THE NURSING SHORTAGE: CAUSES, 

IMPACT, AND INNOVATIVE REMEDIES 

HEARING

BEFORE THE 

COMMITTEE ON EDUCATION AND 

THE WORKFORCE 

HOUSE OF REPRESENTATIVES

ONE HUNDRED SEVENTH CONGRESS

FIRST SESSION

HEARING HELD IN WASHINGTON, DC, SEPTEMBER 25, 2001 

Serial No. 107-31 

Printed for the use of the Committee on Education 

and the Workforce

U.S. GOVERNMENT PRINTING OFFICE 

 77-676 pdf WASHINGTON : 2002

For sale by the Superintendent of Documents, U.S. Government Printing Office 

Internet: bookstore.gpo.gov Phone: (202) 512-1800 FAX: (202) 512-2250 

Mail: Stop SSOP, Washington, DC 20402-0001
ii

COMMITTEE ON EDUCATION AND THE WORKFORCE 

JOHN A. BOEHNER, Ohio, Chairman 

THOMAS E. PETRI, Wisconsin GEORGE MILLER, California 

MARGE ROUKEMA, New Jersey DALE E. KILDEE, Michigan 

CASS BALLENGER, North Carolina MAJOR R. OWENS, New York 

PETER HOEKSTRA, Michigan DONALD M. PAYNE, New Jersey 

HOWARD P. “BUCK” McKEON, California PATSY MINK, Hawaii 

MICHAEL N. CASTLE, Delaware ROBERT E. ANDREWS, New Jersey 

SAM JOHNSON, Texas TIM ROEMER, Indiana 

JAMES C. GREENWOOD, Pennsylvania ROBERT C. “BOBBY” SCOTT, Virginia 

LINDSEY O. GRAHAM, South Carolina LYNN C. WOOLSEY, California 

MARK E. SOUDER, Indiana LYNN N. RIVERS, Michigan 

CHARLIE W. NORWOOD, JR., Georgia RUBEN HINOJOSA, Texas 

BOB SCHAFFER, Colorado CAROLYN McCARTHY, New York 

FRED UPTON, Michigan JOHN F. TIERNEY, Massachusetts 

VAN HILLEARY, Tennessee RON KIND, Wisconsin 

VERNON J. EHLERS, Michigan LORETTA SANCHEZ, California 

THOMAS G. TANCREDO, Colorado HAROLD E. FORD, JR., Tennessee 

ERNIE FLETCHER, Kentucky DENNIS KUCINICH, Ohio 

JIM DeMINT, South Carolina DAVID WU, Oregon 

JOHNNY ISAKSON, Georgia RUSH D. HOLT, New Jersey 

BOB GOODLATTE, Virginia HILDA L. SOLIS, California 

JUDY BIGGERT, Illinois SUSAN DAVIS, California 

TODD RUSSELL PLATTS, Pennsylvania BETTY McCOLLUM, Minnesota 

PATRICK J. TIBERI, Ohio 

RIC KELLER, Florida 

TOM OSBORNE, Nebraska 

JOHN ABNEY CULBERSON, Texas 

Paula Nowakowski, Chief of Staff 

John Lawrence, Minority Staff Director 
iii

TABLE OF CONTENTS 

OPENING STATEMENT OF CHAIRMAN JOHN BOEHNER, COMMITTEE ON 

EDUCATION AND THE WORKFORCE..................................................................... 2

OPENING STATEMENTOF RANKING MEMBER GEORGE MILLER, 

COMMITTEE ON EDUCATION AND THE WORKFORCE ..................................... 4

STATEMENT OF CONGRESSWOMAN SUE KELLY, 19th DISTRICT OF NEW 

YORK, U. S. HOUSE OF REPRESENTATIVES......................................................... 5

STATEMENT OF CONGRESSWOMAN CAROLYN McCARTHY, COMMITTEE 

ON EDUCATION AND THE WORKFORCE.............................................................. 7

STATEMENT OF MELISSA VELAZQUEZ, RN, BURN INTENSIVE CARE UNIT, 

WASHINGTON HOSPITAL CENTER, WASHINGTON, D.C................................... 9

STATEMENT OF LISA TOMPKINS, RN, BSN, TRAUMA/NERUO INTENSIVE 

CARE UNIT, INOVA FAIRFAX HOSPITAL, FALLS CHURCH, VA .................... 11

STATEMENT OF MARY FOLEY, RN, MS, PRESIDENT, AMERICAN NURSES 

ASSOCIATION, WASHINGTON, D.C. ..................................................................... 34

STATEMENT OF SUE ALBERT, RN, MN, MHA, ASSISTANT DEAN OF ALLIED 

HEALTH, COLLEGE OF THE CANYONS, SANTA CLARITA, CA...................... 37

STATEMENT OF CAROLYN McCULLOUGH, MA, RN, NATIONAL 

COORDINATOR, NURSE ALLIANCE, SERVICE EMPLOYEES 

INTERNATIONAL UNION, WASHINGTON, D.C................................................... 39

STATEMENT OF DR. JEAN BARTELS, CHAIR, SCHOOL OF NURSING, 

GEORGIA SOUTHERN UNIVERSITY, STATESBORO, GA.................................. 42

STATEMENT OF CATHERINE GARNER, DrPH, RN, FAAN, DEAN, COLLEGE 

OF NURSING AND HEALTH SCIENCES, UNIVERSITY OF PHOENIX, 

PHOENIX, AZ.............................................................................................................. 45

STATEMENT OF GEORGE F. LYNN, PRESIDENT AND CEO, ATLANTICARE 

HEALTH SYSTEM, TESTIFYING ON BEHALF OF THE AMERICAN HOSPITAL 

ASSOCIATION, WASHINGTON, D.C. ..................................................................... 47

APPENDIX A - WRITTEN STATEMENT OF CHAIRMAN JOHN BOEHNER, 

COMMTITEE ON EDUCATION AND THE WORKFORCE ................................... 59
iv

APPENDIX B - WRITTEN STATEMENT OF CONGRESSWOMAN SUE KELLY, 

19TH DISTRICT OF NEW YORK, U.S. HOUSE OF REPRESENTATIVES ............ 63

APPENDIX C - WRITTEN STATEMENT OF CONGRESSWOMAN CAROLYN 

McCARTHY, COMMITTEE ON EDUCATION AND THE WORKFORCE ........... 67

APPENDIX D - WRITTEN STATEMENT OF MELISSA VELAZQUEZ, RN, BURN 

INTENSIVE CARE UNIT, WASHINGTON HOSPITAL CENTER, WASHINGTON, 

D.C................................................................................................................................ 73

APPENDIX E - WRITTEN TESTIMONY OF LISA TOMPKINS, RN, BSN, 

TRAUMA/NEURO INTENSIVE CARE UNIT, INOVA FAIRFAX HOSPITAL, 

FALLS CHURCH, VA................................................................................................. 77

APPENDIX F - WRITTEN STATEMENT OF MARY FOLEY, RN, MS, 

PRESIDENT, AMERICAN NURSES ASSOCIATION, WASHINGTON, D.C........ 83

APPENDIX G - WRITTEN STATEMENT OF SUE ALBERT, RN, MN, MHA, 

ASSISTANT DEAN OF ALLIED HEALTH, COLLEGE OF THE CANYONS, 

SANTA CLARITA, CA ............................................................................................... 99

APPENDIX H - WRITTEN STATEMENT OF CAROLYN McCULLOUGH, MA, 

RN, NATIONAL COORDINATOR, NURSE ALLIANCE, SERVICE EMPLOYEES 

INTERNATIONAL UNION, WASHINGTON, D.C................................................. 111

APPENDIX I - WRITTEN STATEMENT OF DR. JEAN BARTELS, CHAIR, 

SCHOOL OF NURSING, GEORGIA SOUTHERN UNIVERSITY, STATESBORO, 

GA............................................................................................................................... 123

APPENDIX J - WRITTEN STATEMENT OF CATHERINE GARNER, DrPH, RN, 

FAAN, DEAN, COLLEGE OF NURSING AND HEALTH SCIENCES, 

UNIVERSITY OF PHOENIX, PHOENIX, AZ......................................................... 141

APPENDIX K - WRITTEN STATEMENT OF GEORGE F. LYNN, PRESIDENT 

AND CEO, ATLANTICARE, TESTIFYING ON BEHALF OF THE AMERICAN 

HOSPITAL ASSOCIATION, WASHINGTON, D.C................................................ 147

APPENDIX L – SUBMITTED FOR THE REOCRD, STATEMENT OF 

CONGRESSWOMAN LOIS CAPPS, 22ND DISTRICT OF CALIFORNIA, U.S. 

HOUSE OF REPRESENTATIVES, SEPTEMBER 25, 2001 ................................... 159

APPENDIX M – SUBMITTED FOR THE RECORD, STATEMENT OF 

CONGRESSMAN RUSH HOLT, 12TH DISTRICT OF NEW JERSEY, U.S. HOUSE 

OF REPRESENTATIVES, SEPTEMBER 25, 2001.................................................. 163
v

APPENDIX N – SUBMITTED FOR THE RECORD, LETTER FROM GEORGE R. 

BOGGS, PRESIDENT AND CEO, AMERICAN ASSOCIATION OF COMMUNITY 

COLLEGES, WASHINGTON, D.C., TO BONNIE LEBOLD, EXECUTIVE 

DIRECTOR, NATIONAL ADVISORY COMMITTEE ON INSTITUTIONAL 

QUALITY AND INTEGRITY, U.S. DEPARTMENT OF EDUCATION, 

WASHINGTON, D.C., AUGUST 27, 2001............................................................... 167

APPENDIX O – SUBMITTED FOR THE RECORD, STATEMENT OF KAREN 

DRENKARD, RN, MSN, CNAA, CHIEF NURSE EXECUTIVE, INOVA HEALTH 

SYSTEM, FALLS CHURCH, VA, SEPTEMBER 11, 2001..................................... 173

APPENDIX P – SUBMITTED FOR THE RECORD, STATEMENT OF DEBORAH 

A. CHAMBERS, CRNA MHSA, PRESIDENT, AMERICAN ASSOCIATION OF 

NURSE ANESTHETISTS – FEDERAL GOVERNMENT AFFAIRS OFFICE, 

WASHINGTON, D.C., SEPTEMBER 24, 2001........................................................ 183

APPENDIX Q – SUBMITTED FOR THE RECORD, STATEMENT OF DR. PAUL 

KINSER, PROVOST OF THE WEST CAMPUS, VALENCIA COMMUNITY 

COLLEGE AND NANCY DINON, VICE PRESIDENT, HUMAN RESOURCES, 

ORLANDO REGIONAL HEALTHCARE, ON BEHALF OF PARTNERS FOR A 

HEALTHY COMMUNITY, SEPTEMBER 25, 2001 ............................................... 189

APPENDIX R – SUBMITTED FOR THE RECORD, STATEMENT OF PREMIER, 

INC., WASHINGTON, D.C., SEPTEMBER 25, 2001, AND LETTERS FROM HERB 

KUHN, CORPORATE VICE PRESIDENT, ADVOCACY TO THE HONORABLE 

TOMMY TOMPSON, SECRETARY OF HEALTH AND HUMAN SERVICES, 

SEPTEMBER 20, 2001 AND THE HONORABLE ROD PAIGE, SECRETARY OF 

EDUCATION, JANUARY 22, 2001.......................................................................... 193

APPENDIX S – SUBMITTED FOR THE RECORD, STATEMENT OF THE 

AMERICAN FEDERATION OF STATE, COUNTY AND MUNICIPAL 

EMPLOYEES, SEPTEMBER 25, 2001..................................................................... 205

 APPENDIX T - SUBMITTED FOR THE RECORD, STATEMENT OF

 EMPLOYMENT POLICY FOUNDATION, WASHINGTON, D.C., SEPTEMBER 

 25, 2001..........................................................................................211 

Table of Indexes.......................................................................................................... 220 
1

THE NURSING SHORTAGE: 

CAUSES, IMPACT, AND INNOVATIVE REMEDIES 

____________________

Tuesday, September 25, 2001 

Committee on Education and the Workforce 

U. S. House of Representatives 

Washington, D.C. 

 The Committee met, pursuant to call, at 10:00 a.m., in Room 2175, Rayburn 

House Office Building, Hon. John A. Boehner, Chairman of the Committee, presiding. 

 Present: Representatives Boehner, Ballenger, McKeon, Castle, Greenwood, 

Norwood, Ehlers, Fletcher, Isakson, Goodlatte, Biggert, Tiberi, Osborne, Miller, Kildee, 

Mink, Andrews, Roemer, Scott, Woolsey, Hinojosa, McCarthy, Tierney, Kucinich, Wu, 

Holt, Solis, Davis, and McCollum. 

 Staff Present: Stephanie Milburn, Professional Staff Member; Victoria Lipnic, 

Professional Staff Member; Dave Thomas, Legislative Assistant; John Cline, 

Professional Staff Member; Molly Salmi, Professional Staff Member; Jo-Marie St. 

Martin, General Counsel; Heather Valentine, Press Secretary; Patrick Lyden, Professional 

Staff Member; Deborah L. Samantar, Committee Clerk/Intern Coordinator; Peter 

Rutledge, Senior Legislative Associate/Labor; Michele Varnhagen, Labor 

Counsel/Coordinator; Maria Cuprill, Legislative Associate/Labor; Maggie McDow, 

Legislative Associate/Education; Brendan O'Neil, Legislative Associate/Education; Brian 

Compagnone, Staff Assistant/Labor.

Chairman Boehner. A quorum being present, the Committee on Education and the 

Workforce will come to order. We are meeting today to hear testimony on problems 

associated with the Nation's nursing shortage. And under Committee Rule 12(b), 

opening statements are limited to the Chairman and Ranking Minority Member of the 

Committee. Therefore, if other Members have statements, they will be included in the 

hearing record. 
2

And with that, I ask unanimous consent for the hearing record to remain open for 

14 days to allow Member statements and/or extraneous material referenced during this 

morning's hearing to be submitted in the official hearing record. Without objection, so 

ordered.

OPENING STATEMENT OF CHAIRMAN JOHN BOEHNER, 

COMMITTEE ON EDUCATION AND THE WORKFORCE 

 I thank you for joining us this morning for this hearing. Today this Committee is 

meeting to hear testimony on the nursing shortage facing our country. As most of you 

know, this hearing was originally scheduled to take place 2 weeks ago today, September 

11th.

 Among the many things we have awoken to since that fateful day is the 

importance of the women and men who make up our Nation's medical and emergency 

professions. If the nursing shortage facing our country was in serious condition 2 weeks 

ago, it is in critical condition today. Two weeks ago we watched dedicated nurses and 

other medical personnel selflessly respond to tragic events in New York City and right 

across the river at the Pentagon. 

 Today we have with us on our panel and in our audience nurses who were there to 

care for others in that time of need. We want to thank you for your willingness to join us 

today and for your dedicated response in that emergency. And more than that, we are 

grateful to you and to all of your colleagues for your chosen profession. 

 The choice of nursing is at the heart of what we examine here today. If ever an 

issue demonstrates the lifeblood connection between education and the workplace, this is 

certainly it. The nurses make up the backbone of our health care system. They provide 

much of the direct care all of us receive. Nursing requires exacting and continuing 

education and skill. And while we all know that nursing can be one of the most rewarding 

professions, at the same time it is the one of the most mentally and physically demanding 

careers that one can choose. 

 And so today we will examine the causes and impact of the nursing shortage that 

we face in our country. We expect to hear about innovative remedies currently being 

undertaken by educational institutions and the health care industry as well as suggestions 

for further action. 

 I want to thank our witnesses for coming today and giving us the benefit of their 

perspectives and expertise on this issue. I especially want to acknowledge the appearance 

of our colleagues, Congresswoman Kelly and Congresswoman McCarthy, who will 

testify first on our panel today, and, I might add, whose suggestion led to this hearing that 

we have in front of us today. 
3

Let me provide some additional context for our hearing today. Like many of you, 

I regularly hear from hospitals in my district about the difficulty that they are having in 

recruiting and retaining nurses. And while the individual stories are different, the themes 

are the same. 

 Demand for nurses continues to increase as the population ages and acuity levels 

of patients increase. At the same time, nurses are leaving the hospital setting for other 

opportunities. And while hospitals are making the changes to the nursing workplace to 

make employment more attractive, recruitment efforts have not succeeded in filling all of 

the empty positions. As a result, staffing challenges are exacerbated. In addition, the 

nursing workforce is aging. Fewer new nurses are entering the profession to replace 

those who are retiring or leaving. The average age of the nurse is now just over 43 years. 

 Unfortunately, fewer younger people are choosing to pursue a career in nursing, 

and enrollment in all of the nursing education programs has in fact declined. Certain 

populations remain underrepresented in the nursing field; included in them are men and 

minorities. Hospitals are experiencing tremendous vacancy rates for nursing positions, 

and overall, the pipeline of new graduates from nursing programs is insufficient to keep 

pace with the demand. 

 And while providers in many areas of the country say they currently face a crisis, 

the shortage is only expected to worsen. By 2020, as baby boomers reach their late sixties 

and seventies and need more health care, the nursing workforce is projected to fall to 

nearly 20 percent below projected needs. 

 Now, we have new issues that may impact the profession. For instance, we do not 

yet know how many nurses in the military reserves may be called into active duty. In 

addition, recent events have forced us to evaluate our emergency preparedness around the 

country.

 Through this hearing I hope that we will bring needed attention to the growing 

shortage and provide a venue for exchange of ideas on possible solutions. Strategies to 

address the nursing shortage could impact education, training, and workforce programs. I 

anticipate that we will learn that there are no easy solutions to address this situation. 

 However, our discussion today likely will reinforce the fact that all parties, 

whether they are educators, nurses, employers or the government, need to work together 

to reach out to young people and underrepresented groups to encourage them to become 

nurses. And we need to do everything that we can to keep current nurses working in the 

profession, and I look forward to hearing the suggestion of our witnesses. 

WRITTEN STATEMENT OF CHAIRMAN JOHN BOEHNER, COMMTITEE ON 

EDUCATION AND THE WORKFORCE – SEE APPENDIX A 

Chairman Boehner. It is now my pleasure to yield to my friend and Ranking Member 

of the Committee, Mr. Miller. 
4

OPENING STATEMENTOF RANKING MEMBER GEORGE 

MILLER, COMMITTEE ON EDUCATION AND THE WORKFORCE 

Thank you, Mr. Chairman, very much for holding this hearing and for your 

opening remarks. I too want to join you in welcoming those in our audience today who 

participated in helping those who were so devastated and harmed by the events of 

September 11th. 

