National Black Nurses Association, Inc. 8630 Fenton Street, Suite 330, Silver Spring, MD  20910  ·  Phone: (301) 589-3200 ·   Fax: (301) 589-322

Testimony of Debra A. Toney, PhD, RN

President

National Black Nurses Association

Las Vegas, Nevada

Before the Committee on Appropriations

Subcommittee on Labor, Health and Human Services,

Education and Related Agencies

March 18, 2009

2 P.M.

Discussion topic:  Title VIII, The Nursing Workforce Development Programs;
National Institute of Nursing Research; and, Health Disparities

Good afternoon, Mr. Chairman and Members of the Subcommittee,

The National Black Nurses Association applauds President Obama for his commitment to strengthening, health professional education, community health and the public health infrastructure.

The National Black Nurses Association (NBNA) requests $215 million for Title VIII, the Nursing Workforce Development Program.  For 11 years, our Nation has faced a critical nursing shortage, which is expected to last through the next decade. This shortage threatens the safety and well being of the patients whom we are charged to care for in our health care systems. The nursing shortage only exacerbates health disparities among people of color, especially women and children.  

A HRSA report in 2004 projects the need for 1 million nurses, of which only 64 percent will be met.  Another study by Dr. Peter Buerhaus and others estimates that a half million new nurses will be needed by 2025.  The U.S. Bureau of Statistics estimates that over 140,000 nursing positions remain vacant in hospitals, nursing homes, health departments, community health centers, schools and other work places.  Using the State of California as an example, it is estimated that the State would have a nursing shortage of 12,000 by 2014. 

Many factors contribute to the nursing shortage including:

• an aging nursing workforce with the average age of a nurse being 47 years old.

• 66 percent of the nurse faculty is expected to retire in the next 5-15 years, and not enough nursing students are in the pipeline to fill their roles. 

• an aging population, demanding access to high quality, culturally competent health and nursing care. 

• a population that has preventable chronic diseases that overwhelm the nursing workforce and healthcare systems, leading to higher healthcare costs.

An investment in Title VIII will support the education and training of registered nurses at all levels, including advanced practice nurses, nurse faculty and nurse scientists.

The National Black Nurses Association calls on the President and Congress to strengthen America’s public and community health infrastructure.  Too many uninsured and underinsured people go without primary care or delay utilization of the health care system due to costs and inequitable treatment.

The use of Advanced Practice Nurses is critical to widening the nation’s safety net and providing equitable timely primary health care services.  These services can contribute to our national goals to eliminate health disparities, manage chronic disease and promote adoption of culturally relevant self care management practices. We must provide funding to ensure an adequate pipeline of advanced practice nurses if we are going to improve access to healthcare.

Funding for the Nurse Education Loan Repayment Program is essential as it allows for new nursing graduates to enter health facilities deemed to have critical shortages such as departments of public health, community health centers and disproportionate share hospitals.

Funding for the education of nurses of diverse backgrounds is vital to improving the delivery of culturally competent nursing care and to closing the health disparities gap.  Studies have shown that people are more comfortable receiving care from providers of similar ethnic and cultural background. 

In the academic year 2005-2006, the National League for Nursing found that 88,000 applicants were turned away because of the lack of capacity, such as, lack of faculty, lack of technology, low wages, classroom space, laboratories and limited clinical education sites.  Hospitals and other facilities that are already understaffed cannot handle the patient workload and facilitate the training of nursing students.

It has been found in California State schools of nursing that there are more qualified students than there are slots.  Moreover, many California associate degree nursing schools use a lottery system to admit applicants because there are more qualified applicants than there are openings.

Increasing the level of funding for nursing education has a direct correlation to eliminating health disparities particularly among communities of color and the Nation. 

In a report by the National Black Nurses Foundation it was found that because of the nursing shortage patient safety issues become more frequent. 

• There are longer waits for clinical appointments and admissions into hospitals 

• More medical errors occur

• Staffing for acute care beds are going down, and

• Failure to rescue events go up

Without interventions by nurses, the health disparities gap will only increase. 

The National Black Nurses Association is requesting $175 million for the National Institute of Nursing Research.  Nurse scientists conduct clinical and behavioral research that may be translated into nursing practice to improve the quality of care in vulnerable populations.   Establishing initiatives to eliminate health disparities that include partnering with organizations like the National Black Nurses Association and the National Coalition of Ethnic Minority Nurse Associations is critical in conducting research related to equality in healthcare.  Financial support is needed to create relationships with Historically Black Colleges and Universities and other minority serving institutions that address research and training directed at the elimination of health disparities.  These effective interventions “improve quality of life, offer approaches for self management, symptom management and care giving”.  

Moreover, there is a need for more nurses to be trained to design, implement and lead clinical trials.  Nurses are an integral part of the clinical trials team, recruiting patients, implementing protocols, educating patients, helping them with compliance issues related to their medical regimens, providing follow-up and consultative services. 

Our nation must be strategic and intentional about racial and gender focused clinical trials that are conducted with minority patient populations and communities.  These clinical trials should include nurse lead projects and collaborative interdisciplinary partnerships. 

Mr. Chairman and Members of the Committee, I thank you for the opportunity to testify before you this afternoon.