THE GENERAL ASSEMBLY OF PENNSYLVANIA

SENATE BILL

No.1494
Session of 2002

        INTRODUCED BY SCHWARTZ, MELLOW, O'PAKE, KUKOVICH, 
                                            TARTAGLIONE,
           HUGHES, COSTA, STACK, LOGAN, LAVALLE, A. WILLIAMS AND MUSTO,
           JUNE 28, 2002
 
        REFERRED TO PUBLIC HEALTH AND WELFARE, JUNE 28, 2002
 
                                     
                                            AN ACT

     1  Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An
     2     act relating to health care; prescribing the powers and
     3     duties of the Department of Health; establishing and
     4     providing the powers and duties of the State Health
     5     Coordinating Council, health systems agencies and Health Care
     6     Policy Board in the Department of Health, and State Health
     7     Facility Hearing Board in the Department of Justice;
     8     providing for certification of need of health care providers
     9     and prescribing penalties," further providing for purpose of
    10     certain provisions, for definitions, for powers of the
    11     Department of Health, for administration and for licensure;
    12     providing for compliance with staffing plan and
    13     recordkeeping, for work assignment policy and for public
    14     disclosure of staffing requirements; further providing for
    15     issuance of license, for reliance on accrediting agencies and
    16     Federal Government, for effect on departmental orders and for
    17     actions against violations of law, rules and regulations; and
    18     providing for nurse recruitment.
    19     The General Assembly of the Commonwealth of Pennsylvania
    20     hereby enacts as follows:
    21     Section 1.  Section 801.1 of the act of July 19, 1979
    22     (P.L.130, No.48), known as the Health Care Facilities Act, added
    23     July 12, 1980 (P.L.655, No.136), is amended to read:
    24     Section 801.1.  Purpose.
    25     (a)  Purpose of chapter.--It is the purpose of this chapter
page 2 . . . . 
     1  to protect and promote the public health and welfare through the
     2  establishment and enforcement of regulations setting minimum
     3  standards in the construction, maintenance and operation of
     4  health care facilities. Such standards are intended by the
     5  Legislature to assure safe, adequate and efficient facilities
     6  and services, and to promote the health, safety and adequate
     7  care of the patients or residents of such facilities. It is also
     8  the purpose of this chapter to assure quality health care
     9  through appropriate and nonduplicative review and inspection
    10  with due regard to the protection of the health and rights of
    11  privacy of patients and without unreasonably interfering with
    12  the operation of the health care facility or home health agency.
    13     (b)  Need for safe staffing in health care facilities.--The
    14  General Assembly has a substantial interest in assuring that
    15  delivery of health care services to patients in health care
    16  facilities located within this Commonwealth is adequate and safe
    17  and that health care facilities retain sufficient nursing staff
    18  so as to promote optimal health care outcomes. Recent changes in
    19  health care delivery systems are resulting in a higher acuity
    20  level among patients in health care facilities. Inadequate
    21  hospital staffing results in dangerous medical errors and
    22  patient infections. Registered nurses constitute the highest
    23  percentage of direct health care staff in acute care facilities
    24  and have a central role in health care delivery. To ensure the
    25  adequate protection and care for patients in health care
    26  facilities it is essential that qualified registered nurses be
    27  accessible and available to meet the nursing needs of patients.
    28  Inadequate and poorly monitored nurse staffing practices, which
    29  result in having too few registered nurses providing care,
    30  jeopardize delivery of quality health care services and
page 3 . . . .
     1  adversely impact the health of patients who enter hospitals and
     2  outpatient emergency and surgical centers. The basic principles
     3  of staffing in health care facilities should be focused on
     4  patient health care needs and based on consideration of patient
     5  acuity levels and services that need to be provided to ensure
     6  optimal outcomes. The setting of staffing standards for
     7  registered nurses is not to be interpreted as justifying the
     8  understaffing of other critical health care workers, including
     9  licensed practical nurses and unlicensed assistive personnel.
