[Congressional Record Volume 147, Number 147 (Tuesday, October 30, 2001)]
[Senate]
[Pages S11199-S11202]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. LIEBERMAN (for himself and Mr. Ensign):
  S. 1585. A bill to establish grant and scholarship programs to enable 
hospitals to retain and further educate their nursing staffs; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. LIEBERMAN. Madam President, I rise today to introduce the 
Hospital Based Nursing Initiative Act, a bill that will create new and 
innovative incentives to lessen the impact of the critical shortage of 
nurses in our Nation's hospitals. I am very pleased that my respected 
colleague, Senator John Ensign, is joining as sponsor of this 
legislation/
  Before I get into the specific about the bill, I'd like to talk about 
the overall condition of nursing in America for a moment. Several 
studies have been completed in the past year that show troubling trends 
developing in this historic profession. Take for example, the study 
that reflects a 41 percent dissatisfaction rate among nurses in 
America, higher than the dissatisfaction rate in most other countries 
throughout the world. Think about that for a moment, 4 out of 10 nurses 
in America are dissatisfied with their profession.
  Another study reveals that nearly one third of nurses under the age 
of 30 plan to leave the nursing profession within the next year. In 
addition, the average age of nurses in America is 45, with many nurses 
headed toward early retirement. We cannot afford to lose both the older 
and younger nurses at the same time. Further, while the number of 
people that are being hospitalized may continue to decrease, those 
people who are being admitted are sicker and need more intensive 
nursing care. Not a very rosy picture for patients who are sick. We 
need to ask will there be someone to provide care for them?
  The shortage of nurses has severely affected the health care 
industry. And hospitals have been hit the hardest since nearly 60 
percent of nurses work in hospitals. Further, we know that when nurses 
have more autonomy, greater control and input into the decision making 
process, and better communication with physicians and hospital 
administration, they are more likely to experience greater job 
satisfaction and stay in their jobs longer. These very tenets make up 
the American Nurse Credentialing Center's ``Magnet'' accreditation 
process of nursing services at hospitals. As a result, Magnet hospitals 
lead the way in attracting and retaining nurses.
  Many hospitals have begun to take these steps already. But more must 
be done. There must be incentives for hospitals to revise their 
management principles to improve the quality of the work environment in 
the hospital, initiate aggressive retention programs for nurses 
currently working in the hospital setting, and create the types of 
programs that will increase personal and professional satisfaction for 
the nurses in their facilities.
  That is why I am introducing the Hospital Based Nursing Initiative 
Act of 2001. This bill will create innovative incentives for hospitals 
that have taken the first steps in developing aggressive retention 
techniques and develop a scholarship program for hospital-based nurses 
to return to school on full tuition scholarship to complete a nursing 
degree.
  The first component of this bill will create a competitive grant 
program that would provide funds to hospitals of up to $600,000 based 
on staffed bed size for nursing services to use to bolster their 
retention efforts and improve the work environment for the nursing 
staff in the hospital. These grants would be made available every two 
years on a competitive basis. Several major nursing and hospital 
organizations, such as the American Hospital Association, American 
Nurses Association, American College of Health Care Executives, the 
American Organization of Nurse Executives, the American Academy of 
Nursing, the Pennsylvania State Nurses Association and the American 
Federation of Hospitals have wholeheartedly endorsed this bill. I am 
pleased that legislation which incorporates a number of ideas in this 
bill is moving toward markup in the Senate Health, Education, Labor and 
Pensions Committee. I appreciate the cooperative spirit with which 
members of the committee have worked together on these ideas.
  The second part of my bill would allow nurses who work in hospitals 
to return to school on a full tuition scholarship in order to complete 
a Bachelor of Science in Nursing. This ``Bridge'' scholarship program 
targets the nearly 55 percent of the nursing workforce who hold an 
Associate's Degree in Nursing or Diploma in Nursing. Under the Bridge 
program, nurses will have up to three years to complete the Bachelor's 
degree. In turn, nurses who accept the scholarship must agree to work 
in the sponsoring hospitals for the same number of months that they 
receive scholarship funding. This program is a win-win situation: It 
provides ongoing advanced education for nurses who seek a higher level 
of training and we keep skilled nurses working in our hospitals.
  We have the opportunity to make a difference. With the bill that 
Senator

[[Page S11200]]

Ensign and I are now introducing, we can take the necessary steps to 
thwart the nursing shortage and provide the critical incentives for 
hospitals to retain their nurses. We must do all we can to improve job 
satisfaction for nurses, provide them with opportunities for advanced 
education, and keep nurses on the job. The Hospital Based Nursing 
Initiative is the right bill at the right time. I urge my colleagues to 
support this legislation and help ease the burden on hospitals and 
nurses in our hospitals.
  I ask unanimous consent that the text of the bill be printed in the 
Record. I further ask unanimous consent that letters supporting this 
legislation and its approach from each of the organizations I cited 
above likewise be printed in the Record.
  There being no objection, the bill and additional material was 
ordered to be printed in the Record, as follows:

                                S. 1585

       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;

[[Page S11201]]

       ``(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.''.
                                  ____



                                American Hospital Association,

                                  Washington, DC, October 8, 2001.
     Hon. Joseph Lieberman,
     U.S. Senate, Washington, DC.
       Dear Senator Lieberman: The American Hospital Association 
     (AHA) commends your efforts to address the nursing workforce 
     shortage in your bill, The Hospital-Based Nursing Initiative 
     Act of 2001, and is pleased to endorse your legislation. We 
     believe your bill is an important component in the overall 
     strategy of addressing the national nursing shortage.
       The AHA represents nearly 5,000 hospitals, health systems, 
     networks and other health care provider members.
       Hospitals and health care facilities across America are 
     experiencing a critical shortage of nurses. A recent AHA 
     survey of the workforce shows that there are currently up to 
     126,000 Registered Nurses (RNs) needed by hospitals today. 
     Over the past five years, enrollments in nursing programs 
     have declined and this trend is expected to continue for the 
     foreseeable future. The average age of a working RN is now 
     over 43 years old, and is expected to continue to increase 
     before peaking at age 45.5 in 2010, when many RNs will

[[Page S11202]]

     begin to retire. And, the need for nurses will be further 
     compounded by the potential health care demands of the 
     looming 78 million aging ``baby boomers'' who will begin to 
     retire over the next 10 years.
       The current nursing shortage is creating an environment 
     with the potential to jeopardize hospitals' ability to 
     provide timely access to non-emergency, as well as emergency, 
     services. An inadequate number and mix of personnel has 
     caused some facilities to close beds, put emergency rooms on 
     ``divert'' status, delay elective surgeries, and pare down 
     hospital services.
       Hospitals have enlisted many strategies and creative 
     approaches to address the nursing shortage, but this is a 
     complex problem that cannot be solved by hospitals alone. The 
     role of the federal government is critical in the support and 
     funding of an adequate nursing workforce.
       ``The Hospital-Based Nursing Initiative Act of 2001'' 
     provides significant incentives for hospitals to examine and 
     revise management principles to improve the quality of their 
     work environment, and to foster effective RN retention 
     programs. It establishes incentives for hospitals to develop 
     and implement aggressive recruitment programs to attract 
     nurses into the hospital setting. The legislation also 
     creates bridge programs for RNs currently employed in 
     hospitals to move up the career ladder, a significant 
     recruitment and retention tool.
       Helping alleviate the critical shortage of nurses is a 
     priority for health care providers. As we debate this and 
     other measures to address the nursing shortage, we hope 
     Congress will recognize the important of investing in this 
     critical area of need. We applaud your effort and pledge to 
     work with you to address this very important issue.
           Sincerely,
                                                     Rick Pollack,
     Executive Vice President.
                                  ____

                                             American Organization


                                          of Nurse Executives,

                               Washington, DC, September 14, 2001.
     Hon. Joseph I. Lieberman,
     U.S. Senate, Washington, DC.
       Dear Senator Lieberman: On behalf of more than 3800 members 
     of the American Organization of Nurse Executives (AONE) 
     representing nurses in executive practice, I would like to 
     express our strong support for the ``Hospital-Based Nursing 
     Initiative Act of 2001,'' legislation that you have authored 
     and plan to introduce to address the critical nurse shortage.
       During the past year, AONE has played a pivotal role in 
     addressing the nursing shortage. In October 2000 we published 
     the first comprehensive monograph on this critical issue 
     entitled Perspectives on the Nursing Shortage: A Blueprint 
     for Action and have continued to provide both education and 
     advocacy for the nursing profession on a number of different 
     fronts. Your bill will provide important management 
     incentives for hospitals to revise their management of 
     nursing services in order to foster retention and promote 
     recruitment of nurses back into the inpatient delivery 
     system.
       The majority of AONE's membership are leaders in the day-
     to-day management and delivery of direct patient care 
     services, as a result, we understand firsthand the impacts 
     and consequences of the growing nursing shortage both in this 
     country and internationally. Our support of the ``Hospital-
     Based Nursing Initiative Act of 2001'' is based on the 
     positive contributions that this legislation will make to 
     nurse-directed efforts to foster retention and promote 
     recruitment of nurses within the inpatient settings of our 
     federal, community, and private hospitals. This legislation 
     will also establish important bridge programs for registered 
     nurses currently employed in hospitals to move from diploma 
     and Associate Degree levels of education on to a Bachelor of 
     Science degree within three years.
       AONE applauds your efforts to address the nursing shortage 
     through this innovative grant and scholarship program. We 
     look forward to working with you to solve this critical 
     health manpower problem.
           Sincerely,
                                      Pamela A. Thompson, MSN, RN,
                                               Executive Director.
                                          Dianne Anderson, MS, RN,
     President.
                                  ____



