nursing that offers a 
     doctoral degree in nursing in a State or territory;
       ``(2) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require;
       ``(3) develop and implement a plan in accordance with 
     subsection (c);
       ``(4) agree to submit an annual report to the Secretary 
     that includes updated information on the doctoral program 
     involved, including information with respect to--
       ``(A) student enrollment;
       ``(B) student retention;
       ``(C) graduation rates;
       ``(D) the number of graduates employed part-time or full-
     time in a nursing faculty position; and
       ``(E) retention in nursing faculty positions within 1 year 
     and 2 years of employment;
       ``(5) agree to permit the Secretary to make on-site 
     inspections, and to comply with the requests of the Secretary 
     for information, to determine the extent to which the school 
     is complying with the requirements of this section; and
       ``(6) meet such other requirements as determined 
     appropriate by the Secretary.
       ``(c) Use of Funds.--Not later than 1 year after the 
     receipt of a grant under this section, an entity shall 
     develop and implement a plan for using amounts received under 
     this grant in a manner that establishes not less than 2 of 
     the following:
       ``(1) Partnering opportunities with practice and academic 
     institutions to facilitate doctoral education and research 
     experiences that are mutually beneficial.
       ``(2) Partnering opportunities with educational 
     institutions to facilitate the hiring of graduates from the 
     entity into nurse faculty, prior to, and upon completion of 
     the program.
       ``(3) Partnering opportunities with nursing schools to 
     place students into internship programs which provide hands-
     on opportunity to learn about the nurse faculty role.
       ``(4) Cooperative education programs among schools of 
     nursing to share use of technological resources and distance 
     learning technologies that serve rural students and 
     underserved areas.
       ``(5) Opportunities for minority and diverse student 
     populations (including aging nurses in clinical roles) 
     interested in pursuing doctoral education.
       ``(6) Pre-entry preparation opportunities including 
     programs that assist returning students in standardized test 
     preparation, use of information technology, and the 
     statistical tools necessary for program enrollment.
       ``(7) A nurse faculty mentoring program.
       ``(8) A Registered Nurse baccalaureate to Ph.D. program to 
     expedite the completion of a doctoral degree and entry to 
     nurse faculty role.
       ``(9) Career path opportunities for 2nd degree students to 
     become nurse faculty.
       ``(10) Marketing outreach activities to attract students 
     committed to becoming nurse faculty.
       ``(d) Priority.--In awarding grants under this section, the 
     Secretary shall give priority to entities from States and 
     territories that have a lower number of employed nurses per 
     100,000 population.
       ``(e) Number and Amount of Grants.--Grants under this 
     section shall be awarded as follows:
       ``(1) In fiscal year 2010, the Secretary shall award 10 
     grants of $100,000 each.
       ``(2) In fiscal year 2011, the Secretary shall award an 
     additional 10 grants of $100,000 each and provide continued 
     funding for the existing grantees under paragraph (1) in the 
     amount of $100,000 each.
       ``(3) In fiscal year 2012, the Secretary shall award an 
     additional 10 grants of $100,000 each and provide continued 
     funding for the existing grantees under paragraphs (1) and 
     (2) in the amount of $100,000 each.
       ``(4) In fiscal year 2013, the Secretary shall provide 
     continued funding for each of the existing grantees under 
     paragraphs (1) through (3) in the amount of $100,000 each.
       ``(5) In fiscal year 2014, the Secretary shall provide 
     continued funding for each of the existing grantees under 
     paragraphs (1) through (3) in the amount of $100,000 each.
       ``(f) Limitations.--
       ``(1) Payment.--Payments to an entity under a grant under 
     this section shall be for a period of not to exceed 5 years.
       ``(2) Improper use of funds.--An entity that fails to use 
     amounts received under a grant under this section as provided 
     for in subsection (c) shall, at the discretion of the 
     Secretary, be required to remit to the Federal Government not 
     less than 80 percent of the amounts received under the grant.
       ``(g) Reports.--
       ``(1) Evaluation.--The Secretary shall conduct an 
     evaluation of the results of the activities carried out under 
     grants under this section.
       ``(2) Reports.--Not later than 3 years after the date of 
     the enactment of this section, the Secretary shall submit to 
     Congress an interim report on the results of the evaluation 
     conducted under paragraph (1). Not later than 6 months after 
     the end of the program under this section, the Secretary 
     shall submit to Congress a final report on the results of 
     such evaluation.
       ``(h) Study.--
       ``(1) In general.--Not later than 3 years after the date of 
     the enactment of this section, the Comptroller General of the 
     United States shall conduct a study and submit a report to 
     Congress concerning activities to increase participation in 
     the nurse educator program under the section.
       ``(2) Contents.--The report under paragraph (1) shall 
     include the following:
       ``(A) An examination of the capacity of nursing schools to 
     meet workforce needs on a nationwide basis.
       ``(B) An analysis and discussion of sustainability options 
     for continuing programs beyond the initial funding period.
       ``(C) An examination and understanding of the doctoral 
     degree programs that are successful in placing graduates as 
     faculty in schools of nursing.
       ``(D) An analysis of program design under this section and 
     the impact of such design on nurse faculty retention and 
     workforce shortages.
       ``(E) An analysis of compensation disparities between 
     nursing clinical practitioners and nurse faculty and between 
     higher education nurse faculty and higher education faculty 
     overall.
       ``(F) Recommendations to enhance faculty retention and the 
     nursing workforce.
       ``(i) 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 $1,000,000 for fiscal year 
     2010, $2,000,000 for fiscal year 2011, and $3,000,000 for 
     each of fiscal years 2012 through 2014.
       ``(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 through 2014.''.

