Testimony of the Tri-Council for Nursing Regarding Fiscal Year (FY) 2015 Appropriations for the Title VIII Nursing Workforce Development Programs

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1 Testimony of the Tri-Council for Nursing Regarding Fiscal Year (FY) 2015 Appropriations for the Title VIII Nursing Workforce Development Programs U.S. House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies Department of Health and Human Services March 28, 2014 Submitted on behalf of the Tri-Council for Nursing by Suzanne Miyamoto, Director of Government Affairs and Health Policy, American Association of Colleges of Nursing The Tri-Council for Nursing, comprising the American Association of Colleges of Nursing, the American Nurses Association, the American Organization of Nurse Executives, and the National League for Nursing, respectfully requests $251 million for the Nursing Workforce Development programs authorized under Title VIII of the Public Health Service Act (42 U.S.C. 296 et seq.) and administered by the Health Resources and Services Administration in FY The Tri-Council is a long-standing nursing alliance focused on leadership and excellence in the nursing profession. The members of these respective organizations are acutely aware of the demand for nursing services due to a growing aging population, an increased focus on preventative care, and skyrocketing rates of individuals with multiple chronic conditions. In fact, according to the U.S. Bureau of Labor Statistics (BLS) Employment Projections for the profession of registered nurses (RN) will grow 19 percent for the 10-year timeframe between 2012 and The number of job openings due to demand for RNs and replacements brings the total of RNs needed to million by Replacements in the nursing workforce represent the impending wave of RN retirements. A 2013 HRSA report The U.S. Nursing Workforce: Trends in Supply and Education indicates that over the next 10 to 15 years, the nearly one million RNs over age 50 (comprising approximately one-third of the current workforce), will reach retirement age. 1

for Nursing by Suzanne Miyamoto, Director of Government Affairs and Health Policy, American Association of Colleges of Nursing The Tri-Council for Nursing, comprising the American Association of

2 Moreover, the acute nurse faculty shortage is one significant reason why schools of nursing across the country turn away tens of thousands of qualified applications each year. The demand for nurses and the faculty who educate them is a serious impediment to improving the nation s healthcare needs. Nurses continue to be the largest group of health care providers whose services are directly linked to quality and cost-effectiveness. The Tri-Council is grateful to the Subcommittee for your past commitment to Title VIII funding and respectfully asks that you continue to make the longterm investment that will build the nursing workforce necessary to deliver the quality, affordable care envisioned in health reform. A Proven Solution: Nursing Workforce Development Programs The Nursing Workforce Development programs, authorized under Title VIII of the Public Health Service Act, have helped build the supply and distribution of qualified nurses to meet our nation s healthcare needs since Over these past 50 years, the original programs, newly added and expanded programs have addressed all aspects of supporting the workforce education, practice, retention, and recruitment. They have bolstered nursing education at all levels from entry-level preparation through graduate study and have provided support for institutions that educate nurses for practice in rural and medically underserved communities. A description of the Title VIII programs and their impact are included below. Advanced Nursing Education (ANE) Programs (Sec. 811) fund a number of grant activities including several traineeships that aim to increase the size and quality of the advanced nursing workforce. Supporting the preparation of RNs in master s and doctoral nursing programs, the ANE grants help prepare our nation s nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists, nurse educators, nurse administrators, nurses in executive practice, public health 2

Nurses continue to be the largest group of health care providers whose services are directly linked to quality and cost-effectiveness.

3 nurses, and other nursing specialists requiring advanced nursing education. In FY 2012, these grants supported the education of 15,986 students. Under the ANE program are two critical traineeship programs that are particularly relevant as the demand for primary and acute care services rise. AEN Traineeships assist graduate nursing students by providing full or partial reimbursement for the costs of tuition, books, program fees, and reasonable living expenses. Funding for the AEN Traineeships supports the education of future nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists, nurse educators, nurse administrators, public health nurses, and other nurse specialists requiring advanced education. Nurse Anesthetist Traineeships (NAT) support the education of students in nurse anesthetist programs. In some states, certified registered nurse anesthetists are the sole anesthesia providers in almost 100% of rural hospitals. In FY 2012, the AEN Traineeship and the NAT supported 5,545 nursing students. Nursing Workforce Diversity (NWD) Grants (Sec. 821) prepare students from disadvantaged backgrounds to become nurses, producing a more diverse nursing workforce. This outcome will help meet the increasing need for culturally aligned, quality health care for the nation s rapidly diversifying population and help close the gap in health disparities. This program awards grants and contract opportunities to schools of nursing for a variety of clinical training facilities to address nursing educational needs for not only disadvantaged students but also racial and ethnic minorities underrepresented in the nursing profession. In FY 2012, the program supported 12,077 students. Nurse Education, Practice, Quality and Retention (NEPQR) Grants (Sec. 831, and Sec. 831 A) help schools of nursing, academic health centers, nurse managed health centers, state and local governments to strengthen nursing education programs thereby increasing the size and quality of the nursing workforce. The purposes of the NEPQR are broad and flexible, allowing the program to address emerging needs in nursing workforce development. For example, projects to develop and 3

