NCC Response to Senate HELP Committee Request for Information on Workforce Issues
March 20th, 2023
The Honorable Bernard Sanders
Chairman
Health, Education, Labor, and Pensions Committee
United States Senate
Washington, DC 20510
The Honorable Bill Cassidy
Ranking Member
Health, Education, Labor, and Pensions Committee
United States Senate
Washington, DC 20510
Dear Chair Sanders and Ranking Member Cassidy:
On behalf of the 63 undersigned organizations representing the Nursing Community Coalition (NCC), we applaud your efforts to address health care workforce needs and appreciate the opportunity to provide solutions to support our current and future nurses. The NCC is a cross section of education, practice, research, and regulation within the nursing profession. Together, we represent Registered Nurses (RNs), Advanced Practice Registered Nurses (APRNs),1 nurse leaders, students, faculty, and researchers. As the largest segment of the health care profession,2 nursing is involved at every point of care, including rural and underserved areas, is at the frontlines of public health challenges, and lead the way to ensure today’s science translates to tomorrow’s cures. Our nurses are working in community health centers, hospitals, long-term care facilities, local and state health departments, schools, workplaces, and patients’ homes. As we outline our current realities, the NCC strongly supports consideration for the following proposals to ensure nurses may continue to provide high-quality health care to all communities.
Understanding the Landscape: The Current Realities Impacting our Nursing Workforce As highlighted in the Committee’s hearing, “Examining Health Care Workforce Shortages: Where Do We Go From Here?” we all have witnessed the immense impact this Public Health Emergency (PHE) has had on our health care workforce. Nurses continue to feel that impact. In fact, the American Association of Critical-Care Nurses outlined, “92% of nurses surveyed said they believe the pandemic has depleted nurses at their hospitals and, as a result, their careers will be shorter than they intended.”3 The American Nurses Foundation third COVID-19 impact study found that 19% of nurses said they intend to leave their position in the next six months, and 27% are considering leaving.4
National data supports this need, with the Bureau of Labor Statistics (BLS) projecting demand for RNs would increase 6% by 2031, illustrating an employment change of 195,400 nurses.5
Further, the demand for most APRNs is expected to grow by 40%.6 This demand comes as we are already facing an aging nursing workforce with nurses aged 65 and older making up 19% of the profession.7 Given these realities, many look toward nursing education to ensure the pipeline remains strong. However, AACN’s annual survey found that, “the primary barriers to accepting all qualified students at nursing schools continues to be insufficient clinical placement sites, faculty, preceptors, and classroom space, as well as budget cuts.”8
We agree that bold, innovative, and impactful solutions are needed. Now is the time for historic investment in our current and future nursing workforce.
A Path Forward: Ways to Address Nursing Workforce Needs
Invest in Nursing Education: Support our Nursing Schools, Faculty and Students: To ensure a robust and diverse nursing workforce, investing in the education pathways of our future RNs and APRNs is imperative. Upon its reintroduction, the NCC urges the Committee to consider and pass the Future Advancement of Academic Nursing (FAAN) Act. The FAAN Act would provide those vital resources to support the needs of nursing students, help retain and hire diverse faculty, modernize nursing education infrastructure, and create and expand clinical education opportunities. These efforts are essential and will help prepare nursing students as they transition from the classroom to the frontlines in communities across the country.
Further, we appreciate this Committee’s work to reauthorize the Title VIII Nursing Workforce Development Programs (Title VIII of the Public Health Service Act [42 U.S.C. 296 et seq.]) as part of the CARES Act. Funding for these programs remains a necessity. That is why the NCC is urging Congress to provide at least $530 million for these programs in Fiscal Year (FY) 2024.
Support the Nursing Workforce: Ensure Patients have Access to the High-Quality Care Provided by our Nation’s APRNs: From primary and maternal care to acute and chronic care, APRNs provide high-quality care in all settings and in areas throughout the nation, including rural and underserved communities. As of 2020, over 233,000 APRNs treated Medicare patients and approximately 40% of Medicare beneficiaries received care from an APRN.9 Upon its reintroduction, the NCC urges the Committee to consider and pass the Improving Care and Access to Nurses (ICAN) Act. The ICAN Act would remove outdated barriers in the Medicare and Medicaid programs that currently prevent APRNs from practicing to the full extent of their education and clinical training. Removing these barriers on APRNs and Medicare and Medicaid beneficiaries is consistent with recommendations from a broad range of organizations, including the National Academy of Medicine, the National Governors Association, the National Rural Health Association, the Federal Trade Commission, the Bipartisan Policy Center, the Brookings Institution, Americans for Prosperity, and the American Enterprise Institute.
