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 Ad-
ministration of the Department of Veterans Affairs.
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 ‘‘VA Medical Workforce 
Enhancement Act of 2003’’. 
SEC. 2. FINDINGS AND PURPOSES. 
(a) FINDINGS.—The Congress finds as follows: 
(1) The United States is currently facing crit-
ical workforce shortages in all areas of hospital oper-
ations, including both clinical and nonclinical oper-
ations. 
(2) As its workforce ages, the Veterans Health 
Administration of the Department of Veterans Af-
fairs is facing a loss of staff through retirement at 
a time of staffing shortages across all areas of hos-
pital operations. 
(3) The demand for health professionals will 
grow as the ‘‘Baby Boom’’ generation retires and 
adds to an already burgeoning population of elderly 
requiring more extensive health services. 
(4) There are not enough nurses and health 
care providers to care for veterans who are on the 
Department of Veterans Affairs waiting lists. Dur-
ing the current nationwide nursing shortage, the De-
partment of Veterans Affairs must replace up to 5.3 
percent of its registered nurses each year just to 
keep pace with the loss from nurses who retire. 
(5) The number of nurses retiring in the next 
10 years is expected to far exceed the number of 
new nurses joining the workforce, resulting in a na-
tionwide nursing shortage. 
(6) This shortage will certainly affect health 
care facilities of the Department of Veterans Affairs, 
which, like many other health care facilities, are al-
ready seeing a shrinking pool of highly trained 
nurses. 
(7) Nursing care is vital to providing the best 
patient care possible and, as the nursing shortage 
worsens, care for veterans who have sacrificed much 
for the liberties and freedoms enjoyed by the Amer-
ican people will suffer. 
(8) In order to meet the increasing demand 
from veterans in need of health care, the Depart-
ment of Veterans Affairs must be aggressive in its 
efforts to recruit and retain its nursing staff. 
(9) The failure to maintain adequate staffing 
levels can harm veterans under the Department’s 
care. There is a clear link between nurse-to-patient 
ratios and patient successes. For every additional 
patient over four in a nurse’s workload, the risk of 
death increases by 7 percent for surgical patients. 
Unfortunately, many Department of Veterans Af-
fairs’ facilities do not meet the threshold safe ratio 
of four medical/surgical patients per nurse. Some fa-
cilities have six, seven, or eight surgical patients per 
nurse. 
(10) There are acute shortages plaguing other 
critical healthcare staff including pharmacists, radi-
ology, and laboratory technologists and other ancil-
lary professionals. 
(11) Thirty-one percent of medical technologists 
of the Department of Veterans Affairs are eligible 
for or nearing retirement. 
(12) Nearly 20 percent of the pharmacy techni-
cians of the Department of Veterans Affairs have 
between 20 and 34 years of Government service. 
(13) One-quarter of the nursing assistants of 
the Department of Veterans Affairs have between 20 
and 34 years of Government service and, therefore, 
are eligible for or nearing retirement. 
(14) The lack of allied health care workers and 
hospital support staff on the weekends hurts direct 
patient care. Without support staff, nurses are 
forced to devote less time on direct patient care in 
order to transport patients, clean the wards, and 
perform other duties typically done by nursing as-
sistants, housekeepers, and other ancillary staff. 
Providing a premium pay for regular weekend shifts 
will help maintain adequate levels of support staff on 
the weekends. 
(15) Ongoing education is important to main-
tain high standards of professionalism in nursing 
care. The Department of Veterans Affairs should en-
courage the professional development of its nursing 
staff through ongoing educational programs and 
through funding opportunities to support nurses in 
achieving a baccalaureate or masters degree in nurs-
ing. 
(b) PURPOSES.—The purposes of this Act are the fol-
lowing: 
(1) To clarify that the Secretary of Veterans 
Affairs and labor organizations representing health 
care employees can work together to improve patient 
care by allowing the Secretary the option of negotia-
tion with exclusive employee representatives over 
safe staffing levels to ensure that veterans are pro-
vided with high quality care. 
(2) To improve the consistency, legitimacy, and 
fairness in the nurse pay and promotion system of 
the Veterans Health Administration by allowing the 
Secretary of Veterans Affairs and labor organiza-
tions to negotiate the process by which nurses and 
other health care professionals are promoted. 
