[Congressional Record Volume 150, Number 120 (Wednesday, September 29, 2004)]
[House]
[Pages H7797-H7802]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


[[Page H7797]]
 DEPARTMENT OF VETERANS AFFAIRS NURSE RECRUITMENT AND RETENTION ACT OF 
                                  2004

  Mr. SMITH of New Jersey. Mr. Speaker, I move to suspend the rules and 
pass the bill (H.R. 4231) to provide for a pilot program in the 
Department of Veterans Affairs to improve recruitment and retention of 
nurses, and for other purposes, as amended.
  The Clerk read as follows:

                               H.R. 4231

       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 ``Department of Veterans 
     Affairs Nurse Recruitment and Retention Act of 2004''.

     SEC. 2. PILOT PROGRAM TO STUDY INNOVATIVE RECRUITMENT TOOLS 
                   TO ADDRESS NURSING SHORTAGES AT DEPARTMENT OF 
                   VETERANS AFFAIRS HEALTH-CARE FACILITIES.

       (a) Pilot.--(1) Not later than 90 days after the date of 
     the enactment of this Act, the Secretary of Veterans Affairs 
     shall designate a health-care service region, or a section 
     within such a region, in which health-care facilities of the 
     Department of Veterans Affairs are adversely affected by a 
     shortage of qualified nurses.
       (2) The Secretary shall conduct a pilot program in the 
     region or section designated under paragraph (1) to determine 
     the effectiveness of the use of innovative human-capital 
     tools and techniques in the recruitment of qualified nurses 
     for positions at Department health-care facilities and for 
     the retention of nurses at such facilities. In carrying out 
     the pilot program, the Secretary shall enter into a contract 
     with a private-sector entity for services under the pilot 
     program for recruitment of qualified nurses.
       (b) Private-Sector Recruitment Practices.--For purposes of 
     the pilot program under this section, the Secretary shall 
     identify and use recruitment practices that have proven 
     effective for placing qualified individuals in positions that 
     are difficult to fill due to shortages of qualified 
     individuals or other factors. Recruitment practices to be 
     reviewed by the Secretary for use in the pilot program shall 
     include--
       (1) employer branding and interactive advertising 
     strategies;
       (2) Internet technologies and automated staffing systems; 
     and
       (3) the use of recruitment, advertising, and communication 
     agencies.
       (c) Streamlined Hiring Process.--In carrying out the pilot 
     program under this section, the Secretary shall, at health-
     care facilities of the Department in the region or section in 
     which the pilot program is conducted, revise procedures and 
     systems for selecting and hiring qualified nurses to reduce 
     the length of the hiring process. If the Secretary identifies 
     measures to streamline and automate the hiring process that 
     can only be implemented if authorized by law, the Secretary 
     shall submit to the Committees on Veterans' Affairs of the 
     Senate and House of Representatives recommendations for such 
     changes in law as may be necessary to enable such measure to 
     be implemented.
       (d) Report.--Not later than one year after the date of the 
     enactment of this Act, the Secretary shall submit to the 
     Committees on Veterans' Affairs of the Senate and House of 
     Representatives a report on the extent to which the pilot 
     program achieved the goal of improving the recruitment and 
     retention of nurses in Department of Veterans Affairs health-
     care facilities.

     SEC. 3. ALTERNATE WORK SCHEDULES FOR NURSES.

       (a) Enhanced Shift Flexibility.--Chapter 74 of title 38, 
     United States Code, is amended by inserting after section 
     7456 the following new section:

     ``Sec. 7456a. Alternate work schedules

       ``(a) Applicability.--This section applies to registered 
     nurses appointed under this chapter.
       ``(b) 36/40 Work Schedule.--(1) Subject to paragraph (2), 
     if the Secretary determines it to be necessary in order to 
     obtain or retain the services of registered nurses at a 
     Department health-care facility, the Secretary may provide, 
     in the case of registered nurses employed at that facility, 
     that such a nurse who works three regularly scheduled 12-hour 
     tours of duty within a workweek shall be considered for all 
     purposes (except computation of full-time equivalent 
     employees for the purposes of determining compliance with 
     personnel ceilings) to have worked a full 40-hour basic 
     workweek. Such a schedule may be referred to as a `36/40 work 
     schedule'.
       ``(2)(A) Basic and additional pay for a registered nurse 
     who is considered under paragraph (1) to have worked a full 
     40-hour basic workweek is subject to subparagraphs (B) and 
     (C).
       ``(B) The hourly rate of basic pay for such a nurse for 
     service performed as part of a regularly scheduled 36-hour 
     tour of duty within the workweek shall be derived by dividing 
     the nurse's annual rate of basic pay by 1,872.
       ``(C)(i) Such a nurse who performs a period of service in 
     excess of such nurse's regularly scheduled 36-hour tour of 
     duty within a workweek is entitled to overtime pay under 
     section 7453(e) of this title, or other applicable law, for 
     officially ordered or approved service performed in excess 
     of--
       ``(I) eight hours on a day other than a day on which such 
     nurse's regularly scheduled 12-hour tour falls;
       ``(II) 12 hours for any day included in the regularly 
     scheduled 36-hour tour of duty; and
       ``(III) 40 hours during an administrative workweek.
       ``(ii) Except as provided in clause (i), a registered nurse 
     to whom this subsection is applicable is not entitled to 
     additional pay under section 7453 of this title, or other 
     applicable law, for any period included in a regularly 
     scheduled 12-hour tour of duty.
       ``(3) A nurse who works a 36/40 work schedule described in 
     this subsection who is absent on approved sick leave or 
     annual leave during a regularly scheduled 12-hour tour of 
     duty shall be charged for such leave at a rate of ten hours 
     of leave for nine hours of absence.
       ``(c) 7/7 Work Schedule--(1) Subject to paragraph (2), if 
     the Secretary determines it to be necessary in order to 
     obtain or retain the services of registered nurses at a 
     Department health-care facility, the Secretary may provide, 
     in the case of registered nurses employed at such facility, 
     that such a nurse who works seven regularly scheduled 10-hour 
     tours of duty, with seven days off duty, within a two-week 
     pay period, shall be considered for all purposes (except 
     computation of full-time equivalent employees for the 
     purposes of determining compliance with personnel ceilings) 
     to have worked a full 80 hours for the pay period. Such a 
     schedule may be referred to as a `7/7 work schedule'.
       ``(2)(A) Basic and additional pay for a registered nurse 
     who is considered under paragraph (1) to have worked a full 
     80-hour pay period is subject to subparagraphs (B) and (C).
       ``(B) The hourly rate of basic pay for such a nurse for 
     service performed as part of a regularly scheduled 70-hour 
     tour of duty within the pay period shall be derived by 
     dividing the nurse's annual rate of basic pay by 1,820.
       ``(C)(i) Such a nurse who performs a period of service in 
     excess of such nurse's regularly scheduled 70-hour tour of 
     duty within a pay period is entitled to overtime pay under 
     section 7453(e) of this title, or other applicable law, for 
     officially ordered or approved service performed in excess 
     of--
       ``(I) eight hours on a day other than a day on which such 
     nurse's regularly scheduled 10-hour tour falls;
       ``(II) 10 hours for any day included in the regularly 
     scheduled 70-hour tour of duty; and
       ``(III) 80 hours during a pay period.
       ``(ii) Except as provided in subparagraph (i), a registered 
     nurse to whom this subsection is applicable is not entitled 
     to additional pay under section 7453 of this title, or other 
     applicable law, for any period included in a regularly 
     scheduled 10-hour tour of duty.
       ``(3) A nurse who works a 7/7 work schedule described in 
     this subsection who is absent on approved sick leave or 
     annual leave during a regularly scheduled 12-hour tour of 
     duty shall be charged for such leave at a rate of eight hours 
     of leave for seven hours of absence.
       ``(d) 9-Month Work Schedule.--The Secretary may authorize a 
     registered nurse appointed under section 7405 of this title, 
     with the nurse's written consent, to work full-time for nine 
     months with three months off duty, within a fiscal year, and 
     be paid at 75 percent of the full-time rate for such nurse's 
     grade for each pay period of that fiscal year. A nurse 
     working on such a schedule for any fiscal year shall be 
     considered a \3/4\ full-time equivalent employee for that 
     fiscal year in computing full-time equivalent employees for 
     the purposes of determining compliance with personnel 
     ceilings. Service on such a schedule shall be considered to 
     be part-time service for purposes of computing benefits under 
     chapters 83 and 84 of title 5.
       ``(e) Regulations.--The Secretary shall prescribe 
     regulations for the implementation of this section.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of chapter 74 of such title is amended by inserting 
     after the item relating to section 7456 the following new 
     item:

``7456a. Alternate work schedules.''.

     SEC. 4. TECHNICAL CORRECTION TO LISTING OF CERTAIN HYBRID 
                   POSITIONS IN VETERANS HEALTH ADMINISTRATION.

       Section 7401(3) of title 38, United States Code, is 
     amended--
       (1) by striking ``and dental technologists'' and inserting 
     ``technologists, dental hygienists, dental assistants''; and
       (2) by striking ``technicians, therapeutic radiologic 
     technicians, and social workers'' and inserting 
     ``technologists, therapeutic radiologic technologists, social 
     workers, blind rehabilitation specialists, and blind 
     rehabilitation outpatient specialists''.

     SEC. 5. ASSISTANCE FOR HIRING AND RETENTION OF NURSES AT 
                   STATE VETERANS HOMES.

       (a) In General.--(1) Chapter 17 of title 38, United States 
     Code, is amended by inserting after section 1743 the 
     following new section:

     ``Sec. 1744. Hiring and retention of nurses: payments to 
       assist States

       ``(a) Payment Program.--The Secretary shall make payments 
     to States under this section for the purpose of assisting 
     State homes in the hiring and retention of nurses and the 
     reduction of nursing shortages at State homes.
       ``(b) Eligible Recipients.--Payments to a State for a 
     fiscal year under this section shall, subject to submission 
     of an application, be made to any State that during that 
     year--

[[Page H7798]]