     SEC. 102. GERIATRIC ACADEMIC CAREER AWARDS FOR NURSES.

       Part I of title VIII of the Public Health Service Act (42 
     U.S.C. 298 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 856. GERIATRIC FACULTY FELLOWSHIPS.

       ``(a) Establishment of Program.--The Secretary shall 
     establish a program to provide Geriatric Academic Career 
     Awards to eligible individuals to promote the career 
     development of such individuals as geriatric nurse faculty.
       ``(b) Eligible Individuals.--To be eligible to receive an 
     Award under subsection (a), an individual shall--
       ``(1) be a registered nurse with a doctorate degree in 
     nursing;

[[Page S5947]]

       ``(2)(A) have completed an approved advanced education 
     nursing program in geriatric nursing or geropsychiatric 
     nursing; or
       ``(B) have a State or professional nursing certification in 
     geriatric nursing or geropsychiatric nursing; and
       ``(3) have a faculty appointment at an accredited school of 
     nursing, school of public health, or school of medicine.
       ``(c) Application.--An eligible individual desiring to 
     receive an Award under this section shall submit to the 
     Secretary an application at such time, in such manner, and 
     containing such information as the Secretary may require, 
     which shall include an assurance that the individual will 
     meet the service requirement described in subsection (d).
       ``(d) Service Requirement.--An individual who receives an 
     Award under this section shall provide training in clinical 
     geriatrics, including the training of interdisciplinary teams 
     of health care professionals. The provision of such training 
     shall constitute at least 50 percent of the obligations of 
     such individual under the Award.
       ``(e) Amount and Number.--
       ``(1) Amount.--The amount of an Award under this section 
     shall equal $75,000 annually, adjusted for inflation on the 
     basis of the Consumer Price Index. The Secretary may increase 
     the amount of an Award by not more than 25 percent, taking 
     into account the fringe benefits and other research expenses, 
     at the recipient's institutional rate.
       ``(2) Number.--The Secretary shall award up to 125 Awards 
     under this section from 2008 through 2016.
       ``(3) Regional distribution.--
       ``(A) In general.--The Secretary shall provide Awards to 
     individuals from 5 regions in the United States, of which--
       ``(i) 2 regions shall be an urban area;
       ``(ii) 2 regions shall be a rural area; and
       ``(iii) 1 region shall include a State with--

       ``(I) a medical school that has a department of geriatrics 
     that manages rural outreach sites and is capable of managing 
     patients with multiple chronic conditions, 1 of which is 
     dementia; and
       ``(II) a college of nursing that has a required course in 
     geriatric nursing in the baccalaureate program.

       ``(B) Geographic diversity.--The Secretary shall ensure 
     that the 5 regions established under subparagraph (A) are 
     located in different geographic areas of the United States.
       ``(f) Term of Award.--The term of an Award made under this 
     section shall be 5 years.
       ``(g) Reports.--
       ``(1) Evaluation.--
       ``(A) In general.--The Secretary shall conduct an 
     evaluation of the results of the activities carried out under 
     the Awards established under this section.
       ``(B) Reports to congress.--Not later than 3 years after 
     the date of the enactment of this section, the Secretary 
     shall submit to Congress an interim report on the results of 
     the evaluation conducted under this paragraph. Not later than 
     180 days after the expiration of the program under this 
     section, the Secretary shall submit to Congress a final 
     report on the results of such evaluation.
       ``(2) Content.--The evaluation under paragraph (1) shall 
     examine--
       ``(A) the program design under this section and the impact 
     of the design on nurse faculty retention; and
       ``(B) options for continuing the program beyond fiscal year 
     2018.
       ``(h) Authorization of Appropriations.--
       ``(1) In general.--To fund Awards under subsection (e), 
     there are authorized to be appropriated $1,875,000 for each 
     of fiscal years 2010 through 2018.
       ``(2) Administrative costs.--To carry out this section 
     (except to fund Awards under subsection (e)), there are 
     authorized to be appropriated such sums as may be necessary 
     for each of fiscal years 2008 through 2016.
       ``(3) Separation of funds.--The Secretary shall ensure that 
     the amounts appropriated pursuant to paragraph (1) are held 
     in a separate account from the amounts appropriated pursuant 
     to paragraph (2).''.

  TITLE II--DISTANCE EDUCATION PILOT PROGRAM AND OTHER PROVISIONS TO 
          INCREASE THE NURSING AND PHYSICAL THERAPY WORKFORCE

     SEC. 201. INCREASING THE DOMESTIC SUPPLY OF NURSES AND 
                   PHYSICAL THERAPISTS.

