Nurse Reinvestment Act - Research Paper Example

BILL OF NURSING REINVESTMENT ACT ENVIRONMENT THAT BROUGHT SHORTAGE OF NURSES TO THE FOREFRONT "Nurses are the linchpins in providing high-quality patient care in hospitals" (Hassmiller, S. B. & Cozine, M. 2006) The shortage of nurses gave birth to NRA. The enrolments in nursing school decreased in the late 1990's. and the nurses left the field due to stressful work environment and concerns about quality of care. By 2000, the nursing shortage worsened due to aging of work force and thus there was an increase in the demand for registered nurses. "The current shortage is the product of several trends including: steep population growth in several states, a diminishing pipeline of new students to nursing, a decline in RN earnings relative to other career options, an aging nursing workforce, low job satisfaction and poor working conditions that contribute to high workforce attrition rates, and an aging population that will require intense health care services." (Gerson, J & Oliver, T. 2008). "Patients who have common surgeries in hospitals with the worst nurse staffing levels have an up to 31% increased chance of dying. More nurses at the bedside could save thousands of patient lives each year, as reported today in The Journal of the American Medical Association. The Penn researchers found that every additional patient in an average hospital nurse's workload increased the risk of death in surgical patients by 7%. Patients with life-threatening complications were also less likely to be rescued in hospitals where nurses' patient loads were heavier. The findings impact the national legislative agenda. More than 20 states have enacted or are considering nurse-staffing legislation." (Mcintyre, J. 2002, Oct 23/30) The House of Representatives and Senate Of United States has passed on Dec 20 passed separate versions of legislation which is done in favor of nurses by increasing their number, student community and nursing school faculty over the coming five years. The Senate's bill, named as The Nurse Reinvestment Act (NRA) (S.1864), had programs for lending scholarships and loan repayment programs for nursing students and nurses pursuing additional clinical training or graduate degree. The Bill also provides funding for national, state, and local advertising campaigns that encourage careers in nursing. The Senate's bill, The Nurse Reinvestment Act (NRA), would create scholarships, stipends, and loan repayment programs for nursing students and nurses pursuing additional clinical training or graduate degrees. Upon graduation, some of these programs would require an individual to work (for a specified length of time) in an area or facility with a nursing shortage. The Senate bill would also authorize funding for national, state, and local advertising campaigns that encourage careers in nursing. "The goal for this issue is to strengthen AORN's relationship with other specialty nursing organizations as well as highlight perioperative RN objectives through increased visibility in the nursing community and by supporting the Nurse Reinvestment Act. Support of the Nurse Reinvestment Act was added to AORN's legislative priorities in August 2002, just as the bill was passed by wide margins in both the US House of Representatives and the Senate and before it was signed by President Bush." (Beu, B. 2004, April) There are provisions for granting of nursing schools, health care facilities, community based joint venture to support continuing education programs, internships and specialty training for new as well as experienced nurses in S. 1864. A 2 year grant is intended to be given to nursing schools to identify "best practices" and develop innovative retention strategies and the awards would be based on a facility's size, with large hospitals with over 400 beds with an amount up to $600,00 in support. A "National Commission on the Recruitment and Retention of Nurses" is to be created as a two year program. "Sens. Mikulski and Tim Hutchinson, R-Ark. had introduced an earlier nursing bill in April 2001: The Nursing Employment and Education Development Act NEED. In November, the Senate Health, Education, Labor, and Pensions Committee passed the NEED Act, as well as a bill introduced by Sen. John Kerry D-Mass. S.1597. Many of the provisions in S.721 and S.1597 were included in the NRA." (Mitchell, C. 2002, Jan 11) Other NRA provisions had appeared in nursing bills that had been introduced by Sens. Joseph Lieberman and Hilary Clinton. "The Nurse Reinvestment Act, commonly referred to as the NRA, is legislation that amends the existing Title VIII of the Public Health Service Act - the nursing education legislation. This legislation was passed to address the growing nursing shortage resulting from the aging nursing workforce, retention problems due to a stressful work environment, and problems recruiting young people into nursing." (Glazer, G., Doheny, M., Geolot, D. March 30, 2004) The nursing education and practice comes under the provision of Title VIII legislation. Nowadays, it focuses on improving the basic and advanced nursing work force. HISTORY OF NRA The nursing became more visible in the media and the Congress came to be involved in the nursing work force issues. These lead to the introduction of several bills in the Congress, including the Representatives Lois Capps, Senator Kerry and Senator Hutchison. Atlast, conference talks between the House and Senate paved the way for the passage of Nurse Reinvestment Act, Public Law 107-205 signed by President bush in August 2002. In both the House and Senate leadership, there was strong bipartisan support for this legislation. Many individuals including Representatives Bilirakis and Cappsand Senators Mikulski, Collins, Gregg, Kerry, Jeffords, Frist and Hutchison, played important roles in the passage of this legislation. Also, nursing organizations and health care community played its part in formulating this legislation. The different nursing organizations which gave active support for this legislation are The American Nurses Association, American Organization of Nurse Executives, the National League for Nursing and the American Association of College of Nursing. But, one of the challenges is the competing interests regarding the funding of