    10  Safe staffing practices recognize the importance of all health
    11  care workers in providing quality patient care. Indeed, the
    12  availability of these other health care workers enables
    13  registered nurses to focus on the nursing care functions that
    14  only registered nurses, by law, are permitted to perform and
    15  thereby helps to ensure adequate staffing levels. To ensure
    16  patient safety, hospital patient acuity measurements which are
    17  adequate and followed must be in place. Establishing staffing
    18  standards for registered nurses in acute care facilities will
    19  ensure that health care facilities throughout this Commonwealth
    20  operate in a manner that guarantees the public safety and the
    21  delivery of quality health care services. In order to meet the
    22  staffing standards set forth under this chapter, the General
    23  Assembly recognizes the need to create incentives to increase
    24  the number of registered nurses within this Commonwealth.
    25     Section 2.  Section 802.1 of the act is amended by adding
    26  definitions to read:
    27  Section 802.1.  Definitions.
    28     The following words and phrases when used in this chapter
    29  shall have, unless the context clearly indicates otherwise, the
    30  meanings given them in this section:
page 4 . . . . 
     1     "Acuity system."  An established measurement instrument
     2  which:
     3         (1)  predicts nursing care requirements for individual
     4     patients based on severity of patient illness, need for
     5     specialized equipment and technology, intensity of nursing
     6     interventions required and the complexity of clinical nursing
     7     judgment needed to design, implement and evaluate the
     8     patient's nursing care plan;
     9         (2)  details the amount of nursing care needed, both in
    10     number of direct care nurses and in skill mix of nursing
    11     personnel required, on a daily basis, for each patient in a
    12     nursing department or unit; and
    13         (3)  is stated in terms that readily can be used and
    14     understood by direct care nurses.
    15  The acuity system shall take into consideration the patient care
    16  services provided not only by registered nurses but also by
    17  licensed practical nurses and other health care personnel.
    18     * * *
    19     "Assessment tool."  A measurement system which compares the
    20  staffing level in each nursing department or unit against actual
    21  patient nursing care requirements in order to review the
    22  accuracy of an acuity system.
    23     * * *
    24     "Direct care nurse."  A registered nurse who has direct
    25  responsibility to oversee or carry out medical regimens, nursing
    26  or other bedside care for one or more patients.
    27     "Documented staffing plan."  A detailed written plan setting
    28  forth the minimum number and classification of direct care
    29  nurses required in each nursing department or unit in the health
    30  care facility for a given year, based on reasonable projections
page 5 . . . . 
     1  derived from the patient census and average acuity level within
     2  each department or unit during the prior year, the department or
     3  unit size and geography, the nature of services provided and any
     4  forseeable changes in department or unit size or function during
     5  the current year.
     6     "Extended care facility."  A home health care agency, a
     7  hospice or a long-term care nursing facility.
     8     * * *
     9     "Nurse" or "registered nurse."  An individual licensed to
    10  practice professional nursing under the act of May 22, 1951
    11  (P.L.317, No.69), known as "The Professional Nursing Law."
    12     "Nursing care."  Care which falls within the scope of
    13  practice encompassed within recognized professional standards of
    14  nursing practice, including assessment, nursing diagnosis,
    15  planning, intervention, evaluation and patient advocacy.
    16     "Staffing level."  The actual numerical nurse-to-patient
    17  ratio within a nursing department or unit.
    18     "Unit."  A patient care component within a health care
    19  facility as defined by the Department of Health.
    20     Section 3.  Section 803 of the act, added July 12, 1980
    21  (P.L.655, No.136), is amended to read:
    22  Section 803.  Powers of the Department of Health.
    23     The Department of Health shall have the power and its duty
    24  shall be:
    25         (1)  to promulgate, after consultation with the policy
    26     board, the rules and regulations necessary to carry out the
    27     purposes and provisions of this chapter[; and], including:
    28             (i)  regulations defining terms, setting forth direct
    29         care nurse-to-patient ratios and prescribing the process
    30         for approving acuity systems; and
page 6 . . . . 
