Today, the American Association of Colleges of Nursing (AACN) is pleased to endorse the All-Payer Graduate Medical Education Act.

AACN supports the establishment of an all-payer trust fund to provide broad-based and stable funding of clinical education of advanced practice nurses, physicians, and other health care professionals. As front-line primary care and outpatient treatment become more dominant and hospitals focus more on acute care for the sickest patients, the demand for advanced practice nurses (APNs) continues to climb.

Prepared primarily at the master's-degree level, APNs include nurse practitioners, clinical nurse specialists, nurse anesthetists, and certified nurse-midwives who provide a broad range of primary care and acute care skills. This legislation represents a very important step in supporting the clinical training of APNs with on-going funding that is not subject to the uncertainties of annual appropriations decisions.

Currently, Medicare -- the largest single source of federal dollars for educating America's largest health profession…nursing -- does not support training for nurse practitioners and most other APNs. At the same time, Medicare continues to subsidize hospital-based diploma programs that have been out of the mainstream of nursing education for decades and which produce less than 10 percent of the nation's RNs.

In 1965, when Medicare was created, most categories of advanced practice nursing had not yet emerged. But, in the years since, Medicare policy has not kept pace with the new realities of health care consumers who require a wider choice of quality providers across a range of inpatient and outpatient sites throughout the community. Congressman Cardin's legislation would reform and reduce Medicare's financial support of graduate medical education and would make possible support for graduate-level advanced practice nurses and other health professionals.

Creation of a trust-fund to support training of sufficient numbers of advanced practice nurses makes clear sense for a health system striving to balance the competing concerns of quality, cost, and access. The expertise of advanced nurse clinicians in delivering high-quality care, high patient satisfaction, and cost-effectiveness has been empirically demonstrated across many different urban and rural settings.

In supporting graduate clinical education for nurses, Congressman Cardin's bill would also give hospitals, HMO's, and other facilities an incentive -- namely, reimbursement -- to take on additional numbers of advance practice nursing students for on-site training. Moreover, the monies would allow hiring of additional faculty who are critically needed.

Finally, by supporting the production of needed clinicians, this legislation helps to provide patients who require health services in an increasingly outpatient world, and who must manage chronic multiple conditions, the care most needed by them: easily accessible primary care at a range of community-based sites.

Investment in clinical education for advanced practice nursing is an investment in the nation's health. We appreciate Congressman Cardin's recognition that meeting the nation's needs for quality health care cannot be achieved without strong support for education for the health professions. AACN is most supportive of this legislation.

The American Association of Colleges of Nursing is the only national organization dedicated exclusively to furthering nursing education in America’s universities and four-year colleges. Representing more than 470 member schools of nursing at public and private institutions nationwide, AACN’s educational, research, governmental advocacy, databank, publications, and other programs work to advance the quality of baccalaureate and graduate education, promote research, and develop academic leaders in nursing -- the nation’s largest health care profession.