 But I think, as we will hear from these witnesses today and as we have already 

heard from so many nurses in our own community, it may be that the events of 

September 11th simply put a very, very bright spotlight on the situation that exists in all 

of our communities on a daily basis. The difficulty of responding to community 

emergencies, the difficulty of trying to retain a coherent workforce in our various medical 

facilities exists on a day-to-day, ongoing basis all of the time. 

 We are now into that situation where fewer and fewer people are coming into the 

profession because they have alternatives which is making the profession more and more 

difficult, so more and more people are leaving. And I think that at the end of this 

hearing, if it goes as I expect, and if it is consistent with what I have heard from so many 

in the profession in the San Francisco Bay area, our response is going to have to be 

comprehensive. We are going to have to try to improve the situation for those who are 

already in the profession so they will want to stay, so they will want to continue that 

career. And we are clearly going to have to make it more attractive at the same time for 

those about to enter. But nobody should be mistaken about the urgency of this problem. 

Everywhere in the entire health care chain you can engage anyone and they will tell you 

about the problems because of the lack of nurses. 

 I would like, if I might, Mr. Chairman, ask unanimous consent to insert the 

statement of Congresswoman Lois Capps, on this issue. I would just like to_the part of it 

where she states: In our State of California, less than 10 percent of the registered nurse 

workforce is under the age of 30, and nearly a third of it are over the age of 50, and we 

rank 50th among the States in RNs per hundred thousand people. 

 It is an acute problem. It is a serious problem. And we are going to have to 

certainly lend a Federal effort to solving this problem, and I look forward to hearing from 

our panels today. 

 Thank you again for holding the hearing. 

Chairman Boehner. I would now like to introduce our first panel of witnesses. Our 

first witness is the gentlelady from New York, Representative Sue Kelly. Testifying 

second will be our other colleague, the gentlelady from New York and a Member of this 

Committee, Carolyn McCarthy. Our third witness will be Ms. Melissa Velazquez, RN 

from the Burn Intensive Care Unit of the Washington Hospital Center. And our final 

witness on the panel will be Ms. Lisa Tompkins, RN, BSN. Ms. Tompkins is a registered 
5

nurse from the Trauma/Neuro Intensive Care Unit, Inova Fairfax Hospital in Northern 

Virginia. I would like to remind my colleagues that we do have a 5-minute rule on 

questioning.

 I will explain to our witnesses the lights in front. You will have a green light for 

4 minutes, a yellow light for a minute, and when it gets to red we hope that you would be 

concluding your remarks. Because we have two panels of witnesses today, and a vote is 

expected on the floor sometime during this morning, we want to try to hold to our time 

limits. 

 I understand the gentlelady from New York, Ms. Kelly, who also sits on the 

Aviation Subcommittee, Committee on Transportation and Infrastructure may have to 

leave. Therefore, Ms. Kelly, you may begin. 

STATEMENT OF CONGRESSWOMAN SUE KELLY, 19th DISTRICT 

OF NEW YORK, U. S. HOUSE OF REPRESENTATIVES 

 Thank you, Mr. Chairman and Members of the Committee, for inviting me to 

testify about this nursing shortage. It is a growing problem with the potential to impair 

health care delivery in our Nation. I am pleased that the Committee has recognized the 

severity of this issue and convened this hearing. 

 No doubt you hear all the heart-wrenching accounts from hospitals, skilled nurses, 

and long-term care facilities in your district about the difficulty they face in filling their 

nursing staffing slots. The crisis is real. I have seen it in hospitals in my district and 

appreciate the opportunity to appear here today to discuss both short- and long-term 

solutions to this problem. 

 Now more than ever, attention is focused on the ability of health care personnel 

to respond to critical patient needs. Our Nation's nurses are among the many heroes who 

responded to the recent attacks on the Pentagon and World Trade Center. The New York 

Nursing Association has told me of the overwhelming support from nurses in New York 

and around the country who volunteered to care for victims and rescuers in New York 

City at Ground Zero. I have met and spoken with nurses who returned there to work on 

their days off after hearing of the attacks on the news. 

 This kind of service defines the nursing profession. Nursing is a tough job, both 

mentally and physically. Nurses put their own health and safety at risk daily in the 

course of their jobs. Nursing can be a very rewarding profession, but, unfortunately, I 

have heard from many nurses that they would not recommend the profession to friends or 

family unless major changes take place in the industry. 

 The shortage of nurses in our Nation's hospitals and the pending retirement of 

many nurses should be worrisome to all of us. Hospitals can't run without nurses. RNs 

comprise the largest group of health care providers. Without adequate nursing staff, 

hospitals are forced to close units, turn away patients and redirect their emergency cases.
6

This results in long waits and a reduced quality of care. In critical situations, timing is 

everything. And when patients have to travel further or wait longer for care, they are less 

likely to have a positive recovery time. 

 The average age of a nurse in New York State is 48 years old. The average 

retirement age in New York is 52. The number of nurses approaching retirement, 

coupled with the aging baby boomer population who will require care, only increases the 

need for nurses. Looking down the road, the population of those aged 65 and older is 

expected to double in the next 30 years. 

 The cumulative effect of all of that is nurses are leaving the profession rapidly at a 

time when we need them most. It is imperative that we focus on these problems that will 

bring more nurses into our health care facilities and faculty into our nursing schools. 

 I am introducing new legislation aimed at combating the nursing shortage. I am 

collaborating with Senators Tim Hutchinson and Barbara Mikulsky who have already 

introduced The Nursing Employment and Education Development Act or the Need Act in 

the Senate. In short, the Need Act provides a framework for increasing the awareness of 

opportunities in the nursing profession, growing the enrollment in nursing schools, and 

providing staff coverage for areas experiencing more acute shortages. 

 The Need Act expands nursing loan repayment programs and establishes a Nurse 

Service Authority so nurses can receive scholarships in exchange for postgraduate service 

in geographic areas experiencing shortages. It expands the list of eligible entities at 

which they can fulfill this service requirement to include nursing homes, home health 

agencies, public health departments and nurse-managed health centers. 

 The bill will focus on attracting students to nursing by educating them about the 

benefits of nursing, offer grants for multimedia outreach and public awareness 

campaigns, and help ensure adequate registration at nursing schools in order to retain and 

strengthen our existing nurse workforce. The Need Act contains career ladder provisions 

to encourage nurses and nurses' aids to pursue advanced degrees so they can increase the 

level of care they can provide. Additionally the bill provides grants to encourage 

mentoring internship and residency programs as well as programs to bring former nurses 

back into the field. There are quite a few nurses who have left the field. We need to 

bring them back. 

 The bill also contains provisions for fast-track faculty development at nursing 

schools so there are well-qualified nurse educators to replace those retiring. This 

provision encourages Masters and Doctoral students to expedite their studies through 

loans and scholarships. 

 The answer to the nursing shortage is really fairly simple: Nurses need to have 

better hours, they need less paperwork, and they need better pay. We need to do 

everything that we can do to encourage them to stay in the field and bring them back into 

the field. We need to help them achieve staying in the nursing profession. 
7

Again I commend the Committee for holding this hearing today in order to 

explore solutions to the nursing shortage. I look forward to the testimony of the second 

panel and to working with all of the Members of this Committee to get more nurses into 

our hospitals and to secure the future of nurses. I am happy to answer any questions. 

WRITTEN STATEMENT OF CONGRESSWOMAN SUE KELLY, 19TH DISTRICT 

OF NEW YORK, U.S. HOUSE OF REPRESENTATIVES – SEE APPENDIX B 

Chairman Boehner. Sue, thank you. 

 Mrs. McCarthy, you may begin. 

STATEMENT OF CONGRESSWOMAN CAROLYN McCARTHY, 

COMMITTEE ON EDUCATION AND THE WORKFORCE 

Thank you, Chairman Boehner, and Representative Miller for the opportunity to 

testify before my colleagues on the Education and Workforce Committee. I have always 

been proud to serve on the Subcommittee on Education Reform, but I am especially 

proud today because we are focusing on an issue that is very important to me personally 

and professionally. 

Mr. Chairman, before coming to Congress, I spent over 30 years as a nurse on 

Long Island. And even now, I know that there isn't a better career in world or better 

training than nursing to be a Member of Congress. The only difference today is I have a 

lot more patients here in Congress and certainly at home. 

 That is why I am particularly saddened when we talk about the nursing shortage.

And let's be honest, right now we are in the middle of a national nursing crisis. I have 

been talking about this for almost 5 years since I came to Congress. Of the estimated 2.5 

million licensed nurses in our country, 400,000 have left the profession for other pursuits. 

In the year 2000 alone, Long Island has had an 8 percent RN vacancy rate, and a 

dangerously low 16 percent LPN vacancy rate. It is startling to learn that hospitals need 

about 126,000 nurses to fill all of the nursing positions available today. 

Mr. Chairman, the crisis will only get worse in the future. The demand for more 

nurses will dramatically increase as the baby boomer generation ages. And like the 

general population, the nurse workforce is aging while enrollment in nursing education 

programs has dramatically declined over the past 5 years. Between 1995 and 1998, there 

was a 21 percent decrease in the number of people enrolling in nursing schools. In 

addition, enrollment in the Bachelor of Science in Nursing programs was down 5 percent 

in 1999. This is especially troubling when taking into account that nurses have been 

leaving the field at record rates. 
8

The booming economy of the 1990s increased job opportunities for practicing 

nurses, but reductions in Medicare reimbursements resulted in a shift from inpatient to 

outpatient care. This left the most ill patients in the hospitals creating a more stressful 

environment for nurses who stayed in the field of high-risk patient care areas. Intensive 

care units and emergency rooms require highly skilled nurses with significant experience 

and have been affected most by the shortage. 

 As a nurse, I can tell you that getting the right care in the first 24 hours of being in 

the intensive care unit can make all of the difference in whether or not you recover from 

life-threatening problems. Further, if you do survive, the kind of care you receive within 

the first 24 to 48 hours dictates how long recovery will take. 

 When I speak to the health care professionals or visit the hospitals in my District, 

I hear the same thing from the nurses I meet: "I love my job, but the sacrifices I make are 

too great." Let’s be honest nobody ever went into nursing to make money, but like our 

teachers, nurses deserve better, and like teaching, nursing has traditionally been a 

profession made up mostly of women. In 2000, men held less than 6 percent of nursing 

positions. 

Over the past 20 years, professional opportunities for women have grown greatly. 

Many women who years ago would have gone into nursing are now breaking new ground 

in technology, business, and politics. Unfortunately, what hasn't changed over the last 20 

years is how much we pay our nurses. 

Mr. Chairman, we have outlined the problems. Now what about the solutions? 

There are many things we can do to combat the worker shortage. First, we need to 

recruit qualified, educated students. Our students have so many choices for careers 

today; we need to make nursing a competitive option. One way to do this is to increase 

funding for the nurse loan repayment program and designate the income as nontaxable. 

We need to further increase reimbursement rates to hospitals so they can increase nursing 

salaries. If nurses were compensated as other professionals are, more students would 

want to enter the profession. Finally, we have to create incentives for nurses to stay in 

nursing upon training completion. We should provide grants to encourage nurses to 

upgrade their skills in clinical specialty areas that have shortages. We must work with 

our hospitals to improve working conditions for our nurses. 

Mr. Chairman, solving the nursing shortage was extremely important before 

September 11th. Now more than ever it is vital to our Nation's health care, which is why it 

is my privilege to share this panel with Melissa from Washington, D.C., and Lisa from 

Falls Church, Virginia, two nurses who responded to our national tragedy and worked 

diligently to save the lives of our wounded. I commend them for their hard work and the 

hard work of all of our emergency personnel, and I look forward to their testimony. 

 Just on a side note: I talked my sister into going into nursing about 7 years ago 

and, unfortunately, 2 years ago, which is the average, she left nursing. She loved it. She 

loved the work that she was doing. But I will tell you, on her day off, she didn't want to 
9

answer the phone because she knew it was the hospital calling her to come in. 

 These are the crises that we are facing on a daily basis. We have to make sure our 

hospitals have the money to support the nursing staff which provides the whole 

infrastructure of our hospital care system that obviously goes right to the heart of taking 

care of patients. We have to do something. This Committee has the opportunity, in my 

opinion, to make things easier for people to go into the nursing field, continue in their 

education, and make a difference for everybody that we love, because someday, 

eventually, every single one of us will be spending time in the hospital. 

 I look forward to the questions that anyone on the Committee has to ask me. 

Thank you. 

WRITTEN STATEMENT OF CONGRESSWOMAN CAROLYN McCARTHY, 

COMMITTEE ON EDUCATION AND THE WORKFORCE – SEE APPENDIX C 

Chairman Boehner. Mrs. McCarthy, thank you. Ms. Velazquez, you may begin. 

STATEMENT OF MELISSA VELAZQUEZ, RN, BURN INTENSIVE 

CARE UNIT, WASHINGTON HOSPITAL CENTER, WASHINGTON, 

D.C.

Good morning, Mr. Chairman, and Members of the Committee. My name is 

Melissa Velazquez. I am a registered nurse at the Burn Intensive Care Unit at the 

Washington Hospital Center. I thank you for offering this tremendous opportunity to 

speak to you today. 

 The spirit that we have seen across the Nation has been nothing less than 

astounding; the willingness of Americans to take care of their families, their friends, their 

neighbors, and their communities and ultimately their Nation is overwhelming. It is 

something that you see and feel everywhere that you go. 

 If there is one thought that I absolutely want you to take home today, it is that that 

spirit has been alive and well and thriving in the profession of nursing since its inception, 

not only in the Burn Intensive Care Unit where we have been given the bittersweet 

privilege to care for the men and women injured at the Pentagon, but in hundreds of 

clinical settings all over this country, from the home to the hospital. Nurses give 110 

percent of themselves every day they walk through the doors of their facilities. 

 As the events that day evolved, my priorities changed. I collected my daughter 

from school, got home safe and made the phone calls necessary to make sure my family 

was okay. I called my head nurse and she asked if I would come in that night. And, of 
10

course, the answer was yes. 

 In all honesty, I was expecting absolute mayhem. The only other previous 

experience I had remotely similar was Memorial Day, 2 years ago. Five D.C. Firefighters 

were injured in a house fire, three of which lost their lives. The flurry of activity that 

night was unlike any other. 

 But much to the credit of all that were involved that day of the attack, when I 

arrived that evening, seven of the eight burn victims from the Pentagon were settled in.

And to lend some perspective to that, for just one large burn victim, it takes one doctor, 

one respiratory therapist, and two to three nurses, not to mention the ancillary support 

from the other departments such as the laboratory, pharmacy and radiology, a minimum 

of 2 to 4 hours to settle a patient in, and that is if nothing goes wrong. 

 The members of the burn team that were there that day did it seven times over, 

and in a phenomenal amount of time. So how is that possible if the Washington Hospital 

Center is experiencing the same nursing shortage the rest of the country is? And where 

did those extra nurses come from? 

 Over the last year, the burn ICU lost more than half of their staff to different 

educational and employment opportunities. They simply weren't satisfied with the 

necessary changes in the work environment that were being made. So why do I mention 

this? Because those same nurses that left were the same nurses that you saw that day of 

the attack and in the weeks following. 

 Why? Because we are nurses. That is what we do. And in a time of need, we put 

away any differences that we may have and get to the task at hand. 

 This example speaks volumes to the spirit of the nursing profession. The eighth 

burn victim hadn't arrived yet. This was to be my patient, Lieutenant Kevin Schaeffer of 

the U.S. Navy. And before I go on, be assured that I spoke with Lieutenant Schaeffer, 

and also his wife Blanca and his mother, and gained their permission to talk about him 

today, although I will not discuss any of his injuries. 

 There are a few things that stand out in my mind: When his wife arrived that first 

night and saw him, and the first thing out of her mouth was how much she loved him, and 

a tremendous amount of emotion came over her. She turned around and buried her hands 

in her face and cried, but only for a moment because she knew that her husband needed 

her.

 The very next day I had again the privilege to take care of him. And burn victims 

suffer from a tremendous amount of swelling after their injury, so much so that his eyes 

were shut on that second night. As I was applying some ointment, his eyes just opened. 

And I ran to the waiting room and I got Blanca, and I said, "Blanca you've got to come 

here. I have a surprise for you." And she walked in. And I said, "Kevin, show her what 

you got." And he opened his eyes. And that is just one of the more tremendous moments 

I have ever experienced in my career. 
11

This past weekend, Kevin sat up in a chair. He walked to the tank where we take 

care of cleaning their wounds before they have a new dressing. As a nurse, I have the 

honor of sharing those moments with Lieutenant Schaeffer and his family. These are the 

singular moments that make nurses' hearts sing. And as long as those moments outweigh 

the clinical working environment, I will keep coming back. 

 There is one final thought I would like to add. And if you were to ask me if there 

are enough nurses to staff health facilities in the country, the answer would be a 

resounding no. But, in the case of an emergency, a crisis, the profession of nursing will 

rise to the occasion, bar none, without fail, just as we have seen in the weeks following 

the tragedy. And I for one wouldn't change that for the world. Thank you. 

WRITTEN STATEMENT OF MELISSA VELAZQUEZ, RN, BURN INTENSIVE 

CARE UNIT, WASHINGTON HOSPITAL CENTER, WASHINGTON, D.C. – SEE 

APPENDIX D 

Chairman Boehner. Ms. Velazquez, thank you for your testimony. 

 Ms. Tompkins? 

STATEMENT OF LISA TOMPKINS, RN, BSN, TRAUMA/NERUO 

INTENSIVE CARE UNIT, INOVA FAIRFAX HOSPITAL, FALLS 

CHURCH, VA 

Thank you. Good morning, Mr. Chairman, and Members of the Committee. My 

name is Lisa Tompkins, a registered nurse who works in the Trauma/Neuro Intensive 

Care Unit at Inova Fairfax Hospital. It is an honor to be here today to share with you 

some of the key issues about the nursing shortage that currently faces our Nation. 

 On September 11th, I stood side by side with my nursing and health care 

colleagues across the country in a high state of readiness in the face of the one of the 

worst disasters that this country has seen. Inova Hospital like the rest of the hospitals 

across this region, including New York and Pennsylvania, went into disaster preparations 

in the hospitals of being ready to accept and treat patients who needed our care. 

