FOR IMMEDIATE RELEASE/January 29, 1997 CONTACT: Sara Foer [202/651-7023]; Joan Meehan [202/651-7020] ANA calls for appropriate funding of graduate nurse educationANA provides feedback to IOM committee on implementing a teaching hospital and graduate medical education trust fundWASHINGTON, DC -- Calling for more appropriate, broad-based financing for nursing education in order to meet the diverse health care needs of the nation, the American Nurses Association (ANA) testified at today's meeting of the Institute of Medicine (IOM) Committee on Implementing a Teaching Hospital and Graduate Medical Education (GME) Trust Fund. ANA supports the establishment of an all payer trust fund to provide broad-based and stable funding for clinical education of post-graduate nurses as well as post-graduate physicians. ANA also recommends that in an effort to fairly and progressively distribute the financing, contributions to the trust fund should be derived from Medicare funds as well as from a variety of other potential revenue sources, such as a health plan assessment, an excise tax, or a combination of sources. In oral remarks to the Committee, ANA President Beverly L. Malone, PhD, RN, FAAN, explained that it is critical that the educational programs for nurses have the resources to adapt their curricula and clinical training opportunities to the realities of today's health care delivery system. "Without support from the purchasers of health care, nursing education -- particularly its clinical components -- will not be appropriate for the kinds of practice environments in which nurses will be working," Malone clarified. "As the largest nursing organization, we believe that it is essential to expand the number of nurses enrolled in graduate level education programs in order to meet the needs of tomorrow's patients," Malone continued. "This requires a commitment of stable funding not subject to the uncertainties of the annual federal appropriations process." Specifically, ANA is calling for:
Current Medicare policy does not adequately support the need for clinical nursing education. For the most part, the funds are limited essentially to hospital-based diploma programs that typically do not provide the broad range of clinical training necessary to prepare for today's integrated health delivery models and the population's growing health care needs. As the nation's citizens continue to live longer and face a myriad of potential health care problems, the demand for professional registered nurses (RNs) as well as advanced practice registered nurses (APRNs) is expected to increase. Consequently, it is important to strengthen public support for the education of RNs and APRNs to increase access to health care services in institutional and community settings. APRN is an umbrella term given to an RN who has met advanced educational and clinical practice requirements beyond the 2-4 years of basic nursing education required for all RNs. The four principal types of APRNs are nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, and certified nurse-midwife. Studies have shown that 60 to 80 percent of primary and preventive care, traditionally done by physicians, can be provided by an RN for less money. Currently, there are more than 400,000 RNs, including over 100,000 APRNs, who already provide primary care services, and another 300,000 who provide some aspect of primary care in community and ambulatory settings. Nurses' broad-based education and holistic focus positions them as the logical network of providers on which to build a health care system for the future. In addition, APRNs, such as nurse practitioners and clinical nurse specialists, are increasingly in demand to meet the broad health care needs of Medicare beneficiaries. An IOM report on the role of nursing staff in hospitals and nursing homes released last January found that "more advanced, or more broadly trained, RNs will be needed in the future.....Such training is essentially like that now provided for RNs who receive certification as, for example, advanced practice registered nurses." ANA strongly supports the IOM finding that there is an increasing demand for APRNs. This demand reflects the findings in a number of studies that document the effectiveness and affordability of APRNs in providing primary and preventive health services. For example, in a 1993 meta-analysis assessing the effectiveness of nurse practitioner care when compared to physician care, nurse practitioners were found to provide more health promotion activities and scored higher on quality of care measures than physicians. Due to the restrictive policies of Medicare, however, no funds are currently available to support clinical training of APRNs in hospital or other training sites, which excludes 90 percent of all nursing education programs. For example, of all teaching hospitals receiving Medicare GME payments, only about a quarter of them receive any Medicare payments for nursing education. Since hospital-based nursing programs do not provide baccalaureate or masters degrees for nurses, Medicare is not supporting the kinds of programs that are necessary to meet the needs of Medicare beneficiaries. In order to meet the needs of the Medicare beneficiaries, allocation of the trust fund among the eligible health professions should be similar to the current allocation of Medicare direct GME payments. Currently, 11 percent of GME funding is allocated to eligible nursing programs. ANA believes that it would be more appropriate to redirect up to 20 percent of GME funds to graduate nurse education. ANA calls for an adequate transition period so that diploma nursing programs that would no longer be eligible for GME funding have the opportunity to develop new partnerships or make alternative plans. Malone closed her testimony by noting that a need exists for additional data on the requirements for the health professions taking into account the potential for increased collaborative and independent practice by APRNs and physicians. "Work force planning cannot be based exclusively on a physician model -- new delivery systems are already making broader use of an array of health professionals working within a managed care environment. The collection and analysis of data on work force trends will be important in ensuring that public resources are supporting the educational programs that most appropriately meet the needs of our patients." ANA's testimony was endorsed by the American Association of Colleges of Nursing, the American Association of Operating Room Nurses, and the Emergency Nurses Association. Also testifying at the IOM Committee meeting were representatives from the following organizations: American Association of Health Plans, Association of American medical Colleges, American Hospital Association, American medical Association, American Osteopathic Association, Association for Physicians Assistants, National Association of Community health Centers, and national Association of Public Hospitals. Copies of ANA's written and oral testimonies are available by calling 202-651-7028 or 202-651-7023.
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