II
111th CONGRESS
1st Session
S. 1031
IN THE SENATE OF THE UNITED STATES
May 13, 2009
Mrs. Boxer introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions
A BILL
To amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals, and for other purposes.
Short title
This Act may be cited as the
National Nursing Shortage Reform and
Patient Advocacy Act
.
Minimum direct care registered nurse staffing requirements
Minimum direct care registered nurse staffing requirements
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by adding at the end the following new title:
Minimum direct care registered nurse staffing requirements
Minimum nurse staffing requirements
Staffing plan
In general
A hospital shall implement a staffing plan that—
provides adequate, appropriate, and quality delivery of health care services and protects patient safety; and
is consistent with the requirements of this title.
Effective dates
Implementation of staffing plan
Subject to subparagraph (B), the requirements under paragraph (1) shall take effect not later than 1 year after the date of enactment of this title.
Application of minimum direct care registered nurse-to-patient ratios
The requirements under subsection (b) shall take effect as soon as practicable, as determined by the Secretary, but not later than 2 years after the date of enactment of this title, or in the case of a hospital in a rural area (as defined in section 1886(d)(2)(D) of the Social Security Act), not later than 4 years after the date of enactment of this title.
Minimum direct care registered nurse-to-patient ratios
In general
Except as otherwise provided in this section, a hospital’s staffing plan shall provide that, at all times during each shift within a unit of the hospital, a direct care registered nurse shall be assigned to not more than the following number of patients in that unit, subject to paragraph (4):
1 patient in trauma emergency units.
1 patient in operating room units, provided that a minimum of 1 additional person serves as a scrub assistant in such unit.
2 patients in critical care units, including neonatal intensive care units, emergency critical care and intensive care units, labor and delivery units, coronary care units, acute respiratory care units, postanesthesia units, and burn units.
3 patients in emergency room units, stepdown units, pediatrics units, telemetry units, and combined labor, delivery, and postpartum units.
4 patients in antepartum units, intermediate care nursery units, psychiatric units, and other specialty care units.
5 patients in medical-surgical units, rehabilitation units, and skilled nursing units.
8 patients in well-baby nursery units and postpartum (4 couplets) units.
Similar units with different names
The Secretary may apply minimum direct care registered nurse-to-patient ratios established in paragraph (1) to a type of hospital unit not referred to in such paragraph if such other unit performs a function similar to the function performed by the unit referred to in such paragraph.
Restrictions
Prohibition against averaging
A hospital shall not average the number of patients and the total number of direct care registered nurses assigned to patients in a hospital unit during any 1 shift or over any period of time for purposes of meeting the requirements under this subsection.
Prohibition against imposition of mandatory overtime requirements
A hospital shall not impose mandatory overtime requirements to meet the hospital unit direct care registered nurse-to-patient ratios required under this subsection.
Relief during routine absences
A hospital shall ensure that only a direct care registered nurse may relieve another direct care registered nurse during breaks, meals, and other routine, expected absences from a hospital unit.
Prohibition against imposition of lay-offs
A hospital shall not impose lay-offs of licensed vocational or practical nurses, licensed psychiatric technicians, certified nursing assistants, or other ancillary staff to meet the hospital unit direct care registered nurse-to-patient ratios required under this subsection.
Adjustment of ratios
In general
If necessary to protect patient safety, the Secretary may prescribe regulations that—
increase minimum direct care registered nurse-to-patient ratios under this subsection to further limit the number of patients that may be assigned to each direct care nurse; or
add minimum direct care registered nurse-to-patient ratios for units not referred to in paragraphs (1) and (2).
Consultation
Such regulations shall be prescribed after consultation with affected hospitals and registered nurses.
No preemption of certain State-imposed ratios
Nothing in this title shall preempt State standards that the Secretary determines to be at least equivalent to Federal requirements for a staffing plan established under this title. Minimum direct care registered nurse-to-patient ratios established under this subsection shall not preempt State requirements that the Secretary determines are at least equivalent to Federal requirements for a staffing plan established under this title.
Exemption in emergencies
The requirements established under this subsection shall not apply during a declared state of emergency if a hospital is requested or expected to provide an exceptional level of emergency or other medical services.
