Senate bill to address the state's nursing shortage passes its first hurdle, but some say it wouldn't do enough

Photo illustration via Nolan Group Media

UPDATE, March 1: The Senate passed the bill 36-0.

By Melissa Patrick
Kentucky Health News

A bill to address the nursing shortage in Kentucky passed out of a legislative committee Wednesday, but the state nursing association and several lawmakers said more needs to be done to keep nurses in the profession.

"This is not just related to hospitals, it's related to long-term health-care facilities and anybody else who relies on nursing," Senate President Robert Stivers, a co-sponsor of the bill, told the Senate Health and Welfare Committee. 

Senate Bill 10, sponsored by Sen. Robby Mills, R-Henderson, offers four key measures: licensing reciprocity between other states and nations, higher enrollment caps, looser nursing-instructor qualifications and restructuring the state Board of Nursing.

The panel approved the bill after rewriting it to address issues involving temporary work permits and credentialing requirements for nurses with degrees from foreign nursing schools, and saying a nursing program's students must have an 80% pass rate on the licensure exam over three years, instead of five. 

Delanor Manson, CEO of the Kentucky Nurses Association, told the committee, "Senate Bill 10 and the revisions are going in the right direction, but it doesn't go far enough." She presented a five-point plan that called for spending $100 million in state funds to address the nursing shortage. 

First, she called for repeal of Kentucky's requirement that advanced-practice registered nurses have a collaborative agreement with a physician to prescribe narcotics and some other controlled substances. 

"There are approximately 2000 APRNs who are practicing outside Kentucky because they cannot practice to the full extent of their licensure and experience and education," Manson said. "We need to bring those nurses home."

Manson estimated that other parts of her plan would bring about 1,500 of the 5,000 retired nurses in Kentucky back into the workforce, through education and retraining. It also calls for expanded training through increased faculty salaries and loan forgiveness; recommends a campaign to make sure nurses know they are appreciated; and offers retention bonuses for nurses who stayed in their communities throughout the pandemic.

Several legislators also called for more efforts to keep nurses on the job. 

"I do think the greatest improvement could be if we had some retention money set aside in our budget to really work toward keeping our nurses long term in Kentucky," said Democratic Sen. Denise Harper Angel of Louisville. "But this is an excellent first start." 

Sen. Stephen Meredith, a Leitchfield Republican and former hospital administrator, praised the bill but said, "I'm a little bit concerned that we don't have more focus on the retention side of it. . . I don't think people understand how demanding nursing has become." 

Nancy Galvagni, president of the Kentucky Hospital Association, spoke in favor of the bill, saying the nursing shortage has been building for years and has placed great stress on hospitals. She said hospitals are burning through reserves to hire traveling nurses to fill the gaps, at of $200 to $250 per hour. 

"These expenses are not sustainable and they could easily lead to cuts and services," Galvagni said. "And we know that hospitals are already looking at what services they may need to discontinue." 

Sen. Ralph Alvarado, a physician who works in long-term care facilities, called the situation "dire."

"We have a lot of facilities that are shutting down wings, because they don't have adequate nursing staffing," said Alvarado, R-Winchester. "We know that our hospitals haven't been able to operate at its fullest capacities, because we don't have nursing staff to manage a lot of those wings in our hospitals." 

Democratic Gov. Andy Beshear declared an emergency in mid-December, allowing the state to take special measures to educate and license more nurses.

His order requires the nursing board to approve requests for enrollment increases if a school has sufficient resources; requires schools to report vacant student seats to the board monthly to post online, and send the board a list of needed faculty; allows a school to open new campuses more quickly; and improves reciprocity with other states. Beshear's budget proposal also included scholarship and loan-forgiveness money to attract and retain nurses.