2000 
[DOCID: f:s1594is.txt]






107th CONGRESS
  1st Session
                                S. 1594

 To amend the Public Health Service Act to provide programs to improve 
    nurse retention, the nursing workplace, and the quality of care.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            October 30, 2001

 Mrs. Clinton (for herself, Mr. Smith of Oregon, Mr. Kennedy, and Mrs. 
    Murray) 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 provide programs to improve 
    nurse retention, the nursing workplace, and the quality of care.

    Be it enacted by the Senate and House of Representatives 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 2001''.

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 
        programs has decreased in the past 5 years. Many hospitals 
        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 survey, 50 percent of 
        nurses say they have recently considered leaving the nursing 
        profession for reasons other than retirement.
            (4) A majority of those individuals who are considering 
        leaving nursing express a low level of overall job 
        satisfaction, and their lack of participation in decisionmaking 
        is a major factor contributing to dissatisfaction.
            (5) Magnet hospitals are hospitals that have reorganized 
        care to be more participatory, collaborative, 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 hospitals is 8.35 years, which is 
        twice the length of employment 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 RETENTION, THE NURSING 
                   WORKPLACE, AND THE QUALITY OF CARE

``SEC. 851. DEVELOPING MODELS AND BEST PRACTICES IN NURSING CARE.

    ``(a) Program Authorized.--From amounts appropriated 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 entity' 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, or any other entity as designated by the Secretary.
    ``(c) 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.
    ``(d) Duration of Grants.--
            ``(1) Three-year grants.--Grants awarded under this section 
        shall be awarded for a period of not greater than 3 years.
            ``(2) Grant extensions.--Such grants may be extended if the 
        grantee demonstrates that it--
                    ``(A) as determined by the Secretary based on the 
                factors in paragraph (3), has significantly improved 
                the quality of its workplace for nurses and has 
                enhanced patient care; or
                    ``(B) has been designated as a magnet hospital by 
                the American Nurses Credentialing Center.
            ``(3) Preference.--In awarding grant extensions 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 workplace 
                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 grants under this section shall not be greater than 
        6 years.
    ``(e) Use of Funds.--An eligible entity that receives a grant under 
subsection (a) shall use such grant funds 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 communication among 
        health care professionals;
            ``(3) promoting nurse involvement in organizational and 
        clinical decisionmaking processes;
            ``(4) organizing care to enhance the satisfaction of 
        professional nurses, improve the nursing workplace environment, 
        and promote the quality of nursing 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 measurement of 
                quality outcomes, including identification and 
                measurement of nursing sensitive patient outcomes;
                    ``(B) by basing the development of policies, 
                procedures, guidelines, and organizational systems on 
                research findings and patient outcomes measurement, 
                including nursing-sensitive patient outcomes 
                measurement; and
                    ``(C) by involving professional nurses in 
                developing and implementing ways to measure and improve 
                the quality of care;
            ``(7) promoting a balanced work-life environment; and
            ``(8) offering such other activities as may be determined 
        by the Secretary to enhance the workplace environment for 
        professional nurses.
    ``(f) Application.--
            ``(1) In general.--An eligible entity desiring a grant 
        under subsection (a) shall submit an application to the 
        Secretary at such time, in such manner, and containing such 
        information as the Secretary may reasonab
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ly require.
            ``(2) Contents.--The 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 commitment 
                to the project through a statement describing--
                            ``(i) the involvement of high level 
                        executive management, trustees, nurse 
                        leadership, and medical staff in designing, 
                        implementing, and overseeing the project;
                            ``(ii) the designation of key personnel and 
                        management structures to design, implement, and 
                        oversee the project;
                            ``(iii) any actions that the eligible 
                        entity has already taken that contribute to 
                        developing innovative models and approaches 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 information on 
                        overall project budget and funding resources; 
                        and
                    ``(C) include information regarding the retention 
                rate and occurrence of workplace injuries to nurses at 
                the entity applying for such grant and any other 
                information as the Secretary may reasonably require.

``SEC. 852. SURVEY AND EVALUATION.

    ``The Secretary, in consultation with the Agency for Healthcare 
Research and Quality and the Health Resources and Services 
Administration shall--
            ``(1) conduct an annual survey of the projects carried out 
        under section 851 and provide to Congress 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 
        2001; 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 employing 
                participatory, collaborative, and patient-centered 
                models of nursing care.

``SEC. 853. AUTHORIZATION OF APPROPRIATIONS.

    ``(a) Grants.--There is authorized to be appropriated to carry out 
section 851, $40,000,000 for fiscal years 2002 through 2007.
    ``(b) Survey and Evaluation.--There is authorized to be 
appropriated to carry out section 852, $5,000,000 for fiscal years 2002 
through 2007.''.
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