Development and reevaluation of staffing plan
Considerations in development of plan
In developing the staffing plan, a hospital shall provide for direct care registered nurse-to-patient ratios above the minimum direct care registered nurse-to-patient ratios required under subsection (b) if appropriate based upon consideration of the following factors:
The number of patients and acuity level of patients as determined by the application of an acuity system (as defined in section 3107(1)), on a shift-by-shift basis.
The anticipated admissions, discharges, and transfers of patients during each shift that impacts direct patient care.
Specialized experience required of direct care registered nurses on a particular unit.
Staffing levels and services provided by other health care personnel in meeting direct patient care needs not required by a direct care registered nurse.
The level of technology available that affects the delivery of direct patient care.
The level of familiarity with hospital practices, policies, and procedures by temporary agency direct care registered nurses used during a shift.
Obstacles to efficiency in the delivery of patient care presented by physical layout.
Documentation of staffing
A hospital shall specify the system used to document actual staffing in each unit for each shift.
Annual reevaluation of plan and acuity system
In general
A hospital shall annually evaluate—
its staffing plan in each unit in relation to actual patient care requirements; and
the accuracy of its acuity system.
Update
A hospital shall update its staffing plan and acuity system to the extent appropriate based on such evaluation.
Transparency
In general
Any acuity-based patient classification system adopted by a hospital under this section shall be transparent in all respects, including disclosure of detailed documentation of the methodology used to predict nursing staffing, identifying each factor, assumption, and value used in applying such methodology.
Public availability
The Secretary shall establish procedures to provide that the documentation submitted under subsection (e) is available for public inspection in its entirety.
Registered nurse participation
A staffing plan of a hospital shall be developed and subsequent reevaluations shall be conducted under this subsection on the basis of input from direct care registered nurses at the hospital or, where such nurses are represented through collective bargaining, from the applicable recognized or certified collective bargaining representative of such nurses. Nothing in this title shall be construed to permit conduct prohibited under the National Labor Relations Act or under the Federal Labor Relations Act.
Acuity tool
In general
Not later than 2 years after the date of enactment of the National Nursing Shortage Reform and Patient Advocacy Act, the Secretary shall develop a national acuity tool that provides a method for establishing nurse staffing requirements above the hospital unit direct care registered nurse-to-patient ratios required under subsection (b).
Implementation
Each hospital shall adopt and implement the national acuity tool described in paragraph (1), and provide staffing based on such tool. Any additional direct care registered nursing staffing above the hospital unit direct care registered nurse-to-patient ratios described in subsection (b) shall be assigned in a manner determined by such national acuity tool.
Submission of plan to Secretary
A hospital shall submit to the Secretary its staffing plan required under subsection (a)(1) and any annual updates under subsection (c)(3)(B).
Posting, records, and audits
Posting requirements
In each unit, a hospital shall post a uniform notice in a form specified by the Secretary in regulation that—
explains requirements imposed under section 3101;
includes actual direct care registered nurse-to-patient ratios during each shift; and
is visible, conspicuous, and accessible to staff, patients, and the public.
Records
Maintenance of records
Each hospital shall maintain accurate records of actual direct care registered nurse-to-patient ratios in each unit for each shift for no less than 2 years. Such records shall include—
the number of patients in each unit;
the identity and duty hours of each direct care registered nurse assigned to each patient in each unit in each shift; and
a copy of each notice posted under subsection (a).
Availability of records
Each hospital shall make its records maintained under paragraph (1) available to—
the Secretary;
registered nurses and their collective bargaining representatives (if any); and
the public under
regulations established by the Secretary, or in the case of a federally
operated hospital, under
section
552 of title 5, United States Code (commonly known as the
Freedom of Information Act
).
Audits
The Secretary shall conduct periodic audits to ensure—
implementation of the staffing plan in accordance with this title; and
accuracy in records maintained under this section.
Minimum direct care licensed practical nurse staffing requirements
Establishment
A hospital’s staffing plan shall comply with minimum direct care licensed practical nurse staffing requirements that the Secretary establishes for units in hospitals. Such staffing requirements shall be established not later than 18 months after the date of enactment of this title, and shall be based on the study conducted under subsection (b).
