Remarks to SEIU Nurses

HRSA Speech logo

U.S. Department of Health & Human Services
Health Resources and Services Administration
HRSA Press Office: (301) 443-3376


by HRSA Administrator Mary K. Wakefield, PhD, RN

March 31, 2012
Seattle, WA

Good morning! It’s been my pleasure as a nurse colleague to share lunch with you and to compare notes with you in this informal setting.

Right now is an especially exciting time to talk about nursing in America, and – as I’m sure is the case for most if not all of you – I’ve never regretted my choice of professions.  From clinical care to academia to public policy work serving as a chief of staff to U.S. senators, to now as administrator of a federal agency, in each of these diverse settings my nursing background has served me exquisitely well.

And even as I found an abundance of opportunity, as I’m sure each of you has, I think the road ahead for nurses has even more opportunity for generations coming up behind us.

By that I don’t mean easier work.  Rather, I mean that for nurses there is almost no wrong career door that a nurse can walk through.  A lot of doors are increasingly unlocked and ready for nurses to push open.  Going forward, I see this profession really entering a new era.

Last year’s Institutes of Medicine-Robert Wood Johnson Foundation report on the future of nursing put down an important marker that envisions nurses as leaders building better health care in America.  Clearly, within the profession we’ve talked about nurses as leaders for decades – that part isn’t new.  But this focus on building health care and making health care better aligns exactly with what we in this nation need.  And we need it now.

Having nurse leaders at all levels of practice: academia, public policy and elsewhere isn’t a nicety for nurses, it’s an absolute necessity for the nation’s health care and for the nation’s health.

To achieve this aim, we need nurses who see the doors that can be walked through and we need the opportunity that comes with people valuing nursing as a leadership asset.  And on that front, it doesn’t get much better than when the President of the greatest country on earth doesn’t just talk the talk about the relevance of the nursing profession: he walks the walk.  Here are just a couple of many examples I could give.

President Obama certainly opened a new era for nursing when he named me to head up HRSA and manage its budget of nearly $8 billion.  I’m the first nurse administrator in HRSA’s history.  The agency has had a number of physicians at the helm, but never a nurse – until now.  And earlier this year the President selected Marilyn Tavenner – another nurse – to be the acting administrator of HRSA’s sister agency, the Centers for Medicare and Medicaid Services.

And among my senior advisors at HRSA, nursing is well-represented:

  • Our $2 billion HIV/AIDS Bureau is run by Dr. Deborah Parham-Hopson, a nurse.
  • The Associate Administrator of our Bureau of Health Professions, Dr. Jan Heinrich, is a public health nurse who has long been a supporter of nurses in primary care and advanced practice.
  • Our Office of Global Health Affairs is led by Kerry Nesseler. Kerry also is the chief nurse of the U.S. Public Health Service.
  • And the director of our Division of Nursing, Dr. Julie Sochalski, is, as you might expect, another nurse leader at HRSA.

President Obama recognizes nurses as a source of expertise to help guide key health care programs and policies, and when we think about the future of nursing his support for these current nurse leaders – and frankly, Secretary Sebelius’ significant support as well – helps set the stage for the next generation and the next set of contributions from our profession.

The careers open to today’s nurses – and tomorrow’s – are many.  And there has been a booster shot full of opportunities brought to our collective doorsteps by the Affordable Care Act, the formal name of the health care reform law.

I will discuss the ACA in detail during my conference remarks to follow this luncheon, but
I do want to tell you how the ACA supports nurses in particular.

The ACA expands investments in primary and preventive care programs in which nurses play a vital role.  Its emphasis upon keeping people healthy, preventing illness and managing chronic conditions opens up new opportunities for nurses.  

