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 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,
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Department of Vet-
erans 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 
Affairs shall designate a health-care service region, or a 
section within such a region, in which health-care facilities 
of the Department of Veterans Affairs are adversely af-
fected by a shortage of qualified nurses. 
(2) The Secretary shall conduct a pilot program in 
the region or section designated under paragraph (1) to 
determine 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 contract with a private-sector entity for serv-
ices under the pilot program for recruitment of qualified 
nurses. 
(b) PRIVATE-SECTOR RECRUITMENT PRACTICES.— 
For purposes of the pilot program under this section, the
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Secretary 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 staff-
ing systems; and 
(3) the use of recruitment, advertising, and 
communication 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 re-
gion or section in which the pilot program is conducted, 
revise procedures and systems for selecting and hiring 
qualified nurses to reduce the length of the hiring process. 
If the Secretary 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 Representatives recommendations for such changes in 
law as may be necessary to enable such measure to be 
implemented.
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(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 
scheduled 12-hour tours of duty within a workweek shall 
be considered for all purposes (except computation of full- 
time equivalent employees for the purposes of determining 
compliance with personnel ceilings) to have worked a full
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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 
worked a full 40-hour basic workweek is subject to sub-
paragraphs (B) and (C). 
‘‘(B) The hourly rate of basic pay for such a nurse 
for service performed as part of a regularly scheduled 36- 
hour tour of duty within the workweek shall be derived 
by dividing the nurse’s annual rate of basic pay by 1,872. 
‘‘(C)(i) Such a nurse who performs a period of service 
in excess of such nurse’s regularly scheduled 36-hour tour 
of duty within a workweek 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 12-hour tour 
falls; 
‘‘(II) 12 hours for any day included in the regu-
larly scheduled 36-hour tour of duty; and 
‘‘(III) 40 hours during an administrative work-
week. 
‘‘(ii) Except as provided in clause (i), a registered 
nurse to whom this subsection is applicable is not entitled
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to additional pay under section 7453 of this title, or other 
applicable law, for any period included in a regularly 
scheduled 12-hour tour of duty. 
‘‘(3) A nurse who works a 36/40 work schedule de-
scribed 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 
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 
Department health-care facility, the Secretary may pro-
vide, 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 em-
ployees for the purposes 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).
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‘‘(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 de-
scribed in this subsection who is absent on approved sick 
leave or annual leave during a regularly scheduled 12-hour
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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 equiv-
alent employees for the purposes of determining compli-
ance with personnel ceilings. Service on such a schedule 
shall be considered 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 inserting after the item relating to section 7456 the 
following new item: 
‘‘7456a. Alternate work schedules.’’.
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SEC. 4. 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. 5. 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 submis-
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sion of an application, be made to any State that during 
that year— 
‘‘(1) receives per diem payments under this 
subchapter for that fiscal year; and 
‘‘(2) has in effect an employee incentive schol-
arship program or other employee incentive program 
at a State home designed to promote the hiring and 
retention of nursing staff and to reduce nursing 
shortages 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 consideration the need for flexibility and innova-
tion. 
‘‘(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
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payments estimated 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 sec-
tion shall be made from funds available for other pay-
ments 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
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returned to the State home’s incentive program account 
and credited as a non-Federal funding source. 
‘‘(i) ANNUAL REPORT FROM PAYMENT RECIPI-
ENTS.—Any State home receiving a payment under this 
section for any fiscal year, shall, as a condition of the pay-
ment, be required to agree to provide to the Secretary a 
report setting forth in detail the use of funds received 
through the payment, 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 Sec-
retary 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 ac-
cordance with this subsection. 
‘‘(j) REGULATIONS.—The Secretary shall prescribe 
regulations to carry out this section. The regulations shall 
include the establishment of criteria for the award of pay-
ments under this section.’’. 
(2) The table of sections at the beginning of such 
chapter is amended by inserting after section 1743 the 
following new item: 
‘‘1744. Hiring and retention of nurses: payments to assist States.’’.