(3) To provide for additional pay for Saturday 
tours of duty for additional health care workers in 
the Veterans Health Administration.
(4) To provide for a program to be conducted 
by the Secretary of Veterans Affairs to assess the 
benefits of establishing a nurse preceptor program. 
SEC. 3. ENHANCING SAFETY AND QUALITY OF PATIENT 
CARE. 
Section 7422 of title 38, United States Code, is 
amended—
(1) by redesigning subsection (e) as subsection 
(f); and 
(2) by inserting after subsection (d) the fol-
lowing new subsection (e): 
‘‘(e) Nothing in subsection (b), (c), or (d) precludes 
the Secretary and any labor organization representing em-
ployees of the Veterans Health Administration from enter-
ing into a collective bargaining agreement, at the election 
of the Secretary, with respect to—
‘‘(1) the numbers, types, and grades of employ-
ees or positions assigned to any medical facility, clin-
ic, or organizational subdivision; 
‘‘(2) the number of patients assigned to employ-
ees referred to in section 7401 of this title who are 
physicians, physicians assistants, or nurses; and 
‘‘(3) employee-to-patient ratios for employees 
referred to in section 7401 of this title other than 
those specified in paragraph (2).’’.
SEC. 4. IMPROVEMENTS TO THE RETENTION AND RECRUIT-
MENT OF HEALTH CARE PROFESSIONALS. 
Section 7403 of title 38, United States Code, is 
amended by adding at the end the following new sub-
sections: 
‘‘(h) Nothing in this section, or in subsection (b), (c), 
and (d) of section 7422 of this title, shall limit the right 
or ability of any labor organization representing employees 
in the Veterans Health Administration to engage in collec-
tive bargaining with respect to the promotion processes 
established pursuant to this section. 
‘‘(i) In a case in which a registered nurse has accom-
plished the performance elements for promotion to the 
next grade, the lack of a specific type of educational de-
gree shall not be an impediment to promotion, and in such 
a case the registered nurse shall not be denied a promotion 
on that basis.’’. 
SEC. 5. ADDITIONAL PAY FOR SATURDAY TOURS OF DUTY 
FOR ADDITIONAL HEALTH CARE WORKERS IN 
THE VETERANS HEALTH ADMINISTRATION. 
(a) IN GENERAL.—Section 7454(b) of title 38, 
United States Code, is amended by adding at the end the 
following new paragraph: 
‘‘(3) Employees appointed under section 7408 of this 
title shall be entitled to additional pay on the same basis 
as provided for nurses in section 7453(c) of this title.’’.
(b) APPLICABILITY.—The amendment made by sub-
section (a) shall apply with respect to pay periods begin-
ning on or after the date of the enactment of this Act. 
SEC. 6. NURSE PRECEPTOR PROGRAM. 
(a) NATURE OF PROGRAM.—The Secretary of Vet-
erans Affairs shall carry out a nurse preceptor program 
to develop nurse preceptors who will act as mentors to 
newly hired registered nurses at Department of Veterans 
Affairs health care facilities. 
(b) STRUCTURE OF PROGRAM.—The nurse preceptor 
program shall include the following: 
(1) For registered nurses interested in becom-
ing nurse preceptors, intensive training and screen-
ing programs. 
(2) For registered nurses selected to be nurse 
preceptors—
(A) a rigorous 26-week training program; 
(B) continuous professional development 
classes; and 
(C) a salary increase equivalent to 5 per-
cent of gross annual salary for any period dur-
ing which the nurse functions as a nurse pre-
ceptor. 
(c) ANNUAL REPORT
TO CONGRESS.—Each year 
after the date of the enactment of this Act, the Secretary
shall submit to the Committees on Veterans’ Affairs of 
the Senate and the House of Representatives a report on 
the effectiveness and usefulness of the nurse preceptor 
program. The Secretary shall include in each report the 
following: 
(1) The Secretary’s assessment of the benefits 
to veterans of the program. 
(2) The Secretary’s assessment of the effect of 
the program on the Department of Veterans Affairs, 
including the effect on retention of a qualified nurs-
ing staff. 
(3) Any other findings and conclusions of the 
Secretary with respect to the program.
Æ