While I spent most of my clinical time in intensive care units, it didn’t take a nursing genius to figure out that a lot of the health problems desperately ill patients presented with could have been wholly prevented, or at least markedly mitigated, through earlier investments in disease prevention activities like screenings, health and wellness promotion, and patient education.  And that – for the first time in this country – is where the law takes us.  It takes us to what second-year nursing students and most of your grandmothers and mothers knew – that an ounce of prevention is worth a pound of cure.  When you’re talking prevention, you’re talking about nurses’ knowledge and skills and, more importantly, you’re talking about a healthier nation.

Additionally, the law boosts funds for nurse education and strengthens support for advanced practice nurses.

In two key HRSA programs – community health centers and the National Health Service Corps – the ACA made enormous new investments to expand access to primary and preventive health care in communities that need it most.  And there’s a lot of need out there.

HRSA’s health center network delivers primary and preventive care – including oral and behavioral health care – to about 19.5 million patients at more than 8,500 sites.  Our health centers are an essential part of the national safety net because they serve anyone who walks in.

Since President Obama took office, the number of patients getting care at health centers has grown by 2.4 million, mainly due to an $11 billion, five-year investment from the ACA and, before that, $2 billion from the 2009 Recovery Act.  

Nurses are an essential component of the health center workforce.  Right now about 16,000 nurses – including 4,300 advanced practice nurses – work at health centers across the U.S.  Since the expansion began in 2009, health centers have added about 3,000 nursing positions, including 800 in advanced practice.   Again, this is the result of Recovery Act and ACA investments, and there will be more building out between now and 2015.

Here in the state of Washington, HRSA supports 25 Health Center program grantees.  Collectively, they operate 227 health center sites that employ nearly 500 nurses, including 135 advanced practice nurses.

With ACA funding continuing through FY 2014, the number of nurses working at health centers will grow.  So when I look at nursing’s future, I see health center care, which keeps people healthy and effectively manages chronic illnesses, as a critical opportunity for nurses.  

And related to this, out of the overall ACA investment in health centers, the law includes $200 million to expand school-based health centers, which allow kids – and particularly importantly, disadvantaged kids – to get care before major health problems take root.  

Nurses, of course, are the backbone of school-based care.  So this is another important interface that the ACA supports, in this case between nurses and children’s health. This investment in schools is important in light of high rates of childhood obesity, which place children at higher risk for chronic diseases.  

Another HRSA program that offers great opportunity for nurses is our National Health Service Corps.  The Corps places primary care providers in underserved urban and rural areas for at least two years in exchange for paying down their student loans.  Eligible nursing specialties are primary care nurse practitioners, certified nurse midwives, and psychiatric nurse practitioners.

The ACA allocated $1.5 billion over five years to grow the NHSC.  About half of all NHSC clinicians work in health centers, so growth in the Corps was an important element of the health center expansion.  

The number of nurse practitioners in the NHSC has more than doubled to 1,750 since President Obama took office.  During the same period, the number of certified nurse midwives rose from 88 to 201.  That’s a lot of new access to primary care services in neighborhoods and towns with previous shortages.

In 2011, the NHSC had 343 providers practicing in the state of Washington.  Among them were 63 Nurse Practitioners and 3 certified nurse-midwives.  Another 62 providers were oral health professionals (dentists and hygienists), while 90 others delivered mental and behavioral health care and services.  As of this month, ACA funds supported 133 of those NHSC providers.

And as a nurse with some rural health experience, I know the difference one nurse practitioner can make in a community.  My 94-year-old mother – who lives in a small town – knows that, too.

Late last year, we made a policy change in the Corps to encourage clinicians to practice in areas that really need their help.  Health professionals who work in the very neediest areas now qualify for up to $60,000 in annual loan repayments, and those who practice in less-needy areas can qualify for up to $40,000 in loan repayments.

The NHSC is a great opportunity for health professionals who want to pay down their debt and serve folks who most need care.  To learn more – or to tell others -- about the benefits of joining the NHSC, I encourage you to go to and take a minute to look around. And we’re on Facebook at nationalhealthservicecorps – one word.

