Exploring Human Potential

Why The House of Medicine Needs To Add Nurse Education Funding To Its’ 2011-2012 Legislative Priorities

Posted on | February 1, 2011 | Comments Off on Why The House of Medicine Needs To Add Nurse Education Funding To Its’ 2011-2012 Legislative Priorities

Mike Magee

We will soon add an additional 35 plus million Americans to our health care system with the expectation of improving the overall health, productivity and competitiveness of Americans in the process. Thinking of this challenge in terms of production or provision of services, we are faced with a glaring human resource weakness – primary care clinicians.

The shortages of primary care physicians has been obvious, resistant to easy fixes, and extensively covered – including here at Health Commentary.(1)  The workforce of MD’s and DO’s, supplemented and back-filled in many at-risk communities with International Medical Graduates, has filled mountains of journals and supported the careers of numerous Health Policy pundits. But at the end of the day, the gap between physician primary care supply and demand continues to grow.

What is undeniable as well is that the cost of “making a physician” in years and dollars is dear indeed. Equally obvious, and well documented is that for the major demands of traditional day to day care, prevention and education, physicians are over-prepared. Equally obvious is the escalating demand for relationship based care in light of an aging population laden with heavy chronic disease burden, unmet and escalating public health challenges such as obesity, and an increasingly knowledgable health consumer public, who, absent a live partner and source of guidance, information and coaching will substitute with “friendship” from the Internet. (2)

It is within this context that the House of Medicine needs to provide leadership and support for the profession of Nursing. One thing they should do right now is get behind the rapid conversion of certificate based RN degrees to bachelor’s RN degrees.  Here are the facts(3):

1. About 60% of new nurses graduate from associate’s degree programs, 36% recieve bachelor degree RN’s, and 3% are from old model hospital-sponsored diploma programs.

2. It requires 3 full years to earn associate degree certification. In the same amount of time, it is possible to earn a bachelor’s degree RN.

3. 1/5th of BS RN’s nurses between 1974 and 1994 eventually obtained a master’s or higher degree. Only 1/17th of associate degree RN’s achieved advanced degrees. Of the 72,000 associate degree RN’s graduated in 2010, only 4000 are projected to ever receive advanced degrees. Studies suggest that the barrier for these nurses is primarily having to “go back for a BS degree” before beginning the journey to an advanced degree.

4. Advanced degrees are a requirment to be certified for advanced practice RN certification and to teach at a Nursing School. Demand for advanced practice RN’s has exploded on the in-patient side due to the 80 hour a week training limits for resident physician training and on the out-patient side to address the expanded unmet demand for primary care in traditional and new delivery sites such as the expanded network of community health centers and retail clinics as well as home-based chronic disease management and end of life care.

5. In the next 10 years, ½ of all Nursing instructors will retire and ½ million practicing nurses will retire. To manage the demand, we must have more Nurse educators. And to accomplish this feat, the base of bachelor degree RN’s must rapidly expand.

6. The IOM’s 2010 Nursing Study report says we need to increase the current proportion of nurses with at least a bachelor’s degree from 50% to 80% by 2020.(2) If we had done that between 1974 and 1994, 50,000 more nurses would have advanced degrees today.(3)

So here are three things the House of Medicine can do right now to assure our nation’s Primary Care workplace will be adequate to meet America’s near term needs:

1. Advocate that the $160 million per year in Medicare funding for nursing education be targetted to support clinical training of graduate-level advanced practice RNs rather than diploma nursing programs.

2. Advocate that the $8 billion per year in Perkins funds from the Department of Education include and support a comprehensive federal strategy that would make it possible for all new nurses to graduate with a bachelor’s degree.

3. Support the IOM’s call for discontinuing hospital diploma programs entirely.

The reality is that for America to remain competitive, productive and secure, we must achieve a higher level of wellness based on consistent health planning and active health coaching. It is more than clear that this requires the support of a pervasive home-centered health care system. And it is equally clear that physician primary care power supply can not possibly meet the demand. We need teams and all the hands we can get. It makes sense that the Washington offices of the House of Medicine add expansion of bachelor degree RN’s to their 2011-2012 list of legislative priorities.

For Health Commentary, I’m Mike Magee.


1. Magee M. Rethinking Physician Supply. Health Politics. June 23, 2004.

2. IOM. The Future of Nursing: Leading Change, Advancing Health. 2010.
3. Aiken LH. Nurses for the future. N Engl J Med 2011; 364:196-198, January 20, 2011


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