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Union Calendar No. 312 

108TH CONGRESS 

2D SESSION H. R. 4231 

[Report No. 108–538] 

To provide for a pilot program in the Department of Veterans Affairs to 

improve recruitment and retention of nurses, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 28, 2004 

Mr. SIMMONS introduced the following bill; which was referred to the 

Committee on Veterans’ Affairs 

JUNE 9, 2004 

Additional sponsors: Mr. SMITH of New Jersey and Mr. BILIRAKIS

JUNE 9, 2004 

Reported with an amendment, committed to the Committee of the Whole 

House on the State of the Union, and ordered to be printed 

[Strike out all after the enacting clause and insert the part printed in italic] 

[For text of introduced bill, see copy of bill as introduced on April 28, 2004] 

A BILL 

To provide for a pilot program in the Department of Veterans Affairs to improve recruitment and retention of 

nurses, and for other purposes. 

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

2 This Act may be cited as the ‘‘Department of Veterans 

3 Affairs Nurse Recruitment and Retention Act of 2004’’. 

4 SEC. 2. PILOT PROGRAM TO STUDY INNOVATIVE RECRUIT5 MENT TOOLS TO ADDRESS NURSING SHORT6 AGES AT DEPARTMENT OF VETERANS AF7 FAIRS HEALTH-CARE FACILITIES. 

8 (a) PILOT.—(1) Not later than 90 days after the date 

9 of the enactment of this Act, the Secretary of Veterans Af10 fairs shall designate a health-care service region, or a sec11 tion within such a region, in which health-care facilities 

12 of the Department of Veterans Affairs are adversely affected 

13 by a shortage of qualified nurses. 

14 (2) The Secretary shall conduct a pilot program in 

15 the region or section designated under paragraph (1) to de16 termine the effectiveness of the use of innovative human17 capital tools and techniques in the recruitment of qualified 

18 nurses for positions at Department health-care facilities 

19 and for the retention of nurses at such facilities. In carrying 

20 out the pilot program, the Secretary shall enter into a con21 tract with a private-sector entity for services under the pilot 

22 program for recruitment of qualified nurses. 

23 (b) PRIVATE-SECTOR RECRUITMENT PRACTICES.—For 

24 purposes of the pilot program under this section, the Sec25 retary shall identify and use recruitment practices that 

26 have proven effective for placing qualified individuals in 
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1 positions that are difficult to fill due to shortages of quali2 fied individuals or other factors. Recruitment practices to 

3 be reviewed by the Secretary for use in the pilot program 

4 shall include— 

5 (1) employer branding and interactive adver6 tising strategies; 

7 (2) Internet technologies and automated staffing 

8 systems; and 

9 (3) the use of recruitment, advertising, and com10 munication agencies. 

11 (c) STREAMLINED HIRING PROCESS.—In carrying out 

12 the pilot program under this section, the Secretary shall, 

13 at health-care facilities of the Department in the region or 

14 section in which the pilot program is conducted, revise pro15 cedures and systems for selecting and hiring qualified 

16 nurses to reduce the length of the hiring process. If the Sec17 retary identifies measures to streamline and automate the 

18 hiring process that can only be implemented if authorized 

19 by law, the Secretary shall submit to the Committees on 

20 Veterans’ Affairs of the Senate and House of Representa21 tives recommendations for such changes in law as may be 

22 necessary to enable such measure to be implemented. 

23 (d) REPORT.—Not later than one year after the date 

24 of the enactment of this Act, the Secretary shall submit to 

25 the Committees on Veterans’ Affairs of the Senate and 
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1 House of Representatives a report on the extent to which 

2 the pilot program achieved the goal of improving the re3 cruitment and retention of nurses in Department of Vet4 erans Affairs health-care facilities. 

5 SEC. 3. ALTERNATE WORK SCHEDULES FOR NURSES. 

6 (a) ENHANCED SHIFT FLEXIBILITY.—Chapter 74 of 

7 title 38, United States Code, is amended by inserting after 

8 section 7456 the following new section: 

9 ‘‘§ 7456a. Alternate work schedules 

10 ‘‘(a) APPLICABILITY.—This section applies to reg11 istered nurses appointed under this chapter. 

