ADAMHA budget for FY 1986 to include an additional $16 million MONDAY, MAY 6, 1985. NURSING PROGRAMS AMERICAN COLLEGE OF NURSE MIDWIVES WITNESS ELIZABETH BEAR, PROGRAM DIRECTOR, SCHOOL OF NURSING, UNIVERSITY OF KENTUCKY Mr. NATCHER. Our next witness is Ms. Bear. Come around, Ms. Bear. Ms. BEAR. Thank you, Mr. Chairman, committee members. I am Elizabeth Bear, Director of the Nurse Midwifery Program at the University of Kentucky. I am here representing the American College of Nurse Midwives. It is a pleasure to be here today to speak in support of adequate funding levels for the Nurse Training Act, Title VIII of the Public Health Service Act. The American College of Nurse Midwives is the professional organization of Certified Nurse-Midwives in the United States, and represents 85 percent of all CNMs. A certified nurse-midwife is an individual educated in the disciplines of nursing and of midwifery, who possesses certification from the ACNM. The ACNM is autonomous from other professional organizations and speaks for its membership on all issues affecting the practice, education, recognition, legislation and economics of nurse-midwifery. The ACNM collaborates with other professional groups which share its primary concern of quality maternal and infant health care. The budget deficit is forcing to center stage questions about the manner in which the United States funds nursing students and the institutions which prepare them for practice. Looking at the President's 1986 budget request, which eliminates all Federal funding for nursing education, including nurse-midwifery education, we have recognized that our nurse-midwifery educational programs are clearly at risk. We appreciate this opportunity to demonstrate to you that, one, there continues to be a shortage of nurses with advanced education; two, continued education of certified nurse-midwives assists the U.S. in addressing two of our most serious national health care problems-the persistent rate of low birthweight and premature births, and the rapidly rising cost of health care; and three, that Federal funds spent over the past ten years on nurse-midwifery education have been repaid twice over by CNM services to the poor and underserved in the U.S. Many policymakers feel that the nation as a whole is producing far too many doctors at costs which are more than society, and government in particular, may be willing to bear. Although experts in the medical profession do not always agree that a surplus exists, this argument has been central to the rationale to eliminate Federal funding of the health professions. To set the record straight in relationship to nursing, only 5.6 percent of nurses have advanced nurse education which is necessary to prepare nurse-practitioners such as nurse-midwives, with spe cialized skills. The Nurse Training Act does not educate new nurses, instead, it provides primarily advanced nurse education for those already prepared at entry to practice levels. There are only about 2000 certified nurse-midwives practicing in the U.S. This number only grows yearly, by about 250, the number of graduates from our 28 nurse-midwifery educational programs. All of these programs have been accredited by the ACNM Division of Accreditation which is recognized by the U.S. Office of Education. Graduation from such a program qualifies the nurse to sit for the ACNM's national certifying examination. In contrast, the demand for nurse-midwifery services is growing rapidly. For example, a health attitude survey of consumers indicates that 15 percent of those polled preferred alternatives to traditional obstetrical services provided by hospitals. Currently there are only enough nurse-midwives to deliver 2 percent of infants born in hospitals. More important, perhaps, the nurse-midwifery services that provide care for the poor cannot recruit CNMs to available job openings because of the low supply of nurse-midwives across the U.S. Nurse-midwifery care has been continuously and scientifically scrutinized over the last 60 years and each study has shown that nurse-midwives provide safe care. In addition, CNM's outstanding contributions to the prevention of low birthweight infants have recently been highlighted by three separate groups-the National Academy of Science's Institute of Medicine, the Southern Governors' Association Task Force on Infant Mortality, and the Children's Defense Fund. The Institute of Medicine's Report "Preventing Low Birthweight", as part of its emphasis on improved access to prenatal care, calls for "more reliance on nurse-midwives . . to increase access to prenatal care for hard-to-reach, often high-risk groups." This recommendation is based on studies that indicate that certified nurse-midwives can be particularly effective in managing the care of pregnant women who, because of social and economic factors, are more likely to deliver low birth weight babies. Several studies have shown that women served by CNMs are more likely to keep their prenatal care appointments and to follow treatments and self-care recommended by the nurse-midwives. This theme of providing access to care has been a tradition of nurse-midwifery since its early days. Congress, too, has been supportive of nurse-midwifery by mandating inclusion of nurse-midwifery care in CHAMPUS and medicaid, and 16 State governments have mandated reimbursement to CNMs by private insurance companies operating in that State. The demand for the services by certified nurse midwives is based on documented quality care, consumers' choice of family-centered maternity care, and, increasingly on the knowledge of the cost-effectiveness of the care provided. In this regard, not only does CNM utilization improve access to care and prevent low birthweight and the associated costs of high-tech neonatal care, it also leads to other financial benefits for consumers and public or private payers. For example, expensive laboratory tests, drugs and technologies are used only when clinically indicated, and not routinely. Nurse midwives have implemented programs which decrease or avoid the use of hospitals, such as early discharge programs and free-standing birth centers. A number of other factors may also contribute to the cost-effectiveness of nurse-midwives: The education of families about childbirth often alleviates the need for anesthesia and its related costs. It costs considerably less to educate a CNM than a physician. The earned incomes of CNMs are only a fraction of those of physicians. The return on the Federal Government's investment in nursemidwifery education has been substantial. Since its beginning in eastern Kentucky, nurse-midwifery care has been introduced to other medically underserved areas characterized by poverty, geographical isolation, and other social factors associated with poor obstetrical outcomes. Today the tradition of providing care to the poor continues. More than one-half of our practicing CNMs provide health care to the underserved. This is especially important in light of new information which indicates that obstetricians are caring for smaller numbers of medicaid clients. Federal funds for nurse-midwifery education have been well spent. The Division of Nursing within HHS has funded nurse-midwifery education since 1972. Today three of our programs receive funds from the section on Advanced Nurse Training and 12 receive Nurse Practitioner funds. Directors of all 28 educational programs are seeking additional sources of funding-from State governments, from private foundations and from faculty generating service dollars. This practice is dependent on the State laws under which a CNM is licensed as well as the CNM's ability to gain hospital privileges-a barrier to practice which still restricts nurse-midwifery in some areas of the country. Faculty are further limited since they provide care for poor patients and this type of health care service cannot subsidize the educational programs. The problem is compounded by the rigorous clinical demands on nurse-midwifery students-the number of hours in clinical settings as well as the unpredictability of the hours. This contributes to the almost non-existance of a work/study type program. Federal funding has been critical to sustaining nurse-midwifery education and continues to be so. In summary, sir, the American College of Nurse-Midwives urges Congress to appropriate funding levels adequate for the educating of sufficient numbers of nurse-midwives and other nurses with advanced nurse education. Certified nurse-midwives have a rich tradition of providing access to care for the poor and other underserved populations. Continued growth of nurse-midwifery in the U.S. will help address two serious national health problems-the persistently high rate of premature and low birthweight infants, and the rising cost of health care. Thank you. I will address any questions you may have. |