     1             (ii)  within six months of the effective date 
                                            of this
     2         subparagraph, regulations which at a minimum shall
     3         provide for an accessible and confidential system to
     4         report the failure to comply with requirements of this
     5         chapter and public access to information regarding
     6         reports of inspections, results, deficiencies and
     7         corrections under this chapter; and
     8         (2)  to assure that the provisions of this chapter and
     9     all rules and regulations promulgated under this chapter are
    10     enforced.
    11     Section 4.  Sections 804 and 806 of the act are amended by
    12  adding subsections to read:
    13  Section 804.  Administration.
    14     * * *
    15     (e)  Approval of acuity system.--The department shall adopt
    16  regulations prescribing the method by which it will approve a
    17  health care facility's acuity system. The regulations may
    18  include a system for class approval of acuity systems.
    19  Section 806.  Licensure.
    20     * * *
    21     (h)  Staffing requirements.--Each health care facility, other
    22  than an extended care facility, licensed pursuant to this act
    23  shall ensure that it is staffed in a manner that provides
    24  sufficient, appropriately qualified direct care nurses in each
    25  department or unit within the facility in order to meet the
    26  individualized care needs of the patients therein and to meet
    27  the requirements set forth in subsections (i), (j) and (k).
    28     (i)  Staffing plan.--As a condition of licensing, each health
    29  care facility annually shall submit to the department a
    30  documented staffing plan together with a written certification
page 7 . . . . 
     1  that the staffing plan is sufficient to provide adequate and
     2  appropriate delivery of health care services to patients for the
     3  ensuing year. The staffing plan must:
     4         (1)  Meet the minimum requirements set forth in
     5     subsection (j).
     6         (2)  Be adequate to meet any additional requirements
     7     provided by other law or regulation.
     8         (3)  Employ and identify an approved acuity system for
     9     addressing fluctuations in actual patient acuity levels and
    10     nursing care requirements necessitating increased staffing
    11     levels above the minimums set forth in the plan.
    12         (4) Factor in other unit or department activity, such as
    13     discharges, transfers and admissions and administrative and
    14     support tasks, that is expected to be done by direct care
    15     nurses in addition to direct nursing care.
    16         (5)  Factor in the staffing level of and services
    17     provided by other health care personnel in meeting patient
    18     care needs.
    19         (6)  Identify the assessment tool used to validate the
    20     acuity system relied on in the plan.
    21         (7)  Identify the system which will be used to document
    22     actual staffing on a daily basis within each department or
    23     unit.
    24         (8)  Include a written assessment of the accuracy of the
    25     prior year's staffing plan in light of actual staffing needs.
    26         (9)  Identify each nurse staff classification referenced
    27     therein together with a statement setting forth minimum
    28     qualifications for each classification.
    29         (10)  Be developed in consultation with a majority of the
    30     direct care nurses within each department or unit or, where
page 8 . . . . 
     1     nurses are represented, with the applicable recognized or
     2     certified collective bargaining representative of the direct
     3     care nurses.
     4     (j)  Nurse-to-patient ratios.--The staffing plan must
     5  incorporate, at a minimum, the following direct care nurse-to-
     6  patient ratios:
     7         (1)  One nurse to one patient in operating room and
     8     trauma emergency units.
     9         (2)  One nurse to two patients in all critical care
    10     areas, including emergency critical care and all intensive
    11     care units, labor and delivery units and postanesthesia
    12     units.
    13         (3)  One nurse to three patients in antepartum, emergency
    14     room, pediatrics, step-down and telemetry units.
    15         (4)  One nurse to four patients in intermediate care
    16     nursery, medical/surgical and acute care psychiatric units.
    17         (5)  One nurse to five patients in rehabilitation units.
    18         (6)  One nurse to six patients in postpartum (three
    19     couplets) and well-baby nursery units.
