[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 1585 Introduced in Senate (IS)]
107th CONGRESS
1st Session
S. 1585
To establish grant and scholarship programs to enable hospitals to
retain and further educate their nursing staffs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
October 30, 2001
Mr. Lieberman (for himself and Mr. Ensign) introduced the following
bill; which was read twice and referred to the Committee on Health,
Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To establish grant and scholarship programs to enable hospitals to
retain and further educate their nursing staffs.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Hospital-Based Nursing Initiative
Act of 2001''.
SEC. 2. FINDINGS.
Congress finds that--
(1) a Department of Health and Human Services study found a
correlation between the number of registered nurses on the
staff of a facility and patient health outcomes;
(2) studies have shown that hospitals that promote greater
autonomy for nurses, greater nurse control and input into the
decisionmaking process in the hospital setting, better
communication between nurses and physicians, and input from
nurses at the executive level in the hospital lead to increased
retention of and satisfaction for nurses;
(3) the job dissatisfaction rate among nurses in the United
States, 41 percent, is higher than in most other countries;
(4) \1/3\ of nurses under the age of 30 are planning to
leave the nursing profession within the next year;
(5) hospitals employ nearly 60 percent of the entire
nursing workforce;
(6) while the number of inpatient hospitalizations is
expected to continue to decrease, the acuity of those patients
requiring hospital stays is expected to increase;
(7) the projected supply of registered nurses is
anticipated to grow at a rate of less than 1.5 percent per year
through the next 8 years, while the demand rate (growth) is
projected to be over 21 percent per year;
(8) there must be incentives for hospitals to revise
management principles to improve the quality of the work
environment in hospitals, initiate aggressive retention
programs for the nurses currently employed in hospital
settings, and employ aggressive recruiting tactics to attract
nurses back to hospital settings; and
(9) while numerous hospitals have begun to take the
necessary steps to address these issues, Congress recognizes
the need for intervention and stimulus.
SEC. 3. NURSE GRANT AND SCHOLARSHIP PROGRAMS.
Title VIII of the Public Health Service Act (42 U.S.C. 296 et seq.)
is amended by adding at the end the following:
``PART H--NURSE GRANT AND SCHOLARSHIP PROGRAM
``SEC. 851. DEFINITIONS.
``In this part:
``(1) Division.--The term `Division' means the Nursing
Division of the Bureau of Health Professions of the Health
Resources and Services Administration.
``(2) Nurse leadership.--The term `nurse leadership'
includes--
``(A) nurse executives;
``(B) nurse administrators; and
``(C) nurse managers.
``(3) Professional nurse.--The term `professional nurse'
means a registered nurse who holds a valid and unrestricted
license to practice nursing in a State.
``SEC. 852. QUALITY OF WORK ENVIRONMENT AND RETENTION GRANT PROGRAM.
``(a) Authorization of Grants.--The Secretary may award grants to
hospitals--
``(1) to improve the quality of the work environment in
hospitals;
``(2) to initiate aggressive retention programs for nurses
employed in hospitals; and
``(3) to employ aggressive recruiting tactics to attract
nurses back to hospitals.
``(b) Application.--
``(1) Development of application form.--Not later than
October 1, 2002, the Secretary shall develop an application
form that a hospital shall use in applying for a grant under
this section.
``(2) Submission.--Each hospital desiring a grant under
subsection (a) shall submit an application to the Division at
such time, in such manner, and accompanied by such information
as the Secretary may reasonably require.
``(3) Duties of the division.--The Division shall--
``(A) review each application submitted under
paragraph (2); and
``(B) not later than 30 business days after receipt
of an application submitted under paragraph (2),
forward the application to the Secretary with a
recommendation as to whether the Secretary should award
a grant to the applicant.
``(4) Duties of the secretary.--Not later than 30 business
days after receipt of an application from the Division under
paragraph (3), the Secretary shall determine whether to award a
grant to the applicant.
``(c) Grant Approval Criteria.--
``(1) Priority criteria.--The Secretary shall give priority
in awarding grants under this section to hospitals that have
not previously received a grant under this section.
``(2) Requirements.--Before awarding a grant under
subsection (a), the Secretary shall assure that the hospital
meets the following criteria:
``(A) Multiple grants.--The hospital has not
received a grant under this section during the previous
2 year period.
``(B) System of patient outcomes measurement.--
``(i) In general.--The nurse leadership and
professional nurses of the hospital have
developed a system of patient outcomes
measurement.
``(ii) Delivery of care.--The system of
patient outcomes measurement under clause (i)
evaluates the specific care needs of the
patients served by the hospital and the
educational needs of the nursing staff of the
hospital to ensure that the care the hospital
is providing is meeting the needs of the
patients.
``(iii) Funding.--The hospital allocates
sufficient funds to carry out the system of
patient outcomes measurement under clause (i).
``(C) Decisionmaking.--
``(i) Multidisciplinary approach.--The
hospital uses a multidisciplinary
decisionmaking process that incorporates the
input of the nursing staff of the hospital when
refinements, resulting from the evaluation
under subparagraph (B)(ii), are developed.
