Building and supporting a quality health care system accessible to all is justified by the following:

• In 2007, the United States spent a total of $2.2 trillion on health care, about $7,421 per person, nearly twice the per capita cost of other industrial nations, and yet the United States has worse health outcomes — shorter lifespan and higher infant mortality — than other developed nations.
• In the last two years, approximately 87 million people were uninsured at some point, and nearly 160 million workers with employer-based health insurance are poised to lose coverage.
• The US economy lost as much as $207 billion in 2007 due to the poor health and shorter lifespan of the uninsured.
• When the uninsured cannot pay for the health care needed, health care providers shift costs to those who can pay. A recent study estimates that in 2009, premiums for family coverage were 8 percent higher — a national average of $1,100 — owing to the cost shift from the uninsured.
• Disparity in health status — shorter life expectancy, higher rates of chronic health conditions, and disability — exist in communities and populations throughout the nation. According to the Agency for Healthcare Research and Quality, disparities also are observed in most aspects of health care, including care for chronic conditions such as mental health disorders and substance use, HIV/AIDS, cancer, diabetes, heart disease, oral health conditions, infant mortality and morbidity, respiratory disease, and end stage renal disease.
• Delivering a cost-effective health model of coordinated care, health promotion, and consumer education and empowerment requires effective learning from well-prepared nurses, the predominant profession in health care, and the profession that relies on educating patients and communities and is guided by a holistic philosophy of care.

President Obama released his proposed budget for FY 2010 on May 7, 2009. To the welcome surprise of those nursing organizations that have DC-based advocacy programs, the president’s proposed budget would allocate $263.4 million for the Title VIII programs, which are currently funded at $171 million. The two programs that would receive the increase are the Nursing Faculty Loan Program and Nurse Education Loan Repayment & Nurse Scholarships.

Arkansas Expands Nurse Loan Program

Through Act 9 — passed by the Legislature this session, signed into law February 3 by Governor Mike Beebe (D), and immediately effective — Arkansas now provides nursing student loans of up to $20,000 a year. In addition, the program has been extended to include nurses seeking postgraduate degrees to qualify them as nurse educators. Previously, the Nursing Student Loan Program limited the loans to $6,000 and was available only to students in RN or LPN programs.

Representative Tracy Pennartz (D-Fort Smith), who spearheaded the legislation, said she learned from Arkansas Nursing Board Executive Director Faith Fields that the lack of qualified nurses to fill nursing school educator positions is contributing to the state’s nursing shortage. Therefore, she suggested revamping the loan program to include educating faculty.

Carolyn Mosley, dean of the University of Arkansas at Forth Smith (UAFS) College of Health Sciences and a member of the NLN Board of Governors, also was instrumental in bringing the issue to the forefront. When the Legislature’s Health and Safety Committee met at UAFS, Mosley testified about the difficulty in recruiting faculty. In her testimony she said, “Arkansas is in a unique situation because few people are available because there are few nurses with degrees above associate degrees, and at a minimum, a master’s degree is required for teaching, and preferably a doctorate.” Mosley noted that UAFS has more applicants than it can accept into its nursing program due to limited faculty. She praised the loan program’s expansion, saying it “. . . will enable us to train more educators so we can increase enrollment.”

Under the program’s loan terms, students will have their loans forgiven at the rate of one year’s loan for each year they work in Arkansas as a nurse or in a state nursing education program. The loan program is administered by the Arkansas State Board of Nursing and funded through state and federal appropriations, gifts, grants, bequests, and donations.

Nurse Education Bill Introduced in Ohio

On April 2, Ohio State Senator and RN Sue Morano (D-13) introduced a Comprehensive Nurse Education bill to address the state’s shortage of nursing educators. Incorporating recommendations of the General Assembly’s Nursing Education Study Committee, chaired by Morano, Senate Bill 89 directs the Ohio Board of Regents to encourage universities to share ideas about how best to recruit instructors and to funnel more money to help nurses wanting to teach pay for advanced degrees. The bill also changes requirements for APRNs. The bill does not address the pay of nursing faculty in Ohio (the average annual salary of an entry-level nursing professor is $50,000), but Morano said the Legislature cannot force schools to pay higher salaries. She said that, even with lower salaries, better marketing could make the teaching profession more attractive, and added, “I believe this bill is a big step in the right direction for solving a nursing education crisis.”

Rhode Island Proposes Tax Credit for Nurse Educators

A special legislative commission in Rhode Island formed in May 2008 has come up with a proposal designed to counter a looming shortage of nurses in the state. To retain/recruit nursing faculty and thereby expand the number of nursing school graduates, the commission recommends that the state’s nurse educators be given a $3,500 tax credit annually.

At a news conference unveiling the proposal on April 22, commission members cited projections indicating that Rhode Island will have a shortfall of 1,800 RNs by next year growing to 6,500 by 2020. They stressed that the state’s nursing schools cannot handle the demand. For example, in 2004, nearly 3,900 people applied to nursing schools in Rhode Island, but only 737 were accepted. According to the commission’s report, “Most of the schools of nursing reported faculty shortages as the primary reason why they cannot admit more nursing students.”

Despite its conclusion that the state’s faculty shortages are due to low pay, the commission opted to recommend the tax credit rather than an increase in school salaries. An increase, commission leaders said, would not be practical because, first, the state is in the midst of a budget crisis. Second, according to commission co-chair Senator James E. Doyle (D-Pawtucket), contractual issues at state nursing schools would prevent nursing faculty from receiving larger pay hikes than those teaching other disciplines.

Doyle acknowledged that, if the tax credit is passed, the state could lose as much as $500,000 a year in revenue. However, he added, that would be offset by the economic benefits to health-care facilities that hire the graduates, saving millions of dollars in overtime pay, recruitment costs, and temporary help.

In addition to the tax credit, the commission recommends that in subsequent years the state should give priority to nursing programs, including the expansion, replacement, or renovation of existing facilities. The benefits accruing from the commission’s recommendations are described in its report as follows: “Increasing funding and nursing educational capacity within Rhode Island is a win-win for all — the state economy gains knowledge-based, better-paying jobs which add significantly to the tax base, and the increasingly aging population of Rhode Island receives quality, efficient, and potentially less costly health care with the full inclusion of an educated nursing workforce.”

Because the nurse shortage figures cited by the commission at its news conference raised a number of questions from nurses, particularly new graduates, who are having trouble finding work, the panel spent a good part of its conference explaining why local hospitals are not hiring. In essence, the commission members blamed the economy — the current lack of jobs for new graduates represents an anomaly that will change once the economy turns around.