I
107TH CONGRESS
2D SESSION
H. R. 4654
To amend the Public Health Service Act to provide programs to improve
nurse retention, the nursing workplace, and the quality of care.
IN THE HOUSE OF REPRESENTATIVES
MAY 2, 2002
Mrs. MCCARTHY of New York (for herself and Mrs. BONO) introduced the
following bill; which was referred to the Committee on Energy and Commerce
A BILL
To amend the Public Health Service Act to provide programs
to improve nurse retention, the nursing workplace, and
the quality of care.
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 ‘‘Nurse Retention and
Quality of Care Act of 2002’’.
SEC. 2. FINDINGS.
Congress finds the following:
(1) The current nurse workforce is aging, and
the average age of practicing registered nurses is
43.3 years, representing an increase of 5.9 years
since 1983. This means that the nursing workforce
is aging at twice the rate of other occupations in the
United States, and the enrollment in nursing pro-
grams has decreased in the past 5 years. Many hos-
pitals around the country are reporting vacancy
rates for nursing positions.
(2) Studies have shown a correlation between
higher nurse staffing levels and reduction in adverse
patient outcomes, including risk of infection, shock,
upper gastrointestinal bleeding, and increased length
of stay.
(3) Retention problems are contributing to the
nursing shortage problem. According to a 2001 sur-
vey, 50 percent of nurses say they have recently con-
sidered leaving the nursing profession for reasons
other than retirement.
(4) A majority of those individuals who are con-
sidering leaving nursing express a low level of overall
job satisfaction, and their lack of participation in de-
cisionmaking is a major factor contributing to dis-
satisfaction.
(5) Magnet hospitals are hospitals that have re-
organized care to be more participatory, collabo-
rative, and patient-centered and as a result are able
to attract more nurses.
(6) Even in times of nursing shortages, magnet
hospitals enjoy low turnover. The average length of
employment for registered nurses in magnet hos-
pitals is 8.35 years, which is twice the length of em-
ployment in hospitals generally, and magnet hospital
nurses consistently report greater job satisfaction
than other nurses.
(7) Magnet hospitals report lower mortality
rates, higher patient satisfaction, and greater cost-
efficiency, with patients experiencing shorter stays in
hospitals and intensive care units.
SEC. 3. AMENDMENT.
Title VIII of the Public Health Service Act (42
U.S.C. 296 et seq.) is amended by adding at the end the
following:
‘‘PART H—INITIATIVES TO IMPROVE NURSE RE-
TENTION, THE NURSING WORKPLACE, AND
THE QUALITY OF CARE
‘‘SEC. 851. DEVELOPING MODELS AND BEST PRACTICES IN
NURSING CARE.
‘‘(a) PROGRAM AUTHORIZED.—From amounts ap-
propriated under section 853, the Secretary shall award
grants to eligible entities to enable the eligible entities to
carry out demonstrations of models and best practices in
nursing care for the purpose of developing innovative
strategies or approaches for retention of professional
nurses.
‘‘(b) DEFINITIONS.—In this section:
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means a health care facility, or any partnership
or coalition containing a health care facility and a
collegiate, associate degree, or diploma school of
nursing.
‘‘(2) HEALTH
CARE
FACILITY.—The term
‘health care facility’ means a hospital, clinic, skilled
nursing facility, long-term care facility, home health
care agency, federally qualified health center, rural
health clinic, public health clinic, nurse managed
health center, or any other entity as designated by
the Secretary.
‘‘(c) PRIORITY.—In awarding grants under this sec-
tion (other than awarding grant extensions under sub-
section (e)(2)), the Secretary shall give priority to appli-
cants that have not yet been designated as a magnet hos-
pital by the American Nurses Credentialing Center.
‘‘(d) DISTRIBUTION OF GRANTS.—Grants awarded
under this section shall be distributed among a variety of
geographic regions, and among a range of different types
and sizes of facilities, including facilities located in rural,
urban, and suburban areas.
‘‘(e) DURATION OF GRANTS.—
‘‘(1) THREE-YEAR GRANTS.—A grant awarded
under this section shall be awarded for a period of
not greater than 3 years.
‘‘(2) GRANT
EXTENSIONS.—A grant awarded
under this section may be extended if the grantee
demonstrates that—
‘‘(A) as determined by the Secretary based
on the factors described in paragraph (3), the
grantee has significantly improved the quality
of its workplace for nurses and has enhanced
patient care; or
‘‘(B) after the original award of the grant,
the grantee was designated as a magnet hos-
pital by the American Nurses Credentialing
Center.
