Legislature(2009 - 2010)BUTROVICH 205
03/09/2009 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB12 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 12 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 12-LIMIT OVERTIME FOR REGISTERED NURSES
CHAIR DAVIS announced consideration of SB 12.
1:31:06 PM
TOM OBERMEYER, staff to Senator Davis, sponsor of SB 12, offered
the sponsor statement for SB 12 as follows:
SB 12 prevents registered nurses and licensed
practical nurses from being forced to work mandatory
overtime, i.e., work beyond an agreed to,
predetermined, regularly scheduled shift, and it
protects patients from the dangers caused by
overworked nurses. Except for Alaska Native health
care facilities exempted by this bill under federal
law, Senate Bill 12 is applicable to all hospitals and
health care facilities licensed in Alaska.
Under SB 12 a nurse may not be required or coerced
directly or indirectly to work more than 14
consecutive hours without 10 hours of rest; beyond 80
hours in a 14-day period; or to accept an assignment
of overtime if, in the judgment of the nurse, the
overtime would jeopardize patient or employee safety.
Nurses, however, can volunteer to work additional
shifts beyond this limit, so long as the nurse does
not work more than 14 consecutive hours without 10
hours of rest.
In recognizing the complexity in delivering quality
nursing care on a 24-hour basis, a number of
concessions have been made to Alaska hospitals in this
bill. The 14-hour maximum workday with 10 hours rest,
which exceeds that allowed in many other states,
permits a two-hour transition for nursing supervisors
to call in additional help after 12-hour shifts. This
provision was intended to help remedy the problem of
nurses being called back to work without adequate rest
after working a 12-hour shift.
A number of exceptions have been provided to allow for
longer shifts for flight nurses on medical transport,
residential psychiatric treatment centers, school
nurses on school sponsored field trips, and official
state emergencies. This bill limits hospital
reporting of overtime hours to twice a year; it
prohibits retaliation for complaints; designates
limited employer penalties and requires enforcement
for only "knowing" violations.
The Journal of the American Medical Association,
October 23-30, 2002, reported that nurses who suffer
from fatigue, increased patient work-loads, and shifts
in excess of 12 hours greatly increase nursing errors
and mortality among patients who have common
surgeries. In the 1999 report, "To Err is Human," the
Institute of Medicine estimated that as many as 98,000
hospitalized Americans die each year as a result of
errors in their care. Both nurses and employers alike
state that patient safety is paramount, but nurses are
allowed to work far beyond their endurance levels,
depending on age and condition, unlike other safety-
sensitive jobs, including commercial airline pilots,
FAA controllers, railroad engineers, and long-haul
truckers.
Although nurses file few official overtime complaints
in part due to busy schedules and fear of retaliation
by employers, many nurses have testified to overwork,
emotional exhaustion when they are responsible for
more patients that they can safely care
for, disruption of family life, unexpected shift
changes, mandatory overtime, and mandatory on-call.
Low numbers of complaints and benign exit interviews
belie growing dissatisfaction with the difficult work
and quality of life of nurses, which has caused many
of them to "burn-out" and to leave the profession.
It has been estimated that 500,000 licensed registered
nurses have left or are not working in the profession.
There is an expected shortage of over 400,000 nurses
by 2020. The nursing shortage is a workforce crisis
exacerbated by the growing and unavoidable need for
increased nursing care by the aging "baby boomer"
generation. Bills in Congress to stem the nursing
shortage, include financial aid for education of
nurses and nurse instructors, and more rigorous
regulation of overtime hours and patient safety. Ref:
H.R. 2122, and S.1842 in the 110th Congress, and
before that, H.R. 791, "The Safe Nursing and Patient
Care Act."
The nursing profession must attract more young people
to replace the aging nurses' workforce which
nationwide averages 46 years of age, 48 in Alaska, and
is 95 percent women. In 2000 only 9 percent of RNs
were under age 25, compared to 25 percent in 1980.
Women are finding alternative career choices, so it is
important for the nursing profession to create more
jobs for nurses with higher wages, greater
responsibilities, and better quality of work life.
Nurses are often described as having a "flat" career
path. Only by considerably more education and
experience can they advance in certifications and
earnings. They rarely hold positions of authority in
hospitals to influence policy decisions regarding
nurse/patient ratios, overtime, on-call, and patient
safety. Bargaining units help, but only one-half of
Alaska's 4,500 licensed registered nurses are
represented by bargaining units.