Study
Not later than 1 year after the date of enactment of this title, the Secretary, acting through the Director of the Agency for Healthcare Research and Quality, shall complete a study of licensed practical nurse staffing and its effects on patient care in hospitals. The Director may contract with a qualified entity or organization to carry out such study under this paragraph. The Director shall consult with licensed practical nurses and organizations representing licensed practical nurses regarding the design and conduct of the study.
Application of registered nurse provisions to licensed practical nurse staffing requirements
Paragraphs (2), (4), (5)(A), and (6) of section 3101(b), section 3101(c), and section 3102 shall apply to the establishment and application of direct care licensed practical nurse staffing requirements under this section in the same manner that they apply to the establishment and application of direct care registered nurse-to-patient ratios under sections 3101 and 3102.
Effective date
The requirements of this section shall take effect as soon as practicable, as determined by the Secretary, but not later than 2 years after the date of enactment of this title, or in the case of a hospital in a rural area (as defined in section 1886(d)(2)(D) of the Social Security Act), not later than 4 years after the date of enactment of this title.
Federal assistance for the purchase of safe patient handling equipment
In general
The Secretary shall establish a grant program to provide financial assistance to cover some or all of the costs of purchasing safe patient handling equipment required by the Federal safe patient handling standard, developed under section 3 of the National Nursing Shortage Reform and Patient Advocacy Act, for health care facilities, such as hospitals, nursing facilities, and outpatient facilities, that—
require such equipment in order to comply with the standards established under section 3 of the National Nursing Shortage Reform and Patient Advocacy Act; and
demonstrate the financial inability to otherwise afford the purchase of such equipment.
Application
A health care facility desiring a grant under this section shall submit to the Secretary an application—
in such form and manner as the Secretary shall specify; and
demonstrating true financial need, according to a standard established by the Secretary.
Authorization of appropriations
There are authorized to be appropriated to be used for grant awards under this section $50,000,000 for fiscal year 2010, which shall remain available until expended.
Whistleblower and patient protections
Recognition of duty and right of nurses To advocate in the exclusive interest of the patient
A nurse shall have the right to act as the patient’s advocate, as circumstances require, by—
initiating action to improve health care or to change decisions or activities which, in the professional judgment of the nurse, are against the interests and wishes of the patient; and
giving the patient an opportunity to make informed decisions about health care before it is provided.
Refusal of assignment
A nurse may refuse to accept an assignment as a nurse in a hospital if—
the assignment would violate section 3101 or 3103; or
the nurse is not prepared by education, training, or experience to fulfill the assignment without compromising the safety of any patient or jeopardizing the license of the nurse.
Retaliation for refusal of assignment barred
No discharge, discrimination, or retaliation
No hospital shall discharge, discriminate, or retaliate in any manner with respect to any aspect of employment (as defined in section 3107(5)), including discharge, promotion, compensation, or terms, conditions, or privileges of employment against a nurse based on the nurse’s refusal of a work assignment under subsection (b).
No filing of complaint
No hospital shall file a complaint or a report against a nurse with the appropriate State professional disciplinary agency because of the nurse’s refusal of a work assignment described in subsection (b).
Cause of action
Any nurse who has been discharged, discriminated against, or retaliated against in violation of subsection (c)(1) or against whom a complaint has been filed in violation of subsection (c)(2) may bring a cause of action in a United States district court. A nurse who prevails on the cause of action shall be entitled to one or more of the following:
Reinstatement.
Reimbursement of lost wages, compensation, and benefits.
Attorneys’ fees.
Court costs.
Other damages.
Complaint to Secretary
In general
A nurse, patient, or other individual may file a complaint with the Secretary against a hospital that violates the provisions of this title. For any complaint filed, the Secretary shall—
receive and investigate the complaint;
determine whether a violation of this title as alleged in the complaint has occurred; and
if such a violation has occurred, issue an order that the complaining nurse or individual shall not suffer any retaliation described in subsection (c) or subsection (g).
Toll-free telephone number
In general
The Secretary shall provide for the establishment of a toll-free telephone hotline to provide information regarding the requirements under section 3101 and to receive reports of violations of such section.
Notice to patients
A hospital shall provide each patient admitted to the hospital for inpatient care with the hotline described in paragraph (1), and shall give notice to each patient that such hotline may be used to report inadequate staffing or care.
