[House Report 108-538]
[From the U.S. Government Publishing Office]
108th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 108-538
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DEPARTMENT OF VETERANS AFFAIRS NURSE RECRUITMENT AND RETENTION ACT OF
2004
_______
June 9, 2004.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Smith of New Jersey, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 4231]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred 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, having considered
the same, report favorably thereon with an amendment and
recommend that the bill as amended do pass.
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
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. APPOINTMENT OF NURSES WHO DO NOT HAVE BACCALAUREATE DEGREES.
Section 7403 of title 38, United States Code, is amended by adding at
the end the following new subsection:
``(h) In a case in which a registered nurse applying for an
appointment under this chapter as a registered nurse has presented the
qualifications established under subsection (a) for such an
appointment, the lack of a baccalaureate degree in nursing shall not be
a bar to appointment, and in such a case the registered nurse shall not
be denied appointment on that basis.''.
SEC. 5. 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. 6. 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--
``(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. 7. 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. 8. 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''.
Introduction
The reported bill reflects the Committee's consideration of
two bills in the 108th Congress, H.R. 4231 and H.R. 4020, and a
provision of a draft bill to reform the qualifications and
selection requirements for the position of the Under Secretary
for Health. On April 28, 2004, Honorable Rob Simmons introduced
H.R. 4231, the Department of Veterans Affairs Nurse Recruitment
and Retention Act of 2004. On March 24, 2004, Honorable
Christopher H. Smith and Honorable Lane Evans introduced H.R.
4020, the State Veterans Home Nurse Recruitment Act of 2004.
On May 6, 2004, the Subcommittee on Health held a
legislative hearing to consider these bills. H.R. 4231 would:
establish a pilot program to use outside recruitment agencies,
and interactive and online technologies, to improve the
Department of Veterans Affairs (VA) recruitment of nursing
personnel; allow VA to offer three new alternative work
schedules for nurses; prohibit VA from denying employment to a
registered nurse because the nurse lacks a baccalaureate
degree; and include blind rehabilitation specialists with
certain other health care positions that the VA would be
permitted to appoint through the use of a direct appointment
authority. H.R. 4020 would direct VA to make payments to states
for assisting State veterans' homes in hiring nurses to care
for veterans. A draft proposal considered at that hearing would
reform the qualifications and selection requirements for the
position of the Under Secretary for Health.
Witnesses who appeared before the Subcommittee included
Honorable Gordon H. Mansfield, Deputy Secretary, Department of
Veterans Affairs, who was accompanied by Honorable Tim S.
McClain, General Counsel; Jonathan B. Perlin, M.D., Acting
Under Secretary for Health; and Mr. Thomas J. Hogan, Deputy
Assistant Secretary for Human Resources Management. Witnesses
also included Linda S. Schwartz, R.N., Dr.PH, Commissioner of
the Connecticut Department of Veterans Affairs; Andrea Mengel,
Ph.D., R.N., Head, Department of Nursing, Community College of
Philadelphia, representing the American Association of
Community Colleges; Mr. Robert Van Keuren, Chair of The VA
Advisory Committee on Homeless Veterans; Ms. Marsha Four, R.N.,
Chair of The VA Advisory Committee on Women Veterans; Ms.
Cathleen C. Wimblemo, Deputy Director, Health Care, The
American Legion; Mr. Rick Weidman, Director, Government
Relations, Vietnam Veterans of America; Mr. Richard Jones,
National Legislative Director, AMVETS; Mr. Richard Fuller,
National Legislative Director, Paralyzed Veterans of America;
Mr. Dennis Cullinan, National Legislative Director, Veterans of
Foreign Wars; and Mr. Adrian M. Atizado, Assistant National
Legislative Director, Disabled American Veterans.
On May 13, 2004, the Subcommittee on Health met and
unanimously ordered H.R. 4231, as amended, reported favorably
to the full Committee.
On May 19, 2004, the full Committee met and ordered H.R.
4231, as amended, reported favorably to the House by unanimous
voice vote.
Summary of the Reported Bill
H.R. 4231, as amended, would:
1. LEstablish a pilot program within the Department of
Veterans Affairs (VA) to study the use of outside recruitment,
advertising and communications agencies and the use of
interactive and online technologies to improve VA's program for
recruiting nursing personnel.
2. LAuthorize the Secretary of Veterans Affairs to offer
three new options for alternative tours of duty for nurses
working in VA health care facilities. The first option would
allow a nurse to work three regularly scheduled 12-hour tours
of duty within a workweek (a total of 36 hours) and be paid as
having worked 40 hours. The second option would allow a nurse,
who works seven regularly scheduled 10-hour tours of duty with
seven days off duty within a two-week pay period, to be
considered to have worked a full 80 hours for the pay period.