 My fellow nurses and other health care providers poured into our facilities, many 

on their days off, to assist. Inova Alexandria Hospital saw 23 victims from the Pentagon 

site. Inova Fairfax, Fair Oaks, and Mt. Vernon Hospital readied themselves by preparing 

inpatient bedding, surgery suites, and emergency services to be ready for whatever 

situation presented. 
12

Like every nurse in the northern Virginia and D.C. Region, our only wish is that 

we could have done more. We were connected in spirit to our fellow nurses in New York 

as they stood ready at the doors of their hospitals and in the streets to treat those injured 

in the attack. 

 The event underscores the need to ensure the continued and adequate supply of a 

competent and well-trained nursing workforce in the years to come. 

 Health care industries across the Nation are experiencing a crisis in nurse staffing, 

and we are standing on the precipice of an uncertain future about our nursing workforce.

The causations of the nursing shortage are increasingly known, and include an aging 

nursing workforce, a decrease in nursing school enrollment, a poor image of nurses as a 

career, and job integrity. 

 The work is rewarding, demanding and at times exhausting. It is a distinct honor 

to share information about my experience as a nurse and some innovative solutions that I 

see on the unit where I work. 

 My clinical background is 5-1/2 years in critical care. In May I will be 

completing my master's degree in nursing, which has been partially funded by my 

employer. My clinical competencies include advanced cardiac life support certification, 

certification in trauma nursing, expertise in the care of patients with ventriculostomies, 

continuous cardiac output monitoring, continuous bedside dialysis, and trauma 

resuscitation response to the emergency department. 

 I care for one to two patients each shift I work, and coordinate the multiple 

disciplines of care required for a critically injured trauma patient. These patients require 

a high level of clinical excellence, psychosocial skills, as well as physical labor. I stay in 

nursing because every day is different and presents new challenges. 

 I also have the honor of being able to truly affect lives every day in my work. I 

choose to remain in my unit for numerous reasons. We do our own scheduling, which 

allows for a large amount of flexibility. We have self-governance, letting staff participate 

in all levels of decision-making. We have a clinical ladder program that offers 

promotions and pay increases for levels of clinical excellence at the bedside. 

 We are reimbursed for education and conferences. There is a great environment 

of learning, with clinical autonomy and a climate of trust with our physicians. The unit 

has a strong culture of teamwork and respect, which keeps me going on the hard days, 

which there are plenty of. Hospital nursing is very hard work that does not get put on 

hold for nights, weekends, and holidays. 

 I do work in a great unit with a low vacancy rate, yet we are not exempt from the 

troubles that are seen by nurses throughout the Nation. Sick calls, short staffing, difficult 

patient assignments, use of agency nurses, and a desire for increased financial 

compensation are daily issues. 
13

I believe what nurses need is a combination of attention to the hard stuff including 

salary, benefits and scheduling, as well as the soft stuff of culture, leadership, education 

and development. 

 Although time does not permit, my colleagues and I do have some ideas 

regarding solutions for a National agenda, which are listed in the written testimony. I 

will be happy to answer any questions regarding these issues. I love what I do. And my 

hope for the next generation of nurses is that we address these issues today so that we can 

continue to provide outstanding care tomorrow. 

 Thank you, Mr. Chairman, and all members of the committee for the honor of 

sharing my thoughts with you today. 

WRITTEN TESTIMONY OF LISA TOMPKINS, RN, BSN, TRAUMA/NEURO 

INTENSIVE CARE UNIT, INOVA FAIRFAX HOSPITAL, FALLS CHURCH, VA 

SEE APPENDIX E 

Chairman Boehner. Ms. Tompkins, thank you for your testimony. 

 We thank all of the witnesses on our first panel for their testimony. We have a 

vote on the House floor, and we will break now and resume the hearing in about 20 

minutes. 

The Committee will stand in recess. 

[11:15 a.m.] 

Chairman Boehner. The Committee will resume its hearing. Under the Committee 

rules, you each have up to 5 minutes for questions. 

I think I would like to ask Ms. Velazquez and Ms. Tompkins this question. What 

would you share with a young person about your job that you believe would encourage 

he or she to pursue a career in nursing? 

Ms. Tompkins. I would probably start by telling them a story such as Ms. Velazquez 

just alluded to. That is why we do this, and I think one of our problems with new nurses 

coming in is that a lot of the nurses currently working are so frustrated that they do not 

always give a very positive picture of what nursing really is. 

Ms. Velazquez. I would encourage youth by saying that nursing is a calling. You touch 

people's lives. And as in this story that I shared, those are moments that are going to be 

with me for the rest of my life. Making that connection with people is why I became a 

nurse. It is certainly not for the money. It certainly is not for the hours. And for those 

young people that are interested in making that kind of difference, I would encourage 

them to pursue nursing. 
14

Chairman Boehner. Can you share with us any innovative practices that you see in your 

hospital and your workplace that make it a positive work environment for you? 

Ms. Velazquez. There have been many changes over the last year. I am also an officer 

of the union at the Washington Hospital Center for the District of Columbia Nurses 

Association. Last fall, we entered into contract negotiations and we were able to make 

some changes. But as far as our workplace goes, one of the tremendous advances that we 

have made was entering into a 36-hour option, which gives us a tremendous amount of 

flexibility. As far as the workplace goes, that is as much as I am willing to comment on. 

Chairman Boehner. Can you outline what the 36-hour option is? 

Ms. Velazquez. The 36-hour option is comprised of three 12-hour shifts a week. For 

example, the way it works for me in my life, I have a 7-year-old and I am a single mom. 

Lauren's father takes her every weekend, so that affords me every opportunity to work 

Friday, Saturday, Sunday, so I can be a full-time nurse on the weekend and be a full-time 

mom to my daughter during the week. That is a tremendous amount of flexibility and 

that keeps me where I am right now. 

Chairman Boehner. Ms. Tompkins? 

Ms. Tompkins. I am very fortunate to work in a unit where for the most part everyone is 

extremely happy with the way things run. We do have many programs in place, which I 

described in my testimony, such as our self-governance. We have multiple committees. 

We do peer review evaluations. Self-scheduling is a huge, huge asset. You know, one of 

the biggest complaints about nursing is the schedule. I don't have that complaint. Yes, 

you still have to put in your night and your weekend time, but we do three 12-hour shifts 

a week and you really cannot beat the schedule. 

Chairman Boehner. What is self-scheduling? 

Ms. Tompkins. We do it ourselves. Basically, on a draft, you pick the days you would 

like to work. The second draft comes out and we make sure we have enough nurses to do 

each shift. And in the end, we do sometimes have to make sacrifices to make sure every 

shift has enough nurses, but it is a wonderful thing to have in place. 

Chairman Boehner. Thank you.

Mr. Miller? 

Mr. Miller. Thank you very much. 

 One of the issues that has been raised around this discussion of the shortage is the 

suggestion that there really are enough people out there who want to be and are nurses, 

but for a whole host of reasons they have made a decision to either leave the field 

altogether or to leave the field and engage in it on a part-time, temporary basis. Some 

have made the decision to leave because by their own personal, nursing standards, they 

don't think they could provide the kind of care they think their patients deserve. I have to
15

believe that in the business you are engaged in, that is a very real problem that nurses 

confront on an hourly basis. You have a sense of this person, their conditions, and what 

should be happening, and that may not be consistent with the dictates of the facility in 

which you are working. 

 So it is a little bit like the teaching profession. We have a huge amount of people 

come in and they immediately leave because it doesn't reinforce what they thought they 

would be able to do in nursing. We have a significant number of people who want to 

enter the profession from other areas, but when they really engage in it, they realize it is 

not competitive with other alternatives. It may be demanding on their personal lives or 

family. 

 I wonder what your comments are on that, that this is really about an 

underutilization of the talent pool that already exists, before we get to what the real 

shortage would be? The conditions and the standards to some extent have caused people 

who would like to be in the field to leave. Do either one of you want to respond to that? 

Ms. Tompkins. I think you make a very valid point, but I think that alludes to what you 

were just saying. We need to make the career more desirable. I mean these people didn't 

go into nursing with the intention of quitting or leaving the profession a couple years 

afterwards. You know, my unit is one of a kind, I think. I don't think that is happening 

across the country. It is clear that it is not. I think we need to improve the conditions, as 

you were just saying. 

 Nurses need more support. We are completely strapped at the bedside and don't 

have enough time to do anything. We did not go into nursing to know that at the end of 

the day we just provided adequate care. That is not why we are there. We don't do it 

because of the money, but it is a factor. A nurse's salary is not competitive for the level 

of work they do and the expertise that is needed. 

Ms. Velazquez. Could you refresh the point for me? I was distracted for a moment. 

Mr. Miller. We have a talent pool that is trained, educated, and who in many cases has 

already worked in the profession. They made a decision to leave. How do you get those 

people back in, because they are an immediate qualified talent pool? 

Ms. Velazquez. Exactly. You know, as I was discussing this over the weekend with 

some other colleagues, it struck us that, obviously, nurses are leaving the profession 

because the environment that we work in, for lack of a better phrase, can be toxic at 

times. The constraints that are put upon you in terms of hours of paperwork, which may 

not seem a lot, are a tremendous amount. I routinely stay over my 12-hour shift a 

minimum of a half an hour just to get all of my assessments into the computer to make 

sure that this database is filled out or this floor sheet is filled out. 

 The reason why I choose to stay over is because I would rather spend those 12 

hours with my patient. So I would rather sacrifice the time when I don't have to be 

attending to them, because that is the way I want to be a nurse. 
16

Mr. Miller. I am running out of time here, but you know, the points that you and others 

in the nursing profession raised are interesting. I had an opportunity to have dinner a 

couple weeks ago with one of the CEOs of the largest or second largest health care 

provider in the Nation. And he said if you really want to know what is being put at risk 

with the current arrangements that we have, he said go see the Institute of Medicine 

studies and you will start to understand that this has a very, very real impact on the 

quality of care. I am sure he has battled a number of these staffing changes and he has 

done some progressive things. 

 But to suggest this can be ignored and no harm is being done, I went and got the 

Institute of Medicine studies. The studies laid out a pretty frightening blueprint of what 

we can expect in terms of the quality of care if we don't start to address this very 

immediate problem and get some continuity and consistency in staffing levels and 

capabilities on a regular basis rather, than running around ad hoc at the beginning of a 

shift and trying to see if you can put people in place or not. That is what is happening in 

many health facilities across the country, both rural and urban.

 I thank you, Mr. Chairman, for holding the hearing. I hope the Committee will 

have a chance to address it. 

Chairman Boehner. Sue, did you want to make a point? 

Mrs. Kelly. I would like to simply say that I believe there are things that we as 

legislators can do. There are many people who are in ancillary positions in the medical 

profession. We need to encourage those people to continue to upgrade their education.

We can do that through the bills that are available by offering scholarships. We have 

LPNs. We have CNAs. We need to put them on a career ladder that promotes them. We 

need to raise the RNs that are there into positions so they will be professors of nursing.

These are people that we really need to address and this is something we can do 

legislatively. 

 This is in the bill that I am trying to get through, the Need Act. We have got an 

expanded loan repayment program that would allow people who are in nursing homes, 

people who are in home health agencies, people who are in public health departments and 

managed health care centers to be able to participate in these programs. Let nursing start 

in some of these outer areas and bring them up full into the nursing profession as RNs.

These are natural places for reservoirs of people that we can naturally bring into the 

nursing profession. 

 The Bridge to Practice program that I have in the bill is an incentive for nurses to 

come back into the profession. Currently there are 15 to 20 nurses that aren't practicing. 

If we bring them back in, that is pretty easy. It is not difficult. It doesn't cost a lot to get 

your recertification in most States. But what you do need is mentoring. We need to get 

the money into the hospitals so those nurses can be mentored in the new techniques and 

the new drugs and so forth. 

 These are things that I think we can do. There is more. But I just wanted to point 

out a couple of things. I think we should also establish a commission to study this 
17

nursing shortage to try to address the best and most rapid ways that we can get nurses 

into the field. 

 Thank you, Mr. Chairman, for letting me speak because I think it is very 

important that we reach out to people who are currently in these ancillary professions and 

try to scoop them up and bring them in. 

Mr. Miller. Might I respond Mr. Chairman? 

 I couldn't agree with you more. But if the basic profession that they are going 

into has working conditions that drive them out of it, we have a problem. After we take 

the LPN and make them an RN, and they look around and say I don't want to work here 

because this is inconsistent with patient care, or family life, we have the same problem. 

They come in and leave. 

We want them to come in and stay, because it is a profession that encourages that. 

We have 100 programs to get people into the teaching profession. They look at it a yearand-a-half later and say I am out. 

Mrs. Kelly. Mr. Miller, that is why I feel strongly we have to do everything we can to 

provide the loan program for these people to bring them back in. We also need to do the 

mentoring program to bring them back in. Nursing is a wonderful profession. You have 

heard the commitment of the people who are here. They are deeply committed to helping 

people. Nurses want to do that. But we need to help the hospitals be able to pay them a 

really good wage. 

 We also need to encourage the hospitals to offer exactly what these young women 

who are testifying with us today are comfortable with, and that is flexible hours. Reduce 

the paperwork so hospitals don't have to pay overtime because nurses want to spend the 

time with their patients. We can do that. This is something we can do at a legislative 

level. We can help the hospitals do that by putting the incentives in place to do that. We 

need to do everything we can to encourage the nurses to stay in the profession. I agree 

with you.

Mrs. McCarthy. I want to follow up on that. You know, going back 30 years ago in 

nursing, number one, there was never such a thing as having a full staff. And God forbid 

you should have one or two nurses that were on the floor; we were shipped out to another 

floor that was shorted. 

 But going back to what you were saying as far as keeping nurses there. If we can 

train people so there are enough support staff on every single level that will retain the 

nurses that are in the field, because then they have the help. 

 Following through on that, there are ideas out there that were working 30 years 

ago. The hospitals in my community have taken those that are nurses' aides and those 

that are already working in the hospital and upgrading them. In other words, they are 

getting a nursing career in the hospital, working with one of the universities. 
18

Now, a lot more hospitals would do that, but they don't have the finances to do it. 

But these are things that we can take a look at. When Melissa talked about staying a half 

hour longer, I think she is probably cutting it quite short, because when I worked as a 

nurse I did stay at least a half hour to 45 minutes longer to do my report work and 

everything else like that. It has changed tremendously. 

 We certainly have done an awful lot to make sure there is not fraud and abuse as 

far as payments for reimbursement to Medicare. But I will be very honest with you, in 

every aspect of our health care industry today, we are treating those that are giving the 

health care, whether it is the hospitals, or the nursing homes, like criminals by having 

them prove that they didn't make a mistake filling a form out. And I think we have to 

really look at that, because we didn't go into nursing to spend a heck of a lot of time on 

forms. We know how important nurses' notes are and everything else like that, but it is 

way beyond that today, and we have to look at those types of issues. 

 All of those combinations together will bring people into nursing, because people 

are still going to want to go into nursing. We need to retain them and make sure they 

stay, the same as what we should be doing for our teachers. 

Chairman Boehner. Mr. Osborne, any questions? 

Mr. Osborne. Thank you, Mr. Chairman. I just wanted to make a couple of 

observations.

You mentioned the paperwork. As I have talked to nurses in my area, those who 

have been around for awhile, they maintain they had spent 85 percent of their time 

nursing and 15 percent filling out forms. Now it is 50-50, particularly where there are 

high concentrations of Medicare, as there are in my district. So this is one thing that 

strikes me the government can certainly get active in, because apparently there is a 

duplication of forms that really is needless. 

 The other thing I would like to ask you about is rural areas. You often hear about 

a small town losing its doctor; but probably as prevalent is loss of health care, because 

they have lost one or two nurses. We can't have health care without nursing and support.

And so in an area that is isolated, if you lose two or three nurses, or lose your hospital, 

you are driving 50 to 60 miles to the next hospital. 

 This may not be your area of expertise, but I wonder if anybody has any thoughts 

about rural health care particularly? 

Mrs. Kelly. Mr. Osborne, I just want to say, a lot of people don't realize that when a 

nurse makes notes in a chart for a patient, or when anyone who is a medical professional 

makes notes in a chart for a patient, those notes become a legal document and you are not 

allowed to change them. You can't scratch out and you can't white out. When you make 

a note about a patient, it has to be accurate. And that is one of the reasons why these 

nurses take so much time, because they know they must do it right. They have to get it 

right the first time. 
19

Secondly in the bill that we are sponsoring, because we are offering scholarships, 

we are asking people to commit to at least 2 years service especially in underserved rural 

areas. So we hope that will help deal with that problem. 

It is a huge problem. We don't want to see the hospitals, especially rural 

hospitals, go under because they have no nurses. In the area where I live, in one county 

we had four hospitals. We now have one because the other three have closed down. 

There is a lack of available nursing and lack of support. The people have to drive for 

miles. Now we have to use helicopters to Medistat people to the hospital in case of an 

accident. So it is a very real problem and I thank you for bringing it up. 

Mr. Osborne. Thank you, Mr. Chairman. I have no further questions. 

Chairman Boehner. Chair recognizes the gentleman from Massachusetts, Mr. Tierney. 

Mr. Tierney. Thank you. I just want to follow up a little bit. I want to thank you first of 

all for your testimony and for your legislation, but I wanted to follow up. 

 About a minute ago we were having a little colloquy back and forth between the 

Members about loans and mentoring, which I think are obviously worth pursuing. I think 

that is a different focus on the issue of forced overtime and understaffing, and I don't 

believe that loans and mentoring are going to really solve that issue. And I wanted to ask 

Ms. Tompkins and Ms. Velazquez if I am right on that or am I wrong on that? 

Ms. Velazquez. Loans and mentoring programs certainly have their place in the issue, 

and as we were discussing earlier, the environment can truly be toxic. One of the things 

that happens quite frequently is the rise in patient care or patient-to-nurse ratios. For 

example, I had a colleague of mine share a story with me about a friend of hers who is a 

registered nurse at a children's hospital. The day shift was just fine, and they had 16 

patients with adequate staffing. But on the night shift they only had 2 nurses to cover all 

16 of those patients. 

