II 

111TH CONGRESS 

1ST SESSION S. 1161 

To amend the Public Health Service Act to authorize programs to increase 

the number of nurse faculty and to increase the domestic nursing and 

physical therapy workforce, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 2, 2009 

Mr. BINGAMAN (for himself and Mrs. LINCOLN) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To amend the Public Health Service Act to authorize programs to increase the number of nurse faculty and to 

increase the domestic nursing and physical therapy workforce, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; FINDINGS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Nurse Faculty and Physical Therapist Education Act of 

6 2009’’. 

7 (b) FINDINGS.—Congress makes the following find8 ings: 


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1 (1) The Nurse Reinvestment Act (Public Law 

2 107–205) has helped to support students preparing 

3 to be nurse educators. Yet, nursing schools nation4 wide are forced to deny admission to individuals 

5 seeking to become nurses and nurse educators due 

6 to the lack of qualified nurse faculty. 

7 (2) The American Association of Colleges of 

8 Nursing reported that 42,866 qualified applicants 

9 were denied admission to nursing baccalaureate and 

10 graduate programs in 2006, with faculty shortages 

11 identified as a major reason for turning away stu12 dents. 

13 (3) Seventy-one percent of schools have re14 ported insufficient faculty as the primary reason for 

15 not accepting qualified applicants. The primary rea16 sons for lack of faculty are lack of funds to hire new 

17 faculty, inability to identify, recruit and hire faculty 

18 in the competitive job market as of May 2007, and 

19 lack of nursing faculty available in different geo20 graphic areas. 

21 (4) Despite the fact that in 2006, 52.4 percent 

22 of graduates of doctoral nursing programs enter 

23 education roles, the 103 doctoral programs nation24 wide produced only 437 graduates, which is only an 

25 additional 6 graduates from 2005. This annual 


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1 graduation rate is insufficient to meet the needs for 

2 nurse faculty. In keeping with other professional 

3 academic disciplines, nurse faculty at colleges and 

4 universities are typically doctorally prepared. 

5 (5) The nursing faculty workforce is aging and 

6 will be retiring. 

7 (6) With the average retirement age of nurse 

8 faculty at 62.5 years of age, and the average age of 

9 doctorally prepared faculty, as of May 2007, that 

10 hold the rank of professor, associate professor, and 

11 assistant professor is 58.6, 55.8, and 51.6 years, re12 spectively, the health care system faces unprece13 dented workforce and health access challenges with 

14 current and future shortages of deans, nurse edu15 cators, and nurses. 

16 (7) Research by the National League of Nurs17 ing indicates that by 2019 approximately 75 percent 

18 of the nursing faculty population (as of May 2007) 

19 is expected to retire. 

20 (8) A wave of nurses will be retiring from the 

21 profession in the near future. As of May 2007, the 

22 average age of a nurse in the United States is 46.8 

23 years old. The Bureau of Labor Statistics estimates 

24 that more than 1,200,000 new and replacement reg25 istered nurses will be needed by 2014. 


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1 (9) By 2030, the number of adults age 65 and 

2 older is expected to double to 70,000,000, account3 ing for 20 percent of the population. As the popu4 lation ages, the demand for nurses and nursing fac5 ulty will increase. 

6 (10) Despite the need for nurses to treat an 

7 aging population, few registered nurses in the 

8 United States are trained in geriatrics. Less than 1 

9 percent of practicing nurses have a certification in 

10 geriatrics and 3 percent of advanced practice nurses 

11 specialize in geriatrics. 

12 (11) Specialized training in geriatrics is needed 

13 to treat older adults with multiple health conditions 

14 and improve health outcomes. Approximately 80 per15 cent of Medicare beneficiaries have 1 chronic condi16 tion, more than 60 percent have 2 or more chronic 

17 conditions, and at least 10 percent have coexisting 

18 Alzheimer’s disease or other dementias that com19 plicate their care and worsen health outcomes. Two20 thirds of Medicare spending is attributed to 20 per21 cent of beneficiaries who have 5 or more chronic 

22 conditions. Research indicates that older persons re23 ceiving care from nurses trained in geriatrics are 

24 less frequently readmitted to hospitals or transferred 

25 from nursing facilities to hospitals than those who 


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1 did not receive care from a nurse trained in geri2 atrics. 