The third option would allow a nurse to work full-time for nine
months with three months off duty within a year, with pay
apportioned over the 12-month period.
3. LClarify that VA may not deny employment to a registered
nurse solely due to the lack of a baccalaureate degree in
nursing.
4. LInclude blind rehabilitation specialists in the list of
positions VA is permitted to hire through use of the direct
appointment authority provided in title 38, United States Code.
5. LDirect the Secretary to make payments to States to
assist in hiring and retaining nurses in State homes; make
eligible for such payments a State home that has an employee
incentive program and is receiving per diem payments from VA;
limit the amount of payment a State home may receive each year;
require a State home receiving such payment to provide an
annual report to VA; and require VA to implement the assistance
program so that eligible States would begin to receive payments
no later than January 1, 2005.
6. LRepeal the requirement for VA's Under Secretary for
Health to be a medical doctor.
Background and Discussion
Pilot Program to study innovative recruitment tools to
address nursing shortages at Department of Veterans Affairs
Health-Care Facilities.--The Department of Veterans Affairs
health care system maintains about 1,300 facilities staffed by
more than 180,000 employees. The Veterans Health Administration
(VHA) would rank among the top 25 largest employers as defined
in Hoover's Handbook of American Business. VHA has more
employees, for example, than Blue Cross-Blue Shield, the Kaiser
Foundation Health Plan, and Manor Care, Inc. and is the largest
employer of nurses in this country. The nursing staff comprises
the largest group of employees within VHA, totaling about
58,000 or 32 percent of its employees.
Maintaining an adequate supply of nurses is critical to
caring for the increasing number of veterans seeking VA health
care. Today, about 7.6 million veterans are enrolled in VA
health care and in 2010 it is estimated that this number will
grow to approximately 8.4 million. As demand for VA health care
is rising, VA's nurse vacancy rates are increasing. Mr. Thomas
J. Hogan, VA's Deputy Assistant Secretary for Human Resources
Management, testified on May 6, 2004 before the Subcommittee on
Health that the VA nurse vacancy rate is currently 9 percent
and VA is in need of hiring in excess of 4,500 nurses. A VA
report in September 2003 found that the average VA nurse was
48.9 years old, exceeding the national average age of 41.8.
In order to address the human capital challenges in VA, the
Department needs better tools and strategies to plan, attract,
assess, hire and manage its recruitment process for nurses. In
2002, Public Law 107-135, the Department of Veterans Affairs
Health Care Programs Enhancement Act of 2001, established the
National Commission on VA Nursing. The Commission was charged,
among other matters, to recommend organizational and
legislative changes that would enhance VA's recruitment and
retention of nurses. The Commission's final report was released
on May 13, 2004. Among the recommendations was that ``VHA
should strengthen human resources systems and departments to
develop an active hiring and recruiting process for nursing
staff that is consistent, to the extent possible, across
facilities and VISNs.''
VHA should adopt the best practices of private industry in
recruiting nurses and other essential personnel. In the private
sector, human resources professionals have developed and are
successfully using internet-based recruitment tools, but VA's
use of such tools is limited and ineffective. Forrester
Research, Inc., an independent technology research company that
provides advice about technology's impact on business, recently
reported on the internet that 100 percent of Fortune 500
companies are now using online recruiting (www.forrester.com).
The Committee bill would establish a pilot program to use
outside recruitment, advertising, communication agencies and
use interactive and online technologies for recruiting nursing
personnel to test whether such tools would enhance VA's
recruitment of nurses to fill Department vacancies. The
legislation would require a report of the extent to which the
pilot program achieves this goal. The Committee expects that
the report would analyze whether: employment vacancies are
posted faster and in real time; more qualified candidates are
reached; organizing, screening and comparing skills of
qualified candidates are more effective; employment
applications are received and processed faster; the amount of
time to hire an employee is reduced as soon as the vacancy is
announced; the Department's visibility as a desirable employer
is improved; the Department's workforce diversity is expanded;
and the hiring process is more efficiently managed.