Protection for reporting
Prohibition on retaliation or discrimination
A hospital shall not discriminate or retaliate in any manner against any patient, employee, or contract employee of the hospital, or any other individual, on the basis that such individual, in good faith, individually or in conjunction with another person or persons, has presented a grievance or complaint, or has initiated or cooperated in any investigation or proceeding of any governmental entity, regulatory agency, or private accreditation body, made a civil claim or demand, or filed an action relating to the care, services, or conditions of the hospital or of any affiliated or related facilities.
Good faith defined
For purposes of this subsection, an individual shall be deemed to be acting in good faith if the individual reasonably believes—
the information reported or disclosed is true; and
a violation of this title has occurred or may occur.
Prohibition on interference with rights
Exercise of rights
It shall be unlawful for any hospital to—
interfere with, restrain, or deny the exercise, or attempt to exercise, by any person of any right provided or protected under this title; or
coerce or intimidate any person regarding the exercise or attempt to exercise such right.
Opposition to unlawful policies or practices
It shall be unlawful for any hospital to discriminate or retaliate against any person for opposing any hospital policy, practice, or actions which are alleged to violate, breach, or fail to comply with any provision of this title.
Prohibition on interference with protected communications
A hospital (or an individual representing a hospital) shall not make, adopt, or enforce any rule, regulation, policy, or practice which in any manner directly or indirectly prohibits, impedes, or discourages a direct care registered nurse from, or intimidates, coerces, or induces a direct care registered nurse regarding, engaging in free speech activities or disclosing information as provided under this title.
Prohibition on interference with collective action
A hospital (or an individual representing a hospital) shall not in any way interfere with the rights of nurses to organize, bargain collectively, and engage in concerted activity under section 7 of the National Labor Relations Act (29 U.S.C. 157).
Notice
A hospital shall post in an appropriate location in each unit a conspicuous notice in a form specified by the Secretary that—
explains the rights of nurses, patients, and other individuals under this section;
includes a statement that a nurse, patient, or other individual may file a complaint with the Secretary against a hospital that violates the provisions of this title; and
provides instructions on how to file a complaint under paragraph (2).
Effective dates
Refusal; retaliation; cause of action
In general
Subsections (b) through (d) shall apply to refusals occurring on or after the effective date of the provision to which the refusal relates.
Exception
Subsection (b)(2) shall not apply to refusals in any hospital before the requirements of section 3101(a) apply to that hospital.
Protections for reporting
Subsection (g)(1) shall apply to actions occurring on or after the effective date of the provision to which the violation relates, except that such subsection shall apply to initiation, cooperation, or participation in an investigation or proceeding on or after the date of enactment of this title.
Notice
Subsection (i) shall take effect 18 months after the date of enactment of this title.
Enforcement
In general
The Secretary shall enforce the requirements and prohibitions of this title in accordance with this section.
Procedures for receiving and investigating complaints
The Secretary shall establish procedures under which—
any person may file a complaint alleging that a hospital has violated a requirement or a prohibition of this title; and
such complaints shall be investigated by the Secretary.
Remedies
If the Secretary determines that a hospital has violated a requirement of this title, the Secretary—
shall require the facility to establish a corrective action plan to prevent the recurrence of such violation; and
may impose civil money penalties, as described in subsection (d).
Civil penalties
In general
In addition to any other penalties prescribed by law, the Secretary may impose civil penalties as follows:
Hospital liability
The Secretary may impose on a hospital found to be in violation of this title, a civil money penalty of not more than $25,000 for each knowing violation of a requirement of this title, except that the Secretary shall impose a civil money penalty of more than $25,000 for each such violation in the case of a participating hospital that the Secretary determines has a pattern or practice of such violations (with the amount of such additional penalties being determined in accordance with a schedule or methodology specified in regulations).
Individual liability
The Secretary may impose on an individual who—
is employed by a hospital found by the Secretary to have violated a requirement of this title; and
willfully violates this title,
Procedures
The provisions of section 1128A of the Social Security Act (other than subsections (a) and (b)) shall apply to a civil money penalty under this paragraph in the same manner as such provisions apply to a penalty or proceeding under such section 1128A.
Public notice of violations
Internet website
The Secretary shall publish on the Internet website of the Department of Health and Human Services the names of participating hospitals on which civil money penalties have been imposed under this subsection, the violation for which such penalty was imposed, and such additional information as the Secretary determines appropriate.
