Tuesday, September 30th 2003

Dear Representative:

The organizations listed below, representing the breadth and depth of the nation’s health care delivery system, respectfully urge you to cede to a provision in the Senate version of the FY 2004 Labor, Health and Human Services, and Education Appropriations Act (H.R.2660) that provides an additional $50 million in needed funds for nursing education and recruitment. We urge you to cede to the overall funding level of $163 million for Title VIII of the Public Health Service Act during the FY 2004 conference negotiations. Title VIII is the primary source for nursing workforce development. It supports RNs who are educated at the associate, baccalaureate, master’s, and doctoral degree levels.

Our nation is struggling with a growing shortage of registered nurses (RNs) which impacts our patients and our hospitals, long-term care facilities, home health agencies, and public health clinics on a daily basis. As RNs are the largest health care delivery workforce in the nation, this burgeoning shortage threatens the very fabric of our health care system.

The nursing shortage is already directly affecting patient care. A recent survey of hospitals across the nation concluded that nursing shortages are causing emergency department overcrowding, emergency department diversions, increased wait times for surgery, discontinued patient care programs or reduced service hours, delayed discharges, and canceled surgeries. In addition, numerous recent studies have detailed the positive relationship between nursing and quality patient care.

Disturbingly, this is just the beginning of the nursing shortage. The Division of Nursing at the Health Resources and Services Administration (HRSA) projects that, absent aggressive intervention, the supply of nurses in America will fall 29 percent below requirements by the year 2020. Recent efforts to attract more people into the nursing profession have resulted in a slight increase in school admissions.  However, projections show that the aging workforce (the average age of RNs is 45 years) and the increased demand for health services from aging Baby Boomers will aggravate the current crisis in health care delivery over the next two decades.

Recent world events have further exacerbated this shortage. National security efforts rely heavily upon nurses – both as first responders here in the United States and as humanitarian workers abroad. In addition, the activation of military reserves has drawn even more nurses out of the domestic labor market (there are more than 19,000 RNs in the military reserves). Therefore, this shortage threatens our very strength as a nation.

Last year, Congress took the visionary step of passing the Nurse Reinvestment Act (PL 107-205), which expanded and the nursing workforce development programs of Title VIII. This historic legislation holds the promise of attracting more people into the nursing profession, increasing the capacity for nurse education, and encouraging practicing nurses to remain in the profession. However, the promise of these programs will prove futile without adequate new appropriations.

We strongly urge you to complete the promise of the Nurse Reinvestment Act. Your support for $163 million for the nurse workforce development programs of Title VIII contained in the Senate FY 2004 appropriations bill is crucial to addressing this looming crisis.


American Association of Critical Care Nurses
American Association of Nurse Anesthetists
American Health Care Association
American Hospital Association
American Nurses Association
American Organization of Nurse Executives
American Psychiatric Nurses Association
Association of periOperative Registered Nurses
Association of Women's Health, Obstetric and Neonatal Nurses
Catholic Health Association of the United States
Federation of American Hospitals
Gentiva Health Services
Joint Commission on Accreditation of Healthcare Organizations
National Center for Assisted Living
Oncology Nursing Society
VHA Inc.
Visiting Nurse Associations of America


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