August 2013

Volume 10, Issue 5

HEADLINES

NLN Advocates for Title VII and VIII Funding
Senate Confirms Tavenner as CMS Administrator
Senate Health Chairmen Retirements Could Prompt Policy Changes
FROM THE STATES . . .

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LINKS

NLN Government Affairs Action Center
NLN Public Policy

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NLN Advocates for Title VII and VIII Funding

The NLN Public Policy Committee along with NLN president Judith A. Halstead took to Capitol Hill on June 4. During the meetings with their congressional delegations, committee members advocated for increased funding for Title VIII Nursing Workforce Development Programs and for the Health Professions Programs under Title VII of the Public Health Service Act. Armed with data, NLN members took on the role of nurse advocates. In their visits, they noted that: Title VIII - Nursing Workforce Development Programs

• The NLN supports a budget of $251.099 million in FY 2014 for the Nursing Workforce Development Programs and $20 million for Nurse-Managed Health Clinics (NMHC).
• Our health care system is integral to the US economy. With a spending level of $2.7 trillion in 2011, it constitutes the largest share of the nation's gross domestic product (GDP), growing from 8.8 percent of GDP in 1980 to 17.9 percent of GDP in 2011. It is virtually the only sector that added jobs to the economy on a net basis since 2001.
• With more than 3.662 million active, licensed RNs in 2013, nurses represent the largest occupation of all health care workers in the United States and provide 85 percent of the health care delivery.
• The Bureau of Labor Statistics (BLS) reports that employment of RNs is expected to grow 26 percent from 2010 to 2020. During this time, the system is projected to generate 711,900 new RN jobs.
• The April 5, 2013, BLS Employment Situation Summary — March 2013 reported that while the nation's overall unemployment rate was little changed at 7.6 percent for March 2013, the employment in the health care industry increased in March with the addition of 23,400 jobs, amounting to a full 26 percent of all jobs added in the month. The BLS shows nursing as the predominant occupation in health care, and notes that health care is at the center of the economic recovery, growing even when the recession began in December 2007; health care jobs are up nationwide by 10.5 percent.
• NLN research on America's nearly 60,000 nurse educators shows that a core cause of the faculty deficit is an aging and overworked faculty who earn less than nurses entering clinical practice and less than holders of advanced degrees in other academic disciplines. In 2010-2011, 55 percent of nurse faculty said they were likely to leave academic nursing in the next 10 years.

Title VII - Health Professions Programs

• The NLN is supporting a FY 2014 budget of at least $269 million for Title VII Health Professions Programs.
• Title VII education programs fill the gaps in the workforce not met by traditional market forces, such as the gap in health coverage in the 14,411 government-designated rural and urban Health Professional Shortage Areas.
• A report by the Institute of Medicine characterized the HRSA health professions programs as an "undervalued asset" and recommended that Congress "invest in programs with proven effectiveness."

Nurse-Managed Health Clinics (NMHCs)

• A shortage of primary care providers exists and will continue to grow over the next decade. With the recent growth of NMHCs, APRNs have demonstrated their flexibility as they practice in both primary care and specialty areas.
• NMHCs deliver comprehensive primary health care services, disease prevention, and health promotion in medically underserved areas for vulnerable populations. While providing access points in areas where primary care providers are in short supply, an expansion of NMHCs also increases the number of structured clinical teaching sites available to train primary care providers.

Senate Confirms Tavenner as CMS Administrator

On May 15, the Senate voted 91-7 to confirm Marilyn Tavenner, MHA, BSN, RN, as administrator of the Centers for Medicare & Medicaid Services (CMS), making her the first Senate-confirmed CMS administrator since 2006. The seven senators who voted against the nomination were minority Leader Mitch McConnell (R-KY), Mike Crapo (R-ID), Ted Cruz (R-TX), Ron Johnson (R-WI), Mike Lee (R-UT), Rand Paul (R-KY), and James E. Risch (R-ID).

Tavenner, who has served for more than a year as acting CMS administrator, was widely praised by lawmakers and provider groups. As the head of CMS, she is responsible not only for Medicare and Medicaid, but also for implementing the insurance reforms and marketplaces, or exchanges, included in the Affordable Care Act.

Prior to assuming her CMS leadership role, Tavenner served for four years as Virginia's secretary of health and human resources. Before that, she was an executive with the Hospital Corporation of America.

The NLN, as part of Tri-Council, actively supported Tavenner's confirmation.

Senate Health Chairmen Retirements Could Prompt Policy Changes

With the coming retirements of three Senate Democrats who are key on health issues — Senators Max Baucus (D-MT), Tom Harkin (D-IA), and John D. Rockefeller IV (D-WV) — safety-net advocates are beginning to assess the potential impact of their departures on US health care policy. Over the past three decades, these senators have been pivotal players in creating, expanding, and preserving many of the nation's health and safety-net programs.

