1805 of the Social Security Act) shall submit to Congress 
and the Secretary a report estimating total costs and sav-
ings attributable to compliance with requirements imposed 
under sections 3101 through 3103. Such report shall in-
clude recommendations on the need, if any, to adjust reim-
bursement for Medicare payments under subsection (a). 
‘‘SEC. 3105. PROTECTION OF NURSES AND OTHER INDIVID-
UALS. 
‘‘(a) REFUSAL
OF
ASSIGNMENT.—A nurse may 
refuse to accept an assignment as a nurse in a hospital 
if— 
‘‘(1) the assignment would violate section 3101 
or 3103; or 
‘‘(2) the nurse is not prepared by education, 
training, or experience to fulfill the assignment with-
out compromising the safety of any patient or jeop-
ardizing the license of the nurse. 
‘‘(b) RETALIATION FOR REFUSAL OF ASSIGNMENT 
BARRED.— 
‘‘(1) NO DISCHARGE, DISCRIMINATION, OR RE-
TALIATION.—No hospital shall discharge, discrimi-
nate, or retaliate in any manner with respect to any 
aspect of employment (as defined in section 
3106(5)), including discharge, promotion, compensa-
tion, or terms, conditions, or privileges of employ-
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ment against a nurse based on the nurse’s refusal of 
a work assignment under subsection (a). 
‘‘(2) NO FILING OF COMPLAINT.—No hospital 
shall file a complaint or a report against a nurse 
with the appropriate State professional disciplinary 
agency because of the nurse’s refusal of a work as-
signment under subsection (a). 
‘‘(c) CAUSE OF ACTION.—Any nurse who has been 
discharged, discriminated, or retaliated against in viola-
tion of subsection (b)(1) or against whom a complaint has 
been filed in violation of subsection (b)(2) may bring a 
cause of action in a United States district court. A nurse 
who prevails on the cause of action shall be entitled to 
one or more of the following: 
‘‘(1) Reinstatement. 
‘‘(2) Reimbursement of lost wages, compensa-
tion, and benefits. 
‘‘(3) Attorneys’ fees. 
‘‘(4) Court costs. 
‘‘(5) Other damages. 
‘‘(d) COMPLAINT TO SECRETARY.—A nurse or other 
individual may file a complaint with the Secretary against 
a hospital that violates the provisions of this title. For any 
complaint filed, the Secretary shall— 
‘‘(1) receive and investigate the complaint; 
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‘‘(2) determine whether a violation of this title 
as alleged in the complaint has occurred; and 
‘‘(3) if such a violation has occurred, issue an 
order that the complaining nurse or individual shall 
not suffer any retaliation under subsection (b) or 
under subsection (e). 
‘‘(e) PROTECTION FOR REPORTING.— 
‘‘(1) RETALIATION BARRED.—A hospital shall 
not discriminate or retaliate in any manner with re-
spect to any aspect of employment, including hiring, 
discharge, promotion, compensation, or terms, condi-
tions, or privileges of employment against any indi-
vidual who in good faith, individually or in conjunc-
tion with another person or persons— 
‘‘(A) reports a violation or a suspected vio-
lation of this title to the Secretary, a public reg-
ulatory agency, a private accreditation body, or 
the management personnel of the hospital; 
‘‘(B) initiates, cooperates, or otherwise 
participates in an investigation or proceeding 
brought by the Secretary, a public regulatory 
agency, or a private accreditation body con-
cerning matters covered by this title; or 
‘‘(C) informs or discusses with other indi-
viduals or with representatives of hospital em-
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ployees a violation or suspected violation of this 
title. 
‘‘(2) GOOD FAITH DEFINED.—For purposes of 
this subsection, an individual shall be deemed to be 
acting in good faith if the individual reasonably be-
lieves— 
‘‘(A) the information reported or disclosed 
is true; and 
‘‘(B) a violation of this title has occurred 
or may occur. 
‘‘(f) NOTICE.—A hospital shall post in an appropriate 
location in each unit a conspicuous notice in a form speci-
fied by the Secretary that— 
‘‘(1) explains the rights of nurses and other in-
dividuals under this section; 
‘‘(2) includes a statement that a nurse or other 
individual may file a complaint with the Secretary 
against a hospital that violates the provisions of this 
title; and 
‘‘(3) provides instructions on how to file a com-
plaint under paragraph (2). 
‘‘(g) EFFECTIVE DATES.— 
‘‘(1) REFUSAL; RETALIATION; CAUSE
OF
AC-
TION.— 
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‘‘(A) 
IN
GENERAL.—Subsections 
(a) 
through (c) shall apply to refusals occurring on 
or after the effective date of the provision to 
which the refusal relates. 
‘‘(B) EXCEPTION.—Subsection (a)(2) shall 
not apply to refusals in any hospital before the 
requirements of section 3101(a) apply to that 
hospital. 
‘‘(2) PROTECTIONS
FOR
REPORTING.—Sub-
section (e) shall apply to actions described in sub-
paragraphs (A) and (C) of subsection (e)(1) occur-
ring on or after the effective date of the provision 
to which the violation relates. Subsection (e) shall 
apply to initiation, cooperation, or participation in 
an investigation or proceeding on or after the date 
of the enactment of this title. 
‘‘(3) NOTICE.—Subsection (f) shall take effect 
18 months after the date of the enactment of this 
title. 
‘‘SEC. 3106. DEFINITIONS. 
‘‘For purposes of this title: 
‘‘(1) ACUITY SYSTEM.—The term ‘acuity sys-
tem’ means an established measurement tool that— 
‘‘(A) predicts nursing care requirements 
for individual patients based on severity of pa-
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tient illness, need for specialized equipment and 
technology, intensity of nursing interventions 
required, and the complexity of clinical nursing 
judgment needed to design, implement, and 
evaluate the patient’s nursing care plan; 
‘‘(B) details the amount of nursing care 
needed, both in number of nurses and in skill 
mix of nursing personnel required, on a daily 
basis, for each patient in a nursing department 
or unit; 
‘‘(C) takes into consideration the patient 
care services provided not only by registered 
nurses but also by direct care licensed practical 
nurses and other health care personnel; and 
‘‘(D) is stated in terms that can be readily 
used and understood by nurses. 
‘‘(2) 
DIRECT
CARE
LICENSED
PRACTICAL 
NURSE.—The term ‘direct care licensed practical 
nurse’ means an individual who has been granted a 
license by at least 1 State to practice as a licensed 
practical nurse or a licensed vocational nurse and 
who provides bedside care for 1 or more patients. 
‘‘(3) NURSE.—The term ‘nurse’ means any di-
rect care registered nurse or direct care licensed 
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