Legislature(2013 - 2014)BARNES 124
04/15/2014 03:15 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB156 | |
| SB166 | |
| SB167 | |
| SB183 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 156 | TELECONFERENCED | |
| + | SB 166 | TELECONFERENCED | |
| + | SB 167 | TELECONFERENCED | |
| + | SB 183 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 166-BOARD OF NURSING; NURSES
3:46:31 PM
CHAIR OLSON announced that the next order of business would be
CS FOR SENATE BILL NO. 166(FIN), "An Act relating to nursing and
to the Board of Nursing."
3:46:35 PM
SENATOR CATHY GIESSEL, Alaska State Legislature, stated that she
holds two licenses under the jurisdictions of the Board of
Nursing (BON), as a registered nurse (RN) and as an advanced
nurse practitioner (ANP). She has served two terms on the BON,
serving five years as chair. She said SB 166 is a "clean-up" or
"revisor's" bill. The Legislative Legal Services doesn't do
revisor's bills for professional boards due to the technical
nature.
3:47:38 PM
SENATOR GIESSEL stated that this bill revises the board member
qualifications, requiring that licensed practical nurses have at
least two years of clinical practice before being appointed to
the BON. The registered nurse or nurse educator on the BON can
also be working in a program that provides graduate, bachelor's,
or associate degrees, noting that, previously, the requirement
was for a minimum of a bachelor's degree. The advanced nurse
practitioner must have at a minimum of four years of advanced
practice prior to being appointed to the board. Additionally,
the bill establishes a retired nurse status and "cleans up" some
practical nurse education program criteria. She noted that the
qualifications and duties of the executive administrator have
been revised. The term has changed from executive secretary to
administrator and requires the person to have a minimum
education of a Masters' degree in Nursing.
3:48:55 PM
SENATOR GIESSEL said that this has been raised in other
committees so she elaborated that holding an advance degree is
rather common, and there are over 900 advanced nurse
practitioners (ANPs) in Alaska. She commented that this
represents the minimal level of entry for an ANP. She related
that for the past 25 years, the executive administrator has had
either a masters' degree or a doctorate. In fact, the current
administrator holds a Ph.D., she said. She explained the
changes made for testing, such that SB 166 removes the
requirement for written exams since electronic exams are
administered. The bill would repeal language that allows
licensing through the Canadian Nurses Association testing
examination, which is no longer considered valid for licensure
in the U.S. The bill removes an obsolete term, licensed
vocational nurse. Under the bill, the board would continue to
do background checks and competency requirements to reinstate
lapsed licenses. The board allows a physician's assistant to be
authorized to supervise a licensed practical nurse and would add
a new section that requires an employer to report to the BON
when a nurse or nurse aide is fired or suspended. She explained
the reporting is no longer required to be done under oath. It
would also provide protection for nurses that may refuse to
delegate a task if the person delegated to lacks sufficient
training. The reporting was deemed important since it may
require disciplinary action be taken by the BON.
3:50:56 PM
SENATOR GIESSEL related the committee hearings raised some
issues. One concern related to the criminal background checks,
noting that the BON has performed criminal background checks for
a number of years. Health care professionals have very intimate
contact with their patients and Alaska is an "end of the road"
jurisdiction so criminal background checks have been very
important to ensure public safety. In fact, the BON's mission
is to ensure safety through the regulation of safe nursing
practices. In 2009, someone asked the executive director why
barrier crimes were being imposed on nurses practicing in their
facilities. It turns out that the federal government had placed
a restriction on any health care facility receiving federal
funds. The BON does not have any barrier crimes to licensure.
It has conducted background checks; however, any questionable
criminal background is reviewed individually by the BON. She
acknowledged that for the most part, the BON continues to
license the individual unless the crime is egregious, such as a
murder conviction. Since the federal government created barrier
crimes and required a second background check, some duplication
exists. The BON has contacted the Federal Executive Institute
(FEI) on numerous occasions and has been advised that the
federal administrative procedure restricts the sharing of a
criminal background check by one entity with another.
