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Overview

  1. 1. Oncology Nursing Society Written Testimony to the House Labor-Health and Human Services Appropriations Subcommittee Regarding Fiscal Year 2009 Nursing and Cancer Related Funding Submitted by: Paula Rieger, CEO Oncology Nursing Society March 31, 2008 Overview The Oncology Nursing Society (ONS) appreciates the opportunity to submit written comments for the record regarding fiscal year (FY) 2009 funding for cancer and nursing related programs. ONS, the largest professional oncology group in the United States, composed of more than 35,000 nurses and other health professionals, exists to promote excellence in oncology nursing and the provision of quality care to those individuals affected by cancer. As part of its mission, the Society honors and maintains nursing’s historical and essential commitment to advocacy for the public good. This year more than 1,437,180 million Americans will be diagnosed with cancer, and more than 565,650 will lose their battle with this terrible disease. Overall, age is the number one risk factor for developing cancer. Approximately 77 percent of all cancers are diagnosed at age 55 and older1 . Despite these grim statistics, significant gains in the War Against Cancer have been made through our nation’s investment in cancer research and its application. Research holds the key to improved cancer prevention, early detection, diagnosis, and treatment, but such breakthroughs are meaningless, unless we can deliver them to all Americans in need. Moreover, a recent survey of ONS members found that the nursing shortage is having an adverse impact in oncology physician offices and hospital outpatient departments. Some respondents indicated that when a nurse leaves their practice, they are unable to hire a replacement due to the shortage – leaving them short-staffed and posing scheduling challenges for the practice and the patients. These vacancies in all care settings create significant barriers to ensuring access to quality care. To ensure that all people with cancer have access to the comprehensive, quality care they need and deserve, ONS advocates ongoing and significant federal funding for cancer research and application, as well as funding for programs that help ensure an adequate oncology nursing workforce to care for people with cancer. The Society stands ready to work with policymakers at the local, state, and federal levels to advance policies and programs that will reduce and prevent suffering from cancer and sustain and strengthen the nation’s nursing workforce. We thank the Subcommittee for its consideration of our FY 2009 funding request detailed below. Securing and Maintaining an Adequate Oncology Nursing Workforce Oncology nurses are on the front lines in the provision of quality cancer care for individuals with cancer – administering chemotherapy, managing patient therapies and side-effects, working with insurance companies to ensure that patients receive the appropriate treatment, providing counseling to patients and family members, and engaging in myriad other activities on behalf of people with cancer and their families. Cancer is a complex, multifaceted chronic disease, and people with cancer require specialty-nursing interventions at every step of the cancer experience. People with cancer are best served by nurses specialized in oncology care, who are certified in that specialty. 1 American Cancer Society. Cancer Facts and Figures 2008. Atlanta: American Cancer Society: 2008.
  2. 2. Oncology Nursing Society Written Testimony to the House Labor-Health and Human Services Appropriations Subcommittee Regarding Fiscal Year 2009 Nursing and Cancer Related Funding Submitted by: Paula Rieger, CEO Oncology Nursing Society March 31, 2008 As the overall number of nurses will drop precipitously in the coming years, we likely will experience a commensurate decrease in the number of nurses trained in the specialty of oncology. With an increasing number of people with cancer needing high-quality health care, coupled with an inadequate nursing workforce, our nation could quickly face a cancer care crisis of serious proportion, with limited access to quality cancer care, particularly in traditionally underserved areas. A study in the New England Journal of Medicine found that nursing shortages in hospitals are associated with a higher risk of complications – such as urinary tract infections and pneumonia, longer hospital stays, and even patient death2 . Without an adequate supply of nurses, there will not be enough qualified oncology nurses to provide the quality cancer care to a growing population of people in need, and patient health and well-being could suffer. Further, of additional concern is that our nation also will face a shortage of nurses available and able to conduct cancer research and clinical trials. With a shortage of cancer research nurses, progress against cancer will take longer because of scarce human resources coupled with the reality that some practices and cancer centers resources could be funneled away from cancer research to pay for the hiring and retention of oncology nurses to provide direct patient care. Without a sufficient supply of trained, educated, and experienced oncology nurses, we are concerned that our nation may falter in its delivery and application of the benefits from our federal investment in research. ONS has joined with others in the nursing community in advocating $200 million as the FY 2009 funding level necessary to support implementation of the Nurse