Contemporary Issues

The Nurse Education, Expansion, and Development (NEED) Act, H.R. 5324, was introduced by Representatives Nita Lowey (D-NY) and Lois Capps (D-CA), has the potential to provide some relief for the growing faculty shortage. The NEED Act would authorize capitation grants (formula grants to schools based on the number of students enrolled) for schools of nursing to improve their ability to educate nursing students. Grants would be awarded by the health Resources and Services Administration (HRSA) to each eligible school of nursing that submits an application. A school of nursing is eligible for the capitation grant funding if it is accredited by a Department of Education-approved accrediting agency, has as passage rate on the National Council Licensure Examination for Register Nurses of not less than 80 percent, and has a graduation rate of not less than 80 percent. The following are the basic step that NEED Act will follow in the legislative process.

The Legislative Process

The official legislative process at the federal level begins when a bill or resolution is introduced by the sponsoring member(s) of congress and is numbered, referred to a committee, and printed by the U.S. Government Printing Office. (ANA, 2003). The bill is referred to a standing committee in the House or Senate according to carefully defined procedures. The bill may be referred to a subcommittee or be considered by the committee as a whole: it is examined carefully, and its chances for passage are determined. If the committee does not act on the bill, it is essentially dead. Bills may be referred to a subcommittee for study and hearings; this provides committee members with the opportunity to obtain written or oral testimony about the bull from the executive branch, experts in the related area, and supporters and proponent of the bill. After hearings, the subcommittee may choose to "mark up" the bill, which means make changes or amendments before recommending the bill to the full committee. The bill dies if the subcommittee votes not to refer the bill to the full committee. After the full committee receives the bill from the subcommittee, the committee can conduct further hearings and study or vote on the subcommittee's recommendations. The full committee then votes on its recommendations to the House or Senate, a procedure known as "ordering a bill reported." The committee staff members prepare a written report about the bill that includes its intent, impact on existing laws and programs, position of the executive branch, and views of dissenting members of the committee. The bill is scheduled on the calendar on either the House or the Senate, from where it originated for floor action. There is only one calendar in the Senate. Debate begins when the bill reaches the floor of the House or Senate; various rules govern the conditions and amount of time allowed for debate. After the debate, the bill is passed or defeated by the members voting. After a bill is passed by either the House or Senate, it is referred to the other chamber, where it normally follows the same process through committee and floor action; at this point the bill may be approved as received, rejected, ignored, or changed. If only minor changes are made in the referral to other chamber, the bill will go back to the first chamber or concurrence. However, if the second chamber significantly alters the bill, a conference committee is formed to reconcile the differences between the House and the Senate. The legislation will die if the conferees are unable to reach agreement. Both the House and Senate must approve the conference report. After the bill is approved by both the House and the Senate in identical form, it is sent to the President, who may (a) approve and sign the bill into law, (b) take no action for 10 days while congress is in session, after which time the bill automatically becomes a law, (c) veto the bill, or (d) take no action after congress has adjourned, allowing the legislation to die. The congress may also override the veto which requires a two thirds role call of the members who are present and form a quorum.

The Administrative Process

Once a bill finally becomes a law, implementation falls under the jurisdiction of one of the departments under the executive branch of government. At the federal level most health-related policies fall under the jurisdiction of the Department of Health and Human Services (DHHS) and its related agencies. The agency that will administer the law develops the regulations to implement the law. Implementation of new legislation can often be very different from what was intended when Congress passed the bill. It is important at this point that supporters of the new law take steps to ensure