Senator Barbara Mikulski, who led the way within Congress in establishing the Nurse Reinvestment Act, talks candidly about the legislation, its potential for addressing the nation’s nursing shortage, and the vital need for congressional funding.
Written by Jim Miller
It’s no mystery that the United States has a nursing shortage, one that promises to grow to alarming proportions in the next 15 years. Too many nurses are retiring, and too few are entering the profession. To compound the problem, tens of millions of baby boomers are aging and will soon place unprecedented demands for services on a health system that is already stretched thin. The problem is not limited to hospital nursing. Today, there is also a critical shortage of nursing faculty. As a result, thousands of qualified men and women who want to enter the field are being turned away by the nation’s schools of nursing.
Enter far-sighted members of Congress like Senator Barbara Mikulski (D-Maryland), who have introduced legislation to meet the challenge. The outcome of her efforts and those of her bi-partisan colleagues in the House and Senate, was the passage of a major piece of legislation, the Nurse Reinvestment Act. The bill became law in 2002 and was enacted and funded in 2003. It is implemented through the Nursing Workforce Development Program (Public Health Service Act, Title VIII).
Although the new programs called for under the Nurse Reinvestment Act were not funded at the levels its sponsors hoped for, the Nursing Workforce Development Program has been increased by $50 million since the bill was passed. (See “The Act at a Glance.”)
Johns Hopkins Nursing magazine spoke with Senator Mikulski about her role in establishing the Nurse Reinvestment Act, its objectives, and its prospects within Congress for funding.
Nursing: You have long been a champion of nurses and nursing education. What drives your professional support and personal interest?
Mikulski: Nursing is very important to my family. My niece is a nurse at Johns Hopkins Hospital, and I have a cousin who is a nurse at St. Joseph’s Hospital in Baltimore. I know that nurses are on the front lines caring for the sick and helping the healthy to stay that way. I have always believed that we need to empower men and women to consider nursing by making a nursing education more affordable and by providing opportunities for advancement. It’s essential for our hospitals, and it’s essential for our patients.
In Congress, we know that America is facing a critical nursing shortage, and we are working in bipartisan ways to address this problem and other nursing workforce issues. That’s why I fought to pass the Nurse Reinvestment Act: a federal investment in recruiting and retaining nurses.
Nursing: Can you tell us something about the bill’s legislative history? What happened along the way?
Mikulski: I created the Nurse Reinvestment Act with two things in mind: What do people need to enter the nursing profession, and what do they need to stay there?
I believe that the best ideas come from the people, that’s why I talked to nursing school deans, including Dean Hill, and the American Nurses Association, to determine the needs of the nursing community and the best tools to use to recruit and retain nurses.
In the Senate, I built bipartisan coalitions with my colleagues like Sue Collins, Tim Hutchinson, John Kerry, Jim Jeffords, and Judd Gregg. I worked with my colleagues in the House, like Congresswoman Lois Capps who is also a nurse.
We created the Nurse Reinvestment Act to bring men and women into the nursing profession, keep nurses in the profession, and increase the number of faculty in nursing education programs. In exchange for at least two years of service in facilities that need nurses the most, individuals can receive scholarships for their nursing education. It creates additional education and training opportunities, as well as programs to empower nurses that help nurses move up instead of moving on. This legislation forgives loans for advanced degrees in exchange for a commitment to teach in a nursing school.
I was so proud to pass this legislation in July 2002, and to see it signed into law in August of that same year.
Nursing: Where do we stand in terms of funding the legislation?
Mikulski: Now that the Nurse Reinvestment Act is in the law books, I am fighting to make it a priority in the federal checkbook. I am on the Senate Appropriations Committee, which means I can fight for a federal investment in this act. We started with $15 million in initial funding in 2003. In 2004, I fought for $142 million for the Nurse Reinvestment Act and other nursing education programs. This year I am fighting for $205 million.
Nursing: What are the prospects for getting that level of funding in 2005?
Mikulski: Well, what I’m concerned about is the lip service paid to the nursing shortage. We all know that we have one. There are continuous efforts at gimmicks to solve the shortage—for example, importing foreign workers to be nurses, which I think would be catastrophic. It is not that I’m against immigration, but you need to meet American standards and language proficiency in order to avoid medical errors.