3 (12) The Department of Labor projected that 

4 the need for physical therapists would increase by 

5 36.7 percent between 2004 and 2014. 

6 (13) The need for physical therapists is particu7 larly acute rural and urban underserved areas, which 

8 have 3 to 4 times fewer physical therapists per cap9 ita than suburban areas. 

10 TITLE I—GRANTS FOR NURSING 

11 EDUCATION 

12 SEC. 101. NURSE FACULTY EDUCATION. 

13 Part D of title VIII of the Public Health Service Act 

14 (42 U.S.C. 296p et seq.) is amended by adding at the end 

15 the following: 

16 ‘‘SEC. 832. NURSE FACULTY EDUCATION. 

17 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

18 through the Health Resources and Services Administra19 tion, shall establish a Nurse Faculty Education Program 

20 to ensure an adequate supply of nurse faculty through the 

21 awarding of grants to eligible entities to— 

22 ‘‘(1) provide support for the hiring of new fac23 ulty, the retaining of existing faculty, and the pur24 chase of educational resources; 


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1 ‘‘(2) provide for increasing enrollment and 

2 graduation rates for students from doctoral pro3 grams; and 

4 ‘‘(3) assist graduates from the entity in serving 

5 as nurse faculty in schools of nursing; 

6 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

7 under subsection (a), an entity shall— 

8 ‘‘(1) be an accredited school of nursing that of9 fers a doctoral degree in nursing in a State or terri10 tory; 

11 ‘‘(2) submit to the Secretary an application at 

12 such time, in such manner, and containing such in13 formation as the Secretary may require; 

14 ‘‘(3) develop and implement a plan in accord15 ance with subsection (c); 

16 ‘‘(4) agree to submit an annual report to the 

17 Secretary that includes updated information on the 

18 doctoral program involved, including information 

19 with respect to— 

20 ‘‘(A) student enrollment; 

21 ‘‘(B) student retention; 

22 ‘‘(C) graduation rates; 

23 ‘‘(D) the number of graduates employed 

24 part-time or full-time in a nursing faculty posi25 tion; and 


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1 ‘‘(E) retention in nursing faculty positions 

2 within 1 year and 2 years of employment; 

3 ‘‘(5) agree to permit the Secretary to make on4 site inspections, and to comply with the requests of 

5 the Secretary for information, to determine the ex6 tent to which the school is complying with the re7 quirements of this section; and 

8 ‘‘(6) meet such other requirements as deter9 mined appropriate by the Secretary. 

10 ‘‘(c) USE OF FUNDS.—Not later than 1 year after 

11 the receipt of a grant under this section, an entity shall 

12 develop and implement a plan for using amounts received 

13 under this grant in a manner that establishes not less than 

14 2 of the following: 

15 ‘‘(1) Partnering opportunities with practice and 

16 academic institutions to facilitate doctoral education 

17 and research experiences that are mutually bene18 ficial. 

19 ‘‘(2) Partnering opportunities with educational 

20 institutions to facilitate the hiring of graduates from 

21 the entity into nurse faculty, prior to, and upon 

22 completion of the program. 

23 ‘‘(3) Partnering opportunities with nursing 

24 schools to place students into internship programs 


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1 which provide hands-on opportunity to learn about 

2 the nurse faculty role. 

3 ‘‘(4) Cooperative education programs among 

4 schools of nursing to share use of technological re5 sources and distance learning technologies that serve 

6 rural students and underserved areas. 

7 ‘‘(5) Opportunities for minority and diverse stu8 dent populations (including aging nurses in clinical 

9 roles) interested in pursuing doctoral education. 

10 ‘‘(6) Pre-entry preparation opportunities includ11 ing programs that assist returning students in 

12 standardized test preparation, use of information 

13 technology, and the statistical tools necessary for 

14 program enrollment. 

15 ‘‘(7) A nurse faculty mentoring program. 

