Nursing Education
Background
Legislative initiatives related to nursing education include efforts to recruit and retain nurses as well as support competence and quality care.
Recruitment/Retention
The growing nursing shortage is impacting every aspect of the U.S. healthcare delivery system.
Absent aggressive intervention, the Health Resources and Services Administration (HRSA) projects that by 2020 the shortage will grow to more than 1 million RNs—representing a shortage of 36 percent.
The Bureau of Labor reports that nursing will have the second greatest job growth of all U.S. professions in the time period spanning 2004–2014, which has led to a renewed interest. However, in FY 2007, HRSA turned away 96% of qualified applicants for the nursing scholarship program due to inadequate funding. http://bhpr.hrsa.gov/nursing/scholarship/
Several states have introduced legislation to address nursing education, much of which has included appropriations to either create a new nursing education program or to expand capacity of an existing program, or to provide funds for nursing scholarships and/or loan forgiveness to qualified candidates.
Despite the renewed interest, it has been reported that applications to RN programs have fallen; the drop believed to be the result of widespread awareness of the difficulty of gaining entry to nursing school, fueled by the continuing shortage of nurse faculty. By all indications, if unmet demand for placement persists, with 88,000 qualified applications—one in three of all applications submitted—will be denied. Baccalaureate degree programs turned away 20 percent of its applicants, while associate degree programs turned away 32.7 percent. (2008) www.nln.org/newsreleases/data_release_03032008.htm
As a result of the reduced access to schools, some states designate funds specifically to entice nurses to become faculty.
Sample enacted nursing education funding initiatives (2007-08) some of which is still in effect for FY09 Nursing Education Appropriations.
2009 Nursing Education Funding Introductions
- AL (HB50) provides for an increase in graduate degree scholarship funding for RNs with the agreement of payback by practicing two years in AL.
- AK (HB58) An Act relating to a student loan repayment program for specified occupations or fields in which a shortage of qualified employees exist such as registered nursing.
- AR (HB1022) An act to authorize additional funding for the nursing student loan program and to promote teaching in nursing education programs.
- CT (SB4) An act concerning scholarship funding for nurses pursuing advanced degrees and (SB11) establishes a loan forgiveness program that encourages nurses to obtain advanced degrees in order to qualify for nursing educator positions at the state's colleges and universities.
- MO (SB152) expands those eligible to receive funds through the nursing student loan program to include both full and part time doctoral nursing students.
- MT (SB224/LC1840) Creates a loan reimbursement program for nurses employed in state institutions.
- NY (AB1035/SB388) Provides for the award of regents scholarships and loan forgiveness for nurses on the same terms as physicians.
- OK (SB310) Creates the Oklahoma Health Care Workers and Educators Assistance Program which establishes a program to award scholarships contingent on availability of funds to nursing students and other healthcare workers.
2008 Nursing Education Funding Introductions (Still alive)
- SC (HB3014) Provides that not less than fifteen million dollars of cigarette license tax revenues must be appropriated annually to the state board for technical and comprehensive education for the allied healthcare initiative and not less than ten million dollars must be appropriated to the commission on higher education for the critical needs nursing initiative fund; and that the balance of the revenue must be appropriated annually to the nursing education scholarship fund for the purpose of providing scholarships covering tuition, fees, and books for instate students enrolled in two year and four year nursing programs at public institutions of higher learning in this state.
- TX (SB290) Creates the health professional education grant program to which nursing education programs may apply for support.
- UT (no number assigned) Health, Health Care Providers, Health Care Workforce Financial Assistance Program; the details of which are unavailable at this time.
- WY (HB128) WYIN-nurse repayment ACT provides that certain Wyoming nursing loans may be repaid by practicing as a nurse in Wyoming and (SB23) establishes an education loan repayment program for students with baccalaureate degrees in other disciplines who wish to pursue the accelerated program for baccalaureate degrees in nursing at the University of WY.
Competence/Quality Care
Nursing Education Advancement—What Is It?
There are four nursing education programs leading to eligibility to sit for the licensing exam for authority to practice as a registered nurse: (1) hospital-based diploma, (2) hospital-based or community college associate degree, (3) bachelor’s degree, and (4) master’s degree; the latter (#4) is a less common entry point.
State legislative initiatives and action taken during the 2008 American Nurses Association’s (ANA) House of Delegates has resulted in a renewed discussion related to nursing education and a different approach to advancement.
The 2008 ANA House of Delegates RESOLVED, that the American Nurses Association support initiatives to require registered nurses (RNs) to obtain a baccalaureate degree in nursing within ten years after initial licensure, exempting (grand-parenting) those individuals who are licensed or enrolled as a student in a nursing program at the time legislation is enacted; and be it further RESOLVED, that the American Nurses Association advocates for and promotes legislative and educational activities that support advanced education in nursing. ANA’s efforts to influence nursing education date back to 1965.