All of the deans of four-year nursing schools in Maryland have told me that there is an incredible waiting list to get into their schools. And the students who want to get into these schools need some kind of financial assistance. In addition, the schools need to increase their capacity in terms of both number of faculty and number of classrooms.
So, I think there is lip service. But we do have a bi-partisan effort that I am so proud of. I’ve teamed up with my colleague Senator Sue Collins of Maine, and we now have 41 bi-partisan senators signed up to ask for increased funding to $205 million for Nurse Workforce Development. We’ve gotten together a bi-partisan effort. There is a will among those 41 that now has to be translated into a wallet.
Nursing: How much of that $205 million for FY 2005 is targeted to increasing capacity of schools of nursing and increasing faculty?
Mikulski: The money is to go to a variety of purposes. Number one is for financial assistance to become nurses. Second is to focus on helping us have a faculty. When we talk about capacity, it is not only about bricks and mortar or laboratory space, it’s also about having a faculty. So this will help with faculty development as well as other capacity issues. We face a nursing shortage and a faculty shortage. We need faculty to teach these wonderful women and men who want to become nurses.
Nursing: In addition to the topics you’ve covered, are there any other provisions of the legislation that you feel are particularly important?
Mikulski: We want opportunity for advancement for nurses. We want nurses to be able to participate in intern-ships and residencies in development specialties. We need more nurses in specialties such as psychiatric nursing, pediatric nursing, and geriatric nursing to cope with the aging baby boomers’ needs.
Nursing: What can individuals and organizations do to support your efforts on behalf of increased funding?
Mikulski: Nurses everywhere need to be in touch with their United States senators to urge them to support the Mikulski-Collins additional funding, so that when the appropriation increase comes to the floor, we have the support of their senators.
Nursing: What message would you like to give to the nursing community and those who educate our future nurses?
Mikulski: Thank you, thank you, thank you. I know you are often overworked, underpaid, and undervalued. I know you work 12-hour shifts or longer, and your patient loads get heavier and heavier. You are high-tech, high touch, and high energy. Thank you for doing whatever is asked of you with skill, with determination, with care.
Editors note: In September, the Senate Appropriations Committee passed the FY 2005 Senate Labor, Health, and Human Services Appropriations bill that would increase funding for the Nurse Reinvestment Act and other nursing workforce development programs (Title VIII) by $20 million, bringing the total funding to almost $162 million for these vital programs.
The Act at a Glance
The Nurse Reinvestment Act was created to solve some of the most vexing problems facing the field of nursing. Key provisions of the legislation include:
Establishes Nurse Scholarships
Provides for educational scholarships for individuals who are enrolled or accepted for enrollment as full- or part-time students. Upon their graduation, scholarship recipients must commit to serve as a nurse in a public or private not-for-profit health care facility with a critical shortage of nurses for not less than two years.
The legislation expands the definition of a “practice site,” thereby giving nurses more options for fulfilling their service requirement for the Nursing Education Loan Repayment Program and the new Scholarship Program. New sites include such facilities as ambulatory surgical centers, home health agencies, hospice programs, and rural health clinics.
Establishes Comprehensive Geriatric Training Grants for Nurses
Recognizing the growing need for geriatric services, the act provides for programs to train and educate individuals in providing geriatric care for the elderly.
Establishes a Faculty Loan Cancellation Program
The act establishes a student loan fund to increase the number of qualified nursing faculty. Students may pursue a master’s or doctoral degree through the program. In return for canceling up to 85 percent of their loans, plus interest, students are obligated to spend a specific amount of time in a faculty position in a school of nursing. The maximum loan made by a school is $30,000 per student in an academic year.
Establishes Career Ladder Grant Program
The act establishes the use of career ladders to promote career advancement in nursing and assist those in the nursing workforce in obtaining additional education. It also establishes partnerships between health care providers and schools of nursing to facilitate advanced training.
Establishes Public Service Announcements
The act provides for the promotion of the nursing profession and education of the public about the rewards of a nursing career through both a national public service education and information campaign and local campaigns.
For more detailed information about the provisions of the Nurse Reinvestment Act, a good source is the Web site of the American Association of Colleges of Nursing at www.aacn.nche.edu.