Alternative work schedules for nurses.--On July 18, 2003,
VA made a legislative proposal to Congress that included three
new alternative duty schedules for full-time VA nurses. The
letter accompanying the proposal cited an American Organization
of Nurse Executives survey, which found that a major cause of
dissatisfaction in the nursing workforce is the inflexibility
of work schedules. The Committee bill would authorize VA to
offer the three new alternative duty schedules for nurses that
are comparable to work schedules commonly offered in the
private sector. The first option would allow a nurse to work
three regularly scheduled 12-hour tours of duty within a
workweek (a total of 36 hours) to be paid as having worked 40
hours. The second option would allow a nurse, who works seven
regularly scheduled 10-hour tours of duty with seven days off
duty within a two-week pay period, to be considered to have
worked a full 80 hours for the pay period. The third option
would allow a nurse to work full-time for nine months with
three months off duty within a year, with pay apportioned over
the 12-month period. These options accommodate the need of
nurses to have more control over their schedules and improve
VA's ability to retain them in a career status.
Appointment of nurses who do not have baccalaureate
degrees.--VA's qualification standards define the education
requirements for a Registered Nurse (RN) to be appointed to one
of five grade levels in VA. Under these standards, all new RN
appointees must present a baccalaureate degree in nursing (BSN)
to be appointed above the ``Nurse I'' grade level.
In April 2003, the National Commission on VA Nursing held
public hearings in New Orleans, Philadelphia, Chicago and Long
Beach. Nurses' testimony at those hearings repeatedly indicated
that VA's appointment and promotion policy discourages nurses
with associate degrees in nursing and those with diplomas from
hospital schools of nursing from seeking VA employment because
it qualifies nurses with significant experience and clinical
expertise for appointment only at the Nurse I level (the lowest
pay level) under the qualification standards.
Several educational paths are available for licensed
registered nurses. In 2002, enrollment in associate degree
nursing programs nationwide increased by 16 percent compared to
an eight percent increase in enrollment in baccalaureate
nursing programs. The American Association of Community
Colleges (AACC) reports that 62 percent of employed staff
nurses, including 45 percent in nurse clinician positions, 42
percent in clinical nurse specialist positions, 52 percent in
head nurse positions and 65 percent in nurse supervisor
positions received their nursing educational preparation
through associate degree or diploma nursing programs. In VA,
however, the nursing employment picture is quite different from
the national norm. Almost 59 percent of VA's nurses possess
bachelors or higher degrees, but only 41 percent have associate
degrees or diplomas.
All nursing graduates must pass uniform licensing board
examinations administered by individual States to become
registered nurses. Once licensed, registered nurses are
authorized to provide the identical scope of practice under
State law, without regard to their particular educational
preparation. Possession of the BSN degree does not expand the
RN's patient care responsibilities under any State law. A
recent report by the National Council of State Boards of
Nursing indicates that associate-degree nurses' success rates
in passing State board examinations are virtually identical to
those with baccalaureate degrees taking the same
examinations.\1\
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\1\ Crawford L, Marks C, Gawel S, White E, Obichere L.2001.2000
Licensure and Examinations Statistics: National Council of State Boards
of Nursing, Inc.
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Dr. Andrea Mengel, Head, Department of Nursing, Community
College of Philadelphia, representing the American Association
of Community Colleges, testified before the Subcommittee on
Health on May 6, 2004, that:
Nursing practice outside of the VHA is a better
career choice for the well-educated, high quality, and
often experienced who earned their degrees at community
colleges. With hundreds of choices of workplace
opportunities, why would new RN graduates from
associate degree programs choose to work at the VHA
where the hiring and promotion policy will hold them
back? Community colleges across the nation report that
their graduates are not choosing the VHA. For example,
not one of 300 RNs who graduated from Community College
of Philadelphia in the past four years chose to work in
the VA.
Additionally, at the same hearing, Dr. Linda S. Schwartz,
Commissioner of the Connecticut Department of Veterans Affairs,
stated that:
You have put me in a hard place, though, because I
also served on the board of directors of the American
Nurses Association, which you know promotes the
baccalaureate degree. But these are tough times and 20
years ago I came before the committee to talk about the
nursing shortage and we are back again. And the reality
of all of this is the largest producers of nursing, who
qualify as nurses and follow licensure, are in the
associate degree programs. And, so I would just ask the
rhetorical question, which is better, no nurse or a
nurse from an associate degree program? And to me the
answer is a nurse from an associate degree program
because many nurses are very, very determined to go on
to get their baccalaureate degree and to go on to
higher studies.
The Committee is concerned that in the midst of a
nationwide shortage of registered nurses, VA is losing
opportunities to bring experienced, qualified nurses into VA
health care because of its overemphasis on basic educational
preparation rather than a more balanced policy that also
considers experience and expertise. A 2001 study published in
the Journal of Nursing Administration found that the experience
levels of nurses, rather than education alone, accounted for
lower rates of adverse events.\2\ The Committee bill would
clarify that VA cannot deny employment consideration to a
qualified registered nurse solely due to the lack of a
baccalaureate degree in nursing.
