The question before the General Assembly is what to do about the North Carolina Center for Nursing (NCCN). One of the proposed solutions is to simply eliminate the state-funded think tank. This might be the time to do so – or at least remove it from the state budget.
The NCCN was founded in 1991 by the state legislature to “address issues of supply and demand for nursing” and to propose ways to bring them in balance It was the nation’s first nursing workforce center, and its example has spawned other centers throughout the country. Among its basic functions are the gathering and analysis of data concerning the employment of nurses in the state and making that data available to various state and private health care entities. It was intended to help the legislature in policy analysis. It also acts as an advocate for the nursing profession and seeks to aid in recruitment, retention and training of nurses.
The fate of the NCCN is an education issue because the University of North Carolina (UNC) is seeking to gain control of the center.
According to testimony at a March 12 meeting of the General Assembly’s Joint Legislative Appropriations Subcommittee on Education, the center has been largely ineffective. Furthermore, its basic functions are shared by other organizations throughout North Carolina. If it were to disappear, the potential savings for taxpayers is relatively small — the center received $505,000 from the state in 2007. But a potential economic downturn suggests the need for belt-tightening by the state government. Eliminating the center would also permit the legislature to untangle some bureaucratic redundancy.
UNC’s general administration is not only asking for a continuation but an increase in funding. But university officials also want oversight of the NCCN’s executive director, an unwelcome suggestion to the current chair of the NCCN’s board, Cherry Beasley.
In the 2007 legislative session, the General Assembly asked UNC to convene a task force to study NCCN’s continued viability and its strengths and weaknesses. The legislature’s fiscal research division also examined the center.
At the subcommittee meeting, Richard Bostic of the fiscal research division laid out the major funding proposals for the NCCN:
• Continuing the center with state funding. This could happen in several ways. The NCCN could remain as an independent entity responsible directly to the legislature, or it could be moved to either UNC’s general administration or the state’s Department of Administration. Under the wing of UNC, the center might become part of another university entity, such as the Cecil G. Sheps Center for Health Services Research.
• Continuing the center without state funding, This might entail authorizing the Board of Nursing to charge nurses working in the state small annual fees ($10 was suggested) to fund the center. The NCCN could also be set up as a private non-profit organization responsible for funding itself through donations.
• Disbanding the center.
According to the research division, the N.C. Board of Nursing, the Sheps Center, and the federal Health Resources and Services Administration (HRSA) all conduct research similar to the NCCN. The division’s report suggested that there is also considerable redundancy in its advocacy, policy analysis, and recruitment functions.
Harold Martin, the UNC system’s senior vice president for academic affairs, said that the apparent redundancy is misleading. For these other organizations to pick up most, but not all, of the NCCN’s functions would require $435,000 in additional state funding, nearly the entire budget of the NCCN.
At the same time, the UNC Task Force’s report found many flaws with the center. The task force criticized the center for lack of cooperation with other agencies, said that many considered the center’s analysis to be questionable due to its advocacy for the nursing industry, and suggested that the center has not been an effective resource for the legislature in developing policy.
One issue where the NCCN has rankled some segments of the nursing profession is its perceived favoritism toward nurses with advanced degrees. The center’s rebuttal to this criticism has been that it wishes to ensure enough nursing faculty at a time when community college faculty salaries are much lower than nurses with master’s degrees can earn in private practice. This follows from the NCCN’s stated mission “to assure that the State of North Carolina has the nursing resources necessary to meet the healthcare needs of its citizens.”
Yet the supposed nursing shortage, which was a major justification for the center’s existence, must be questioned. The long-term trends of the profession, provided by the financial research division and predating the center’s founding, show a different picture. In 1979, there were fewer than 50 nurses per 10,000 people in North Carolina, below a U.S. average of approximately 55. Today, there are 92 nurses per 10,000 people in the state, much higher than the national average of 82.5. In the state’s metropolitan areas, where most of the people live, there are 101.7 nurses per 10,000. In the rural districts where the availability of nurses fails below the national average, there are shortages of many things – not just health care professionals.
Because the issues of the nursing profession are so intertwined with the education of nurses, it is natural that the UNC system would want to continue the NCCN and bring it under its control. Perhaps university expertise could make the NCCN more efficient. But another question is raised — how broad should the powers of the UNC system be? Almost every key function in the state requires some involvement with higher education – does this mean that all of these key functions should be folded into the university system?
The center shares much of its mission with other organizations, and by most measures it has not performed at peak levels. State revenues are likely to fall. Such a clear opportunity to reduce the cost and size of government should not be lightly regarded. If the NCCN truly performs a vital function, then let it stand on its own, funded by either the nursing profession or by private donors.