Make Waivers that have Supported our Nation’s Health during this Public Health Emergency Permanent: As we near the end of the PHE on May 11th, we must ensure there is no lapse in the high-quality care our patients have relied upon these past three years. The models of care implemented during these unprecedented times helps inform and improve healthcare throughout the nation. Therefore, we urge Congress to take legislative action to make permanent various waivers so nurses and APRNs can continue to provide high quality health care to patients in all communities, including in rural and underserved areas, now and into the future.
Institute Safety Measures for the Current and Future Nursing Workforce: A culture of safety in care delivery settings, including violence prevention, is an indispensable aspect of a highperforming, high-quality health care system. Resources and investments are needed to build and sustain safe work environments and preventive practices. Funding should be directed toward concrete violence prevention efforts such as abatement of known risks (e.g. with respect to building exteriors and interiors) and establishment of robust ongoing prevention programs.
Invest in Maternal Health Today for a Healthier Tomorrow: From growing and diversifying the perinatal workforce and investing in social determinants of health to supporting mom’s mental health and the nurses who are caring for these patients, legislation such as the Black Maternal Health Momnibus Act and the Midwives for MOMs Act, provide a multipronged approach to addressing the maternal health needs in the United States. We encourage the Committee’s support of these efforts as they are reintroduced this Congress.
Support the Mental Health and Healthy Working Environments for Nurses: Caring for the caretaker has become even more important as we witness the mental stress COVID-19 has had on our frontline workers. In fact, an American Nurses Foundation survey found that 59% of nurses continue to feel exhausted and 52% report feeling overwhelmed.10 Part of this exhaustion among nurses can be attributed to the staffing shortage. In the January 2022 American Nurses Foundation’s Pulse on the Nation’s Nurses Two-Year Impact Assessment found that, “nine-out-of-ten nurses indicated their organization was experiencing a staffing shortage, with 90% classifying it as a serious problem.”11 We appreciate the resources dedicated to health providers’ mental health in the American Rescue Plan Act and through other legislative efforts, but more must be done. We strongly recommend Congress includes mental health resources and funding, specifically for our nation’s nursing students, nurses, and APRNs, in any legislative package moving forward.
Invest in our Public Health Infrastructure: According to a national profile of local health departments, “the estimated number of registered nurses decreased by 36% from 2008 to 2019.”12 This drastic shortage of nurses within our public health system has been brought into stark reality during the COVID-19 pandemic. We must ensure nurses are at the table as we plan for tomorrow’s challenges and create a more equitable system. This includes ensuring nursing students, nurses, and APRNs are incorporated into all aspects of public health infrastructure needs and that our public health departments have at least one nurse or APRN on staff.
Support for Nurse Scientists and Researchers: As one of the 27 Institutes and Centers at the National Institutes of Health (NIH), the National Institute of Nursing Research (NINR) funds research that establishes the scientific basis for quality patient care. With a renewed purpose of addressing social determinants of health, NINR is at the forefront of disease prevention, patient care, and recovery. Our nation’s nurse researchers and scientists are essential to developing new evidence-based practices to care for all patients. That is why the NCC supports at least $210 million for NINR in Fiscal Year (FY) 2024.
From our nursing schools, faculty, and students to our RNs, APRNs, and researchers, we recognize how vital our nursing workforce is to the fabric of America’s health care system. With over four and half million licensed RNs, APRNs, and nursing students, the profession embodies the drive and passion to ensure the health of patients, families, and our country continues to improve.13 Again, we deeply appreciate the Committee’s dedication to addressing health care workforce needs and look forward to working with you this Congress. As these conversations continue, and if our organizations can be of any assistance or if you have any questions, please do not hesitate to contact the coalition’s Executive Director, Rachel Stevenson, at rstevenson@thenursingcommunity.org.
Sincerely,
Academy of Medical-Surgical Nurses
Academy of Neonatal Nursing
American Academy of Ambulatory Care Nursing
American Academy of Emergency Nurse Practitioners
American Academy of Nursing
American Association of Colleges of Nursing
American Association of Critical-Care Nurses
American Association of Heart Failure Nurses
American Association of Neuroscience Nurses
American Association of Nurse Anesthesiology
American Association of Nurse Practitioners
American Association of Occupational Health Nurses
American Association of Post-Acute Care Nursing
American College of Nurse-Midwives
American Nephrology Nurses Association
American Nurses Association
American Nursing Informatics Association
American Organization for Nursing Leadership
American Pediatric Surgical Nurses Association, Inc.