``(ii) Participation in decisionmaking.--
The nurse leadership of the hospital has
developed and implemented policies and
practices that--
``(I) ensure participation of the
nursing staff of the hospital in the
decisionmaking processes of the
hospital; and
``(II) foster the nursing staff's
ability to maintain autonomy in the
delivery of care.
``(D) Nurse executive participation.--The nurse
executive in the hospital participates and provides
input in all facets of senior level management as a
member of the executive team of the hospital.
``(E) Nurse retention committee.--The nurse
leadership of the hospital has organized a Nurse
Retention Committee that--
``(i) includes nursing staff
representatives from the various nursing
specialties practicing in the hospital;
``(ii) meets on a regular basis and
forwards recommendations for initiatives to
increase nurse retention to the nurse
leadership; and
``(iii) works with the nurse leadership of
the hospital to address and forward the
recommendations under clause (ii) to the
executive team of the hospital.
``(F) Nurse residency training program.--
``(i) In general.--The hospital has
developed a Nurse Residency Training Program
(referred to in this section as the `NRTP')
for--
``(I) new graduate nurses entering
the workforce on a full-time basis in a
hospital setting; and
``(II) nurses returning to a
hospital staff on a full-time basis
after an absence of not less than 3
years without working in the nursing
field.
``(ii) Returning nurses.--The nurse
leadership of the hospital evaluates the skills
and competencies of each nurse described in
clause (i)(II) to determine--
(I) whether that nurse needs to
participate in the NRTP; and
(II) for how long that nurse should
participate in the NRTP if it is
determined under subclause (I) that the
nurse needs to participate in the NRTP.
``(iii) Training.--The--
``(I) hospital coordinates, to the
greatest extent possible, the NRTP with
an accredited school of nursing; or
``(II) NRTP is not less than 3
months and not more than 1 year in
duration and accommodates sufficient
training opportunities as determined by
the nurse leadership in the facility.
``(G) Continuing education.--The hospital promotes
and, to the greatest extent possible, provides
continuing education for the nursing staff--
``(i) to obtain nursing-related
certification;
``(ii) to maintain continuing education
units as required for nursing-licensure; and
``(iii) to further clinical skills through
advanced training opportunities.
``(H) Recognition and reward program.--The hospital
has developed a recognition and reward program in
conjunction with subparagraph (G) for a nurse who
obtains a nursing-related certification from an
accredited or professionally recognized organization
that provides--
``(i) financial recognition and rewards; or
``(ii) non-financial recognition and
rewards that are determined by the Nurse
Retention Committee of the hospital to be
appropriate.
``(d) Allocation.--
``(1) In general.--The Secretary shall determine the amount
of a grant awarded to a hospital under this section on a case
by case basis subject to paragraph (2).
``(2) Maximum amounts.--The Secretary shall not award a
grant exceeding--
``(A) $200,000 for a hospital with less than 100
staffed beds;
``(B) $400,000 for a hospital with less than 400
staffed beds; and
``(C) $600,000 for a hospital with 400 or more
staffed beds.
``(e) Receipt of Funds.--Not later than 60 days after awarding a
grant to a hospital under subsection (a), the Secretary shall
distribute the grant funds to the hospital.
``(f) Uses of Funds.--A grant awarded to a hospital under
subsection (a) shall be used for 1 or more of the following:
``(1) Improvements to the work environment of the hospital
for the nursing staff that improves the nursing staff's job
satisfaction or safety, or both.
``(2) To provide continuing education programs for the
nursing staff.
``(3) To continue the Nurse Residency Training Program.
``(4) To carry out initiatives recommended by the Nursing
Retention Committee of the hospital to increase retention of
the nursing staff.
``(g) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $30,000,000 for each of fiscal
years 2003 through 2005 and such sums as are necessary for each of
fiscal years 2006 and 2007.
``SEC. 853. BRIDGE SCHOLARSHIP PROGRAM.
``(a) Program Authorized.--The Secretary shall establish a Bridge
Scholarship Program (referred to in this section as the `program') to
provide scholarships to hospital-based professional nurses to enable
such nurses to complete a Bachelor of Science in Nursing degree
(referred to in this section as the `degree') in exchange for service
from such nurses in sponsoring hospitals upon completion of such
degree.
``(b) Eligibility.--To be eligible to participate in the program an
individual shall--
``(1) be employed by a hospital;
``(2) be accepted for enrollment, or be enrolled, in an
accredited school of nursing;
``(3) submit the required materials in accordance with
subsection (c)(2); and
``(4) be able to complete the degree not later than 3 years
after enrolling in the accredited school of nursing.
``(c) Application Process.--
``(1) Development of application form.--The Secretary shall
develop an application form that an individual shall use to
apply for a scholarship under the program.
``(2) Submission.--Each individual desiring a scholarship
under the program shall submit to the hospital where the
individual is employed--
``(A) an official letter from each State licensing
agency where the individual is licensed to practice
nursing that the individual--
``(i) has an unrestricted license to
practice nursing; and
``(ii) is in good standing;
``(B) an application for participation in the
program;
``(C) proof of acceptance for enrollment, or
enrollment in, an accredited school of nursing; and
``(D) a written contract accepting payment of a
scholarship in exchange for providing the required
service in the hospital where the individual is
employed.