Brief History of ANA’s Position on Nursing Education
Passage of the Comprehensive Nurse Training Act in 1964 prompted the American Nurses Association (ANA) Committee on Education to study nursing education, practice and scope of responsibilities. At the time, the study recognized the increasing complexity of health care and changes in practice, raising concerns about hospital - based diploma education programs. Subsequently, in 1965, the ANA Board of Directors adopted the Committee on Education’s statement, which became ANA's “position paper” and contained the recommendation that the “minimum preparation for beginning professional nursing practice should be baccalaureate degree education in nursing. The position paper noted that the educational programs of the time prepared workers for current practice and structures, not for the future. Also contained within the position paper was the description of three levels of nursing education: baccalaureate education for beginning nursing practice, associate degree education for beginning technical nursing practice, and vocational education for assistants in the health service occupations.
The 1965 ANA position paper was later reaffirmed by a 1978 ANA House of Delegates resolution which resulted in the recommendation that by 1985 the minimum preparation for entry into professional practice would be the baccalaureate degree. The designation of two levels of nursing practice, professional and technical, was reaffirmed. What was envisioned to be an orderly transition to an educational system of two levels and subsequent differentiated practice never occurred.
Practice has continued to evolve with increased specialization, greater demands related to technology, paperwork, and responsibility for coordinating and supervising care provided by other workers. Declining reimbursement rates have had a great influence on staffing patterns. Nurse positions have been eroded with nurse extenders (assistive personnel) filling positions previously designated for nurses; leading to fewer nurses supervising more assistive personnel in provision of care for increasingly complex patients.
Why Seek Legislation Or Regulations That Would Require A Nurse To Attain A Baccalaureate Degree In Nursing Within Ten Years Of Initial Licensure?
This approach continues to recognize all educational entries into the profession while acknowledging the changing healthcare environment and associated competencies necessary to adapt to those changes.
An incremental approach permits those choosing to enter the profession with a diploma or associate degree to pursue additional skill sets while strengthening entry level competencies: moving from novice to expert.
Nursing education advancement with work experience can result in greater relevance for the learner.
Baccalaureate nursing education is intended to result in a deeper understanding of the cultural, political, economic, and social issues that affect patients and influence health care delivery. Coursework offered at the baccalaureate level include such areas as healthcare economics, health informatics, health policy, leadership, and research.
It is also known that….
- Research has revealed the relationship between advanced education and patient outcomes, such as lower patient mortality.
- Baccalaureate prepared nurses are more likely to report higher job satisfaction scores in relation to opportunities for growth, and to remain in practice longer than others.
- Increasingly more complex healthcare needs of a multi cultural and aging population underscores the need for advanced education.
- A stronger theoretical base and foundation in nursing research is needed as a result of the shift to evidenced based practice and expansion of more sophisticated technologies, pharmacologic and other treatment modalities.
- Sound leadership skills are essential for case management, as well as to support the ability to delegate and supervise care provided by dependent practitioners (LPNs) and nurse extenders within the framework of varying care delivery models.
- There is a shortage of nursing faculty and subsequent limited cadre of nurses from which to draw.
- Advanced education will better enable nurses to practice as full partners on a multidisciplinary team, given the education advancement of a number of other health professions: Social workers - master’s degree; Physical therapists – master’s degree in 2002, doctoral required by 2020; Pharmacists – PharmD has replaced the bachelor of pharmacy degree.
- The military (US Army, Navy and Air Force) require a baccalaureate degree for nurses on active duty. The Veteran’s Health Administration requires a baccalaureate degree for nurses wishing to advance beyond entry level appointment. Internationally, the baccalaureate degree in nursing is required upon entry into the profession in the Philippines, Australia, Ireland, and half of Canada’s provinces. The Royal College of Nurses voted to support a transition to require a university degree for professional nursing practice.
- A recommendation that at least 2/3 of the nursing workforce hold a baccalaureate degree or higher by 2010 was presented to Congress by the National Advisory Council on Nursing Education and Practice (a group appointed by the Secretary of Health and Human Services)
2008 Legislation requiring nursing education advancement resulting in a BSN was introduced:
Advanced nursing education tool kit: briefing paper, strategic action plan; model bill and talking points is now available to members.
Mandatory Continuing Education
Another approach used to support nursing competence and quality care is mandatory education for RNs for license renewal/re-registration.
Updated 4/23/09
Disclaimer: Every effort has been made to include all legislation enacted, but omissions are possible.