**PRINCIPLE NURSE CONSULTANT RESPONSE TO 1999 NCONA RESOLUTIONS**

**June 15, 2000**

PROPOSAL 99-1

SUPPORT FOR THE REAUTHORIZATION OF P.L. 94-437

> THEREFORE BE IT RESOLVED THAT
>
> NCON demonstrate support of the Reauthorization of P.L. 94-437 Title I
> Sections which directly impact Nursing Care in Indian Country
>
> THEREFORE BE IT FURTHER RESOLVED THAT
>
> The National Council of Nurse Administrators which consists of Nurse
> Administrators from, IHS, Tribal and Urban Health Programs, strongly
> support maintaining the unsolicited continuos funding of specific
> sections of Title I (Indian Health Manpower) up for renewal in P.L.
> 94-437
>
> **[RESPONSE]{.underline}**
>
> Indian Health Nursing leadership has been involved in the on-going
> consultation with Indian Health/Tribal/Urban programs to amend and
> update the Indian Health Care Improvement Act. NCON drafted a letter
> in support of 437 Reauthorization. Kitty Rogers has been the
> Headquarters Project Manager for 437 Reauthorization activities; nurse
> consultants have represented nursing at local and regional meetings;
> and Pat Smith, Albuquerque Nurse Consultant and Celissa Stephens,
> Nurse Recruiter, attended the National planning meeting . The National
> 437 Steering Committee forwarded the final proposed bill to the
> Director of IHS and to each authorizing committee in the House and
> Senate. The entire document as proposed is available on the IHS
> website at www.ihs.gov.
>
> The following is a summary of proposed changes of sections affecting
> nursing.
>
> TITLE I
>
> Section 102: General Requirements
>
> NEW Section
>
> Term "Health Professionals" used throughout to reflect the broadest
> view of what professions are included (rather than listing professions
> separately).
>
> Replaces competitive grants and demonstrations with program
> authorizations.
>
> More local discretion to address human resource development.
>
> Scholarship and loan recipients already in the pipeline are protected
> from any new requirements.
>
> Section 102: Health Professions Recruitment Program for Indians
>
> Now Section 103
>
> Term "grants" changed to funding.
>
> "Indian" more clearly defined
>
> Section 103: Health Professions Preparatory Scholarship for Indians
>
> Now Section 104
>
> Term "grants" replaced by "scholarship"
>
> Scholarship assistance shall not be denied based solely on the basis
> of scholastic achievement as long as the student is maintained in good
> standing at an accredited institution.
>
> Eligibility requirements amended so only persons who are Indian are
> eligible.
>
> Section 104: Indian Health Professions Scholarship
>
> Now Section 105 A and B.
>
> Clarifies the Secretary's role as purely administrative
>
> Requires that the recipient meet the service obligation "within the
> service area from which the scholarship was awarded", except in
> special circumstances and with agreement between Areas or programs.
>
> Section 120: Matching Grants to Tribes for Scholarship Programs moved
> to this section.
>
> Modified to allow Tribes or tribal organizations to use any source of
> funds for their 20% match.
>
> Section 105: IHS Summer Extern Program
>
> Now Section 107
>
> Extern employment for scholarship recipients is a right within the
> Service, but discretionary for Tribes, tribal organizations and urban
> Indian programs.
>
> Section 106: Continuing Education Allowances
>
> Now Section 108
>
> Replaces listing of qualified professions with the general term
> "health professionals".
>
> Eliminates wording limiting the amount that can be used to establish
> post-doctoral training programs
>
> Section 108: IHS Loan Repayment Program
>
> Now Section 110
>
> Eliminates specific wording defining percentage distribution for
> select disciplines, including the 25% once allocated to nursing
>
> Section 109: Recruitment Activities
>
> Now Section 112
>
> Includes Tribes and tribal organizations in eligibility for site
> visits
>
> Section 110: Tribal Recruitment Retention Program
>
> Now Section 113.
>
> Funding of innovative demonstration projects aimed at recruiting,
> placing and retaining health care professionals
>
> Section 112: American Indians Into Nursing
>
> Now Section 115
>
> Changes terminology "nurse practitioner" to "advance practice nurse",
> throughout.
>
> Deleted section on funding clinics for Native American health care at
> schools of nursing.
>
> Section 114: INMED Program
>
> Now Section 117
>
> Section 117: Retention Bonus
>
> Now Section 119
>
> Available to "any" health professional"
>
> Section 118: Nursing Residency Program (NECI)
>
> Now Section 120
>
> Eligible course work amended to include "advanced degrees in nursing
> and public health"-although not specifically stated, this could be
> interpreted as including masters and doctoral programs.
>
> Obligated service decreased to "the amount of time during which the
> individual participates in the program."
>
> Eligibility requirements amended so only persons who are Indian are
> eligible.
>
> Section 120: Matching Grants to Tribes for Scholarship Programs
>
> Moved to Section 105 as noted previously
>
> Section 122: USD Pilot Project
>
> Now Section 123
>
> Amended to read "health professionals" instead of listing specific
> professional categories.
>
> Section 124: Scholarships
>
> Specifies scholarships provided under Title I are non-taxable under
> the IRS code
>
> (The specific wording reads "[scholarships]{.underline} provided to
> individuals pursuant to this Title", but a summary from the National
> Steering Committee indicates that it is clearly intended that "all
> scholarships, loans and repayments of loans" are non-taxable.