 Now, whether or not you have ancillary support in terms of LPNs or other kinds 

of aides, 16 children aren't getting the care that they deserve. And I caution about 

legislating patient care ratios because I think there is a harm in that becoming, the ceiling 

around the floor, so to speak. If I say, okay in ICU there should be one nurse for every 

two patients, then that is going to become the rule, rather than having a little more 

flexibility and have nurses taking back the judgment on what it takes to run a clinical 

setting.

Ms. Tompkins. I just want to add something. I think we made it very clear that we need 

to fix the current situation for those people that are already in practice. But I think we 

shouldn’t lose sight of very important things such as scholarships and loans. I can speak 

from personal experience. I went to nursing school through a scholarship program 

through a hospital. And I wasn't one of those people that knew from age 5 that I wanted 

to be a nurse. So it was that opportunity that probably swayed me more in that direction 

versus maybe going another career route. 
20

Mr. Tierney. I am not ignoring our Members, but I can see them any time. But from 

your own personal experiences, how much involvement do the nurses have with hospital 

management in actually determining and establishing policy regarding the nurses? 

Ms. Tompkins. I think that really depends on the institution. 

Mr. Tierney. What is your personal experience? 

Ms. Tompkins. As I said earlier, we do self-governance in my unit. We have a lot of 

staff-run committees. It tends to be a somewhat open forum for grievances, and things 

you want to bring up. I mean it is definitely doable. I have never felt as if I couldn't get 

my point across. 

Mr. Tierney. It applies directly to staffing issues. Have you had success there? 

Ms. Tompkins. I have had my patient care director have to go to bat for us at higher 

levels concerning vacancy rates, things like that. 

Mr. Tierney. Thank you. 

Ms. Velazquez. Actually, prior to last fall, there was a staff nurse representation on the 

majority of the committees at the hospital. And that is one of the things we fought for in 

the contract negotiations that occurred last fall. And quite honestly, I personally haven't 

seen any changes that have truly addressed some of the issues that we were most 

concerned about. As I mentioned before, we did have some changes in scheduling, but 

you know, committees, present company excluded, tend to work a little slowly. And I 

am sure there are changes in the works, but I have yet to see them actually implemented 

in the workplace. 

Mr. Tierney. Thank you, Mr. Chairman. So you can move quickly, I yield back the 

balance of my time. 

Chairman Boehner. Thank you, Mr. Tierney. The gentlelady from Illinois, Mrs. 

Biggert.

Mrs. Biggert. Thank you, Mr. Chairman. 

I have a question for Congresswoman Kelly. In the Need Act, you talk about the 

public awareness campaigns and the multimedia outreach. Is this something that would 

be done in the schools or is this just kind of public service addresses to tout nursing 

careers? 

Mrs. Kelly. It is all part of nurse recruitment, and we would like to have about

$5 million for a national campaign. That would be on TV, radio, or whatever they feel is 

the best way to recruit nurses. The other part of it would be another $5 million in States 

so they can get into places like high schools and even grade schools where kids start 

thinking about who they admire in society and what those people are actually doing.

Exposing young people to seeing the value of nursing is a really valuable way to recruit
21

people.

 So we are really leaving it up to both the national and the State levels to decide 

how they want to spend this money. We haven't really lined it out. It is fairly flexible 

because you approach different areas in different ways. 

There are area health centers that we really want to help develop as models of 

excellence for school nurses and public health nurses and perinatal nurses. There are also 

nurse outreach grants. I mean we are doing a lot to try to bring in health care providers 

from other areas and get the communities to partner in on this, to bring in a network of 

help to try to not only build the quantity of nurses that are there, but also create a support 

network for them and to help them retain them. 

 We have also incorporated scholarships for people who are in the disadvantaged 

programs. We want people from disadvantaged backgrounds to have a shot at the pie 

also. So we have included that in. 

Mrs. Biggert. I don't know if you would know this or if this is a question for the next 

panel. The schools that have nursing are trying to recruit nurses, but do more people 

apply for the nursing school than are accepted? Maybe some don't have the 

qualifications or have the grades to get into nursing school, or is it just that everyone is 

taken in that applies? 

Mrs. Kelly. In the nursing schools that I have dealt with, Mrs. Biggert, they tell me that 

when they feel that a student is capable, even if the student hasn't performed perhaps at a 

certain level because of their English ability for example, they will work with those 

students to try to help them. 

 Duchess Community College in my area has an excellent program to try to 

mentor people into nursing, and they have a superb nursing school there. There are a 

number of people, at least in my area, through the community colleges as well as the 

regular colleges that have very good programs. I am sure in Ms. McCarthy's area down 

in New York City, we have nursing schools teaching to the Ph.D. Level. So we are doing 

everything to mentor and push those people along. 

Mrs. McCarthy. And we can follow through with that, but still not enough people are 

applying to the schools themselves, and that is a big problem. And as our colleague has 

said, we have to start putting out the positive aspects of nursing. You know in my 

opinion, I think all of us will agree it is the best profession to go into. But over the last 

several years, you are only hearing the negative part of it. But this is something that we 

have to work on on several fronts. Obviously the pay is a problem, but all of us have said 

we didn't go into nursing because of the money. And you will never get the kind of 

money, in my opinion that nurses deserve for the work that they do. But you still have to 

be competitive. 

 I have been meeting with nurses and hospital administrators for the last several 

years in roundtable discussions, and the nurses have now become more active in going to 

the schools. But, this is kids; they ask, what kind of money do you make? I mean that is 
22

a question that they ask. And when you tell them what your salary is and that you are 

talking about working holidays, weekends, 24-hour shifts as far as it has to be covered, 

they ask if you are nuts? Who in their right mind would do that? 

 But aside from that, there are still many, many people changing careers. Those 

coming out of the service, our police officers that come out and still are on the fairly 

young side becoming a health care professional. And certainly there is a shortage of 

nursing. But let me say there is a shortage in every aspect of health care. You know, 

whether it is your occupational therapist, whether it is your speech therapist, this is a 

team effort. And that is important to bring out. 

 We talk about the shortage of nursing because we are the ones there by the 

bedside first. But it is not going to do any good if a physical therapist isn't there to work 

with the stroke patient. It isn't going to do any good if a speech therapist is not there to 

teach that patient how to speak again. 

 So we have a long way to go to look and try to get everybody around here to see 

that we have to all be together. Any kind of health care is a team effort. 

Mrs. Biggert. Thank you. Thank you, Mr. Chairman. 

Chairman Boehner. The Chair recognizes the gentlelady from California, Ms. 

Woolsey.

Ms. Woolsey. First of all, I want all the nurses to know that you are at the top of my list 

of heroes, and it makes it clear to me why I consider these two colleagues of mine and 

Lois Capps to be so special. I have always held you in high regard. It is that nurse in you 

that I think works for me, and thank you, all of you, for what you do. 

 When Ms. Velazquez was speaking, something occurred to me that I just have to 

share. And that is, on the 11th of September, while a lot of us were dithering around, I 

will speak for myself, not knowing what I should be doing and what I could do, you had 

hands-on activities. You were needed. You knew what your role was. And that had to 

make you feel better than the rest of us in this country who cared so much and felt 

useless.

 So thank you for what you did. It makes me realize when you don't have any 

control if you are doing something it makes a difference. Thank you. 

 I have a question for Sue Kelly and it is about your Need Act. You have another 

piece of legislation that you authored with Lois Capps. Could we bring those two 

together, because there are 100 cosponsors on the other one? Which one better addresses 

salaries and patient nurse ratios and training facilities? I mean there is so much we need 

to be dealing with. I think we should blend those. 

Mrs. Kelly. Well, what happened on the Kelly-Capps bill, when Lois and I originally 

drafted that bill, we worked hard to get that bill where we thought it would address all of 

the needs. And then after we offered that bill, I realize that there were some further 
23

things that we needed to do, and that is what this other bill is about. That is the career 

ladder I am talking about. You heard Ms. McCarthy speak about the fact that medical 

care and hospital care is a team effort. It is that team we can draw from to bring people 

along to enlarge the nursing pool.

Ms. Woolsey. Let me reclaim my time, just a minute, Sue. Can we blend those two 

because you have 100 cosponsors? You have people loving that first one. We need the 

whole thing. 

Mrs. Kelly. I think we certainly should look at that. I am hopeful we can do something 

like that. But I just want to make sure we are doing the things that I had not thought of 

with that first bill. 

Ms. Woolsey. Thank you. I am going to talk to Congresswoman McCarthy about 

training. I have legislation called Go Girl, because young girls don't get involved in 

technology. About 30 years ago we had good ideas for nursing, but nursing is becoming 

highly technical. What are we doing to ensure that young girls who want to be nurses 

start at very early ages getting ready to become nurses in this technological world we live 

in? How do we get the nurses' aides capable to be in the technological world? 

Mrs. McCarthy. I certainly want my colleagues to address this. Nursing today is totally 

different. The high-tech aspect of nursing care has gone up. That goes back to working 

with women in grade school, middle school, and high school to go onto computers, the 

sciences and math. A lot of people don't realize how much science and math you need to 

go to nursing school. I mean these are all areas that are very important. 

 And with that being said, again, we have many solutions. If we could have a 

comprehensive education bill, we should have a health care bill dealing with every single 

aspect of the health care crisis that we are facing, including getting nurses. 

Also don't forget the hospitals. Good hospitals have to put any moneys they 

make, which God knows they don't make any, into the infrastructure and the equipment 

that they need. So they have always operated on a shoestring the majority of the time. If 

you want a good health care system, then you have to make sure our hospitals are in good 

financial condition so they get the equipment and the technology that they need on every 

single level, and hire those that work with all of that technology. So it is ongoing.

 These are the things that this Congress and we will have to face, because we are 

dealing with a Band-Aid here and a Band-Aid here and a Band-Aid there. We really do 

triage the whole system, and we are not going to be any better 5 or 10 years down the 

road.

Ms. Woolsey. Thank you. 

Chairman Boehner. The Chair recognizes the gentleman from Pennsylvania, Mr. 

Greenwood.
24

Mr. Greenwood. I am sorry I wasn't here for your opening statements. I was at a 

briefing on the disaster at the Commerce Department. And I am sorry if you covered this 

in your opening statements, but the question has to do with attracting males into nursing. 

 I don't know what the statistics are, but we all know that nursing was a femaledominated career since its inception and I assume it still is a female-dominated 

profession. However, it seems to me from my layman's casual observation that more and 

more males have been attracted to nursing. It was always embarrassing to me when I 

would meet somebody and I asked them, as we do, Hi, what do you do? "I am a male 

nurse." Well, you didn't need to tell me the first thing. I noticed that. But it was almost 

this sort of need to establish maleness, even though I am in this female-dominated 

profession. And I think we can recall how we used to have stewardesses in airplanes and 

we changed the name to make it gender neutral and realized that it was a profession that 

welcomed males as well as females. 

 So my questions are what do we know about the percentage of nurses who are 

males? What is being done to attract males into the profession? Because if we have this 

shortage and we are not really aggressively pursuing half of the eligible population, it 

seems that would be a rich source of new recruits. 

I am trying to figure out a way to say this that is somehow not politically 

incorrect, but it seems to me that the term "nurse" is so identified with feminine and 

gender that I can imagine if you went to a group of 16- and 17-year-old boys and said, 

"You know there is a great career path for you as a nurse," that their reaction might be, 

"That is for girls, isn't it?" I wonder if the terminology needs to be changed, because that 

word "nurse" is so identified with females, to help draw males in? 

So what can you tell me about the percentage of nurses that are males? Is that 

going up or down, and are there aggressive efforts to attract males? And did I say 

something politically incorrect? 

Mrs. McCarthy. Yes. We don't want to change “nurses.” The percentage of males 

going into nursing in 2000 was about 6 percent. But again, you also don't see that many 

males going into teaching, and teaching was basically a female dominated field as far as 

that goes. 

Mr. Greenwood. I bet it is way over 6 percent in the teaching profession. 

Mrs. McCarthy. It has increased in teaching more so than nursing. We have looked at 

our veterans coming out of the service. We have looked at fire and police officers that 

have gone out of their particular field to go into the health care fields; I am saying health 

care fields because there are so many aspects. 

 When my son needed care, Kevin is 6'4 and 240 pounds, every time he had to go 

into the hospital, we would try to get male nurses to take care of him, only because of his 

size. And I am talking about the private duty aspect of taking care of him, because when 

he goes for an operation of any kind, he is usually 100 percent incapacitated, so it would
25

take two or three nurses to take care of him. 

 The Committee should meet some of these male nurses. These are big burly guys, 

most of whom were firemen or police officers. Why did they go into those particular 

professions? Look at what caring people firemen and policemen are. Can we do more? 

Absolutely. We are working on that and they might have more information on that. 

Ms. Tompkins. I just have one thing I wanted to add. I believe education is extremely 

important and there has been a huge step-up in efforts to really educate the younger 

generations. We may not necessarily be able to fix that old stigma of nursing being for 

girls, but I know they did a summer camp for nursing for seventh and eighth graders.

And in a graduate class I took a couple of semesters ago, we did a book that will be 

published for that adolescent age group that educated them on exactly what it is nurses 

do. We are trying to get rid of that picture of the white dress and walking around with a 

bedpan, because that is not how it is anymore. We tried to give them a picture of the 

technical aspects and the cool things that we do.

Mr. Greenwood. My time has expired. I am sure that this will be politically incorrect, 

but it occurs to me, and Mrs. McCarthy was very adamant, that nomenclature matters. 

When you have a profession and a word that simultaneously means both a health care 

provider and to breast-feed a baby, you might think about how that impacts on attracting 

men into the profession. 

Chairman Boehner. The gentleman's time has expired. There is no other Member of 

Congress more discreet than the gentleman from Pennsylvania, and usually very tactful. 

Was, anyway. 

 The Chair recognizes the gentleman from Virginia, Mr. Scott. 

Mr. Scott. Thank you, Mr. Chairman. I thank you for addressing this issue on a timely 

basis before it gets much worse. I just have a couple of questions.

 I wanted to ask Ms. Tompkins, on the self-governing or staffing committees, do 

you do that on your own time or do you have to volunteer for that? Is it part of your job. 

Ms. Tompkins. No, it is not required. We do try to encourage everyone to get involved 

on committees, and it is on your own time. 

Mr. Scott. It is on your own time? It is not on paid time? 

Ms. Tompkins. We get paid, but it is not during your usual 12-hour shift. We have to 

come in on our days off to participate. 

Mr. Scott. Are any of the nurses involved in that part of unions? 

Ms. Tompkins. No. 
26

Mr. Scott. I think we all agree that salaries have to go up. Can I ask Representative 

McCarthy or Representative Kelly exactly how, the legislation that you are proposing 

would actually increase salaries? If you put more money into Medicare or Medicaid, it 

could go any kind of way. How do we make sure that the initiatives we take will actually 

result in increased salaries? 

Mrs. McCarthy. Well, I am hearing Sue Kelly on the side. I know my legislation will 

not increase salaries, but we are hoping to make the health care systems, whether it is 

Medicare reimbursements or forgiving student loans for those that go into nursing, look 

at that. And then hopefully have the moneys available for the hospitals. Maybe the 

Federal Government can do that. 

Mr. Scott. I don't want to be cynical, but if you give the hospitals more money that 

doesn't necessarily translate into higher nurses' salaries. 

Mrs. McCarthy. If they want to keep their nurses it does. Every hospital association and 

every hospital CEO that I have talked to, maybe Long Island is unique, but I really do not 

think so, want to pay their nurses more. They would love to pay their nurses more. But 

they are working under constraints as much as any other business to stay afloat. 

 You have to understand, we want to certainly pay our nurses the most money that 

we possibly can. But when you have a new technology that comes out, whether it is an 

MRI or the newest technique instead of having a barium enema, they have to invest in 

that because that is good for the patient. 

Mr. Scott. That makes my point. What can we do to make sure that the money actually 

gets to nurse salaries? 

Mrs. McCarthy. If I say this, my staff will absolutely kill me, because I have been 

talking about it for 2 years. Every time I mention the word they tell me I you can't say 

that. I will say it. 

We subsidize our farmers. We subsidize many things in the government. And if 

you truly want good nurses, and if you truly want good teachers, then I think the Federal 

Government has a role in it. Of course, every time you mention “subsidizing” something 

around here there are heart attacks all over the place. The truth is if we don't start looking 

at salaries realistically for the worth of the nurses and our teachers, you are not going to 

get more and more young people, or anyone, to go into those fields. That is the bottom 

line.

Mr. Scott. Representative Kelly? 

Mrs. Kelly. Well, part of it is that the legislation that I have is in scholarships directed to 

nurses only. They are directed just for nurse core scholarship programs, to bring 

ancillary people into the nursing profession and to bring people who are RNs back into 

the nursing profession. 
27

One of the other things that I think you may want to explore, is the part of the 

problem that has to do with the HCFA rules, or whatever they are calling the agency 

today that governs hospitals. Any moneys that go to the hospitals need some flexibility, 

because as we all know, hospitals all over the Nation are trying to get into metropolitan 

statistic districts so they can pay their nurses at a higher level, so that they don't have a 

problem getting nurses to come in and work. 

 If we were able to address that hospital problem through a change in the HCFA 

rules, that would help bring nurses in, I think. But in the bills that I have, the 

scholarships are directed to bringing people in and retaining nurses specifically. The 

money doesn't go to hospitals. 

Ms. Velazquez. If I may add a point in here, please. I so appreciate everybody wanting 

to pay attention to salaries, because that is a factor, but the work environment is what I 

feel is truly important here. You can throw as much money as you want to me and my 

colleagues, but if I go home at the end of the day, losing a patient because I didn't have 

the time to take care of them, or having any of my colleagues put in the position where 

they weren't able to do the best job that they could, there is not enough money in this 

country to make up for that feeling. 

 As we said before, nursing is a calling, and not everybody can do it. And I would 

hate to bring up the male perspective here, but there is a reason why nurses are mostly 

women. I am sorry. 

Chairman Boehner. No, go right ahead. Please. We have an open forum here. 

Ms. Velazquez. But on a more political note, regarding issues of mandatory overtime, 

patient care ratios, and staff nurses having a say on hospital committees it is my 

understanding JCO requires nurses being involved on these committees. But many times 

the nurse involvement is nurse managers and upper level nursing positions. Those are the 

kinds of issues that affect nurses all over this country, and until you fix the working 

environment, really the salary issue is kind of moot. 

Chairman Boehner. The Chair recognizes the gentlelady from Hawaii, Mrs. Mink. 

