Legislature(2007 - 2008)BELTZ 211
04/26/2007 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| SB140 | |
| SB102 | |
| SB28 | |
| SB118 | |
| HB121 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 118 | TELECONFERENCED | |
| + | HB 121 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 140 | TELECONFERENCED | |
| += | SB 102 | TELECONFERENCED | |
| += | SB 28 | TELECONFERENCED | |
SB 28-LIMIT OVERTIME FOR REGISTERED NURSES
1:58:11 PM
CHAIR ELLIS announced SB 28 to be up for consideration.
THOMAS OBERMEYER, staff to Senator Davis, said this bill was
introduced because there is a shortage of 330,000 to 500,000
nurses in the country; they are being overworked and being asked
to work mandatory overtime. Many states and the U.S. Congress
are enacting legislation to try to control mandatory overtime.
These are hours that are typically worked on demand when no
other nurses are available. It has been determined that nurses
have about three times as many errors after working for 12 hours
putting patients safety at risk.
MR. OBERMEYER said CSSB 28(L&C), version L, essentially didn't
make any substantive changes other than to change 12 consecutive
hours off-duty to 10. He said the sanctions in this bill are
fairly minimal compared to other states. This is not to be a
money issue against the providers; but to provide some relief to
the nurses who have been experiencing increasing difficult in
work schedules - that has also resulted in fewer people applying
to go to nursing schools.
He said that nurses are reluctant to come forward out of fear of
reprisals that can be very subtle. This bill provides
enforcement against reprisals and a reporting provision that
requires the providers to list by individual - not by name but
perhaps by i.d. number - the hours worked. He explained that
this is significant because most providers would rather lump all
the mandatory overtime hours available together and one couldn't
determine which units are truly putting people at risk.
2:03:26 PM
SENATOR STEVENS asked if nurses will be able to continue to work
overtime voluntarily.
MR. OBERMEYER replied that voluntary overtime has not been an
issue. However, some nurses in critical care units are required
to take an extra shift because there just aren't enough nurses
in that area. Even their supervisors are busy with other
administrative functions and can't relieve them for lunches or
breaks.
SENATOR STEVENS asked how the bill protects nurses from being
forced to agree to work.
MR. OBERMEYER replied the bill provides for an anonymous
reporting procedure and hopefully the facility would recognize a
problem and hire more people.
2:05:49 PM
DIANNE O'CONNELL, Executive Director, Alaska Nurses Association
(ANA), said this is its top legislative priority. She said ANA
has about 1000 members and represent 4000 to 5000 more nurses in
the state. She said that SB 28 attempts to address the dangers
of mandatory overtime - the biggest dangers being fatigue and
errors. She said they are referring to this as the Alaska Safe
Nursing and Patient Care Act.
MS. O'CONNELL said a number of studies, two especially, indicate
long hours pose some of the most serious threats to patient
safety that they know. Prolonged periods of wakefulness can
produce affects that are similar to effects of alcohol
intoxication - decreases in reaction time and the speed of
mental processes. Periods of wakefulness in excess of 16 hours
can produce performance detriments equivalent to the blood
alcohol of .05 percent.
The studies showed the likelihood of making an error increased
with longer work hours and was three times higher when nurses
worked shifts lasting 12.5 hours or more and working overtime
increased the odds of making at least one error including being
less alert to patients' changes, slower reaction times, and
medication errors.
MS. O'CONNELL emphasized this is not a bargaining issue; it is a
public safety issue. The public needs to know the nurse is
properly rested and alert and a person who is registering in a
hospital should not have to request a copy of the most recent
collective bargaining agreement to see how successful
negotiations on reasonable working conditions have been.
2:09:51 PM
She said that a lobbyist for Washington State Nursing
Association (WSNA) said that Washington State passed a law in
2002 to prohibit mandatory overtime for nurses with the
cooperation of the Washington State Nurses Association, other
nursing unions and the Washington Hospital Association. MS.
O'CONNELL said the goal of this legislation is first to protect
the safety and quality of patient care.
The Institute of Medicine Report estimates 44,000 to 98,000
hospital deaths can be attributed to medical errors each year.
Mandatory overtime is a serious contributing factor to medical
errors. The report's final recommendation was that all overtime,
voluntarily and involuntarily, should be curtailed.
She showed them a slide indicating that 11 states have already
banned or limited mandatory overtime. Fifteen states are lining
up to do the same. She concluded saying it's good public policy
and would help recruit more nurses.
2:13:16 PM
ROD BEATTIE, President, Alaska State Hospital and Nursing Home
Association (ASHNHA), said there are 37 facilities in the state
that belong to the association. He did not believe the bill was
necessary saying:
We're equally concerned about patient care and about
the fair treatment of nurses and each of our
facilities have policies that address that. We believe
that those goals are being met currently and that this
legislation would not improve on that situation.
