H. R. 5924
IN THE HOUSE OF REPRESENTATIVES
April 29, 2008
Mr. Wexler (for himself and Mr. Sensenbrenner) introduced the following bill; which was referred to the Committee on the Judiciary, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
To provide relief for the shortage of nurses in the United States, and for other purposes.
This Act may be cited as the
Emergency Nursing Supply Relief
Nursing shortage relief
Increasing visa numbers
Section 106 of the American Competitiveness in the Twenty-first Century Act of 2000 (Public Law 106–313; 8 U.S.C. 1153 note) is amended by adding at the end the following:
Visa Shortage Relief for Nurses and Physical Therapists
Subject to paragraph (2), for petitions filed during the period beginning on the date of the enactment of the Emergency Nursing Supply Relief Act and ending on September 30, 2011, for employment-based immigrants (and their family members accompanying or following to join under section 203(d) of the Immigration and Nationality Act (8 U.S.C. 1153(d)), which are or have been approved based on Schedule A, Group I as defined in section 656.5 of title 20, Code of Federal Regulations, as promulgated by the Secretary of Labor, the numerical limitations set forth in sections 201(d) and 202(a) of such Act (8 U.S.C. 1151(d) and 1152(a)) shall not apply.
Limitation on number of visas
The Secretary of State may not issue more than 20,000 immigrant visa numbers in any one fiscal year (plus any available visa numbers under this paragraph not used during the preceding fiscal year) to principal beneficiaries of petitions pursuant to paragraph (1).
The Secretary of Homeland Security shall provide a process for reviewing and acting upon petitions with respect to immigrants described in paragraph (1) not later than 30 days after the date on which a completed petition has been filed.
Fee for use of visas under subsection (a)
The Secretary of Homeland Security shall impose a fee upon each petitioning employer who uses a visa provided under subsection (e) to provide employment for an alien as a professional nurse, except that—
such fee shall be in the amount of $1,500 for each such alien nurse (but not for dependents accompanying or following to join who are not professional nurses); and
no fee shall be imposed for the use of such visas if the employer demonstrates to the Secretary that—
the employer is a health care facility that is located in a county or parish that received individual and public assistance pursuant to Major Disaster Declaration number 1603 or 1607; or
the employer is a health care facility that has been designated as a Health Professional Shortage Area facility by the Secretary of Health and Human Services as defined in section 332 of the Public Health Service Act (42 U.S.C. 254e).
A fee imposed by the Secretary of Homeland Security pursuant to paragraph (1) shall be collected by the Secretary as a condition of approval of an application for adjustment of status by the beneficiary of a petition or by the Secretary of State as a condition of issuance of a visa to such beneficiary.
Capitation grants To increase the number of nursing faculty and students; domestic nursing enhancement account
Part D of title VIII of the Public Health Service Act (42 U.S.C. 296p et seq.) is amended by adding at the end the following:
For the purpose described in subsection (b), the Secretary, acting through the Health Resources and Services Administration, shall award a grant each fiscal year in an amount determined in accordance with subsection (c) to each eligible school of nursing that submits an application in accordance with this section.
A funding agreement for a grant under this section is that the eligible school of nursing involved will expend the grant to increase the number of nursing faculty and students at the school, including by hiring new faculty, retaining current faculty, purchasing educational equipment and audiovisual laboratories, enhancing clinical laboratories, repairing and expanding infrastructure, or recruiting students.
Amount per student
Subject to paragraph (2), the amount of a grant to an eligible school of nursing under this section for a fiscal year shall be the total of the following:
$1,800 for each full-time or part-time student who is enrolled at the school in a graduate program in nursing that—
leads to a master’s degree, a doctoral degree, or an equivalent degree; and
prepares individuals to serve as faculty through additional course work in education and ensuring competency in an advanced practice area.
$1,405 for each full-time or part-time student who—
is enrolled at the school in a program in nursing leading to a bachelor of science degree, a bachelor of nursing degree, a graduate degree in nursing if such program does not meet the requirements of subparagraph (A), or an equivalent degree; and
has not more than 3 years of academic credits remaining in the program.
$966 for each full-time or part-time student who is enrolled at the school in a program in nursing leading to an associate degree in nursing or an equivalent degree.