       (a) Establishment of Nurse and Physical Therapists Distance 
     Education Pilot Program.--
       (1) In general.--The Secretary of Health and Human Services 
     (referred to in this section as the ``Secretary''), in 
     conjunction with the Secretary of Education, shall establish 
     a Nurse and Physical Therapist Distance Education Pilot 
     Program through which grants may be awarded for the conduct 
     of activities to increase accessibility to nursing and 
     physical therapy education.
       (2) Purpose.--The purpose of the Nurse and Physical 
     Therapist Distance Education Pilot Program established under 
     paragraph (1) shall be to increase accessibility to nursing 
     and physical therapy education to--
       (A) provide assistance to individuals in rural areas who 
     want to study nursing or physical therapy to enable such 
     individuals to receive appropriate nursing education and 
     physical therapy education;
       (B) promote the study of nursing and physical therapy at 
     all educational levels;
       (C) establish additional slots for nursing and physical 
     therapy students at existing accredited schools of nursing 
     and physical therapy education programs; and
       (D) establish new nursing and physical therapy education 
     programs at institutions of higher education.
       (3) Application.--To be eligible to receive a grant under 
     the Pilot Program under paragraph (1), an entity shall submit 
     to the Secretary an application at such time, in such manner, 
     and containing such information as the Secretary may require.
       (4) Authorization of appropriations.--There is authorized 
     to be appropriated such sums as may be necessary to carry out 
     this subsection.
       (b) Increasing the Domestic Supply of Nurses and Physical 
     Therapists.--
       (1) In general.--Not later than January 1, 2010, the 
     Secretary, in conjunction with the Secretary of Education, 
     shall--
       (A) submit to Congress a report concerning the country of 
     origin or professional school of origin of newly licensed 
     nurses and physical therapists in each State, that shall 
     include--
       (i) for the most recent 3-year period for which data is 
     available--

       (I) separate data relating to teachers at institutions of 
     higher education for each related occupation who have been 
     teaching for not more than 5 years; and
       (II) separate data relating to all teachers at institutions 
     of higher education for each related occupation regardless of 
     length of service;

       (ii) for the most recent 3-year period for which data is 
     available, separate data for each related occupation and for 
     each State;
       (iii) a separate identification of those individuals 
     receiving their initial professional license and those 
     individuals licensed by endorsement from another State;
       (iv) with respect to those individuals receiving their 
     initial professional license in each year, a description of 
     the number of individuals who received their professional 
     education in the United States and the number of individuals 
     who received such education outside the United States; and
       (v) to the extent practicable, a description, by State of 
     residence and country of education, of the number of nurses 
     and physical therapists who were educated in any of the 5 
     countries (other than the United States) from which the most 
     nurses and physical therapists arrived;
       (B) in consultation with the Department of Labor, enter 
     into a contract with the Institute of Medicine of the 
     National Academy of Sciences for the conduct of a study and 
     submission of a report that includes--
       (i) a description of how the United States can balance 
     health, education, labor, and immigration policies to meet 
     the respective policy goals and ensure an adequate and well-
     trained nursing and physical therapy workforce;
       (ii) a description of the barriers to increasing the supply 
     of nursing and physical therapy faculty, domestically trained 
     nurses, and domestically trained physical therapists;
       (iii) recommendations of strategies to be utilized by 
     Federal and State governments that would be effective in 
     removing the barriers described in clause (ii), including 
     strategies that address barriers to advancement to become 
     registered nurses for other health care workers, such as home 
     health aides and nurses assistants;
       (iv) recommendations for amendments to Federal laws that 
     would increase the supply of nursing faculty, domestically 
     trained nurses, and domestically trained physical therapists;
       (v) recommendations for Federal grants, loans, and other 
     incentives that would provide increases in nurse and physical 
     therapist educators and training facilities, and other 
     measures to increase the domestic education of new nurses and 
     physical therapists;
       (vi) an identification of the effects of nurse and physical 
     therapist emigration on the health care systems in their 
     countries of origin; and
       (vii) recommendations for amendments to Federal law that 
     would minimize the effects of health care shortages in the 
     countries of origin from which immigrant nurses arrived; and
       (C) collaborate with the heads of other Federal agencies, 
     as appropriate, in working with ministers of health or other 
     appropriate officials of the 5 countries from which the most 
     nurses and physical therapists arrived into the United 
     States, to--
       (i) address health worker shortages caused by emigration; 
     and
       (ii) ensure that there is sufficient human resource 
     planning or other technical assistance needed to reduce 
     further health worker shortages in such countries.
       (2) Access to data.--The Secretary shall grant the 
     Institute of Medicine access to the data described under 
     paragraph (1)(A), as such data becomes available to the 
     Secretary for use by the Institute in carrying out the 
     activities under paragraph (1)(B).
       (3) Authorization of appropriations.--There is authorized 
     to be appropriated $1,400,000 to carry out paragraph (1)(B).
                                 ______