There’s good news and bad news for nursing funds

$ 1.2

$ 6.0

$ 6.0

0 0

This is a good news, bad news story. The good news is that the US Senate agreed to fund nursing education and research for 1984 at four times the amount recommended by President Reagan. The House total was somewhat lower than the Senate’s but also much higher than the President‘s. Both House and Senate figures were up slightly from 1983. (Proposed amounts are shown in Table 1 .)

The bad news is that the congressional sums are nowhere near the $80 million ad- vised in a prestigious national study earlier this year. The study by the National institute of Medicine analyzed the need for continuing federal support.

The funding was included in appropriations bills for the US Departments of Health and Human Services, Education, Labor, and some independent agencies. Final totals were being worked out between the House and Senate. Then the bill would go to the President for his signature.

In sending his budget to Congress in Janu- ary, the President claimed that since “the sup- ply of most health care professionals is now adequate, direct federal support for health pro- fessions is no longer essential.”

The House Appropriations Committee coun- tered by stating, “Recent national studies have again reinforced the importance of the federal role in training of supervisory academic and specialty nurses.” One of the studies was the Institute of Medicine report.

Although the study did not recommend fed-

$13.3 $13.3

$11.8 $11.8

$ 6.0 $ 8.3

$ 9.6 $ 9.6 $ 8.0 $10.0

Table 1

Proposed funding for nurse training

1983 1984proposelS level Presldent House Senate

Advanced nurse training

Nurse practi- tioner pro- grams

Special projects

Traineeships Research

grants Total

$13.3

$1 1.8

$ 6.3

$ 9.6 $ 5.0

$46.0 -

$13.2 I $48.7($53.0

era1 support to increase the overall nurse sup ply, it said funding is needed to meet specific needs. Examples are assistance for education of graduate students, nurse practitioners, and nurses caring for the elderly.

In its testimony before Congress in May, the American Nurses’ Association (ANA) pointed out that “previous cuts have virtually crippled nursing education programs.

“Additional reductions will result in more school closings and will lessen the ability of professional nursing to provide quality health care services to this nation’s citizens.”

About nursing research, ANA said these programs “are struggling for survival with a very limited ability to award new projects.”

Congress was late with its appropriations

AORN Journal, December 1983, Vol38, No 6 959

because the new fiscal year began Oct 1. A stop-gap spending bill, called a continuing resolution, was passed for the interim.

If the President signs the final appropriations bill, it will be the first time in six years that Congress has passed an official budget for these departments. In the past five years, the Senate has reached an impasse. Funding levels were carried over from year to year by continuing resolution.

H Establlahlng a new Natlonal Institute of Nunlng does not seem controversial. You would expect it to sail through Congress, right? Not necessarily.

The new institute would provide a home for nursing research, which federal experts say is needed. (See November legislative column.) Rep Edward Madigan (R-Ill) planned to add an amendment providing for the institute to the bill reauthorizing the National Institutes of Health (NIH). AORN’s Washington monitors, Larry Merthan and Jerry Cox, have been watching the bill for us.

Unfortunately, the amendment may be caught in the political cross fire over NIH fund- ing, they report. On one side was Rep Henry Waxman (D-Calif), powerful chairman of the subcommittee where the bill was lodged. He wanted to restructure NIH activities to give Congress more control. NIH opposed Wax- man’s bill, and President Reagan had threatened to veto it.

Hoping to save the day, House Republicans planned to offer a substitute bill on the House floor. There was concern that Waxman might delay consideration of the bill, fearing the sub- stitute might win.

Madigan intended to attach the amendment to whichever bill survived. But its troubles wouldn’t be over. Waxman and the White House both oppose the nursing amendment.

What about the Senate? Could an amend- ment be offered there? Prospects did not look good, because the Senate NIH bill was stalled by a debate over fetal research. Sen Bob Packwood (R-Ore) was preventing it from com- ing to the floor. Merthan and Cox thought the Senate was more likely to consider the House-passed bill than its own.

Politics are never simple. But there are reasons for optimism. First, the need for nurs- ing research is gaining recognition. It received

a major boost this year from the report by the National Institute of Medicine. Pointing out that the nursing profession’s capacity to do re- search “is hampered by insufficient support,” the report recommended “an organizational entity to place nursing research in the mainstream of scientific investigation.”

Next, a congressman took the initiative in sponsoring the amendment. Madigan called on the ANA, the National League for Nursing, and the American Association of Colleges of Nursing for help in drafting the amendment. ANA noted that it had supported such an insti- tute since 1978 but did not think it was politi- cally feasible until now.