Change of ownership
With respect to a participating hospital that had a change in ownership, as determined by the Secretary, penalties imposed on the hospital while under previous ownership shall no longer be published by the Secretary of such Internet website after the 1-year period beginning on the date of change in ownership.
Offset
Funds collected by the Secretary under this paragraph shall be used to offset the costs of enforcing this title.
Definitions
For purposes of this title:
Acuity system
The term acuity system means an established measurement tool that—
predicts nursing care requirements for individual patients based on severity of patient illness, need for specialized equipment and technology, intensity of nursing interventions required, and the complexity of clinical nursing judgment needed to design, implement, and evaluate the patient’s nursing care plan;
details the amount of nursing care needed, both in number of nurses and in skill mix of nursing personnel required, on a daily basis, for each patient in a nursing department or unit;
takes into consideration the patient care services provided not only by registered nurses but also by direct care licensed practical nurses and other health care personnel; and
is stated in terms that can be readily used and understood by nurses.
Direct care licensed practical nurse
The term direct care licensed practical nurse means an individual who has been granted a license by at least 1 State to practice as a licensed practical nurse or a licensed vocational nurse and who provides bedside care for 1 or more patients.
Nurse
The term nurse means any direct care registered nurse or direct care licensed practical nurse (as the case may be), regardless of whether or not the nurse is an employee.
Direct care registered nurse
The term direct care registered nurse means an individual who has been granted a license by at least 1 State to practice as a registered nurse and who provides bedside care for 1 or more patients.
Employment
The term employment includes the provision of services under a contract or other arrangement.
Hospital
The term hospital has the meaning given that term in section 1861(e) of the Social Security Act and includes a long-term care hospital, as defined in section 1861(ccc) of such Act.
Staffing plan
The term staffing plan means a staffing plan required under section 3101.
Declared state of emergency
The term declared state of emergency means a state of emergency that is an unpredictable or unavoidable occurrence at an unscheduled or unpredictable interval, relating to health care delivery and requiring immediate medical interventions and care, that has been declared by the Federal Government or the head of the appropriate State or local governmental agency having authority to declare that the State, county, municipality, or locality is in a state of emergency, but such term does not include a state of emergency that results from a labor dispute in the health care industry or consistent understaffing.
Rule of construction
Nothing in this title shall be construed to authorize disclosure of private and confidential patient information, except in the case where such disclosure is otherwise required by law, compelled by proper legal process, consented to by the patient, provided in confidence to regulatory or accreditation agencies or other government entities for investigatory purposes, or provided pursuant to formal or informal complaints of unlawful or improper practices for purposes of achieving corrective and remedial action.
.
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 ensuring that sufficient numbers of nurses are available to meet the requirements imposed by title XXXI of the Public Health Service Act, as added by subsection (a).
Federal safe patient handling standard
In general
Not later than 1 year after the date of enactment of this Act, the Secretary of Labor, acting through the Director of Occupational Safety and Health Administration, shall establish a Federal Safe Patient Handling Standard, consistent with section 6 of the Occupational Safety and Health Act of 1970 (29 U.S.C. 655) to prevent musculoskeletal disorders for direct care registered nurses and other health care providers working in health care facilities.
Development of standard
In developing the standard under subsection (a), the Secretary shall solicit input from direct care registered nurses and organizations representing direct care registered nurses in implementing the standard.
Requirements
The standard promulgated under subsection (a) shall include—
a zero lift policy;
a musculoskeletal injury prevention plan, which shall include hazard identification and risk assessments in relation to patient care duties and patient handling;
a program to identify problems and solutions regarding safe patient handling;
a system to report, track, and analyze trends in injuries, as well as make injury data available to the public;
training for staff, including interactive classroom-based and hands-on training by a knowledgeable person or staff, on safe patient handling policies, equipment, and devices at least on an annual basis, which shall include training on hazard identification, assessment, and control of musculoskeletal hazards in patient care areas; and
annual evaluations of safe patient handling efforts, as well as new technology, handling procedures, and engineering controls.
Compliance with the standard
The Secretary of Labor shall require—
all health care facilities to comply with the standard developed under subsection (a); and
health care facilities to purchase, use, and maintain safe lift mechanical devices.
