Legislature(2007 - 2008)CAPITOL 106
02/26/2008 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: the Alaska Nursing Association|| Sb28 | |
| HB407 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 337 | TELECONFERENCED | |
| += | HB 345 | TELECONFERENCED | |
| *+ | HB 407 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
[Contains discussion of SB 28.]
3:07:45 PM
CHAIR WILSON announced that the first order of business would be
a presentation from the Alaska Nurses Association. She
introduced Patricia Senner.
3:10:29 PM
PATRICIA SENNER, Family Nurse Practitioner; Chair, Legislative
Committee, Alaska Nurses Association (AaNA), introduced members
of the various nursing groups representing nursing in Alaska.
3:11:29 PM
DIANNE TARRANT, Family Nurse Practitioner; President, Alaska
Nurse Practitioner Association, informed the committee that she
has been an Alaska resident since 1973. Her experience began as
a registered nurse in 1976 and she now teaches family nurse
practitioners (NP)s in the graduate program at the University of
Alaska (UA). She stated that nurse practitioners perform as
primary caregivers, which means that they can prescribe and
diagnose common acute and chronic problems. Most nurse
practitioners have master's degrees and the UA offers the only
statewide program to graduate as a primary care provider in the
state. The UA graduates approximately 10 nurse practitioners
per year and 90 percent of those graduates stay in the state to
practice. Mandated in 2015, there will be an entry level
Doctorate in Nursing Practice available through the UA.
3:15:57 PM
CHAIR WILSON asked about the mandated program.
MS. TARRANT re-stated that the mandated program is a NP entry
level program that has been directed by the American College of
Nursing and Accrediting.
3:16:05 PM
REPRESENTATIVE CISSNA related her personal experience and noted
that advanced NP's provide a mid-range of care. She opined that
advanced degrees will raise the cost of care and asked whether
there will be a lower, thus lower cost, level of NP care
available.
3:17:34 PM
MS. TARRANT stated that the issue is yet to be resolved at the
national level. The UA charges $300 per unit and credit, which
educates the graduate for $25,000.
3:18:41 PM
CHAIR WILSON observed that, in Alaska, advanced NPs are used as
providers in many areas. In the process of further education
for nurse practitioners, the cost of health care in Alaska will
increase.
3:19:44 PM
MS. TARRANT opined that the ultimate result is unknown. She
listed the specialties for NPs and compared the quality of care
with that of physicians. Ms. Tarrant listed studies that
indicate that NPs provide a quality of care equal to that of
family physicians at a lower cost. In a 2007 survey, it was
found that there are 465 advanced NPs practicing in Alaska. She
opined that NPs can be invisible, even though they provide
835,192 primary care visits per year. Furthermore, the average
NP earns $45 per hour, 7.6 percent of NPs are the sole health
care provider in their community, and one in four practice in a
medically underserved community. She then explained that 76
percent of NPs accept Medicare reimbursement, often without
limits, and 86 percent will accept Medicaid reimbursement.
Nurse Practitioners serve a disproportionate number of elderly,
low income, and minority groups. Ms. Tarrant concluded that
Alaskan NPs want to participate in the discussion of health care
in the state and need the support of the legislature for the
nurse practitioner program at the UA. She warned that the UA
may lose the psychiatric nurse practitioner program due to the
lack of faculty.
3:27:56 PM
REPRESENTATIVE ROSES asked for a comparison of populations
served in urban, rather than rural, communities.
3:28:10 PM
CHAIR WILSON expressed her understanding of the nursing
profession's desire for advanced education; however, further
education will increase cost, but not the level of service.
MS. TARRANT stated that the goal of the master's program is to
be close to a three-year degree.