12 ‘‘(b) 36/40 WORK SCHEDULE.—(1) Subject to para13 graph (2), if the Secretary determines it to be necessary 

14 in order to obtain or retain the services of registered nurses 

15 at a Department health-care facility, the Secretary may 

16 provide, in the case of registered nurses employed at that 

17 facility, that such a nurse who works three regularly sched18 uled 12-hour tours of duty within a workweek shall be con19 sidered for all purposes (except computation of full-time 

20 equivalent employees for the purposes of determining com21 pliance with personnel ceilings) to have worked a full 40- 

22 hour basic workweek. Such a schedule may be referred to 

23 as a ‘36/40 work schedule’. 

24 ‘‘(2)(A) Basic and additional pay for a registered 

25 nurse who is considered under paragraph (1) to have 
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1 worked a full 40-hour basic workweek is subject to subpara2 graphs (B) and (C). 

3 ‘‘(B) The hourly rate of basic pay for such a nurse 

4 for service performed as part of a regularly scheduled 36- 

5 hour tour of duty within the workweek shall be derived by 

6 dividing the nurse’s annual rate of basic pay by 1,872. 

7 ‘‘(C)(i) Such a nurse who performs a period of service 

8 in excess of such nurse’s regularly scheduled 36-hour tour 

9 of duty within a workweek is entitled to overtime pay under 

10 section 7453(e) of this title, or other applicable law, for offi11 cially ordered or approved service performed in excess of— 

12 ‘‘(I) eight hours on a day other than a day on 

13 which such nurse’s regularly scheduled 12-hour tour 

14 falls; 

15 ‘‘(II) 12 hours for any day included in the regu16 larly scheduled 36-hour tour of duty; and 

17 ‘‘(III) 40 hours during an administrative work18 week. 

19 ‘‘(ii) Except as provided in clause (i), a registered 

20 nurse to whom this subsection is applicable is not entitled 

21 to additional pay under section 7453 of this title, or other 

22 applicable law, for any period included in a regularly 

23 scheduled 12-hour tour of duty. 

24 ‘‘(3) A nurse who works a 36/40 work schedule de25 scribed in this subsection who is absent on approved sick 
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1 leave or annual leave during a regularly scheduled 12-hour 

2 tour of duty shall be charged for such leave at a rate of 

3 ten hours of leave for nine hours of absence. 

4 ‘‘(c) 7/7 Work Schedule—(1) Subject to paragraph (2), 

5 if the Secretary determines it to be necessary in order to 

6 obtain or retain the services of registered nurses at a De7 partment health-care facility, the Secretary may provide, 

8 in the case of registered nurses employed at such facility, 

9 that such a nurse who works seven regularly scheduled 10- 

10 hour tours of duty, with seven days off duty, within a two11 week pay period, shall be considered for all purposes (except 

12 computation of full-time equivalent employees for the pur13 poses of determining compliance with personnel ceilings) to 

14 have worked a full 80 hours for the pay period. Such a 

15 schedule may be referred to as a ‘7/7 work schedule’. 

16 ‘‘(2)(A) Basic and additional pay for a registered 

17 nurse who is considered under paragraph (1) to have 

18 worked a full 80-hour pay period is subject to subpara19 graphs (B) and (C). 

20 ‘‘(B) The hourly rate of basic pay for such a nurse 

21 for service performed as part of a regularly scheduled 70- 

22 hour tour of duty within the pay period shall be derived 

23 by dividing the nurse’s annual rate of basic pay by 1,820. 

24 ‘‘(C)(i) Such a nurse who performs a period of service 

25 in excess of such nurse’s regularly scheduled 70-hour tour 
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1 of duty within a pay period is entitled to overtime pay 

2 under section 7453(e) of this title, or other applicable law, 

3 for officially ordered or approved service performed in ex4 cess of— 

5 ‘‘(I) eight hours on a day other than a day on 

6 which such nurse’s regularly scheduled 10-hour tour 

7 falls; 

8 ‘‘(II) 10 hours for any day included in the regu9 larly scheduled 70-hour tour of duty; and 

10 ‘‘(III) 80 hours during a pay period. 

11 ‘‘(ii) Except as provided in subparagraph (i), a reg12 istered nurse to whom this subsection is applicable is not 

13 entitled to additional pay under section 7453 of this title, 

14 or other applicable law, for any period included in a regu15 larly scheduled 10-hour tour of duty. 