3:52:53 PM
SENATOR GIESSEL referred to an audit performed by the Division
of Legislative Audit. She pointed out that the BON was in
compliance for the authorized use of criminal background checks,
but were found out of compliance since the board stores its
records for license applications in the Alaska archives. She
characterized this as being a "ding" by the FBI, which shows how
stringent the agency is in terms of sharing the document. She
referred to page 3 of the audit that showed the BON was in
compliance in having a reason to request the information. She
said these audits are "very real," and the FBI takes its
jurisdiction and prevention of sharing background checks
seriously. Some health care providers finish their education,
seek licensure, and must submit to a criminal background check
for the BON for licensure. She related a scenario in which a
nurse then applies for work at a hospital in Bethel. The nurse
must submit to a second background check. On March 21, 2014,
the BON formulated a subcommittee that plans to meet this summer
with Alaska State Hospital and Nursing Home Association (ASHNA)
and the FBI to discuss and find solutions for the duplicate
requirements and associated costs to new employees.
3:54:56 PM
SENATOR GIESSEL next referred to an issue raised by the
Christian Science Committee on Publication for Alaska. She
stated that as a religious community, the Christian Science
community has religious ministers that the community refers to
as "nurses." She explained that these ministers go into homes
and provide services such as cooking, bathing, housekeeping,
encouragement, and spiritual guidance. These services are all
non-medical. She noted that the Christian Science Community has
come to the BON on numerous occasions requesting an exemption to
use the protected term "nurse" for their church members who are
preforming these services. The board has repeatedly denied this
exemption since "nurse" is a protected term. She referred to a
letter [dated September 3, 2013] from the Department of Law that
limits the term of "nurse" since AS 08.68.340 (a)(4) identifies
a nurse as a medical health care provider and it would be
inappropriate to make an exemption. Also, the BON recognizes
that the public assigns a certain identity to the term "nurse."
3:56:17 PM
REPRESENTATIVE JOSEPHSON asked about notice to the board of a
termination of a nurse. He asked whether that is done in other
professions.
SENATOR GIESSEL answered yes, that the BON provisions are
modeled after the state medical profession statutes.
REPRESENTATIVE JOSEPHSON surmised that the BON would make a
distinction for personality conflicts and not much more would
happen.
SENATOR GIESSEL answered that would raise other questions about
fair employment practices. She clarified that these are related
to professional conduct and competency.
3:57:17 PM
REPRESENTATIVE JOSEPHSON referred to the Christian Science
Committee on Publication letter in members' packets that read,
"Notably, the Alaska Medical Practice Act already has a
religious exception in place." He asked whether any analogy
exists.
SENATOR GIESSEL said she has reviewed the medical statutes and
the statement exists; however, she recalled the next section of
statutes relates to the definitions and it is very clear that
the term "physician" and "doctor" are protected terms under the
medical statutes. The medial board does not allow other people
to use the terms, "physician" or "medical doctor" unless they
are scientifically and medically trained physicians.
CHAIR OLSON remarked that the committee has seen naturopath
issues that have arisen in terms of the title "doctor."
REPRESENTATIVE JOSEPHSON recalled that naturopaths advertise
themselves in that manner.
CHAIR OLSON responded that the naturopaths advertise themselves
as being "naturopathic doctors" or "NDs." He asked the sponsor
if the BON has had that experience.
SENATOR GIESSEL agreed he is correct.
3:58:58 PM
REPRESENTATIVE JOSEPHSON asked whether some compromise could be
reached in which the Christian Science community could use a
term other than "nurse" or term that said "pastoral nurse." He
further asked whether that has been discussed.
SENATOR GIESSEL said it has and the Christian Science community
wants to use the term "nurse." She explained that the BON does
not have any opposition to the services provided by the
spiritual guides but the term "nurse" is protected. She offered
her belief that Alaska's citizens believe that a "nurse"
represents a medically trained individual.
3:59:59 PM
REPRESENTATIVE SADDLER asked for the reason that the Christian
Science community has for using the term "nurse" and if it is
motivated by respect, professional standing, or additional
billing status.
SENATOR GIESSEL answered that using the term would enable them
to advertise and to be reimbursed by insurance for services.
4:00:38 PM
REPRESENTATIVE SADDLER referred to page 4, line 2, to paragraph
(3), to the required education for a practical nurse. He
related his understanding that if a registered nurse fails the
exam, the individual could be licensed as a practical nurse.
SENATOR GIESSEL agreed. This is something the board would
review before licensure. She deferred to the executive
administrator to provide more details.
4:01:24 PM
CHAIR OLSON suggested that the Christian Science community may
wish to seek a separate bill to address their issue since it
would raise several other concerns.
