GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1989

H	1 

HOUSE BILL 320*

Short Title:  Nursing Shortage Alleviation Act.	(Public)
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Sponsors: Representatives Nesbitt, Bowen, Jack Hunt, Woodard; Albertson, Anderson, Balmer, Barbee, Barnes, Beall, Beard, Blue, Bowman, Brown, Buchanan, Chapin, Church, Colton, N. Crawford, Cromer, Culp, Cunningham, Dawkins, Diamont, Easterling, Esposito, B. Ethridge, Fitch, Fletcher, Grady, Greenwood, Grimmer, Hackney, Hall, Holt, Judy Hunt, R. Hunter, Hurley, Isenhower, James, Jones, Kennedy, Kimsey, Ligon, Lilley, Lineberry, Locks, Mercer, Michaux, Miller, Perdue, Privette, Ramsey, Redwine, Rogers, Stamey, Stewart, Tart, R. Thompson, S. Thompson, Warner, Watkins, Wicker, P. Wilson, Wiser, and Wood.
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Referred to:  Education.
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February 22, 1989

A BILL TO BE ENTITLED
AN ACT TO PROVIDE FOR THE IMPLEMENTATION OF PROGRAMS TO ADDRESS THE NURSING SHORTAGE IN THE STATE.
The General Assembly of North Carolina enacts:
Section 1.  (a) Rural, long-term care, and critical care nursing shortages.  The Board of Governors of The University of North Carolina, and the State Board of Community Colleges, shall direct their respective schools of nursing to develop clinical training sites in various settings.  The nursing schools shall work with various health care provider groups in developing the training sites.
(b) The schools of nursing at The University of North Carolina and its constituent institutions shall attempt to locate summer externships for nursing students in rural and other nursing shortage areas of the State.  The Area Health Education Centers of The University of North Carolina shall assist in setting up regional meetings with nursing schools, hospitals, nursing homes and other health care providers to discuss the availability of students and the opportunities for summer employment in rural and other nursing shortage areas.
(c) The Area Health Education Centers of The University of North Carolina shall provide information and training to hospitals and other employers about programs which help retain new nursing graduates.
Sec. 2. Certified Registered Nurse Anesthetist (CRNA).  The Board of Governors of The University of North Carolina shall explore the need and feasibility of establishing a Master of Science in Nursing(MSN)/CRNA program in eastern North Carolina.  The Board of Governors of The University of North Carolina shall review the potential and need for expansion of existing MSN/CRNA programs.  The Board of Governors shall report its findings to the Commission on Nursing by March 1, 1990.
Sec. 3. Health Occupations in Public Schools. (a) The Department of Public Education shall develop a second, more rigorous academic health occupations track for students planning to pursue a college degree in health occupations.  The Department of Public Education shall report on its progress in developing the second health occupations track to the General Assembly and to the Legislative Commission on Nursing by November 1, 1989.
(b) The Department of Public Education and the Board of Governors of The University of North Carolina shall work collaboratively to determine if current health occupations courses in the secondary schools can be altered to meet the criteria for acceptance under The University of North Carolina's minimum entrance requirements.
(c) The Department of Public Education and the Area Health Education Centers of The University of North Carolina shall jointly plan summer programs in health careers for rising ninth, tenth, and eleventh grade students to provide exposure to  health careers, to provide part-time employment in health care facilities for students, and to offer further academic instruction and credit in science and math.  The programs may be targeted to particular regions of the State, and may be designed to use such resources as the vocational education teachers, the experiences of The University of North Carolina Math-Science Education Network's Pre-College Program, and The North Carolina School of Science and Mathematics.  These plans, with cost estimates, shall be reported back to the General Assembly and to the Legislative Commission on Nursing by November 1, 1989.
(d) The Area Health Education Centers of The University of North Carolina shall collaborate with the Department of Public Education to provide informative materials and training in health careers (including nursing) for middle-school career exploration teachers, with the purpose of increasing the exposure of students to health careers.
(e) The General Assembly encourages the Area Health Education Centers of The University of North Carolina to work with schools of nursing to ensure that high school guidance counselors receive health occupation marketing materials and information.