16 ‘‘(3) A nurse who works a 7/7 work schedule described 

17 in this subsection who is absent on approved sick leave or 

18 annual leave during a regularly scheduled 12-hour tour of 

19 duty shall be charged for such leave at a rate of eight hours 

20 of leave for seven hours of absence. 

21 ‘‘(d) 9-MONTH WORK SCHEDULE.—The Secretary 

22 may authorize a registered nurse appointed under section 

23 7405 of this title, with the nurse’s written consent, to work 

24 full-time for nine months with three months off duty, within 

25 a fiscal year, and be paid at 75 percent of the full-time 
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1 rate for such nurse’s grade for each pay period of that fiscal 

2 year. A nurse working on such a schedule for any fiscal 

year shall be considered a 3 3 ⁄4 full-time equivalent employee 

4 for that fiscal year in computing full-time equivalent em5 ployees for the purposes of determining compliance with 

6 personnel ceilings. Service on such a schedule shall be con7 sidered to be part-time service for purposes of computing 

8 benefits under chapters 83 and 84 of title 5. 

9 ‘‘(e) REGULATIONS.—The Secretary shall prescribe 

10 regulations for the implementation of this section.’’. 

11 (b) CLERICAL AMENDMENT.—The table of sections at 

12 the beginning of chapter 74 of such title is amended by in13 serting after the item relating to section 7456 the following 

14 new item: 

‘‘7456a. Alternate work schedules.’’. 

15 SEC. 4. APPOINTMENT OF NURSES WHO DO NOT HAVE BAC16 CALAUREATE DEGREES. 

17 Section 7403 of title 38, United States Code, is amend18 ed by adding at the end the following new subsection: 

19 ‘‘(h) In a case in which a registered nurse applying 

20 for an appointment under this chapter as a registered nurse 

21 has presented the qualifications established under subsection 

22 (a) for such an appointment, the lack of a baccalaureate 

23 degree in nursing shall not be a bar to appointment, and 

24 in such a case the registered nurse shall not be denied ap25 pointment on that basis.’’. 
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1 SEC. 5. TECHNICAL CORRECTION TO LISTING OF CERTAIN 

2 HYBRID POSITIONS IN VETERANS HEALTH 

3 ADMINISTRATION. 

4 Section 7401(3) of title 38, United States Code, is 

5 amended— 

6 (1) by striking ‘‘and dental technologists’’ and 

7 inserting ‘‘technologists, dental hygienists, dental as8 sistants’’; and 

9 (2) by striking ‘‘technicians, therapeutic 

10 radiologic technicians, and social workers’’ and in11 serting ‘‘technologists, therapeutic radiologic tech12 nologists, social workers, blind rehabilitation special13 ists, and blind rehabilitation outpatient specialists’’. 

14 SEC. 6. ASSISTANCE FOR HIRING AND RETENTION OF 

15 NURSES AT STATE VETERANS HOMES. 

16 (a) IN GENERAL.—(1) Chapter 17 of title 38, United 

17 States Code, is amended by inserting after section 1743 the 

18 following new section: 

19 ‘‘§ 1744. Hiring and retention of nurses: payments to 

20 assist States 

21 ‘‘(a) PAYMENT PROGRAM.—The Secretary shall make 

22 payments to States under this section for the purpose of 

23 assisting State homes in the hiring and retention of nurses 

24 and the reduction of nursing shortages at State homes. 

25 ‘‘(b) ELIGIBLE RECIPIENTS.—Payments to a State for 

26 a fiscal year under this section shall, subject to submission 
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1 of an application, be made to any State that during that 

2 year— 

3 ‘‘(1) receives per diem payments under this sub4 chapter for that fiscal year; and 

5 ‘‘(2) has in effect an employee incentive scholar6 ship program or other employee incentive program at 

7 a State home designed to promote the hiring and re8 tention of nursing staff and to reduce nursing short9 ages at that home. 

10 ‘‘(c) USE OF FUNDS RECEIVED.—A State may use an 

11 amount received under this section only to provide funds 

12 for a program described in subsection (b)(2). Any program 

13 shall meet such criteria as the Secretary may prescribe. In 

14 prescribing such criteria, the Secretary shall take into con15 sideration the need for flexibility and innovation. 

