Nearly $7 million that supports nursing education and research in Missouri is at risk under federal proposals to eliminate key Title VIII workforce programs.
The U.S. House Appropriations committee, responsible for regulating government expenditures, proposed in September to eliminate the National Institute of Nursing Research and all Nursing Workforce Development programs, except the Nurse Corps. The programs represent the only dedicated federal funding for nursing education.
The cuts align with the Trump administration’s request to eliminate Title VIII programs but have yet to be approved by Congress. The official federal budget is currently set to be passed by Jan. 30.
Potential impact on patients
According to the American Association of Colleges of Nursing, the National Institute of Nursing Research received $197.693 million in federal funding, with $1,607,363 dedicated to research in Missouri during fiscal year 2024. It is the only institute that exists solely to support nursing research, typically done by nurse educators and practitioners.
“We view it as an integral component to the ecosystem of nursing education and research,” said Josh Adams, director of policy and regulatory affairs at the American Association of Colleges of Nursing.
That impact extends beyond academia.
Lori Popejoy, dean at the University of Missouri’s Sinclair School of Nursing, said research plays a direct role in improving patient care.
“Everybody in the sphere of healthcare, research and education, is concerned with delivering the best quality care they can, and part of the research enterprise is discovering new, efficient, effective ways of doing that,” Popejoy said.
Adams expressed similar concerns about what’s at risk for health care professionals.
“I think the impact would be losing those insights and a forward momentum that is part of the enterprise of science in general, but in health care, we are always working to try to deliver better, higher quality health care to as many people as possible. I think losing the research that informs how we do that would be incredibly detrimental,” Adams said.
Nursing Workforce Development programs
The Nursing Workforce Development programs live under Title VIII in the Public Service Act, reauthorized in 2020. The programs provide federal grants to support nursing education, expand the nursing workforce and strengthen access to care in underserved communities.
Its elimination would result in a nearly $50 million decrease nationally from the current funds of $305.472 million for these programs, resulting in funding levels that have not been seen since FY 2020. Missouri received $4,795,783 in Title VIII funding in FY 2023.
One of the programs that has already been canceled is the Nurse Faculty Loan Program, a key component of the Nursing Workforce Development portfolio.
The program provided low-interest loans to graduate nursing students who planned to become faculty members. Those who went on to teach full time for up to four years could have as much as 85% of their loan balance, including interest, forgiven.
“For myself, I used the Nurse Faculty Loan Program, and some of my student loan funding was cut due to change in the Presidential Office,” said Karina Floyd, director of nursing at Stephens College. “I don’t know if I would’ve pursued an MSN and Ph.D. in nursing if I knew the government would move the student loan contracts and delete the programs.”
Both Floyd and Popejoy, leaders of nursing schools in Columbia, expressed concern about the consequences of this cancellation, saying that it not only hurts current nursing faculty students, but could also deter prospective graduate nursing students from continuing their education.
“When I finished my Ph.D., I had a John A. Hartford Foundation pre-doctoral scholarship, and it covered all my education and a stipend,” Popejoy said. “I walked away from my graduate education without any debt because of that scholarship. That’s the best-case scenario for students. And there’s fewer and fewer of those opportunities privately available.”
Floyd said that nursing programs are already reporting that students are pausing or giving up plans for advanced nursing degrees due to the debt cap.
“If this continues, it will directly weaken the education-to-workforce pipeline at every level, not just graduate programs,” she said.
“You’re strangling it at the beginning, and that pipeline just narrows all the way through,” Popejoy added.
Both education advocates and administrators recognize how vital this funding is to help improve access to health care across the state and the country.
“Title VIII funding was created to strengthen the national nursing workforce, particularly in moments of high demand,” Floyd said.
She said reducing support now could worsen existing shortages.
“Hospitals depend on nurses who pursue graduate preparation to become faculty, managers, clinical educators and advanced practice clinicians. When graduate education becomes financially out of reach, the pipeline of future nurse educators shrinks, and that directly limits how many new nurses can be trained,” Floyd said.
“It ultimately affects Missouri patients and the safety and stability of our health care system. As schools of nursing work toward expansion to meet workforce needs, these reductions risk slowing or preventing that growth precisely when the state needs more nurses, not fewer,” she added.
While Congress returned to work this week, they still have time to potentially reinstate funding for the National Institute of Nursing Research and Title VIII programs and deny the president and the House Appropriations Committee’s requests to eliminate this funding.
Both Popejoy and Adams are encouraged by the level of support from the public and nursing advocates like the American Association of Colleges of Nursing.
“I think that there’s enough push from the agencies nationally on Congress, and we’re seeing a huge amount of blowback and frustration from the public,” Popejoy said.
“We saw reasonably positive funding support coming out of both the House and the Senate. There was some separation in what they were comfortable allocating, but there’s support for these programs,” Adams added.
