To amend title 38, United States Code, to improve patient care and working conditions at the Veterans Health Administration of the Department of Veterans Affairs.

May 5, 2003

Mr. LYNCH (for himself and Mr. QUINN) introduced the following bill; which was referred to the Committee on Veterans' Affairs

To amend title 38, United States Code, to improve patient care and working conditions at the Veterans Health Administration of the Department of Veterans Affairs.

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 `VA Medical Workforce Enhancement Act of 2003'.

SEC. 2. FINDINGS AND PURPOSES.

(a) FINDINGS- The Congress finds as follows:

(1) The United States is currently facing critical workforce shortages in all areas of hospital operations, including both clinical and nonclinical operations.

(2) As its workforce ages, the Veterans Health Administration of the Department of Veterans Affairs is facing a loss of staff through retirement at a time of staffing shortages across all areas of hospital operations.

(3) The demand for health professionals will grow as the `Baby Boom' generation retires and adds to an already burgeoning population of elderly requiring more extensive health services.

(4) There are not enough nurses and health care providers to care for veterans who are on the Department of Veterans Affairs waiting lists. During the current nationwide nursing shortage, the Department of Veterans Affairs must replace up to 5.3 percent of its registered nurses each year just to keep pace with the loss from nurses who retire.

(5) The number of nurses retiring in the next 10 years is expected to far exceed the number of new nurses joining the workforce, resulting in a nationwide nursing shortage.

(6) This shortage will certainly affect health care facilities of the Department of Veterans Affairs, which, like many other health care facilities, are already seeing a shrinking pool of highly trained nurses.

(7) Nursing care is vital to providing the best patient care possible and, as the nursing shortage worsens, care for veterans who have sacrificed much for the liberties and freedoms enjoyed by the American people will suffer.

(8) In order to meet the increasing demand from veterans in need of health care, the Department of Veterans Affairs must be aggressive in its efforts to recruit and retain its nursing staff.

(9) The failure to maintain adequate staffing levels can harm veterans under the Department's care. There is a clear link between nurse-to-patient ratios and patient successes. For every additional patient over four in a nurse's workload, the risk of death increases by 7 percent for surgical patients. Unfortunately, many Department of Veterans Affairs' facilities do not meet the threshold safe ratio of four medical/surgical patients per nurse. Some facilities have six, seven, or eight surgical patients per nurse.

(10) There are acute shortages plaguing other critical healthcare staff including pharmacists, radiology, and laboratory technologists and other ancillary professionals.

(11) Thirty-one percent of medical technologists of the Department of Veterans Affairs are eligible for or nearing retirement.

(12) Nearly 20 percent of the pharmacy technicians of the Department of Veterans Affairs have between 20 and 34 years of Government service.

(13) One-quarter of the nursing assistants of the Department of Veterans Affairs have between 20 and 34 years of Government service and, therefore, are eligible for or nearing retirement.

(14) The lack of allied health care workers and hospital support staff on the weekends hurts direct patient care. Without support staff, nurses are forced to devote less time on direct patient care in order to transport patients, clean the wards, and perform other duties typically done by nursing assistants, housekeepers, and other ancillary staff. Providing a premium pay for regular weekend shifts will help maintain adequate levels of support staff on the weekends.

(15) Ongoing education is important to maintain high standards of professionalism in nursing care. The Department of Veterans Affairs should encourage the professional development of its nursing staff through ongoing educational programs and through funding opportunities to support nurses in achieving a baccalaureate or masters degree in nursing.

(b) PURPOSES- The purposes of this Act are the following:

(1) To clarify that the Secretary of Veterans Affairs and labor organizations representing health care employees can work together to improve patient care by allowing the Secretary the option of negotiation with exclusive employee representatives over safe staffing levels to ensure that veterans are provided with high quality care.

(2) To improve the consistency, legitimacy, and fairness in the nurse pay and promotion system of the Veterans Health Administration by allowing the Secretary of Veterans Affairs and labor organizations to negotiate the process by which nurses and other health care professionals are promoted.

(3) To provide for additional pay for Saturday tours of duty for additional health care workers in the Veterans Health Administration.

(4) To provide for a program to be conducted by the Secretary of Veterans Affairs to assess the benefits of establishing a nurse preceptor program.

SEC. 3. ENHANCING SAFETY AND QUALITY OF PATIENT CARE.

Section 7422 of title 38, United States Code, is amended--

(1) by redesigning subsection (e) as subsection (f); and

(2) by inserting after subsection (d) the following new subsection (e):

`(e) Nothing in subsection (b), (c), or (d) precludes the Secretary and any labor organization representing employees of the Veterans Health Administration from entering into a collective bargaining agreement, at the election of the Secretary, with respect to--

`(1) the numbers, types, and grades of employees or positions assigned to any medical facility, clinic, or organizational subdivision;

`(2) the number of patients assigned to employees referred to in section 7401 of this title who are physicians, physicians assistants, or nurses; and

`(3) employee-to-patient ratios for employees referred to in section 7401 of this title other than those specified in paragraph (2).'.

SEC. 4. IMPROVEMENTS TO THE RETENTION AND RECRUITMENT OF HEALTH CARE PROFESSIONALS.

Section 7403 of title 38, United States Code, is amended by adding at the end the following new subsections:

`(h) Nothing in this section, or in subsection (b), (c), and (d) of section 7422 of this title, shall limit the right or ability of any labor organization representing employees in the Veterans Health Administration to engage in collective bargaining with respect to the promotion processes established pursuant to this section.

`(i) In a case in which a registered nurse has accomplished the performance elements for promotion to the next grade, the lack of a specific type of educational degree shall not be an impediment to promotion, and in such a case the registered nurse shall not be denied a promotion on that basis.'.

SEC. 5. ADDITIONAL PAY FOR SATURDAY TOURS OF DUTY FOR ADDITIONAL HEALTH CARE WORKERS IN THE VETERANS HEALTH ADMINISTRATION.

(a) IN GENERAL- Section 7454(b) of title 38, United States Code, is amended by adding at the end the following new paragraph:

`(3) Employees appointed under section 7408 of this title shall be entitled to additional pay on the same basis as provided for nurses in section 7453(c) of this title.'.

(b) APPLICABILITY- The amendment made by subsection (a) shall apply with respect to pay periods beginning on or after the date of the enactment of this Act.

SEC. 6. NURSE PRECEPTOR PROGRAM.

(a) NATURE OF PROGRAM- The Secretary of Veterans Affairs shall carry out a nurse preceptor program to develop nurse preceptors who will act as mentors to newly hired registered nurses at Department of Veterans Affairs health care facilities.

(b) STRUCTURE OF PROGRAM- The nurse preceptor program shall include the following:

(1) For registered nurses interested in becoming nurse preceptors, intensive training and screening programs.

(2) For registered nurses selected to be nurse preceptors--

(A) a rigorous 26-week training program;

(B) continuous professional development classes; and

(C) a salary increase equivalent to 5 percent of gross annual salary for any period during which the nurse functions as a nurse preceptor.

(c) ANNUAL REPORT TO CONGRESS- Each year after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report on the effectiveness and usefulness of the nurse preceptor program. The Secretary shall include in each report the following:

(1) The Secretary's assessment of the benefits to veterans of the program.

(2) The Secretary's assessment of the effect of the program on the Department of Veterans Affairs, including the effect on retention of a qualified nursing staff.

(3) Any other findings and conclusions of the Secretary with respect to the program.

END