    20         (7)  For any units not listed above, including
    21     psychiatric units in facilities other than acute care
    22     hospitals, direct care nurse-to-patient ratio as established
    23     by the department.
    24     (k)  Additional standards.--
    25         (1)  The ratios set forth in subsection (j) shall
    26     constitute the minimum number of direct care nurses to be
    27     allocated within a department or unit. Additional direct care
    28     nurses must be added and the ratio adjusted to ensure
    29     adequate staffing of each nursing department or unit, in
    30     accordance with an approved acuity system.
page 9 . . . . 
     1         (2)  Nothing shall preclude the department from
     2     establishing and requiring a staffing plan to have higher
     3     nurse-to-patient ratios than those set forth in subsection
     4     (j).
     5         (3)  The staffing plan may not incorporate or assume that
     6     nursing care functions required by licensing law or
     7     regulations or accepted standards of practice to be performed
     8     by a registered nurse are to be performed by other personnel.
     9     Section 5.  The act is amended by adding sections to read:
    10  Section 806.2.  Compliance with staffing plan and recordkeeping.
    11     (a)  General rule.--As a condition of licensing, a health
    12  care facility required to have a staffing plan under section 806
    13  shall at all times staff in accordance with its staffing plan
    14  and the staffing standards set forth under section 806. However,
    15  nothing in this section shall be deemed to preclude any health
    16  care facility from implementing higher direct care nurse-to-
    17  patient staffing levels, nor shall the requirements set forth be
    18  deemed to supersede or replace any higher requirements otherwise
    19  mandated by law, regulation or contract.
    20     (b)  Assigned nursing staff.--For purposes of compliance with
    21  the minimum staffing requirements standards set forth under
    22  section 806, no nurse shall be assigned or included in the count
    23  of assigned nursing staff in a nursing department or unit or a
    24  clinical area within the health care facility unless that nurse
    25  has an appropriate license under the act of May 22, 1951
    26  (P.L.317, No.69), known as "The Professional Nursing Law,"
    27  received prior orientation in that clinical area sufficient to
    28  provide competent nursing care to the patients in that area, and
    29  demonstrated current competence in providing care in that area.
    30     (c)  Records.--As a condition of licensure, each health care
page 10 . . . . 
     1  facility required to have a staffing plan under section 806
     2  shall maintain accurate daily records showing:
     3         (1)  The number of patients admitted, released and
     4     present in each nursing department or unit within the
     5     facility.
     6         (2)  The individual acuity level of each patient present
     7     in each nursing department or unit within the facility.
     8         (3)  The identity and duty hours of each direct care
     9     nurse in each nursing department or unit within the facility.
    10     (d)  Daily statistics.--As a condition of licensure, each
    11  health care facility required to have a staffing plan under
    12  section 806 shall maintain daily statistics, by nursing
    13  department and unit, of mortality, morbidity, infection,
    14  accident, injury and medical errors.
    15     (e)  Time period for retaining records.--All records required
    16  to be kept under this section shall be retained for a period of
    17  seven years.
    18     (f)  Release to department and public.--All records required
    19  to be kept under this section shall be made available upon
    20  request to the department and to the public. However,
    21  information released to the public shall comply with applicable
    22  patient privacy laws and regulations.
    23  Section 806.3.  Work assignment policy.
    24     (a)  Work assignment refusal.--As a condition of licensure,
    25  each health care facility other than an extended care facility
    26  shall adopt, disseminate to direct care nurses and comply with a
    27  written policy that meets the requirements set forth in this
    28  section, detailing the circumstances under which a direct care
    29  nurse may refuse a work assignment.
    30     (b)  Minimum conditions.--At a minimum, the work assignment
page 11 . . . . 
                                            
     1  policy shall 
                                            permit a direct care nurse to refuse an assignment
     2  if:
     3         (1)  The nurse is not prepared by education, training or
     4     experience to safely fulfill the assignment without
     5     compromising or jeopardizing patient safety, the nurse's
     6     ability to meet foreseeable patient needs or the nurse's
     7     license.
