II 

108TH CONGRESS 

2D SESSION H. R. 4231 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 30, 2004 

Received 

AN ACT 

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 Vet3 erans Affairs Nurse Recruitment and Retention Act of 

4 2004’’. 

5 SEC. 2. PILOT PROGRAM TO STUDY INNOVATIVE RECRUIT6 MENT TOOLS TO ADDRESS NURSING SHORT7 AGES AT DEPARTMENT OF VETERANS AF8 FAIRS HEALTH-CARE FACILITIES. 

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

10 of the enactment of this Act, the Secretary of Veterans 

11 Affairs shall designate a health-care service region, or a 

12 section within such a region, in which health-care facilities 

13 of the Department of Veterans Affairs are adversely af14 fected by a shortage of qualified nurses. 

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

16 the region or section designated under paragraph (1) to 

17 determine the effectiveness of the use of innovative 

18 human-capital tools and techniques in the recruitment of 

19 qualified nurses for positions at Department health-care 

20 facilities and for the retention of nurses at such facilities. 

21 In carrying out the pilot program, the Secretary shall 

22 enter into a contract with a private-sector entity for serv23 ices under the pilot program for recruitment of qualified 

24 nurses. 

25 (b) PRIVATE-SECTOR RECRUITMENT PRACTICES.— 

26 For purposes of the pilot program under this section, the 
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1 Secretary shall identify and use recruitment practices that 

2 have proven effective for placing qualified individuals in 

3 positions that are difficult to fill due to shortages of quali4 fied individuals or other factors. Recruitment practices to 

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

6 shall include— 

7 (1) employer branding and interactive adver8 tising strategies; 

9 (2) Internet technologies and automated staff10 ing systems; and 

11 (3) the use of recruitment, advertising, and 

12 communication agencies. 

13 (c) STREAMLINED HIRING PROCESS.—In carrying 

14 out the pilot program under this section, the Secretary 

15 shall, at health-care facilities of the Department in the re16 gion or section in which the pilot program is conducted, 

17 revise procedures and systems for selecting and hiring 

18 qualified nurses to reduce the length of the hiring process. 

19 If the Secretary identifies measures to streamline and 

20 automate the hiring process that can only be implemented 

21 if authorized by law, the Secretary shall submit to the 

22 Committees on Veterans’ Affairs of the Senate and House 

23 of Representatives recommendations for such changes in 

24 law as may be necessary to enable such measure to be 

25 implemented. 
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1 (d) REPORT.—Not later than one year after the date 

2 of the enactment of this Act, the Secretary shall submit 

3 to the Committees on Veterans’ Affairs of the Senate and 

4 House of Representatives a report on the extent to which 

5 the pilot program achieved the goal of improving the re6 cruitment and retention of nurses in Department of Vet7 erans Affairs health-care facilities. 

8 SEC. 3. ALTERNATE WORK SCHEDULES FOR NURSES. 

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

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

11 section 7456 the following new section: 

12 ‘‘§ 7456a. Alternate work schedules 

13 ‘‘(a) APPLICABILITY.—This section applies to reg14 istered nurses appointed under this chapter. 

15 ‘‘(b) 36/40 WORK SCHEDULE.—(1) Subject to para16 graph (2), if the Secretary determines it to be necessary 

17 in order to obtain or retain the services of registered 

18 nurses at a Department health-care facility, the Secretary 

19 may provide, in the case of registered nurses employed at 

20 that facility, that such a nurse who works three regularly 

21 scheduled 12-hour tours of duty within a workweek shall 

22 be considered for all purposes (except computation of full23 time equivalent employees for the purposes of determining 

24 compliance with personnel ceilings) to have worked a full 
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1 40-hour basic workweek. Such a schedule may be referred 

2 to as a ‘36/40 work schedule’. 

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

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

5 worked a full 40-hour basic workweek is subject to sub6 paragraphs (B) and (C). 

