2004 Legislation: Nursing Education (updated 12/04)

Background: Nursing Education

A fundamental shift has occurred in the registered nurse workforce over the last two decades. As occupational opportunities for young women have expanded and the working conditions for nurses have deteriorated, the number of young people entering nursing schools has declined. Projections show there will be a national shortage of nurses in the next 8 to 10 years if nothing is done to alleviate the pressures that are driving nurses out of the profession and entice young people into choosing nursing as a career. In addition, the capacity of schools of nursing to educate adequate numbers of nursing students is being threatened by an emerging shortage of nurse educators. In 2004, although enrollment in Baccalaureate programs in nursing increased by ten percent from the previous year, over 26,000 applicants were turned away because of lack of educators.

On the federal level, in 2004, ANA worked with Congress to secure adequate funding for federal nursing recruitment, education, and retention programs. On December 8, 2004, President Bush signed into law the 3,320 page FY 2005 omnibus appropriations bill. (P.L. 108-447). Among many other provisions, this law included the final FY 2005 funding for the nursing workforce development programs contained in Title VIII of the Public Health Service Act (this includes the programs enacted by the Nurse Reinvestment Act). Title VIII received total funding of $151 million for FY 2005, a $9 million (6 percent) increase over FY 2004. This increase is evenly divided between the National Nurse Corps (which includes the Nurse Education Loan Repayment Program and the Nursing Scholarship) and the Nurse Education, Practice, and Retention line item. Funding for the National Institute for Nursing Research (a division of the National Institutes of Health) was increased by $3 million, to a FY 2005 total of $138 million.

While ANA advocated for a much greater increase, this $9 million is welcome news given the very tight fiscal constraints put on this spending bill. Overall, the bill kept discretionary, non-defense spending to the FY 2004 level. Many health care programs received deep cuts (e.g., the National Health Service Corps was cut by $38.5 million, or 23%).

On the state level in 2004, over 140 bills were introduced in 26 states to address nursing education and the following 11 states passed legislation. CA enacted two nursing education bills. One appropriates funding for nursing education by accredited programs and the other provides authorization and funding for California State University to establish entry-level master’s degree nursing programs. CT legislation requires the Department of Education to provide financial assistance to four community colleges that enter into partnerships with hospitals to secure private funding to increase faculty members. FL legislation re-creates the Nursing Student Loan Forgiveness Trust Fund. Two bills were passed in IL -- the first authorizes scholarships for registered nurses pursuing graduate degrees and to students in those areas identified as shortage areas. The second bill increases the amount of money for nursing scholarships in the Nursing Dedicated and Professional Fund. Enacted legislation in IA designated February 12, 2004 as Iowa Nursing Student and Faculty Day for the purpose of encouraging the state’s residents to consider pursuing a career in nursing. LA enacted two study bills. The first requires the Board of Regents to study and report in 2005 issues related to admission of students into the clinical portion of nurse training programs. The second bill requires a task force to address the necessary work force initiatives to address the nursing shortage. MD legislation requires nonresident students enrolled in specific programs with a service obligation requirement to furnish a promissory note prior to qualifying for reduced tuition. MO legislation establishes the Missouri Area Health Education Center's program designed to improve the supply, distribution, availability and quality of healthcare personnel. MS enacted legislation appropriates money to support public community and junior colleges including nursing programs. NC legislation allows Cabarrus Memorial Hospital to award advanced degrees to graduates of nursing programs. VT legislation provides funds for health professional loan repayment for those who practice in health professional shortage areas.

