I 

108TH CONGRESS 

1ST SESSION H. R. 1951

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. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 5, 2003

Mr. LYNCH (for himself and Mr. QUINN) introduced the following bill; which 

was referred to the Committee on Veterans’ Affairs 

A BILL

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.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘VA Medical Workforce 

5 Enhancement Act of 2003’’. 

6 SEC. 2. FINDINGS AND PURPOSES. 

7 (a) FINDINGS.—The Congress finds as follows: 

8 (1) The United States is currently facing crit9 ical workforce shortages in all areas of hospital oper-
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1 ations, including both clinical and nonclinical oper2 ations. 

3 (2) As its workforce ages, the Veterans Health 

4 Administration of the Department of Veterans Af5 fairs is facing a loss of staff through retirement at 

6 a time of staffing shortages across all areas of hos7 pital operations. 

8 (3) The demand for health professionals will 

9 grow as the ‘‘Baby Boom’’ generation retires and 

10 adds to an already burgeoning population of elderly 

11 requiring more extensive health services. 

12 (4) There are not enough nurses and health 

13 care providers to care for veterans who are on the 

14 Department of Veterans Affairs waiting lists. Dur15 ing the current nationwide nursing shortage, the De16 partment of Veterans Affairs must replace up to 5.3 

17 percent of its registered nurses each year just to 

18 keep pace with the loss from nurses who retire. 

19 (5) The number of nurses retiring in the next 

20 10 years is expected to far exceed the number of 

21 new nurses joining the workforce, resulting in a na22 tionwide nursing shortage. 

23 (6) This shortage will certainly affect health 

24 care facilities of the Department of Veterans Affairs, 

25 which, like many other health care facilities, are al-
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1 ready seeing a shrinking pool of highly trained 

2 nurses. 

3 (7) Nursing care is vital to providing the best 

4 patient care possible and, as the nursing shortage 

5 worsens, care for veterans who have sacrificed much 

6 for the liberties and freedoms enjoyed by the Amer7 ican people will suffer. 

8 (8) In order to meet the increasing demand 

9 from veterans in need of health care, the Depart10 ment of Veterans Affairs must be aggressive in its 

11 efforts to recruit and retain its nursing staff. 

12 (9) The failure to maintain adequate staffing 

13 levels can harm veterans under the Department’s 

14 care. There is a clear link between nurse-to-patient 

15 ratios and patient successes. For every additional 

16 patient over four in a nurse’s workload, the risk of 

17 death increases by 7 percent for surgical patients. 

18 Unfortunately, many Department of Veterans Af19 fairs’ facilities do not meet the threshold safe ratio 

20 of four medical/surgical patients per nurse. Some fa21 cilities have six, seven, or eight surgical patients per 

22 nurse. 

23 (10) There are acute shortages plaguing other 

24 critical healthcare staff including pharmacists, radi-
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1 ology, and laboratory technologists and other ancil2 lary professionals. 

3 (11) Thirty-one percent of medical technologists 

4 of the Department of Veterans Affairs are eligible 

5 for or nearing retirement. 

6 (12) Nearly 20 percent of the pharmacy techni7 cians of the Department of Veterans Affairs have 

8 between 20 and 34 years of Government service. 

9 (13) One-quarter of the nursing assistants of 

10 the Department of Veterans Affairs have between 20 

11 and 34 years of Government service and, therefore, 

12 are eligible for or nearing retirement. 

13 (14) The lack of allied health care workers and 

14 hospital support staff on the weekends hurts direct 

15 patient care. Without support staff, nurses are 

16 forced to devote less time on direct patient care in 

17 order to transport patients, clean the wards, and 

18 perform other duties typically done by nursing as19 sistants, housekeepers, and other ancillary staff. 

20 Providing a premium pay for regular weekend shifts 

21 will help maintain adequate levels of support staff on 

22 the weekends. 

23 (15) Ongoing education is important to main24 tain high standards of professionalism in nursing 

25 care. The Department of Veterans Affairs should en-
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1 courage the professional development of its nursing 

2 staff through ongoing educational programs and 

3 through funding opportunities to support nurses in 

4 achieving a baccalaureate or masters degree in nurs5 ing. 

6 (b) PURPOSES.—The purposes of this Act are the fol7 lowing: 

8 (1) To clarify that the Secretary of Veterans 

9 Affairs and labor organizations representing health 

10 care employees can work together to improve patient 

11 care by allowing the Secretary the option of negotia12 tion with exclusive employee representatives over 

13 safe staffing levels to ensure that veterans are pro14 vided with high quality care. 

