Nurses hold own in federal battle for education funds

Nurses won skirmishes for federal nursing education funds in April when the House health subcommittee passed a bill for health professions education. The panel voted not to phase out capitation grants to schools of nurs- ing and to fund nursing scholarships at the current level.

Health professions education is a major item on the congressional agenda. Both the Health Professions Education Assistance Act and the Nurse Training Act expire Sept 30. These laws are the backbone of federal funding because they authorize programs and funding levels for schools and students. Congress must either pass new laws or renew the old ones for funds to continue. Then each year, Congress de- cides how much money to appropriate for each program within the prescribed limits.

Sponsored by Rep Henry A Waxman (D- Calif), health subcommittee chairman, the bill includes nursing along with the other health professions and the National Health Service Corps. The bill also passed the full House Interstate and Foreign Commerce Committee in early May with no changes in the nursing section. The Senate health subcommittee was due to take up its own bills in June. The Ameri- can Nurses’ Association testified at the Senate subcommittee hearings in March, disputing the Administration’s contention that no more nurses are needed.

Senate bills are sponsored by Sen Richard Schweiker (R-Pa) (S 2144), Sen Edward Ken- nedy (D-Mass) (S 2375), and Sen Jacob Javits

Legislation *m * (R-NY) (S 2378). President Carter said he plans to cut nursing funds back to about $29 million in 1981 from this year’s level of $103 million. In contrast, the Kennedy bill would au- thorize $106 million, and the Schweiker bill, $97 million. Compare this to appropriations of $1 61 million in 1976, $1 18 million in 1977, and $1 19.5 million in 1978.

There is growing concern that going over the President’s recommendation could bring a veto.

The President and Congress seem to agree that capitation funds to schools are on the way out. That was clear in April when Waxman’s health subcommittee voted to phase out these per-student grants for all health professions except nursing. The grants would probably end after 1983. Kennedy would replace the capitation program with annual grants based on a sliding scale according to how successful each school has been in such areas as recruit- ing minority students and sending graduates to underserved areas.

Apparently the President doesn’t plan to use the National Health Service Corps to solve shortage problems, either, because only steady-state funding is proposed. The NHSC sends teams of physicians, dentists, nurses, and other health professionals to serve in areas where health personnel and services are inadequate.

In his search for federal funds to cut, Presi- dent Carter asked Congress to rescind funds they had appropriated for capitation grants to nursing schools and for nursing research. But so far, Congress hasn’t gone along. By early May, a House committee and Senate sub- committee had turned down the President’s nursing rescission requests. Rescission re-

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quests must be approved by both houses within 45 days or the money is available to spend.

Under a proposed medical board rule, Massachusetts physicians could be disci- plined if they do not inform breast cancer pa- tients who want the information about alterna- tive therapies. Breast cancer is the only dis- ease that has been singled out for a disclosure rule in the state, said Richard Neidinger, legal intern for the Board of Registration and Disci- pline in Medicine.

Women could decline the information, but physicians would be required to express willingness to discuss alternatives and current risks and benefits. They would also have to answer the patient’s questions about therapy and provide names of consultants. They would have to document disclosure and informed consent in the patient’s record.

Massachusetts state law now requires physicians to provide breast cancer patients with “complete information on all alternative treatments which are medically viable.” This is part of a patient’s rights law passed last sum- mer. (See AORN Journal, November 1979, 942-946.) Patients may sue for violations. The proposed rule would add discipline by the med- ical board.

Opposition to the law from physicians is so “firm and widespread” that the Massachusetts Medical Society tried to have the act repealed, the Boston Globe reported (April 22). The at- tempt failed. The proposed medical board rule was open for public comment until May 18, when a decision would be made on its final form.

At the root of the controversy are the nature of breast cancer, the effectiveness of current treatments, physician autonomy, and greater pressure by women patients to participate in making decisions about their care.

rn A new Wisconsin law clarifying the legal status of certified nurse-midwives was await- ing the governor’s signature in early May. The law would allow the state board of nursing to recognize certified nurse midwives and estab- lish rules about where they may practice.

The status of nurse-midwives has been fuzzy because a section of the medical prac- tice act disallowed the practice of midwives

unless they were in practice before 1953. Also, the attorney general had issued an opinion on lay midwifery, leaving the status of nurse- midwives unclear.

Although there were compromises with medicine, “we are pleased with the bill,” said Joyce Esser, RN, legislative director for the Wisconsin Nurses Association. Initiative for the legislation came from individuals, she said. WNA has been working for a more general recognition for nurse practitioners, and she be- lieves this precedent will be helpful.

Among the compromises are a requirement that the nurse-midwife have a formal written agreement with a physician with formal train- ing in obstetrics and that they are limited to nonsurgical family planning methods. “Basically, this means certified nurse- midwives can do between-pregnancy care in- cluding contraceptives, family planning, and intrauterine devices, but not menstrual period regulation,” Esser said.

Nurses fought off attempts to require direct supervision by physicians, to prohibit self- employment by nurse-midwives, and to insert language intending that nurse-midwives be paid less than physicians.

rn Therapeutic use of marijuana or research in the area have been authorized by 20 states, according to a report in Legislative Roundup, published by the American Medical Associa- tion. South Carolina, Georgia, and Ohio were the last to join the list.

Patricia Patterson Associate editor

118 AORN Journal, July 1980, Vol32, No 1