Mrs. Mink. Thank you very much, Mr. Chairman. Thank you for calling these hearings 

on the nursing shortage issue. It is a terribly important question that we have delayed too 

long to address in this Committee. Now, I want to compliment my two colleagues of the 

House for their thoughtful contributions to this discussion, and certainly our two other 

panelists who have a day-to-day contact with this issue. 

 It is a very easy problem, it seems to me, if we have the will to do something 

about it. And we have some outstanding legislation that is before the Congress. We 

ought to pass it with dispatch. I don't think that there is a profession in our communities 

that is more highly regarded, more highly respected than the nursing profession. We all 

deal with the tremendous reliance that we have if someone becomes ill and we totally put 

ourselves at the disposal of the nurses and the physicians in a hospital situation. And we 

depend upon them. We depend upon not only their caring spirit, but also the
28

professionalism that they bring to the hospital environment. So it is criminal for us not to 

take hold of the pending legislation and do something about it. 

 If it is a recruitment problem, a retention problem, a retraining problem, we ought 

to deal with it immediately and try to bring those who are interested in the profession into 

it and train them, and those that have left, bring them back and retrain them. It seems to 

me it is obvious that we have the power and authority to do that in the Congress. 

 On the other hand, there are other perspectives of this issue that are very troubling 

and probably outside of the parameters of this Committee. As I understand it, one of the 

reasons for this crunch in the hospitals reducing the numbers of nursing staff is because 

of the diminishing reimbursements under the Medicare/Medicaid system. And that is our 

responsibility indirectly, but not in this Committee. And so we ought to put pressure on 

the Ways and Means and other Committees that have jurisdiction in this situation and 

take a look at the impact of diminishing reimbursements to the hospitals and the impact 

on quality of health care, to squeeze out the staffing that a hospital needs to have. 

 I understand from some of the testimony that we have received, that California 

has taken a very bold step forward by establishing standards for hospitals in terms of the 

number of licensed, credentialed, registered nurses that must be hired for each of those 

departments. And I think that that is the way to go; maybe too far for the Congress to go, 

but certainly something that we ought to encourage. 

 As for my colleague Mr. Scott's concern that if we did put more money into 

Medicare and Medicaid, that wouldn't go to nurses, we can certainly earmark it and say if 

we are going to reimburse Medicare patients at a higher level, that this amount be 

reserved for staffing so that the quality of care in the hospitals can be improved. 

 I think this effort requires a comprehensive look by a number of Committees in 

the Congress, and certainly under the leadership of Congresswomen Kelly and McCarthy 

we can push the bills that are in this Committee and get them moving forward and 

encourage people to enter the profession. 

 In my own State, as I looked at the statistics I find that there are huge numbers of 

registered nurses, certified, who have left the profession because of the work environment 

that they find difficult to deal with. So we have to look at the overtime questions and 

some of those other things, and hopefully can get these nurses to return back to their 

profession.

 So I applaud all of you in your contributions to this discussion and hope that this 

Committee will speedily act on our portions of this issue. Thank you very much, Mr. 

Chairman. 

Chairman Boehner. The Chair recognizes the gentlelady from California, Ms. Solis. 

Ms. Solis. Thank you, Mr. Chairman. And I want to applaud you for having this 

hearing. I think this is probably one of the most important issues that, as a new freshman 

when I came in, I wanted to see some reform made in. Coming from California, we 
29

worked on various pieces of legislation to try to address the abuses that go on throughout 

the system in terms of health care delivery, but particularly the whole issue of forced 

overtime. 

 The fact that many nurses in our districts, and particularly in mine, have lost their 

jobs because they refused, after 12 hours, or after maybe a shift or more, and said, you 

know, I am putting myself at risk and my patient at risk, and the bottom line is I am not 

prepared to do that. 

 I haven't heard anyone here talk about that in particular. But that is something 

that is really happening not just in my community, but also across the country. And I 

would be interested to hear about some of your ideas regarding the use of voluntary 

overtime and the fact that perhaps there should be some protections in place for nurses 

who are the ones who are really making the decisions about the quality of care that a 

patient receives; you know, when that ends and when it begins. 

 I would like to hear some of your thoughts on that. 

Ms. Tompkins. I am not sure I really understand the question. 

Ms. Solis. Well, part of it is, you in particular talked about being able to self-schedule 

yourself. In many of the hospitals and care facilities I represent, they don't have the 

luxury of doing that. So how does that work, then? Have you ever been in a particular 

situation where maybe you were asked to work forced overtime, and how did that affect 

your ability to provide health care? 

Ms. Tompkins. I can't speak to that. I have never been asked to work mandatory 

overtime. I have been asked at the end of a 12-hour shift if I would stay for a 16-hour 

shift. That happens frequently. But it is nothing that is forced upon us. 

Ms. Solis. Would you say that affects your ability to provide the same level of care? 

Ms. Tompkins. Sure, 12 hours is a very long day in itself. When you add 4 more hours 

on top of this when you weren't planning to be there, sure it does. 

Ms. Solis. Is that something that has been brought to the attention of your particular 

facility? Is that being addressed in any way? 

Ms. Tompkins. It is just part of the entire shortage that is going on. This is happening in 

all of the units. It is being addressed. 

Ms. Solis. Addressed in your particular setting? I would like to hear from the other 

witness. Ms. Velazquez, what is your take on this? 

Ms. Velazquez. As I said before, I am an officer of the union at the hospital where I 

work. One of the huge issues that we had with our last contract negotiation was that of 

mandatory overtime. It was brought out that there were specific units that were affected 

by mandatory overtime. And our bottom line was no mandatory overtime, because 
30

mandatory overtime is kind of a Band-Aid to put the fix on short staffing. Okay, we can't 

find any nurses so, hey, we are going to make you stay. 

 That is thoroughly unacceptable. Now, obviously our bottom line was no 

mandatory overtime. What we did end up achieving are significant limitations on 

mandatory overtime in those specific units. I can remember that the cath lab was one of 

them. I am sorry, I am a little foggy on the actual details without having the contract in 

front of me as to who had less strict limitations on mandatory overtime than we did for 

the rest of the hospital. But there is also a mandatory overtime bonus that was added. 

 We are really not about the money. If I am working a 12-hour shift, so to speak, 

and I need to go home and get my daughter, get her off to school, what do I care if I am 

making an extra $10 an hour for that 3- or 4-hour period? 

 As I was saying, the restrictions that we ended up achieving in the rest of the 

hospital were something to the effect of a limit of three 4-hour periods within a 6-week 

schedule. And there are some guidelines to actually phase that out, to no mandatory 

overtime over a period of time. So we were able to achieve some language in the contract 

with reference to that. But, as I said, our stance is no mandatory overtime. But hopefully 

one day we will be able to get to that point. 

Ms. Solis. I have just a last question on the education and media campaign to try to 

recruit more individuals into this career. I find that there isn't adequate outreach being 

done to particular populations. I am talking about the diversity of our communities, in 

particular the Hispanic community. 

 We have very few individuals who actually go into the career. So it isn't just 

enough to say that we are going to provide with you financial aid and assistance, but 

there also have to be mentors and role models who represent that community who will be 

made available. Particularly folks, who can share that kind of expertise, and a long-term 

commitment to make sure that these students, once they are eventually brought into the 

institutions, succeed and that retention levels are there. 

 Perhaps the Congresswoman can address if there is any notion about providing 

not just the recruitment and the media in the bill, but the retention aspect of what needs to 

be done to keep those students in these curricular programs. 

Mrs. Kelly. Yes. Thank you. The bill does address disadvantaged students. It does 

address keeping students in school, helping them get through the programs, doing what 

has to be done to do pre-entry preparation and then work on retention once they are in 

school.

 But I would agree with you that America is a wonderfully diverse population.

Our unity is born from our willingness to recognize that diversity and work with each 

other. It is extremely important that any scholarship be given to anyone who is interested 

in the field. And in the outreach, it is my hope that we will be able to include language 

that will especially go to reach certain discrete populations that are not as heavily 

represented. And we need them. We need them for a number of reasons. We need them 
31

for their multilingual ability. 

 One of the problems that I experienced when I was working in the emergency 

room was that we would have people come in and they would be speaking a language 

that we could not identify immediately. We would have to try to think through from the 

syllables that were being said, what language they were speaking and then try to get 

someone down to interpret for us. 

 It is very important that we acknowledge and direct our efforts toward that 

diversity, and I thank you for bringing it up. 

Chairman Boehner. Mr. Andrews. 

Mr. Andrews. Thank you, Mr. Chairman. I want to thank you and the Full Committee 

for inviting Mr. George Lynn, who is a resident of New Jersey and one of our health care 

leaders who is going to appear on the second panel. And I welcome him. 

 I also want to say for the record how proud we are of our New Jersey nurses and 

all of our health care professionals who played a very significant role in dealing with the 

events of 2 weeks ago in New York. Sadly, most of the nurses and health care 

professionals that I talked to said that they were shocked, because they were prepared to 

receive thousands of casualties as the day went on and did not receive them because the 

death toll was so high. So we in New Jersey are particularly proud of our men and 

women in the health care professions. 

 The issue I wanted to raise was about long-term care and that the number of 

Americans over the age of 70 will more than double in the next two decades. And that 

means that our resources for long-term care are wholly inadequate today and will be 

taxed and tested greatly in the future. 

 Now, nurses are a part, of course, of the health care team, the full team of people 

that deals with the health care needs of patients. The GAO recently concluded that we 

are going to need 800,000 additional nurses' aides, many of which will be in long-term 

care in the next 7 years. I wonder what the panel thinks we should do about that problem? 

I realize that it is a broader question than your previous testimony. But my understanding 

is nurses are committed to the health care needs of the patients in a holistic sense, not 

simply the needs of nurses as caregivers. 

 I want to know what you think we ought to do to encourage people to go into this 

profession and be trained for it and be prepared to help meet that need? I would be happy 

to hear from any of panelists that would care to answer. 

Ms. Velazquez. I think I will stick with what I was maintaining earlier. The work 

environment needs to change. You just can't attract people into a profession when they 

are treated as poorly as they are in some cases, especially in long-term care. And once 

we can get that changed, the attitude of the profession is going to change, and the 

attraction into the profession will follow that. 
32

Mr. Andrews. Ms. Velazquez, I think your point talks to the wisdom of the bill that Ms. 

Kelly and Ms. McCarthy have put forward, talking about Medicaid reimbursements. 

 In my State, New Jersey, on the average, Medicaid reimbursements are about $20 

less a day then the cost of taking care of the patient. Our facilities are losing money 

every day by taking care of Medicaid patients. So the option of raising the pay of 

anyone, and therefore helping to improve the working conditions of anyone, is not on the 

table. I think the wisdom of the legislation before us is its insistence on raising those 

reimbursement rates, which is why I am happy to support it. 

Mrs. McCarthy. I think that as far as the amount of nurses' aides that we are going to 

have, certainly there will always be people that will go into being nurses' aides, because 

they might look at it as a way of moving up. 

 I will share an experience with you. When I graduated from nursing school, my 

first night in ICU in charge, it was two nurses’ aides and I. Thank God that they were 

there, because I have to tell you that they probably had 20 years' experience. We had one 

heck of a night, and I thought that I was prepared, as all new nurses do. They got me 

through the night. 

 There are many that want to stay in that particular level because they love it, 

because they want to stay by the bedside; the same as you will hear so many nurses say, 

well, I don't want to move up because I want to be a bedside nurse. So you will see a lot 

of people that are coming into the field to be the nurses' aides. But, again with 

technology it is making the education levels even for a nurse technician higher. Hospitals 

now take nurses' aides and move them up into that category on what they can do. 

 I think you will see people going into those fields. Let's face it; as we have more 

and more immigrants coming into this country, this is how a lot of them come into the 

hospital health care system, to improve their own education and to improve the 

opportunity for them to move up. We have to make sure that those opportunities are 

there.

 What you had also said is nurses are going to be older, and they are. If I had 

stayed in nursing, I would be 57 years old, and I certainly had no intentions of ever 

leaving nursing. 

Mr. Andrews. We are glad that you did. 

Mrs. McCarthy. Sometimes I am glad that I did, too. Only because I don't think my 

back could take it. Because you have to realize, there comes a point, especially with 

nurses or nurses' aides or anyone in the health care field, when bodies can't take it. 

 I worked in ICU for many years, and I loved it. I was telling some of my 

colleagues earlier, I was proud. A few years ago, I could have lifted a 180- or 190-pound 

person. You can, because you have learned the techniques to do it. But as you get older, 

it gets a lot harder and you need someone to help you. There are techniques on how to do 

it, but there comes a point in your age when the will is there but the body is not. And I 
33

don't care how well you take care of yourself; the muscle tone is not the same. It is just 

part of the aging process. 

Mr. Andrews. Thank you, Mr. Chairman. 

Chairman Boehner. Thank you. Let me thank the witnesses, our two colleagues and 

our two nurses from the local area. Thank you for your testimony. And that concludes 

our first panel. 

 And we welcome the second panel to come forward. 

 Well, let’s attempt to begin. I would like to yield to my colleague from California, 

Mr. McKeon, to introduce the gentlelady who will be our second witness today. 

Mr. McKeon. Thank you, Mr. Chairman. It is my pleasure to be able to introduce to 

you today one of our witnesses. 

 Before I do, I would like to take a moment and say how very pleased I am that the 

Chairman has arranged for us to hold this hearing to learn more about this important 

issue. Florence Nightingale, who is remembered as a pioneer of nursing and a reformer of 

hospital sanitation methods, was often called the lady with a lamp because she believed 

that a nurse's care was never ceasing, night or day. She taught that nursing was a noble 

profession and she certainly made it so. Her influence has been far-reaching, as a caring 

nurse at one time or another has assisted countless people through the years. I am 

appreciative of the work that nurses do, work that is demanding, physically tiring, and 

insistent. 

 Let me now introduce to you a nurse from my district, Sue Albert, who is the 

Assistant Dean of Allied Health, College of the Canyons in Santa Clarita, California. Sue 

received her nursing license and her Bachelor's in Nursing from the University of 

California, Los Angeles. Later she received a Master's in Nursing, also from UCLA, and 

then a Master's in Health Care Administration from the University of LaVerne. 

 I commend Sue for her 13 years of service as a pediatric and a medical surgical 

staff nurse. This practical knowledge, along with her experience as a professor of nursing 

and her supervisory and management roles within the higher education community, will 

teach us much about the nursing field and the issues and problems we are currently 

facing.

 I want to thank Sue, who came here a couple of weeks ago for this hearing when 

it was originally scheduled, and then due to the national tragedy we all experienced, 

returned home, and came back again today for this hearing. I appreciate you doing that, 

Sue, and look forward to hearing your testimony. 

Chairman Boehner. Thank you, Mr. McKeon.

 Our first witness today on the second panel is Ms. Mary Foley. She is President 

of the American Nurses Association, Washington, D.C. Our third guest is Ms. Carolyn
34

McCullough. She is a registered nurse and the national coordinator for the Service 

Employees International Union Nurse Alliance. We want to welcome you. Our fifth 

witness is Ms. Catherine Garner, Dean of the College of Nursing and Health Sciences at 

the University of Phoenix. We welcome you. Our sixth witness today is Mr. George 

Lynn, President and CEO, AtlantiCare. He will be testifying on behalf of the American 

Hospital Association. 

 I don't see my good friend from Georgia, so, Ms. Bartels, you won't get a very 

fancy introduction until we get it from Mr. Norwood. Our fourth witness Dr. Jean Bartels 

is the Chair of the School of Nursing at Georgia Southern University. We want to 

welcome you. 

 And with that, Ms. Foley, you may begin. 

STATEMENT OF MARY FOLEY, RN, MS, PRESIDENT, 

AMERICAN NURSES ASSOCIATION, WASHINGTON, D.C. 

 Thank you and good afternoon. I am Mary Foley, and I am President of the 

American Nurses Association. I am proud to be a registered nurse. Our members of the 

ANA in 53 State and territorial associations include registered nurses who work and 

teach in all practice settings. 

 It is hard to find words to express the profound sorrow and compassion that I feel 

for those impacted by the unspeakable acts of September 11th. ANA is grateful to all of 

the heroes who immediately responded in this time of need, and they do renew my faith 

in what is good in our Nation. 

 On that fateful Tuesday, nurses were among the many who answered the call to 

provide emergency services. And you have heard two of their stories today. My written 

statement also contains an addendum with additional accounts from nurses who dropped 

everything to provide care to the victims and to the families. 

 Our affiliates in New York, Virginia, and D.C. Have told me that their phones 

have been overrun by thousands of offers of support from nurses, literally around the 

world. And I am not surprised. This overwhelming response is the norm for my 

profession, and we will be there to help in time of crisis. 

 We will always be here to help to prepare for the campaign against terrorism. We 

need to consider ways to make sure that more of America's civilian nurses are educated in 

the protocols for biological and chemical warfare and other weapons of mass destruction. 

 In addition, it is important to recognize that the activation of medical military 

units will increase pressure on the already strained nursing workforce back at home. Just 

as in the Gulf War, the current activation of our military, National Guard and Reserves 

will drain nurses away from the civilian health care workforce, certainly to a worthy 

cause, but this will only add to an existing nursing shortage. There is no time to waste. 
35

Just as there is a need for nurses in extraordinary times, there will always be a need for 

nurses in ordinary times. 

 There are now a half-million registered nurses with active licenses who are no 

longer working in nursing. We may now have an opportunity to bring them back to 

patient care, or to mentoring or to teaching. I have heard from a number of nurses who 

have left the profession, who are willing to use their considerable skills and experience to 

help in this time of crisis. With support for clinical refresher courses and mentoring, it 

may be possible to bring them back. 

 But the nursing shortage demands more from all of us. Current events 

demonstrate the importance of nurses in our health care system. And we know that we 

need sustained efforts to keep nurses in patient care. 

 The Secretary of Health and Human Services recently released additional funds to 

support existing nurse recruitment and education efforts. In addition, both bodies of 

Congress are actively considering legislation authorizing new nurse education programs. 

 ANA urges you to support these efforts. We look forward to working with you, 

the administration, our schools of nursing, and health care facilities to make sure that 

these nurse recruitment programs are successful. 