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\2\ Blegen M, Vaughn T. Goode C. 2001. Nurse experience and
education: effect on quality of care. Journal of Nursing Administration
31(1):33-9.
Correction to listing of certain hybrid positions in
Veterans Health Administration.--Under current law, VA has
three separate authorities to employ hospital and clinical
staff based on the functions and duties the employee performs.
Critical care staffs such as physicians and nurses are employed
under a unique authority to VA contained in chapter 74 of title
38, United States Code. In addition to title 38 employees, VA
employs some clinical staff under traditional civil service
authorities specified in title 5. A third group of VA clinical
staff is employed under a system known as ``hybrid title 38''
status. The hybrid title 38 positions were developed to merge
certain characteristics of the title 38 and title 5 hiring and
compensation benefits. The hybrid title 38 authority allows
employees to be hired more quickly, receive special pay rates
and promotions based on individual qualifications and peer
review, as contained in title 38 for other direct-care
professions. However, these employees are also entitled to the
same grievance, annual leave and other benefits and protections
afforded to title 5 employees. The Committee bill would make
technical corrections to the listing of hybrid title 38
positions from Public Law 108-170 by replacing the term
``dental technologists'' with the terms ``dental hygienists''
and ``dental assistants'', by replacing the term
``technicians'' with the term ``technologists'', and by
replacing the term ``therapeutic radiologic technicians'' with
the term ``therapeutic radiologic technologists.'' This bill
would also add blind rehabilitation specialists and blind
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rehabilitation outpatient specialists to the hybrid category.
Assistance for hiring and retention of nurses at State
veterans homes.--Over the past five years, the veteran
population most in need of nursing home care, those veterans 85
years or older, has increased more than 100 percent, growing
from about 387,000 in fiscal year 1998 to 870,000 in fiscal
year 2003. This veteran population is expected to continue to
rise to about 1.3 million by mid-decade. Now the largest
provider of long-term care to veterans, the State veterans'
home system plays a vital role. Currently, there are over
38,000 veterans cared for in 128 State veterans' homes.
The Department of Health and Human Services (HHS)
commissioned a survey, released in November 2002 by the Center
for Health Workforce Studies, School of Public Health,
University at Albany, State University of New York, to learn
how States are responding to needs for health care workers.
Ninety percent of the States reported a shortage of nursing
staff as a major concern and 44 of 50 States reported
establishing task forces and commissions to study and seek
solutions to health care work force shortages. In 25 of these
States, the focus of the task forces or commissions was to
study shortages in the long-term care work force.
The Committee bill would authorize VA to make payments to
States for the purpose of assisting State veterans' homes in
hiring and retaining nurses to care 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 such a program.
Under Secretary for Health.--Current law requires the Under
Secretary for Health to be a ``doctor of medicine,''
restricting the pool of candidates that may be considered by
the President for nomination to the position. Senior executives
in the health care industry who may have exceptional
credentials and experience, but who are not doctors of
medicine, are excluded from consideration.
The Committee bill would repeal the requirement for VA's
Under Secretary for Health to be a medical doctor and allow the
Secretary flexibility to nominate candidates with demonstrated
abilities to fill this key position from the widest spectrum of
talents.
Section-By-Section Analysis
Section 1 of the bill would name this Act the ``Department
of Veterans Affairs Nurse Recruitment and Retention Act of
2004''.
Section 2(a) of the bill would establish a pilot program
within a health-care region adversely affected by a shortage of
nurses and would require the Secretary to enter into a contract
with a private-sector entity for services under the pilot
program to determine the effectiveness of the use of innovative
private-sector recruiting practices to place qualified nurses
in vacant positions at Department health-care facilities.
Section 2(b) of the bill would require the Secretary for
purposes of the pilot program established under this section to
identify and use proven effective recruitment practices for
placing individuals in difficult to fill positions including
employer branding and interactive advertising strategies;
internet technologies and automated staffing systems; and
recruitment, advertising and communication agencies.
Section 2(c) of the bill would require the Secretary in
carrying out the pilot program established under this section
to streamline systems and procedures used in the hiring process
at sites where the pilot program is conducted and, if
necessary, to make recommendations to amend the law.
Section 2(d) of the bill would require the Secretary to
submit a report to the Committees on Veterans Affairs on the
extent to which the pilot program achieved the goal of
improving the recruitment and retention of nurses in VA health-
care facilities.