``(3) Duty of the hospital.--A hospital that receives the
materials described in paragraph (2) shall--
``(A) make a determination as to whether to enter
into the contract under paragraph (2)(D) with the
individual; and
``(B) if the hospital elects to enter into the
contract with the individual, not later than May 31 of
each calendar year, forward the materials it receives
under paragraph (2) to the Division.
``(4) Duties of the division.--The Division shall--
``(A) review the materials forwarded under
paragraph (3); and
``(B) not later than 30 days after receipt of the
materials forwarded under paragraph (3), forward the
materials to the Secretary with a recommendation as to
whether the Secretary should award a scholarship to the
applicant.
``(5) Duties of the secretary.--Not later than 30 days
after--
``(A) receipt of the materials forwarded under
paragraph (4), the Secretary shall approve or
disapprove the application submitted under paragraph
(2); and
``(B) the Secretary approves or disapproves an
application under subparagraph (A), the Secretary shall
notify the applicant in writing of the approval or
disapproval.
``(d) Contract.--
``(1) In general.--The Secretary shall develop a written
contract for participation in the program.
``(2) Content.--The contract described in paragraph (1)
shall be an agreement between the Secretary, the individual,
and the sponsoring hospital that states that, subject to
paragraph (3)--
``(A) the Secretary agrees to--
``(i) provide the individual with a
scholarship in each school year, not to exceed
3 years, in which the individual is pursuing
the degree; and
``(ii) accept the individual into the
program;
``(B) the individual agrees to--
``(i) accept any provision of such a
scholarship;
``(ii) maintain enrollment in the
accredited school of nursing until the
individual completes the degree;
``(iii) while enrolled in the accredited
school of nursing, maintain an acceptable level
of academic standing; and
``(iv) work as a nurse at the sponsoring
hospital upon completion of the degree for a
period of 1 month for each month the individual
was provided a scholarship under the program;
and
``(C) the sponsoring hospital agrees to--
``(i) provide the option for the individual
to work as a nurse while the individual is
enrolled in the accredited school of nursing
for any employment-shifts on which the
individual and sponsoring hospital jointly
agree (such work will not count towards the
requirements of the individual to work at the
sponsoring hospital under subparagraph
(B)(iv)); and
``(ii) if the sponsoring hospital
terminates the employment of the individual
while the individual is working at the
sponsoring hospital pursuant to subparagraph
(B)(iv), submit to the Secretary a written
explanation as to why the individual was
terminated.
``(3) Limitation.--The contract described in paragraph (1)
shall contain a provision that any financial obligation of the
United States arising out of a contract entered into under this
section and any obligation of the individual and the sponsoring
hospital which is conditioned thereon, is contingent upon funds
being appropriated for scholarships under this section.
``(e) Payment.--
``(1) In general.--A scholarship provided to an individual
under the program shall consist of payment to, or (in
accordance with paragraph (2)) on behalf of, the individual of
the amount of the tuition of the individual in such school
year.
``(2) Contract.--The Secretary may contract with an
accredited school of nursing, in which an individual in the
program is enrolled, for the payment to the accredited school
of nursing of the amount of tuition described in paragraph (1).
``(f) Breach of Agreement.--
``(1) Individual.--Subject to paragraph (3), if an
individual participates in the program under this section and
agrees to work as a nurse at the sponsoring hospital for a
period of time in consideration for receipt of a scholarship to
pursue a degree, the individual is liable to the Federal
Government for the amount of such scholarship, and for interest
on such amount at the maximum legal prevailing rate, if the
individual--
``(A) fails to work as a nurse in accordance with
subsection (d)(2)(B)(iv);
``(B) fails to maintain an acceptable level of
academic standing in the degree program (as indicated
by the accredited school of nursing in accordance with
requirements established by the Secretary);
``(C) is dismissed from the degree program for
disciplinary reasons; or
``(D) voluntarily terminates the degree program.
``(2) Sponsoring hospital.--If the sponsoring hospital
fails to comply with subsection (d)(2)(C)(ii), the sponsoring
hospital is liable to the Federal Government for the amount of
the scholarship, and for interest on such amount at the maximum
legal prevailing rate, of the individual whose employment was
terminated.
``(3) Waiver or suspension of liability.--The Secretary
shall waive liability--
``(A) under paragraph (1) if compliance by the
individual with the agreement involved is impossible
due to a catastrophic life event of the individual; or
``(B) under paragraph (1)(A) if the sponsoring
hospital terminates the employment of the individual.
``(g) Report.--
``(1) In general.--Not later than 18 months after the first
scholarship is awarded under this section, the Division shall
submit to Congress a report evaluating the success of the
program.
``(2) Information.--In order to prepare the report under
paragraph (1), the Division shall maintain information about
the scholarship recipients under this section, including--
``(A) grade reports from the accredited schools of
nursing;
``(B) the degree graduation rate; and
``(C) the default rate on the contracts under the
program.
``(h) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $20,000,000 for each of fiscal
years 2003 through 2005 and such sums as are necessary for each of
fiscal years 2006 and 2007.''.
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