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Nurses and the Affordable Care Act

Wakefield, Mary K. PhD, RN

AJN, American Journal of Nursing: September 2010 - Volume 110 - Issue 9 - p 11
doi: 10.1097/01.NAJ.0000388242.06365.4f

New legislation gives nurses a greater voice.

Mary K. Wakefield is the administrator of the U.S. Health Resources and Services Administration, Washington, DC. Contact author:

President Obama's commitment to nursing is affirmed in the recent passage of the Patient Protection and Affordable Care Act, which reauthorizes and strengthens the nursing programs funded by the Health Resources and Services Administration (HRSA)—the primary source of federal funding for nursing education.

Schools of nursing have long had shortages of doctoral-level faculty, and faculty shortages are the primary reason that more than 50,000 qualified nursing applicants are turned away each year. The Affordable Care Act addresses nursing workforce challenges in several ways. It lifts the cap on the Advanced Education Nursing Traineeship and the Nurse Anesthetist Traineeship programs. Previously, HRSA couldn't give more than 10% of this funding to doctoral students.

  • The Nurse Faculty Loan Program, which enables schools to offer loans to master's or doctoral-level nursing students interested in becoming teachers, is significantly larger now thanks to a combination of increased fiscal year 2010 appropriations and additional funding from the American Recovery and Reinvestment Act of 2009.
  • The Nursing Student Loan and the Nursing Workforce Diversity programs help to alleviate the nursing shortage by giving students from disadvantaged backgrounds or with limited finances access to resources to help them succeed in nursing school. These resources include access to long-term, low-interest loans and partial loan cancellation for nurses who choose to work in parts of the country where there's a shortage of health care professionals. The Affordable Care Act increases the amount students may borrow by almost 25%—to a maximum of $17,000—and awards it in annual increments.
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  • The Nurse Education, Practice, and Retention grant program was updated to emphasize a renewed focus on quality. With the need for continual assessment and improvement of quality standards in health care delivery systems, nurses will need an even stronger background in this area.

The Obama administration has also dramatically expanded the National Health Service Corps—a great option for NPs, psychiatric nurse specialists, and certified nurse midwives who need help in repaying their education loans. In exchange for working a minimum of two years in an underserved area, nurses can receive up to $50,000 in student loan repayments. The service commitment can also be extended for additional loan repayments. For example, a nurse who serves five years can receive up to $145,000.

The Affordable Care Act also authorizes up to $1.5 billion in new grants over the next six years to increase home visits from nurses and social workers to expectant mothers in high-risk communities. As we've seen in our Maternal and Child Health programs, notably Healthy Start, home visits can sharply reduce infant mortality and improve outcomes for mothers and children alike.

A new grant program has also been established to fund community-based Nurse-Managed Health Centers that are operated and managed by qualified advanced practice nurses. In addition, the expected growth over the next few years of the federally supported health center system could increase its patient base to as many as 40 million people. Nurses are already its single largest group of workers—more than 15,000 strong. More support for health centers means more people can access important primary care services. And more patients mean thousands of new nursing jobs, more nurse administrators, and more responsibility for nurses.

The fact that the president selected me—a nurse from North Dakota—as the administrator of a $7.8 billion health care agency underscores his recognition of the nursing profession's contributions and ensures that our expertise informs health policy and reform. Nurses also serve in other leadership positions in the Obama administration.

For more information about the Affordable Care Act, go to Nurses need to know about this terrific resource. It will help to answer many of the questions your patients and their families have been asking.

© 2010 Lippincott Williams & Wilkins, Inc.