The dozen staff nurses who meet to devise new strategies to recruit nurses for Carilion Health System hit the ceiling when one said that her daughter was told by a high school career guidance counselor that she was "too bright" to go into nursing, recalled Kim Enochs.
But Enochs, director of planning and staffing at the 10-hospital system based in Roanoke, Va., said her role as a recruiter has evolved over the past seven years from a focus on signing up degree-bearing nurses to changing young people's opinions about nursing when they are considering careers. Often it's the adults-counselors, teachers and parents-who require the most change in mindset, she said.
"I really think people out there don't know what (nurses) do," Enochs said.
Separate federal legislation passed by both the House and the Senate in the final days before adjournment last month would pay for advertising campaigns to inform people about the nursing profession. Although both bills have the same name-the Nurse Reinvestment Act-the Senate version offers a richer array of provisions to address the looming nurse shortage and is favored by hospital and nurse groups.
The Senate bill authorizes about $132 million for provisions in fiscal 2003 but doesn't specify amounts from 2004 to 2007. The six-year House bill doesn't specify amounts for any year.
The next step, which has not been scheduled, is for the bills to go to a conference committee so lawmakers can negotiate a final version that could be put forward for President Bush's signature.
The bills passed the same week that the American Association of Colleges of Nursing released a survey showing that enrollment in entry-level college nursing programs increased for the first time in six years. Enrollment in such programs rose 3.7% in 2001 from 2000.
The grants to promote interest in nursing careers, included in both bills and pegged at $8 million in the Senate legislation, rank low among the priorities of some nurse advocates, said AACN Executive Director Geraldine Bednash. Instead, money needs to be spent on increasing the number of nursing school faculty. "It doesn't do any good to get the message out if you can't accommodate these people," she said.
Nursing schools turned away almost 5,000 qualified applicants in 2001, Bednash said. More than one-third of nursing programs surveyed said faculty shortages are a reason why they didn't accept all qualified applicants.
The Senate version of the bill would repay student loans for future nursing school faculty to pursue advanced degrees. It would also establish a nurse service corps to give nursing scholarships to students who agree to work in medically underserved areas and provide grants for career-ladder programs in hospitals.
The House version was "stripped down," according to lobbyists and congressional staff members, to get support from the Republican majority. It includes nursing scholarships in exchange for working in underserved areas but offers no funding for increasing nursing school faculty or financial support for single mothers to return to school to earn a nursing degree, a priority of the American Nurses Association.
Some House Republicans question whether the nursing shortage needs to be addressed at all, said Erin McKeon, the ANA's associate director of government affairs. Though the American Hospital Association reported in June that 11% of hospital nursing position vacancies were unfilled, government studies completed in 2001 show the nation won't have an across-the-board shortage of registered nurses until 2010.
The ANA, the AACN and the American Organization for Nurse Executives, a subsidiary of the AHA, all said they will be urging the conference committee to move beyond the House version and closer to the bill passed by the Senate.
A spokeswoman for Rep. Lois Capps (D-Calif.), the House bill's primary architect, said she supports moving the bill toward the Senate version. The original House bill introduced by Capps, who has been a registered nurse for more than 40 years and once worked as head nurse at 722-bed Yale-New Haven (Conn.) Hospital, included more provisions to get high school students involved in nursing than the bill passed by the Senate.
The industry groups also will be pushing for the conference committee to act quickly. Congress is scheduled to take up reauthorization of an existing nurse education program, called Title VIII of the Public Health Service Act, later this year. If the Nurse Reinvestment Act isn't through the conference committee by midyear, Bednash said, it may get lost as lawmakers turn their attention to the Title VIII reauthorization.
Pamela Thompson, the AONE's executive director, said the bills address the complexity of the nurse shortage. "There is no quick fix here and everything we do has an impact on the rest of the system."
Neither bill would limit hospitals from requiring nurses to work mandatory overtime. The ANA has said that eliminating mandatory overtime is critical to improving nurse retention levels. The AHA has opposed such action.
However, McKeon is satisfied that the bills passed by the House and the Senate begin to address the nursing shortage. "It is a good first step," she said.