2:14:30 PM
He said that a number of federal and state organizations inspect
his facilities continuously and those all produce good reports
and don't point to any problem with respect to nurse staffing
and patient care. Also, he said there is a complaint
investigation process through the Department of Health if
someone believes they haven't gotten good care. However, he has
seen no nursing issues come forward.
He reported that each of ASHNHA's members participate in both
mandatory and optional reporting arrangements on quality
indicators at the federal level. Alaska's facilities do very
well in all of those areas and report at or above the national
average among other facilities. The Department of Health can
accept complaints about care.
2:15:53 PM
MR. BEATTIE said he did a survey to see where his facilities
used mandatory overtime and it clearly showed they aren't using
it. He said shortages and gaps are being filled with temporary
nursing staff and the state's bigger facilities negotiate
nursing hours in collective bargaining agreements. He has been
told there are no issues that aren't agreeably worked through
between nursing and management and that overtime is spelled out
in those agreements. Most facilities allow 8, 10 and 12 hour
shifts to meet the needs of their nursing staff.
He reported that he reviewed the facility personnel records and
couldn't find any grievances filed by nurses around use of
overtime. Additionally, the Department of Labor and Workforce
Development confirmed that it hadn't received any formal wage
complaints in the last 10 years. He believed the real issue here
is the ongoing shortage of nurses to fill critical positions in
health care settings. ASHNHA has done what I can to address that
on an individual nursing level as responsibly as one could
expect. It has also contributed funds to the University of
Alaska Nursing Program that is now graduating 200 nurses per
year instead of 100.
MR. BEATTIE said it would be more helpful if the legislature
focused on closing the nursing shortage gap faster for the years
ahead.
CHAIR ELLIS said he was interested in actual documentation of
this being an actual problem as opposed to a speculative or an
anticipated problem - whether it's in private or public
facilities - which facilities are using mandatory overtime and
which ones aren't.
2:19:16 PM
MARY STACKHOUSE, Newborn Intensive Care Unit, Providence Alaska
Medical Center, said she is the founding president of Providence
Registered Nurses Union and has been a nurse for 33 years,
mostly in critical care. During this time she has seen different
ways mandatory overtime is used and the biggest time it comes
into effect is when a facility is short staffed. She explained
that mandatory on-call is mandatory overtime and Providence has
that in its operating room.
The problem with instituting more mandatory overtime is that
there is already a nursing shortage in general. When people call
in sick because they work themselves to death there is even more
shortage. When you have a bigger assignment, worse acuities,
that's the time when you're not getting a break because staff is
already short so even the charge nurse can't relieve you for a
break. So, you end up working longer with no breaks and then at
the end of the shift you're still trying to pick up the pieces
of your shift and if mandatory time is allowed and there is a
sick call you are mandated to stay. You don't have the chance to
say you are tired.
She explained how in her unit some babies need to be rescued
immediately. Within the last six months she had to rescue one
after she had been working 13 hours with one 10-minute break.
She said this unit has had almost 50 babies routinely for the
last six months and no one had planned for the nursing shortage.
She warned that next time someone they love could be at risk
because their nurse has been worked to death. No one wants to be
recruited by a facility that has mandatory overtime. Nursing is
already a hard profession on family life and dangerous because a
nurse can bring home diseases from the hospital.
2:24:58 PM
MS. STACKHOUSE related that she works with a mandatory call and
the director of her unit took her aside at their last
negotiation and said that they were going for mandatory overtime
because it was the only way to make everyone work the overtime
hours that are needed equitably. As a result, she said, nurses
gave up wages and benefits at the bargaining table in order to
keep mandatory overtime out of the contract.
SENATOR STEVENS asked if she sees a problem with using
"voluntary" and "mandatory" in the bill.
MS. STACKHOUSE replied that "voluntary" allows her to make the
decision of whether she is too tired to continue working or not.
2:27:02 PM
CHAIR ELLIS noted a number of amendments that would be
considered at a future meeting.
2:27:16 PM
LAURIE HERMAN, Regional Director, Government Affairs, Providence
Health System, opposed CSSB 102(L&C) saying the energy should be
focused on getting more experienced nurses. She said Providence
is forbidden from using mandatory overtime in its contract
language and has a healthy working relationship with its nurses
and their leaders. Its nurse retention rate is 85 to 90 percent
and its vacancy rate is 7.5 percent - compared to 10 to 12
percent nationally.
2:28:31 PM
MS. HERMAN stated: "I can promise you that if any nurse at
Providence went to their supervisor and said I'm too tired to
work anymore, they would be told to go home and get some rest."
2:28:56 PM
She was told by her head of human resources that in the not too
distant past, straight eight-hour shifts a day were put on the
bargaining table and that was rejected.
