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allied health practitioners in a variety of fields will rise accordingly, and combined with greater longevity will have a significant impact on demand for practitioners in rehabilitation fields such as occupational therapy, physical therapy, respiratory therapy and audiology." Further, advancements in medicine and technology have increased the frequency of survival from accidental trauma or severely disabling conditions present at birth, thereby heightening demand for services to enhance functional independence and quality of life.

Future projections illustrate the need for Congress to take action now if a crisis in health care is to be averted in the years ahead. The National Academy of Sciences' Institute of Medicine, in a major study conducted in 1988, noted that unless Federal policymakers intervene the nation will suffer from a "serious shortage of allied health professionals". More specifically, the IoM projected that the most serious personnel shortages by the year 2000 could occur in the fields of occupational and physical therapy.

U.S. Department of Labor estimates lend further credence to this warning. Projections by the Bureau of Labor Statistics indicate that between now and the turn of the century, the nationwide demand for physical therapists and occupational therapists will increase by 57 percent and 49 percent respectively, with 34 percent increases for speech-language pathology and respiratory therapy, and similar increases for other allied health professionals.

In addition to significantly increased demand for services, a serious lack of focused Federal support for the education and training of allied health professionals generally, and medical rehabilitation professionals specifically, has compounded the personnel shortages currently being experienced. While historically the Title VII health professions programs represented the primary source of Federal support for the training of allied health professionals, funding for these programs ended after 1980. Some modest initiatives to redress this situation were enacted when Congress reauthorized the Title VII programs in 1988. However, annual authorization levels targeted to allied health totaled only $6 million, and appropriations over the three year period totaled $2.3 million.

The educational system for rehabilitation professionals has not been able to meet the surging demand. This inability to produce an ample supply of qualified practitioners is caused by a variety of factors including an inadequate supply of faculty, an inability to increase class sizes because of a lack of resources, a shortage of education programs in some professions, and a decrease in funds for scholarships to attract students into programs.

Mr. Chairman, Congress will be reauthorizing the title VII health professions training programs this year for fiscal year 1992 and subsequent years. The Caucus is urging authorization of $24 million in FY'92 for Title VII allied health Initiatives and we strongly urge this Subcommittee to consider full funding at whatever levels are ultimately authorized.

Our specific recoinmendations are as follows:

Allied Health Project Grants and Contracts (796) - $7 million to assist in the development, expansion and improvement of allied health education programs

Traineeships for Advanced Training (Section 797) - $7 million for the development of post-graduate programs and traineeships to increase the availability of qualified faculty.

Entry Level Traineeships (proposed) $10 million for entry level assistance to attract additional students into shortage fields or specialties.

We further urge that, in light of limited resources, funds appropriated be targeted to those professions that have substantial shortages and which plan a significant role in the care and rehabilitation of the elderly and persons with disabilities. With this targeted effort we can begin to address the most serious existing shortages and position ourselves to meet the health care requirements of those rapidly growing segments of our population most in need of medical rehabilitation services.

Again, Mr. Chairman, on behalf of the National Rehabilitation Caucus, I thank you for this opportunity to share our views on this important issue.

Senator HARKIN. Susan, thank you for being here. It is good to see you again. We appreciate your testimony. You have allied health funding at $1.7 million in fiscal year 1991.

Ms. SCOTT. That is right, Senator. And that was an increase from the previous year and we are most appreciative of that increase.

Senator HARKIN. If I am not mistaken, that program started being funded here in the Senate.

Ms. Scott. That is right. Absolutely.
Senator HARKIN. And what are you asking in total for next year?

Ms. SCOTT. Well, Senator, the program is up for reauthorization this year, so we do not really have an authorized number. Our recommendation to Congress in the reauthorization process, will be for a total of $24 million. And all we are asking is that this subcommittee get us close to whatever numbers are ultimately authorized as would be possible.

Senator HARKIN. We appreciate it very much, Susan. Thank you. STATEMENT OF MARIE WHITEHEAD, AMERICAN NURSES ASSOCIA

TION Senator HARKIN. Next is Marie Whitehead representing the American Nurses Association. Your statement will be made a part of the record in these proceedings.

Ms. WHITEHEAD. Mr. Chairman, I am Marie Whitehead, a staff nurse in the coronary care unit at the Medical College of Pennsylvania in Philadelphia and president of the Pennsylvania Nurses Association.