Although the University of Alaska has made great
progress in increasing the numbers of nursing
graduates in Alaska and in improving nursing programs
at all levels, these efforts can only be successful
through employment and retention if the nursing
profession can provide a quality of life comparable to
that in other competitive fields. SB 12 will help
remedy this problem by encouraging employers to employ
and train more nurses rather using mandatory overtime,
mandatory on-call, and large numbers of "travelers,"
as staffing tools to fill both routine and critical
care positions on a daily basis. The greatest
beneficiaries will be the patients who will receive
the care and safety they deserve.
1:36:26 PM
DEBBIE THOMSON, Executive Director and Program Director, Alaska
Nurses Association, said she wanted to talk to them about the
dangers of mandatory overtime and the fatigue and the errors
that happen with it. She explained that some say that nurse
might just as well have had a drink because the long hours
worked by some of them pose some of the most serious threats to
patient safety that result in decreasing the reaction time and
the speed of mental processing. Periods of wakefulness in excess
of 16 hours can produce performance decrements equivalent to a
blood alcohol concentration of .05 percent. Alcohol intoxication
is defined as .08 to .10 percent varying among the states.
MS. THOMSON presented slides from the Michigan Nurses
Association Public Policies Association Incorporated on the Cost
of Mandatory Overtime for Nurses (written in August 2004), which
indicated the likelihood of making an error increases with the
number of hours that are worked and are almost three times
higher when nurses work shifts lasting 12.5 hours. She found
that working overtime increases the odds of making at least one
error and it didn't matter if it was 12.5 hours or 8; it was
overtime over the originally scheduled shift.
Dangers to patient safety include the nurse being less alert,
having slower reactions, and making medication errors; causing
higher incidence of institutional infections and bed sores. The
last two are no longer reimbursable because they are acquired in
hospital.
1:41:17 PM
The Institute of Medicine (IOM) estimates that about 100,000
hospital deaths can be attributed to medical errors each year,
and mandatory overtime is a seriously contributing factor. The
final recommendation of the IOM is that all overtime, voluntary,
mandatory and involuntary done by nurses should be curtailed.
They are working on what to allow the Interns and the Residents
in Medicine to work as their shifts.
MS. THOMSON said this is not a bargaining issue, but a public
and patient safety issue. The Alaska public has a right to
expect that the nurse taking care of them is properly rested and
alert and that she hasn't been working 16 hours that day
already. Patients should not have to worry about staff working
conditions when they register at a hospital. Many nurses in the
state are not represented by unions; Fairbanks and Mat-Su Valley
nurses are to areas. Washington State passed its no mandatory
overtime law in 2002.
She state that many health care facilities use mandatory
overtime to fill staff shortages. One reason for shortages is
that nurses are leaving the field because of poor working
conditions. One of the reasons that the nursing shortage is as
it is today is because qualified nurses are not working in the
field or they are leaving the profession because they can no
longer work the long hours or safely take care of their
patients. A University of Massachusetts study shows a strong
link between working overtime and work-related injury. This was
found to be true of all occupations and working longer than 12
hours a day was associated with a 30 percent increase in that
risk. She provided a list of states which have already passed or
banned forced overtime.
1:47:36 PM
ROD BETIT, CEO, Alaska State Hospital and Nursing Home
Association (ASHNHA), opposed SB 12. He said ASHNHA represents
27 private, federal, state and tribal health care facilities
located throughout Alaska and his testimony has been approved by
their general membership. He said that the sponsor of SB 12,
Senator Davis, is well respected by ASHNHA's members for her
commitment to improving health care access and quality in
Alaska. They share her goals for increasing eligibility levels
for Denali Kid Care to at least 200 percent of the federal
poverty level and to have the Alaska Health Care Commission to
address Alaska's health care issues. However, they do not
believe that SB 12 is needed to assure continued delivery of
excellent patient care throughout the state. ASHNHA has a strong
a commitment to respect the individual importance of each nurse
in their health care delivery mission and to treat each nurse
fairly in the work place. Their annual nurse overtime survey
demonstrates their commitment is being met.
MR. BETIT said that ASHNHA conducted a facility survey on
mandatory overtime for the last four years to gain a better
understanding of the frequency with which mandatory overtime is
used by member facilities. In this context "mandatory" is
overtime that is not willingly worked by a nurse and does not
include on call overtime hours. It indicated that the number of
mandatory overtime hours incurred are minimal and only happens
at a few facilities, mostly at the state operated Alaska
Psychiatric Institute - and that is down substantially from
2006. They do not have the kind of abuse in mandatory overtime
that led to the State of Washington's legislation.