       ``(1) receives per diem payments under this subchapter for 
     that fiscal year; and
       ``(2) has in effect an employee incentive scholarship 
     program or other employee incentive program at a State home 
     designed to promote the hiring and retention of nursing staff 
     and to reduce nursing shortages at that home.
       ``(c) Use of Funds Received.--A State may use an amount 
     received under this section only to provide funds for a 
     program described in subsection (b)(2). Any program shall 
     meet such criteria as the Secretary may prescribe. In 
     prescribing such criteria, the Secretary shall take into 
     consideration the need for flexibility and innovation.
       ``(d) Limitations on Amount of Payment.--(1) A payment 
     under this section may not be used to provide more than 50 
     percent of the costs for a fiscal year of the employee 
     incentive scholarship or other incentive program for which 
     the payment is made.
       ``(2) The amount of the payment to a State under this 
     section for any fiscal year is, for each State home in that 
     State with a program described in subsection (b)(2), the 
     amount equal to 2 percent of the amount of payments estimated 
     to be made to that State, for that State home, under section 
     1741 of this title for that fiscal year.
       ``(e) Applications.--A payment under this section for any 
     fiscal year with respect to any State home may only be made 
     based upon an application submitted by the State seeking the 
     payment with respect to that State home. Any such application 
     shall describe the nursing shortage at the State home and the 
     employee incentive scholarship program or other incentive 
     program described in subsection (c) for which the payment is 
     sought.
       ``(f) Source of Funds.--Payments under this section shall 
     be made from funds available for other payments under this 
     subchapter.
       ``(g) Disbursement.--Payments under this section to a State 
     home shall be made as part of the disbursement of payments 
     under section 1741 of this title with respect to that State 
     home.
       ``(h) Use of Certain Receipts.--The Secretary shall require 
     as a condition of any payment under this section that, in any 
     case in which the State home receives a refund payment made 
     by an employee in breach of the terms of an agreement for 
     employee assistance that used funds provided under this 
     section, the payment shall be returned to the State home's 
     incentive program account and credited as a non-Federal 
     funding source.
       ``(i) Annual Report From Payment Recipients.--Any State 
     home receiving a payment under this section for any fiscal 
     year, shall, as a condition of the payment, be required to 
     agree to provide to the Secretary a report setting forth in 
     detail the use of funds received through the payment, 
     including a descriptive analysis of how effective the 
     incentive program has been on nurse staffing in the State 
     home during that fiscal year. The report for any fiscal year 
     shall be provided to the Secretary within 60 days of the 
     close of the fiscal year and shall be subject to audit by the 
     Secretary. Eligibility for a payment under this section for 
     any later fiscal year is contingent upon the receipt by the 
     Secretary of the annual report under this subsection for the 
     previous year in accordance with this subsection.
       ``(j) Regulations.--The Secretary shall prescribe 
     regulations to carry out this section. The regulations shall 
     include the establishment of criteria for the award of 
     payments under this section.''.
       (2) The table of sections at the beginning of such chapter 
     is amended by inserting after section 1743 the following new 
     item:

``1744. Hiring and retention of nurses: payments to assist States.''.

       (b) Implementation.--The Secretary of Veterans Affairs 
     shall implement section 1744 of title 38, United States Code, 
     as added by subsection (a), as expeditiously as possible. The 
     Secretary shall establish such interim procedures as 
     necessary so as to ensure that payments are made to eligible 
     States under that section commencing not later than January 
     1, 2005, notwithstanding that regulations under subsection 
     (j) of that section may not have become final.

     SEC. 6. TECHNICAL CLARIFICATION.

       Section 8111(d)(2) of title 38, United States Code, is 
     amended by inserting before the period at the end of the last 
     sentence the following: ``and shall be available for any 
     purpose authorized by this section''.

     SEC. 7. UNDER SECRETARY FOR HEALTH.

       Section 305(a)(2) of title 38, United States Code, is 
     amended--
       (1) in the matter preceding subparagraph (A), by striking 
     ``shall be a doctor of medicine and''; and
       (2) in subparagraph (A), by striking ``and in health-care'' 
     and inserting ``or in health-care''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Smith) and the gentleman from Texas (Mr. Rodriguez) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey (Mr. Smith).