The ACA also created a new five-year, $1.5 billion program that assigns considerable responsibility – and new opportunities – to nurses: the Maternal, Infant, and Early Childhood Home Visitation Program.  

Under this program, nurses, social workers and others visit pregnant women and young children in high-risk communities.  There they provide counseling and intervention services that – based on evidence – are known to improve health outcomes.  Last year the Home Visiting program got fully under way, and in September HRSA announced an award of $224 million to state agencies to implement it.  States use the funds to support one or more of nine evidence-based home visiting models.

To date, 29 states have selected Nurse-Family Partnerships – one of the models – as the basis for their work.  Nurse-Family Partnerships are a nurse-led home visiting model that partners low-income, first-time moms with maternal and child health nurses.  The expansion of this proven model through the ACA adds to nurses’ ability to contribute directly to the health of families and communities.

The Affordable Care Act also confirms nurses’ role in delivering primary health care.  The law invests in several nurse training and education programs that HRSA administers.

For example, the Act directed $15 million to Nurse-Managed Health Clinics, which are run by advanced practice nurses and affiliated with schools of nursing.   These clinics train new nurses while delivering primary care to public housing residents and other vulnerable populations.

Another HRSA program – the Nursing Education Loan Repayment Program – has seen its budget more than double since 2009 to almost $94 million today.  Under this program, RNs who work for two years in a facility with a critical nursing shortage can get 60 percent of their school debt paid off.  There are currently ¬¬99 nurse scholars and loan repayors working in your state under this program.

And in response to Secretary Sebelius’ interest in our strengthening of primary care, HRSA has just taken steps to ensure that more nurse practitioners take advantage of this loan repayment program.  With a steady focus on ramping up access to primary care, in December of last year we released guidance that reserves 50 percent of available 2012 funds to repay the loans of nurse practitioners.  That will help them go to school and do it full time.

Moreover, the Center for Medicare and Medicaid Services (CMS), our sister agency, is using ACA dollars to put more advanced practice nurses at the forefront of primary care.  Under the Graduate Nurse Education Demonstration, CMS will provide hospitals working with nursing schools to train advanced practice registered nurses (APRNs) with payments of up to $200 million over four years to cover the costs of APRNs’ clinical training.  

The ACA also provided $31 million to 26 schools of nursing to boost the number of primary care nurse practitioners and nurse midwives by 600 over five years, again emphasizing the critically important role that those two nursing specialties play in expanding the reach of primary health care.

In addition, nurses are directly affected by the ACA’s promotion of “care coordination,” which is at the core of efforts to improve health care quality and safety and an orientation and intervention that nurses frequently lead.

The ACA’s emphasis on team-based care recognizes that there are gaps in health care between settings and among health care providers.  And these gaps can put the health of patients at risk while driving inefficiency and increasing costs.

We can help resolve these problems by changing the way we educate and deploy our health care workforce.  So HRSA has become deeply involved in efforts across the health care spectrum to push forward the concept of “interprofessional education” and team practice.  The ACA supports this orientation too.

On this particular front, for more than a year now HRSA has partnered with health-related foundations and experts from government and academia to promote team-based care.  Last May we announced the creation of a set of interprofessional competencies to be disseminated for use in health professions education and practice.  We’ll soon be announcing more activity to drive this agenda forward.

And we’re already taking steps to promote interprofessional education in two of our nursing programs.  Our Nurse Education, Quality, Practice and Retention Program and our Advanced Nurse Education Program will support grant proposals that help to develop interprofessional education and practice.

Those two programs are among seven HRSA nursing grant programs active at five universities in the state of Washington. In 2011, we awarded $4.2 million to these grantees for nurse training.

I hope my remarks have helped you appreciate the importance of the Affordable Care Act to nursing and, because of that, the importance of the ACA to the American people.  To learn more about the ACA and the benefits I mentioned, please go to  

I’m very proud to be a member of the profession that you and I share. I thank you for listening and for all that you do.

Date Last Reviewed:  April 2017