Reinvestment Act and the range of nursing workforce development programs housed at the U.S. Health Resources and Services Administration (HRSA). Enacted in 2002, the Nurse Reinvestment Act (P.L. 107-205) included new and expanded initiatives, including loan forgiveness, scholarships, career ladder opportunities, and public service announcements to advance nursing as a career. Despite the enactment of this critical measure, HRSA fails to have the resources necessary to meet the current and growing demands for our nation’s nursing workforce. For example, in FY 2006 HRSA received 4,222 applications for the Nurse Education Loan Repayment Program, but only had the funds to award 615 of those applications3 . Also, in FY 2007 HRSA received 6,611 applications for the Nursing Scholarship Program, but only had funding to support 220 awards4 . While a number of years ago one of the biggest factors associated with the shortage was a lack of interested and qualified applicants, due to the efforts of the nursing community and other interested stakeholders, the number of applicants is growing. As such, now one of the greatest factors contributing to the shortage is that nursing programs are turning away qualified 2 Needleman J., Buerhaus P., Mattke S., Stewart M., Zelevinsky K. “Nurse-Staffing Levels and the Quality of Care in Hospitals.” New England Journal of Medicine 346:, (May 30, 2002): 1715-1722. 3 U.S. Health Resources and Services Administration: Nurse Education Loan Repayment Program:http://bhpr.hrsa.gov/nursing/loanrepay.htm 4 U.S. Health Resources and Services Administration: Nursing Scholarship Program Statistics: http://bhpr.hrsa.gov/nursing/scholarship/
  3. 3. Oncology Nursing Society Written Testimony to the House Labor-Health and Human Services Appropriations Subcommittee Regarding Fiscal Year 2009 Nursing and Cancer Related Funding Submitted by: Paula Rieger, CEO Oncology Nursing Society March 31, 2008 applicants to entry-level baccalaureate programs, due to a shortage of nursing faculty. According to the American Association of Colleges of Nursing (AACN), U.S. nursing schools turned away 42,866 qualified applicants from baccalaureate and graduate nursing programs in 2006, due to insufficient number of faculty5 . The nurse faculty shortage is only expected to worsen with time, as half of the RN workforce is expected to reach retirement age with in the next 10 to 15 years6 . At the same time, significant numbers of faculty are expected to retire in the coming years, with insufficient numbers of candidates in the pipeline to take their places. If funded sufficiently, the components and programs of the Nurse Reinvestment Act will help address the multiple factors contributing to the nursing shortage. The nursing community opposes the President’s FY 2009 budget proposal that decreases nursing workforce funding by $46 million – a cut which eliminates all funding for advanced nursing education programs. With additional funding in FY 2009, these important programs will have much-needed resources to address the multiple factors contributing to the nationwide nursing shortage, including the shortage of faculty – a principal factor contributing to the current shortage. Advanced nursing education programs play an integral role in supporting registered nurses interested in advancing in their practice and becoming faculty. As such, these programs must be adequately funded in the coming year. ONS strongly urges Congress to provide HRSA with a minimum of $200 million in FY 2009 to ensure that the agency has the resources necessary to fund a higher rate of nursing scholarships and loan repayment applications and support other essential endeavors to sustain and boost our nation’s nursing workforce. Nurses – along with patients, family members, hospitals, and others – have joined together in calling upon Congress to provide this essential level of funding. The National Coalition for Cancer Research (NCCR), a non-profit organization comprised of 26 national organizations, is also advocating $200 million for the Nurse Reinvestment Act in FY 2009. ONS and its allies have serious concerns that without full funding, the Nurse Reinvestment Act will prove an empty promise, and the current and expected nursing shortage will worsen, and people will not have access to the quality care they need and deserve. Sustain and Seize Cancer Research Opportunities Our nation has benefited immensely from past federal investment in biomedical research at the National Institutes of Health (NIH). ONS has joined with the broader health community in advocating a 6.6% increase ($31.1 billion) for NIH in FY 2009. This will allow NIH to sustain and build on its research progress, resulting from the recent doubling of its budget, while avoiding the severe disruption to that progress that would result from a minimal increase. 5 American Association of Colleges of Nursing ,“2006-2007 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing.” http://www.aacn.nche.edu/IDS/datarep.htm, March 2007. 6 Preliminary Results: “National Survey of Nurse Educators: Compensation, Workload, and Teaching Practices.” National League of Nursing/Carnetgie Foundation. (February 7, 2007) http://www.nln.org/newsreleases/pres_budget2007.htm