3:30:12 PM
DEBBIE THOMPSON, Operating Room Nurse; President, Alaska Nurses
Association, stated that SB 28 addresses the matter of mandatory
overtime. She noted that the bill has been improved by changes
and bans mandatory overtime, also known as mandatory call, and
limits working hours for nurses to fourteen hours per day with a
rest period of ten hours. Ms. Thompson turned to the subject of
nursing demographics and related the following: most are aged
51 to 60 years and are close to retirement; 84.4 percent leave
their profession due to retirement; and nursing specialties
include midwives, anesthetists, clinical specialists, educators,
administrators, public health nurses (PHN)s, NPs, office nurses,
nurse managers and staff nurses. Ms. Thompson then informed the
committee that the Alaska Nurse Alert System (ANAS) is a
volunteer program to mobilize nurses during public health
emergencies. Presently, there are over 300 nurses who have
volunteered, and 40 percent are prepared to serve in remote
areas.
3:35:31 PM
CHRIS VAN CLEVE, School Nurse; Alaska Representative, National
School Nurses Association and Alaska School Nurses Association,
stated that school nurses, principals, and parents are convinced
that healthy kids learn better; in fact, care by school nurses
reduces school absenteeism. The majority of school nurses serve
children in Anchorage, the Mat-Su Borough, Kenai Peninsula,
Fairbanks, and Juneau; there are very few school nurses in Bush
communities. Ms. Van Cleve noted that the federal government
recommends one registered nurse per every 750 regular education
students, and a higher ratio for special education students.
3:38:27 PM
REPRESENTATIVE ROSES observed that school nurses are also
counselors and serve in many other capacities. A lack of a
nurse can mean that school secretaries administer medications.
3:39:11 PM
NANCY DAVIS, Registered Nurse; Public Health Nurse, Department
of Health and Social Services, informed the committee that
public health nursing is a combination of nursing art and
science, and public health science. One hundred and fifty-two
public health nurses (PHN)s connect with every community across
the state and provide nursing service to every village with a
school, and to any location where there is a communicable
disease outbreak. Public health nurses focus on disease
prevention and protection; health promotion and health
education; community health assessment; community health
development and problem solving of health issues; and timely
intervention when emergencies occur. Ms. Davis stated that PHNs
work for the state, local governments and tribal health
organizations; in fact, one of their important functions is to
link the public to needed government health services. She
provided statewide statistics for public nursing services.
3:44:10 PM
REPRESENTATIVE CISSNA recalled that there were more PHNs in the
past.
3:44:36 PM
MS. DAVIS said that the number of nurses stays about the same,
although the general population has increased.
3:45:22 PM
REPRESENTATIVE ROSES shared his experience as a teacher on TB
test day.
3:45:53 PM
MS. SENNER provided information about the University of Alaska
Anchorage (UAA) School of Nursing. She pointed out that 9,000
Registered Nurse (RN) licenses have been issued in Alaska, but
only 6,000 of those nurses live in Alaska. In fact, about one-
third of the nursing workforce is traveling nurses. To address
this shortage, a task force was convened in 2002, that made the
following recommendations: double enrollments in, and
graduations from, the nursing programs; extend those programs to
rural and frontier communities; identify and implement
strategies to retain nurses; and financially support the
expansion. Although the UA wants to expand, and is supporting
expansion financially, there are limits to the number of
instructors and clinical sites available. At this time, the
school of nursing has a two-year waiting list for acceptance
into the program, and 600 waiting students who have completed
their core courses.
3:50:30 PM
REPRESENTATIVE GARDNER advised that many newly graduated nurses
are not getting jobs due to lack of experience or specialty
training.
3:51:04 PM
MS. SENNER recalled that, about 20 years ago, hospitals
eliminated many training programs for new graduates. Therefore,
there is a shortage of nurses in that age group.
3:51:57 PM
REPRESENTATIVE GARDNER asked whether training programs have been
reinstated.
MS. THOMPSON opined that most facilities now have internships
and fellowships, depending on the specialty of the student.
Providence Health finds that new graduates take four months to
two years to feel comfortable in their work. Furthermore,
technology is not taught in nursing school and must be learned
with experience.
3:53:13 PM
REPRESENTATIVE GARDNER asked whether feeling comfortable equated
to competence.
MS. THOMPSON indicated yes.
3:55:38 PM
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