AEN Traineeships assist graduate nursing students by providing full or partial reimbursement for the costs of tuition, books, program fees, and reasonable living expenses.

4 disseminate collaborative practice models that incorporate the full range of health care workers in team-based care are of certain interest. NEPQR supports infrastructure development to enhance the coordination and capacity building of interprofessional practice and education among health professions across the United States, and particularly in medically underserved areas. For other interests, a number of grant activities have been funded to support several legislative purposes such as expanding the size of academic programs that are able to confer a baccalaureate degree of science in nursing (BSN); recruiting and educating individuals as qualified personal and home care aides in occupational shortage and/or high demand areas; training qualified nursing assistants and home health aides to meet the growing health care needs of the aging population; and/or supporting nurse managed health clinics that serve as primary care access points in areas where primary care providers are in short supply. NURSE Corps (formerly known as the Nursing Education Loan Repayment and Scholarship Program) (Sec. 846, Title VIII, PHSA) provides monies to students by paying up to 85 percent of a student s loan in return for at least three years of service in a designated health shortage area or in an accredited school of nursing. The NURSE Corps Loan Repayment Program (LRP) is a financial incentive program under which individual RNs and advanced practice RNs (APRNs) enter into a contractual agreement with the federal government to work full-time in a health care facility with a critical shortage of nurses, in return for repayment of qualifying nursing educational loans. In FY 2013, the Nursing Education Loan Repayment Program supported 1,446 nurses working in these facilities. However, given the current climate, the HRSA 2015 Congressional Budget Justification anticipates that they can only support 1,296 in FY Nurse Faculty Loan Program (NFLP) (Sec. 846 A, Title VIII, PHSA) increases the number of qualified nurse faculty by creating a student loan fund within individual schools of nursing and supporting individual students. Students must agree to teach at a school of nursing in exchange for 4

particularly in medically underserved areas.

5 cancellation of up to 85 percent of their educational loans, plus interest, over a four-year period. In FY 2012, these grants supported the education of 2,259 future nurse educators. Comprehensive Geriatric Education Program (CGEP) Grants (Sec. 855, Title VIII, PHSA) provide support to nursing students specializing in care for the elderly. These grants may be used to educate RNs who will provide direct care to older Americans, develop and disseminate geriatric curriculum, prepare faculty members, and provide continuing education. They may also fund traineeships for individuals who are preparing for advanced education nursing degrees in geriatric nursing, long-term care, gero-psychiatric nursing or other nursing areas that specialize in the care of the elderly population. In FY 2012, there were 11,600 trainees supported by these grants. Our nation is faced with a growing health care crisis that must be addressed on many fronts. Nurses are an important part of the solution to the crisis of cost, burden of disease, and access to quality care. To meet this challenge, funding of proven federal programs such as Title VIII will help ease the demand for RNs. The Tri-Council respectfully requests your support of $251 million for the Title VIII Nursing Workforce Development Programs in FY Eileen Breslin, PhD, RN, FAAN Geraldine Polly Bednash, PhD, RN, FAAN American Association of Colleges of Nursing Karen Daley, PhD, MPH, RN, FAAN Marla J. Weston, PhD, RN, FAAN American Nurses Association Linda Knodel, MHA, MSN, RN, NE-BC CPHQ, FACHE Pamela A. Thompson, MS, RN, CENP, FAAN and Sr. Vice American Organization of Nurse Executives Marsha Howell Adams, PhD, RN, CNE, ANEF Beverly Malone, PhD, RN, FAAN National League for Nursing 5

These grants may be used to educate RNs who will provide direct care to older Americans, develop and disseminate geriatric curriculum, prepare faculty members, and provide continuing education.

Marsha Adams, PhD, RN, CNE, FAAN, ANEF, President, National League for Nursing

Testimony Regarding Fiscal Year 2016 Appropriations for the Title VIII Nursing Workforce Development Programs April 7, 2015 Submitted by: Marsha Adams, PhD, RN, CNE, FAAN, ANEF, President, Beverly Malone,