                             General Leave

  Mr. SMITH of New Jersey. Mr. Speaker, I ask unanimous consent that 
all Members may have 5 legislative days within which to revise and 
extend their remarks and include extraneous material on the bill under 
consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. SMITH of New Jersey. Mr. Speaker, I yield myself such time as I 
may consume.
  (Mr. SMITH of New Jersey asked and was given permission to revise and 
extend his remarks.)
  Mr. SMITH of New Jersey. Mr. Speaker, I rise in very strong support 
of H.R. 4231, as amended, the Department of Veterans Affairs Nurse 
Recruitment and Retention Act of 2004. I want to thank the gentleman 
from Connecticut (Mr. Simmons), the chairman of our Subcommittee on 
Health, my friend and colleague, for introducing this legislation, and 
for his astute judgment and perseverance that was essential in bringing 
this bill before the House today. I also want to thank the gentleman 
from Texas (Mr. Rodriguez), as well the gentleman from Illinois (Mr. 
Evans), because, again, that partnership is so important in bringing 
these veterans bills to the floor; and I want to thank them for their 
leadership as well.
  As amended, H.R. 4231 would authorize several new and innovative 
approaches to help the VA maintain the quality of its workforce in all 
VA health care facilities. The bill would establish a pilot program to 
use outside recruitment agencies with interactive and online 
technologies to improve VA recruitment of vital nursing personnel. It 
would also allow the VA to offer three alternative work schedules for 
nurses so that employment in VA can be more sensitive to family and 
personal needs for scheduling flexibility and career development.
  It also contains a provision to aid State veterans homes which care 
for thousands of veterans in need of nursing home care each and every 
year.
  One measure in the bill as reported deserves a moment of discussion, 
because it caused some concern for members of the committee and 
organizations whose members might be affected. As reported, the bill 
would have prohibited VA from denying employment to a State-licensed 
registered nurse whose educational preparation was other than a 
baccalaureate degree. There is a well-documented shortage, Mr. Speaker, 
of trained, registered nurses in the United States. Community colleges 
in every State have stepped forward to offer professional nursing 
careers through associate degree preparation. Their success in 
preparing their students is reflected in the rate at which associate 
degreed nurses pass required State registered nurse examinations.
  Associate degree nurses are systematically and vigorously recruited 
in almost every health care institution in the United States. In the 
VA, there is a preference in hiring baccalaureate graduates and a 
policy of excluding associate degree nurses from internal VA 
promotions. At a time when nurses are in short supply and when 
community colleges are the primary source of new nursing graduates, 
should the VA be emphasizing baccalaureate degrees to the exclusion of 
others who are fully qualified as professional nurses? We think not.
  The committee is concerned that these current VA hiring practices and 
the variation in these practices noted in the recent report of the VA's 
National Commission on VA Nursing discouraged nurses with associate 
degrees from even seeking VA employment. VA's practice of exclusion in 
the face of high demand and scarcity of nursing personnel discourages 
qualified nurses from seeking VA employment. This practice also 
adversely affects VA's ability to retain current nurses.
  Following extensive discussions after this bill was ordered reported, 
the bill before the House today does not include section 4 of the bill 
as ordered reported. Section 4 was designed to keep the VA competitive 
with the private sector and to clarify that the lack of a baccalaureate 
degree could not be the basis to deny nurse employment in a VA 
facility. However, the aim of the provision was misread by some who 
believe that the best qualified nurses are those who have a bachelor's 
degree or some advanced degree in nursing.
  Most of us who seek health care look to providers who are competent, 
compassionate, critical thinkers, good communicators, and who are 
dedicated to expanding their knowledge of human

[[Page H7799]]

susceptibility to disease. None of those qualities are guaranteed to be 
present in a particular graduate of any health care profession from any 
school. In the case of nurses, competence is tested by State licensing 
exams, and only those who pass the exam are licensed to practice in a 
State or in the VA. The other qualities I mentioned are acquired from 
associating with and learning from other professionals who possess 
them. There is no guarantee that any particular licensed professional 
possesses all of them.
  Mr. Speaker, VA's own hiring policy requires that persons with 
associate degrees in nursing be considered at entry-level positions. 
The committee supports the underlying premise of this policy, and there 
should be no discrimination based against persons who demonstrate 
competence by passing a State examination. Unfortunately, the committee 
has gathered irrefutable evidence that some VA medical centers did 
violate VA's hiring policy and discriminated against prospective 
employees who possessed an associate degree in nursing.
  The committee has recently received assurances, however, from the 
acting Under Secretary for Health that the VA will correct these 
improper practices. He has pledged that the VA will continue to adhere 
to its policy of considering appointment of licensed, registered nurses 
to entry-level positions without regard to the institution that granted 
them their nursing degree. In addition, the Under Secretary promised to 
undertake a number of significant steps to address any lingering 
effects from the improper recruiting practices which the committee 
discovered.
  In light of this commitment and the VA's concern about the potential 
inadvertent effect of this language, the bill before us today does not 
contain the nursing qualification provision as ordered by the 
committee.
  The committee looks forward to full reports on the execution of the 
several commitments made in a letter signed by Under Secretary on 
September 21 of this year, and I will include the letter at this point 
in the Record.

                                   Department of Veterans Affairs,


                               Veterans Health Administration,

                               Washington, DC, September 21, 2004.
     Hon. Christopher H. Smith,
     Chairman, Committee on Veterans' Affairs,
     House of Representatives, Washington, DC.
       Dear Mr. Chairman: This letter provides the Veterans Health 
     Administration (VHA) position regarding H.R. 4231, Section 
     4--Appointment of nurses who do not have Baccalaureate 
     Degrees.
       VHA is committed to hiring all levels of licensed nurses 
     including Bachelors prepared and registered nurses who have 
     associate degrees or diplomas. In calendar year 2000, VHA 
     appointed 815 associate degree nurses; in calendar year 2004 
     to date, VHA has appointed 1,337 associate degree nurses. 
     Given the national nursing shortage, VHA cannot afford to 
     overlook associate degree nurses. We recognize and value 
     their contributions.
       In order to further enhance recruitment of associate degree 
     nurses, VHA is taking the following actions:
       1. Instruct Department of Veterans Affairs (VA) facility 
     managers and human resources staff to no longer include in 
     vacancy announcements language limiting applicants to those 
     who hold a Bachelor of Science in Nursing (BSN) degree or 
     convey a preference for a BSN for ``Nurse I'' positions.
       2. Continue working with the American Association of 
     Community Colleges (AACC) to augment our marketing and 
     recruiting efforts to associate degree nursing graduates. The 
     Office of Nursing Services in Washington, D.C., will meet 
     with the AACC on a quarterly basis and will present a 
     marketing and recruiting strategy to them. An acceptable 
     plan, including a commitment of VA resources, shall be in 
     place by June 30, 2005.
       3. The Health Care Staff Development and Retention Office 
     will visit at least one community college nursing program 
     affiliated with the AACC in each Veterans Integrated Services 
     Network (VISN) in the coming year, and VA will ensure local 
     facilities conduct outreach to community college programs. VA 
     will provide information regarding employment opportunities, 
     promotion policies, and scholarship and loan repayment 
     programs available from VA. The first cycle of visits will be 
     completed by December 31, 2005. In addition, to accomplish 
     this goal, VISN staff will conduct many of the visits in 
     coordination with the Health Care Staff Development and 
     Retention Office.
       I hope this information is of assistance to you. Should you 
     need additional information, a member of your staff may 
     contact Nevin Weaver, Director, Management Support Office at 
     202-273-5805.
           Sincerely,

