Lobbying Strategies for Federal Appropriations

226 Pages·2009·1.17 MB·English

Lobbying Strategies for Federal Appropriations: Nursing versus Medical Education
by
Suzanne Michelle Begeny

A dissertation submitted in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
(Nursing)
in the University of Michigan
2009

Doctoral Committee:
Professor Beatrice J. Kalisch, Chair
Professor Richard L. Hall
Professor Emerita Ada Sue Hinshaw
Associate Professor Kristy Kiel Martyn
© Suzanne M. Begeny
2009
This dissertation is dedicated to my family and friends who believe in my potential and
the policy nurses who inspired my career.

ii
ACKNOWLEDGMENTS
I would like to thank my amazing Chair, Dr. Beatrice Kalisch and my
distinguished committee members Drs. Ada Sue Hinshaw, Richard Hall, and Kristy Kiel
Martyn for their patience, dedication, support, and motivation during my doctoral studies.
Their commitment to my education and enthusiasm for my dissertation topic provided me
the momentum to finish this study. I would also like to thank my participants who took
time out of their work to shape our nation’s new healthcare system to participate in my
study. I am extremely grateful to the American Association of Colleges of Nursing,
especially Dr. Polly Bednash, Robert Rosseter, and Chandra Burnside for their support
and editing eyes. This dissertation would not have been possible without the support of
my colleagues and dearest friends. Tannaz Rassouli, Ann Walker-Jenkins, and Kerri
Wade— thank you for the humor. I would also like to thank Christine Anderson,
Elizabeth Kennedy, and Lauren Underwood for their interest in my work. A special and
heartfelt thank you to Yuichi Miyamoto for his love, support, and understanding that my
dissertation had to be a top priority. Finally and most importantly, I would like to thank
my beautiful family, Dad, Mom, Elizabeth, Robert, Steven, Alex, and Flora. You
supported my decision to become a nurse, spend a decade of my life in higher education,
and my move to Washington, DC, but above all your faith in me and your love is what I
cherish most.

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TABLE OF CONTENTS
Dedication ii

Acknowledgements iii

List of Figures v

List of Tables vii

List of Appendices ix

List of Abbreviations x

Abstract xi

Chapter

ONE Introduction 1

TWO Review of Relevant Literature 35

THREE Methods and Procedures 87

FOUR Results 97

FIVE Discussion 149

Appendices 172

References 203

iv
List of Figures

Figure 1.1 15
Historical Trends of Nursing School Enrollments, Graduations, and
Qualified Applicants Turned Away: 2002-2008

Figure 1.2 19
Vacancy Rate by Region in Schools Reporting Vacancies for Academic
Years 2008-2009

Figure 1.3 21
Percentage of Doctorally Prepared Faculty in Baccalaureate and
Graduate Nursing Programs: 1979:2008

Figure 1.4 22
Number of Part-time Nursing Faculty vs. Full-time Nursing Faculty:
1992-2007

Figure 1.5 23
Percentage of Part-time Faculty and Yearly Trends: 1992-2007

Figure 1.6 27
Enrollments and Graduations from Master’s and Doctoral
Nursing Programs: 2000-2007

Figure 1.7 29
Selected Characteristics of Vacant Faculty Positions for Academic
Years 2008-2009

Figure 2.1 61
Title VIII Funding: FY 1964-2008

Figure 2.2 63
Historical Funding for Title VIII: Consumer Price Index Inflation

Figure 2.3 64
The Effects of Level Funding on the Number of Students Supported
by Title VIII

Figure 2.4 65
Title VIII Data by State
v
Figure 2.5 70
Federal Funding for HRSA Administration and Programs:
FY 2005-2009

Figure 2.6 82
Federal Funding for Title VII Health Professions Programs:
FY 2005-2009

Figure 2.7 83
Federal Funding for Title VIII and CHGME: FY 2000-FY 2009

Figure 2.8 84
Comparing Funding for Title VIII and CHGME: FY 2000-FY 2009

Figure 2.9 85
Comparison of CHGME vs. Title VIII Funding FY 2005-2009

Figure 5.1 162
Congressional Nursing Relationship Model

Figure 5.2 164
Congressional Nursing Relationship Model: Applied to Demonstrate
Nursing’s Inability to Achieve Increased Title VIII Funding

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List of Tables

Table 1.1 16
Reason for Not Accepting all Applications by Type of Program

Table 1.2 16
Reason for Insufficient Numbers of Faculty by Type of Program

Table 1.3 30
Comparison of Median and 75th Percentile Faculty Salaries to
Clinical/Administrative Nursing Positions

Table 2.1 43
Title VIII Programs and Authorization Levels

Table 2.2 53
Reauthorization and Amendments to Title VIII

Table 2.3 62
Title VIII Funding FY 1964-2008

Table 2.4 64
Nurses and Nursing Students Supported by Title VIII
FY 2006-2008

Table 2.5 69
Title VIII Funding: FY 2008-2009

Table 4.1 99
Demographic Characteristics of Nursing Lobbyists

Table 4.2 100
Demographic Characteristics of CHGME Lobbyists

Table 4.3 101
Demographic Characteristics of Congressional Staff

Table 4.4 103
Strategies Used to Develop an Appropriations “Ask”

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Table 4.5 107
Strategies Used to Secure Federal Funding

Table 4.6 119
Nursing Appropriations Advocacy Financing by Organizational
Type

Table 4.7 120
CHGME Appropriations Advocacy Financing by Organizational
Type

Table 4.8 122
Most Effective Strategies to Secure Federal Funding
viii
List of Appendices

Appendix A 172
Nursing Community Consensus Document

Appendix B 190
Federal Funding for Title VIII Programs by State and FY

Appendix C 192
Health Sciences Institutional Review Board: Exemption Notice

Appendix D 195
Introductory Script and Interview Guide: Lobbyist Participants

Appendix E 198
Introductory Script and Interview Guide: Congressional Staff
Participants

Appendix 201
Debriefing Script: All Participants

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