16 ‘‘(d) LIMITATIONS ON AMOUNT OF PAYMENT.—(1) A 

17 payment under this section may not be used to provide 

18 more than 50 percent of the costs for a fiscal year of the 

19 employee incentive scholarship or other incentive program 

20 for which the payment is made. 

21 ‘‘(2) The amount of the payment to a State under this 

22 section for any fiscal year is, for each State home in that 

23 State with a program described in subsection (b)(2), the 

24 amount equal to 2 percent of the amount of payments esti-
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1 mated to be made to that State, for that State home, under 

2 section 1741 of this title for that fiscal year. 

3 ‘‘(e) APPLICATIONS.—A payment under this section for 

4 any fiscal year with respect to any State home may only 

5 be made based upon an application submitted by the State 

6 seeking the payment with respect to that State home. Any 

7 such application shall describe the nursing shortage at the 

8 State home and the employee incentive scholarship program 

9 or other incentive program described in subsection (c) for 

10 which the payment is sought. 

11 ‘‘(f) SOURCE OF FUNDS.—Payments under this section 

12 shall be made from funds available for other payments 

13 under this subchapter. 

14 ‘‘(g) DISBURSEMENT.—Payments under this section to 

15 a State home shall be made as part of the disbursement 

16 of payments under section 1741 of this title with respect 

17 to that State home. 

18 ‘‘(h) USE OF CERTAIN RECEIPTS.—The Secretary 

19 shall require as a condition of any payment under this sec20 tion that, in any case in which the State home receives a 

21 refund payment made by an employee in breach of the 

22 terms of an agreement for employee assistance that used 

23 funds provided under this section, the payment shall be re24 turned to the State home’s incentive program account and 

25 credited as a non-Federal funding source. 
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1 ‘‘(i) ANNUAL REPORT FROM PAYMENT RECIPIENTS.— 

2 Any State home receiving a payment under this section for 

3 any fiscal year, shall, as a condition of the payment, be 

4 required to agree to provide to the Secretary a report setting 

5 forth in detail the use of funds received through the pay6 ment, including a descriptive analysis of how effective the 

7 incentive program has been on nurse staffing in the State 

8 home during that fiscal year. The report for any fiscal year 

9 shall be provided to the Secretary within 60 days of the 

10 close of the fiscal year and shall be subject to audit by the 

11 Secretary. Eligibility for a payment under this section for 

12 any later fiscal year is contingent upon the receipt by the 

13 Secretary of the annual report under this subsection for the 

14 previous year in accordance with this subsection. 

15 ‘‘(j) REGULATIONS.—The Secretary shall prescribe reg16 ulations to carry out this section. The regulations shall in17 clude the establishment of criteria for the award of pay18 ments under this section.’’. 

19 (2) The table of sections at the beginning of such chap20 ter is amended by inserting after section 1743 the following 

21 new item: 

‘‘1744. Hiring and retention of nurses: payments to assist States.’’. 

22 (b) IMPLEMENTATION.—The Secretary of Veterans Af23 fairs shall implement section 1744 of title 38, United States 

24 Code, as added by subsection (a), as expeditiously as pos25 sible. The Secretary shall establish such interim procedures 
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1 as necessary so as to ensure that payments are made to 

2 eligible States under that section commencing not later than 

3 January 1, 2005, notwithstanding that regulations under 

4 subsection (j) of that section may not have become final. 

5 SEC. 7. TECHNICAL CLARIFICATION. 

6 Section 8111(d)(2) of title 38, United States Code, is 

7 amended by inserting before the period at the end of the 

8 last sentence the following: ‘‘and shall be available for any 

9 purpose authorized by this section’’. 

10 SEC. 8. UNDER SECRETARY FOR HEALTH. 

11 Section 305(a)(2) of title 38, United States Code, is 

12 amended— 

13 (1) in the matter preceding subparagraph (A), 

14 by striking ‘‘shall be a doctor of medicine and’’; and 

15 (2) in subparagraph (A), by striking ‘‘and in 

16 health-care’’ and inserting ‘‘or in health-care’’. 
Union Calendar No. 312 

108TH CONGRESS 

2D SESSION H. R. 4231 

[Report No. 108–538] 

A BILL 

To provide for a pilot program in the Department 

retention of nurses, and for other purposes. of Veterans Affairs to improve recruitment and 

JUNE 9, 2004 

Reported with an amendment, committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union,