Resolving the U.S. nursing shortage will require the collective effort of stakeholders at the national, state, and local levels. Federal legislators have demonstrated a commitment to addressing this health care crisis by nearly doubling the amount of funding for Nursing Workforce Development programs (Title VIII of the Public Health Service Act) from $78.8 million in FY 2001 to $149.7 million in FY 2006. With the nursing community struggling to maintain funding levels in the current fiscal year, future increases in federal programs promising nursing shortage relief may not be realized.

To help bridge this gap and more fully address local needs, many state initiatives are underway to increase the number of new nurses entering the workforce and pursuing faculty careers. These efforts generally center on the creation of new legislation to remove financial barriers to pursuing a nursing degree, mostly at the graduate level, and often result from a collaborative push by representatives from both the education and practice communities.

In recent years, the number of new statewide legislative initiatives to address the nursing shortage seems to be multiplying. This year, Illinois, Kansas, Maryland, and Utah were among the states that enacted sweeping legislation to address the shortage of Registered Nurses (RNs) and nurse educators over the next five to ten years. States including Colorado, Georgia, Nebraska, Minnesota, and Texas have focused efforts on alleviating the shortage of nurse educators, the primary obstacle faced by schools of nursing looking to expand student capacity. Other states, including Massachusetts, Missouri, and Pennsylvania, are working inside and outside of the legislative arena to launch programs involving strong collaborations between education, practice, and community stakeholders.

To assess the efforts underway at the state level, the Government Affairs Committee (GAC) of the American Association of Colleges of Nursing (AACN) conducted a survey of our nation's senior nursing colleges and universities. This Issue Bulletin will share details about some efforts that have proven successful at strengthening the nursing workforce and bridging resource gaps at schools of nursing looking to expand student enrollments and meet supply expectations.

"The success stories featured in this Issue Bulletin serve as a blueprint for those wishing to pursue legislative solutions to the shortages of RNs and nurse educators at the state level," said Dr. Jane Kirschling, dean of the University of Kentucky College of Nursing and GAC chair. "While AACN is committed to increasing the nurse faculty population and securing funding for nursing education, much more can be done at the state and local levels to address these important concerns."

Comprehensive Statewide Strategies

Several states are leading the way by pursuing comprehensive strategies to address the nursing shortage on several fronts. In April 2006, Maryland's Health Services Cost Review Commission (HSCRC) awarded grants to seven academic institutions totaling $6 million over five years as part of the first round of funding through the newly created Nurse Support Program (NSP). The NSP was created through legislation proposed by Governor Robert L. Ehrlich, Jr., the Nurse Support Program Assistance Fund (SB 230/HB 322), that was vigorously supported by Maryland nurse educators.

The NSP aims to expand the pool of nurses in Maryland by increasing the capacity of nursing programs in two phases. The first statewide initiative provides funding for graduate nursing faculty scholarships and living expenses, new nursing faculty fellowships, and state nursing scholarship and living expenses grants. The second program, the competitive institutional grants initiative, expands the state's nursing capacity through shared resources, enhancing nursing student retention, and increasing the pipeline for nurse faculty.

Through this innovative program, HSCRC generates funding by levying a 0.1% increase to the rate structure of all Maryland hospitals retroactive from July 1, 2005. This change will generate approximately $8.8 million annually to be awarded to the state's schools of nursing. The projected outcomes of this first round of seven institutional grants are is an increase of 500 nursing students in undergraduate programs and 250-300 students in graduate programs.

"This state initiative is unprecedented," says Dr. Janet D. Allan, dean of the University of Maryland School of Nursing. "This funding comes at a time when the state and the nation are experiencing a severe shortage of nurse faculty. Maryland needs nurses, and to get more nurses, we need the nurse faculty to educate them. This program couldn't have come at a better time."