REPRESENTATIVE HERRON referred to page 3, paragraph (10) of
Section 2. He commended Dr. Nancy Sanders, who was helpful with
respect to nurse aide classes in rural Alaska. He said that she
helped foster a solution for the Bethel Health Center. He said
he was considering an amendment. He asked whether the existing
AS 08.68.101 could be amended to allow, but not require, a
criminal background check previously ordered by the department.
REPRESENTATIVE HERRON appreciated hearing that the
administrator, Dr. Nancy Sanders, will convene a workgroup to
work with all the parties with respect to the FBI ruling on
criminal background checks. He suggested that this would give
the board an opportunity to use the background check working
group in anticipation that the legislature could address the law
next session. In this way the working group could work on a
solution, totally within their purview, but come to the
legislature next session.
4:04:31 PM
SENATOR GIESSEL acknowledged this is the reason the board has
convened the subcommittee; however, she expressed concern about
inserting permissive language in the event a potential licensee
contests the board saying it could have used another criminal
background check. [Referring to the 2/11/14 letter from the
executive administrator, Nancy Sanders, that under AS 08.68.344]
the Board of Nursing may deny a certification or impose a
disciplinary sanction. She hoped the FBI will be helpful in
finding a solution, although she did find letters dating back to
2007 denying the double use. Thus, she was unsure of the FBI's
outcome and how quickly it might act. She offered her belief
that it is possible to more quickly address the issue next
session based on the interim work. At that point the BON will
know if it has permission to use the background check for two
different facilities; however, currently it may just add
confusion to the administration of the licensing procedures.
She deferred to the executive administrator.
4:06:10 PM
REPRESENTATIVE HERRON asked whether the FBI's initial concern
was about a Department of Health and Social Services (DHSS)
requested background check.
SENATOR GIESSEL answered yes. She read [from a U.S. Department
of Justice] letter dated July 5, 2005, which read, in part,
"Criminal history information obtained under this authority may
be used solely for the purpose requested and cannot be
disseminated outside the receiving departments, related
agencies, or other authorized entities."
4:07:18 PM
REPRESENTATIVE HERRON looked forward to the outcome of the
working group. He referred to proposed language [in members'
packets, not yet offered] that would amend AS 08.68.101 to
allow, but not require, use of a background check previously
ordered by the department. He asked whether his proposed
language would help, in advance of the working group's solution.
NANCY SANDERS, Ph.D., RN; Executive Administrator, Board of
Nursing, Department of Commerce, Community & Economic
Development answered that she thought it would be premature to
do so. She suggested some decisions need to be made. The BON
asked for background checks to make a decision about licensing.
The DHSS asked for an employment background check, which are two
very separate purposes. In terms of putting in proposed
language changes, the BON does not currently have a process
since the FBI will not allow sharing the criminal background
information. She understood the DHSS could not share with the
Board of Nursing and hoped more information would be forthcoming
via the work group to figure out how to streamline this.
4:10:34 PM
REPRESENTATIVE HERRON asked what talent and skill sets Dr.
Sanders will bring to the work group.
DR. SANDERS envisioned a representative from DHSS would serve on
the work group. She also hoped she would serve, as well as a
member from the Alaska State Hospital and Nursing Home
Association. She suggested that someone from the FBI should
provide consultation and added that the full complement of
people to serve has not yet been identified.
4:11:30 PM
REPRESENTATIVE HERRON asked whether she would consider adding
someone from the Kuskokwim Health Corporation to participate in
the work group.
MS. SANDERS answered she would entertain that idea; however, she
said that the proposed language would not just affect nurse
aides but would affect everyone licensed by the BON, including
registered nurses, licensed practical nurses, and certified
nurse assistants. She suggested she would like a broad
representation, including someone from a rural setting such as
the Yukon Kuskokwim Delta.
4:12:43 PM
CHAIR OLSON suggested the language could affect 16,000 people.
DR. SANDERS acknowledged that's the current number, but it also
would affect those applying to be licensed or certified as well
as those seeking reinstatement. It might be 1,000 to 1,300 more
per year, she said.
CHAIR OLSON noted that was a significant number.
REPRESENTATIVE HERRON asked to put on record that he would like
the FBI involved in the work group.
SENATOR GIESSEL answered that she believed that was the intent.
She also appreciated the suggestion to have a rural facility
represented. She acknowledged that the board seeks geographic
distribution in its composition, too.
CHAIR OLSON asked whether she would work with Representative
Herron on a letter of intent to SB 166.