PROPOSAL 99-3

IHS LOAN REPAYMENT PROGRAM

> THEREFORE BE IT RESOLVED THAT
>
> The percentage of dedicated nursing funds for the Indian Health
> nursing program remain at least twenty-five percent of the total IHS
> Loan Repayment Program.
>
> **[RESPONSE]{.underline}**
>
> Nursing only received 15% of loan repayment funding this cycle. As
> noted above, the proposed 437 Reauthorization revisions would
> eliminate specific percentages of loan repayment dollars for all
> categories. It has become more difficult to support the specific
> percentage for nurses in view of significant shortages in health care
> professions (e.g., pharmacists) who never received a specific
> allocation of dollars and relatively stable vacancy and turnover rates
> for nursing. However, Indian country is beginning to experience the
> nursing shortage that has been predicted for the Nation. This could be
> used as leverage to obtain more loan repayment dollars for nursing.
>
> Judy Enyart, Nurse Recruiter, is on the multidisciplinary work group,
> which continues look at loan repayment criteria and other issues. She
> will continue to advocate on behalf of nursing for additional funding.
> It may become necessary for you, local IHS, tribal, and urban nurse
> administrators, to report vacancy rates and other personnel statistics
> to enable her to support nursing arguments.

PROPOSAL 99-4

TAX EXEMPT STATUS FOR NURSING SCHOLARSHIPS

> THEREFORE BE IT RESOLVED THAT
>
> IHS Scholarship awards should be tax exempt.
>
> **[RESPONSE]{.underline}**
>
> As noted above, proposed wording of the 437 Reauthorization Act would
> make all scholarships under the law non-taxable.

PROPOSAL 99-5

NURSING CLASSIFICATION STANDARDS

> THEREFORE BE IT RESOLVED THAT
>
> The current 610 classification standards for nursing be reviewed and
> revised to reflect nursing practice as it exists today.
>
> **[RESPONSE]{.underline}**
>
> Headquarters Nursing and the National Council of Nursing strongly
> support the need for the review and revision of the nursing
> classification standards and has included this in the NCON Strategic
> Plan. Classification standards have not been changed for almost 30
> years, but nursing certainly has changed. However, control of the 610
> classification standards rests with the Office of Personnel Management
> (OPM), not with IHS personnel This makes revision difficult. When we
> first began to pursue this issue, we were informed by OPM that the
> Department of Defense was already working on revision. It was decided
> to let them pursue changes.
>
> We have been unsuccessful in obtaining an update on the status of the
> revisions for this conference, but Headquarters Nursing will continue
> to pursue this issue.

PROPOSAL 99-6

REASSESSMENT AND INCREASE IN SPECIAL PAY

> THEREFORE BE IT RESOLVED THAT
>
> Indian Health Service reassess special pay rates in relationship to
> current private sector salary and benefits offerings.
>
> THEREFORE BE IT FURTHER RESOLVED THAT
>
> Indian Health Service pursue special pay raises
>
> **[RESPONSE]{.underline}**
>
> Headquarters Nursing and NCON fully support this amendment and have
> included it in the NCON Strategic Plan. NCON is in the process of
> gathering data from the private sector regarding salaries and benefits
> and hope to have that phase completed by August. The issue of special
> pay for nursing was presented to the Executive Leadership Group by the
> NCON Chair last fall. Action was delayed due to the acute shortage of
> pharmacists and dentists, requiring intensive efforts to obtain
> incentives for them. We have been assured that the nursing issue will
> be moved forward now that special pay for dentists and pharmacists
> have been implemented. Headquarters Nursing and NCON will continue to
> monitor the progress of this issue.

PROPOSAL 99-7

FUNDING FOR INTERNSHIP FOR NEW GRADUATES IN ACUTE CARE SETTINGS

> THEREFORE BE IT RESOLVED THAT
>
> Indian Health Service support the development and funding of a nurse
> internship program for new graduates in an acute care setting.
>
> THEREFORE BE IT FURTHER RESOLVED THAT
>
> The Indian Health Service include funding for such internship in P.L.
> 94-437 reauthorization requests.
>
> **[RESPONSE]{.underline}**
>
> No wording regarding this issue was included in the 437
> Reauthorization proposal.
>
> Headquarters Nursing and NCON acknowledge the need for support of new
> graduates. It is a major concern that facilities do not or cannot hire
> the many new graduates coming out of nursing scholarship programs.
> Lack of resources and support for orienting and mentoring these nurses
> has been cited as a major reason. Complaints received at headquarters
> are causing IHS leadership to reconsider the availability of nursing
> scholarships since we are not willing to hire scholarship recipients
> once they graduate.
>
> IHS has funded an internship program in the past, however, it was
> deemed too expensive for the number of nurses it was able to turn out,
> and, therefore, canceled. Since that time, IHS nursing has
> periodically funded specialty training, including self-learning
> modules for nurses entering public health nursing. Most recently,
> however, the IHS Scholarship Program and Headquarters Nursing has
> funded the development of an 3 month long Internship Program in the
> Navajo Area. The modules for developed for this program will
> eventually be made available for any Area desiring them, once they
> have been evaluated. The program is scheduled to enroll it's first
> participants later this summer. You will be able to learn more about
> the program at the poster sessions.
>
> Headquarters Nursing would also be willing to advocate for funds for
> Areas, Tribes or Urban Programs submitting a formal, well written and
> thought out, detailed proposal for an internship or similar program.
> We also recommend that you, the members of NCONA to resolve the issue
> of hiring new scholarship graduates within the I/T/Us.

PROPOSAL 99-9

SUPPORT FOR THE REAUTHORIZATION OF P.L. 94-437

> THEREFORE BE IT RESOLVED THAT
>
> Section 118 be amended to provide financial support for a doctoral
> education level for nurses.
>
> **[RESPONSE]{.underline}**
>
> As noted above, the proposed 437 Reauthorization includes wording
> supporting "advanced degrees in nursing and public health".