                                       Jonathan B. Perlin, MD,

                                                  PhD, MSHA, FACP,
                                Acting Under Secretary for Health.

  The last provision in the amended bill I want to mention incorporates 
the provisions of a bill that I introduced earlier this year, H.R. 
4020. That bill would direct the Secretary of Veterans Affairs to make 
increased grants to assist States in hiring and retaining their own 
nursing personnel at State-owned operating nursing homes for veterans. 
State homes that currently receive per diem payments from the VA and 
have established employee incentive programs would be eligible to apply 
for incentive assistance and could receive up to 50 percent of the 
annual cost of the incentive program.
  Mr. Speaker, in the wake of the Civil War, State veterans homes began 
caring for veterans and are now the largest provider of long-term care 
to our Nation's veterans. Today, over 16,000 veterans are being cared 
for in 128 State veterans homes in 47 States in the key partnership 
between the States and the VA.
  The Department of Health and Human Services in 2002 surveyed the 50 
States and Puerto Rico to learn how States are responding to the needs 
of health care workers. Ninety percent reported a shortage of nursing 
staff as a major concern in their responses. In efforts to respond to 
these nursing and other health care worker shortages, 44 of the 50 
States reporting established task forces and commissions to study and 
seek solutions. The focus of the task forces or commissions in 25 
States was to study shortages in the long-term health care force.
  I am aware of difficulties that the three New Jersey State veterans 
homes in Vineland, Paramus, and Menlo Park have faced over the past 
several years in recruiting and retaining nursing staff. We can address 
this effort with new Federal incentives that supplement and assist 
State initiatives in providing long-term care to veterans. I think this 
legislation provides a sound blending of authorities to help maintain 
quality nursing personnel for veterans cared for in both the VA and 
State-run facilities.
  Mr. Speaker, I rise in strong support of H.R. 4231, as amended, the 
Department of Veterans Affairs Nurse Recruitment and Retention Act of 
2004.
  I want to thank the Chairman of our Subcommittee on Health, my friend 
the gentleman from Connecticut, Mr. Simmons, for introducing this 
legislation and for his astute judgment and perseverance that was 
essential to bringing this bill before the House today. I also want to 
thank Mr. Evans, the ranking member of the full committee, and Mr. 
Rodriguez, the ranking member of the Health Subcommittee for their 
leadership on this measure.
  As amended, H.R. 4231 would authorize several new and innovative 
approaches to help the VA maintain the quality of its workforce in all 
VA health care facilities.
  The bill would establish a pilot program to use outside recruitment 
agencies, with interactive and online technologies, to improve VA 
recruitment of vital nursing personnel. It would also allow VA to offer 
three new alternative work schedules for nurses so that employment in 
VA can be more sensitive to family and personal needs for scheduling 
flexibility and career development. It also contains a provision to aid 
State veterans homes which care for thousands of veterans in need of 
nursing home care each year.
  One measure in the bill as reported deserves a moment of discussion 
because it caused some concern by Members of the Committee and 
organizations whose members might be affected. As reported, the bill 
would have prohibited VA from denying employment to a State-licensed 
registered nurse whose educational preparation was other than a 
baccalaureate degree.
  There is a well-ducumented shortage of trained registered nurses in 
the United States. Community colleges in every state have stepped 
forward to offer professional nursing careers through associate degree 
preparation. Their success in preparing their students is reflected in 
the rate at which associate degree nurses pass required state 
registered nurse examinations. Associate degree nurses are 
systematically and vigorously recruited in almost every health care 
institution in the United States.
  In the VA there is a preference in hiring for baccalaureate 
graduates, and a policy of excluding associate degree nurses from 
internal VA promotions. At a time when nurses are in short supply and 
when community colleges are the primary source of new nursing 
graduates, should VA be emphasizing baccalaureate graduates to the 
exclusion of others who are fully qualified as professional nurses? We 
think not.
  The Committee is concerned that these current VA hiring practices, 
and the variation in these practices noted in the recent report of

[[Page H7800]]

