Finding nurses is one thing. Keeping them is another. The latter is something unions say the Nurse Reinvestment Act doesn't adequately address.
"It's a partial measure. You have to change the working conditions," said Lisabeth Jacobs, spokeswoman for the California Nurses Association. The Oakland, Calif.-based union represents 45,000 registered nurses in 150 healthcare facilities.
"Nurses don't want to be in hospitals because the conditions are so unpleasant," agreed Barbara Coufal, legislative affairs specialist with the American Federation of State, County and Municipal Employees, which represents 60,000 nurses. "The nursing shortage is really a self-inflicted wound."
Hospitals acknowledge they need to change, said Fran Roberts, vice president of professional services for the Arizona Hospital and Healthcare Association, who worked on the American Hospital Association's workforce report released earlier this year.
Roberts said other factors play a role in the nursing shortage-including low nursing school enrollment and an aging workforce. "To say that the only problem is the work environment is inaccurate and irresponsible," she said.
Late in negotiations over the legislation, nurse unions lost a battle to remove a provision that will allow nursing students to repay federal loans by working for any healthcare facility with a nursing shortage. Currently, students must agree to work for not-for-profits.
"There is a limited amount of funding out there," said Diane Sosne, co-chair of the Service Employees International Union Nurse Alliance which represents 110,000 nurses. "We don't want them (for-profit companies) going to the public coffers."
Yet both not-for profit and for-profit hospital groups agreed on the provision. "There is no distinctive feature based on the tax structure of an institution," said Carla Luggiero, senior associate director of federal relations for the AHA.
In some markets, particularly rural areas, for-profit hospitals represent the only facilities, said Dan Boston, vice president of legislation and political affairs for the Federation of American Hospitals. He said extending the loan benefit for students who choose to work at for-profit facilities constitutes "a reflection of public policy catching up with current practice of medicine."
For-profit hospitals only will be included in the loan repayment program until 2007, when the bill expires. In the meantime, the law directs the General Accounting Office to study the extent of nurse shortages in different types of facilities and hiring differences between non-profit and for-profit hospitals.