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.

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.

Summary: VA Medical Workforce Enhancement Act of 2003 - States that: (1) current collective bargaining requirements within the Veterans Health Administration (VHA) shall not preclude the Secretary of Veterans Affairs and any labor organization representing VHA employees from entering into a collective bargaining agreement with respect to the numbers, types, and grades of employees, the number of patients assigned to physicians, physicians assistants, or nurses, and employee-to-patient ratios within any VHA medical facility, clinic, or organizational subdivision. And (2) nothing shall limit the right or ability of any labor organization representing such employees from engaging in collective bargaining with respect to VHA promotion processes. Provides that when a VHA registered nurse has accomplished the performance elements of promotion to the next higher grade, the lack of a specific type of educational degree shall not be an impediment to such promotion. Authorizes additional pay for Saturday VHA nursing duty. Directs the Secretary to carry out a program to develop nurse preceptors to act as mentors to newly hired registered nurses at Department of Veterans Affairs health care facilities.