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

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

9 hour tour of duty within the workweek shall be derived 

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

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

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

13 of duty within a workweek is entitled to overtime pay 

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

15 for officially ordered or approved service performed in ex16 cess of— 

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

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

19 falls; 

20 ‘‘(II) 12 hours for any day included in the regu21 larly scheduled 36-hour tour of duty; and 

22 ‘‘(III) 40 hours during an administrative work23 week. 

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

25 nurse to whom this subsection is applicable is not entitled 
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1 to additional pay under section 7453 of this title, or other 

2 applicable law, for any period included in a regularly 

3 scheduled 12-hour tour of duty. 

4 ‘‘(3) A nurse who works a 36/40 work schedule de5 scribed in this subsection who is absent on approved sick 

6 leave or annual leave during a regularly scheduled 12-hour 

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

8 ten hours of leave for nine hours of absence. 

9 ‘‘(c) 7/7 Work Schedule—(1) Subject to paragraph 

10 (2), if the Secretary determines it to be necessary in order 

11 to obtain or retain the services of registered nurses at a 

12 Department health-care facility, the Secretary may pro13 vide, in the case of registered nurses employed at such 

14 facility, that such a nurse who works seven regularly 

15 scheduled 10-hour tours of duty, with seven days off duty, 

16 within a two-week pay period, shall be considered for all 

17 purposes (except computation of full-time equivalent em18 ployees for the purposes of determining compliance with 

19 personnel ceilings) to have worked a full 80 hours for the 

20 pay period. Such a schedule may be referred to as a ‘7/ 

21 7 work schedule’. 

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

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

24 worked a full 80-hour pay period is subject to subpara25 graphs (B) and (C). 
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1 ‘‘(B) The hourly rate of basic pay for such a nurse 

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

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

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

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

6 in excess of such nurse’s regularly scheduled 70-hour tour 

7 of duty within a pay period is entitled to overtime pay 

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

9 for officially ordered or approved service performed in ex10 cess of— 

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

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

13 falls; 

14 ‘‘(II) 10 hours for any day included in the regu15 larly scheduled 70-hour tour of duty; and 

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

17 ‘‘(ii) Except as provided in subparagraph (i), a reg18 istered nurse to whom this subsection is applicable is not 

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

20 or other applicable law, for any period included in a regu21 larly scheduled 10-hour tour of duty. 

22 ‘‘(3) A nurse who works a 7/7 work schedule de23 scribed in this subsection who is absent on approved sick 

24 leave or annual leave during a regularly scheduled 12-hour 
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1 tour of duty shall be charged for such leave at a rate of 

2 eight hours of leave for seven hours of absence. 

3 ‘‘(d) 9-Month WORK SCHEDULE.—The Secretary 

4 may authorize a registered nurse appointed under section 

5 7405 of this title, with the nurse’s written consent, to 

6 work full-time for nine months with three months off duty, 

7 within a fiscal year, and be paid at 75 percent of the full8 time rate for such nurse’s grade for each pay period of 

9 that fiscal year. A nurse working on such a schedule for 

any fiscal year shall be considered a 3 10 ⁄4 full-time equivalent 

11 employee for that fiscal year in computing full-time equiv12 alent employees for the purposes of determining compli13 ance with personnel ceilings. Service on such a schedule 

14 shall be considered to be part-time service for purposes 

15 of computing benefits under chapters 83 and 84 of title 

16 5. 

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

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

19 (b) CLERICAL AMENDMENT.—The table of sections 

20 at the beginning of chapter 74 of such title is amended 

21 by inserting after the item relating to section 7456 the 

22 following new item: 

‘‘7456a. Alternate work schedules.’’. 
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1 SEC. 4. 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. 5. 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 

18 the 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 

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

2 that year— 

3 ‘‘(1) receives per diem payments under this 

4 subchapter for that fiscal year; and 

5 ‘‘(2) has in effect an employee incentive schol6 arship program or other employee incentive program 

7 at a State home designed to promote the hiring and 

8 retention of nursing staff and to reduce nursing 

9 shortages at that home. 