Section 3(a) of the bill would amend chapter 74 of title
38, United States Code, to add a new section 7456a to provide
for alternative work schedules for nurses.
New section 7456a(a) would specify that this section
applies to registered nurses under chapter 74.
New section 7456a(b)(1) would provide the Secretary
discretionary authority for chapter 74 nurses to work three
regularly scheduled 12-hour tours of duty within a workweek,
and for such tour to be considered for all purposes a full 40-
hour basic workweek (a ``36/40'' work schedule) except for the
purposes of determining compliance with personnel ceilings.
New section 7456a(b)(2) would provide the formula for
determining the hourly rate and set forth rules for overtime
pay for a nurse who work a 36/40 work schedule described in new
section 7456a(b)(1).
New section 7456a(b)(3) would provide the formula for
determining charged leave for a nurse who works a 36/40 work
schedule described in new section 7456a(b)(1).
New section 7456a(c)(1) would provide the Secretary
discretionary authority for chapter 74 nurses to work seven
regularly scheduled 10-hour tours of duty, with seven days off
duty, within a two-week pay period and for such tour to be
considered for all purposes a full 80-hour pay period (a ``7/
7'' work schedule) except for the purposes of determining
compliance with personnel ceilings.
New section 7456a(c)(2) would provide the formula for
determining the hourly rate and set forth rules for overtime
pay for a nurse who works a 7/7 work schedule described in new
section 7456a(c)(1).
New section 7456a(c)(3) would provide the formula for
determining charged leave for a nurse who works a 7/7 work
schedule described in section 7456(c)(1).
New section 7456a(d) would provide the Secretary
discretionary authority for chapter 74 nurses to work full-time
for 9 months with 3 months off within a fiscal year and be paid
at 75 percent of the full-time rate over the full 12-month
period (a ``9 month'' work schedule); be considered .75 full-
time equivalent employees; and be considered part-time service
for purposes of computing retirement benefits.
New section 7456a(e) would direct the Secretary to
prescribe regulations to implement new section 7456a(d).
Section 3(b) of the bill would amend the table of sections
at the beginning of chapter 74, United States Code, to add the
following new item: ``7456a. Alternate work schedules.''.
Section 4 of the bill would amend section 7403 of title 38,
United States Code, so that a registered nurse applying for a
VA appointment and presenting the established qualifications
for employment may not be denied appointment on the basis of
the lack of a baccalaureate degree in nursing.
Section 5 of the bill would amend section 7401(3) of title
38, United States Code, to modify VA authority to make direct
appointments of certain personnel to include blind
rehabilitation specialists and blind rehabilitation outpatient
specialists.
Section 6(a)(1) of the bill would amend chapter 17 of title
38, United States Code, to add a new section 1744 to authorize
the Secretary to provide assistance to States for the purpose
of hiring and retaining nurses at State veterans homes.
New section 1744(a) would authorize the Secretary to make
payments to States for the purpose of assisting State homes in
the hiring and retention of nurses.
New section 1744(b) would make eligible for such assistance
State homes that receive per diem payments under chapter 17,
subchapter V for the care of veterans for that fiscal year, and
that have in effect an employee incentive scholarship or other
program designed to promote the hiring and retention of nursing
staff and reduce nursing shortages.
New section 1744(c) would require States to use funds
received under new section 1744 only to provide funds for a
program described in new section 1744(b).
New section 1744(d) would limit a payment under new section
1744 to no more than 50 percent of the fiscal year costs of a
program described in new section 1744(b).
New section 1744(e) would require a State seeking payment
with respect to any State home to submit an application and set
forth requirements for that application.
New section 1744(f-h) would set forth requirements for the
source of funds, disbursement of funds and use of payments
under new section 1744.
New section 1744(i) would require any State home receiving
a payment under new section 1744 for any fiscal year, within 60
days of the close of the fiscal year, to submit a report on the
use of funds received through the payment.
New section 1744(j) would direct the Secretary to prescribe
regulations for the implementation of new section 1744.
Section 6(a)(2) of the bill would amend the table of
sections at the beginning of chapter 17, United States Code, to
add the following new item: ``1744. Hiring and retention of
nurses: payments to assist States.''.
Section 6(b) of the bill would require the Secretary to
implement new section 1744 as expeditiously as possible, so
that payments are made to eligible States commencing no later
than January 1, 2005.
Section 7 of the bill would amend section 8111(d)(2) of
title 38, United States Code, to add that the established DOD-
VA Health Care Sharing Incentive Fund is available for any
purpose authorized by section 8111.