     8         (2)  The assignment otherwise would violate requirements
     9     set forth in this act.
    10     (c)  Minimum procedures.--At a minimum, the work assignment
    11  policy shall contain procedures for the following:
    12         (1)  Reasonable requirements for prior notice to the
    13     nurse's supervisor regarding the nurse's request and
    14     supporting reasons for being relieved of the assignment or
    15     continued duty.
    16         (2)  Where feasible, an opportunity for the supervisor to
    17     review the specific conditions supporting the nurse's request
    18     and to decide whether to remedy the conditions, to relieve
    19     the nurse of the assignment or to deny the nurse's request to
    20     be relieved of the assignment or continued duty.
    21         (3)  A process which permits the nurse to exercise the
    22     right to refuse the assignment or continued on-duty status
    23     when the supervisor denies the request to be relieved if:
    24             (i)  the supervisor rejects the request without
    25         proposing a remedy or the proposed remedy would be
    26         inadequate or untimely;
    27             (ii)  the complaint and investigation process with a
    28         regulatory agency would be untimely to address the
    29         concern; and
    30             (iii)  the employee in good faith believes that the
page 12 . . . . 
     1         assignment meets conditions justifying refusal.
     2         (4)  A nurse who refuses an assignment pursuant to a work
     3     assignment policy as set forth in this section shall not be
     4     deemed, by reason thereof, to have engaged in negligent or
     5     incompetent action, patient abandonment or otherwise to have
     6     violated applicable nursing law.
     7  Section 806.4.  Public disclosure of staffing requirements.
     8     As a condition of licensing, a health care facility required
     9  to have a staffing plan under section 806 shall:
    10         (1)  Post in a conspicuous place readily accessible to
    11     the general public a notice prepared by the department
    12     setting forth the mandatory provisions for safe staffing
    13     under this chapter together with a statement of the mandatory
    14     and actual daily nurse staffing levels in each nursing
    15     department or unit.
    16         (2)  Upon request, make copies of the staffing plan filed
    17     with the department available to the public.
    18         (3)  Make readily available to the nursing staff with a
    19     department or unit, during each work shift, the following
    20     information:
    21             (i)  A copy of the current staffing plan for that
    22         department or unit.
    23             (ii)  Documentation of the number of direct care
    24         nurses required to be present during the shift based on
    25         the approved adopted acuity system.
    26             (iii)  Documentation of the actual number of direct
    27         care nurses present during the shift.
    28     Section 6.  Section 808(a) of the act, amended December 18,
    29  1992 (P.L.1602, No.179), is amended to read:
    30  Section 808.  Issuance of license.
page 13 . . . . 
     1     (a)  Standards.--The department shall issue a license to a
     2  health care provider when it is satisfied that the following
     3  standards have been met:
     4         (1)  that the health care provider is a responsible
     5     person;
     6         (2)  that the place to be used as a health care facility
     7     is adequately constructed, equipped, maintained and operated
     8     to safely and efficiently render the services offered;
     9         (3)  that the health care facility provides safe and
    10     efficient services which are adequate for the care, treatment
    11     and comfort of the patients or residents of such facility;
    12         (4)  that there is substantial compliance with the rules
    13     and regulations adopted by the department pursuant to this
    14     act; [and]
    15         (5)  that a certificate of need has been issued if one is
    16     necessary[.]; and
    17         (6)  in the case of a health care facility required to
    18     have a staffing plan under section 806, that the facility has
    19     submitted a documented staffing plan and is operating in
    20     compliance with the requirements pertaining thereto set forth
    21     in this chapter and in applicable regulations.