Sec. 4. Nursing programs: curricula and faculty.  (a) Nursing programs in community colleges shall be funded at a level above the normal per student curriculum funding.  The ratio of the funding shall be determined by legislative appropriation.  The Board of Governors of The University of North Carolina shall ensure that adequate resources are available for expansion of nursing programs.
(b) The Board of Governors of The University of North Carolina, and the State Board of Community Colleges, shall take action to ensure that salaries of nursing instructors employed by the community colleges and The University of North Carolina nursing instructors are adequate to compete in the current nursing employment market and to attract additional instructors to meet program expansion needs.
Sec. 5. Outreach and recruiting.  (a) The North Carolina Foundation for Nursing, Inc., shall develop a comprehensive, generic professional media campaign on nursing as a profession.  The Foundation may contract for various services and shall coordinate the campaign with similar local and national efforts.  The Foundation shall consult with the Legislative Commission on Nursing prior to executing contracts which would expend State funds.
(b) The State Board of Community Colleges and the Board of Governors of The University of North Carolina shall direct their respective schools of nursing to develop new ideas to attract students from a variety of population groups.
(c) The Area Health Education Centers of The University of North Carolina shall expand their pilot nursing recruitment programs across the State to include such efforts as the establishment of speakers bureaus and self-study refresher courses, the exploration of career choices among high school students, and the development of recruitment materials in collaboration with nursing schools in the State.
(d) The State Board of Community Colleges and the Board of Governors of The University of North Carolina shall direct their respective schools of nursing to review their curriculum structure and schedule to ensure flexibility and accessibility for non-traditional students. The State Board shall report its findings and actions to the Legislative Commission on Nursing by March 1, 1990.
(e) The Board of Governors of The University of North Carolina shall direct The University of North Carolina schools of nursing to consider targeted recruitment efforts aimed at non-nursing community college students and at non-traditional students.  Nursing curricula should be examined to see if restructuring is needed to allow targeted students to complete the nursing curriculum in two years. The Board of Governors shall report the results of these efforts to the General Assembly and the Legislative Commission on Nursing by November 1, 1989.
(f) The Department of Community Colleges, the Board of Governors of The University of North Carolina, the Area Health Education Centers of The University of North Carolina, and the North Carolina Board of Nursing shall develop and implement a plan to ensure that refresher courses in nursing are available statewide and on a more frequent basis.  The plan shall be reported to the Legislative Commission on Nursing by December 1, 1989.
Sec. 6.  The Work Environment for Nurses.  (a) The State encourages employers to implement innovative pilot programs to retain nurses in patient care.
(b) The Area Health Education Centers of The University of North Carolina shall continue and shall expand their pilot efforts to retain nursing professionals.  These efforts shall include the following: education efforts for various groups regarding nursing recruitment and retention; assistance in the implementation of pilot professional practice models; mini-fellowships for hospital nursing managers to visit sites of new nursing practice models; initiatives in nursing management and leadership and certification review courses; developing summer internships for senior nursing students to reduce "reality shock”and to increase mastery of clinical skills; and continued research on the retention of nurses.
(c) The State of North Carolina shall strive to be a model employer with respect to State nursing positions. State institutions which employ nurses may participate in the efforts of Area Health Education Centers, and may make experimental efforts aimed at increasing the retention of nurses in the nursing profession. The Department of Human Resources, the Department of Corrections, and the North Carolina Memorial Hospital shall each report to the General Assembly and to the Legislative Commission on Nursing on their efforts, and shall indicate any additional authority needed to carry out retention efforts.  Each Department shall submit its report by November 1, 1989.
Sec. 7. Retention incentives and nursing focus.  (a) The Legislative Commission on Nursing shall plan for the establishment of a Center for Excellence in Nursing.  The Commission may appoint a separate group to plan for this Center.
(b) The planning group for the Center for Excellence in Nursing shall consider the need for a focal point for the State's efforts to improve the nursing profession and shall make recommendations to the Commission on the organization, structure, duties, and costs involved in establishing and maintaining the Center.