1:50:01 PM
He asks his members every year how the individual facilities
view the nursing shortage. This time around, eight of the
facilities reported that the situation was about the same, nine
reported that they thought the nursing shortage was worse and
three thought it had improved. The next column showed the kinds
of shifts that are worked in each facility - anywhere from 7.5
hours in the state facilities up to 16 in a psychiatric
facility. Nurse vacancy rates for 2007/8 were fairly close at
10-12 percent on average across the state, although some
facilities were significantly higher like Mt. Edgecumbe that in
2007 reported 25 percent (although they are now down to 12
percent). Providence Valdez reported a 22 percent vacancy rate.
The yellow column showed the number of reported mandatory
overtime hours throughout the year and that number was coming
down; there were four in 2008 that reported some mandatory
overtime being assigned. Most of that was at API. The next two
columns dealt with on call nurses and these nurses are usually
used in specific units that require highly technical skill. The
blue column indicated the number of temporary nursing hours that
member facilities purchase per year in order to not resort to
mandatory overtime to fill their schedules; in 2007 it was
nearly quarter million hours. This year, with Fairbanks not
reporting yet, there are 200,000 hours. The final column shows
the number of grievances, but none have come forward.
MR. BETIT said that ASHNHA member facilities have taken a number
of steps over the years to minimize the need to use mandatory
overtime to fill gaps in nursing shifts. Some examples include
financially contributing to the University of Alaska nursing
program expansion from 100 to 200 nurses each year, creating
clinical experiences for students nurses and recently graduated
nurses to gain hands-on nursing experience required to complete
their education or to achieve the patient care experiences
necessary to become employed in the hospital or nursing home
setting, providing distance learning opportunities so local
residents can take nursing course in their own community with
minimal need to spend large amounts of time out of town to
achieve their clinical experiences (very successful in several
communities), and purchasing tens of thousands of hours of
temporary nursing staff. Even so, approximately half the
facilities reporting on this year's survey believe that the
nursing shortage situation has worsened.
1:55:01 PM
He recapped their concerns with the bill: the data doesn't show
that that hospitals and nursing homes are relying on mandatory
overtime to fill staffing gaps. On the contrary it shows its
usage is rare. Second, ASHNHA believes that working hours and
scheduling are appropriately a local employer responsibility to
negotiate with its employees. He said that workforce challenges
vary for community to community, so a single approach is
unworkable. He said a number of facilities are either in
negotiations with nursing staff currently or will begin them
shortly and they should be given an opportunity to address any
concerns rising from the nursing staff.
1:55:51 PM
MR. BETIT said it is important to have flexibility to be able to
bring a nurse in when a procedure happens, but isn't scheduled,
and the right personnel have to be there to make sure it is done
correctly. Ongoing monitoring systems operated by federal, state
or independent private agencies in Alaska show Alaska health
care quality is excellent and none have identified mandatory
overtime as a problem related to delivery of excellent patient
care, he said.
1:56:58 PM
ASHNHA members have contributed funding to support a nursing
program and are graduating a lot of nurses but they aren't
enough and they are not getting into some of the rural
communities where they are desperately needed.
Finally, he said, the bill would impose a new reporting burden
for facilities that would have to be filed semi-annually and
contain detailed work hour information for each staff nurse
employed by the facility as well as each contract nurse.
1:57:54 PM
SENATOR PASKVAN said it appears that only two facilities allow
shifts beyond 14 hours (SB 12), Alaska Pioneer Homes and
Northstar Behavioral Health System. All others appear to use
fewer.
MR. BETIT said that is correct; when his facilities go beyond
the 12 or 14 hour shift, it is only for an hour or two, and an
on call situation can be very different.
1:59:24 PM
SENATOR PASKVAN said asked what definition of "mandatory" the
sponsor is using.
MR. BETIT said that is a fair question, because that has been
one of the issues in a lot of testimony over the last few years.
In their context and that of this legislation, if a nurse is
working willingly or following a prescribed on-call schedule, it
is not mandatory.
2:00:54 PM
RON ADLER, CEO, Alaska Psychiatric Institute (API), said he was
available for questions.
