ANA Calls for Federal Funding to Bolster RN Training

About $250 million will be needed in 2015 to ensure that the nation's nursing schools can continue to produce enough registered nurses to meet the nation's estimated demand for the next seven years, says the head of the American Nurses Association.

The American Nurses Association is calling on Congress to increase federal funding by 12% to bolster programs to educate, recruit, and retain registered nurses.

A graying demographic is expected to need more healthcare services. Americans, including nurses, are getting older. ANA estimates that more than 40% of nurses are over age 50, the average age for a clinically practicing nurse is about 45, and 72% of nurse faculty are age 50 or older.

ANA President Pamela F. Cipriano, RN, says additional funding for the Nurse Training Act (Title VIII of the Public Health Service Act), which would total about $250 million in 2015, is needed to ensure that the nation's nursing schools can continue to produce the estimated 1.1 million new registered nurses the Bureau of Labor Statistics says is needed by 2022 to replace a retiring generation of Baby Boomers.

"This has been a pretty confusing time for anyone trying to estimate labor force needs," Cipriano says. "What we have seen since the recession in 2008 is that people held on to their jobs. At the same time, nurses were experiencing a downturn in retirement funding, so many continued to work, both in the clinical and academic settings."

Also in the mix, the Patient Protection and Affordable Care Act and other reforms have put healthcare in a state of flux. About 60% of RNs work in hospitals, and nursing staff layoffs are a common occurrence as hospitals struggle with tighter margins and declining admissions. It's not clear if those jobs are coming back.

"Whether there are overt layoffs or positions are just not getting reposted and refilled is sometimes hard to track. We really haven't seen the aggregate workforce decline in the last year," Cipriano said.

"While there are some new jobs that have been created in the post-hospital environment, such as home care and outpatient clinics, they're never at the magnitude of what we have seen with hospital-based employment."

"And," Cipriano continued, "we continue to see real variations in terms of what is happening in the local labor markets which is really where it affects nurses, even though we think of it as a national workforce."

Even though consensus has formed around the anticipated demand for more nurses, questions remain about what will become of the nurse workforce as hospitals shift toward outpatient care models.

"How deep will the workforce be in the non-hospital setting?" Cipriano ask. "As we transition more care out of the hospital, we've not really been able to do the forecasting to tell us if the overall size of the work force will shrink a little or a lot as we try to keep people healthy. We don't have a good answer to that question right now. That is a question for the next decade."

Cipriano's comments come as the ANA marks the 50th anniversary on Sept. 4 of the Nurse Training Act. The group is urging Congress to:

• Increase federal funding for Title VIII by 12%, to about $250 million for 2015. The program has seen an average 2% funding decrease in the last four years.
• Strengthen nursing education by hiring more nursing professors and ensuring an adequate number of clinical training sites for nursing students. That would require nursing schools to significantly boost the salaries offered to highly credentialed nurses who can often earn twice as much or more in a clinical setting.

More than 140,000 RNs passed their entrance exams last year, but ANA says that more than 80,000 qualified applicants are rejected by nursing schools each year because there aren't enough faculty or clinical training sites.

"Nursing is one of the most intensive educational programs you will find," Cipriano says.

"Because there has to be a lot of hands-on [learning] it requires that hospitals have space and staff that will help with the placement of those individuals so they can complete their clinical education. As we have been trying to bring more students in those clinical placements are overcrowded."