Legislature(2005 - 2006)CAPITOL 106
05/03/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB150 | |
| HB288 | |
| HB271 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 288 | TELECONFERENCED | |
| + | SB 150 | TELECONFERENCED | |
| + | HB 271 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 271-LIMIT OVERTIME FOR REGISTERED NURSES 4:18:05 PM CHAIR WILSON announced that the final order of business was HOUSE BILL NO. 271 "An Act relating to limitations on overtime for registered nurses in health care facilities; and providing for an effective date." 4:18:25 PM [CHAIR WILSON turned the gavel over to Vice-Chair Seaton.] The committee took an at-ease from 4:18:37 PM to 4:19:26. 4:19:31 PM CHAIR WILSON, as sponsor of HB 271, stated that mandatory overtime causes significant problems, including increased injury rates, for both patients and health care workers, and can be life threatening. She reported that the abuse of mandatory overtime shifts has been associated with: unhealthy weight gain, increased use of alcohol and tobacco, and lowered levels of functional ability in job performance. A national study showed that between 44,000-98,000 hospital deaths can be attributed to medical errors each year. The final recommendation of the Institute of Medicine was that all overtime done by nurses - voluntary and mandatory - should be curtailed. CHAIR WILSON noted that in a study entitled, "The Working Hours of Hospital Staff Nurses and Patient Safety," published in the July/August issue of Health Affairs, found that the risk of making an error is three times higher when nurses work shifts longer than 12 hours, which she indicated is one of the main reasons nurses are leaving their profession. She recalled a study a couple of years ago that said by the year 2010, 4,000 more nurses will be needed in Alaska. She offered anecdotes about her experience as a nurse. CHAIR WILSON said the proposed legislation will not prohibit a nurse from working overtime, but it will discourage an employer from assigning mandatory overtime. It would also prohibit an employer from threatening or retaliating against a nurse who refuses overtime. Nationwide, she said, 10 other states have mandated this type of legislation, while similar legislation has been proposed in 20 other states. REPRESENTATIVE GARDNER said she supports this legislation because it seems like a human rights issue. Notwithstanding that, she asked what the result would be for patient care in Alaska if the bill passes. 4:28:16 PM CHAIR WILSON noted that critical access hospitals would be exempted. She said hospitals in Alaska work with personnel as much as they can to ensure that they don't use mandatory [overtime] for nurses. She said the only complaints she has received were from state institutions: API, the Pioneer's Homes, and [the Department of Corrections]. In response to a follow-up question from Representative Gardner, she confirmed that the bill would apply to state institutions. REPRESENTATIVE CISSNA said that part of this is really a quality issue for patients. 4:31:24 PM VICE CHAIR SEATON asked why the bill only applies to registered nurses and further asked if the effect will be that lesser qualified employees are substituted for those nurses. CHAIR WILSON said that is a possibility; however, she said there are guidelines regarding what level of practitioner must be on duty to supervise others. 4:33:57 PM VICE CHAIR SEATON clarified that he wants to know if it's being said that overtime is dangerous for registered nurses, but not for licensed practitioner nurses. CHAIR WILSON said, "I'm sure that that would be also the same for them." She said she wouldn't have any objection to adding LPNs. 4:34:26 PM JANE BARNES, Nursing Director, Alaska Psychiatric Institute (API), told the committee that API employees 40 registered nurses and has no LPNs. Currently there are 5 staff nurse vacancies, which is about the norm. Some improvement was made when the a raise was approved in 2002; at that time there were 12 vacancies, or 25 percent of the staff nursing positions. Ms. Barnes said API does use mandatory overtime in order to meet patient care demands. It uses mandatory overtime only when needed to minimally staff the patient care unit, and the mandatory overtime used is minimal. She offered some details. She stated that the use of voluntary overtime is higher, at about 337 hours monthly. It is estimated that over half of the nurses who volunteer for overtime do so to avoid being assigned mandatory overtime. MS. BARNES said should HB 271 pass, she expects about half of the nurses currently doing voluntary overtime to decline working overtime altogether. She said she anticipates that the result would be maybe 200 hours of overtime that wouldn't be met by voluntary means. She predicted that [API] would have to use "agency nurses" at $60/hour for 13-week periods. It could also ask for the establishment of additional positions, but given the fact that there is already a difficulty filling the positions, that may be of little help. MS. BARNES, regarding agency nurses, indicated that it's problematic that those nurses are there for short periods of time and sometimes don't know how to use certain equipment or have to learn a program unique to API's therapeutic milieu and work with a team. A new nurse at API, she noted, partakes in intensive training for four weeks, which she pointed out is a third of an agency nurse's contract time. MS. BARNES concluded: The total elimination of mandated overtime, without any options for a lesser bill, such as limiting that overtime to so many hours at a time, places a real burden on us as an employer, and I believe will have a negative impact on patient care. REPRESENTATIVE GARDNER asked if it is fair to say that the real problem is that [API] cannot find the staff it needs to hire or can't retain staff. 