Nursing Workforce Development

The American Nurses Association continues in its effort to have Congress significantly increase funding for the Nursing Workforce Development Programs contained in Title VIII of the Public Health Service Act.

The Title VIII Nursing Workforce Development programs administered by HRSA are the primary source of federal funding for nursing education and include programs like the Nurse Education, Practice, Quality and Retention Grants, which supports schools and nurses at the associate and baccalaureate degree level.

Alexis D. Bakos, PhD, MPH, RN, acting director, Division of Nursing, Bureau of Health Professions, HRSA, says that over the past few years, “the funding has been relatively stable.” The FY 2013 total for Title VIII funding is $213,253,000.

Although increased funding for the Title VIII programs would be welcomed by HRSA, agency officials believe Title VIII program funding is well used to address this need.

“We are looking into areas such as interprofessional education and interprofessional collaborative practice, and what we want to do is prepare the nursing workforce for the future,” Bakos says. “These are priority areas where a lot of funding is currently focused.”

According to Joan Wasserman, DrPH, RN, Chief, Advanced Nursing Education Branch, Division of Nursing, HRSA, another area HRSA is concerned with is its nurse workforce diversity.

“We have an America that is aging and more diverse in terms of racial and ethnic groups so we are very much concerned that our nursing workforce can meet those needs in the coming decades,” she says.

“Nursing Workforce Diversity grants provide funding to increase opportunities for individuals who are from disadvantaged backgrounds, including students from economically disadvantaged families as well as racial and ethnic minorities underrepresented in the nursing profession.”


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FY 2014


Priorities for use of the Title VIII funding were reflected in President Obama’s latest budget request. When you examine a breakdown of the budget, you can clearly see where the dollars are focused – mainly enhanced nursing education and interprofessional education.

The president’s budget proposal for FY 2014 released in April recommends $251 million for Title VIII Nursing Workforce Development Programs, an approximately $20 million increase over the president’s previous budget proposals.

These vital programs serve to recruit new nurses into the profession, promote career advancement within nursing, and allocate nurses to critical shortage areas, ANA officials said.

“With the proposed increase to Title VIII funding, the Obama administration continues to recognize the invaluable contribution that nurses make in the delivery of care and the need to strengthen our primary care system,” says ANA President Karen A. Daley, PhD, RN, FAAN.

“This proposed budget takes the long view and reflects tough choices by the Obama administration, while still supporting programs that are needed to transform the healthcare system and improve health for all.”

ANA also applauded the Obama administration for additional healthcare investments, including:

  • $80.1 billion in discretionary funding for the Department of Health and Human Services, a $3.9 billion increase over FY 2012 funding levels, for investments in Affordable Care Act (ACA) implementation, medical research, and other priorities;
  • $803.5 million for the Centers for Medicare and Medicaid Services’ insurance exchange operations;
  • $235 million in funding for new mental health programs, including $50 million to train master’s-level mental health specialists such as nurses, psychologists, and counselors who work in schools. This funding will expand the mental health workforce and help schools detect early warning signs in students that can threaten the safety of classmates, teachers, and the surrounding community; and
  • $3.8 billion for community health centers that will provide key primary care services for underserved communities.

Money Matters 

But what people don’t always understand is who’s in charge of dispensing the money and who is watching to ensure it winds up in the right hands.

Bakos says that it’s not government employees that decided who gets funded but the unbiased peer review process that evaluates the merit of each application received in response to a funding opportunity announcement.

“When a funding opportunity is issued, most of the funding is awarded through a grant or cooperative agreement and the initial applications are put through a peer review process of individuals considered experts in a particular area,” she says. “They will then review the application, score the application and the scores are ranked from highest to lowest.”

The Division of Independent Review is charged with receiving the grant applications and identifying peer reviewers.

A peer review may have multiple members but each panel is comprised of experts in the field and individuals from academia, nursing, or individuals in practice. The experts read the applications and convene as a group to discuss them and assign a score.

The Division of Independent Review is separate from the programmatic management and oversight of grants and cooperative agreements. For lack of a better word, it’s a sort of firewall between the two entities. This helps to ensure that the review process is fair and unbiased.

Many believe Title VIII holds the promise of addressing many of the challenges facing nursing today, but it will require a concentrated effort by those in need of funding to examine the HRSA guidelines and create a grant proposal that will pass the review process.

Every funding opportunity is announced on the HRSA webpage along with the review criteria.


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Beneficial For New Grads

One key purpose of the Title VIII programs is to provide nursing students with the critical skills they need for employment in the field of nursing.

“A number of our grants and cooperative agreements go to schools of nursing for focus on education, training and practice,” Bakos says. “The Advanced Education Nursing program focuses on skill development and especially on preparing the nursing workforce to meet future needs.”

This program provides grants to nursing schools, academic health centers, and other entities to enhance education and practice for nurses in master’s and post-master’s programs. These programs help prepare nurse practitioners, nurse midwives, and nurse anesthetists, to practice in primary care settings.

For the past several years this program has had a focus on interprofessional education, most recently using an interprofessional framework for training primary care nurse practitioners to care for persons with multiple chronic conditions.

Another grant program preparing the nursing workforce for the future is the Comprehensive Geriatric Education Grant program. This program provides funds to train nurses to provide direct care for the elderly, support geriatric nursing curriculum, train faculty in geriatrics, and provide continuing education to nurses who provide geriatric care. This focus area is especially critical, given the aging of the Nation’s population.

In 2010, there were approximately 40 million people aged 65 and older in the U.S., accounting for 13 percent of the total population. This is an increase from 35 million adults ages 65 and older in 2000, and from just three million in 1900. Thus, there are now more older adults in this country than at any other time in U.S. history. This number is expected to increase as Baby Boomers continue to age.1

In addition to supporting nursing educations, some of the programs also assist with employment in areas of high need. One is the National Nurse Service Corps, which helps to curtail faculty shortage issues. Bakos explains, it’s a nurse education loan repayment program, which repays between 60% and 85% of nursing student loans in return for at least two years of practice in a facility designated to have a critical shortage of nurses.

The Nursing Scholarship Program supports students enrolled in nursing school. Upon graduation, scholarship recipients are required to work full-time for at least two years in a facility designated to have a critical shortage of nurses. The Nurse Faculty Loan Program is a loan forgiveness program that forgives up to 80% of a loan in return for four years of service as a faculty member in a school of nursing.


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For Veterans

On April 29, a new program funding opportunity was released that focuses on assisting veterans with prior medical training transition into nursing education programs.

“We were concerned with the number of vets coming home from the war who have skills as medics and corpsmen but are having difficulty finding jobs,” Bakos says. “Grants will be awarded to schools of nursing to create programs to enroll and train veterans who have a healthcare background gain admittance, get them through the rigorous process and have them be competitive and ready for the NCLEX exam at the end of the nursing program.”

Wasserman adds, “We are looking for innovative ways to give veterans academic credit for prior military healthcare experiences that can be used towards a nursing degree. A good number of applications are coming in and are being reviewed through the competitive review process. The White House has made assisting veterans obtain job skills a priority and we developed this funding opportunity in response.”

Jennifer Fiedelholtz, deputy director, Office of Policy Coordination, BHPr/HRSA, says that the question of shortages and needs depends on each local situation and the geographic distribution of the nursing workforce is as much an issue as quantity.

Keith Loria is a freelance writer.

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