IB 
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 Vet-
erans Affairs to improve recruitment and retention of 
nurses, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Department of Veterans 
Affairs Nurse Recruitment and Retention Act of 2004’’. 
SEC. 2. PILOT PROGRAM TO STUDY INNOVATIVE RECRUIT-
MENT TOOLS TO ADDRESS NURSING SHORT-
AGES AT DEPARTMENT OF VETERANS AF-
FAIRS HEALTH-CARE FACILITIES. 
(a) PILOT.—(1) Not later than 90 days after the date 
of the enactment of this Act, the Secretary of Veterans Af-
fairs shall designate a health-care service region, or a sec-
tion within such a region, in which health-care facilities 
of the Department of Veterans Affairs are adversely affected 
by a shortage of qualified nurses. 
(2) The Secretary shall conduct a pilot program in 
the region or section designated under paragraph (1) to de-
termine the effectiveness of the use of innovative human- 
capital tools and techniques in the recruitment of qualified 
nurses for positions at Department health-care facilities 
and for the retention of nurses at such facilities. In carrying 
out the pilot program, the Secretary shall enter into a con-
tract with a private-sector entity for services under the pilot 
program for recruitment of qualified nurses. 
(b) PRIVATE-SECTOR RECRUITMENT PRACTICES.—For 
purposes of the pilot program under this section, the Sec-
retary shall identify and use recruitment practices that 
have proven effective for placing qualified individuals in
positions that are difficult to fill due to shortages of quali-
fied individuals or other factors. Recruitment practices to 
be reviewed by the Secretary for use in the pilot program 
shall include— 
(1) employer branding and interactive adver-
tising strategies; 
(2) Internet technologies and automated staffing 
systems; and 
(3) the use of recruitment, advertising, and com-
munication agencies. 
(c) STREAMLINED HIRING PROCESS.—In carrying out 
the pilot program under this section, the Secretary shall, 
at health-care facilities of the Department in the region or 
section in which the pilot program is conducted, revise pro-
cedures and systems for selecting and hiring qualified 
nurses to reduce the length of the hiring process. If the Sec-
retary identifies measures to streamline and automate the 
hiring process that can only be implemented if authorized 
by law, the Secretary shall submit to the Committees on 
Veterans’ Affairs of the Senate and House of Representa-
tives recommendations for such changes in law as may be 
necessary to enable such measure to be implemented. 
(d) REPORT.—Not later than one year after the date 
of the enactment of this Act, the Secretary shall submit to 
the Committees on Veterans’ Affairs of the Senate and
House of Representatives a report on the extent to which 
the pilot program achieved the goal of improving the re-
cruitment and retention of nurses in Department of Vet-
erans Affairs health-care facilities. 
SEC. 3. ALTERNATE WORK SCHEDULES FOR NURSES. 
(a) ENHANCED SHIFT FLEXIBILITY.—Chapter 74 of 
title 38, United States Code, is amended by inserting after 
section 7456 the following new section: 
‘‘§ 7456a. Alternate work schedules 
‘‘(a) APPLICABILITY.—This section applies to reg-
istered nurses appointed under this chapter. 
‘‘(b) 36/40 WORK SCHEDULE.—(1) Subject to para-
graph (2), if the Secretary determines it to be necessary 
in order to obtain or retain the services of registered nurses 
at a Department health-care facility, the Secretary may 
provide, in the case of registered nurses employed at that 
facility, that such a nurse who works three regularly sched-
uled 12-hour tours of duty within a workweek shall be con-
sidered for all purposes (except computation of full-time 
equivalent employees for the purposes of determining com-
pliance with personnel ceilings) to have worked a full 40- 
hour basic workweek. Such a schedule may be referred to 
as a ‘36/40 work schedule’. 
‘‘(2)(A) Basic and additional pay for a registered 
nurse who is considered under paragraph (1) to have
leave or annual leave during a regularly scheduled 12-hour 
tour of duty shall be charged for such leave at a rate of 
ten hours of leave for nine hours of absence. 
‘‘(c) 7/7 Work Schedule—(1) Subject to paragraph (2), 
if the Secretary determines it to be necessary in order to 
obtain or retain the services of registered nurses at a De-
partment health-care facility, the Secretary may provide, 
in the case of registered nurses employed at such facility, 
that such a nurse who works seven regularly scheduled 10- 
hour tours of duty, with seven days off duty, within a two- 
week pay period, shall be considered for all purposes (except 
computation of full-time equivalent employees for the pur-
poses of determining compliance with personnel ceilings) to 
have worked a full 80 hours for the pay period. Such a 
schedule may be referred to as a ‘7/7 work schedule’. 