Safe patient handling plan
In accordance with the standard developed under subsection (a), and not later than 180 days after such standard is published, health care facilities shall develop and implement a safe patient handling plan that—
provides adequate, appropriate, and quality delivery of health care services that protects patient safety and prevents musculoskeletal disorders for direct care registered nurses and other health care providers;
is consistent with the requirements of the Federal Safe Patient Handling Standard;
provides for input by direct care registered nurses and organizations representing direct care registered nurses in implementing the plan; and
ensures that safe lifting mechanical devices shall only be used by direct care registered nurses and other health care providers.
Definitions
In this section—
the term lift team means employees of a hospital who are specially trained to handle patient lifts, repositions, and transfers using patient transfer devices or lifting devices as appropriate for the specific patient, based on a needs assessment of the individual hospital employer; and
the term zero lift policy means replacing unassisted manual lifting, repositioning, and transferring of patients with the use of patient transfer devices, lifting devices, and lift teams. Such term does not require the use of patient transfer or lifting devices when the lift, reposition, and transfer needs assessment indicates it is safe for the patient and the employee to use manual lifting, repositioning, and transferring techniques.
Payment adjustment for hospitals under the Medicare program based on additional costs of complying with certain requirements
Section 1886 of the Social Security Act (42 U.S.C. 1395ww), as amended by section 4102 of the HITECH Act (Public Law 111–5), is amended by adding at the end the following new subsection:
Adjustment based on additional costs of complying with certain requirements
In general
With respect to inpatient hospital services furnished by a subsection (d) hospital during a fiscal year (beginning with fiscal year 2010), in addition to the amount otherwise paid under this section, there shall also be paid to the subsection (d) hospital, from the Federal Hospital Insurance Trust Fund established under section 1817, an amount equal to the applicable amount specified in paragraph (2) for the subsection (d) hospital for the fiscal year.
Applicable amount
The applicable amount specified in this paragraph for a subsection (d) hospital for a fiscal year is equal to the quotient of—
the total amount of additional costs incurred by the hospital in providing inpatient hospital services to beneficiaries during the fiscal year that are attributable to compliance with the requirements under sections 3101, 3102, and 3103 of the Public Health Services Act (as estimated by the Secretary, taking into account recommendations contained in the report under paragraph (3)); and
the total number of discharges during the fiscal year (as estimated by the Secretary).
Medicare payment advisory commission report
Not later than 2 years after the date of the enactment of this subsection, the Medicare Payment Advisory Commission shall submit to Congress and the Secretary a report containing an estimate of the total costs to and savings for subsection (d) hospitals during a fiscal year that are attributable to compliance with the requirements under sections 3101, 3102, and 3103 of the Public Health Service Act, including recommendations regarding the adjustment in payments to such hospitals under this subsection, together with recommendations for such legislation and administrative action as the Commission determines appropriate.
.
Enforcement of requirements through Federal programs
Medicare program
Section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(1)) is amended—
by striking
and
at the end of subparagraph (U);
by striking the
period at the end of subparagraph (V) and inserting , and
;
and
by inserting after subparagraph (V) the following:
in the case of a hospital, to be subject to the provisions of title XXXI of the Public Health Service Act.
.
Medicaid program
The first sentence of section 1902(a) of the Social Security Act (42 U.S.C. 1396(a)), as amended by section 5006(e)(2)(A) of Division B of the American Recovery and Reinvestment Act of 2009 (Public Law 111–5), is amended—
by striking
and
at the end of paragraph (72);
by striking the
period at the end of paragraph (73) and inserting ; and
;
and
by inserting after paragraph (73) the following new paragraph:
provide that any hospital receiving payments under such plan shall be subject to the provisions of title XXXI of the Public Health Service Act.
.
Registered nurse workforce initiative
Title VIII of the Public Health Service Act (42 U.S.C. 296 et seq.) is amended by adding at the end the following:
Registered nurse workforce initiative
Registered nurse workforce initiative
Establishment
The
Secretary, acting through the Administrator of the Health Resources and
Services Administration, shall carry out a Registered Nurse Workforce
Initiative (referred to in this part as the RNWI
) to ensure that
there is an adequate number of registered nurses and to reduce critical
workforce shortages in hospitals.