  4. 4. Oncology Nursing Society Written Testimony to the House Labor-Health and Human Services Appropriations Subcommittee Regarding Fiscal Year 2009 Nursing and Cancer Related Funding Submitted by: Paula Rieger, CEO Oncology Nursing Society March 31, 2008 Cancer research is producing extraordinary breakthroughs – leading to new therapies that translate into longer survival and improved quality of life for cancer patients. We have seen extraordinary advances in cancer research, resulting from our national investment, which have produced effective prevention, early detection and treatment methods for many cancers. To that end, ONS calls upon Congress to allocate $5.26 billion to the National Cancer Institute (NCI) in FY 2009 to support the battle against cancer. The National Institute of Nursing Research (NINR) supports basic and clinical research to establish a scientific basis for the care of individuals across the life span – from management of patients during illness and recovery, to the reduction of risks for disease and disability and the promotion of healthy lifestyles. These efforts are crucial in translating scientific advances into cost-effective health care that does not compromise quality of care for patients. Additionally, NINR fosters collaborations with many other disciplines in areas of mutual interest, such as long-term care for older people, the special needs of women across the life span, bioethical issues associated with genetic testing and counseling, and the impact of environmental influences on risk factors for chronic illnesses, such as cancer. ONS joins with others in the nursing community in advocating a FY 2009 allocation of $150 million for NINR. Boost Our Nation’s Investment in Cancer Prevention, Early Detection, and Awareness Approximately two-thirds of cancer cases are preventable through lifestyle and behavioral factors and improved practice of cancer screening7 . Although the potential for reducing the human, economic, and social costs of cancer by focusing on prevention and early detection efforts remains great, our nation does not invest sufficiently in these strategies. The nation must make significant and unprecedented federal investments today to address the burden of cancer and other chronic diseases, and to reduce the demand on the healthcare system and diminish suffering in our nation both for today and tomorrow. As the nation’s leading prevention agency, the Centers for Disease Control and Prevention (CDC) plays an important role in translating and delivering, at the community level, what is learned from research. Therefore, ONS joins with our partners in the cancer community in calling on Congress to provide additional resources for the CDC to support and expand much- needed and proven effective cancer prevention, early detection, and risk reduction efforts. Specifically, ONS advocates the following FY 2009 funding levels for the following CDC programs: • $250 million for the National Breast and Cervical Cancer Early Detection Program; • $65 million for the National Cancer Registries Program; • $25 million for the Colorectal Cancer Prevention and Control Initiative; • $50 million for the Comprehensive Cancer Control Initiative; • $25 million for the Prostate Cancer Control Initiative; 7 American Cancer Society
  5. 5. Oncology Nursing Society Written Testimony to the House Labor-Health and Human Services Appropriations Subcommittee Regarding Fiscal Year 2009 Nursing and Cancer Related Funding Submitted by: Paula Rieger, CEO Oncology Nursing Society March 31, 2008 • $5 million for the National Skin Cancer Prevention Education Program; • $10 million for the Ovarian Cancer Control Initiative; • $5.5 million for the Geraldine Ferraro Blood Cancer Program; • $145 million for the National Tobacco Control Program; and • $65 million for the Nutrition, Physical Activity, and Obesity Program. Conclusion ONS maintains a strong commitment to working with Members of Congress, other nursing societies, patient organizations, and other stakeholders to ensure that the oncology nurses of today continue to practice tomorrow, and that we recruit and retain new oncology nurses to meet the unfortunate growing demand that we will face in the coming years. By providing the FY 2009 funding levels detailed above, we believe the Subcommittee will be taking the steps necessary to ensure that our nation has a sufficient nursing workforce to care for the patients of today and tomorrow and that our nation continues to make gains in our fight against cancer. DC01/ 538184.2DC01/ 538184.2
  6. 6. Oncology Nursing Society Written Testimony to the House Labor-Health and Human Services Appropriations Subcommittee Regarding Fiscal Year 2009 Nursing and Cancer Related Funding Submitted by: Paula Rieger, CEO Oncology Nursing Society March 31, 2008 • $5 million for the National Skin Cancer Prevention Education Program; • $10 million for the Ovarian Cancer Control Initiative; • $5.5 million for the Geraldine Ferraro Blood Cancer Program; • $145 million for the National Tobacco Control Program; and • $65 million for the Nutrition, Physical Activity, and Obesity Program. Conclusion ONS maintains a strong commitment to working with Members of Congress, other nursing societies, patient organizations, and other stakeholders to ensure that the oncology nurses of today continue to practice tomorrow, and that we recruit and retain new oncology nurses to meet the unfortunate growing demand that we will face in the coming years. By providing the FY 2009 funding levels detailed above, we believe the Subcommittee will be taking the steps necessary to ensure that our nation has a sufficient nursing workforce to care for the patients of today and tomorrow and that our nation continues to make gains in our fight against cancer. DC01/ 538184.2DC01/ 538184.2

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