 But even that is not enough. As long as nurses remain disheartened by their work 

environments and as long as nurses feel compelled to discourage their friends and 

families from entering this great profession because of the work environment, the root 

cause of this shortage will remain unaddressed 

Mr. Chairman, I have been a registered nurse for 28 years, and 21 of those last 

years in the State of California. I have been a staff nurse, a nurse executive, and a 

clinical instructor in nursing. And I know something about nurses. We are called to the 

profession and, as Melissa said earlier today, by a desire to provide compassionate care to 

people in need. No one becomes a nurse for the money. We are driven by a desire to 

provide caring and high-quality health care. We will remain in patient care as long as 

that is possible. And as long as the unreasonable schedules, the mandatory overtime, our 

dangerous understaffing and fears of institutional reprisal keep nurses from meeting this 

calling, many will continue to leave the bedside. 

 I also believe that it isn't truly a paperwork issue in its entirety or in isolation, 

since documentation of critical information is so important. But in a workload 

environment or in a lack of system support, where nurses have to make critical decisions 

between patient care and fulfilling the documentation requirements, we know that there 

are added stresses, and it should be looked at in that respect. 

 Nurses will continue to refuse to be part of any health care system that cannot 

meet the needs of their patients. My written statement contains specific 

recommendations on means to improve the environment in which nurses work, and I 

can't overstate the importance of these workplace initiatives. 
36

We look forward to working with you to make the current health care 

environment conducive to high-quality care. Improvements in the environment or 

nursing caseload, combined with the aggressive and innovative recruitment efforts, will 

help address the nursing shortage. The resulting stable supply of nursing care will 

support high-quality care for all Americans at all times. 

 Thank you for this opportunity, and I look forward to answering any questions. 

WRITTEN STATEMENT OF MARY FOLEY, RN, MS, PRESIDENT, AMERICAN 

NURSES ASSOCIATION, WASHINGTON, D.C. – SEE APPENDIX F 

Chairman Boehner. Thank you, Ms. Foley.

Ms. Albert, before you begin, your host, Mr. Norwood, has arrived.

Mr. Norwood, I gave your constituent a brief introduction. 

Mr. Norwood. Thank you very much, Mr. Chairman. I appreciate you interrupting the 

testimony to allow me to introduce a friend, Dr. Jean Bartels. Dr. Bartels is currently the 

Chairwoman of the School of Nursing at my Alma Mater, Georgia Southern University, 

and remains an authority on nursing practices in education. 

Dr. Bartels holds a Ph.D. In nursing from the University of Wisconsin and has 

received numerous awards and achieved high credentials in over 30 years of 

distinguished service in the field of nursing. In addition to serving as a professor of 

nursing, Dr. Bartels is currently the Secretary for the American Association of Colleges 

of Nursing, where she has been a board member since 1995. She is also on the editorial 

board for the Journal of Professional Nursing. 

Dr. Bartels has conducted research in a variety of nursing practice and higher 

education areas. Her experience, Mr. Chairman, has focused on community-based 

nursing practices in education as well as the health care needs of individuals responding 

to chronic illnesses. Dr. Bartel's current research involves the development and 

measurement of teaching, learning, and assessment outcomes in nursing education. 

 She has presented her findings at the American Association of Higher Education 

and the American Educational Research Association. Furthermore, Mr. Chairman, she 

has directed workshops, presentations, consultations at the local, State and national, and 

even international, level related to community-based nursing practices and nursing 

education.

 It is pretty clear, I could go on, but I think my point is clear. Mr. Chairman, we 

have an expert amongst us, ladies and gentlemen, Dr. Jean Bartels. 

 Thank you, Mr. Chairman, for allowing me to interrupt. 

Chairman Boehner. With that, Ms. Albert, you may begin. 
37

STATEMENT OF SUE ALBERT, RN, MN, MHA, ASSISTANT DEAN 

OF ALLIED HEALTH, COLLEGE OF THE CANYONS, SANTA 

CLARITA, CA 

I would like to thank the Committee for allowing me to testify. And I would like 

to thank Mr. McKeon for submitting my name as a witness. It does show his keen insight 

into the value of the community college associate degree nursing programs. 

 My focus in this presentation is on the status of nurses, nursing education in the 

community college, and its ability to decrease the critical nursing shortage that exists in 

the United States today. 

 In California, the community college associate degree nursing program provides 

70 percent of the registered nursing graduates. Across the Nation, community colleges 

provide approximately 50 to 60 percent of the registered nursing graduates. The 

community college nursing programs allow students to progress through the program in 

as little as 2 years at anywhere from one-half to one-quarter of the cost of students in 

State baccalaureate programs. For instance, in the California community colleges, the 

State provides approximately $4,400 per full-time equivalent students as compared to 

8,600 for the Cal State University, and 18,600 for the UC system, University of 

California system. Figures such as these are similar across the Nation. 

 At the completion of the associate degree nursing program, the graduates 

generally perform as well or better than students completing the baccalaureate or BSN in 

nursing. This is demonstrated by their performance on the benchmark for measuring the 

success of nursing education, the national licensure exam. 

 Certainly we have talked about the issues with the nursing shortage, and nursing 

education. We have had a decline in enrollment. California had 469 open positions in 

schools of nursing in 1999-2000. And when you are ranked 50th in nurse per capita 

patients, that is a problem. 

 We have other issues in nursing education. For California, we have very open 

access policy, which means we cannot screen for admissions into the community college 

programs. That means that our attrition rates are increasing. If you bring a person into 

the program and they drop out of the program, that is an empty position and fewer 

persons are graduated. 

 We have a shortage of nursing instructors. In California alone, we will have 150 

open positions in 5 years. And as with any school across the Nation, we need 

classrooms, we need clinical lab space, and we need clinical space. 

 Increasing access for education, we need economic support for students. I am not 

talking scholarships. I am talking living expenses. When you are looking at the person 

going into nursing today, those people are the ones that are single parents. They are 

raising children. Just simply paying for tuition isn't going to help them. We need workstudy programs in which students work in a hospital and get paid while they are working.
38

This allows them to learn nursing and still be able to support a family. 

 We certainly, as I said before, need more classroom space, more skills lab space, 

and more clinical practice space. We have to better utilize the space that we have. We 

need technology for the skills lab. Health care technology changes approximately every 

3 years. That means skills labs must be updated every 3 years. Funding is needed for all 

of these. We are looking in our own district at using bonds. 

 Web sites for better use of clinical sites need to be expanded. This allows for 

better utilization by all the schools using the hospitals. When four or five schools are 

using a hospital, that impacts quite a bit on their nursing staff. And the staff nurses also 

need to be reimbursed for their roles as preceptors with students. 

 Alternative modes of instructions need to be provided to allow for the diverse 

learning needs of the population. Special provisions need to be made for persons for 

whom English is not their first language. We need more instructors. We need to have 

the education from ADN up through Ph.D. Subsidized. 

 Partnership between industry and education needs to be reported. At College of 

the Canyons, we have a new division. We have my new position, and my position is to 

expand the program. They have opened a second nursing allied health skills lab, using 

grant money and industry support. 

 We have a general obligation bond for 82.1 million to provide additional 

classroom and lab space. We are looking for industry support for faculty positions. We 

have created articulation with high schools so that students can take anatomy and 

physiology and bring it right into our program. We have articulation with Cal State 

University-Northridge to move them to the baccalaureate degree faster. 

 We have a gender equity tutor. We have a male student who is there to tutor our 

students and help them through and provide a role model for males. 

 We just developed a course for medical terminology for English as a second 

language. We have 119 students on our waiting list after opening up application, but we 

have no place to put them. 

 It is imperative that nursing improves its image. It is the responsibility for all 

nurses and mass media. We need funds for growth as we look at how to get the nurses.

And the government must recognize the need for total quality management, quality 

products that are created faster, cheaper and better. Associate degree nursing programs 

do this. Associate degree nursing programs represent a successful avenue to an 

affordable and high-quality education for many individuals who would not otherwise be 

able to pursue the career of nursing. 

 These programs are the most cost effective to the taxpayers. These programs 

increasingly reflect the diverse demographic composition of the Nation, and the graduates 

have reliably and consistently demonstrated competence and excellence in the workplace. 
39

At this time we are looking at the very real possibility of further terrorist attacks 

and wars. We have no concept of the number of casualties that we will incur in this 

process. We are already in a nursing crisis. We need nurses and we need them now, not 

in 4 years. It is an absolute necessity that all nurses and all levels of government work 

together for solutions to the nursing crisis. 

WRITTEN STATEMENT OF SUE ALBERT, RN, MN, MHA, ASSISTANT DEAN OF 

ALLIED HEALTH, COLLEGE OF THE CANYONS, SANTA CLARITA, CA – SEE 

APPENDIX G 

Chairman Boehner. Thank you, Ms. Albert. 

 Ms. McCullough, you may begin. 

STATEMENT OF CAROLYN McCULLOUGH, MA, RN, NATIONAL 

COORDINATOR, NURSE ALLIANCE, SERVICE EMPLOYEES 

INTERNATIONAL UNION, WASHINGTON, D.C. 

Thank you for allowing me to testify at this hearing on behalf of the 1.4 million 

members of the Service Employees International Union, of whom 110,000 are nurses. 

My name is Carolyn McCullough. I am a registered nurse and the national coordinator of 

SEIU's Nurse Alliance. 

 This hearing was changed because of the devastating attacks on September 11th. 

Because of these tragic events, thousands of people needed medical care, and nurses were 

on the front lines delivering this care. Nurses were ready to provide whatever care was 

needed, without being asked, and without concern about time or hours worked and about 

being paid. But this crisis highlights the need to have adequate numbers of nurses. 

Therefore, addressing the current nursing crisis and the impending shortage is imperative. 

 In May 2001, our Nurse Alliance released "The Shortage of Care," a report that is 

helping to redefine the Nation's nursing shortage. The report claims that the real problem 

is a shortage of nurses willing to work in hospitals under current conditions. 

 This opinion was also shared by the GAO in their recent report, "Nursing 

workforce: Emerging Nurse Shortages Due to Multiple Factors." We view the situation 

as a staffing crisis rather than a nursing shortage. Systemic understaffing by the industry 

has led to unbearable working conditions and increasing concern about the quality of 

patient care. 

 Inadequate staffing has led to increased numbers of medical errors. In 1999, the 

Institute of Medicine found that between 44,000 and 98,000 Americans die each year due 

to medical errors. More people die of medical errors than from motor vehicle accidents, 
40

breast cancer, or AIDS. A majority of nurses in our SEIU survey identified understaffing 

as the cause of medical errors, and the situation, they say, is not improving. 

 A devastating side effect of the understaffing crisis is that of abuse of mandatory 

overtime. Nurses are often mandated to work back-to-back 8-hour shifts or 4 extra hours 

on top of 12-hour shifts. This threatens patient safety. An exhausted, overworked nurse 

is not as alert and accurate as a well-rested one. 

 According to our survey, nurses in hospitals work an additional 8-1/2 weeks of 

overtime, on average, every year. Nurses are stretched to the limit. They are 

experiencing high levels of stress, chronic fatigue, and work-related injuries. These 

conditions are driving nurses from hospitals. 

 The current supply of nurses far exceeds the demand. According to a recent 

Health Resource Services Administration report, there are approximately 500,000 nurses 

who have licenses but are not practicing. 

 RNs employed in hospitals have decreased from 68 percent in 1988 to 59 percent 

in 2000. Few young people are entering nursing. Nursing school enrollment has 

declined in each of the last 6 years. A Washington State nurse gave these reasons why 

she is leaving hospital nursing, and I quote: 

 "it is difficult to tell you how terrible it is to work scared all of the time. A 

mistake that I might make could easily cost someone their life and ruin mine. Every 

night we routinely race the clock. All of us do without lunch and breaks, and work 

overtime, often without pay, to ensure care for our patients. We have patient assignments 

2-1/2 times greater than the staffing guidelines established by the hospital. 

 "I cannot continue to participate in this unsafe and irresponsible practice, so I am 

leaving; not because I don't love nursing, but because hospitals are not safe places, not for 

patients and not for nurses."

 Nurses who are in unions have turned to the bargaining table to change their 

working conditions in order to ensure safer staffing and better patient care. At present, 

collective bargaining is the only venue that nurses can use to protect themselves against 

unfair and abusive working conditions such as mandatory overtime that jeopardize 

quality patient care. 

 SEIU's nurses have negotiated limits on mandatory overtime and staffing 

standards. Yet our right to collectively bargain is constantly under threat. Two recent 

Supreme Court decisions have eroded nurses' rights to act collectively. As these 

challenges to nurses' ability to address workplace and quality patient care issues through 

collective bargaining mount, it becomes more imperative that policymakers act now to 

ensure decent working conditions for our country's nurses and ensure safe patient care 

and an adequate nurse workforce for the future. 
41

SEIU and other unions have introduced legislation on the State level to establish 

staffing standards, ban mandatory overtime, and provide whistleblower protection.

California was the first State to pass legislation to require staff-to-patient ratios in 

hospitals. In an action of historic proportions, Kaiser-Permanente has recently become 

the first employer to endorse the ratio proposal put forth by the SEIU California Nurse 

Alliance. Maine and Oregon have passed legislation banning mandatory overtime. 

 On the Federal level, legislation has been introduced to attract new people into the 

nursing profession by making it easier to access educational and training resources. We 

applaud these efforts; however, this will not address the fundamental problem. These 

measures will only treat the symptoms, not cure the disease. The solution to the nursing 

crisis lies in the establishment of safe staffing standards in our hospitals. 

 We must set staffing standards linked to the acuity of patients, skill of the staff, 

and skill mix. We must make staffing a requirement for all hospitals receiving Federal 

taxpayer dollars. 

 The Federal Government must provide adequate oversight of our hospitals and 

reform the industry's self-monitoring system under the Joint Commission on 

Accreditation of Healthcare Organizations. And we must protect nurses who blow the 

whistle on staffing problems that jeopardize the quality of care. 

 On the educational front, SEIU would encourage this committee to explore the 

establishment of public-private partnerships for educational programs that establish 

career ladders for nursing assistants to become licensed practical nurses, and for licensed 

practical nurses to become registered nurses. Tens of thousands of dedicated workers in 

our country's hospitals, nursing homes, and in-home care, are a valuable resource that we 

can use to address our future shortage needs. 

 SEIU is currently working on developing such a program jointly with a number of 

employers. This program will incorporate tuition reimbursement, the use of online 

distance learning, a clinical component based in the workplace, and a learning assessment 

tool that credits the student for prior learning and experience. The providers will be 

reputable institutions of higher education. 

 These types of programs should be supported nationally, and we would be happy 

to assist the committee in any way possible. But there is a step we can take today, 

immediately, to stop the hemorrhaging; and that is to put a ban on mandatory overtime. 

SEIU and other unions are working with Representative Stark to introduce legislation that 

would ban mandatory overtime. 

 Thirty years ago, I became a nurse because I wanted to make a difference. Caring 

for people when they are ill and at their must vulnerable, especially those so often 

underserved, really appealed to me. I thought I could help them get better and stay 

healthy. And what I found out is that I really could. I have spent many years as a nurse, 

and along the way I learned that nurses are the critical link between people and health 

care, and without nurses there is no health care. 
42

I look forward to working with you and will be happy to answer any questions. 

WRITTEN STATEMENT OF CAROLYN McCULLOUGH, MA, RN, NATIONAL 

COORDINATOR, NURSE ALLIANCE, SERVICE EMPLOYEES INTERNATIONAL 

UNION, WASHINGTON, D.C. – SEE APPENDIX H 

Chairman Boehner. Thank you, Ms. McCullough.

 Dr. Bartels, you may begin. 

Ms. Bartels. Good afternoon, Mr. Chairman. 

Chairman Boehner. Dr. Bartels, if you could suspend for just a moment. We do have a 

vote on the House floor. Several of our Members have gone to vote. Maybe they will 

return quick enough for us to go vote, and we can continue the hearing. Otherwise, we 

will have a short pause, just so you know what the confusion up here is. You may begin. 

STATEMENT OF DR. JEAN BARTELS, CHAIR, SCHOOL OF 

NURSING, GEORGIA SOUTHERN UNIVERSITY, STATESBORO, 

GA

Good afternoon, Mr. Chairman, and Members of the Committee. Thank you for 

inviting me to speak to you today about educating the future workforce of nurses. I am 

Dr. Jean Bartels, the Chair and Professor of the School of Nursing at Georgia Southern 

University in, proud to say, rural Statesboro, Georgia. 

 I am also here presenting the views of the American Association of Colleges of 

Nursing, which represents 556 baccalaureate and graduate schools of nursing across the 

United States. 

 I am heartened that the Congress is investigating the nationwide shortage of 

nurses available to care for all of our citizens. And I am hopeful that Congress will 

investigate the health care education infrastructure, part of which is the current 

unprecedented number of nurses we have working, 2.7 million who make up the 

backbone of today's workforce, and in memory of those hundreds of thousands of nurses 

who have always been on the front lines every time this country has been in conflict and 

will be there again this time. 

 The United States is in the midst of a nursing shortage that is projected to 

intensify as baby boomers age and the need for health care grows and becomes even 

more complex. Compounding the problem is the fact that the pipeline of new nurses is 

shrinking. Additionally, faculty shortages are reducing the capacity of the educational 

system to increase enrollment to offset current and future shortages. Faculty shortages at
43

schools of nursing across the country are contributing to the overall decline in new 

enrollments. AACN data shows that baccalaureate nursing schools have turned away 

about 4,967 qualified students across the United States due largely to insufficient 

numbers of faculty, clinical sites, classroom space, clinical preceptors and, again, budget 

constraints.

 More than a third of the schools surveyed pointed to a faculty shortage, 

particularly for faculty prepared at the doctoral level, as reasons for not accepting all 

qualified applicants into entry-level baccalaureate programs. 

 As enrollments continue to plunge, States and local communities are developing 

very innovative approaches to attracting students to the nursing profession, and funding 

their education through scholarships and loan forgiveness programs. 

 In past cyclical nursing shortages, Congress has acted decisively by funding new 

initiatives that increase capacity in nursing schools and attract new students to the 

profession. Again, we urge Congress to take this shared burden with the States and 

private sector. 

Without question, new initiatives are needed in the areas of faculty preparation, 

enrollment incentives and post-baccalaureate residency programs to safeguard our 

Nation's health care delivery system. At Georgia Southern University, initiatives in these 

areas have actually proven to be fairly successful, and I would like to share with you 

several innovative ideas and success stories from Georgia Southern. 