Purposes
The purposes of the RNWI are to—
achieve short-term mitigation and remedy of the nationwide nursing shortage; and
establish and maintain the necessary educational system foundations and institutional involvement to ensure sufficient labor supply and labor market stability essential to ensuring safe and competent hospital nursing care on an ongoing basis.
Duration
The RNWI is established as a 5-year program for the purpose of adding new registered nurses to the workforce, and may be extended beyond the initial 5-year period, if the Secretary determines appropriate.
Educational assistance benefits
Grants for associate and baccalaureate degree programs
Basic educational assistance benefits
To address the critical shortage of direct care registered nurses, the Secretary shall establish a nursing educational assistance grant program for eligible individuals who are accepted to, or are enrolled in, associate and baccalaureate degrees in nursing programs, based on such individuals' financial need, as determined by the Secretary.
Supplemental educational assistance benefit
Benefits
Each individual awarded a grant under this subsection shall receive—
nursing educational assistance to help meet, in part, the annual expenses of enrolling in and attending an associate or a baccalaureate degree in nursing program; and
a monthly living stipend to help meet the individual’s basic living expenses.
Grant amounts
The Secretary shall determine the amounts awarded under subparagraph (A) for each fiscal year, based upon the cost of living and the cost of attending a nursing program for such fiscal year.
Eligibility
An individual desiring a grant under this subsection shall—
be an individual who has been accepted to an accredited nursing education program;
provide assurances that such individual will work for a health care provider that is eligible to receive national health service corps professionals for a period of not less than 3 years, in a setting that the Secretary determines appropriate; and
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
Grants for advance degrees in nursing
In general
To address the critical shortage of nurse educators holding master’s or doctoral degrees in nursing, as well as the lack of master’s and doctoral nursing students, the Secretary shall establish a program to award grants to eligible individuals to assist such individuals in pursuing graduate nursing degrees.
Eligible individuals
An individual desiring a grant under this section shall—
hold an unencumbered license as a registered nurse;
be accepted into an accredited master's or doctorate degree program in nursing;
provide assurances that such individual will work as a nurse educator at an accredited nursing program for a period of 5 years after graduating from an accredited graduate degree program in nursing; and
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
Repayment obligation
A recipient of a grant under this section who fails to meet the requirements of the grant, as described in this section or as specified by the Secretary, shall repay the Secretary all amounts received through such grant, with interest.
Preceptorship and mentorship demonstration projects
In general
The Secretary shall award grants to eligible entities for the purpose of conducting 5-year nursing preceptorship and mentorship demonstration projects, designed to address nurse workforce shortages and improve patient care by providing additional support to nurses entering the workforce to promote the retention of nurses in the workforce.
Eligible entities
An entity desiring a grant under this section shall—
be a hospital; and
submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
Priority
In awarding grants under this section, the Secretary shall give priority to hospitals that have a critical shortage of nurses, as determined by the Secretary.
Preceptorship program
In general
The preceptorship program shall provide—
a period of practical experience and training for nursing students, by providing clinical supervision by a direct care registered nurse expert or specialist in a particular field; or
a period of orientation for newly-graduated or newly hired direct care registered nurses.
Purpose
The purpose of the preceptorship program is to establish a period of practical and clinical experiences and training for nursing students, newly hired nurses and recent graduates of a direct care degree program for registered nurses.
Mentorship program
In general
The mentorship program shall match newly hired direct
care registered nurses (referred to in this subsection as the
mentees
) with experienced direct care registered nurses, who
shall serve as advocates and role models and help the mentees grow
professionally, feel supported, and adapt to the culture of the acute care
hospital. Mentors shall provide personal and career support in the
workplace.
Purpose
The purpose of the mentorship program is to assist new or transitional direct care registered nurses to succeed in making their own contributions to the care of patients and to the nursing profession.
Report
Each recipient of a grant under this section, at the end of such recipient's 5-year demonstration project, shall submit to the Secretary a report containing an evaluation of the effect of the demonstration project on nurse retention and patient care in the hospital for which such grant was awarded.
Authorization of appropriations
To carry out this part, there are authorized to be appropriated such funds as may be necessary for fiscal years 2010 through 2014.
.