16 ‘‘(8) A Registered Nurse baccalaureate to 

17 Ph.D. program to expedite the completion of a doc18 toral degree and entry to nurse faculty role. 

19 ‘‘(9) Career path opportunities for 2nd degree 

20 students to become nurse faculty. 

21 ‘‘(10) Marketing outreach activities to attract 

22 students committed to becoming nurse faculty. 

23 ‘‘(d) PRIORITY.—In awarding grants under this sec24 tion, the Secretary shall give priority to entities from 


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1 States and territories that have a lower number of em2 ployed nurses per 100,000 population. 

3 ‘‘(e) NUMBER AND AMOUNT OF GRANTS.—Grants 

4 under this section shall be awarded as follows: 

5 ‘‘(1) In fiscal year 2010, the Secretary shall 

6 award 10 grants of $100,000 each. 

7 ‘‘(2) In fiscal year 2011, the Secretary shall 

8 award an additional 10 grants of $100,000 each and 

9 provide continued funding for the existing grantees 

10 under paragraph (1) in the amount of $100,000 

11 each. 

12 ‘‘(3) In fiscal year 2012, the Secretary shall 

13 award an additional 10 grants of $100,000 each and 

14 provide continued funding for the existing grantees 

15 under paragraphs (1) and (2) in the amount of 

16 $100,000 each. 

17 ‘‘(4) In fiscal year 2013, the Secretary shall 

18 provide continued funding for each of the existing 

19 grantees under paragraphs (1) through (3) in the 

20 amount of $100,000 each. 

21 ‘‘(5) In fiscal year 2014, the Secretary shall 

22 provide continued funding for each of the existing 

23 grantees under paragraphs (1) through (3) in the 

24 amount of $100,000 each. 

25 ‘‘(f) LIMITATIONS.— 


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1 ‘‘(1) PAYMENT.—Payments to an entity under 

2 a grant under this section shall be for a period of 

3 not to exceed 5 years. 

4 ‘‘(2) IMPROPER USE OF FUNDS.—An entity 

5 that fails to use amounts received under a grant 

6 under this section as provided for in subsection (c) 

7 shall, at the discretion of the Secretary, be required 

8 to remit to the Federal Government not less than 80 

9 percent of the amounts received under the grant. 

10 ‘‘(g) REPORTS.— 

11 ‘‘(1) EVALUATION.—The Secretary shall con12 duct an evaluation of the results of the activities car13 ried out under grants under this section. 

14 ‘‘(2) REPORTS.—Not later than 3 years after 

15 the date of the enactment of this section, the Sec16 retary shall submit to Congress an interim report on 

17 the results of the evaluation conducted under para18 graph (1). Not later than 6 months after the end of 

19 the program under this section, the Secretary shall 

20 submit to Congress a final report on the results of 

21 such evaluation. 

22 ‘‘(h) STUDY.— 

23 ‘‘(1) IN GENERAL.—Not later than 3 years 

24 after the date of the enactment of this section, the 

25 Comptroller General of the United States shall conVerDate Nov 24 2008 23:08 Jun 02, 2009 Jkt 079200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1161.IS S1161

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1 duct a study and submit a report to Congress con2 cerning activities to increase participation in the 

3 nurse educator program under the section. 

4 ‘‘(2) CONTENTS.—The report under paragraph 

5 (1) shall include the following: 

6 ‘‘(A) An examination of the capacity of 

7 nursing schools to meet workforce needs on a 

8 nationwide basis. 

9 ‘‘(B) An analysis and discussion of sus10 tainability options for continuing programs be11 yond the initial funding period. 

12 ‘‘(C) An examination and understanding of 

13 the doctoral degree programs that are success14 ful in placing graduates as faculty in schools of 

15 nursing. 

16 ‘‘(D) An analysis of program design under 

17 this section and the impact of such design on 

18 nurse faculty retention and workforce short19 ages. 

20 ‘‘(E) An analysis of compensation dispari21 ties between nursing clinical practitioners and 

22 nurse faculty and between higher education 

23 nurse faculty and higher education faculty over24 all. 


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1 ‘‘(F) Recommendations to enhance faculty 

2 retention and the nursing workforce. 

