The recently enacted American Recovery and Reinvestment Act of 2009, also known as the stimulus package, and the 2010 federal budget proposal are first steps in long-awaited efforts to reduce critical shortages of nurses and other health care workers. The American Nurses Association (ANA) reported that the plan includes $11.46 billion for strengthening the health care workforce, including $500 million for investments such as Title VIII nurse training programs.

Organizations such as the ANA and the American Association of Colleges of Nursing support the Obama administration's initiatives. "Overall we're pleased with the stimulus package," said Rose Gonzalez, director of government affairs for the ANA. "It's an indication our government is aware there's a nursing shortage and they're trying to address it."

Title VIII programs are the primary source of federal funding for nursing education. They include the Nursing Education Loan Repayment Program, which repays 60% of nursing student loans in exchange for at least two years of practice in a facility with a critical shortage of nurses, and the Nurse Education, Practice, and Retention Program, which awards grants to schools and nurses at the associate's and bachelor's degree levels.

In addition, the package sets aside $10 billion for the National Institutes of Health, some of which will be allocated to the National Institute of Nursing Research. It also provides funding for the Prevention and Wellness Fund and the Centers for Disease Control and Prevention, and more than $20 billion will go to the development and adoption of health information technologies.

Gonzalez applauded the expenditures on health information technology, but Charles Idelson, a spokesperson for the California Nurses Association, said he would have preferred to see the money used elsewhere. "That money would be better spent on providing care and nursing education," he said.

The $3.6 trillion budget proposal for fiscal year 2010 includes a 10-year, $630 billion reserve fund to help finance universal health coverage. The proposal also provides $330 million to address the shortage of health care providers in medically underserved areas. And it would expand loan-repayment programs for physicians, nurses, and dentists who agree to practice in these areas. "That's nice," Idelson said. "But it's nowhere near what's needed. It would be great to see a lot more money dedicated to nursing programs."

Gonzalez, however, called it an important first step. "We see this as a down payment on addressing workforce shortages," she said. "We're looking forward to having enough providers and nurses to care for patients until we can achieve meaningful health system reform."

Annemarie Mannion