Baucus chairs the Senate Finance Committee, which has jurisdiction over Medicare, Medicaid, and tax policy; Harkin chairs the Senate Health, Education, Labor, and Pensions (HELP) Committee; and Rockefeller chairs the Senate Finance Health Subcommittee. While health program advocates voice regret over their departures, they express confidence that the senators in line to succeed them — assuming Democrats retain control of the Senate in 2014 — will not abandon current policies, although the new committee chairs could bring a different policy focus.

Based strictly on seniority, Senator Ron Wyden (D-OR) would succeed Baucus at Finance, Senator Barbara Mikulski (D-MD) would follow Harkin at the HELP Committee, and Debbie Stabenow (D-MI) would succeed Rockefeller at the Finance Health Subcommittee.

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FROM THE STATES . . .

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The Quiet Before the (Shortage) Storm in Michigan

In 2007, warning of a nurse shortage in Michigan and long admission waiting lists for nursing schools, then-Governor Jennifer Granholm proclaimed: "Something's wrong with this picture and we are going to fix it." Six years and millions of dollars later, renewed warnings of impending nursing shortages exist. Faculty hiring bottlenecks persist at the nursing schools that could turn out more nurses. As they retire, aging nursing faculty are poised to leave more teaching vacancies.

At the moment, however, Carole Stacy, director of the Michigan Center for Nursing, believes there are enough nurses in Michigan to meet demand. In her view, job postings in hospitals and elsewhere that are going unfilled are often due to specific credential requirements, as opposed to a general shortage of qualified candidates. But with thousands of Michigan nurses in their 50s and 60s that could soon change - one in three RNs is approaching retirement age.

Nevada Governor Signs APRN Bill

On June 4, Nevada Governor Brian Sandoval (R) signed Assembly Bill 170 into law, giving APRNs full practice authority and expanded prescriptive authority. With the passage of this legislation, Nevada becomes the 17th state along with the District of Columbia allowing APRNs (nurse practitioners, nurse midwives, nurse anesthetists, and clinical nurse specialists) to practice to the full extent of their education and training.

Like many other states, Nevada faces a troubling shortage of health care providers. A 2011 study by the Nevada State Office of Rural Health found that the 281,000 residents of rural Nevadan counties were served by only 215 medical doctors, two licensed psychiatrists, and 1,350 registered nurses. This legislation is meant to provide more Nevadans with access to high-quality health care.

California Senate Approves Scope of Practice Legislation

The California State Senate passed SB 491 by a vote of 22 to 12 on May 28. The proposed legislation would remove barriers to practice for nurse practitioners in California, allowing them to work autonomously without physician supervision. This would help address California's primary care shortage, providing better access to health care for millions of residents. SB 491 now moves to the California State Assembly for consideration.

Illinois Doctors Block Expanded Scope of Practice Bill

With demand expected to surge under health care reform, nurses, dentists, and psychologists asked the Illinois Legislature this spring for more authority to make medical decisions, but lawmakers sided with doctors and turned them down. It was a resounding victory in Springfield for the Illinois State Medical Society (ISMS), which has represented doctors in a longstanding turf battle over how to address a growing shortage of medical services in rural and low-income urban neighborhoods across the state.

Nurses and other medical providers argued they could help ease the burden if given more control, but in lobbying hard to defeat those proposals, the ISMS argued they lacked proper qualifications. "From the position of safety, we want to make sure no one is practicing beyond their abilities," said ISMS president Eldon Trame. According to Trame, the ISMS supports a team approach with doctors and nurses working together to address the primary care shortage.

In one-fifth of Illinois counties, widespread shortages of primary care doctors exist. Another 200 pockets of Illinois also have shortages, in both urban and rural areas. It would take nearly 1,000 new primary care doctors, to bring all those areas of Illinois up to a healthy supply.

APRNs wanted the right to practice independently, without a written agreement with a doctor, but met opposition from the medical society. Sue Clark, a lobbyist for two Illinois nurses' organizations, said lawmakers were at first willing to sign on as co-sponsors to the bill. As she lobbied for the measure, Clark said, many lawmakers, who had said they would co-sponsor, later told her they were no longer able to help. "I'd say, 'What happened?' and they'd tell me, 'The medical society came in and asked me not to sign.'"

That forced a compromise. A negotiated bill passed the Legislature that will make it easier for nurses to set up written agreements with physicians, for example, allowing a nurse to set up an agreement with a doctor anywhere in Illinois. But the nurses were not able to eliminate the written agreement entirely.

The ISMS also worked against bills that would have set up state licensing requirements for direct-entry midwives, colon hydrotherapists, and naturopaths.