VA's National Commission on VA Nursing, discourage nurses with 
associate degrees from even seeking VA employment. VA's practice of 
exclusion in the face of high demand and scarcity of nursing personnel 
discourages qualified nurses from seeking VA employment. This practice 
also adversely affects VA's ability to retain current nurses.
  Following extensive discussions after this bill was ordered reported, 
the bill before the House today does not include section 4 of the bill 
as ordered reported. Section 4 was designed to keep VA competitive with 
the private sector, and to clarify that the lack of a baccalaureate 
degree could not be the basis to deny that nurse employment in a VA 
facility. However, the aim of the provision was misread by some who 
believe that the best-qualified nurses are those who have a bachelor's 
degree or some advanced degree in nursing.
  Most of us who seek health care look for providers who are competent, 
compassionate, critical thinkers, good communicators, and who are 
dedicated to expanding their knowledge of human susceptibility to 
disease. None of those qualities are guaranteed to be present in a 
particular graduate of any health professions school. In the case of 
nursing, competence is tested by State licensing exams, and only those 
who pass that exam are licensed to practice in a State or in the VA. 
The other qualities I mentioned are acquired from associating with and 
learning from other professionals who possess them. There is no 
guarantee that any particular licensed professional possesses all of 
them.
  VA's own hiring policy requires that persons with associate degrees 
in nursing be considered for entry-level positions. The Committee 
supports the underlying premise of this policy--that there should be no 
discrimination against person who demonstrate competence by passing a 
State examination. Unfortunately, the Committee has gathered 
irrefutable evidence that some VA medical centers did violate VA's 
hiring policy and discriminated against prospective employees who 
possessed an associate degree in nursing.
  The Committee has recently received assurance from the Acting 
Undersecretary for Health that VA will correct these improper 
practices; he has pledged that VA will continue to adhere to its policy 
of considering appointment of licensed registered nurses to entry-level 
positions without regard to the institution that granted them their 
nursing degree. In addition, the Under Secretary promised to undertake 
a number of significant steps to address any lingering effects from the 
improper recruiting practices which the Committee discovered. In light 
of this commitment, and the VA's concerns about the potential 
inadvertent effects of this language, the bill before the House today 
does not contain the nursing qualification provision as ordered 
reported by the Committee.

  The Committee looks forward to full reports on the execution of the 
several commitments it made in a letter signed by the Under Secretary 
on September 21, 2004. I ask unanimous consent to insert a copy of that 
letter in the Record at this point.
  The last provision in the amended bill I want to mention incorporates 
the provisions of a bill I introduced earlier this year, H.R. 4020. 
That bill would direct the Secretary of Veterans Affairs to make 
increased grants to assist States in hiring and retaining their own 
nursing personnel at State-operated nursing homes for veterans. State 
homes that currently receive per diem payments from VA and have 
established employee incentive programs would be eligible to apply for 
incentive assistance and could receive up to 50 percent of the annual 
cost of the incentive program.
  In the wake of the Civil War, State veterans' homes began caring for 
veterans and are now the largest provider of long-term care to our 
Nation's veterans. Today, over 16,000 veterans are being cared for in 
128 State veterans' homes in 47 States in a key partnership between the 
States and the VA.
  The Department of Health and Human Services (HHS) in 2002 surveyed 
the 50 States and Puerto Rico to learn how States are responding to 
needs for health care workers. Ninety percent reported a shortage of 
nursing staff as a major concern in their responses. In efforts to 
respond to these nursing and other health workforce shortages, 44 of 50 
States reported establishing task forces and commissions to study and 
seek solutions. The focus of the task forces or commissions in 25 
States was to study shortages in the long-term care work force.