2:01:26 PM
MARIE ORIAH, Northstar Behavioral Services, said she wanted to
testify as nurse, mother and wife. She has voluntarily worked at
her 16-hour shift, and she needs the hours in this position,
because she is a mother of two and their primary care giver; she
also home-schools her son. Her husband works in the forest
industry and his hours have been cut back. So they are missing
one paycheck, but because she has a "Baylor" shift, she is able
to pull one extra night shift to supplement that lost income.
Many mothers and nurses like her would be placed in a bad
position financially. She asked the legislature to reconsider
keeping those Baylor positions.
2:04:27 PM
CHAIR DAVIS said she could amend the bill to include those
positions and they will discuss it at a later time.
2:05:06 PM
MARY STACKHOUSE, RN, said she started working in Ketchikan in
1987; she has been at Providence in Anchorage since 1988. During
her career she has worked shifts from 8 to 12 hours, and lots of
overtime, both voluntary and "not so voluntary" - meaning that
it wasn't written in the plan at the hospital that it would be
mandatory. She explained that there had been a coercion of sorts
with the idea always present that "there is nobody else to
replace you, think of your patients, think of your coworkers,
you must stay."
She said she has never thought of abandoning a patient and that
it is cause for loss of licensure; and it means that you have
left your patient at the end of your shift when you have not
reported off to someone else. The problem she sees with the idea
of mandatory overtime is that it is not the nurse's choice. She
does not have the ability to say she is too tired to do it.
2:07:52 PM
MS. STACKHOUSE said she takes her patients very seriously. In
the recent past they have had far more babies in their unit than
they had staffing for. Thanks to some of the new people who are
in the lead, they have been able to increase their staff; but
more nurses are needed. Their census still has big fluxes and
when it is high is when nurses are most at risk of not getting a
break or even lunch; they can't cover for each other because
there are too many babies. She said that it takes an incredible
amount of paying attention to new babies to recognize subtle
changes to make fine adjustments in medications and they are
being born as early as 22 weeks old. She explained if the nurse
is too tired or hasn't eaten, she may not be thinking clearly
and in critical care they have seconds to respond - with adults
it might be a few minutes. If you don't have enough staff and
the staff that you have is already exhausted, then you are
running the risk of some of their patients not making it through
a crisis.
Nurses are leaving the profession in droves. Women have a lot of
different choices these days, and are choosing not to place
themselves in the position of being responsible for others'
lives. That way they don't put their families at risk from
things they can bring home. On-call time is scheduled, but she
would not want to be the patient who is waiting for help when
the nurse is too tired to care for them. When her husband has
been a patient in the hospital she stays with him, because she
knows how short staffed they are and wants to be sure his needs
are met.
2:12:35 PM
Older nurses won't last forever, and the pool of younger nurses
is smaller and smaller. If they are mandated to work overtime,
they'll burn out faster. One of her flight attendants recently
said she had been a nurse for less than 10 years, but got out
because of the working conditions - and mandatory overtime is
one of the working conditions that scared her the most. Every
nurse will be there in a true emergency, but mandatory overtime
is not the way to deal with regular staffing issues.
2:14:59 PM
EVANGELINE "Angel" DOTOMAIN, President and CEO, Alaska Native
Health Board (ANHB), said they represent 24 regional and tribal
health organizations across state and approximately 7,000
employees. They have deep reservations with SB 12. It is the
experience of Tribal Health providers that nurses are highly
dedicated caring providers who will give their last ounce of
skill to care for their patients. ANHB expends a great deal of
effort and expense to recruit and retain good nurses to provide
care and cover all necessary shifts.
2:16:35 PM
They think SB 12 would hurt patient care especially in rural
Alaska where all it would take to leave a shift uncovered would
be for one or two nurses to decide for any reason or for no
reason at all that they do not want to work overtime. The rural
tribal health provider would in many cases have no choice but to
simply not cover that shift and put other patients at risk.
She explained that rural tribal health providers do not have the
urban luxuries of calling other off-duty nurses, getting
temporary agency nurses to cover a shift on short notice, or
redirecting patients to a nearby facility. In practice, SB 12
would make it impossible for them to cover all the shifts in
rural facilities. Perhaps this is why almost no rural state has
adopted similar legislation.