I appear before you today on behalf of the American Nurses Association, the Association of Operating Room Nurses, and the American Association of Critical Care Nurses to speak about funding for nursing education and nursing research.

My testimony is a personal story of how money for nursing education can make a difference in the life of someone who is pursuing the opportunity for advancement.

In 1978 I was separated from my husband and with minimum job skills and three children to raise, I was employed as a child care worker for $5 an hour and I was receiving supplemental food stamps. I wanted to become a nurse and my welfare worker told me to quit my job and go on public assistance full time while I was in school.

I entered the diploma program at Chestnut Hill Hospital in Philadelphia for a 3-year course of study to become a registered nurse. While I was in school I received Federal and State grants totaling approximately $5,000. During my third and last year of school there were drastic funding cuts in scholarship programs and I had a very difficult time getting enough money to continue school and to buy all the books and supplies that were needed.

I graduated with an RN degree in 1982 and I have been employed full time as a registered nurse since then. I now pay in income tax every year approximately the

same amount of money I received in public assistance per year. The investment made in my education has not only permitted me to support myself and my children without public assistance, but it has given me the opportunity to pay back something to society by providing health care service.

Nursing education support is essential to the nontraditional student of today. Many nursing students are older with family responsibilities and are pursuing nursing as a second career. The option of not working while going to school is not a reality for many students who must work full time while attending class and clinical training. Federal nursing education funds are particularly important for students who may have no other resources available.

The nursing shortage is not over and we must continue to provide avenues for students to enter nursing. The older, nontraditional student is an important asset to a profession that must continue to actively recruit students in order to meet the ever-increasing demand for nursing service into the next decade.

I urge this committee to continue its record of support for nursing by funding nursing education at $66 million in fiscal year 1992.

PREPARED STATEMENT Additionally, I urge the committee to appropriate $58.8 million for the National Center for Nursing Research. The clinical practice of nursing depends on research. It demonstrates the effectiveness and outcomes of nursing intervention. In this era of cost containment, it is important that interventions provide the most successful outcome with the limited resources available in health care.

Thank you for your past support of nursing and the opportunity to appear before you today.

[The statement follows:)

STATEMENT OF MARIE WHITEHEAD

Mr. Chairman I am Marie Whitehead RN, CCRN, a staff nurse in the Coronary Care Unit at the Medical College of Pennsylvania Hospital and President of the Pennsylvania Nurses Association. I appear today on behalf of the 200,000 members of the American Nurses Association (ANA) and its 53 constituent state and territorial associations, the 46,000 registered professional operating room nurses who are members of the Association of Operating Room Nurses (AORN), and the 70,000 registered nurse members of the American Association of Critical-Care Nurses (AACN). I appreciate the opportunity to testify before you today on nursing education and research appropriations.

We gratefully acknowledge this committee's past support for nursing education and research. The committee has recognized the important role nurses play in the health care delivery system by providing funding for nursing education and innovative practice models that will ensure a constant supply of nurses are available to ineet increasing demands.

Mr. Chairman, I am sure you are aware of the dramatic changes that are occurring in the American health care delivery system. These changes have been brought about by many factors including: the demographics of a culturally diverse population; the aging of the American population; ongoing advances in medical technology; sweeping reforms in health care financing; the emergence of new and innovative practice settings and patterns of health care delivery; increasing levels of acuity in hospitalized patients; and the strain placed on resources by long-term care issues such as cancer, chronic disease in the elderly, and AIDS.

Nurses are the principal care givers for significant segments of our population, including the elderly and the disadvantaged. Nurses are also the principal care givers in non-acute health care settings such as the home and community. It is nurses who comprise the largest group of health care providers in the nation's hospitals, and provide services in public health clinics and in rural and underserved areas. Nurses not only deliver health care while serving as patient advocates, but as nursing case managers, guide consumers through an increasingly complex health care maze and coordinate a multitude of providers.

Within this context, we see that our health care system is faced with many serious challenges. Among the greatest is meeting the health care needs of a growing elderly population with chronic health care needs. Nurses provide critically needed, cost-effective care in both the community and the home that promotes maximum quality of life, management of health problems, and independence for the majority of elderly Americans.

A serious challenge facing our health care system is the increasing level of acuity in hospitalized patients. Due to a variety of factors, hospitals are admitting and treating patients who are much sicker and who require more intensive nursing care. Many critically ill patients who, ten years ago, may have died during hospitalization, are now able to recover and live longer and better because of advances in technology. The intensity of nursing care required for these patients has correspondingly increased as the technologies have advanced.