4:40:44 PM MS. BARNES answered that API can usually find people to hire but cannot retain them. She said API is one of the few hospitals in town that will hire a "full-time, permanent placement, brand new nurse, new [graduate]." Most other hospitals require nurses to have 6-12 months experience as an associate nurse. She explained that the nurses API hires often work for one year to get that experience and then leave to work someplace else where they can earn 25-35 percent more per hour. REPRESENTATIVE GARDNER concluded that bottom line is that the pay rate is too low to retain qualified people. MS. BARNES answered yes. REPRESENTATIVE CISSNA surmised that not only is the pay too low, but also API must pay more in constant training. She asked if that has ever been calculated. MS. BARNES offered her understanding that the committee received a fiscal impact statement. She said she doesn't have a good calculation regarding what it takes to train any new employee. VICE CHAIR SEATON asked if API is paying less for registered nurses than compared to hospitals in town. MS. BARNES answered that's correct. She added that API has also lost nurses to doctor's offices. In response to a follow-up question from Vice Chair Seaton, she guessed that API's pay scale is set by the legislature. 4:44:03 PM DIANNE O'CONNELL, Labor Program Director, Alaska Nurses Association, said she has been working with "a number of nurses throughout the state, and quite a few at API, actually, in developing, ... supporting, and encouraging the passage of HB 271." She said there is more than one way of attacking the problem at hand. She noted, "It's been primarily a state institution problem." She indicated that nurses from many facilities throughout the state are concerned that their colleagues are in "what they consider an untenable situation," but also that the problem will spread if nothing is done now. MS. O'CONNELL, referring to Vice Chair Seaton's previous question, stated her belief that the pay scale [at API] is set by the Department of Administration and perhaps approved by the legislature. She said currently there is a request in for a reclassification study, which would take registered nurses, for example, "down a notch or two" in order to make up for the 25-35 percent pay differential. She said hopefully that will take place; however, she noted that that's a "separate project" than mandatory overtime, although they are related. She revealed that she had worked as a chaplain at API, and she said it was an emotional place to work [compared to some health care institutions]. She said, "And if you're there and you're faced with this mandatory overtime in addition to the lower salaries, in addition to the stress, in addition to being a brand new nurse, you're going to leave." MS. O'CONNELL stated that the reason the bill addresses RNs only at present is that that's where the biggest shortage is and that's where most of the responsibility lies for patient care. She echoed Ms. Barnes' notation that although there may be only 40 hours of mandatory overtime, there are 337 hours a month of what is euphemistically called "voluntary overtime." 4:50:04 PM CAROL WIDMAN, Registered Nurse, Alaska Psychiatric Institute, testified in support of HB 271. She said every time she goes to work she is subject to mandatory overtime. She said she has difficulty coming in on her days off because she has two small children; therefore, she is generally at the top of the list of those who have to stay [for mandatory overtime]. She said she gives medications to 20-30 patients. She stated that mandatory overtime is very dangerous and has caused many medication and judgment errors. 4:51:14 PM DAVE WILLIAMS, Project Coordinator, Pioneers' Homes, said that RNs are crucial to pioneers' homes, but there are also LPNs and Certified Nurse Assistants (CNAs). He said there is a lot of overtime. Most of it is voluntary, but some of it is mandatory. He said the pioneers' homes staff of RNs work overtime voluntarily because they care greatly for the residents they serve. He said the bill would require careful documentation as to whether overtime was voluntary or mandatory, because "some of the provisions in the bill would penalize if it wasn't." In response to a question from Vice Chair Seaton, he stated his belief that every one of the RNs, LPNs, and CNAs work overtime. He noted that the RNs are "Nurse I, II, and III in the state system" and are the people who the pioneers' homes are required by licensure to have on board in order to provide services. He said he does not know what the pioneers' homes would do if nobody showed up to work and it was necessary to call someone up without the ability to use mandatory overtime. MR. WILLIAMS said one alternative may be to use contracted services; however, he said he doesn't know how practical that would be, especially in a more remote place. He stated that the issue is supply; there are not enough RNs available. He opined that nurses who work at the pioneers' homes carefully weigh the benefits they receive, because "it's the package of wages and benefits that need to be balanced against what's in the private sector." He proffered that if working at the pioneers' homes is made more valuable, then there may come a time when the hospitals would have a "hole" in their system. He indicated that he also works with hospitals and he confirmed that they do "look at contract nurses." He reemphasized the need to have RNs available in order to operate. He said he would get a fiscal note to the committee to reflect how much overtime at the pioneers' homes is voluntary and how much is mandatory. 4:55:42 PM REPRESENTATIVE CISSNA asked if "lifting" is used to alleviate the nursing load. In response to a request for clarification, she said by "lifting" she means shifting some of the responsibilities that don't require the education of an RN to other employees. MR. WILLIAMS said the pioneers' homes do that, which is why it employs a lot of CNAs. 4:57:11 PM VICE CHAIR SEATON closed public testimony. CHAIR WILSON moved to adopt the fiscal note from the Department of Labor and Workforce Development, dated 4/19/05. There being no objection, it was so ordered. VICE CHAIR SEATON returned the gavel to Chair Wilson. [HB 271 was held over.]
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