Also, SB 12 is an unfunded mandate that will unnecessarily drive
up costs, she said. Rural facilities are having enough trouble
staying open already and this will make it worse. SB 12 is
designed to solve urban problems and is not applicable to all
areas in the state. There are chronic issues with nursing
staffing, but they are no different from the challenges in other
medical areas. She said that Alaska Tribal Health providers are
not purposely understaffing as an abusive labor practice. The
reality is that to the degree they have nursing staffing
challenges, it is because of the tight national labor pool
compounded by the never-ending challenge of figuring out how to
get good nurses, doctors, technicians, administrators and others
to work and live in remote Alaska locations. SB 12 proponents
agree that there are few official overtime complaints by nurses
and that there are low numbers of complaints and benign exit
interviews.
She acknowledged that nursing is a difficult profession, but the
challenges come with the territory and all must schedule their
work to meet the needs of their patients - and - this issue can
be addressed differently. Because of the well-documented nurse
shortage in Alaska there is a very tight labor market for nurses
that gives them significant leverage in negotiating the terms
and conditions of their employment. She thanked the committee
and asked them to vote no.
2:21:26 PM
SENATOR PASKVAN asked if there was a rural exemption, what size
community should be exempt.
MS. DOTOMAIN replied that is difficult to say because if
something is put in place that makes recruitment easier in urban
Alaska, that makes it tougher on recruiting in rural facilities.
2:22:43 PM
CHAIR DAVIS suggested she get together with the Nurses
Association to work on possible language for this particular
bill.
2:23:22 PM
CINDY ALKAIER, Assistant Chief Nurse Executive, Providence
Health and Services Alaska, opposed SB 12. She said that most
Alaska hospitals have been successful at avoiding mandatory
scheduled overtime recognizing that nurses need rest between
their shifts. Providence has not scheduled mandatory overtime
within its facility.
Secondly, this bill does not appropriately address the on-call
situations currently present in their operating rooms, post
anesthesia care unit, cath lab, and dialysis unit. "On call" is
defined as being available within 30 minutes (when there is a
life threatening incident). The issue of on call is not easy to
solve since hospitals provide 24 hour emergency services. Nurses
work in their OR cath lab which deals with removing clots when
there are strokes, acute MIs and caring for babies with cardiac
defects.
2:25:16 PM
Dialysis also has emergency situations after normal operating
hours when someone has overdosed on drugs or has a life
threatening need for dialysis. It takes specialized training and
experience to function in those specialized areas; requiring
training for sometimes as much as two years. Routine procedures
are scheduled during regular hours, but if an emergency occurs
after hours they have to be able to call trained people in.
This bill treats on call the same as any other work. If a nurse
has just worked a shift and is on call on the same day she could
easily go over 80 hours in 4 days. Some nurses choose to take
their on call on the days they are scheduled to work so it
doesn't interfere with their regular scheduled days off. This
legislation would impact their ability to manage their own
schedule and their own time off. Requiring an on-call staff
person to fulfill their on-call obligation as mandatory overtime
will adversely impact the ability of hospitals to provide
emergency surgery, heart caths and emergency dialysis.
2:28:29 PM
MS. ALKAIER said one of the complications of feeding a premature
baby is the possibility of obstruction of the bowel and if that
isn't operated on immediately, the baby will die. If they cannot
get someone on call to come in, the family will be told they
can't treat their patient. This could happen in any emergency,
so they need the flexibility to bring staff in to care for those
emergent situations.
Hospitals have safeguards in place to ensure good quality care
and have detailed inspections by the federal government, the
State Department of Public Health and private accrediting
agencies such as joint commissions. Quality performance
improvement, staffing competencies and patient satisfaction are
monitored continuously. To maintain accreditation, hospitals are
required to measure patient acuity and care requirements and
provide adequate hours of nursing care to meet those
requirements. In addition, their hospital's ability to maintain
the confidence of the community determines their future success.
Providence believes if there are problems with mandatory
overtime at their facilities it should be handled during
collective bargaining.
2:31:27 PM
Providence is scheduled to begin union negotiations this month
and mandatory overtime and on call will be part of that. She
asked them to allow them to deal with these problems then.
2:31:58 PM
CHAIR DAVIS said she understood they'd started negotiations in
January or February.
MS. ALKAIER replied no; their first meeting will be March 19.
CHAIR DAVIS encouraged them to take these issues up with nurses
at the bargaining table. She said she didn't believe any nurse
would not stay to do what needs to be done in an emergency; but
if emergencies are ongoing, that is a workload, not an
emergency, and it does cause a hazard.