‘‘(2)(A) Basic and additional pay for a registered 
nurse who is considered under paragraph (1) to have 
worked a full 80-hour pay period is subject to subpara-
graphs (B) and (C). 
‘‘(B) The hourly rate of basic pay for such a nurse 
for service performed as part of a regularly scheduled 70- 
hour tour of duty within the pay period shall be derived 
by dividing the nurse’s annual rate of basic pay by 1,820. 
‘‘(C)(i) Such a nurse who performs a period of service 
in excess of such nurse’s regularly scheduled 70-hour tour
of duty within a pay period is entitled to overtime pay 
under section 7453(e) of this title, or other applicable law, 
for officially ordered or approved service performed in ex-
cess of— 
‘‘(I) eight hours on a day other than a day on 
which such nurse’s regularly scheduled 10-hour tour 
falls; 
‘‘(II) 10 hours for any day included in the regu-
larly scheduled 70-hour tour of duty; and 
‘‘(III) 80 hours during a pay period. 
‘‘(ii) Except as provided in subparagraph (i), a reg-
istered nurse to whom this subsection is applicable is not 
entitled to additional pay under section 7453 of this title, 
or other applicable law, for any period included in a regu-
larly scheduled 10-hour tour of duty. 
‘‘(3) A nurse who works a 7/7 work schedule described 
in this subsection who is absent on approved sick leave or 
annual leave during a regularly scheduled 12-hour tour of 
duty shall be charged for such leave at a rate of eight hours 
of leave for seven hours of absence. 
‘‘(d) 9-MONTH WORK SCHEDULE.—The Secretary 
may authorize a registered nurse appointed under section 
7405 of this title, with the nurse’s written consent, to work 
full-time for nine months with three months off duty, within 
a fiscal year, and be paid at 75 percent of the full-time
rate for such nurse’s grade for each pay period of that fiscal 
year. A nurse working on such a schedule for any fiscal 
year shall be considered a 3⁄4 full-time equivalent employee 
for that fiscal year in computing full-time equivalent em-
ployees for the purposes of determining compliance with 
personnel ceilings. Service on such a schedule shall be con-
sidered to be part-time service for purposes of computing 
benefits under chapters 83 and 84 of title 5. 
‘‘(e) REGULATIONS.—The Secretary shall prescribe 
regulations for the implementation of this section.’’. 
(b) CLERICAL AMENDMENT.—The table of sections at 
the beginning of chapter 74 of such title is amended by in-
serting after the item relating to section 7456 the following 
new item: 
‘‘7456a. Alternate work schedules.’’. 
SEC. 4. APPOINTMENT OF NURSES WHO DO NOT HAVE BAC-
CALAUREATE DEGREES. 
Section 7403 of title 38, United States Code, is amend-
ed by adding at the end the following new subsection: 
‘‘(h) In a case in which a registered nurse applying 
for an appointment under this chapter as a registered nurse 
has presented the qualifications established under subsection 
(a) for such an appointment, the lack of a baccalaureate 
degree in nursing shall not be a bar to appointment, and 
in such a case the registered nurse shall not be denied ap-
pointment on that basis.’’.
SEC. 5. TECHNICAL CORRECTION TO LISTING OF CERTAIN 
HYBRID POSITIONS IN VETERANS HEALTH 
ADMINISTRATION. 
Section 7401(3) of title 38, United States Code, is 
amended— 
(1) by striking ‘‘and dental technologists’’ and 
inserting ‘‘technologists, dental hygienists, dental as-
sistants’’; and 
(2) 
by 
striking 
‘‘technicians, 
therapeutic 
radiologic technicians, and social workers’’ and in-
serting ‘‘technologists, therapeutic radiologic tech-
nologists, social workers, blind rehabilitation special-
ists, and blind rehabilitation outpatient specialists’’. 
SEC. 6. ASSISTANCE FOR HIRING AND RETENTION OF 
NURSES AT STATE VETERANS HOMES. 
(a) IN GENERAL.—(1) Chapter 17 of title 38, United 
States Code, is amended by inserting after section 1743 the 
following new section: 
‘‘§ 1744. Hiring and retention of nurses: payments to 
assist States 
‘‘(a) PAYMENT PROGRAM.—The Secretary shall make 
payments to States under this section for the purpose of 
assisting State homes in the hiring and retention of nurses 
and the reduction of nursing shortages at State homes. 