legislation. When the NRA was passed in 2002, it demanded funds which must be appropriated to carry out the specific activities. The appropriation process is signed by the President after submitting the plan by the Congress in an yearly basis. There were competing interest which have difference of opinion about the funding with national security and the economy. An amendment was added in the economic year 2003 by Senator Mikulski to the appropriation bill to fund parts of NRA. A recommendation was given by a joint House and Senate Conference in the year 2004 to add $30 million for Title VIII and the NRA components. When the NRA passed in August 2002 it authorized new types of activities that could be started under the Title VIII legislation. Once legislation is passed, funds must be appropriated to carry out the specific activities. The appropriation process is handled separately by Congress on a yearly basis and then signed by the President once he agrees with the appropriation level and plan. Often, there are differences in opinion on what should be funded - competing interests, as you suggest, with national security and the economy overall. In fiscal year 2003, Senator Mikulski added an amendment to the appropriation bill to fund parts of the NRA. The appropriation level for fiscal year 2004 recommended by a joint House and Senate Conference Report recommends an additional $30 million for Title VIII and the NRA components POLICY GOAL This legislation gives many provisions for the staff nurses. First, grants are provided for internships and resident programs which would give some additional exposure and experience. There are also programs for returning nurses who were out of the nursing field for a while and who want to rejoin and rework in this field. Residency programs are there for those who are changing from one role to another. "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" (Miller, J. 2004) For nurse educators, there is one Nurse Faculty Loan Program in which an agreement is established with a school of nursing which receives the money and then gives the loan to the person who is interested to become a teacher. This loan has also a cancellation provision by which the loan will get cancelled for every year the person works in a school of nursing in a faculty role, and thus 85% of the loan be cancelled by working a s a full time faculty member. The Nurse Faculty Loan Program was specifically planned to make up the Faculty shortage and also there is the whole advanced education nursing grant section which are grant given to schools of nursing for advanced education programs, including master's and doctoral level programs. In addition to support for advanced education, funds are provided fro traineeship support for individual student support at the graduate level. EFFECTS ON PROVIDERS OF CARE Another interesting feature of this part is the grant provided for enhancing patient care delivery system. The grant is provided in order to implement some of the organizational characteristics which have been successful in the magnet hospitals with the help of nursing involvement in patient care, decision making, team work hours or work environment. These grants try to retain nurses in the work place and thus improve the quality of care. POLICY GOAL ACHIEVED IN A STATE "New Mexico has created a Nursing Excellence Program and Fund to identify strategies to enhance recruitment and retention of professional nurses, set standards, and increase career and educational opportunities. Legislation also mandates improved interactions between health facilities' administrators, the medical professions, and institutions of higher education. Additional legislation enacts the Nursing Licensure Compact, to encourage the cooperation of participating states in the areas of nurse licensure and regulation." (Bailey, S. 2003, June). SUGGESTIONS It is very important to develop strategies to elevate the image of the nurses rather than unnecessarily conducting advertising campaigns for the nurses. University of Maryland school of nursing now takes initiatives to partnering with Gilden Advertising in services and to launch an integrated marketing plan to recruit more student into nursing. "What I would suggest is that nurses work through their member nursing organizations. The nursing organizations are very active in raising issues related to the nursing workforce and spend considerable time educating their local politicians and members of Congress about the needs." (Glazer, G., Doheny, M., Geolot, D. March 30, 2004) REFERENCES Bailey, S. (2003, June). Registered Nursing Shortages: Public Policy, and Higher Education in the Western States. Policy Insights. WICHE. Retrived 23 July 2008 from http://www.wiche.edu/Policy/PolicyInsights/Nursing2003/Nursing.pdf Beu, B. (2004, April) A Strategic view of AORN's federal legislative issues. AORN Journal. BNET Business Network. Retrieved on 24 July 2008 from http://findarticles.com/p/articles/mi_m0FSL/is_4_79/ai_n6074244 Gerson, J & Oliver, T. (2008). Addressing the Nursing Shortage. KaiserEDU.org. [Online] Retrived 24 July 2008 from http://www.kaiseredu.org/topics_im.aspid=138&imID=1&parentID=70 Glazer, G., Doheny, M., Geolot, D. (March 30, 2004). Legislative: "Nurse Reinvestment Act: Implications for the Nursing Profession: Discussion with Denise Geolot." Online Journal of Issues in Nursing. Retrived 23 July 2008 from www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Legislative/ReinvestmentActDiscussion.aspx Hassmiller, S. B. & Cozine, M. (2006). Addressing the nurse Shortage to Improve the Quality of Patient Care. Health Affairs. 25.(1) p. 268-274. Retrived 23 July 2008 from http://content.healthaffairs.org/cgi/content/full/25/1/268 Mcintyre, J. (2002, Oct 23/30). Nurse Staffing and Patient Mortality. Journal of American Medical Association. 10-22-02.pdf Retrieved 24 July 2008 from http://www.nursing.upenn.edu/news/pdf/PennNursing_JAMA_10-22-02.pdf Miller, J. (2004) Acting Now. John Hopkins Nursing, 2(2) [Online] Retrieved 23 July 2008 from http://www.son.jhmi.edu/JHNmagazine/archive/fall2004/pages/fea_2.html Mitchell, C. (2002, Jan 11) Nursing Shortage Addressed by House and Senate Bills. AAMC. Retrieved 23 July 2008 from http://www.aamc.org/advocacy/library/washhigh/2002/011102/_5.htm Read More