‘‘(9) PROFESSIONAL
JUDGMENT.—The term 
‘professional judgment’ means, in accordance with 
State nursing laws and regulations of the State in 
which the direct nursing care is being performed, the 
direct care registered nurse’s application of knowl-
edge, expertise, and experience in conducting a com-
prehensive nursing assessment of each patient and 
in making independent decisions about patient care 
including the need for additional staff. 
‘‘(10) STAFFING
PLAN.—The term ‘staffing 
plan’ means a staffing plan required under section 
3401. 
‘‘(11) STATE OF EMERGENCY.—The term ‘state 
of emergency’— 
‘‘(A) means a state of emergency that is 
an unpredictable or unavoidable occurrence at 
an unscheduled or unpredictable interval, relat-
ing to health care delivery and requiring imme-
diate medical interventions and care; and 
‘‘(B) does not include a state of emergency 
that results from a labor dispute in the health 
care industry or consistent understaffing. 
‘‘SEC. 3408. RULE OF CONSTRUCTION. 
‘‘Nothing in this title shall be construed to authorize 
disclosure of private and confidential patient information, 
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if such disclosure is not authorized or required by other 
applicable law.’’. 
(b) RECOMMENDATIONS TO CONGRESS.—Not later 
than 1 year after the date of enactment of this Act, the 
Secretary of Health and Human Services shall submit to 
Congress a report containing recommendations for ensur-
ing that sufficient numbers of nurses are available to meet 
the requirements imposed by title XXXIV of the Public 
Health Service Act, as added by subsection (a). 
(c) REPORT BY HRSA.— 
(1) IN GENERAL.—Not later than 2 years after 
the date of enactment of this Act, the Administrator 
of the Health Resources and Services Administra-
tion, in consultation with the National Health Care 
Workforce Commission, shall submit to Congress a 
report regarding the relationship between nurse 
staffing levels and nurse retention in hospitals. 
(2) UPDATED REPORT.—Not later than 5 years 
after the date of enactment of this Act, the Adminis-
trator of the Health Resources and Services Admin-
istration, in consultation with the National Health 
Care Workforce Commission, shall submit to Con-
gress an update of the report submitted under para-
graph (1). 
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SEC. 3. ENFORCEMENT OF REQUIREMENTS THROUGH FED-
ERAL PROGRAMS. 
(a) MEDICARE PROGRAM.—Section 1866(a)(1) of the 
Social Security Act (42 U.S.C. 1395cc(a)(1)) is amend-
ed— 
(1) in subparagraph (X), by striking ‘‘, and’’ 
and inserting a comma; 
(2) in subparagraph (Y), by striking the period 
at the end and inserting ‘‘, and’’; and 
(3) by inserting after the subparagraph (Y) the 
following new subparagraph: 
‘‘(Z) in the case of a hospital, to comply with 
the provisions of title XXXIV of the Public Health 
Service Act.’’. 
(b) MEDICAID PROGRAM.—Section 1902(a) of the 
Social Security Act (42 U.S.C. 1396a(a)) is amended— 
(1) by striking ‘‘and’’ at the end of paragraph 
(86); 
(2) by striking the period at the end of para-
graph (87)(D) and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (87) the fol-
lowing new paragraph: 
‘‘(88) provide that any hospital that receives a 
payment under such plan comply with the provisions 
of title XXXIV of the Public Health Service Act (re-
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lating to minimum direct care registered nurse staff-
ing requirements).’’. 
(c) HEALTH BENEFITS PROGRAM OF THE DEPART-
MENT OF VETERANS AFFAIRS.—Section 8110(a) of title 
38, United States Code, is amended by adding at the end 
the following new paragraphs: 
‘‘(7) In the case of a Department medical facility that 
is a hospital, the hospital shall comply with the provisions 
of title XXXIV of the Public Health Service Act. 
‘‘(8) Nothing either in chapter 74 of this title or in 
section 7106 of title 5 shall preclude enforcement of the 
provisions of title XXXIV of the Public Health Service Act 
with respect to a Department hospital through grievance 
procedures negotiated in accordance with chapter 71 of 
title 5.’’. 
(d) HEALTH BENEFITS PROGRAM OF THE DEPART-
MENT OF DEFENSE.— 
(1) IN
GENERAL.—Chapter 55 of title 10, 
United States Code, is amended by adding at the 
end the following new section: 
‘‘§ 1110c. Staffing requirements 
‘‘In the case of a facility of the uniformed services 
that is a hospital, the hospital shall comply with the provi-
sions of title XXXIV of the Public Health Service Act.’’. 
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(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of such chapter is amended 
by inserting after the item relating to section 1110b 
the following new item: 
‘‘1110c. Staffing requirements.’’. 
(e) INDIAN HEALTH SERVICES PROGRAM.—Title 
VIII of the Indian Health Care Improvement Act (25 
U.S.C. 1671 et seq.) is amended by adding at the end 
the following new section: 
‘‘SEC. 833. STAFFING REQUIREMENTS. 
‘‘All hospitals of the Service shall comply with the 
provisions of title XXXIV of the Public Health Service Act 
(relating to minimum direct care registered nurse staffing 
requirements).’’. 
(f) FEDERAL LABOR-MANAGEMENT RELATIONS.— 
(1) IN
GENERAL.—Section 7106 of title 5, 
United States Code, is amended by adding at the 
end the following: 
‘‘(c) Nothing in this section shall preclude enforce-
ment of the provisions of title XXXIV of the Public Health 
Service Act through grievance procedures negotiated in ac-
cordance with section 7121.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
7106(a) of title 5, United States Code, is amended 
by striking ‘‘Subject to subsection (b) of this sec-
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tion,’’ and inserting ‘‘Subject to subsections (b) and 
(c),’’. 
SEC. 4. NURSE WORKFORCE INITIATIVE. 
(a) SCHOLARSHIP AND STIPEND PROGRAM.—Sub-
section (d) of section 846 of the Public Health Service 
Act (42 U.S.C. 297n) is amended— 
(1) in the subsection heading, by inserting 
‘‘AND STIPEND’’ after ‘‘SCHOLARSHIP’’; and 
(2) in paragraph (1), by inserting ‘‘or stipends’’ 
after ‘‘scholarships’’. 
(b) NURSE RETENTION GRANTS.—Section 831(c)(1) 
of the Public Health Service Act (42 U.S.C. 296p(c)(1)) 
is amended— 
(1) by striking ‘‘GRANTS FOR CAREER LADDER 
PROGRAMS’’ and inserting ‘‘GRANTS FOR NURSE RE-
TENTION’’; 
(2) in subparagraph (B), by striking ‘‘; and’’ 
and inserting a semicolon; 
(3) in subparagraph (C), by striking the period 
at the end and inserting a semicolon; and 
(4) by adding at the end the following: 
‘‘(D) to provide additional support to 
nurses entering the workforce by implementing 
nursing preceptorship projects that establish a 
period of practical and clinical experiences and 
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