[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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