 The first thing that we discovered was creating fast-track nursing scholarship 

programs and loan programs has provided an opportunity for many of our nursing faculty 

to go back to school supported by local and Federal grants. Providing scholarships and 

loans to students to become nurses is really absolutely ineffective if you have inadequate 

faculty to educate them. It is the old adage of when you are out of faculty, you are out of 

mission. When you are out of mission, you are out of nurses in this case. 

 To increase the number of nurse educators, the Fast-Track Nursing Faculty 

Shortage Scholarship and Loan Program could provide economic incentives to both 

masters and doctoral students who commit to serving as faculty members. This program 

should require participating students to serve as educators in schools of nursing for a 

number of years equivalent to the time that that participant has received Federal support. 

At Georgia Southern University, as I mentioned, local and State grant support has 

facilitated our ability to hire additional educators and several eminent scholars who are 

focused on meeting the needs of our rural, very underserved communities. 

 Second, we should establish a capitation grant program. Schools of nursing must 

have strong infrastructures equipped with high-tech communications equipment, teaching 

software and labs that simulate hospital-patient care units. A capitation program similar 

to the one that was created in the 1970s could help to recruit new students and help us to 

retain faculty. With Federal support of $1,200 for each full-time student enrolled in the 

collegiate nursing program, schools could purchase equipment, hire faculty and build 
44

new learning labs. 

 As a model, Georgia Southern University, funded by State and local initiatives, 

will soon open a new nursing building featuring research and nursing skill labs, distance 

learning classrooms and a community nursing outreach clinic serving the underserved 

needs of our local community. The facility will enable the school to attract increased 

numbers of students and qualified faculty to the region by using technologically 

sophisticated clinical labs, Web-based learning technologies and distance learning 

initiatives, which I will point out my faculty are ready, are highly skilled at providing to 

those who can't reach educational environments so that we can educate all the future 

generations of professional nurses. 

 And third, creating a post-baccalaureate nursing residency program would ensure 

the successful transition of new nurses from student to expert nurse and assure that our 

Nation's health care system includes highly educated nurses with clinical expertise. For 

example, Georgia Southern's faculty partnership with the local rural hospital, East 

Georgia Regional Medical Center, has resulted in the development of a program to train 

nurses as mentors to both students and new graduates. Faculty worked with the hospital 

to achieve Magnet status by increasing their involvement in committees and study groups 

that were designed to help that institution look at working conditions for their nurses. 

 Plans are under way to reestablish a nurse extern program for new baccalaureate 

graduates and to develop joint leadership training initiatives for both practicing nurses 

and undergraduate students. I am happy to report that that process has resulted in our 

rural environment's retaining 80 percent of the nurses we educate in rural underserved 

areas, 14 percent of which are men and 28 percent of which are women and men of ethnic 

minority backgrounds. 

 Once again, another cycle of nursing shortages is wreaking havoc in the health 

care delivery system. As the Congress investigates solutions to the current shortage, it 

must focus on the long-range problems that affect nursing as a profession. Steps really 

need to be taken to evaluate and improve the practice environment, and simultaneously 

schools of nursing must be adequately funded to strengthen and expand the capacity to 

educate the nursing work force for the coming century. The nursing profession must 

create a career pathway that both attracts individuals to nursing and supports current 

practitioners in their chosen career. 

 In closing let me offer a word of caution, however. During shortages of nurses, 

there has been a trend to push nurses through abbreviated academic programs. Lowering 

educational standards is an inappropriate and potentially dangerous response to a 

shortage of health care professionals, and the short-term responses will interfere with the 

delivery of quality patient care. As an intensive care unit nurse with many years of 

experience, and as mother of a daughter who needed the health care system recovering 

from a malignant brain tumor, I personally expect only the most highly educated, wellprepared nurses to be at the bedside both as my colleagues and as the providers of care 

for my family. I think we can really demand no less for all citizens of this country. 

 Thank you, and I look forward to answering your questions. 
45

WRITTEN STATEMENT OF DR. JEAN BARTELS, CHAIR, SCHOOL OF 

NURSING, GEORGIA SOUTHERN UNIVERSITY, STATESBORO, GA – SEE 

APPENDIX I 

Chairman Boehner. Dr. Bartels, thank you for your testimony. 

 We are going to take a short break, and Mr. McKeon will resume the hearing as 

soon as he gets here, and then I will be back. 

Mr. McKeon. [Presiding.] Tag team match we have going here. 

Dr. Garner? 

STATEMENT OF CATHERINE GARNER, DrPH, RN, FAAN, DEAN, 

COLLEGE OF NURSING AND HEALTH SCIENCES, UNIVERSITY 

OF PHOENIX, PHOENIX, AZ

Thank you, Mr. McKeon and Members of the Committee. We appreciate the 

opportunity to be here today. The University of Phoenix is the Nation's largest private 

institution of higher learning with 120,000 students, including 6,000 who were called to 

active duty within this last week. Over 26,000 of our students go to school completely 

online.

 The College of Nursing is 10 years old, and in those 10 years, we have grown to 

over 2,000 undergraduate students and over 1,800 graduate students looking for their 

master's degree in nursing, including some family nurse practitioner students. We are at 

37 percent minority currently and over 10 percent male and see that as a great success, 

albeit that our average age of student is 37. 

 We are geared primarily to the working adult, and we attribute some of our 

success to an innovative teaching learning model that is designed exclusively for the 

working adult, to our just-in-time curriculum and our use of expert practitioner faculty. 

We offer one course at a time on-ground that allows the student to work full time and 

also pursue their education. The classes are kept small with a 1 to 10 ratio for online for 

faculty and students and a 1 to 15 ratio for our on-ground classes. 

 Our over 300 plus practitioner faculty work full time in their profession while 

teaching part time, and all are prepared in their area of expertise. We have absolutely no 

trouble at recruiting academically prepared faculty at the moment despite the fact that we 

have no career track or a tenure system. Our faculty includes chief nursing executives, 

State board of nursing staff and members, managed care professionals and chief financial 

officers. 

 Our nursing education establishment must embrace the concept of public-private 

partnerships particularly to deal with the increasing need of health professionals to have 

greater skills and advanced critical thinking. The traditional year 4-year BSN students
46

are rapidly losing ground, and we are looking again to some of the traditional roots of 

nursing, vocational development in high schools, our strong community college system 

with associate degree nursing programs that articulate onto the bachelor's degree and 

master's degree in nursing programs. These programs need to allow people to work full 

time to support their families while going to school for advanced education. 

 In fact, what we are seeing is that many men and women do, in fact, want a career 

in nursing, and that there are 2- to 3-year waiting lists at the community college level. A 

majority of those on waiting lists are actually the ethnically diverse, nontraditional 

students who must also work to support their families. The traditional semester daytime 

class model is not designed to support these students. We need to work actively to 

develop innovative delivery models and to encourage the innovators in our nursing 

education systems. 

 In a number of communities we are partnering with the community college 

system and a number of local hospital employers to double the number of 1-year 

community college licensed practical nursing graduates and then to articulate them 

seamlessly into our 30-month LPN to BSN program. This allows the student to work full 

time, support their family and complete their nursing education in a relatively short 

period of time. We are going to offer this program to over 900,000 licensed practical 

nurses over this next year, and we are hoping to encourage them to move into the 

registered nurse program. The program also accommodates the active duty medic corps 

and allows them while on active duty to achieve their bachelor of science and nursing 

over a 30-month period of time. That is helping us with our 2005 goal of an all BSN 

corps by 2005. 

 Our distance education model gives us educational opportunities in rural areas as 

well as for those nursing students who work odd shifts to pursue education at their 

convenience. The online cohorts bond greatly, and in December our first national cohort 

of the Nation's 38 Children's Hospitals will have a pediatric group starting their master's 

degree online. 

 We hope the committee will consider some of the following things that we would 

like to recommend. The tuition loan forgiveness is vitally important to encouraging 

people back to school and having them complete education. This committee oversees the 

largest student loan program in the Nation that serves millions of students each year. We 

are asking you to consider expanding the loan forgiveness to nurses to your existing 

student loan program for teachers, and it would be an efficient way of promoting 

recruitment and retention efforts. 

 We would like to encourage members of this committee also to work with the 

Department of Education and to change laws and regulations that are creating roadblocks 

to expanding educational opportunities to these nontraditional students, particularly in the 

online distance modality, and also to encourage employers to see education of their 

current work force as a way to recruit and retain people in our profession. 

 Thank you again for this opportunity, and I look forward to answering any 

questions you might have. 
47

WRITTEN STATEMENT OF CATHERINE GARNER, DrPH, RN, FAAN, DEAN, 

COLLEGE OF NURSING AND HEALTH SCIENCES, UNIVERSITY OF PHOENIX, 

PHOENIX, AZ – SEE APPENDIX J 

Mr. McKeon. Thank you very much. 

 Mr. Lynn? 

STATEMENT OF GEORGE F. LYNN, PRESIDENT AND CEO, 

ATLANTICARE HEALTH SYSTEM, TESTIFYING ON BEHALF OF 

THE AMERICAN HOSPITAL ASSOCIATION, WASHINGTON, D.C. 

Thank you, Mr. Chairman, Members of the Committee. I am George Lynn, 

president and CEO of AtlanticCare, southeastern New Jersey's largest health care 

delivery system, and I am here today as a member of the American Hospital Association's 

board of trustees representing AHA's nearly 5,000 hospitals, health system and health 

care provider members. Thank you for the opportunity to address an issue of concern to 

all, the immediate and long-term shortage of nurses. 

 AtlantiCare's integrated network of services encompasses Atlantic City Medical 

Center, a 581-bed, two-divisional regional health care institution. Our system of more 

than 2,800 health care workers includes 800 registered nurses and 350 physicians 

representing the full spectrum of medical care. 

Mr. Chairman, before I begin, I would like to state on behalf of the entire hospital 

community how proud we are of how our colleagues in New York, New Jersey and the 

Washington area and other parts of the country responded to the terrorist attacks of 

September 11. Physicians, nurses, emergency personnel and all members of the health 

care work force provided care and relief to those in need. And we are fortunate as a 

Nation to have such individuals who have dedicated their lives to the health care field. 

Mr. Chairman, you are familiar with the problems of the work force shortage. 

The demand for hospital care is rising. Demand is also increasing as we care for baby 

boomers, as we have heard, who are already being treated for cancer, heart disease and 

orthopedic conditions. The supply of nurses is not keeping pace with demand. Overall 

enrollment in nursing schools has decreased 22 percent since 1993, resulting in a dearth 

of nurses to replace retirees. 

 The bottom line is that the demand for health care may soon exceed our capacity 

to provide it, and that was our analysis before the world changed on September 11. My 

health care system and the nurses and doctors who worked there were on alert waiting 

and then praying for care for the New York survivors. But the tragedy and the death toll 

were unimaginable. For our Nation, the result of those tragic events is a heightened state 

of disaster readiness. For our Nation's hospitals, it means disaster preparedness plans 

must be revised and upgraded. 
48

Plans and resources essential to a prepared Nation will be critical. Even stronger 

relationships among community firefighters, police, health care workers and other 

emergency response team members will be critical. And hospitals' continued leadership, 

as an integral part of this Nation's essential community infrastructure will be critical. The 

events of September 11 that raise new questions about readiness for any number of 

contingencies and sufficient numbers of hospital personnel, especially nurses, will be 

essential to ensuring America's readiness. 

 So how can we address these shortages? Like many health care facilities, 

AtlanticCare is constantly looking for ways to develop innovative working environments 

and to promote nursing as a career. Our programs include providing flexible hours, 

enhanced compensation and benefits, on-site childcare and programs to attract youth to 

health care areas. We sponsor RNs to BSN programs, nursing scholarships, a workplace 

improvement task force made up of hospital staff, and partnerships with local schools and 

community organizations to promote health careers. 

 Our approaches are proactive and creative, and they are working. We have a 

lower-than-average nursing vacancy rate. But as good as they are, they are not enough. 

Finding long-term solutions will take a collaborative approach from all stakeholders, 

including high schools, academia, professional organizations and our local, State and 

Federal Governments. 

 The AHA has endorsed several bills aimed at expanding the supply of nurses, 

including H.R. 1436, the Nurse Reinvestment Act, sponsored by Representatives Sue 

Kelly and Lois Capps. As Representatives Kelly and McCarthy have presented today, 

this bill addresses educational incentives for nursing students, including the creation of a 

national nurse service corps. While the Nurse Reinvestment Act would assist in the 

education of future nurses, the American Hospital Preservation Act, H.R. 1556, would 

give hospitals a fully inflationary update so they can provide fair and reasonable wages 

and benefits. And the Area Wage and Base Payment Improvement Act, H.R. 1609, 

creates a floor on the Medicare wage index to better balance work force competition in 

rural and urban areas. 

 The AHA is also taking steps to alleviate the shortage of caregivers. In order to 

address this, the AHA convened in April a commission on work force for hospitals and 

health systems. This diverse group of stakeholders includes hospital administrators, 

nurses, academics, business and organized labor leaders. The final report, which will 

include recommendations for solutions to this national dilemma, will be presented at the 

AHA annual meeting next spring. 

Mr. Chairman, the Nation faces a critical shortage of nurses and other health care 

workers. To turn things around, every stakeholder must work together to respond to this 

growing problem that will personally affect each of us in the coming years, and in order 

to properly care for our patients now and in the future, we encourage you to support these 

initiatives to expand the nursing work force and meet the growing health care needs and 

readiness demands of our Nation. Thank you. 
49

WRITTEN STATEMENT OF GEORGE F. LYNN, PRESIDENT AND CEO, 

ATLANTICARE, TESTIFYING ON BEHALF OF THE AMERICAN HOSPITAL 

ASSOCIATION, WASHINGTON, D.C. – SEE APPENDIX K 

Mr. McKeon. Thank you very much. 

 As I mentioned earlier, I really wanted to thank the Chairman for holding this 

hearing. I was aware that we had a serious problem, but I am much more aware today 

after having listened to the testimony. I am also encouraged, because I hear all of the 

good things that you are doing to address the problem. And I think that while much is 

needed to be done, there are very good people out there doing very good things. So I feel 

good about that. 

Dr. Garner, I spoke at one of your graduations a few years ago, and there were 

many graduates in nursing. You mention in your testimony about innovative delivery 

programs. I don't know if you’re aware of Mr. Isakson's bill, and he probably wanted to 

talk a little bit about that, but I wanted to give him a plug, too. His bill, H.R. 1992, does 

address some of these issues and makes it easier for schools to be creative and to do some 

different things in reaching out to people to get more people into the program. And I 

think it would be very important for this particular problem of nursing shortages to get 

his bill passed, and he is to be commended for the work he has done on that. 

 Tuition loan forgiveness, I think that is also something we can look at, and I am 

sure we will as we go through this process. 

Mr. Lynn, you mentioned throughout your testimony the efforts that hospitals are 

undertaking to recruit and retain nurses. Would you please expand upon these efforts? I 

served as a member of a board and chaired a board at a local community hospital. This 

was 15 years ago, and the problem was serious then, and I am concerned that it is even 

worse now. Would you please expand upon those efforts? 

Mr. Lynn. We have taken our message into the high schools to try and make students 

aware of the variety of health care careers that are available to them. We don't think that 

in our community we have done as good a job as we should have in reaching out to 

students in high school. We have also partnered with our community college and with 

Richard Stockton College and Thomas Jefferson University to provide opportunities for 

education. We have sponsored scholarship programs for our employees and for 

dependents of our employees, which have been very successful. We have sponsored a 

series of scholarship efforts with the Hispanic Alliance of Atlantic City and with the 

NAACP where they select applicants for our scholarships, and we provide mentors and 

tuition and extern programs during their education. So it is a fairly far-reaching, 

community wide effort on our part to raise the level of awareness of not just nursing 

careers that are available, but also the spectrum of health care career opportunities. 
50

Mr. McKeon. I heard Ms. Velazquez state very clearly that money was not the most 

important thing, that working conditions were very important, and that sounds like 

something the hospital association could really work towards addressing. Do you have 

efforts that you are making in that regard? 

Mr. Lynn. We are working on working conditions every day. In January we took 17 

care providers and support personnel offline for 30 days in our organization and asked 

them to redesign the health care delivery system as we knew it and to work the edges of 

innovation to try and find ways that we can solve the problems that have been talked 

about today, such as the burden of paperwork, not having enough time to spend with the 

patient, how to use additional personnel to support the activities of nurses. 

 If I could, I would like to address the issue of compensation. In all of the surveys 

that we see, I don't think I can ever remember one where compensation was the first and 

most important issue, and I think you have heard today that nurses didn't get into nursing 

to get rich. But compensation figures into every one of those surveys that I have seen, 

and I think everybody in this room who works within direct patient care and health care 

knows that there is a number, a salary and compensation number at which point the 

500,000 people who have licenses but don't practice direct patient care begin to return to 

hospitals, and high school seniors who have choices begin to elect nursing. We have to 

find that number. 

 My institution and most hospitals I know peg our nursing salaries at a market rate, 

but I think we all know that that market rate doesn't reflect the compensation that should 

take place for the kind of responsibility and authority that you heard the first panel talk 

about. So that is a battle, I think, that we all have to share, and it is to find the right 

compensation package. That creates the platform that I think we need to recruit and 

retain nurses. All of the other activities that we engage in are to improve the quality of 

work life. 

Mr. McKeon. I don't see anybody that knows what that means. Maybe it meant my 

time is up. Mr. Scott? 

Mr. Scott. Thank you, Mr. Chairman. 

 Let me follow up on that, Mr. Lynn. You indicated it was the market rate. When 

people leave nursing, what kind of jobs do they take instead? 

Mr. Lynn. Nurses are in demand by industry for employee health programs, for school 

systems. HMOs are now offering opportunities to nurses in private physician office 

practice. There are a lot of opportunities available for nurses that weren't there 10 or 15 

years ago. 

Mr. Scott. Do those positions pay more than hospitals? 

Mr. Lynn. Generally speaking, they don't pay more. They have other benefits that 

nurses find attractive, such as a policy of working an 8-hour day with weekends off, and 

they are willing to sacrifice something in the way of compensation and benefits in order 
51

to get that lifestyle. 

Mr. Scott. Ms. McCullough, you indicated there was a difference between staffing and 

shortages. What did you mean by that? 