‘‘(b) ELIGIBLE RECIPIENTS.—Payments to a State for 
a fiscal year under this section shall, subject to submission
of an application, be made to any State that during that 
year— 
‘‘(1) receives per diem payments under this sub-
chapter for that fiscal year; and 
‘‘(2) has in effect an employee incentive scholar-
ship program or other employee incentive program at 
a State home designed to promote the hiring and re-
tention of nursing staff and to reduce nursing short-
ages at that home. 
‘‘(c) USE OF FUNDS RECEIVED.—A State may use an 
amount received under this section only to provide funds 
for a program described in subsection (b)(2). Any program 
shall meet such criteria as the Secretary may prescribe. In 
prescribing such criteria, the Secretary shall take into con-
sideration the need for flexibility and innovation. 
‘‘(d) LIMITATIONS ON AMOUNT OF PAYMENT.—(1) A 
payment under this section may not be used to provide 
more than 50 percent of the costs for a fiscal year of the 
employee incentive scholarship or other incentive program 
for which the payment is made. 
‘‘(2) The amount of the payment to a State under this 
section for any fiscal year is, for each State home in that 
State with a program described in subsection (b)(2), the 
amount equal to 2 percent of the amount of payments esti-
mated to be made to that State, for that State home, under 
section 1741 of this title for that fiscal year. 
‘‘(e) APPLICATIONS.—A payment under this section for 
any fiscal year with respect to any State home may only 
be made based upon an application submitted by the State 
seeking the payment with respect to that State home. Any 
such application shall describe the nursing shortage at the 
State home and the employee incentive scholarship program 
or other incentive program described in subsection (c) for 
which the payment is sought. 
‘‘(f) SOURCE OF FUNDS.—Payments under this section 
shall be made from funds available for other payments 
under this subchapter. 
‘‘(g) DISBURSEMENT.—Payments under this section to 
a State home shall be made as part of the disbursement 
of payments under section 1741 of this title with respect 
to that State home. 
‘‘(h) USE
OF CERTAIN RECEIPTS.—The Secretary 
shall require as a condition of any payment under this sec-
tion that, in any case in which the State home receives a 
refund payment made by an employee in breach of the 
terms of an agreement for employee assistance that used 
funds provided under this section, the payment shall be re-
turned to the State home’s incentive program account and 
credited as a non-Federal funding source.
‘‘(i) ANNUAL REPORT FROM PAYMENT RECIPIENTS.— 
Any State home receiving a payment under this section for 
any fiscal year, shall, as a condition of the payment, be 
required to agree to provide to the Secretary a report setting 
forth in detail the use of funds received through the pay-
ment, including a descriptive analysis of how effective the 
incentive program has been on nurse staffing in the State 
home during that fiscal year. The report for any fiscal year 
shall be provided to the Secretary within 60 days of the 
close of the fiscal year and shall be subject to audit by the 
Secretary. Eligibility for a payment under this section for 
any later fiscal year is contingent upon the receipt by the 
Secretary of the annual report under this subsection for the 
previous year in accordance with this subsection. 
‘‘(j) REGULATIONS.—The Secretary shall prescribe reg-
ulations to carry out this section. The regulations shall in-
clude the establishment of criteria for the award of pay-
ments under this section.’’. 
(2) The table of sections at the beginning of such chap-
ter is amended by inserting after section 1743 the following 
new item: 
‘‘1744. Hiring and retention of nurses: payments to assist States.’’. 
(b) IMPLEMENTATION.—The Secretary of Veterans Af-
fairs shall implement section 1744 of title 38, United States 
Code, as added by subsection (a), as expeditiously as pos-
sible. The Secretary shall establish such interim procedures
as necessary so as to ensure that payments are made to 
eligible States under that section commencing not later than 
January 1, 2005, notwithstanding that regulations under 
subsection (j) of that section may not have become final. 
SEC. 7. TECHNICAL CLARIFICATION. 
Section 8111(d)(2) of title 38, United States Code, is 
amended by inserting before the period at the end of the 
last sentence the following: ‘‘and shall be available for any 
purpose authorized by this section’’. 
SEC. 8. UNDER SECRETARY FOR HEALTH. 
Section 305(a)(2) of title 38, United States Code, is 
amended— 
(1) in the matter preceding subparagraph (A), 
by striking ‘‘shall be a doctor of medicine and’’; and 
(2) in subparagraph (A), by striking ‘‘and in 
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 
of Veterans Affairs to improve recruitment and 
retention of nurses, and for other purposes. 
JUNE 9, 2004 
Reported with an amendment, committed to the Com-
mittee of the Whole House on the State of the Union, 
and ordered to be printed