Remarks to the National Nurse Practitioner Summit 

Prepared Remarks of Denise Geolot, Ph.D., R.N., F.A.A.N.
Director, Division of Nursing, Health Resources and Services Administration

National Nurse Practitioner Summit
Washington, D.C.
February 4, 2002

Good morning.

It is a pleasure to have the opportunity to participate in this Federal Update session with colleagues from the Center for Medicare and Medicaid Services, the Agency for Healthcare Research and Quality and the National Institute for Nursing Research.  I commend the American College of Nurse Practitioners for sponsoring this effort that allows federal health policymakers and the nurse practitioner community the chance to listen and learn from each other.

I am Director of the Division of Nursing in the Health Resources and Services Administration. I’ve been asked to give you an overview of the agency – which everyone calls HER-sah -- and the work we do that makes a difference in the lives of some of the Nation’s most vulnerable individuals and families.

HRSA’s programs reach into every corner of America, providing a solid safety net of health care services relied on by millions of our fellow citizens.

·        HRSA grantees at health centers  – along with health professionals in our National Health Service Corps -- deliver preventive and primary health care to low-income, unemployed and underserved individuals and families.

·        HRSA administers Ryan White CARE Act programs that give low-income people with HIV/AIDS the medication and care they need to get better or stay well.

·        We work with States to ensure that babies are born healthy and that pregnant women and children have access to health care.

·        We help train physicians, nurses and other health care providers and place them in communities where their services are desperately needed.

·        We help rural health care providers build coordinated systems of care to serve local residents better.

·        And we oversee the Nation’s organ transplantation system.

Our work is done primarily through four bureaus focused on Primary Care, HIV/AIDS, Maternal and Child Health, and Health Professions Training.

We’ve also got more than half dozen offices and centers working on other key issues: rural health, managed care, telehealth, quality, women’s health, and minority health.

HRSA’s programs help form the foundation of the Nation’s health care safety net.  President Bush and Secretary Thompson have made it clear that they are strongly committed to strengthen this safety net by providing more health care directly to Americans.

The recently passed FY 2002 budget is evidence of that.  Our health centers received an increase of $175 million in 2002, to a total of more than $1.34 billion.  These additional funds represent a down payment on the President’s five-year plan to create new or expand health center sites in 1,200 communities and increase the number of patients served annually to more than 16 million.  His 2003 proposed budget would raise health center funding to $1.5 billion – that’s a funding increase of almost 30 percent over the past two years.

The President also has big plans for the National Health Service Corps.  He has announced a reform initiative that will examine several issues, including the ratio of scholarships to loan repayments, and will consider amending the Health Professional Shortage Area definition to include non-physician providers and J-1 and H-1C visa providers practicing in communities.  These efforts will enable the NHSC to more accurately define shortage areas and target placements to areas of greatest need.

The President’s 2003 budget proposal would give the Corps a $44 million increase to $191.5 million.  The added funds would provide scholarships or loan assistance to about 1,800 professionals practicing in underserved areas -- an increase of about 560 participants.

We know you work closely with the Corps to recruit providers to underserved  communities.  These improvements should help you in the future.

Early in his tenure, Secretary Thompson identified the shortage of nurses as a critical national priority.  And the Administration is acting decisively to train more nurses by adding funds for the Nursing Education Loan Repayment program.  That program repays the education loans of clinical care nurses who agree to work for two years in designated public or nonprofit health facilities that face a critical shortage of nurses.  Last year, the budget for the loan repayment program was almost $7.3 million.  For 2002, the appropriation rose to $10.2 million, and in next year’s budget President Bush plans to ask for a total of $15 million.  This proposed 50 percent increase would support 675 new and 125 third-year nursing education loan agreements.

HRSA has in place a variety of other education and training programs that play a critical role in addressing emerging shortages of nurses.

Under Title VIII of the Public Health Service Act, the Division of Nursing administers three broad authorities to permit a comprehensive and flexible approach to federal support for nursing workforce development.  Programs focus on:  Advanced Education Nursing; Nursing Workforce Diversity; and Basic Nursing Education and Practice.  In FY 2002, HRSA will invest $82.5 million in these three programs.  

The Advanced Education Nursing Program supports projects that educate advanced practice nurses, which include nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives.  Program funds also support education for nurses in  faculty positions at nursing schools, public health nurses, and nurse administrators.  Advanced education program funds support projects that enroll approximately 4,550 students and provide traineeship support for 5,800 graduate-level students. 

The Nursing Workforce Diversity Program provides support to projects targeting 1800 minority and disadvantaged students in elementary and secondary schools, pre-nursing programs, and nursing schools.  This program provides remedial and support services necessary to assure successful completion of those students enrolled in nursing programs.

The Basic Nurse Education and Practice Program supports nurse-managed clinics and academic and continuing education projects designed to recruit and retain a strong nursing workforce.  Funds are used to support basic entry-level career ladder programs for licensed practical nurses, innovative academic distance learning projects for rural RNs, and projects to expand enrollments in baccalaureate nursing programs.

HRSA also provides significant nursing workforce analytic activities that include the following:

·        The National Sample Survey of Registered Nurses is the nation’s most extensive and comprehensive source of statistics about licensed registered nurses in the United States.  The seventh survey was conducted in March 2000. Preliminary findings of this survey were released in February 2001 and the final report will be available in the near future.  The sample is drawn from the universe of all licensed RNs, whether or not they are part of the labor market.  It collects information on the number and characteristics of licensed RNs; their education background and specialty areas; their employment status including type of employment setting, position level, and salaries, their geographic distribution; and their personal characteristics including gender, racial/ethnic background, age, and family status;

·        The Nursing Supply Forecasting Model is a statistically based model that projects the future supply, and FTE supply of registered nurses for each of the 50 States, the District of Columbia, and the United States as a whole.  Projections are provided based on the highest level of nursing education.  The Nursing Supply Model captures age-specific dynamics of the flow of nurses in and out of licensure and the workforce; their progression from one educational level to another; and their state-to-state mobility; and

·        The Nursing Demand Model Based Requirements Forecasting Model is a statistically-based model used to forecast future requirements for registered nurses as a function of health care utilization, health care market, and socioeconomic changes to the year 2020.  The model incorporates the capability of forecasting health care service requirements for thirteen health care sectors and types of nursing personnel.  The projections are made at the national, regional and state level.

In addition, we support the work of the National Organization of Nurse Practitioner Faculties to expand the nurse practitioner primary care core competencies and to develop competencies in specialty areas of adult, family, gerontology, pediatric and women’s health.

And we’re supporting an innovative interdisciplinary program at Duke University Medical Center that brings in graduate faculty teams from nurse practitioner, nurse-midwifery and physician assistant programs from around the country to learn ways to incorporate genetics in the graduate curricula.  Up to 25 faculty teams will participate in this program over the next three years.

All of these programs and services have a single impetus at their core: to further HRSA’s mission to expand access to quality health care for all Americans who need it.  Meeting that mission requires us to address the nursing shortage.  A shortage of nurses not only affects the availability of care but also the quality of care.

By coming together at this forum, we have a golden opportunity to figure out how best to keep the nation’s pipeline filled with nurses who are willing to serve in those communities where they are needed most. It is essential that we address this problem with the sense of urgency it deserves.

You play a central role in helping to meet the goals we all share.  Your work has great importance to all of us who are committed to improving nursing education and practice nationwide.

I urge you to let us know what is important to you ... what works and what doesn’t...and what barriers need to be overcome.  We’re all on the same team.

At HRSA, our pledge to you is this: when you talk, we will listen and respond. 

Thank you.