In calculating the amount of a grant to a school under paragraph (1), the Secretary may not make a payment with respect to a particular student—
for more than 2 fiscal years in the case of a student described in paragraph (1)(A) who is enrolled in a graduate program in nursing leading to a master’s degree or an equivalent degree;
for more than 4 fiscal years in the case of a student described in paragraph (1)(A) who is enrolled in a graduate program in nursing leading to a doctoral degree or an equivalent degree;
for more than 3 fiscal years in the case of a student described in paragraph (1)(B); or
for more than 2 fiscal years in the case of a student described in paragraph (1)(C).
this section, the term
eligible school of nursing means a school
of nursing that—
is accredited by a nursing accrediting agency recognized by the Secretary of Education;
has a passage rate on the National Council Licensure Examination for Registered Nurses of not less than 80 percent for each of the 3 academic years preceding submission of the grant application; and
has a graduation rate (based on the number of students in a class who graduate relative to, for a baccalaureate program, the number of students who were enrolled in the class at the beginning of junior year or, for an associate degree program, the number of students who were enrolled in the class at the end of the first year) of not less than 80 percent for each of the 3 academic years preceding submission of the grant application.
The Secretary may award a grant under this section to an eligible school of nursing only if the school gives assurances satisfactory to the Secretary that, for each academic year for which the grant is awarded, the school will comply with the following:
The school will maintain a passage rate on the National Council Licensure Examination for Registered Nurses of not less than 80 percent.
The school will maintain a graduation rate (as described in subsection (d)(3)) of not less than 80 percent.
Subject to subparagraphs (B) and (C), the first-year enrollment of full-time nursing students in the school will exceed such enrollment for the preceding academic year by 5 percent or 5 students, whichever is greater.
Subparagraph (A) shall not apply to the first academic year for which a school receives a grant under this section.
With respect to any academic year, the Secretary may waive application of subparagraph (A) if—
the physical facilities at the school involved limit the school from enrolling additional students; or
the school has increased enrollment in the school (as described in subparagraph (A)) for each of the 2 preceding academic years.
Not later than 1 year after receiving a grant under this section, the school will formulate and implement a plan to accomplish at least 2 of the following:
Establishing or significantly expanding an accelerated baccalaureate degree nursing program designed to graduate new nurses in 12 to 18 months.
Establishing cooperative intradisciplinary education among schools of nursing with a view toward shared use of technological resources, including information technology.
Establishing cooperative interdisciplinary training between schools of nursing and schools of allied health, medicine, dentistry, osteopathy, optometry, podiatry, pharmacy, public health, or veterinary medicine, including training for the use of the interdisciplinary team approach to the delivery of health services.
Integrating core competencies on evidence-based practice, quality improvements, and patient-centered care.
Increasing admissions, enrollment, and retention of qualified individuals who are financially disadvantaged.
Increasing enrollment of minority and diverse student populations.
Increasing enrollment of new graduate baccalaureate nursing students in graduate programs that educate nurse faculty members.
Developing post-baccalaureate residency programs to prepare nurses for practice in specialty areas where nursing shortages are most severe.
Increasing integration of geriatric content into the core curriculum.
Partnering with economically disadvantaged communities to provide nursing education.
Expanding the ability of nurse managed health centers to provide clinical education training sites to nursing students.
The school will submit an annual report to the Secretary that includes updated information on the school with respect to student enrollment, student retention, graduation rates, passage rates on the National Council Licensure Examination for Registered Nurses, the number of graduates employed as nursing faculty or nursing care providers within 12 months of graduation, and the number of students who are accepted into graduate programs for further nursing education.
The school will allow the Secretary to make on-site inspections, and will comply with the Secretary’s requests for information, to determine the extent to which the school is complying with the requirements of this section.
Reports to congress
The Secretary shall evaluate the results of grants under this section and submit to Congress—
not later than 18 months after the date of the enactment of this section, an interim report on such results; and
not later than September 30, 2010, a final report on such results.
An eligible school of nursing seeking a grant under this section shall submit an application to the Secretary at such time, in such manner, and containing such information and assurances as the Secretary may require.
Authorization of appropriations
In addition to the amounts in the Domestic Nursing Enhancement Account, established under section 833, there are authorized to be appropriated such sums as may be necessary to carry out this section.
Domestic nursing enhancement account
is established in the general fund of the Treasury a separate account which
shall be known as the
Domestic Nursing Enhancement Account.
Notwithstanding any other provision of law, there shall be deposited as
offsetting receipts into the account all fees collected under section 106(f) of
the American Competitiveness in the Twenty-first Century Act of 2000 (Public
Law 106–313; 8 U.S.C. 1153 note). Nothing in this subsection shall prohibit the
depositing of other moneys into the account established under this
Use of funds
Amounts collected under section 106(f) of the American Competitiveness in the Twenty-first Century Act of 2000, and deposited into the account established under subsection (a) shall be used by the Secretary of Health and Human Services to carry out section 832. Such amounts shall be available for obligation only to the extent, and in the amount, provided in advance in appropriations Acts. Such amounts are authorized to remain available until expended.