3 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.— 

4 ‘‘(1) IN GENERAL.—For the costs of carrying 

5 out this section (except the costs described in para6 graph (2), there are authorized to be appropriated 

7 $1,000,000 for fiscal year 2010, $2,000,000 for fis8 cal year 2011, and $3,000,000 for each of fiscal 

9 years 2012 through 2014. 

10 ‘‘(2) ADMINISTRATIVE COSTS.—For the costs of 

11 administering this section, including the costs of 

12 evaluating the results of grants and submitting re13 ports to the Congress, there are authorized to be ap14 propriated such sums as may be necessary for each 

15 of fiscal years 2010 through 2014.’’. 

16 SEC. 102. GERIATRIC ACADEMIC CAREER AWARDS FOR 

17 NURSES. 

18 Part I of title VIII of the Public Health Service Act 

19 (42 U.S.C. 298 et seq.) is amended by adding at the end 

20 the following: 

21 ‘‘SEC. 856. GERIATRIC FACULTY FELLOWSHIPS. 

22 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Secretary 

23 shall establish a program to provide Geriatric Academic 

24 Career Awards to eligible individuals to promote the career 

25 development of such individuals as geriatric nurse faculty. 


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1 ‘‘(b) ELIGIBLE INDIVIDUALS.—To be eligible to re2 ceive an Award under subsection (a), an individual shall— 

3 ‘‘(1) be a registered nurse with a doctorate de4 gree in nursing; 

5 ‘‘(2)(A) have completed an approved advanced 

6 education nursing program in geriatric nursing or 

7 geropsychiatric nursing; or 

8 ‘‘(B) have a State or professional nursing cer9 tification in geriatric nursing or geropsychiatric 

10 nursing; and 

11 ‘‘(3) have a faculty appointment at an accred12 ited school of nursing, school of public health, or 

13 school of medicine. 

14 ‘‘(c) APPLICATION.—An eligible individual desiring to 

15 receive an Award under this section shall submit to the 

16 Secretary an application at such time, in such manner, 

17 and containing such information as the Secretary may re18 quire, which shall include an assurance that the individual 

19 will meet the service requirement described in subsection 

20 (d). 

21 ‘‘(d) SERVICE REQUIREMENT.—An individual who 

22 receives an Award under this section shall provide training 

23 in clinical geriatrics, including the training of interdiscipli24 nary teams of health care professionals. The provision of 


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1 such training shall constitute at least 50 percent of the 

2 obligations of such individual under the Award. 

3 ‘‘(e) AMOUNT AND NUMBER.— 

4 ‘‘(1) AMOUNT.—The amount of an Award 

5 under this section shall equal $75,000 annually, ad6 justed for inflation on the basis of the Consumer 

7 Price Index. The Secretary may increase the amount 

8 of an Award by not more than 25 percent, taking 

9 into account the fringe benefits and other research 

10 expenses, at the recipient’s institutional rate. 

11 ‘‘(2) NUMBER.—The Secretary shall award up 

12 to 125 Awards under this section from 2008 

13 through 2016. 

14 ‘‘(3) REGIONAL DISTRIBUTION.— 

15 ‘‘(A) IN GENERAL.—The Secretary shall 

16 provide Awards to individuals from 5 regions in 

17 the United States, of which— 

18 ‘‘(i) 2 regions shall be an urban area; 

19 ‘‘(ii) 2 regions shall be a rural area; 

20 and 

21 ‘‘(iii) 1 region shall include a State 

22 with— 

23 ‘‘(I) a medical school that has a 

24 department of geriatrics that manages 

25 rural outreach sites and is capable of 


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1 managing patients with multiple 

2 chronic conditions, 1 of which is de3 mentia; and 

4 ‘‘(II) a college of nursing that 

5 has a required course in geriatric 

6 nursing in the baccalaureate program. 

7 ‘‘(B) GEOGRAPHIC DIVERSITY.—The Sec8 retary shall ensure that the 5 regions estab9 lished under subparagraph (A) are located in 

10 different geographic areas of the United States. 

11 ‘‘(f) TERM OF AWARD.—The term of an Award made 

12 under this section shall be 5 years. 

