Thursday, June 24th 2004

House and Senate
Appropriations Committees

Dear Appropriator:

The organizations listed below, representing the breadth and depth of the nation’s health care delivery system, are contacting you to urge you to make funding for Nursing Workforce Development programs (Title VIII, Public Health Service Act) a priority in FY 2005. Specifically, we ask you to increase Title VIII funding by $63 million, to bring FY 2005 appropriations to a total of $205 million.

Our nation is struggling with a growing shortage of registered nurses (RNs) that affects our hospitals, nursing facilities, assisted living residences, home health agencies, and public health clinics on a daily basis. Because RNs are the largest health care delivery workforce in the nation, this burgeoning shortage threatens the very fabric of our health care system.

In February, the Bureau of Labor Statistics reported that registered nursing will have the greatest job growth of all US professions in the time period spanning 2002–2012. During this ten-year period, health care facilities will need to fill more than 1.1 million RN job openings in order to accommodate growing patient needs and to replace retiring nurses. A recent report from the Health Resources and Services Administration projects that, absent aggressive intervention, the RN workforce will fall 29 percent below requirements by the year 2020.

The nursing shortage is already directly impacting patient care. Recent studies have reported 126,000 hospital RN vacancies and 13,900 staff RN vacancies in nursing homes. A recent survey of hospitals across the nation concluded 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.

The Nurse Reinvestment Act (P.L.107-205), a triumph of bipartisan and bicameral efforts, represents an important step toward addressing this growing crisis. It holds the promise of attracting new recruits into the nursing profession and offering education opportunities while improving the work environment to maintain experienced nurses in patient care. However, a significant investment for the programs authorized by the Nurse Reinvestment Act is necessary to meet this promise.

Current funding levels are not meeting the growing need for nurses. One program contained in the Nurse Reinvestment Act offers loan repayments and scholarships to RNs and nursing students who agree to work full-time for at least two years in a health care facility deemed to have a critical shortage of nurses. In FY 2003, HRSA was forced to turn away 92 percent of the applicants for the Nurse Education Loan Repayment Program and 98 percent of the applicants for the Nursing Scholarship Program, due to lack of adequate funding. In addition, the American Association of Colleges of Nursing reports that U.S. nursing schools turned away 15,944 qualified applicants to entry-level baccalaureate nursing programs in 2003 due to lack of faculty and other capacity problems.

Given adequate resources, Title VIII programs could attract more students into nursing programs, support schools of nursing to provide faculty and updated curricula, recruit a more diverse student population, provide assistance to students to enable them to complete nursing studies, and ensure the collection and analysis of current nursing workforce data. Your support for a $63 million increase for Title VIII is vital to maintaining and improving the health of our nation.


American Association of Colleges of Nursing
American Health Care Association
American Hospital Association
American Nurses Association
American Organization of Nurse Executives
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
VHA Inc.


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