Global health care cooperation
Title III of the Immigration and Nationality Act (8 U.S.C. 1401 et seq.) is amended by inserting after section 317 the following:
Temporary absence of aliens providing health care in developing countries
Notwithstanding any other provision of this Act, the Secretary of Homeland Security shall allow an eligible alien and the spouse or child of such alien to reside in a candidate country during the period that the eligible alien is working as a physician or other health care worker in a candidate country. During such period the eligible alien and such spouse or child shall be considered—
to be physically present and residing in the United States for purposes of naturalization under section 316(a); and
to meet the continuous residency requirements under section 316(b).
In this section:
candidate country means a country
that the Secretary of State determines to be—
eligible for assistance from the International Development Association, in which the per capita income of the country is equal to or less than the historical ceiling of the International Development Association for the applicable fiscal year, as defined by the International Bank for Reconstruction and Development;
classified as a lower middle income country in the then most recent edition of the World Development Report for Reconstruction and Development published by the International Bank for Reconstruction and Development and having an income greater than the historical ceiling for International Development Association eligibility for the applicable fiscal year; or
qualified to be a candidate country due to special circumstances, including natural disasters or public health emergencies.
eligible alien means an alien
has been lawfully admitted to the United States for permanent residence; and
is a physician or other healthcare worker.
The Secretary of Homeland Security shall consult with the Secretary of State in carrying out this section.
The Secretary of State shall publish—
not later than 180 days after the date of the enactment of this section, a list of candidate countries;
an updated version of the list required by paragraph (1) not less often than once each year; and
an amendment to the list required by paragraph (1) at the time any country qualifies as a candidate country due to special circumstances under subsection (b)(1)(C).
Not later than 180 days after the date of the enactment of this Act, the Secretary of Homeland Security shall promulgate regulations to carry out the amendments made by this subsection.
The regulations promulgated pursuant to paragraph (1) shall—
permit an eligible alien (as defined in section 317A of the Immigration and Nationality Act, as added by paragraph (1)) and the spouse or child of the eligible alien to reside in a foreign country to work as a physician or other healthcare worker as described in subsection (a) of such section 317A for not less than a 12-month period and not more than a 24-month period, and shall permit the Secretary to extend such period for an additional period not to exceed 12 months, if the Secretary determines that such country has a continuing need for such a physician or other healthcare worker;
provide for the issuance of documents by the Secretary to such eligible alien, and such spouse or child, if appropriate, to demonstrate that such eligible alien, and such spouse or child, if appropriate, is authorized to reside in such country under such section 317A; and
provide for an expedited process through which the Secretary shall review applications for such an eligible alien to reside in a foreign country pursuant to subsection (a) of such section 317A if the Secretary of State determines a country is a candidate country pursuant to subsection (b)(1)(C) of such section 317A.
Technical and conforming amendments
101(a)(13)(C)(ii) of the Immigration and Nationality Act (8 U.S.C.
1101(a)(13)(C)(ii)) is amended by adding at the end the following:
except in the case of an eligible alien, or the spouse or child of such
alien, who is authorized to be absent from the United States under section
Section 211(b) of such Act (8 U.S.C. 1181(b)) is
amended by inserting
, including an eligible alien authorized to reside
in a foreign country under section 317A and the spouse or child of such
eligible alien, if appropriate, after
Section 212(a)(7)(A)(i)(I) of such Act (8 U.S.C.
1182(a)(7)(A)(i)(I)) is amended by inserting
other than an eligible
alien authorized to reside in a foreign country under section 317A and the
spouse or child of such eligible alien, if appropriate, after
The table of contents of such Act is amended by inserting after the item relating to section 317 the following:
Sec. 317A. Temporary absence of aliens providing health care in developing countries.
Authorization of appropriations
There are authorized to be appropriated to U.S. Citizenship and Immigration Services such sums as may be necessary to carry out this subsection and the amendments made by this subsection.
Attestation by health care workers
Section 212(a)(5) of the Immigration and Nationality Act (8 U.S.C. 1182(a)(5)) is amended by adding at the end the following:
Health care workers with other obligations
An alien who seeks to enter the United States for the purpose of performing labor as a physician or other health care worker is inadmissible unless the alien submits to the Secretary of Homeland Security or the Secretary of State, as appropriate, an attestation that the alien is not seeking to enter the United States for such purpose during any period in which the alien has an outstanding obligation to the government of the alien’s country of origin or the alien’s country of residence.
