Lawmakers target nursing shortage. (Updata).

The prospects for alleviating the nation's increasingly acute shortage of nurses have improved somewhat with approval of the Nurses Reinvestment Act. Versions of the bill have sailed through both chambers of Congress with broad, bipartisan support. Individuals speaking on behalf of Rep. Lois

Both the House and Senate bills expand scholarship and loan repayment programs for nurses who agree to work in underserved areas, mandate studies to generate additional solutions to the shortage, and promote the field of nursing through national awareness campaigns. The Senate bill, the more detailed of the two, also includes grants to improve working conditions, bolster recruiting programs, create new scholarship programs, provide stipends for poor students, and pay hospices and home health agencies for training. The differences in the way the bills were written could have much to do with the leadership of the two chambers, with Republicans running the House and Democrats having control of the Senate.

It is uncertain whether these differences will necessitate convening a formal conference committee or whether a final version will emerge through staff negotiations. In either instance, Congress confronted a full docket when it returned in late January from its holiday recess, so further progress may yet be weeks away. The spokespersons for Rep. Capps and Sen. Mikulski said there were no particularly problematic areas and the final version should reflect the best of both bills.

Capps, who previously worked as a registered nurse, has been a proponent of legislative action addressing the shortage. The fact that Congress would so easily approve legislation that could create more than $100 million in new spending during these tight budget times is evidence of how dire the nursing shortage has become. Lawmakers report hearing from constituents about access problems in rural areas and long waits to see nurses in urban areas, and the ongoing threat of terrorism has made shoring up the nation's healthcare infrastructure a high priority. Additionally, ratings groups see spiraling wage costs due to labor shortages as negatively affecting the bottom line of the nation's healthcare facilities, especially as demand for care increases with the aging of the population.

Advocacy groups also long have expressed concern about the issue. The National League for Nursing states that the number of nursing program graduates declined 13 percent between 1995 and 1999. The average registered nurse is 45 years old, nine years older than in 1980, according to the American Federation of Teachers.

"The Hospital Workforce Shortage and its Implications for America's Hospitals," a comprehensive report commissioned by the American Hospital Association, the Association of American Medical Colleges, the Federation of American Hospitals, and the National Association of Public Hospitals and Health Systems, reports that the mean vacancy rate for nurses is 13 percent, and one in seven hospitals is dealing with nursing vacancies exceeding 20 percent. The report states these vacancy rates have worsened at 60 percent of hospitals since 1999. Hospitals say the shortage commonly leads to emergency department overcrowding and diversions, a reduced number of staffed beds, severe budget problems, and cancellations and increased wait times for surgery.

To read the report, go to http://www.aha.org/workforce/resources/Content/FcgWorkforceReport.pdf .

A spate of controversial legislation also has been introduced in Congress and state legislatures to improve working conditions for nurses. For example, New Jersey recently joined Oregon and Maine in passing legislation curtailing mandatory overtime for nurses. Overall, such bills were introduced in 16 states and Congress in the past year, according to the American Nurses Association. Furthermore, on January 22, 2002, California governor Gray Davis released proposed nurse-to-patient ratios to cover all departments in the state's acute care hospitals, making California the first state to attempt to determine such ratios. Currently, only intensive/critical care, well-baby nursery, neonatal intensive care unit, intermediate care nursery, and operating departments have minimum ratios. The ratios result from legislation (AB 394) enacted in 1999. Regulations supporting the new ratios should be available for public review this spring and may take effect no later than July 2003.

To read the New Jersey law, go to http://www.njleg.state.nj.us/2000/Bills/S2500/2093_S3.pdf. To view the California ratios, go to http://www.governor.ca.gov/govsite/msdocs/press_release/PRO2_023_Nurs e_to_Patient_attach.doc.

Some groups contend that these efforts to improve working conditions for nurses are more effective in relieving the shortage than creating new recruitment and scholarship programs. However, provider organizations oppose many of the current proposals, arguing that they are unfeasible, diminish service capacity, and are financially and administratively burdensome.

Overall, healthcare providers employed 10.5 million people in 2001, adding 304,000 jobs (including 136,000 new jobs at hospitals) over the course of the year, according to the U.S. Bureau of Labor Statistics (BLS). Health care ranked second only to local governments (325,000 new jobs) in creating new civilian jobs, and far outstripped most other employment categories. The spectacular growth in healthcare employment, coupled with the alarming shortage of nurses, makes for an interesting juxtaposition against the nation's overall labor market, which last year saw a record 21,345 layoff actions resulting in 2.5 million initial claims filings for unemployment insurance.

To view more BLS statistics, go to http://www.bls.gov. To read the "Nurses Reinvestment Act," go to http://thomas.loc.gov (search on S. 1846 for the Senate version, H.R. 1436 for the House version).