MS. ALKAIER said the on call work she refers to has to do with
the emergencies that come up in the middle of the night. Regular
staff don't know how to deal with some of those emergencies and
they have to call in a special team. If they lose on call staff,
those teams may not even answer the phone. They need to have
those on call people available in the cases of those
emergencies.
2:34:48 PM
SENATOR PASKVAN said hospitals are in the business of providing
care in emergencies; so he wanted to know how routine
emergencies are. Does it happen weekly? If it's weekly, then
it's routine.
2:35:29 PM
MS. ALKAIER explained that some emergencies, like a ruptured
intestine in a baby, only happen about twice a year, but if one
person is lost because they can't get the care they need when
that happens, then it's unacceptable. Other things come up more
frequently like a ruptured appendectomy, but an OR team can
handle that. It's only when a second crisis comes up at the same
that no one is there.
She repeated when specialized people are needed, they can't just
bring any nurse in. The on-call people are in specialized teams.
It's only when someone comes in at night with a heart attack
that was unexpected who needs to have that surgery right then or
they are going to die - that the team has to be called in. Only
a handful of nurses know how to do those kinds of procedures.
2:37:42 PM
MARILYN EDWARDS, Operating Room (OR) Clinical Manager,
Providence Alaska Medical Center, said it would be devastating
to enact a "one size" solution in to state law to solve a
mandatory nurse overtime concern that does not exist at the
Providence operating room. Her immediate concerns revolve around
safe quality patient outcomes and a safe work environment for
her OR staff.
MS. EDWARDS said the OR nurses pride themselves on providing
optimum work life balance care while taking good care of their
patients. The OR is fully staffed and less than half of her
nurses work full time. She has 48 OR registered nurses; this
includes 2 educators, 1 RN traveler, 16 specialty clinical
nurses, and 1 registered dialysis nurse. Eight of these 48
nurses work 12-hour shifts, 4 of these 12-hour shifts were added
in the past year at the request of these 4 RNs. Seven nurses
work 10-hour shifts and 33 work 8-hour shifts. She said that 22
RNs work a 1.0 fulltime equivalent position, 9 RNs work at .9
fulltime equivalent, 4 RNs work a .8, 2 RNs work a .6. They
have 10 registry RNs who are required to work 3 shifts per month
and a minimal on call.
She explained that a 1.0 fulltime employee working 6:46 a.m. to
3:15 p.m. Monday through Friday has an average of one evening
call, one night call and two weekend shifts, either as scheduled
shifts or call per four-week period. A 12-hour RN, a .9 fulltime
usually has night or weekend call. Much of this call is assigned
around the individual RN's request because they may want the
call scheduled when they are also scheduled to work to allow
them to have consecutive days and nights off at a time to spend
with their families.
MS. EDWARDS said she has 2 RN team leaders that volunteer to
take second night call more often. One team leader averages 7 to
9 orthopedic call shifts per month; the one heart team leader
voluntarily averages 14 to 17 shifts or more per month.
During the interview process for a new position in the OR, all
OR staff candidates are advised of the call requirements. The
assigned call coverage is necessary to provide rapid (30 minutes
from notification) response for emergent patient care above what
they are routinely staffed for based on volume trends of
operation.
2:41:26 PM
She has read and heard of anecdotal stories of nurses being
tired and unable to provide quality safe care to patients. While
this is true at some facilities, Providence provides time off to
be with sick or dying relatives and did that with one of their
cardiac nurses; others covered her shift while traveling nurses
interviewed for a fill in. If their OR nurses had not been
allowed to cover the call shifts due to already meeting their
call and work requirements as set out by SB 12, they could not
have accepted heart patients while that nurse was gone. The
patient would have to be diverted; this means a facility doesn't
have staff for a procedure. If all three facilities in Anchorage
go on divert, actually no one is on divert. Someone needs to
care for that patient.
2:43:17 PM
NANCY DAVIS, RN, President, Alaska Nurses Association, said she
works now as a hospice nurse and has worked as a public health
nurse. She was chief of Public Health Nursing for the state; so
she is familiar with nurse issues across Alaska. She supported
SB 12. "It is a patient safety issue." She said that this state
deserves assurance that all nurses will be rested and capable of
taking care of their patients. She didn't think any nurse wanted
less than to provide the best possible care for her paitent; but
sometimes it is difficult to do that.