In this subparagraph, the term
means an obligation incurred as part of a valid, voluntary individual agreement
in which the alien received financial assistance to defray the costs of
education or training to qualify as a physician or other health care worker in
consideration for a commitment to work as a physician or other health care
worker in the alien’s country of origin or the alien’s country of
The Secretary of Homeland Security may waive a finding of inadmissibility under clause (i) if the Secretary determines that—
the obligation was incurred by coercion or other improper means;
the alien and the government of the country to which the alien has an outstanding obligation have reached a valid, voluntary agreement, pursuant to which the alien’s obligation has been deemed satisfied, or the alien has shown to the satisfaction of the Secretary that the alien has been unable to reach such an agreement because of coercion or other improper means; or
the obligation should not be enforced due to other extraordinary circumstances, including undue hardship that would be suffered by the alien in the absence of a waiver.
Effective date; application
The amendment made by paragraph (1) shall take effect on the date that is 180 days after the date of the enactment of this Act.
Application by the Secretary
Not later than the effective date described in subparagraph (A), the Secretary of Homeland Security shall begin to carry out subparagraph (E) of section 212(a)(5) of the Immigration and Nationality Act, as added by paragraph (1), including the requirement for the attestation and the granting of a waiver described in clause (iii) of such subparagraph (E), regardless of whether regulations to implement such subparagraph have been promulgated.
Nurse Training and Retention Demonstration Grant Act of 2008
Congress makes the following findings:
America’s healthcare system depends on an adequate supply of trained nurses to deliver quality patient care.
Over the next 15 years, this shortage is expected to grow significantly. The Health Resources and Services Administration has projected that by 2020, there will be a shortage of nurses in every State and that overall only 64 percent of the demand for nurses will be satisfied, with a shortage of 1,016,900 nurses nationally.
To avert such a shortage, today’s network of healthcare workers should have access to education and support from their employers to participate in educational and training opportunities.
With the appropriate education and support, incumbent healthcare workers and incumbent bedside nurses are untapped sources which can meet these needs and address the nursing shortage and provide quality care as the American population ages.
Purposes of grant program
It is the purpose of this section to authorize grants to—
address the projected shortage of nurses by funding comprehensive programs to create a career ladder to nursing (including Certified Nurse Assistants, Licensed Practical Nurses, Licensed Vocational Nurses, and Registered Nurses) for incumbent ancillary healthcare workers;
increase the capacity for educating nurses by increasing both nurse faculty and clinical opportunities through collaborative programs between staff nurse organizations, healthcare providers, and accredited schools of nursing; and
provide training programs through education and training organizations jointly administered by healthcare providers and healthcare labor organizations or other organizations representing staff nurses and frontline healthcare workers, working in collaboration with accredited schools of nursing and academic institutions.
later than 6 months after the date of enactment of this Act, the Secretary of
Labor (referred to in this section as the
establish a partnership grant program to award grants to eligible entities to
carry out comprehensive programs to provide education to nurses and create a
pipeline to nursing for incumbent ancillary healthcare workers who wish to
advance their careers, and to otherwise carry out the purposes of this
To be eligible to receive a grant under this section an entity shall—
a healthcare entity that is jointly administered by a healthcare employer and a labor union representing the healthcare employees of the employer and that carries out activities using labor management training funds as provided for under section 302 of the Labor-Management Relations Act, 1947 (18 U.S.C. 186(c)(6));
an entity that operates a training program that is jointly administered by—
one or more healthcare providers or facilities, or a trade association of healthcare providers; and
one or more organizations which represent the interests of direct care healthcare workers or staff nurses and in which the direct care healthcare workers or staff nurses have direct input as to the leadership of the organization; or
a State training partnership program that consists of non-profit organizations that include equal participation from industry, including public or private employers, and labor organizations including joint labor-management training programs, and which may include representatives from local governments, worker investment agency one-stop career centers, community based organizations, community colleges, and accredited schools of nursing; and
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.
Additional requirements for healthcare employer desrribed in subsection (d)
To be eligible for a grant under this section, a healthcare employer described in subsection (d) shall demonstrate—
an established program within their facility to encourage the retention of existing nurses;
it provides wages and benefits to its nurses that are competitive for its market or that have been collectively bargained with a labor organization; and
support for programs funded under this section through 1 or more of the following:
The provision of paid leave time and continued health coverage to incumbent healthcare workers to allow their participation in nursing career ladder programs, including Certified Nurse Assistants, Licensed Practical Nurses, Licensed Vocational Nurses, and Registered Nurses.
Contributions to a joint labor-management or other jointly administered training fund which administers the program involved.