    22     * * *
    23     Section 7.  Section 810 of the act is amended by adding a
    24  subsection to read:
    25  Section 810.  Reliance on accrediting agencies and Federal
    26                 Government.
    27     * * *
    28     (d)  Construction.--This section shall not be construed to
    29  permit the department to delegate any of its functions with
    30  respect to the staffing requirements set forth under this
page 14 . . . . 
     1  chapter.
     2     Section 8.  Section 815(c) of the act, added July 12, 1980
     3  (P.L.655, No.136), is amended to read:
     4  Section 815.  Effect of departmental orders.
     5     * * *
     6     (c)  Medical assistance payments.--Orders of the department,
     7  to the extent that they are sustained by the board, which fail
     8  to renew a license or which suspend or revoke a license, shall
     9  likewise revoke or suspend certification of the facility as a
    10  medical assistance provider, and no medical assistance payment
    11  for services rendered subsequent to the final order shall be
    12  made during the pendency of an appeal for the period of
    13  revocation or suspension without an order of supersedeas by the
    14  appellate court. Any health care facility that falsifies or
    15  causes to be falsified documentation required by this chapter
    16  shall be prohibited from receiving any medical assistance
    17  payment for a period of six months subsequent to the final order
    18  of violation.
    19     Section 9.  Section 817 of the act, amended December 18, 1992
    20  (P.L.1602, No.179), is amended to read:
    21  Section 817.  Actions against violations of law, rules and
    22                 regulations.
    23     (a)  Actions brought by department.--Whenever any person,
    24  regardless of whether such person is a licensee, has violated
    25  any of the provisions of this chapter or the regulations issued
    26  pursuant thereto, the department may maintain an action in the
    27  name of the Commonwealth for an injunction or other process
    28  restraining or prohibiting such person from engaging in such
    29  activity.
    30     (b)  Civil penalty.--
page 15 . . . . 
     1         (1)  Any person, regardless of whether such person is a
     2     licensee, who has committed a violation of any of the
     3     provisions of this chapter or of any rule or regulation
     4     issued pursuant thereto, including failure to correct a
     5     serious licensure violation (as defined by regulation) within
     6     the time specified in a deficiency citation, may be assessed
     7     a civil penalty by an order of the department of up to $500
     8     for each deficiency for each day that each deficiency
     9     continues.
    10         (2)  A health care facility required to have a staffing
    11     plan under section 806 that fails to comply with the
    12     requirements of section 806.2(c) may be assessed a civil
    13     penalty by an order of the department of up to $10,000 for
    14     each day of noncompliance.
    15         (3)  Civil penalties shall be collected from the date the
    16     facility receives notice of the violation until the
    17     department confirms correction of such violation.
    18     (b.1)  Civil penalty for interference with reporting
    19  obligations.--Any person or health care facility that fails to
    20  report or falsifies information, or coerces, threatens,
    21  intimidates or otherwise influences another person to fail to
    22  report or to falsify information required to be reported under
    23  this chapter, may be assessed a penalty of up to $10,000 for
    24  each incident.
    25     (c)  Funds collected as a result of the assessment of a civil
    26  penalty.--When all other sources of funding have been exhausted,
    27  the department shall apply funds collected as a result of the
    28  assessment of a civil penalty to the protection of the health or
    29  property of patients or residents of the health care facility.
    30  Funds may be utilized to:
page 16 . . . . 
     1         (1)  Provide payment to temporary management.
     2         (2)  Maintain the operation of the health care facility
     3     pending correction of deficiencies or closure.
     4         (3)  In the case of a long-term care nursing facility,
     5     relocate residents to other licensed health care facilities.
     6         (4)  In the case of a long-term care nursing facility,
     7     reimburse residents for misappropriated personal needs
     8     allowance.
     9     (d)  Facility closure for threat to health or safety.--
    10  Whenever the department determines that deficiencies pose an
    11  immediate and serious threat to the health or safety of the
    12  patients or residents of the health care facility, the
    13  department may direct the closure of the facility and the
    14  transfer of patients or residents to other licensed health care
    15  facilities.