States enacted the following legislation in 2003: AR passed two bills, the first reestablished the Nursing Student Loan Revolving Fund and the second established a legislative commission to study the nursing shortage. CA legislation requires the Office of Statewide Planning and Development to establish a statewide Associate Degree Nursing Scholarship Pilot Program. FL legislation will establish the North Brevard Co. Hospital District Board and a training school for nurses. A GA bill will provide financial assistance to students, postgraduate trainees or parents for programs of study in fields with personnel shortages. HI’s bill creates a nurses education loan program of up to $10,000 per student per year along with a special fund. IN legislation extends the date for a report from the Commission on Excellence in Health to October 31, 2004. LA legislation provides that certain students studying to become qualified to teach nursing to be eligible for a loan repayment program. MS also approved two bills, both pertain to the enactment of a paid educational leave program, one for hospital employees working in sponsoring hospitals, the other for employees of state health institutions. Default on these contracts could lead to loss of license. NH legislation combines the states career incentive program and the nursing leveraged scholarship lean program within the Department of Postsecondary Education and establishes a workforce incentive program. NV enacted a bill creating a Committee to Evaluate Higher Education that will study areas of high priority areas including education programs for students who desire to become nurses or teachers. OR enacted a bill that directs the Oregon Health and Science University to distribute grants to post-secondary institutions to expand the capacity of nursing education programs. OR also passed a resolution that urges the Governor to allocate money under the Federal Workforce Investment Act for training of providers to alleviate the shortage of nurses. SD decided to expand their nurse tuition reimbursement program to include recruitment incentive payments of $5,000 to other health care professionals provided they practice full-time in an eligible facility for a minimum of two years. TX legislation requires the TX Higher Education Coordinating Board to adopt procedures for assuring money to fund enrollment growth for nursing programs, grants for faculty, innovations, retention and critical shortage areas. It also creates the Nurse Advisory Committee and adds an RN to the State Council and establishes a nurse resource section within the health profession resource center. VA has enacted a bill that requires the State Council of Higher Education to develop with the Board of Nursing and the Advisory Council on the Future of Nursing, a strategic plan to ensure adequate supply of nurses and must address issues regarding education, recruitment and retention. The Council shall recommend changes in public policy necessary to meet the need for nursing services to the General Assembly. WY agreed to establish a program that encourages nursing education, provides eligibility criteria and loan administration for nursing students, requires the community college commission to coordinate nurse education programs, and specifies the conditions for funding additional teaching positions.

In 2002, significant legislation included the following: AZ legislation established a five year plan to increase the number of nurses who graduate from nursing programs in Arizona. CA decided to standardize all nursing program prerequisites, admission requirements and corequisites on a statewide basis. CO passed two bills, the first directs the state to develop admission policies for nursing programs at state schools to allow for more students and subject to monies in the More Nurses for CO fund. The second bill creates a 3-year direct care provider career path pilot program. Two bills in FL one authorizes the Department of Health to make payments to nursing graduates of up to $4,000 per year for up to four years who practice in designated facilities. Another creates a grant program for school districts to establish an exploratory nursing program in middle schools and a career and technical education program in high schools to promote a seamless transition to post secondary education or employment. IA created a nurse recruitment program with funds to be administered by the College Student Aid Commission. KY legislation creates the Nursing Workforce Foundation to provide funding and award grants to nursing education programs and nursing employers for the recruitment of students and the training of registered nurses who are pursing advanced degrees to become nursing faculty. LA passed two bills, one establishes a commission to address, among other things, the education of future health care workers while the second bill is a study to develop a special high school curriculum in medical sciences. MI agreed to authorize the disbursement of funds to nursing scholarship programs and in a second bill, created a nursing school program that awards $4,000 for each year a student is in the program (funded through the tobacco settlement). Two SD bills revise provisions regarding the nurses' education assistance loan program by funding tuition reimbursement ($5,000) for nurses upon practicing for two years and makes an appropriation to expand the nursing programs at South Dakota's public universities. VA legislation allows part-time nursing students to be eligible for scholarship and loan repayment programs, while WV legislation creates a scholarship program for persons pursing a master's degree in nursing ($10,000) or a fourth year medical student ($20,000) who agrees to practice at least two years in a medically underserved area in West Virginia or a nurse who agrees to teach two years for a school of nursing.

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