‘‘(3) PREFERENCE.—In awarding grant exten-
sions under this subsection, the Secretary shall give
preference to entities that have—
‘‘(A) significantly increased retention rates
for professional nurses;
‘‘(B) significantly reduced rates of work-
place injuries for professional nurses; and
‘‘(C) significantly reduced rates of nursing-
sensitive adverse patient outcomes.
‘‘(4) MAXIMUM
DURATION
OF
GRANTS.—The
total maximum duration of a grant under this sec-
tion shall not be greater than 6 years.
‘‘(f) USE OF FUNDS.—An eligible entity that receives
a grant under subsection (a) shall use funds received
under the grant to carry out demonstrations of models and
best practices in nursing care for the purpose of—
‘‘(1) promoting retention and satisfaction of
professional nurses;
‘‘(2) promoting collaboration and communica-
tion among health care professionals;
‘‘(3) promoting nurse involvement in organiza-
tional and clinical decisionmaking processes;
‘‘(4) organizing care to enhance the satisfaction
of professional nurses, improve the nursing work-
place environment, and promote the quality of nurs-
ing care;
‘‘(5) promoting opportunities for professional
nurses to pursue education, career advancement, and
organizational recognition;
‘‘(6) promoting high quality of patient care—
‘‘(A) by enhancing institutional measure-
ment of quality outcomes, including identifica-
tion and measurement of nursing-sensitive pa-
tient outcomes;
‘‘(B) by basing the development of policies,
procedures, guidelines, and organizational sys-
tems on research findings and patient outcomes
measurement, including nursing-sensitive pa-
tient outcomes measurement; and
‘‘(C) by involving professional nurses in de-
veloping and implementing ways to measure
and improve the quality of care;
‘‘(7) promoting a balanced work-life environ-
ment; and
‘‘(8) offering such other activities as may be de-
termined by the Secretary to enhance the workplace
environment for professional nurses.
‘‘(g) APPLICATION.—
‘‘(1) IN GENERAL.—An eligible entity desiring a
grant under subsection (a) shall submit an applica-
tion to the Secretary at such time, in such manner,
and containing such information as the Secretary
may reasonably require.
‘‘(2) CONTENTS.—An application submitted
under paragraph (1) shall—
‘‘(A) include a description of the project
proposed to be carried out with grant funds;
‘‘(B) demonstrate the eligible entity’s com-
mitment to the project through a statement
describing—
‘‘(i) the involvement of high-level exec-
utive management, trustees, nurse leader-
ship, and medical staff in designing, imple-
menting, and overseeing the project;
‘‘(ii) the designation of key personnel
and management structures to design, im-
plement, and oversee the project;
‘‘(iii) any actions that the eligible en-
tity has already taken that contribute to
developing innovative models and ap-
proaches for retention of professional
nurses; and
‘‘(iv) the eligible entity’s funding or
any evidence of other contributions and
commitment for the project, along with in-
formation on overall project budget and
funding resources; and
‘‘(C) include information regarding the re-
tention rate and occurrence of workplace inju-
ries to nurses at the entity applying for such
grant and any other information as the Sec-
retary may reasonably require.
‘‘SEC. 852. SURVEY AND EVALUATION.
‘‘The Secretary, in consultation with the Agency for
Healthcare Research and Quality and the Health Re-
sources and Services Administration shall—
‘‘(1) conduct an annual survey of the projects
carried out under section 851 and provide to Con-
gress the results of such survey beginning not later
than 2 years after the date of enactment of the
Nurse Retention and Quality of Care Act of 2002;
and
‘‘(2) develop and provide to Congress, not later
than December 30, 2007, a final report that—
‘‘(A) evaluates the projects funded by
grants under section 851; and
‘‘(B) includes findings about best practices
and the impact on patients and staff of employ-
ing participatory, collaborative, and patient-cen-
tered models of nursing care.
‘‘SEC. 853. AUTHORIZATION OF APPROPRIATIONS.
‘‘(a) GRANTS.—There is authorized to be appro-
priated to carry out section 851, $20,000,000 for the pe-
riod of fiscal years 2002 through 2007.
‘‘(b) SURVEY AND EVALUATION.—There is author-
ized to be appropriated to carry out section 852,
$2,500,000 for the period of fiscal years 2002 through
2007.’’.
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