The provision of paid release time, incentive compensation, or continued health coverage to staff nurses who desire to work full- or part-time in a faculty position.
The provision of paid release time for staff nurses to enable them to obtain a bachelor of science in nursing degree, other advanced nursing degrees, specialty training, or certification program.
The payment of tuition assistance to incumbent healthcare workers.
The Secretary may not make a grant under this section unless the applicant involved agrees, with respect to the costs to be incurred by the applicant in carrying out the program under the grant, to make available non-Federal contributions (in cash or in kind under subparagraph (B)) toward such costs in an amount equal to not less than $1 for each $1 of Federal funds provided in the grant. Such contributions may be made directly or through donations from public or private entities, or may be provided through the cash equivalent of paid release time provided to incumbent worker students.
Determination of amount of non-Federal contribution
Non-Federal contributions required in subparagraph (A) may be in cash or in kind (including paid release time), fairly evaluated, including equipment or services (and excluding indirect or overhead costs).
Supplement, not supplant
Funds made available under this section shall supplement, and not supplant, resources dedicated by an entity, or other Federal, State, or localfunds available to carry out activities described in this section.
Entities carrying out or overseeing programs carried out with assistance provided under this section shall demonstrate collaboration with accredited schools of nursing which may include community colleges and other academic institutions providing associate, bachelor’s, or advanced nursing degree programs or specialty training or certification programs.
Amounts awarded to an entity under a grant under this section shall be used for the following:
To carry out programs that provide education and training to establish nursing career ladders to educate incumbent healthcare workers to become nurses (including Certified Nurse Assistants, Licensed Practical Nurses, Licensed Vocational Nurses, and Registered Nurses). Such programs shall include one or more of the following:
Preparing incumbent workers to return to the classroom through English as a second language education, GED education, precollege counseling, college preparation classes, and support with entry level college classes that are a prerequisite to nursing.
Providing tuition assistance with preference for dedicated cohort classes in community colleges, universities, accredited schools of nursing with supportive services including tutoring and counseling.
Providing assistance in preparing for and meeting all nursing licensure tests and requirements.
Carrying out orientation and mentorship programs that assist newly graduated nurses in adjusting to working at the bedside to ensure their retention post graduation, and ongoing programs to support nurse retention.
Providing stipends for release time and continued healthcare coverage to enable incumbent healthcare workers to participate in these programs.
To carry out programs that assist nurses in obtaining advanced degrees and completing specialty training or certification programs and to establish incentives for nurses to assume nurse faculty positions on a part-time or full-time basis. Such programs shall include one or more of the following:
Increasing the pool of nurses with advanced degrees who are interested in teaching by funding programs that enable incumbent nurses to return to school.
Establishing incentives for advanced degree bedside nurses who wish to teach in nursing programs so they can obtain a leave from their bedside position to assume a full- or part-time position as adjunct or full time faculty without the loss of salary or benefits.
Collaboration with accredited schools of nursing which may include community colleges and other academic institutions providing associate, bachelor’s, or advanced nursing degree programs, or specialty training or certification programs, for nurses to carry out innovative nursing programs which meet the needs of bedside nursing and healthcare providers.
In awarding grants under this section the Secretary shall give preference to programs that—
provide for improving nurse retention;
provide for improving the diversity of the new nurse graduates to reflect changes in the demographics of the patient population;
provide for improving the quality of nursing education to improve patient care and safety;
have demonstrated success in upgrading incumbent healthcare workers to become nurses or which have established effective programs or pilots to increase nurse faculty; or
are modeled after or affiliated with such programs described in paragraph (4).
An entity that receives a grant under this section shall annually evaluate, and submit to the Secretary a report on, the activities carried out under the grant and the outcomes of such activities. Such outcomes may include—
an increased number of incumbent workers entering an accredited school of nursing and in the pipeline for nursing programs;
an increasing number of graduating nurses and improved nurse graduation and licensure rates;
improved nurse retention;
an increase in the number of staff nurses at the healthcare facility involved;
an increase in the number of nurses with advanced degrees in nursing;
an increase in the number of nurse faculty;
improved measures of patient quality as determined by the Secretary; and
an increase in the diversity of new nurse graduates relative to the patient population.
Not later than September 30, 2011, the Secretary of Labor shall, using data and information from the reports received under paragraph (1), submit to Congress a report concerning the overall effectiveness of the grant program carried out under this section.
Authorization of appropriations
There are authorized to be appropriated to carry out this section for fiscal years 2010, 2011, and 2012, such sums as may be necessary. Funds appropriated under this subsection shall remain available until expended without fiscal year limitation.