                                  American Nurses Association,

                               Washington, DC, September 19, 2001.
     Hon. Joseph Lieberman,
     U.S. Senate, Washington, DC.
       Dear Senator Lieberman: I am writing you on behalf of the 
     American Nurses Association (ANA) to express support for the 
     Hospital-Based Nursing Initiative Act. We applaud your hard 
     work on this important issue. ANA is the only full-service 
     association representing the nation's registered nurses (RNs) 
     through its 54 state and territorial member nurse 
     associations. With more than 160,000 members, the ANA 
     represents RNs in all practice settings throughout our 
     nation.
       ANA understands that a major contributing factor to the 
     current and emerging nursing shortage is dissatisfaction with 
     the work environment. The Congressional Research Service, 
     General Accounting Office, academic research, and recent ANA 
     surveys of American nurses have all revealed startling levels 
     of frustration with working conditions. This dissatisfaction 
     is leading experienced nurses to leave the bedside, and 
     hindering recruitment efforts.
       Fortunately, we know what can be done to address this 
     growing problem. There are proven best practices for nursing 
     that improve patient outcomes, and enhance nurse recruitment 
     and retention. The American Nurses Credentialing Center, an 
     ANA affiliate, recognizes facilities that have met these best 
     practices by granting the `Magnet' designation. Magnet 
     facilities have consistently outperformed their peers in 
     nursing services, even in times of national nursing 
     shortages. In fact, average nurse retention in Magnet 
     facilities is twice as long as that of non-Magnet 
     institutions.
       ANA is pleased to endorse your efforts to further the 
     implementation of these best practices through the Hospital-
     Based Nursing Initiative Act. The quality of work environment 
     and nurse retention grant program, and the continuing 
     education scholarships contained in your bill will greatly 
     aide in the adoption of Magnet criteria. ANA looks forward to 
     working with you and your staff to support this legislation.
           Sincerely,
                                           Rose Gonzalez, MPS, RN,
     Director, Government Affairs.
                                  ____

                                                  American College


                                     of Healthcare Executives,

                                  Chicago, IL, September 18, 2001.
     Hon. Joseph I. Lieberman,
     U.S. Senate, Washington, DC.
       Dear Senator Lieberman: Thank you for inviting the American 
     College of Healthcare Executives to review and provide 
     comments on the ``Hospital-Based Nursing Initiative Act of 
     2001.''
       Upon reviewing the bill, ACHE wishes to endorse it. This 
     legislation offers a comprehensive approach to the crisis 
     facing our nation's healthcare system--a shortage of nurses. 
     The bill attempts to address this important issue by 
     supporting hospitals in a number of ways, including: 
     retaining nurses; improving the work environment for nursing 
     staff; fostering nursing leadership; providing continuing 
     education programs for nurses; creating recognition and 
     reward programs for nurses who obtain nursing-related 
     certification; and finally, offering educational assistance 
     for nurses to earn their Bachelor of Science Degree in 
     Nursing. We believe this bill encompasses the various 
     elements to make a genuine difference and increase the 
     nursing population.
       Thank you for your work in developing this legislation. If 
     there is anything ACHE can do to assist further in this 
     endeavor, please contact Susan M. Oster, CAE, Vice President, 
     Administration at (312) 424-9340.
           Sincerely,
                               Thomas C. Dolan, Ph.D., FACHE, CAE,
     President and Chief Executive Officer.
                                  ____

                                                Pennsylvania State


                                           Nurses Association,

                               Harrisburg, PA, September 17, 2001.
     Hon. Joseph Lieberman,
     U.S. Congress, Washington, DC.
       Dear Senator Lieberman: The Pennsylvania State Nurses 
     Association (PSNA) would like to commend you for the 
     excellent legislation you plan to introduce, which is meant 
     to establish grant and scholarship programs enabling 
     hospitals to retain and further educate their nursing staffs. 
     The bill contains excellent ideas and creative solutions to 
     entice nurses to join or remain a member of a hospital 
     nursing staff.
       The focus on nurses having opportunities to participate in 
     decision-making regarding nursing care and maintaining 
     autonomy in the delivery of care are especially important 
     attractants for nurses. Also, the emphasis on having a system 
     for measuring outcomes is imperative for quality patient 
     care.
       The organization welcomes the opportunity to work with you 
     in ensuring the passage of the legislation that will greatly 
     benefit the profession of nursing and the quality of care 
     provided to consumers.
           Sincerely,
                                       Jessie F. Rohner, DrPH, RN,
                                  Interim Executive Administrator.
                                 ______