Not only are we seeing more acutely ill patients in the hospital setting, but we are also seeing more acutely ill patients being discharged. The philosophy behind the prospective payment system to limit hospitalization and to care for patients in less costly settings has meant that many patients must be provided care in the home setting or skilled nursing facility. The premature infant, the elderly patient who has undergone hip replacement, the patient who has suffered a heart attack and must now undergo rehabilitation and make lifestyle changes; these are all examples of the types of patients who are being discharged earlier from the hospital setting. Their nursing care needs however, are still great and must be fulfilled to permit maximum recovery.

Another serious challenge to our health care system is in the area of special health care problems. Two poignant examples of special health care problems which have had an enormous impact on nursing are the AIDS epidemic and the tragedy of infant mortality. People with AIDS not only require highly skilled nursing care during episodes of hospitalization, but are also in need of a variety of outpatient nursing services. The demand for nursing care has increased dramatically as AIDS affects a growing number of individuals.

We find ourselves similarly situated with infant mortality. Overall, our nation's infant mortality rate at ten percent is the highest among eighteen industrialized nations. This high rate has underscored the need for better and more available prenatal and post-partum nursing care and patient education to reduce the number of low-birthweight babies. Low birthweight accounts for nearly tivo-thirds of the more than 45,000 infants who die each year in the United States.

Additionally, the nation is experiencing an epidemic increase in childhood measles, rising rates of geriatric tuberculosis and epidemic proportions of sexually transmitted diseases. We believe that as the emphasis on public health decreased so did the supply and utilization of nurses in school, community, and public health programs. Nursing has been the backbone of such programs that ensured infectious disease prevention. The resurgence of such preventable diseases highlights the need for an increased number of community health nurses. Without them we can expect deaths from diseases that previously had been controlled. These, as well as other special health care problems have placed a particular strain on our ability to meet the health care needs of the public.

The challenges that our health care system are facing come at a time when our nation is experiencing a serious shortage of professional nurses. ANA estimates that about 160,000 registered nurse positions were unfilled in 1989, the last year for which figures are available. Surveys indicate that some parts of the country are as much as 15 percent short of needed nurse staffing levels, with an average of 11 percent.

Financial and workplace incentives have attracted more nurses to the profession. The RN supply has grown steadily, with about 1.6 million RNs working in 1988. However, in spite of the increasing number of RNs in the workforce, the demand continues to far exceed the anticipated supply for the year 2000. Federal estimates project more than 600,000 new jobs for RNs will be created by the year 2000 to meet escalating demands in all health care settings including home care, industry, public health agencies and outpatient facilities. With these issues before us we must strongly and effectively support nursing education and recruitment and retention strategies to increase the number of nurses if we are to adequately meet the health care needs of the future. Unless we increase the nursing supply in proportion to the projected demand for nursing care in the next decade, the health and well-being of many of our citizens, especially the elderly and vulnerable, are at great risk.

Clearly, this is not a climate in which the health and welfare of the American public would be well served by cutting federal support of nursing education. The impact of budgetary cutbacks,' which would decrease the future supply of nurses would fall most heavily on the segments of our population most in need. Furthermore, such cuts would be counterproductive, as numerous studies in recent years have demonstrated the cost savings 10 the health care system that accrue from effective utilization of nursing resources.

Recognizing the important role that nurses play in our health care delivery system, the 100th Congress reauthorized the Nurse Education Act. In doing so, the authorization levels for a variety of nursing programs were virtually doubled and the Act contained several programs which addressed the nursing shortage by providing funds for basic nursing education and innovative practice models. Unfortunately, because of budgetary constraints, the appropriations for nursing education programs have been approximately half the full authorization levels during the past three years. While ANA is grateful for this committee's support of nursing education, appropriation levels must be increased if we are to continue to resolve the shortage of nurses. We are beginning to see progress in that enrollments in schools of nursing were up 8.9 percent in 1989 but it will be several years before enrollments impact the workforce since changes in graduations lag behind enrollments.

On behalf of your constituents throughout the nation, those who as patients will suffer from the loss of health care services without adequate numbers of professional nurses, we recommend funding of the Nursing Shortage Reduction and Education Act (NEA) in fiscal

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