SENATOR GIESSEL answered that she would be happy to do so
4:14:38 PM
REPRESENTATIVE SADDLER referred to page 2, line 16, which adds
retired nurse status. He asked what activities a retired nurse
would be allowed.
DR. SANDERS answered that this category of licensure is one the
BON is continually asked to issue. This does not allow nurses
to continue to work, even in a voluntary capacity. She
characterized it as keeping an honorarium since nurses worked
hard for their licenses and would like to be recognized as
nurses.
4:15:41 PM
REPRESENTATIVE SADDLER clarified that it doesn't allow them to
practice. He asked whether there is any legal status given to
retired nurses.
DR. SANDERS answered no; it just provides an honorary title.
REPRESENTATIVE SADDLER related that he is married to a
registered nurse.
REPRESENTATIVE SADDLER said the sponsor statement states that
this is the first improvement to nursing statutes in 10 years.
He asked for any trends in nursing.
DR. SANDERS offered her belief that a bill would likely be
introduced next year to introduce the advanced practice
registered nurses (APRNs) consensus model for advanced practice
nurses. Currently a subgroup, the APRN alliance, has been
working on the national movement. She envisioned that if nurse
practitioners or certified nurse midwives move out of state that
their practice would be similar to their practice in Alaska.
4:17:37 PM
REPRESENTATIVE SADDLER referred to page 2, line 17, to
subparagraph (D), which read, "establishing criteria for
approval of practical nurse education programs that are not
accredited by a national nursing accrediting body;" He asked
whether the programs are educational programs in Alaska.
DR. SANDERS said that many practical nurse programs throughout
the U.S. are not nationally accredited nursing programs through
the national nursing accreditation. This would allow the board
to consider an applicant's transcript to determine whether the
applicant has met the same educational standard as programs in
the state. She explained that the regulations in Alaska require
the practical nurse program "will" achieve national
accreditation, but many programs in the Lower 48 are not
nationally accredited.
REPRESENTATIVE SADDLER asked whether the BON expects many
applicants to come from non-accredited programs.
4:18:57 PM
DR. SANDERS said there are a significant number of people who
have graduated from these programs that might apply for
licensure in Alaska. She was unsure of the percentage, but they
may be accredited through a regional accreditation, but not
specifically a nursing accreditation. There is one advanced
practice nurse program (APN) in Alaska, which is moving towards
becoming nationally nursing accredited.
4:19:40 PM
REPRESENTATIVE SADDLER asked for an assessment of the quality of
education for consumers.
DR. SANDERS answered that the BON currently licenses APNs;
however, the BON is tightening its regulations about nursing
education, regarding the minimum level of education. This would
allow the BON to scrutinize their education. Currently, as the
administrator, she will go the applicant's home jurisdiction and
board site and compare the minimum qualifications for that
jurisdiction and compare it to Alaska's requirements to
determine equivalency.
4:21:02 PM
JANA SHOCKMAN, Registered Nurse, President, Alaska Nurses
Association, related that the ANA supports the requirement in
this bill for the executive administrator to hold a Master's
degree in Nursing as a minimum. This position requires broad
knowledge of nursing issues that range from the certified nurse
assistant (CNA) level to the advanced practice nurse.
Historically, this position has been filled for the past two
decades with that background. She reported that there are
currently more than 1,000 nurses who meet that qualification in
Alaska. The ANA believes that any background check amendment is
premature. The plans underway for the work group meeting are
also supported by the ANA. She stated that the ANA does not
support the Christian Science nurses use of the title "nurse"
although it recognizes the value of the services they provide.
She pointed out that the Christian Science spiritual guides are
not educated as nurses. The use of the title could be confusing
to the public. She concluded that the ANA supports SB 166,
without any amendments.
4:23:07 PM
BETH FARNSTROM, Registered Nurse; Chair, Board of Nursing,
Department of Commerce, Community & Economic Development, stated
that the BON supports SB 166, without any amendments for the
various reasons previously stated.
PATRICIA SENNER, Advanced Nurse Practitioner (ANP), asked to
speak in support of SB 166 as has been brought to the committee.
4:24:26 PM
KAREN PURDUE, President & CEO, Alaska State Hospital Nursing
Home Association (ASHNHA), stated that the association supports
this bill and is interested in having the background issue
addressed. She emphasized that the ASHNHA employs numerous
nurses and nursing assistants in their facilities. She said
that ASHNHA depends on the BON to maintain a qualified work
force. She offered support for rigorous licensing, background
checks, and the type of work that the board conducts. She
clarified that the complexity of the background check has been
added to because the legislature passed another bill in 2008.
