[Congressional Record Volume 155, Number 119 (Monday, August 3, 2009)]
[Senate]
[Page S8688]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. STABENOW:
  S. 1569. A bill to expand our Nation's Advanced Practice Registered 
Nurse workforce; to the Committee on Finance.
  Ms. STABENOW. Mr. President, I rise today to introduce legislation to 
address our growing workforce shortage. I am pleased to be joining my 
good friend, Congresswoman Lois Capps, a nurse herself, in introducing 
this legislation. Our legislation is supported by AARP, the American 
Academy of Nurse Practitioners, the American Association of Colleges of 
Nursing, the American Association of Nurse Anesthetists, the American 
College of Nurse Practitioners, the American College of Nurse-Midwives, 
the American Nurses Association, the National Association of Pediatric 
Nurse Practitioners, and the National Organization of Nurse 
Practitioner Faculties.
  Since its creation in 1965, Medicare has provided some support for 
the costs of nursing education. While relatively small as compared to 
support for graduate medical education for physicians, $150 million vs. 
$9 billion per year, Medicare has for many years been the largest 
federal source of funding for nurse training. While nursing education 
and patient care needs have changed tremendously since 1965, Medicare's 
policy in this area has not kept up to date.
  My bill amends Medicare to provide incentives to expand the number of 
advanced practice registered nurses, APRN, trained and to prepare them 
to undertake the essential cost-saving reforms to our health care 
delivery system: an increased focus on primary and preventive care, 
improved coordination of care, access to primary care and anesthesia 
services in rural and medically underserved areas, and enhanced efforts 
to reduce costly medical errors that will lower health care costs and 
improve patient care. This legislation also focuses on training nurses 
in community-based settings, such as community health centers, rural 
clinics and individual health professional offices, arming them with 
the practical clinical experience they need.
  The respected economic analysis firm The Lewin Group has conducted a 
thorough analysis of this proposal. They found that it would increase 
the number of APRNs graduating by 25 percent. This is a very 
significant increase and one that is greatly needed. Additionally, 
training more APRNs will help us develop more faculty, which are 
desperately needed to train the next generation of nurses. Every 
nursing school dean in Michigan has told me that this is a huge issue 
to them.
  This relatively modest investment in APRNs will provide Americans, 
especially those in rural and other areas of health care shortages, 
with the primary and preventive care, care coordination, and chronic 
care management they too often lack today.
  At a time when our country faces a shortage of healthcare 
professionals, funding for the clinical education of APRNs, including 
nurse practitioners, certified nurse-midwives, certified registered 
nurse anesthetists, and clinical nurse specialists is vitally important 
to meet the demand for expanded health care, which is expected under a 
newly reformed delivery system.
  Mr. President, I ask unanimous consent that a letter of support be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                    July 29, 2009.
     Hon. Debbie Stabenow,
     U.S. Senate,
     133 Senate Hart Building, Washington, DC.
       Dear Senator Stabenow: On behalf of the undersigned 
     organizations, we would like to express our support for your 
     legislation that will amend Title XVIII of the Social 
     Security Act to provide payment to hospitals for the costs of 
     expanded advanced practice nurse training programs. At a time 
     when our country faces a shortage of healthcare 
     professionals, funding for the clinical education of Advanced 
     Practice Registered Nurses (APRNs), including nurse 
     practitioners, certified nurse-midwives, certified registered 
     nurse anesthetists, and clinical nurse specialists is vitally 
     important to meet the demand for expanded health care, which 
     is expected under a newly reformed delivery system.
       APRNs are ideally suited to help implement delivery system 
     reforms such as an increased focus on primary, transitional, 
     and preventive care, enhancing access for rural and medically 
     underserved populations, improving care coordination, chronic 
     care management, and reducing costly medical errors. Yet in 
     2008, U.S. nursing schools turned away 6,904 qualified 
     applicants from graduate nursing programs due to insufficient 
     numbers of faculty, clinical sites, classroom space, clinical 
     preceptors, and budget constraints. This Medicare funding 
     would expand the current focus to nursing education at the 
     graduate level. It would also expand clinical education 
     provided through Medicare funding to include home and 
     community-based settings as well as hospitals, using 
     affiliations between accredited schools of nursing and 
     community-based health care settings. The outcome would be a 
     much more robust APRN workforce to meet growing demand 
     especially among the Medicare population and those in 
     underserved areas. In fact, according to a Lewin report 
     commissioned by AARP to investigate this type of proposal, 
     your bill would increase the number of APRNs by 25%.
       We applaud your efforts and those of your staff for 
     introducing Graduate Nursing Education legislation, which 
     will benefit future APRNs so they can provide high quality, 
     cost effective care to the most vulnerable populations in all 
     areas across the country. Thank you for your recognition of 
     the role APRNs will play in a reformed healthcare system.
           Sincerely,
         AARP, American Academy of Nurse Practitioners, American 
           Association of Colleges of Nursing, American 
           Association of Nurse Anesthetists, American College of 
           Nurse Practitioners, American College of Nurse-
           Midwives, American Nurses Association, National 
           Association of Pediatric Nurse Practitioners, National 
           Organization of Nurse Practitioner Faculties.

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