Section 8 of the bill would amend section 305(a)(2) of
title 38, United States Code to strike the requirement that the
Under Secretary for Health be a doctor of medicine.
Performance Goals and Objectives
The Department of Veterans Affairs' performance goals and
objectives are established in annual performance plans and are
subject to the Committee's regular oversight and evaluation by
the U.S. General Accounting Office. VA also publishes a
performance and accountability report for each fiscal year.
Statement of the Views of the Administration
Statement of The Honorable Gordon H. Mansfield, Deputy Secretary of
Department of Veterans Affairs, before the Subcommittee on Health,
Committee on Veterans Affairs, U.S. House of Representatives
May 6, 2004
H.R. 4231
This bill would help make VA more competitive in its ongoing
efforts to recruit and retain registered nurses. I am especially
pleased that the bill includes VA's proposal allowing enhanced
flexibility in scheduling tours of duty for registered nurses. Mr.
Chairman, in testimony last Fall before this Committee, we noted the
projected increase in the number of aging veterans and increased
enrollment in the VA healthcare system by veterans of all ages over the
next several years and the projected national shortage of registered
nurses. VA's health care providers are its most important resource in
delivering high-quality, compassionate care to our Nation's veterans.
VA's nurses are critical front-line components of the VA health care
team. We must be able to recruit and retain well-qualified nurses. The
ability to offer compensation, employment benefits and working
conditions comparable to those available in their community is critical
to our ability to recruit and retain nurses, particularly in highly
competitive labor markets and for hard-to-fill specialty assignments.
Thanks to the efforts of this Committee and the Senate Veterans'
Affairs Committee, VA has been able to offer generally competitive pay
for nurses in most markets. VA continuously monitors the recruitment
and retention of health care providers, particularly nurses, monitoring
trends in private sector employment and workforce projections.
VA generally supports H.R. 4231 as it will assist VA in meeting the
increasing challenge of recruiting and retaining sufficient nurses to
meet its patient care needs.
Section 3 of H.R. 4231 adopts a VA proposal for enhanced
flexibility in scheduling tours of duty for registered nurses. VA
strongly supports this provision. This provision will help VA remain a
competitive place of employment for nurses and to meet current and
future veteran healthcare needs.
Your bill would also establish a pilot program to study innovative
recruitment tools to address nursing shortages at VA health-care
facilities, to be carried out in a region adversely affected by a
nursing shortage. Using the services of a contractor, VA would identify
and implement proven private sector recruitment practices. Such
practices would include employer branding and interactive advertising
strategies; internet technologies and automated staffing systems; and
the use of recruitment, advertising and communication agencies. In
carrying out the pilot program, the bill would require VA to streamline
hiring procedures. If necessary, VA would be required to submit
proposed legislation. Within one year, VA is to report to the House and
Senate Veterans' Affairs committees on the pilot program. VA is already
undertaking numerous initiatives to improve nurse recruitment and
retention. Some of the aspects of the bill appear duplicative of these
initiatives. Therefore, we believe this proposal is unnecessary.
H.R. 4231 also would amend section 7403 of title 38 to provide that
a registered nurse who applies for appointment and who meets VA's
qualification standards may not be denied appointment based on the fact
that such nurse does not have a baccalaureate degree. VA believes this
proposal is unnecessary.
The lack of a baccalaureate degree is not a bar to appointment
under VA's current qualification standards. We note that we have
provided the Committee with information that VA currently employs and
continues to appoint many nurses educated in diploma and associate
degree programs. VA hires graduates of associate degree and diploma
programs at the Nurse 1 grade, and graduates of associate degree and
diploma programs with bachelor degrees in related fields are eligible
for appointment and promotion to the Nurse II grade, the same grade as
are nurses with a Bachelor of Science in Nursing (BSN). In addition,
VHA provides financial support to nurses desiring to obtain a higher
nursing degree. VA does not ``deny'' appointment based on the lack of a
baccalaureate degree.
Finally, section 5 is a technical amendment to correct the titles
of some of the new hybrid occupations, and adds additional occupations
to those converted. Public Law number 108-170 converted a number of
additional VHA health care positions to hybrid status. This section
would substitute ``dental hygienists'' and ``dental assistants'' for
``dental technologists'', and would substitute ``technologists'' for
``technicians'' and therapeutic radiologic technologists'' for
therapeutic radiologic technicians''. VA supports the clarification of
the occupations converted to hybrid status. In addition, this section
would convert blind rehabilitation specialists and blind rehabilitation
outpatient specialists to hybrid status. VA is currently reviewing the
need for additional hybrid positions and, therefore, cannot comment on
this proposal at this time.
