Legislature Considers Bills To Address The Nursing Shortage

By Jan Howard

Several bills were introduced in the General Assembly in Hartford this session to address the nursing shortage the state is facing and to encourage retention of existing health care workers. Some of the bills have died, others are continuing in the process.

The proposed bills would address the nursing and healthcare workforce shortage through varied programs, including scholarships and tuition forgiveness.

If any of the proposals are to become law, they must be approved by the legislature and signed into law by the governor. The current legislative session ends in June.

State Rep Julia Wasserman (R-106th) of Newtown said recently there is no way to know the fate of the bills currently before the legislature. The bills addressing the nursing shortage are only a small part of the over 4,000 bills the legislature has received this session.

“I haven’t a clue what will happen. Some may die,” she said, noting, however, that sometimes a bill gains a second life when a legislator might attach it as an amendment to a similar bill.

The deadlines are up for committee recommendations, but bills can die anywhere in the process, Rep Wasserman noted.

The next step for bills that successfully come out of committee is to go before House and Senate screening committees, which each make recommendations, and then representatives of the committees meet, she explained.

“The original author of the bill will no longer recognize their own bill,” the state representative said. The author of a bill is present at the screening committee so he or she hears what changes are suggested.

Bills that have undergone changes will be designated as substitute bills with the original numbers, she explained.

Rep Wasserman said one of the most important bills to come through the legislature this year is sponsored by the Legislative Program Review and Investigations Committee, of which she is co-chairman. If passed, the bill would increase nursing homes’ minimum nursing staff-to-resident ratios, establish a methodology for Department of Public Health (DPH) inspectors to use to assess nursing staff adequacy, and require DPH to track the date of nursing home inspections to ensure randomness.  The bill would improve patient care and ensure that sufficient numbers and levels of licensed nurses and nurses’ aides are provided. On April 3, it received a joint favorable vote, and on April 5 was filed with the legislative commissioner’s office, which gives it a file number in addition to the bill number. On April 16, the bill was referred to the Office of Legislative Research and Office of Fiscal Analysis.

The National Citizens Coalition for Nursing Home Reform has lobbied for an increase in nursing staff ratios for several years. However, as Rep Wasserman’s committee’s study notes, the key barriers to increasing nursing home nursing staff are cost and the shortage of trained personnel in the labor market.

Nursing facilities question the policy of raising nursing staff thresholds when there is difficulty in recruiting nursing staff because of a nationwide shortage.

It is important for other bills before the legislature, which offer incentives to encourage people to enter the nursing profession and to retain personnel through improved working conditions, to be passed, she said.

“It’s a good major bill,” Rep Wasserman said of Bill 5668. “But it is important that other bills be passed to bring it to fruition. Our bill gives impetus to other bills. This is the start of it.”

Whether any of them have a chance of passage, “I don’t know,” she said. Each proposed bill must also go through fiscal analysis of its cost and where the money would come from.

She said Governor Rowland’s budget calls for $25 million to be earmarked for nursing homes in 2002 and $20 million in 2003.

The public health bill her committee recommended would have a total cost of $20 million, with $13 million to be provided by the state through Medicaid, of which one-half comes from the federal government, with $7 million to be absorbed by the nursing home industry.

In regard to incentives to encourage more people to choose nursing as a profession, Rep Wasserman said she would back a bill that would call for tuition reimbursement for nursing graduates who agree to work in the state for a minimum of two years.

“Reimbursement is the way to go, with a minimum of two years,” she said. “Five years is unrealistic.” Bills submitted this year had recommended a working period after graduation from two to five years.

Rep Wasserman said current workers who want to upgrade their skills should be reimbursed for attendance at school through a partnership between the state and nursing facilities.

Some Proposed Bills

Bill 1374 would set up a nursing and health care workforce shortage trust fund to provide for grants-in-aid of education and the promotion of nursing as a profession and other categories of healthcare workers experiencing workforce shortages. The bill would establish a commission to develop and implement a plan to promote recruitment and retention of registered nurses, licensed practical nurses, certified nursing assistants, and home health aides. It would establish a scholarship program for nursing education and a program for the forgiveness of loans provided by the state to residents for nursing education if the resident was to remain in the field in Connecticut for five years. Funds for the trust fund would come from surplus.

The bill would also set up a health care workforce scholarship program for nursing education and criteria for scholarship recipients who would agree to work for three years following their graduation. It would set a maximum scholarship of $12,000, with no more than $2,500 per semester. It would address initiatives to be taken by the state’s educational facilities to promote nursing education. The bill was submitted to the appropriations committee on April 5 because it has a cost associated with it.

Free tuition at public institutions of higher education would be available for students in certain health care professions under Bill 5772. The goal would be to encourage people to go into certain health care professions in which there is a shortage of personnel. It would have the Board of Governors of Higher Education adopt regulations for determining financial need for tuition waivers for prospective physician assistants, registered nurses, licensed practical nurses, and certified nurses’ assistants. The regulations would include provisions for requiring reimbursement of tuition fees for failure to fulfill the requirements for such tuition waivers. It would also require a written commitment to enter the profession after completion of education and to work in Connecticut for a period of not less than two consecutive years. The bill would be funded from the General Fund surplus. On April 16 the bill was referred to the Office of Legislative Research and Office of Fiscal Analysis.