13 ‘‘(g) REPORTS.— 

14 ‘‘(1) EVALUATION.— 

15 ‘‘(A) IN GENERAL.—The Secretary shall 

16 conduct an evaluation of the results of the ac17 tivities carried out under the Awards estab18 lished under this section. 

19 ‘‘(B) REPORTS TO CONGRESS.—Not later 

20 than 3 years after the date of the enactment of 

21 this section, the Secretary shall submit to Con22 gress an interim report on the results of the 

23 evaluation conducted under this paragraph. Not 

24 later than 180 days after the expiration of the 

25 program under this section, the Secretary shall 


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1 submit to Congress a final report on the results 

2 of such evaluation. 

3 ‘‘(2) CONTENT.—The evaluation under para4 graph (1) shall examine— 

5 ‘‘(A) the program design under this section 

6 and the impact of the design on nurse faculty 

7 retention; and 

8 ‘‘(B) options for continuing the program 

9 beyond fiscal year 2018. 

10 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.— 

11 ‘‘(1) IN GENERAL.—To fund Awards under 

12 subsection (e), there are authorized to be appro13 priated $1,875,000 for each of fiscal years 2010 

14 through 2018. 

15 ‘‘(2) ADMINISTRATIVE COSTS.—To carry out 

16 this section (except to fund Awards under subsection 

17 (e)), there are authorized to be appropriated such 

18 sums as may be necessary for each of fiscal years 

19 2008 through 2016. 

20 ‘‘(3) SEPARATION OF FUNDS.—The Secretary 

21 shall ensure that the amounts appropriated pursuant 

22 to paragraph (1) are held in a separate account 

23 from the amounts appropriated pursuant to para24 graph (2).’’. 


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1 TITLE II—DISTANCE EDUCATION 

2 PILOT PROGRAM AND OTHER 

3 PROVISIONS TO INCREASE 

4 THE NURSING AND PHYSICAL 

5 THERAPY WORKFORCE 

6 SEC. 201. INCREASING THE DOMESTIC SUPPLY OF NURSES 

7 AND PHYSICAL THERAPISTS. 

8 (a) ESTABLISHMENT OF NURSE AND PHYSICAL

9 THERAPISTS DISTANCE EDUCATION PILOT PROGRAM.— 

10 (1) IN GENERAL.—The Secretary of Health and 

11 Human Services (referred to in this section as the 

12 ‘‘Secretary’’), in conjunction with the Secretary of 

13 Education, shall establish a Nurse and Physical 

14 Therapist Distance Education Pilot Program 

15 through which grants may be awarded for the con16 duct of activities to increase accessibility to nursing 

17 and physical therapy education. 

18 (2) PURPOSE.—The purpose of the Nurse and 

19 Physical Therapist Distance Education Pilot Pro20 gram established under paragraph (1) shall be to in21 crease accessibility to nursing and physical therapy 

22 education to— 

23 (A) provide assistance to individuals in 

24 rural areas who want to study nursing or phys25 ical therapy to enable such individuals to reVerDate Nov 24 2008 23:08 Jun 02, 2009 Jkt 079200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S1161.IS S1161

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1 ceive appropriate nursing education and phys2 ical therapy education; 

3 (B) promote the study of nursing and 

4 physical therapy at all educational levels; 

5 (C) establish additional slots for nursing 

6 and physical therapy students at existing ac7 credited schools of nursing and physical therapy 

8 education programs; and 

9 (D) establish new nursing and physical 

10 therapy education programs at institutions of 

11 higher education. 

12 (3) APPLICATION.—To be eligible to receive a 

13 grant under the Pilot Program under paragraph (1), 

14 an entity shall submit to the Secretary an applica15 tion at such time, in such manner, and containing 

16 such information as the Secretary may require. 

17 (4) AUTHORIZATION OF APPROPRIATIONS.— 

18 There is authorized to be appropriated such sums as 

19 may be necessary to carry out this subsection. 