She recalled that Representative Herron referred to the DHSS
background check. Part of the issue arises from the FBI, but
also part of it is that the state has a duplicate background
check system. Basically, each individual who is working in a
facility licensed by the DHSS or paid by the department must
submit to a background check conducted by the DHSS.
MS. PURDUE offered her belief that this has added thousands of
background checks to the process, even though it uses the same
seminal information that the licensing board and FBI
fingerprinting uses. The ASHNHA questions whether this can be
more efficient but not lower the standards or impact the BON's
ability to regulate licensees. She further asked if expenses
and complexity will be cut. She looked forward to the work
group process and to participating vigorously. She closed by
saying that the recent focus has been on the CNA, so those
individuals have a very short training time and make about $16
per hour. These jobs provide the backbone of the care industry.
She emphasized that she is very focused on jobs being available
in rural Alaska. Anything that the ASHNHA can do to ensure that
those individuals obtain employment is important, which includes
background checks, taking timely tests, and ensuring that
classes are available. She thanked members and assured them
that the ASHNHA is ready to participate in the process.
REPRESENTATIVE HERRON noted that she raised a good point that
the issue might not rest with the FBI and may rest with [the
legislature and the state].
4:27:36 PM
BEVERLY SMITH, Media and Legislative, Christian Science Church,
stated that she has no desire to hold up the bill. She has held
discussions with the Chair of the Board of Nursing and is
willing to work with the board during the interim. First, the
Christian Science Nurses refer to themselves only as "Christian
Science Nurses" and would never hold themselves out as a
"nurse." She explained that they have been in operation for 106
years and there has never been any confusion anywhere in the
world with this term. The "Christian Science Nurses" do not
advertise in the yellow pages, but do advertise in a religious
publication so someone seeking the services of a "Christian
Science Nurse" would know where to look for the service. She
thinks it is a little strange that a person could live in
Michigan and practice this religious practice and use the
services of "Christian Science Nurses" but cannot do so in
Alaska and thought that there should be some accommodation. She
referred to a letter in members' packets from the Christian
Science - Committee on Publication for Alaska [dated 4/15/2014].
She pointed out the first amendment issue for practicing one's
religion. She mentioned the model nurse practices act, which
has a suggested accommodation for caring for the sick in
accordance with tenets and practices related to religious
denomination that teaches reliance on spiritual means for
healing. She reported that most other states in the U.S. and
other countries do permit "Christian Science nurses" to practice
in their jurisdiction through regulation, statute, or advisory
opinion. Again, the Christian Science church is looking for
such an accommodation in Alaska so its citizens who are
Christian Scientists can practice their religion fully.
CHAIR OLSON said that working with the BON is a good start.
4:31:37 PM
REPRESENTATIVE SADDLER asked how many Christian Science
practitioners are in Alaska.
MS. SMITH answered that the practitioners are different than the
"Christian Science nurses." She estimated that perhaps five or
six practitioners are in the state and fewer "Christian Science
nurses" since they currently cannot practice in Alaska.
4:32:06 PM
REPRESENTATIVE SADDLER asked how many practice the faith in
Alaska.
MS. SMITH suggested it is a small group, in the hundreds. She
related Christian Science nursing facilities exist in the Lower
48, similar to a hospital, and the services are reimbursed by
Medicare and other insurance companies. She anticipated that
the potential "Christian Science nurse" would provide home care
in Alaska.
CHAIR OLSON, after first determining no one else wished to
testify, closed public testimony on SB 166.
REPRESENTATIVE JOSEPHSON remarked that this is an interesting
issue and is something he taught about the constitution. He
said if a law has general application then everyone is subject
to it. The other theory is that one has to be sensitive to free
exercise issues and accommodate those issues in the least
restrictive way possible. He said two strains of jurisprudence
exist and he has previously represented nurses [as a lawyer], so
he understands the need to keep the "nurse" title as privileged.
He also recalled that naturopaths called themselves doctors and
sometimes the terms are a little confusing. He acknowledged his
comments just represent a discussion point.
4:34:57 PM
REPRESENTATIVE HERRON moved to report CSSB 166(FIN) out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, CSSB 166(FIN) was
reported from the House Labor and Commerce Standing Committee.