H.R. 4020
H.R. 4020 would add a new section to title 38, United States Code,
to require VA to make payments to States to assist them in hiring and
retaining nurses at State veterans homes. To receive these payments, a
State would need to establish an employee incentive scholarship program
or other a similar program designed to reduce nursing shortages at its
State homes. The programs would also need to meet any criteria that VA
prescribes by regulation. VA would contribute 50% of the actual cost of
the State program, but limited to 2% of the total per diem payments
that the State would receive for that home for any fiscal year. States
would be required to submit reports to VA on their use of the funds and
the effectiveness of their programs.
VA opposes this proposal. This bill would require VA to make these
payments from the Medical Services appropriations account. We estimate
this bill could cost about $8.2 million per year. These funds would be
taken from medical care programs for veterans. VA already pays States a
per diem for the care of each veteran. These payments are intended to
help cover all the costs of operating State homes including those
involved in nurse recruitment. In times of fiscal constraint, we do not
believe this additional grant to state homes at the expense of VA's own
medical programs can be justified.
Draft Bill re Qualifications and Selection of Under Secretary for
Health
This draft bill would amend section 305 of title 38, which concerns
the procedures for appointment and qualifications of the Under
Secretary for Health. As currently written, section 305 requires that
the Under Secretary be a physician. The proposal would delete that
requirement and substitute in its stead a requirement that the Under
Secretary have executive knowledge, skill and ability. It would require
that such knowledge, skill and ability be in health care
administration, policy formulation and financial management. The draft
bill also would eliminate the current four-year term for that position,
and the current search commission process utilized to recommend
candidates to the President for vacancies. Instead, the Secretary would
be required to conduct a search for candidates and make a
recommendation to the President. In conducting the search, the
Secretary would be required to ``consult'' with stakeholders similar to
those required to be on the search commission under the current
procedure.
VA supports enactment of these amendments as an improvement over
current law, but we believe that the best outcome would be to amend
section 305 to provide simply that the Under Secretary is appointed by
the President, by and with the advice and consent of the Senate, and
that the Under Secretary shall supervise the Veterans Health
Administration under the authority of the Secretary of Veterans
Affairs. The VHA medical system is the largest in the world, with 158
hospitals, more than 850 ambulatory care and community-based outpatient
clinics, 132 nursing homes, 42 domiciliaries, 73 comprehensive home-
care programs, 21 service networks and 206 Vet (Readjustment
Counseling) Centers. More than 4.8 million people received care in VA
health care facilities in 2003, with nearly 600,000 inpatient
admissions and approximately 49.8 million outpatient visits.
VHA also manages the largest medical education and health
professions training program in the United States. VHA facilities are
affiliated with 107 medical schools, 55 dental schools and more than
1,200 other schools across the country. Each year, about 81,000 health
professionals are trained in VHA medical centers. More than half of the
physicians practicing in the United States have had part of their
professional education in the VA health care system.
VA's medical system additionally serves as a backup to the
Department of Defense during national emergencies and as a federal
support organization during major disasters.
Moreover, VHA has experienced unprecedented growth in the medical
system workload over the past few years. The number of patients treated
increased by nearly seven percent from 2002 to 2003.
Because of the complexity, size and scope of VHA's operations, the
person who heads VHA first and foremost must be someone with
significant executive leadership ability and a demonstrated track
record. The President should not be limited to appointing a physician
to this critical leadership position, but should be able to appoint the
person with those executive qualifications that best meets the needs of
VHA.
We also favor the proposal to replace the formalized Search
Commission process with a less-formal search process. The Search
Commission process has proven to be very cumbersome and very slow.
Importantly, the less-formal search process would retain stakeholder's
involvement on a consultative basis. This proposal would allow the
President to fill a vacant Under Secretary position in a more
expeditious manner, without sacrificing important stakeholder input.
Finally, we note that the Subcommittee has inserted as section 2 of
the draft bill a technical amendment to section 8111(d)(2) of title 38
to clarify the purposes for which the DOD-VA Health Care Sharing
Incentive Fund may be used. The amendment would add at the end ``and
shall be available for any purpose authorized by this section''. We
thank the Subcommittee for this and strongly concur with this
provision.