15 (2) To improve the consistency, legitimacy, and 

16 fairness in the nurse pay and promotion system of 

17 the Veterans Health Administration by allowing the 

18 Secretary of Veterans Affairs and labor organiza19 tions to negotiate the process by which nurses and 

20 other health care professionals are promoted. 

21 (3) To provide for additional pay for Saturday 

22 tours of duty for additional health care workers in 

23 the Veterans Health Administration. 
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1 (4) To provide for a program to be conducted 

2 by the Secretary of Veterans Affairs to assess the 

3 benefits of establishing a nurse preceptor program. 

4 SEC. 3. ENHANCING SAFETY AND QUALITY OF PATIENT 

5 CARE. 

6 Section 7422 of title 38, United States Code, is 

7 amended—

8 (1) by redesigning subsection (e) as subsection 

9 (f); and 

10 (2) by inserting after subsection (d) the fol11 lowing new subsection (e): 

12 ‘‘(e) Nothing in subsection (b), (c), or (d) precludes 

13 the Secretary and any labor organization representing em14 ployees of the Veterans Health Administration from enter15 ing into a collective bargaining agreement, at the election 

16 of the Secretary, with respect to—

17 ‘‘(1) the numbers, types, and grades of employ18 ees or positions assigned to any medical facility, clin19 ic, or organizational subdivision; 

20 ‘‘(2) the number of patients assigned to employ21 ees referred to in section 7401 of this title who are 

22 physicians, physicians assistants, or nurses; and 

23 ‘‘(3) employee-to-patient ratios for employees 

24 referred to in section 7401 of this title other than 

25 those specified in paragraph (2).’’. 
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1 SEC. 4. IMPROVEMENTS TO THE RETENTION AND RECRUIT2 MENT OF HEALTH CARE PROFESSIONALS. 

3 Section 7403 of title 38, United States Code, is 

4 amended by adding at the end the following new sub5 sections: 

6 ‘‘(h) Nothing in this section, or in subsection (b), (c), 

7 and (d) of section 7422 of this title, shall limit the right 

8 or ability of any labor organization representing employees 

9 in the Veterans Health Administration to engage in collec10 tive bargaining with respect to the promotion processes 

11 established pursuant to this section. 

12 ‘‘(i) In a case in which a registered nurse has accom13 plished the performance elements for promotion to the 

14 next grade, the lack of a specific type of educational de15 gree shall not be an impediment to promotion, and in such 

16 a case the registered nurse shall not be denied a promotion 

17 on that basis.’’. 

18 SEC. 5. ADDITIONAL PAY FOR SATURDAY TOURS OF DUTY 

19 FOR ADDITIONAL HEALTH CARE WORKERS IN 

20 THE VETERANS HEALTH ADMINISTRATION. 

21 (a) IN GENERAL.—Section 7454(b) of title 38, 

22 United States Code, is amended by adding at the end the 

23 following new paragraph: 

24 ‘‘(3) Employees appointed under section 7408 of this 

25 title shall be entitled to additional pay on the same basis 

26 as provided for nurses in section 7453(c) of this title.’’. 
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1 (b) APPLICABILITY.—The amendment made by sub2 section (a) shall apply with respect to pay periods begin3 ning on or after the date of the enactment of this Act. 

4 SEC. 6. NURSE PRECEPTOR PROGRAM. 

5 (a) NATURE OF PROGRAM.—The Secretary of Vet6 erans Affairs shall carry out a nurse preceptor program 

7 to develop nurse preceptors who will act as mentors to 

8 newly hired registered nurses at Department of Veterans 

9 Affairs health care facilities. 

10 (b) STRUCTURE OF PROGRAM.—The nurse preceptor 

11 program shall include the following: 

12 (1) For registered nurses interested in becom13 ing nurse preceptors, intensive training and screen14 ing programs. 

15 (2) For registered nurses selected to be nurse 

16 preceptors—

17 (A) a rigorous 26-week training program; 

18 (B) continuous professional development 

19 classes; and 

20 (C) a salary increase equivalent to 5 per21 cent of gross annual salary for any period dur22 ing which the nurse functions as a nurse pre23 ceptor. 

24 (c) ANNUAL REPORT TO CONGRESS.—Each year 

25 after the date of the enactment of this Act, the Secretary 
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1 shall submit to the Committees on Veterans’ Affairs of 

2 the Senate and the House of Representatives a report on 

3 the effectiveness and usefulness of the nurse preceptor 

4 program. The Secretary shall include in each report the 

5 following: 

6 (1) The Secretary’s assessment of the benefits 

7 to veterans of the program. 

8 (2) The Secretary’s assessment of the effect of 

9 the program on the Department of Veterans Affairs, 

10 including the effect on retention of a qualified nurs11 ing staff. 

12 (3) Any other findings and conclusions of the 

13 Secretary with respect to the program.

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