[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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