    16     (e)  Discharge or discrimination.--No person shall discharge,
    17  discriminate or in any manner retaliate against any employee
    18  because such employee has filed any complaint or instituted or
    19  caused to be instituted any proceeding under or related to this
    20  act or has testified or is about to testify in any such
    21  proceeding or because of the exercise by such employee on behalf
    22  of himself or others of any right afforded by this act.
    23     (f)  Private right of action for certain violations.--Any
    24  health care facility other than an extended care facility which
    25  violates the rights of an employee set forth in subsection (e)
    26  or under an adopted work assignment policy under section 806.3
    27  may be held liable to the employee in an action brought in a
    28  court of competent jurisdiction for the legal or equitable
    29  relief appropriate to effectuate the purposes of this chapter,
    30  including, but not limited to, reinstatement, promotion, lost
page 17 . . . .
     1  wages and benefits and compensatory and consequential damages
     2  resulting from the violation together with an equal amount in
     3  liquidated damages. The court in the action shall, in addition
     4  to any judgment awarded to the plaintiff, award reasonable
     5  attorney fees and costs of action to be paid by the defendant.
     6  The employee's right to institute a private action under this
     7  subsection is not limited by any other rights granted under this
     8  chapter.
     9     Section 10.  The act is amended by adding a section to read:
    10  Section 901.1.  Nurse recruitment.
    11     (a)  Nurse recruitment grant program.--
    12         (1)  The department shall award grants as set forth under
    13     this section to increase nursing education opportunities.
    14         (2)  Eligible entities to whom grants may be provided
    15     include the following:
    16             (i)  A health care facility.
    17             (ii)  A labor organization representing registered
    18         nurses in this Commonwealth.
    19             (iii)  An approved nursing education program for the
    20         preparation of professional registered nurses in
    21         accordance with the requirements of the act of May 22,
    22         1951 (P.L.317, No.69), known as "The Professional Nursing
    23         Law."
    24         (3)  Grants shall be available to:
    25             (i)  Support outreach programs at elementary and
    26         secondary schools that inform guidance counselors and
    27         students of education opportunities regarding nursing.
    28             (ii)  Create demonstration programs to provide
    29         mentors for high school students designed to encourage
    30         them to enter a career in professional nursing.
page 18 . . . . 
     1             (iii)  Provide scholarships or tuition 
                                            reimbursement,
     2         or both, to Pennsylvania residents from diverse racial
     3         and ethnic backgrounds who want to become registered
     4         nurses. To be eligible for a scholarship or tuition
     5         reimbursement, a student must meet designated academic
     6         criteria and be accepted into an approved nursing
     7         program. Scholarships and tuition reimbursement may be
     8         conditioned on a commitment of paid service up to three
     9         years in duration. Preference for scholarships shall be
    10         given to a student who is from an underrepresented ethnic
    11         and minority background or who is otherwise
    12         underrepresented in the profession of nursing. A student
    13         who is awarded a scholarship is obligated to perform
    14         three years of service at full pay at a health care
    15         facility or face a penalty of treble the scholarship
    16         amount plus interest.
    17     (b)  Career ladder grant program.--
    18         (1)  The department shall award grants to health care
    19     facilities to assist in creating career ladder programs that
    20     will encourage employees to obtain the education required to
    21     become registered nurses. In making awards, preference shall
    22     be given to health care facilities that have active labor
    23     management cooperative programs.
    24         (2)  Grants provided under this subsection shall be used
    25     to cover costs incurred by employees of the health care
    26     facility who enroll in an approved program to become
    27     registered nurses, including tuition costs, work release time
    28     and dependent care costs.
    29     (c)  Nursing faculty loan program.--The department shall
    30     establish and implement a grant program designed to encourage
page 19 . . . .
                                            
     1  health care 
                                            facilities to loan professional nursing staff to
     2  serve as faculty at approved nursing schools or nursing
     3  education programs.
     4     Section 11.  This act shall take effect in one year
.

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