  While the HHS study documented the extent of the problems nationally, 
I am aware of difficulties that the three New Jersey State veterans' 
homes in Vineland, Paramus and Menlo Park have faced over the past 
several years in recruiting and retaining quality nursing staff. We can 
address this effort with new Federal incentives that supplement and 
assist State initiatives.
  State homes are important partners in providing long-term care to 
veterans. I think this legislation provides a sound blending of 
authorities to help maintain quality nursing personnel for veterans 
cared for in both VA and State-run facilities.
  Finally, H.R. 4231 would reform the qualification requirements for 
candidates for the position of Under Secretary for Health. Current law 
requires the Under Secretary for Health to be a doctor of medicine, 
limiting the pool of candidates that VA may consider for this vital 
executive position. Executives in the American health care industry who 
present exceptional credentials and experience, but did not receive a 
medical degree as a part of their preparation, are excluded by law from 
consideration. In fact, of the 62 top hospital, health insurance and 
managed care organizations in the United States, only five CEOs hold 
the doctor of medicine degree. H.R. 4231 would repeal the requirement 
for VA's Under Secretary for health to be a doctor of medicine. This 
change would allow a future Administration to consider candidates from 
the widest spectrum of executive talents, including doctors of 
medicine, nurses, dentists, health academics, health economists, 
insurance executives and other qualified candidates with the 
demonstrated abilities to fill such a key leadership role in veterans' 
affairs.
  Mr. Speaker, this is a carefully crafted bill that will advance 
measures that are important to providing our veterans with quality 
health care services.
  Mr. Speaker, I reserve the balance of my time.
  Mr. RODRIGUEZ. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise in support of H.R. 4231, as amended, the 
Department of Veterans Affairs Nursing Recruitment and Retention Act of 
2004. This act has a variety of innovative approaches designed to 
assist the VA in managing its nursing workforce. The VA nurses are 
significantly older, on average, than nurses in other sectors; and more 
than one-third of the VA nursing staffs would be eligible for 
retirement in the next 5 years. Those are substantial figures.
  In the meantime, fewer students are training for careers in nursing 
care, while the need for those professions is growing. This will make 
the VA effort to retain and recruit nurses critical in ensuring that it 
is able to maintain high-quality and accessible services.
  This bill contains provisions to address the projected nursing 
shortage, including a pilot project to examine the effectiveness of new 
recruiting techniques and, in addition, new flexible work schedules 
that may be attractive to nurses with young children or those who are 
interested in full-time employment with seasonable breaks. State 
veterans homes, an important partner to our veterans health system, may 
also offer new educational opportunities to their nurses.
  I want to take this time, Mr. Speaker, to recognize the gentleman 
from New Jersey (Chairman Smith) and thank him and acknowledge the 
leadership of the chairman of our Subcommittee on Health, the gentleman 
from Connecticut (Mr. Simmons), in his efforts. I want to thank him and 
his staff in drafting this piece of legislation and working with me and 
us and all of us together to consider improvements to this particular 
bill.
  I also once again want to thank the gentleman from New Jersey 
(Chairman Smith) and the gentleman from Illinois (Ranking Member 
Evans), who continues to be at this present time in the Committee on 
Armed Services as we speak. I urge my colleagues to support this bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. SMITH of New Jersey. Mr. Speaker, I ask unanimous consent that 
the remainder of our time be controlled by the gentleman from 
Connecticut (Mr. Simmons), the distinguished chairman of the 
Subcommittee on Health, and just say how grateful I am for his 
sponsorship of this very important piece of legislation.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. SIMMONS. Mr. Speaker, I thank the gentleman for yielding me the 
time, I thank him for his leadership, and I thank the ranking member, 
the gentleman from Texas (Mr. Rodriguez), for all of his hard work.
  Mr. Speaker, I yield myself such time as I may consume. I just want 
to take a few moments to focus on a couple of points that the chairman 
raised with regard to this legislation. Since 1966, the number of 
patients treated annually by the VA has risen by 70 percent.

[[Page H7801]]

During this same period of time of a growing demand for VA health 
services, the number of nursing program graduates nationwide began to 
fall. So at a time when the demand for services went up, the supply of 
nurses has been going down. The latest U.S. Health Resources and 
Services Administration report projects that the shortage of nurses 
this year will reach approximately 138,000 nurses.
  We have received testimony before the Subcommittee on Health that the 
nurse vacancy rate at VA is currently at 9 percent and rising, in 
excess of 4,500 positions. In addition, the report found that the 
average VA nurse was nearly 49 years old, ahead of the national average 
for nurses, which is 42 years old. Now, while 49 years old may be young 
compared to my age and the age of some of my colleagues, I think that 
we have to see that there is a serious trend here when it comes to VA 
nurses. The VA is falling behind in its effort to staff these critical 
positions.