20 (b) INCREASING THE DOMESTIC SUPPLY OF NURSES

21 AND PHYSICAL THERAPISTS.— 

22 (1) IN GENERAL.—Not later than January 1, 

23 2010, the Secretary, in conjunction with the Sec24 retary of Education, shall— 


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1 (A) submit to Congress a report con2 cerning the country of origin or professional 

3 school of origin of newly licensed nurses and 

4 physical therapists in each State, that shall in5 clude— 

6 (i) for the most recent 3-year period 

7 for which data is available— 

8 (I) separate data relating to 

9 teachers at institutions of higher edu10 cation for each related occupation who 

11 have been teaching for not more than 

12 5 years; and 

13 (II) separate data relating to all 

14 teachers at institutions of higher edu15 cation for each related occupation re16 gardless of length of service; 

17 (ii) for the most recent 3-year period 

18 for which data is available, separate data 

19 for each related occupation and for each 

20 State; 

21 (iii) a separate identification of those 

22 individuals receiving their initial profes23 sional license and those individuals licensed 

24 by endorsement from another State; 


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1 (iv) with respect to those individuals 

2 receiving their initial professional license in 

3 each year, a description of the number of 

4 individuals who received their professional 

5 education in the United States and the 

6 number of individuals who received such 

7 education outside the United States; and 

8 (v) to the extent practicable, a de9 scription, by State of residence and coun10 try of education, of the number of nurses 

11 and physical therapists who were educated 

12 in any of the 5 countries (other than the 

13 United States) from which the most nurses 

14 and physical therapists arrived; 

15 (B) in consultation with the Department of 

16 Labor, enter into a contract with the Institute 

17 of Medicine of the National Academy of 

18 Sciences for the conduct of a study and submis19 sion of a report that includes— 

20 (i) a description of how the United 

21 States can balance health, education, labor, 

22 and immigration policies to meet the re23 spective policy goals and ensure an ade24 quate and well-trained nursing and phys25 ical therapy workforce; 


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1 (ii) a description of the barriers to in2 creasing the supply of nursing and physical 

3 therapy faculty, domestically trained 

4 nurses, and domestically trained physical 

5 therapists; 

6 (iii) recommendations of strategies to 

7 be utilized by Federal and State govern8 ments that would be effective in removing 

9 the barriers described in clause (ii), includ10 ing strategies that address barriers to ad11 vancement to become registered nurses for 

12 other health care workers, such as home 

13 health aides and nurses assistants; 

14 (iv) recommendations for amendments 

15 to Federal laws that would increase the 

16 supply of nursing faculty, domestically 

17 trained nurses, and domestically trained 

18 physical therapists; 

19 (v) recommendations for Federal 

20 grants, loans, and other incentives that 

21 would provide increases in nurse and phys22 ical therapist educators and training facili23 ties, and other measures to increase the 

24 domestic education of new nurses and 

25 physical therapists; 


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1 (vi) an identification of the effects of 

2 nurse and physical therapist emigration on 

3 the health care systems in their countries 

4 of origin; and 

5 (vii) recommendations for amend6 ments to Federal law that would minimize 

7 the effects of health care shortages in the 

8 countries of origin from which immigrant 

9 nurses arrived; and 

10 (C) collaborate with the heads of other 

11 Federal agencies, as appropriate, in working 

12 with ministers of health or other appropriate of13 ficials of the 5 countries from which the most 

14 nurses and physical therapists arrived into the 

15 United States, to— 

16 (i) address health worker shortages 

17 caused by emigration; and 

18 (ii) ensure that there is sufficient 

19 human resource planning or other tech20 nical assistance needed to reduce further 

21 health worker shortages in such countries. 

22 (2) ACCESS TO DATA.—The Secretary shall 

23 grant the Institute of Medicine access to the data 

24 described under paragraph (1)(A), as such data be25 comes available to the Secretary for use by the InstiVerDate Nov 24 2008 23:08 Jun 02, 2009 Jkt 079200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\S1161.IS S1161

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1 tute in carrying out the activities under paragraph 

2 (1)(B). 

3 (3) AUTHORIZATION OF APPROPRIATIONS.— 

4 There is authorized to be appropriated $1,400,000 

5 to carry out paragraph (1)(B). 

Æ 


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