American Public Health Association, Public Health Nursing Section
American Psychiatric Nurses Association
American Society for Pain Management Nursing
American Society of PeriAnesthesia Nurses
Association for Radiologic and Imaging Nursing
Association of Community Health Nursing Educators
Association of Nurses in AIDS Care
Association of Pediatric Hematology/Oncology Nurses
Association of periOperative Registered Nurses
Association of Public Health Nurses
Association of Rehabilitation Nurses
Association of Veterans Affairs Nurse Anesthetists
Association of Women’s Health, Obstetric and Neonatal Nurses
Commissioned Officers Association of the U.S. Public Health Service
Dermatology Nurses’ Association
Friends of the National Institute of Nursing Research
Gerontological Advanced Practice Nurses Association
Emergency Nurses Association
Hospice and Palliative Nurses Association
Infusion Nurses Society
International Association of Forensic Nurses
International Society of Psychiatric-Mental Health Nurses
National Association of Clinical Nurse Specialists
National Association of Hispanic Nurses
National Association of Neonatal Nurse Practitioners
National Association of Neonatal Nurses
National Association of Nurse Practitioners in Women’s Health
National Association of Pediatric Nurse Practitioners
National Association of School Nurses
National Black Nurses Association
National Council of State Boards of Nursing
National Forum of State Nursing Workforce Centers
National Hartford Center of Gerontological Nursing Excellence
National League for Nursing
National Nurse-Led Care Consortium
National Organization of Nurse Practitioner Faculties
Nurses Organization of Veterans Affairs
Oncology Nursing Society
Organization for Associate Degree Nursing
Pediatric Endocrinology Nursing Society
Preventive Cardiovascular Nurses Association
Society of Pediatric Nurses
Society of Urologic Nurses and Associates
Wound, Ostomy, and Continence Nurses Society
1 APRNs include certified nurse-midwives (CNMs), certified registered nurse anesthetists (CRNAs), clinical nurse specialists (CNSs) and nurse practitioners (NPs).
2 United States Census Bureau. (2021) Who are our Health Care Workers? Retrieved from: https://www.census.gov/library/stories/2021/04/who-are-our-health-care-workers.html
3 American Association of Critical-Care Nurses. (2021). Hear Us Out Campaign. Retrieved from: https://www.aacn.org/newsroom/hear-us-out-campaign-reports-nurses-covid-19-reality
4 American Nurses Foundation. (2023). Three-Year Annual Assessment Survey: Nurses Needed Increased Support from their Employer. Retrieved from: https://www.nursingworld.org/~48fb88/contentassets/23d4f79cea6b4f67ae24714de11783e9/anf-impactassessment-third-year_v5.pdf
5 U.S. Bureau of Labor Statistics. (2022). Occupational Outlook Handbook- Registered Nurses. Retrieved from: https://www.bls.gov/ooh/healthcare/registered-nurses.htm
6 U.S. Bureau of Labor Statistics. (2022). Occupational Outlook Handbook- Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners. Retrieved from: https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-andnurse-practitioners.htm
7 National Council of State Boards of Nursing and the National Forum of State Nursing Workforce Centers (2021) The 2020 National Nursing Workforce Survey. Retrieved from: https://www.journalofnursingregulation.com/article/S2155-8256(21)00027-2/fulltext
8 American Association of Colleges of Nursing. (2022) Nursing Schools See Enrollment Increases in Entry-Level Programs, Signaling Strong Interest in Nursing Careers. Retrieved from: https://www.aacnnursing.org/NewsInformation/PressReleases/View/ArticleId/25183/Nursing-Schools-SeeEnrollment-Increases-in-Entry-Level-Programs
9 Centers for Medicare & Medicaid Services Data.CMS.gov. CMS Program Statistics-Medicare Providers. (2022) Retrieved from: https://data.cms.gov/summary-statistics-on-use-and-payments/medicare-service-type-reports/cmsprogram-statistics-medicare-physician-non-physician-practitioner-supplier
10American Nurses Foundation. (2022). COVID-19 Survey Series: 2022 Workplace Survey. Retrieved from: https://www.nursingworld.org/practice-policy/work-environment/health-safety/disasterpreparedness/coronavirus/what-you-need-to-know/covid-19-survey-series-anf-2022-workplace-survey/.
11 American Nurses Foundation. (2022). Pulse on the Nation’s Nurses Survey Series: 2022 Workplace Survey Nurses Not Feeling Heard, Ongoing Staffing and Workplace Issues Contributing to Unhealthy Work Environment. Page 2. August 2, 2022. Retrieved from: https://www.nursingworld.org/~4a209f/globalassets/covid19/anf-2022-workforcewritten-report-final.pdf
12 National Association of County & City Health Officials. National Profile of Local Health Departments. Page 60. 2019. Retrieved from: https://www.naccho.org/uploads/downloadable-resources/Programs/Public-HealthInfrastructure/NACCHO_2019_Profile_final.pdf
13 National Council of State Boards of Nursing. (2023). Active RN Licenses: A profile of nursing licensure in the U.S. as
of March 20, 2023. Retrieved from: https://www.ncsbn.org/active-rn-licenses.
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