                              {time}  1745

  This legislation before us today would establish a pilot program 
within the VA to study the use of outside recruitment, advertising and 
communications techniques. Online technologies that are currently being 
used by 100 percent of the Fortune 500 companies to attract people into 
Fortune 500 companies, well, it can attract people into VA nursing.
  Furthermore, the legislation includes provisions that allow nurses to 
have more control over their schedules and their private lives so their 
work schedules are less inflexible and the working conditions that they 
have are more congenial.
  Another important provision is that the VA will be allowed to assist 
State nursing homes, that is, veterans facilities managed by States, to 
reduce shortages at long-term-care facilities operating under the 
authority of the VA but managed by the State. For example, in my home 
State of Connecticut, the Rocky Hill Home for veterans is engaged in a 
major program with the Veterans Administration to provide long-term 
care. This will include the construction of a 250-bed long-term-care 
facility, but it also includes partnering between the VA and the 
Connecticut Department of Veterans' Affairs so that the cost of that 
long-term nursing care is distributed between the State and the Federal 
Government.
  Mr. Speaker, I want to express my appreciation to our chairman, to 
our ranking member, the gentleman from Illinois (Mr. Evans) and to our 
staffs on the majority and minority staff, and to my colleague, the 
gentleman from Texas (Mr. Rodriguez), and all the members of the 
committee and subcommittee for operating in a bipartisan fashion to 
bring this legislation forward for the benefit of our veterans.
  Mr. Speaker, I see that there are no further speakers on my side, and 
I would be prepared to yield back, but I will give my colleague the 
opportunity to speak.
  Mr. Speaker, I reserve the balance of my time.
  Mr. RODRIGUEZ. Mr. Speaker, I yield 3 minutes to the gentleman from 
California (Mr. Filner), my friend and fellow colleague, a member of 
the committee who has been a staunch supporter of veterans.
  Mr. FILNER. Mr. Speaker, I thank the gentleman for the time, and Mr. 
Speaker, I also rise in support of this bill, H.R. 4231, to provide for 
nurse recruitment and retention for our Department of Veterans' 
Affairs.
  We have heard that the VA is currently the largest employer of nurses 
in the United States, and with the growth in the number of veterans 
using the VA for their health care, the increase in the number of aging 
veterans and the projected national shortage of registered nurses, we 
must keep the VA competitive in the recruitment and retention of 
nurses.
  So we have this bill, what we have heard described, establishing a 
pilot program that would study the use of outside recruitment, 
advertising and online technology to make the VA more competitive. We 
also know that the bill provides flexible work schedules to be more 
family-friendly and to allow nurses to take care of their family needs 
and personal needs and give them more control over their own schedules.
  I thank very much the chairman of the committee for his strong 
statement on the provision that was in the original bill but is not 
now, but how we will go about making up for that; in the early drafts 
of the bill, an important provision clarified the status of nurses who 
meet the VA's qualification standards but do not have a baccalaureate 
degree. The National Council of State Boards of Nursing reports that 
the pass rates for licensing of nurses trained with associate and 
baccalaureate degrees are virtually identical. So to discriminate 
against nurses with 2-year degrees makes no sense and, of course, is 
counterproductive to our needs today.
  As first drafted, H.R. 4231 committed to hiring nurses with associate 
degrees. It is not in the bill now, but as the chairman pointed out, a 
letter by the acting Under Secretary of Health at the VA, Mr. Perlin, 
and is now in the record to the Committee on Veterans Affairs' chairman 
and ranking member, outlined the plans of the VA to enhance the 
recruitment and hiring of associate-degree nurses. Committee on 
Veterans' Affairs members will be monitoring their progress.
  Of course, the next step we need to take is to fix the promotion 
requirements for nurses in the VA so nurses with those associate 
degrees are eligible for promotions based on their competency, not 
their degree. This is a vital change that must be made in order to 
retain VA nurses, and I appreciate the gentleman from New Jersey's 
(Chairman Smith's) strong statement of the need for competency-based 
promotion and not on the kind of degree.
  All of us here today have made clear that health care for our 
Nation's veterans must be a high priority. This bill is a step forward 
in those efforts to provide the VA with the tools to recruit qualified 
nurses to care for our veterans, whether they are from World War II or 
to the present conflicts in Afghanistan and Iraq.
  I urge support of H.R. 4231.


                             General Leave

  Mr. SIMMONS. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks and include extraneous material on H.R. 4231, as amended.
  The SPEAKER pro tempore (Mr. Shimkus). Is there objection to the 
request of the gentleman from Connecticut?
  There was no objection.
  Mr. SIMMONS. Mr. Speaker, I yield myself such time as I may consume.
  (Mr. SIMMONS asked and was given permission to revise and extend his 
remarks.)
  Mr. SIMMONS. Mr. Speaker, this bill is responsible legislation that 
will advance quality health care for veterans, and I urge my colleagues 
to support H.R. 4231 as amended.
  Mr. Speaker, I have no further requests for time, and I reserve the 
balance of my time.
  Mr. RODRIGUEZ. Mr. Speaker, I yield myself such time as I may 
consume.
  Let me first of all take this opportunity to thank the chairman, the 
gentleman from Connecticut (Mr. Simmons) for his efforts on this 
particular piece of legislation, and one of the beauties of this 
particular piece of legislation also is that it sets a trend. There is 
no doubt that in this country, and just like the VA's having difficulty 
with nurses, the entire country is having difficulty in getting nurses.
  In addition to that, in the area of health professions, there will be 
a need for us to look at doctors. I know that we have a large number of 
slots in the area of doctors in the VA that have also not been filled. 
For some reason, this country has not produced the number of doctors 
that we need. We continue to produce 12,000 to 15,000 and bring in 
about 5,000 from abroad each year. In fact, right prior to 9/11, we 
brought in some 300,000 professionals from abroad, of which, in that 
category, was a little less than 5,000 doctors.
  So we need to really begin to look, especially in the health 
profession and how it impacts the VA and these other areas, both these 
specialties, as well as physicians and the other health professionals 
that are needed.
  So, once again, I want to thank everyone.
  Mr. Speaker, I yield back the balance of my time.

[[Page H7802]]

  Mr. SIMMONS. Mr. Speaker, I yield myself such time as I may consume.
  There may not be another opportunity with this session coming to a 
close to thank my colleague on the floor in the context of doing a bill 
for our veterans. His leadership in Veterans' Affairs has been 
extraordinary. The impact of his service on this committee will have a 
beneficial effect on millions and millions of veterans for many, many 
years to come, and I thank him for all of his hard work.
  Mr. EVANS. Mr. Speaker, I rise in support of H.R. 4231.
  It is a good bill that will give the Department of Veterans Affairs 
some new opportunities to meet the challenges of maintaining a strong 
nursing workforce during the severe nursing shortage projected for the 
near future.
  I have said many times that nurses are the lifeblood of our medical 
care system.
  VA should be looking at any and all feasible options for ensuring 
that it is able to satisfy the needs and expectations of these valuable 
employees.
  I want to commend the chairman and ranking member of our Health 
Subcommittee for their work on this bill and urge Members to support 
it.
  Mr. SIMMONS. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from New Jersey (Mr. Smith) that the House suspend the rules 
and pass the bill, H.R. 4231, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds of 
those present have voted in the affirmative.
  Mr. SIMMONS. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

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