* * * * * * *
Congressional Budget Office Cost Estimate
The following letter was received from the Congressional
Budget Office concerning the cost of the reported bill:
U.S. Congress,
Congressional Budget Office,
Washington, DC, June 9, 2004
Hon. Christopher H. Smith
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 4231, the
Department of Veterans Affairs Nurse Recruitment and Retention
Act of 2004.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sam
Papenfuss, who can be reached at 226-2840.
Sincerely,
Douglas Holtz-Eakin,
Director
Enclosure.
Statement of Federal Mandates
The preceding Congressional Budget Office cost estimate
states that the bill contains no intergovernmental or private
sector mandates as defined in the Unfunded Mandates Reform Act.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, the reported bill is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
TITLE 38, UNITED STATES CODE
PART I--GENERAL PROVISIONS
* * * * * * *
CHAPTER 3--DEPARTMENT OF VETERANS AFFAIRS
* * * * * * *
Sec. 305. Under Secretary for Health
(a)(1) * * *
(2) The Under Secretary for Health [shall be a doctor of
medicine and] shall be appointed without regard to political
affiliation or activity and solely--
(A) on the basis of demonstrated ability in the
medical profession, in health-care administration and
policy formulation, [and in health-care] or in health-
care fiscal management; and
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
subchapter i--general
Sec.
1701. Definitions.
* * * * * * *
subchapter v--payments to state homes
* * * * * * *
1744. Hiring and retention of nurses: payments to assist States.
* * * * * * *
SUBCHAPTER V--PAYMENTS TO STATE HOMES
* * * * * * *
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--
(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.
* * * * * * *
PART V--BOARDS, ADMINISTRATIONS, AND SERVICES
* * * * * * *
CHAPTER 74--VETERANS HEALTH ADMINISTRATION--
PERSONNEL
subchapter i--appointments
Sec.
7401. Appointments in Veterans Health Administration.
* * * * * * *
subchapter iv--pay for nurses and other health-care personnel
7451. Nurses and other health-care personnel: competitive pay.
* * * * * * *
7456a. Alternate work schedules.
* * * * * * *
SUBCHAPTER I--APPOINTMENTS
Sec. 7401. Appointments in Veterans Health Administration
There may be appointed by the Secretary such personnel as the
Secretary may find necessary for the health care of veterans
(in addition to those in the Office of the Under Secretary for
Health appointed under section 7306 of this title), as follows:
(1) * * *
* * * * * * *
(3) Audiologists, speech pathologists, and
audiologist-speech pathologists, biomedical engineers,
certified or registered respiratory therapists,
dietitians, licensed physical therapists, licensed
practical or vocational nurses, medical instrument
technicians, medical records administrators or
specialists, medical records technicians, medical [and
dental technologists] technologists, dental hygienists,
dental assistants, nuclear medicine technologists,
occupational therapists, occupational therapy
assistants, kinesiotherapists, orthotist-prosthetists,
pharmacists, pharmacy technicians, physical therapy
assistants, prosthetic representatives, psychologists,
diagnostic radiologic [technicians, therapeutic
radiologic technicians, and social workers]
technologists, therapeutic radiologic technologists,
social workers, blind rehabilitation specialists, and
blind rehabilitation outpatient specialists.
* * * * * * *
Sec. 7403. Period of appointments; promotions
(a)(1) * * *
* * * * * * *
(h) In a case in which a registered nurse applying for an
appointment under this chapter as a registered nurse has
presented the qualifications established under subsection (a)
for such an appointment, the lack of a baccalaureate degree in
nursing shall not be a bar to appointment, and in such a case
the registered nurse shall not be denied appointment on that
basis.
* * * * * * *
SUBCHAPTER IV--PAY FOR NURSES AND OTHER HEALTH-CARE PERSONNEL
* * * * * * *
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.
* * * * * * *
PART VI--ACQUISITION AND DISPOSITION OF PROPERTY
CHAPTER 81--ACQUISITION AND OPERATION OF HOSPITAL AND DOMICILIARY
FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE LEASES OF REAL
PROPERTY
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SUBCHAPTER I--ACQUISITION AND OPERATION OF MEDICAL FACILITIES
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Sec. 8111. Sharing of Department of Veterans Affairs and Department of
Defense health care resources
(a) * * *
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(d) Joint Incentives Program.--(1) * * *
(2) To facilitate the incentive program, effective October 1,
2003, there is established in the Treasury a fund to be known
as the ``DOD-VA Health Care Sharing Incentive Fund''. Each
Secretary shall annually contribute to the fund a minimum of
$15,000,000 from the funds appropriated to that Secretary's
Department. Such funds shall remain available until expended
and shall be available for any purpose authorized by this
section.
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