Ms. McCullough. There are more than enough nurses than are needed right now to meet 

the demand within the country. This shortage that we are looking at is coming, as we had 

said before in the first panel, when the baby boomers are reaching 60 and 65, and that is 

in 2020. We need to get those 500,000 nurses back to the hospitals, and the reason they 

have left is because, as I have said, the working conditions are deplorable. 

As Mr. Lynn has said, they leave for places where they can have a more 

reasonable, normal work life. And the other thing is what we heard from the two nurses 

on the first panel regarding the inability to deliver quality care daily to their patients. This 

is a real burden and a real drain on the nurses' willingness to continue to work in that 

environment. 

 The story that I told from the Washington State nurse is quintessential as an 

example of what nurses are facing when they say things like hospitals are not safe for 

patients anymore, and they are not safe for nurses. 

Mr. Scott. I yield to the gentleman from Ohio. 

Mr. Kucinich. I thank the gentleman, and I thank the Chair for calling this hearing. I 

wanted to ask for unanimous consent to submit a report relating to the mergers, drug 

costs and health caregivers staffing ratios along with some points that illustrate the study, 

and together with a question that I pose.

 Could I have unanimous consent to submit this material for the record? 

Mr. McKeon. Without objection, so ordered. 

Mr. Scott. Thank you. Reclaiming my time. 

 Can you explain the problem with paperwork, Ms. Foley? 

Ms. Foley. I don't want to underplay the fact that there are concerns being raised right 

now and, in fact, a lot of attention being placed on paperwork, but I don't want it to be 

taken out of the context in which it really should be.

If you ask a nurse on a survey of what concerns them, paperwork will not appear 

on the top of that list. It is the sense of satisfaction that is primary to their care and to the 

souls of nurses in these days. I think Melissa spoke well about an environment where her 

priority for 12 hours is on the patient and obviously the family. She told the beautiful 

story about the husband and the wife she was caring for in terms of both physical and 

mental health at that time. And she very honestly acknowledged that because of her 

commitment to that care, she would save some of that documentation that could be saved 
52

until the end of the shift, which often may have run overtime. 

 The reality is our systems are not as efficient as they should be. If Melissa is in 

the room and charting at the critical care unit bedside, if we had some good automation, 

then perhaps much of that documentation would be entered automatically in a medical 

record, and there wouldn't need to be separate steps taken numerous times to do the same 

work. That work would have been critical and important to that patient's welfare; his 

vital signs, his stability on the monitoring machines. 

 So it is not to underplay the fact that, yes, it is a factor, but I would not say that if 

we stopped charting, that nurses would necessarily be any happier. In fact, the care 

would be undermined, and the sense of satisfaction really has to be looked at. What are 

the arrangements in that work life that give support to the nurse being able to give the 

time and the attention to that patient and to their family? Are there enough hours? Is 

their patient assignment appropriate for their ability to give that attention? 

 I would shudder to think of that pediatric unit with two registered nurses and 16 

unwell children and the stress they must feel that at any time 14 children are not being 

looked at by a registered nurse. It has to be brought back into context in terms of the 

workload, and much of the documentation is absolutely essential. And I am not here to 

argue that there isn't some duplication that could be improved upon by some system 

improvements. 

 I also want to jump in, if I could, about improvements that are being made across 

this country in the actual care environment. Lisa from Fairfax Hospital is a nurse at a 

hospital with the very first Magnet status in this country. They are a Magnet hospital, 

and that is an award that has been given to only 37 hospitals in this country, but there are 

hundreds of hospitals and long-term care centers looking at the opportunity to make 

improvements so that they, too, could be recognized with a Magnet credential. 

 Now, it isn't whether we give that credential out, it is what the environment can be 

improved to look like and the concept of what are the forces of magnetism. The support 

by the university is a wonderful example of an academic setting helping an institution of 

care. The examples given, nurse participation in governance, whether it be through 

shared governance or through collective bargaining, is an absolutely root cause of 

improved nurse satisfaction and better decision making if nurses who give the care 

actually participate in the decision making in the allocation of the care. 

 Some of those key critical decisions, whether we are building up the work force 

or reducing the work force, should come from the perspective of how does the care get 

given and how can it still be maintained at a high quality level. Opportunities to look at 

your own schedule, a very important concept of participating in the decision making; the 

measurement of patient care outcomes, the ability to take a look at a unit and see how that 

care is impacted by a change in staff and a change in the computer system, very 

important for us to know more about that care. 
53

Magnet hospitals incorporate all of those concepts, and I think they offer a set of 

solutions to the dilemma of how to make our environment better. These settings have 

lower turnover, higher retention, higher patient satisfaction, higher nurse satisfaction, and 

even have lower needle stick injuries. So we have a growing body of research that tells 

us we have some answers to the questions of how to make those improvements. Thank 

you.

Mr. Scott. I yield back the balance of my time. 

Mr. McKeon. Mr. Isakson? 

Mr. Isakson. Thank you, Mr. Chairman. 

 I would like to add my praise to that of Dr. Norwood for Dr. Bartels being here 

today from Georgia Southern University, School of Nursing. And let me ask you, of your 

students, what percentage of them are typical college-age students studying for their first 

career, and what percentage of them are adults that are returning to a college campus to 

learn? 

Dr. Bartels. There are about 95 percent traditional-age students. Almost every single 

one of them wants to go into the high-risk, low-served areas in terms of critical care, 

emergency rooms. They are the very young people that we need to get in at the ground 

level where we have got the biggest shortages. Five percent are perhaps somewhat 

nontraditional, but yet they are still under 30 years of age, and about 14 percent of them 

are males. And we have between 28 and 30 percent of students with minority 

backgrounds.

Mr. Isakson. Ms. Garner, you have 2,000 students in undergraduate nursing, 1,800 in 

graduate nursing, and the average age is 37. I presume, then, most of your students are 

second career. Is that a fair assumption? 

Ms. Garner. Actually in our undergraduate program we have concentrated in the past on 

the RN to BSN, so that 1,800 does represent working registered nurses who are pursuing 

the bachelor's degree, majority of whom are looking at supervisory positions or moving 

into a teaching ladder. 

Mr. Isakson. What about the 2,000 undergraduates? 

Ms. Garner. Our undergraduates are all working adults who are at the RN level already, 

and we are just now in this next year expanding to the LPN level. 

Mr. Isakson. Are your 36 campuses that these courses are offered on, on the distancelearning model? Are they all campuses of Phoenix, or are they campuses of other 

institutions that are doing a joint venture with Phoenix? 

Ms. Garner. Currently, they are campuses of Phoenix, although I hate to term it 

"campus" because we don't own any real estate. We lease space, and that allows us to 

expand and contract easily. And all of our student services are offered online. So our
54

enrollment, and our academic advisement are online. Three thousand of our students go 

full time on-ground, and 1,000 of our students go full time online. 

Mr. Isakson. I wanted to also appreciate Mr. McKeon’s acknowledgment of the 

distance-learning bill, 1992, and appreciate your testimony acknowledging that in it as 

well. And I think Phoenix has proven to be an excellent example in terms of distance 

learning and second careers in many, many fields, so I want to thank you for what you 

are doing. 

 I have one last question, Ms. McCullough. When you say hospitals aren't safe for 

patients and nurses, that is a relative statement, isn't it? 

Ms. McCullough. I was quoting the story of the nurse from Washington State. 

Mr. Isakson. My experience, just for the record, is a lot of times people read things that 

are said here, and the next thing you know, it is a headline somewhere. 

Mr. Lynn, would you agree that most hospitals are safe, but we can always do 

better? 

Mr. Lynn. I would agree most hospitals are safe, and hospitals are committed to 

continuous quality improvement. That is a daily effort in hospitals all across this country. 

Mr. Isakson. I yield back my time, Mr. Chairman. 

Mr. McKeon. Mr. Tierney? 

Mr. Tierney. Thank you, Mr. Chairman, and thanks to the members of the panel. 

Ms. Foley, if I could ask you, I know members of my staff and you had 

conversations on what I thought was an interesting topic about whether or not there was 

anything Congress could simultaneously do about this situation in nursing and the 

problem we have now with layoffs in the airline industry. Would you talk about that 

conversation that you had and your ideas? 

Ms. Foley. I have been brainstorming, being a frequent flyer and being struck by how 

massive the potential layoffs are in that industry, an industry where there is great ethnic 

diversity in the people who have chosen the customer service field. I thought what a 

wonderful opportunity. We need more customer service-oriented, ethnically diverse, 

committed Americans to become nurses. Perhaps there is an opportunity here to do a 

partnership, a take-off on work-to-work from one field to another and have a ready 

response to a particular need. 

 It was just a brainstorm I have been having, and I just think there are opportunities 

for us to capture the excitement of nursing for people that may not have thought about it 

before. In my written testimony I mention that a couple of the folks who watched the 

nurses respond at the World Trade Center, have already asked for information about how 

to become a nurse. So I think there is awareness, and perhaps this could be a relief
55

program that Congress could look at. 

Mr. Tierney. Some of the background that flight attendants have corresponds to things 

that nurses need. 

Ms. Foley. In fact, the original flight attendants were nurses. The very first requirements 

were that they be nurses. I was at the Red Cross headquarters the day after this event, 

and an American Airlines flight attendant had just become a nurse. She wasn't sure she 

wanted to fly, but she sure knew she wanted to be a nurse that day. And she was 

struggling with her own career choices, but I thought it was interesting she made that 

transition.

Mr. Tierney. This question is basically for anybody who feels they want to contribute to 

the answer. How long do you think the transition time would be in terms of providing 

flight attendants with the necessary tools or educational background that they need to get 

them to the point where they are in service? 

Ms. Bartels. I think the time could potentially be accelerated. We have accelerated 

programs to get people who have various kinds of credentials up to speed a little bit 

quicker and into the work force quicker; for example, medics and EMTs and people who 

also have similar kinds of backgrounds. 

 I would caution that while it is possible to actually think about how to do that, the 

reality is there are not enough resources in terms of faculty, clinical placement sites and 

many other things that are needed. Having a big pool is a great idea, but if you look at 

the legislation that was passed in Texas recently, you will see that there was some 

legislation that really gave resources to bring more people in. Immediate response of 

3,000 people who were calling schools wanting entry into those programs had to be 

turned away, 3,000 of them, because there was not enough space to put them. So while 

the pool may be big, the resources to educate that pool are very limited. 

Mr. Tierney. Ms. McCullough, if we had that program and added these people to the 

rest of the pool, I fear that it wouldn’t have done anything about retaining them or 

improving their conditions to make them want to stay in their profession. If we increased 

the size of the pool by somehow encouraging people to go from one career to another, we 

still are confronted with a situation of how do you retain them. 

Ms. McCullough. We don't want to create a revolving door. If we don't adjust the 

working conditions, we can spend a lot of money in all sorts of innovative ways in 

bringing people into the profession. However, if the workplace is not conducive for them 

to do the kind of nursing they want to do, for them to feel that they have actually helped 

patients and for them to have some semblance of a life, they are not going to stay. We 

see that happening every day. 

Mr. Tierney. Mr. Lynn, what do you say to that? How does your organization respond 

to that? 
56

Mr. Lynn. I don't think there is any doubt that the patient care delivery system needs to 

be redesigned. It is complicated in that many of the nurses who practice in our 

environment learn primary nursing, one-on-one patient relationships. It is clear now that 

in a shortage situation like we face, that a more team-based approach is needed. 

Mr. Tierney. I am sorry. I have to go back. I am hearing a mixed message. I am 

hearing there is no shortage of people who want a nursing career, and no shortage of 

people that are nurses. There are instead people that are leaving because they don't like 

the conditions. I want to try to reconcile that and what your organization does to 

reconcile that. 

Mr. Lynn. The nurses that we need in the in-patient care setting are not there in 

sufficient quantities. They have taken other opportunities. So part of the problem is 

getting people in the pipeline, getting students to elect nursing, and improving the 

compensation benefits in the working environment for those nurses in direct patient care. 

Mr. Tierney. What is your organization doing about the latter part of that? 

Mr. Lynn. We are working with nurses to redesign nursing unit patient care delivery 

systems to reduce the amount of paperwork that they need to prepare, and to provide 

them more support in the patient care setting, such as more caregivers, more hands, more 

support within the patient care delivery team, by moving into models where the care 

delivery team really functions as a team and supports each other. 

Mr. Tierney. Are you doing anything with respect to hours of work, such as mandatory 

overtime and issues like that? 

Mr. Lynn. Mandatory overtime, in my experience, is not commonplace. 

Mr. Tierney. I can tell you in my district, it is absolutely commonplace. All the 

hospitals in my area are hard-pressed, and it is the number one issue of the many nurses 

that come in to talk to me about it. So I am not sure why it hasn't infected your area yet, 

and maybe I should have them write your organization. I think they want the expertise 

and the attention of your AHA in helping them address this problem. I think it is going to 

be necessary. 

Mr. Lynn. Mandatory overtime, as I am familiar with it, is a tool of last resort. It is a 

way that after all other methods have been exhausted, which includes calling people that 

are on the on-call schedule, working through your in-house pools and working through 

outside agency contracts. If there is no other way to staff a unit, and that unit is vital, then 

mandatory overtime is used. 

Mr. Tierney. In fairness, sometimes it is mandatory, as you say. Sometimes it is the 

pressure people put on themselves. Many of these nurses simply will not refuse to 

answer the call, because they know that it means one of their peers is going to be left 

shorthanded, and the patient is going to be left without service. I don't mean to say you 

are badgering people, but more often than not they know the rest of that shift is going to 

be shortchanged, and there are patients going without the kind of care they need. I think
57

you have to look at it in terms of that, too. 

Mr. Lynn. I think you may be referencing a pocket where there is a particular problem, 

but I don't think it is a widespread issue across the country. I think there are communities 

that have a higher vacancy rate than others. Our vacancy rate runs about half the national 

average, so it hasn't become a huge issue for us, and we don't have problems when we ask 

people to work additional hours. September 11 was a great example. We had more staff 

than we possibly could have used that day. 

Chairman Boehner. [Presiding.] The Chair recognizes the gentleman from North 

Carolina Mr. Ballenger. 

Mr. Ballenger. Ms. Foley, my home hospital in North Carolina is a Magnet hospital. I 

am very proud of that. I would like to thank you and Ms. McCullough for your efforts in 

getting the needle stick bill passed. 

 I would like to ask a question because I know in my home area, we have been 

able to hire a lot of Canadian nurses. Is there a large disparity between the pay scale in 

Canada and the pay scale in the United States? 

Ms. Foley. I think for a period of time, Canadian nurses found the U.S. quite attractive 

and had ease migrating to this area. However, the Canadian Nurses Association and the 

country are now asking their nurses to stay home. They have a 60,000-nurse shortage out 

of about 240,000 registered nurses. So their country is being affected as well. 

Mr. Ballenger. If I may we are running out of time. I wanted to ask Ms. Bartels a 

question, and it would apply to Ms. Garner, too. 

 In my area, because of the shortage that we know we are going to face and so 

forth, we got the University of North Carolina, Appalachian State University, our 

community college and a private college together in three out of four nursing programs. 

However, one of them is 60 miles away, one is 40 miles away, and the community 

college is completely filled. We can't put any more kids in there. 

 We did a poll, and we found out that we had a lot of people who would like to be 

nurses, or ex-nurses that would like to go back to work, but they don't want to go for 

training 50 or 60 miles away. Is distance learning a practical alternative to educate a 

person to become a nurse? 

Ms. Bartels. Absolutely. The State of Georgia has done quite a bit of that, and our 

particular school is doing a significant amount with distance learning, both asynchronous 

learning and Web-based learning. We have always done that with our RN to BSN 

programs and with our graduate program. We are looking at doing it with our 

undergraduate program as well using preceptorships. 

 We face the same problems in rural Georgia. We have had opportunities to do 

partnerships with institutions that have decided, based on staffing criteria, that they would 

like to have programs brought to them. So we are doing a combination of distance
58

learning initiatives with four pre-licensure students, those without a credential, combining 

distance learning through a system wide Georgia network to do core requirements. 

Mr. Ballenger. I don't want to interrupt you, but my time is running out. I've got to go 

vote. I would like to ask a question. Would it be possible to get information along those 

lines to my area of North Carolina? 

Ms. Bartels. Absolutely. 

Mr. Ballenger. And, Ms. Garner, I hate to cut you off, but I am going to be short on my 

vote. Thank you very much. 

Chairman Boehner. You are not going to be as short as the Chairman and Mr. Scott, 

who are going to finish up. Do you have anything else? 

Mr. Scott. I ask unanimous consent that the statement from the gentleman from New 

Jersey, Mr. Holt, be entered into the record. 

Chairman Boehner. Without objection, so ordered. 

 Let me thank the witnesses for your testimony and apologize to you that from 

time to time when we schedule hearings, we have recorded votes on a host of issues, and 

today was one of those days. We usually treat our witnesses much better than you have 

been treated. So accept our apologies, and with that, thank you for your testimony, and 

the hearing is adjourned. 

Whereupon, at 1:50 p.m., the Committee was adjourned. 
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Table of Indexes 

Chairman Boehner, 1, 3, 4, 7, 9, 11, 13, 14, 16, 18, 19, 20, 22, 23, 25, 27, 28, 31, 33, 36, 

39, 42, 45, 57, 58 

Dr. Garner, 45, 49 

Mr. Andrews, 31, 32, 33 

Mr. Ballenger, 57, 58 

Mr. Greenwood, 24, 25 

Mr. Isakson, 53, 54 

Mr. Kucinich, 51 

Mr. Lynn, 49, 50, 54, 56, 57 

Mr. McKeon, 33, 45, 47, 49, 50, 51, 53, 54 

Mr. Miller, 14, 15, 16, 17 

Mr. Norwood, 36 

Mr. Osborne, 18, 19 

Mr. Scott, 25, 26, 50, 51, 53, 58 

Mr. Tierney, 19, 20, 54, 55, 56 

Mrs. Biggert, 20, 21, 22 

Mrs. Kelly, 16, 17, 18, 20, 21, 22, 23, 26, 30 

Mrs. McCarthy, 17, 21, 23, 24, 26, 32 

Mrs. Mink, 27 

Ms. Bartels, 42, 53, 55, 57, 58 

Ms. Foley, 34, 51, 54, 55, 57 

Ms. McCullough, 51, 54, 55 

Ms. Solis, 28, 29, 30 

Ms. Tompkins, 13, 14, 15, 19, 20, 25, 29 

Ms. Woolsey, 22, 23