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

11 an amount received under this section only to provide 

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

13 program shall meet such criteria as the Secretary may 

14 prescribe. In prescribing such criteria, the Secretary shall 

15 take into consideration the need for flexibility and innova16 tion. 

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

18 A payment under this section may not be used to provide 

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

20 employee incentive scholarship or other incentive program 

21 for which the payment is made. 

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

23 this section for any fiscal year is, for each State home 

24 in that State with a program described in subsection 

25 (b)(2), the amount equal to 2 percent of the amount of 
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1 payments estimated to be made to that State, for that 

2 State home, under section 1741 of this title for that fiscal 

3 year. 

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

5 for any fiscal year with respect to any State home may 

6 only be made based upon an application submitted by the 

7 State seeking the payment with respect to that State 

8 home. Any such application shall describe the nursing 

9 shortage at the State home and the employee incentive 

10 scholarship program or other incentive program described 

11 in subsection (c) for which the payment is sought. 

12 ‘‘(f) SOURCE OF FUNDS.—Payments under this sec13 tion shall be made from funds available for other pay14 ments under this subchapter. 

15 ‘‘(g) DISBURSEMENT.—Payments under this section 

16 to a State home shall be made as part of the disbursement 

17 of payments under section 1741 of this title with respect 

18 to that State home. 

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

20 shall require as a condition of any payment under this sec21 tion that, in any case in which the State home receives 

22 a refund payment made by an employee in breach of the 

23 terms of an agreement for employee assistance that used 

24 funds provided under this section, the payment shall be 
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1 returned to the State home’s incentive program account 

2 and credited as a non-Federal funding source. 

3 ‘‘(i) ANNUAL REPORT FROM PAYMENT RECIPI4 ENTS.—Any State home receiving a payment under this 

5 section for any fiscal year, shall, as a condition of the pay6 ment, be required to agree to provide to the Secretary a 

7 report setting forth in detail the use of funds received 

8 through the payment, including a descriptive analysis of 

9 how effective the incentive program has been on nurse 

10 staffing in the State home during that fiscal year. The 

11 report for any fiscal year shall be provided to the Sec12 retary within 60 days of the close of the fiscal year and 

13 shall be subject to audit by the Secretary. Eligibility for 

14 a payment under this section for any later fiscal year is 

15 contingent upon the receipt by the Secretary of the annual 

16 report under this subsection for the previous year in ac17 cordance with this subsection. 

18 ‘‘(j) REGULATIONS.—The Secretary shall prescribe 

19 regulations to carry out this section. The regulations shall 

20 include the establishment of criteria for the award of pay21 ments under this section.’’. 

22 (2) The table of sections at the beginning of such 

23 chapter is amended by inserting after section 1743 the 

24 following new item: 

‘‘1744. Hiring and retention of nurses: payments to assist States.’’. 
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1 (b) IMPLEMENTATION.—The Secretary of Veterans 

2 Affairs shall implement section 1744 of title 38, United 

3 States Code, as added by subsection (a), as expeditiously 

4 as possible. The Secretary shall establish such interim pro5 cedures as necessary so as to ensure that payments are 

6 made to eligible States under that section commencing not 

7 later than January 1, 2005, notwithstanding that regula8 tions under subsection (j) of that section may not have 

9 become final. 

10 SEC. 6. TECHNICAL CLARIFICATION. 

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

12 is amended by inserting before the period at the end of 

13 the last sentence the following: ‘‘and shall be available for 

14 any purpose authorized by this section’’. 

15 SEC. 7. UNDER SECRETARY FOR HEALTH. 

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

17 amended— 

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

19 by striking ‘‘shall be a doctor of medicine and’’; and 
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1 (2) in subparagraph (A), by striking ‘‘and in 

2 health-care’’ and inserting ‘‘or in health-care’’. 

Passed the House of Representatives September 30, 

2004. 

Attest: JEFF TRANDAHL, 

Clerk.