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May 2014



Volume 11, Issue 5


For Title VIII - Nursing Workforce Development Programs
For Title VII - Health Professions Programs


NLN Government Affairs Action Center
NLN Public Policy


Last week the NLN Board of Governors brought its concerns to Capitol Hill. During the meetings with their congressional delegations, board members focused on returning war veterans and their need for mental health and substance abuse disorders health care (MH/SUD) They also advocated for robust funding for Title VIII Nursing Workforce Development Programs and the Health Professions Programs under Title VII of the Public Health Service Act.

Advocating for increased funding in FY 2015 for SAMHSA, board members noted that with one in three adults living with a mental disorder and one in 10 children having a serious mental or emotional disorder, states and communities cannot tolerate further cuts. The unintended consequences of cutbacks are taking a devastating toll especially on our most vulnerable patient populations, including America’s servicemen, servicewomen, and their families. More service members than ever are returning home with the invisible wounds of war, ranging from post-traumatic stress disorder (PTSD) to SUD and suicide. Their families struggle as well. Increasingly, service members and their families are seeking behavioral health and primary care services in their communities.

In their visits, when discussing SAMHSA, board members noted that:

  • Among the US troops returning from Iraq and Afghanistan, nearly 40 percent of soldiers, a third of the Marines, and half of the National Guard members report symptoms of psychological problems. Thirty-one percent of all Army soldiers and other military personnel who have experienced heavy combat in Iraq and Afghanistan also have at least one mental or psychosocial disorder.
  • There are 301 confirmed or suspected soldier suicides in 2010, including those on active duty and reservists or National Guard troops on an inactive status. This compares with 242 in 2009. The Army's current suicide rate is about 22 deaths per 100,000, which is above a civilian rate that has been adjusted to match the demographics of the Army. That rate is 18 per 100,000. Only the Marine Corps has a higher suicide rate – 24 per 100,000.
  • Suicide is the first leading cause of death for female veterans.
  • Sexual victimization is a problem in military populations. In the general US population, lifetime prevalence of sexual assault is 17 percent and 3 percent for women and men, respectively. The rate of sexual victimization among male military members is roughly the same as general population, but for women in the military, rates of sexual victimization are higher with estimates tending to cluster in the 23 to 33 percent range.

During the meetings with their congressional delegations, board members also 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, the board members noted that:

For Title VIII - Nursing Workforce Development Programs

The NLN supports a budget of $251 million in FY 2015 for the Nursing Workforce Development Programs.

  • Our health care system is integral to the US economy. With a spending level of $2.8 trillion in 2012, it constitutes the largest share of the nation’s gross domestic product (GDP), growing from 8.8 percent of GDP in 1980 to 17.2 percent of GDP in 2012. It is virtually the only sector that added jobs to the economy on a net basis since 2001.
  • With more than 4.031 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.
  • According to the Bureau of Labor Statistics (BLS), by 2022, total employment of RNs and APRNs will increase by 574,400 jobs. With upcoming RN retirements in the mix, the nation will need to produce 1.13 million new RNs by 2022 to fill those jobs.
  • The BLS projects that there will need to be 35 percent more faculty members to meet the expected increase in demand for nurses.

For Title VII – Health Professions Programs

  • The NLN is supporting an FY 2015 budget of $280 million for Title VII – Health Professions Programs.
  • Destabilizing funding for the Title VII programs would reduce education and training support for primary care physicians, nurses, and other health professionals, exacerbating shortages and further straining the nation's already fragile health care system.
  • 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."
  • The United States currently has 7,356 geriatricians – one geriatrician for every 2,551 Americans 75 or older. As baby boomers age, this ratio is expected to drop to one geriatrician for every 3,798 older Americans in 2030. Since its inception, the Title VII Geriatric Education Program has trained more than 425,000 health practitioners in more than 27 health disciplines.

For Nurse-Managed Health Clinics

The NLN supports a budget of $20 million for Nurse-Managed Health Clinics (NMHC).

  • A shortage of primary care providers exists which 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. This shift suggests that professionals' practice can be directed to changing workforce and population needs as the increased use of APRNs holds the potential for improving access, reducing costs for high-value care, and changing patterns of care.
  • NMHCs deliver comprehensive primary health care services, disease prevention, and health promotion in medically underserved areas for vulnerable populations. Approximately 58 percent of NMHC patients are either uninsured, Medicaid recipients, or self-pay.



On October 9-10, 2013, the IOM Global Forum on Innovation in Health Professional Education held a workshop to explore the challenges, opportunities, and innovations in assessment across the education-to-practice continuum. Issues such as assessment of learners and educators of interprofessional education and team-based care were discussed. The document that was released summarizes the workshop. In an era of evolving technology and changing health and health care environments, creative thinking about assessment methods and tools could be the driver for innovations that are affordable, easily integrated into education, and assess competencies at all levels. Read the report here.



The Connecticut legislature has given final approval to a bill that would give nurse practitioners more independence, a measure that both supporters and opponents say could have a major effect on health care in the state. The House voted 110 to 35 to pass the bill while it cleared the Senate by a vote of 25 to 11. Governor Dannel P. Malloy (D), whose administration proposed the measure, is expected to sign it.

The proposal allows nurse practitioners to practice independent of doctors after they have worked at least three years in collaboration with a physician. Although not in the measure, Democratic legislators agreed to amend a separate bill to require that nurse practitioners practice for at least 2,000 hours under a collaborative agreement with a physician. That change was made in response to concerns that an APRN could fulfill the three-year requirement by working one day a week and not gain enough experience. The amendment also brings the continuing education requirements for nurse practitioners in line with those required for doctors.


On April 22, Governor Dave Heineman (R) vetoed the bill, which removed the requirement that nurses have an integrated practice agreement with a collaborating physician in order to practice in Nebraska. In the final vote, legislators had approved the measure unanimously.

Nurse practitioners will still need to collaborate with physicians to practice in Nebraska. Heineman says that in the future there will be a shift toward additional independence for nurse practitioners, but the option provided by the bill went too far, too quickly. Heineman and chief medical officer Dr. Joseph Acierno expressed concern about patient safety in the governor's veto letter.

Lawmakers adjourned last week, so they cannot try to override the governor's veto.


A new law in New York State, which becomes effective January 1, 2015, eliminates the written practice agreement between physicians and nurse practitioners who have more than 3,600 hours of practice experience. According to Stephen Ferrara, DNP, FNP, FAANP, executive director of the Nurse Practitioner Association New York State, the law does not eliminate the natural collaboration that occurs between nurse practitioners and physicians, nor does it expand NPs' scope of practice.

Over the years, bills like the Nurse Practitioners Modernization Act have passed in more than a dozen states and the District of Columbia. The New York State law will also sunset in 2021, providing the opportunity to review data collected and make tweaks to the law as needed, which the Nurse Practitioner Association New York State sees as a positive thing.