(c) The Area Health Education Centers of The University of North Carolina shall conduct two pilot institute programs in 1989-90 for nurses involved in direct patient care.
Sec. 8. (a) Educational mobility for nurses.  The Department of Community Colleges and the baccalaureate schools of nursing are encouraged to continue their efforts to improve the transferability of course credits for the associate's degree in nursing to baccalaureate nursing programs.  The Board of Governors of The University of North Carolina, and the Department of Community Colleges shall report on the results of these efforts to the Legislative Commission on Nursing by November 1, 1989.
(b) Hospital-based diploma schools of nursing are encouraged to work with the schools offering associate and baccalaureate degrees in nursing in their service areas in order to structure diploma-school course offerings so that more of these courses meet the criteria for academic credit at the associate and baccalaureate degree levels.  The schools are requested to report the results of these efforts to the General Assembly and the Legislative Commission on Nursing by November 1, 1989.
(c) The State Board of Community Colleges shall expand its efforts where feasible to offer associate degree in nursing programs on employment sites, including State institutions, for Licensed Practical Nurses.  The State Board shall report its efforts, plans, and results to the Legislative Commission on Nursing by March 1, 1990.
(d) Schools of nursing of The University of North Carolina shall examine efforts made on various campuses such as UNC-Charlotte to provide on-campus Bachelor of Science in Nursing (BSN) programs structured for working registered nurses.  These schools shall make every effort to provide similar opportunities in their regions.  The Board of Governors of The University of North Carolina shall report on these efforts to the General Assembly and the Legislative Commission on Nursing by November 1, 1989.
(e) Area Health Education Centers of The University of North Carolina shall continue and shall expand their off-campus baccalaureate and masters degree programs.  The Area Health Education Centers shall continue to contract for these programs to provide flexibility to meet changing geographic demands and to serve unserved areas of the State.
Sec. 9.  Public Health Nurses. (a) Vacancies in public health agencies significantly impact the State's implementation of various health programs; therefore, the State urges counties to keep salaries for public health nurses competitive with the salary levels of other nurses.
(b) The State recommends that the North Carolina Hospital Association and the North Carolina Health Care Facilities Association study annuities or other retirement planning options which might be offered jointly to nurses and other allied health workers.
(c) The Office of State Personnel shall study the need for flexible fringe benefit options for the State's nurse employees.  The Office of State Personnel shall report its findings and recommendations to the Legislative Commission on Nursing by March 1, 1990.
Sec. 10. Nursing Profession Salaries. (a) State institutions are encouraged to experiment with professional practice models for nursing.
(b) The Office of State Personnel shall review State nursing clinical pay scales and report its findings to the General Assembly and the Legislative Commission on Nursing by November 1, 1989.
(c) The Office of State Personnel shall monitor nursing salaries over time and report its findings to the Legislative Commission on Nursing and the Joint Legislative Commission on Governmental Operations.  The State urges private sector employers of nurses to address the wage compression problem in nursing salaries.
Sec. 11.  Incentive Pay.  The Area Health Education Centers shall provide information and training to nurse employers regarding entrepreneurial approaches and other incentives which establish pay arrangements which are creative and give more dollars to those employees who produce more or who work more efficiently.  These efforts may be incorporated into current efforts to stimulate professional practice models.
Sec. 12. Productivity.  The Area Health Education Centers of The University of North Carolina shall develop programs for institutional managers and directors to further educate them on nursing needs and roles.  These programs shall include training and consultation on methods to achieve the proper mix of nursing staff and support staff, on how computerization can effectively reduce paperwork and increase nursing care time in hospital settings, and on other productivity tools.
Sec. 13. Continuing Education.  The Legislative Commission on Nursing shall study the need, potential cost, and alternatives to changing the State's Medicaid program to reimburse hospitals, nursing homes, and home health agencies for tuition and education expenses for health care employees at amounts above the current Medicaid rates, with a maximum add-on per institution or per employee.
Sec. 14. Career advancement.  The State encourages the integration of career ladders with educational advancement and salary levels for nurses.