MS. DAVIS said, however, there are times when health care
pressures and health care facility pressures create an extra
burden and this is why the mandatory overtime prohibition is
important. She feels the bill has adequate safeguards to deal
with unforeseen emergency circumstances, and the midnight
surgeries and car accidents would fall under that category. All
nurses would rise to that occasion. Those emergencies should not
be the standard plan of staffing for dealing with shortages,
though.
She said the bulk of the ANHSHA's data comes from discussions
with administrators, not staff-level nurses. The Alaska Nurses
Association did a survey last spring speaking with nurses across
the state, and they found that nurses are routinely asked to
work overtime without sufficient rest between shifts. "It's
really an issue for patient safety."
As for being a bargaining issue, Ms. Davis said, not all nurses
work under collective bargaining unit, and one union they talked
to declined to make it an issue because they said the
legislature would take care of it. "Someone needs to take care
of this and I believe SB 12 is a good answer."
MS. DAVIS also remarked that one of the nurses commented on the
impact of the economy and how the overtime is necessary for her
to provide for her family. But Ms. Davis said she fears that the
economic pressures are going to increase the likelihood of
mandatory overtime as people lose their jobs and nurses seek to
try to cover the economic needs of their families and perhaps
ask for additional overtime in order to make ends meet. SB 12 is
the best assurance for patient safety regardless of what her
personal needs might be as a nurse for her own economic welfare.
She believed that a standard statewide approach to defining
maximum work hours and minimum rest period is the best way to do
it.
2:49:13 PM
CHRISTY ORTUSO, RN, Director, Neurosciences, Providence Alaska
Medical Center, said she is also a Board of Directors Member of
the American Association of Critical Care Nurses Certification
Corporation, the largest specialty nursing certification
corporation in the country. They have pioneered healthy work
environments and looking at the nurses' role in maintaining them
over several years.
Anecdotally she related how she chose to work overtime to be
able to buy a house and how she was concerned about language in
SB 12 that would limit her choice to working certain hours. She
has been in Alaska less than three years; before that she worked
in hospitals where mandatory overtime was used to staff the
units in one of the worst nursing shortage experienced in the
past two decades, and she was never mandated to work because she
chose to work. The nurses she has known over the years have
valued that flexibility as one of the driving reasons for
staying in nursing. Her experience in Alaska is that hospitals
are very well staffed when she compares it to her 26 years of
experience in the Northeast.
MS. DAVIS said she is currently on faculty at two universities,
UAA and the University of Phoenix, and she has contacts with
nurses across the United States and one concept comes out
clearly in her classrooms - nurses need for autonomy and making
their own choices. Everything she reads about Alaska indicates
that mandatory overtime is not a great problem here; small
instances of it can be resolved by developing healthier work
environments and allowing nurses to rise to the professional
standard they have wanted to work in throughout the years.
2:54:56 PM
STACY ALLEN, RN, Business Agent, Laborers Local 341, said she
represents about 265 nurses at Alaska Regional Hospital,
supported SB 12. No one has mentioned the conflict that nurses
feel between their ethical, moral and legal responsibilities as
a patient advocate and their personal need to not work more than
is safe for themselves or the public.
She recalled from nursing school how nurses is uniquely placed
to be the patient's advocate, and the public has come to expect
a high degree of care ethically and physically. More studies are
coming out talking about things that keep nurses from the
profession or keep them from hospital nursing; one is the stress
some feels in knowing they are not safe to work, but there is no
one else to replace you or the person being called in to replace
you is just as tired as you are. SB 12 levels the playing field
not for just the individual nurse, but for the institutions
themselves. It sets a minimum standard that the public has a
right to expect in health care.
2:57:29 PM
ROGER LEVRENTZ, RN, Clinical Nurse Educator, Heart Center,
Providence Health Care Center, said he is responsible for staff
in the cath lab, the observation unit and their cardiovascular
intervention unit. He said the cath lab is a highly specialized
area where people having strokes, heart attacks and other life
threatening problems receive care. Staff consists of RNs,
cardiovascular technologists and radiology technologists; they
all have extensive specialized training. They care for patients
of every age from neo-natal to over 100 years old. It is not
unusual for them to be called in at 2 a.m. and the restrictions
SB 12 would impose would negatively impact their ability to
provide care for the patient population due to the
unavailability of trained staff.
CHAIR DAVIS announced that she would bring SB 12 back at a later
date.
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