Thus, even if the amendment does not make it this year, chances are good that it will be reintroduced, giving momentum a chance to build.

H Women’s struggle for equal pay may have advanced a bit further with a Septem- ber federal court ruling in Washington State. US District Judge Jack Tanner found the state guilty of “direct, overt and institutionalized“ wage discrimination against its female em- ployees.

In a second part of the case, employee unions said they would seek back pay and salary increases. The lawsuit was filed by two unions representing state employees. The state said it would appeal.

The case is a direct result of the 1981 US Supreme Court decision in County of Wash- ington Y Gunther, which opened new legal ter- ritory for women’s pay cases. Previously, the grounds under which a woman could sue for wage discrimination were narrow. Essentially, she had to show that she was doing identical work to a man but was paid less. The narrow standard stymied women working in female- segregated jobs.

In the Gunther ruling, the Supreme Court expanded the base for wage discrimination suits. It said that women who are paid less than men are entitled to sue their employers, even if the jobs are not identical. The suit had been brought by four matrons working in the county jail who claimed they were being paid 35% less than male guards. The matrons guarded pris- oners but were also required to do other cleri- cal duties such as typing; thus, the jobs were not identical.

962 AORN Journal, December 1983, Vol38, No 6

In the new decision, employees contended that Washington State had deliberately ig- nored its own job evaluations and paid women less than men. In the early 1970% the state did a study of job worth based on a point system. There were cases in which predominantly female jobs got the same number of points as male jobs, but the state continued to pay the women less. The practice continued even though the state updated its job study several times.

Ruling in the employees’ favor, the judge said, “The evidence is overwhelming there has been past historical discrimination in employ- ment of women in the state of Washington.”

As the first post-Gunther ruling, the case is important, explained Dennis Alessi, a lawyer in the American Nurses’ Association Labor Rela- tions Department. It helps to confirm what the Supreme Court intended in the Gunther case.

Here’s new evidence that the baccalau- reate is gaining strength as the entry level for professional nursing practice. A special in- terest group has organized to oppose it. Its name is FANEL-the Federation for Accessi- ble Nursing Education and Licensure.

The group has said it will “work with state and local groups committed to retaining the current licensure system and resisting efforts by the minority of baccalaureate nurse educators and their allies to reduce the number of RNs and ensure elite status for bac- calaureate graduates.” Based in Seattle, the organization’s president is Lorraine Sherk, RN, of Missouri.

FANEL seems to be swimming against the tide. A wide variety of nursing organizations have endorsed the four-year degree as entry level, including AORN, ANA, and the National League for Nursing. Two prestigious reports, one from the Commission on Nursing of the American Hospital Association and the other from the National Institute of Medicine, have recommended continuing the trend toward re- quiring the BSN.

For the baccalaureate to become a licen- sure requirement, state legislatures would have to change state nursing practice acts. So far, no state has done so, although several have introduced bills. That is where FANEL plans to swing into action, by blocking legisla- tion that is introduced.

Just what nursing needs-another focus for division.

“Organs for sale.” They may not hang out signs, but at least two companies were plan- ning to become brokers for donors who would sell their organs for profit, reports Science magazine (Oct 7). At present, it’s legal.

The government and private organizations were rushing to cope with the problem. Mem- bers of Congress were proposing a national clearinghouse for organ donation (not sale). The White House was encouraging private groups to set up a clearinghouse.

Sen Albert Gore (D-Tenn), sponsor of one organ donation bill, was said to be considering a measure to ban organ sales. Sen Paul E Tsongas (D-Mass) was also planning legisla- tion.

Patricia Patterson Legislative consultant

Survey of health care professionals ’ salaries Anesthesiologists made more than any other health care professional including surgeons, according to a survey by a health care personnel placement company. The salaries of personnel working at hospitals, health maintenance organizations, nursing facilities, corporate medical centers, and private practice were included.

The highest paid professionals in nursing are directors of nursing. They have a median income of $38,300, and the range is $34,370 to $55,000.

Personnel Median net income Surgeon $141,600 Anesthesiologist $1 50,200 Radiologist $1 35,250

Director of nursing $38,300 Assistant director of

nursing $31,060 Operating room supervisor $32,050 Nursing supervisor $27,100 Clinical nurse specialist $27,435 Nurse anesthetist $28,600 Staff nurse $22,080

ObstetriciadGynecoIogist $133,600

AORN Journal, December 1983, Vol38, No 6 963