Sec. 15. Legislative Commission on Nursing.  (a) There is established the Legislative Commission on Nursing.  The membership of the Commission shall be as follows:
(1)	Four members of the Senate appointed by the President Pro Tempore of the Senate;
(2)	Four members of the House of Representatives appointed by the Speaker of the House of Representatives; and
(3)	Six members of the general public; three appointed by the President Pro Tempore of the Senate, and three appointed by the Speaker of the House of Representatives.
(b) The Speaker of the House of Representatives and the President Pro Tempore of the Senate shall each appoint one member as cochairperson of the Commission.
(c) Members of the Commission shall receive per diem and travel allowances in accordance with G.S. 120-3.1 for members who are legislators, and G.S. 138-5 for members who are not legislators.
(d)	The Commission is charged with the following powers and duties:
(1)	To study issues identified in and funded by this act;
(2) 	To monitor the progress of entities that receive funding under this act, and to receive reports required of entities that receive funding under this act;
(3)	To make recommendations, including cost estimates, to the General Assembly aimed at impacting the nursing shortage;
(4)	To monitor other issues which relate to the nursing shortage, including the status of activities required by Sections 2, 3, 4, 5, and 6 of Chapter 1049 of the 1987 Session Laws.
(e) The Commission shall report its findings and recommendations to the General Assembly by April 1, 1991.
(f) The Commission may, with the approval of the Legislative Services Commission, meet in the State Legislative Building or the Legislative Office Building.  The Legislative Commission on Nursing may use the staff of the General Assembly to the extent authorized by the Legislative Services Commission.  Clerical assistance to the Legislative Commission on Nursing shall be furnished by the General Assembly.  The Legislative Commission on Nursing may enter into contracts for staff and other services, if necessary, after obtaining authorization from the Legislative Services Commission.
Sec. 16. There is appropriated from the General Fund to the General Assembly the sum of seventy-five thousand dollars ($75,000) for the 1989-90 fiscal year to be used for the operations of the Legislative Commission on Nursing created by Section 15 of this act.
Sec. 17. Chapter 90 of the General Statutes is amended by adding a new Article to read: 
“Article 9D.
"Need-Based Nursing Scholarships.
"§ 90-171.65. Need-based nursing scholarships fund.
(a)	There is created a need-based scholarship loan fund for nursing students. Need-based scholarship loans shall be available for study in nursing programs offered by community colleges and The University of North Carolina, and by private colleges which offer licensed practical nursing or registered nursing programs. Part-time students and nontraditional students who have post-secondary degrees, and registered nurses pursuing a baccalaureate degree in nursing, are eligible to receive need-based nursing scholarship loans.
(b)	Need-based nursing scholarship loan funds shall be administered by the State Board of Community Colleges, the Board of Governors of The University of North Carolina, and the State Education Assistance Authority.  The State Board of Community Colleges and the Board of Governors of The University of North Carolina shall allocate the scholarship loan funds among their respective constituent institutions which have programs of education leading to a degree in nursing. Distribution shall be in a manner determined by the appropriate governing body. The State Education Assistance Authority shall distribute scholarship loan funds to private nonprofit colleges which offer nursing degree programs.  Distribution shall be in a manner determined by the Board of the State Education Assistance Authority after consultation with the North Carolina Association of Independent Colleges and Universities.
(c)	The State Education Assistance Authority shall carry out the following functions in implementing the need-based nursing scholarship loan program:
(1)	Promulgate the rules and regulations necessary to implement the scholarship program;
(2)	Disburse, collect, and monitor scholarship loan funds;
(3)	Establish the terms and conditions of promissory notes executed by loan recipients;
(4)	Approve service repayment agreements; and,
(5)	Collect cash repayments required when service repayment is not completed.
(d)	Each institution to which scholarship loan funds are allocated shall publicize the availability of, shall disseminate, receive and review applications for, and  shall select the recipients of scholarship loans.  Scholarship loans shall be made only to prospective and enrolled nursing students under the terms and conditions established for the need-based nursing scholarship loan program by the State Education Assistance Authority."
Sec. 18. This act shall become effective July 1, 1989.