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December 20, 2005


The Honorable George W. Bush


The White House


1600 Pennsylvania Avenue, NW


Washington, DC 20500


Dear Mr. President:


As your Administration begins work on the fiscal year 2007 budget request for submission to the Congress, the undersigned organizations of the Americans for Nursing Shortage Relief (ANSR) Alliance encourage you to increase funding for the Nursing Workforce Development programs authorized by Title VIII of the Public Health Service Act. ANSR would like to bring the following facts to your attention. In 1974, during the last serious nursing shortage, the Congress appropriated $153 million for nurse education programs. In today's dollars, that would be worth $592 million, approximately 4 times what the federal government is spending now. Without an infusion of funding that can really make a difference, the nursing and nursing faculty shortages will continue at the expense of the health and well-being of this country's citizens.


While we acknowledge the fact that the country is facing some severe budget constraints, Title VIII funding is now required to educate and prepare the nursing workforce needed to provide our citizens with nursing care on a daily basis, as well as during major emergencies and disasters. As Hurricane Katrina has taught us, nurses are a critical, but often unrecognized, component of the federal healthcare response to major emergencies and disasters. In the case of a major emergency, nurses have and will continue to be called upon to triage, provide immediate care, and, when needed, assist with chemoprophylaxis (oral or injectable medications/vaccinations) of hundreds of thousands or millions of Americans.


Registered nurses and advanced practice registered nurses (APRNs, including nurse midwives, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists) will be called on to respond in the event of a pandemic avian flu outbreak that, according to the Department of Health and Human Services' Pandemic Influenza Preparedness and Response Plan, will stretch the nation's "medical capabilities, potentially resulting in hundreds of thousands of deaths, millions of hospitalizations." The plan also stresses that unlike a tornado or hurricane, a pandemic outbreak will involve a broad and sustained resource strain that will make it difficult to shift resources between states, deeply affecting our nation's ability to deliver primary and surgical healthcare to patients who need it. Therefore, communities nationwide will need to have sufficient numbers of nurses, APRNs, and other healthcare providers to respond to the many healthcare challenges driven by a potential avian flu pandemic. As an example, the Office of Public Health Preparedness at the Health Resources and Services Administration (HRSA) estimates that a population of 100,000 people attacked by biological weapons would require 200 personnel working 100 hours just to deliver chemoprophylaxis. This effort would require approximately 16,171 trained persons for a city the size of New York.


Nurses are a vital resource for our nation, and yet, federal funding lags far below the need. In February 2004, the Bureau of Labor Statistics projected that registered nursing would have the greatest job growth of all professions in the United States in the years spanning 2002 to 2012. During this 10-year period, healthcare facilities will need to fill more than 1.1 million RN job openings. HRSA projects that, without aggressive intervention, the RN workforce will fall 29% below requirements by the year 2020. These estimates do not include the nurses that are redirected in the event of a major national health event, such as Hurricane Katrina.


Today's nursing shortage is very real and very different from shortages in the past. The current shortage is evidenced by an aging workforce-the average working RN is more than 43 years old-and an inadequate number of people entering the profession. All of this is occurring at the same time as the increasing healthcare demands of an aging US population continue to grow, which means that more nurses will be needed, not fewer. By the year 2025, 68.3% of the current nursing workforce will be among the first of 78 million baby boomers reaching retirement age and enrolling in the Medicare program. By 2030, 20% of the population-70 million-will be older Americans, more than twice their number in 1999.


The projected loss of a large segment of the currently practicing nurse population is a loss of not just a member of the workforce but also of expertise. Currently, APRNs, who have superior record for providing cost-effective, quality healthcare services, are also in very high demand. While APRNs practice in every US setting, these healthcare providers predominate in rural and medically underserved America. The loss of one APRN in a community can affect access to healthcare for the entire community. In addition, APRNs work in highly technical and specialized areas that significantly impact patient safety and quality outcomes.


The current nursing shortage is further complicated by the fact that schools of nursing continue to suffer from a growing shortage of faculty, which prevents these institutions from admitting more students. According to recent statistics from the National League for Nursing (NLN), an estimated 147,000 applications were turned away from nursing programs at all levels for the academic year 2004-2005. Insufficient faculty is the top reason cited by nursing schools for not accepting all qualified applicants into their programs. This dilemma translates into a "Catch 22" situation and the continuation of the nursing shortage rather than its abatement. This condition is not expected to improve in the near term because an adequate number of nurse educators are currently not in the education pipeline to replace the current aging (average age is 53.5 years) and retiring faculty. Waiting lists of 2 to 5 years to get into a nursing program are common in many parts of the country. This simply will not do and will not solve the nursing shortage.


For additional information regarding the Alliance's stance on this critical issue, please feel free to contact any of the organizations below. Thank you for your consideration.


Sincerely yours,


Academy of Medical-Surgical Nurses


American Academy of Ambulatory Care Nursing


American Academy of Nurse Practitioners


American Association of Critical-Care Nurses


American Association of Nurse Anesthetists


American Association of Occupational Health Nurses, Inc.


American College of Nurse-Midwives


American College of Nurse Practitioners


American Nephrology Nurses Association


American Organization of Nurse Executives


American Society of PeriAnesthesia Nurses


American Society of Plastic Surgical Nurses


Association of PeriOperative Registered Nurses


Association of Rehabilitation Nurses


Association of State and Territorial Directors of Nursing


Association of Women's Health, Obstetric and Neonatal Nurses


Children's Hospital of San Diego


Dermatology Nurses Association


Emergency Nurses Association


Infusion Nurses Society


International Society of Nurses in Genetics


National Association Nurse Massage Therapists


National Association of Clinical Nurse Specialists


National Association of Orthopaedic Nurses


National Association of Pediatric Nurse Practitioners


National Association of School Nurses


National Black Nurses Association


National Conference of Gerontological Nurse Practitioners


National Council of State Boards of Nursing


National League for Nursing


National Nursing Centers Consortium


Nurses Organization of Veterans Affairs


National Student Nurses' Association


Oncology Nursing Society


Society of Gastroenterology Nurses and Associates


Society of Trauma Nurses


Society of Urologic Nurses and Associates