2:29:23 PM
CAROL WIGMAN, RN, Alaska Psychiatric Institute (API), Department
of Health and Social Services (DHSS), said nurses that work at
API are subject to mandatory overtime. She has been mandated so
many times that she has lost count and she has even been asked
to work mandatory overtime two consecutive days in a row. During
these times she has administered medications for more than 20 to
30 patients. She stated that numerous medication, transcriptions
and judgment errors are caused by this practice which is used to
make up for the understaffing of hospitals. If she refuses to
work a mandatory overtime, she will be subject to disciplinary
actions or the loss of her job.
Mandatory overtime also causes stress on her family of two young
children and a husband. Personally she would not want a nurse
who has been forced to work a 16 shift to give her or her family
medication or making critical nursing decisions. She added that
a nurse who works a 16-hour shift is tired during that shift,
but she is also tired at work the next day. This bill is crucial
to patient safety.
2:31:13 PM
RON ADLER, Director, Alaska Psychiatric Institute (API),
Department of Health and Social Services (DHSS), stated that API
does use mandatory overtime and they tell perspective employees
what the consequences of that are. They also have a nursing desk
procedure which allows nurses to opt out of mandatory overtime.
If a nurse came to the nursing shift supervisor and said she was
too tired to go on, she would absolutely be relieved. Having
said this, he emphasized there has been significant improvement
in API's mandatory overtime after the last nursing salary
adjustment in July.
2:32:38 PM
MR. ADLER said it was also important to understand that API has
to take certain kinds of patients on involuntary civil
commitment and doesn't have the ability to triage them to other
hospitals. As a result those are the times it cannot fall under
minimum staffing.
2:33:01 PM
PAT HIGGENS, North Star Hospital, said it has no mandatory
overtime. They would expect any nurse or employee who felt
impaired for any reason to get relieved.
2:33:59 PM
PATTIE ARTHUR, LPN, North Star Hospital, said she is testifying
on behalf of six nurses that work under the original Baylor's
plan and CSSB 102(L&C) would affect all of them. They work every
single weekend - Saturdays and Sundays only - for 16 hours each
day for a total of 32 hours of actual patient care, but they get
paid for 40 hours. She stated emphatically:
This is a conscientious choice that myself and the
other five nurses have made when we signed our
contract to North Star Hospital to work weekends only.
For this we receive vacation time, emergency time off
and benefits like insurance and 401K plans.
She said that working this schedule allows her to go to UAA full
time to work on completing its RN program. If this bill passes,
she would have to seek employment at another facility that
offers another Baylor schedule. Some of them have been working
these 16-hour shifts for over 4 years with no regrets. These
hours suit their needs and lifestyles today and will tomorrow.
She related how Alaska has difficulty in filling its nursing
positions anyhow and the nurses who graduate from UAA mostly
leave the state. She suggested adding a (7) to section
18.20.400(c) that would exclude all Baylor plans.
CHAIR ELLIS said that was an important issue he would consider.
2:37:36 PM
JOHN BRINGHURST, CEO, Petersburg Medical Center, said he is also
chairman of the Alaska State Hospital Association. Since Mr.
Beattie already spoke on behalf of ASHA, he spoke wearing his
hat as CEO in a small hospital in Alaska. He said the volumes of
Medicare regulations covering hospitals are now so voluminous
that the regulatory bodies enforcing them are often unable to
answer his questions.
A study commissioned by the American Hospital Association found
that America's nurses are so overloaded with paperwork that on
average for every hour spent in direct patient care, home health
nurses spend 48 minutes on paper work, skilled nurses spend 30
minutes on paperwork, acute care nurses spend 36 minutes on
paperwork and emergency room nurses spend an additional hour.
What began as appropriate and necessary record-keeping has been
expanded upon by one regulatory measure after another. This
represents an overall loss of productivity of 42 percent. SB 28
is unnecessary, he said; it is using a sledgehammer to squash a
gnat as a State Hospital Association study found that only one
facility in the state uses mandatory overtime.
MR. BRINGHURST said smaller hospitals such as his staff at
minimum levels all the time and they do not have a large "float
pool" of nurses to draw from. Although he has never had to use
mandatory overtime to staff his facility, should the need arise,
he could be forced to staff a unit at less than minimums under
SB 28. They would have to choose to violate the law or
jeopardize patient safety. Also, he said without mandatory call,
small hospitals would be forced to close their doors, because
they cannot operate without it.
MR. BRINGHURST said Petersburg Medical Center would not take
lightly the necessity at times to ask a nurse to work additional
hours following a 12-hour shift. They fill their nursing
vacancies with traveling nurses, not with overtime, and exhaust
all other options before asking for back-to-back shifts. He said
he uses 12-hour shifts at the request of his nursing staff and
that has led them to voluntary cooperation with filling
emergency situations when overtime is necessary.
2:41:44 PM
CHAIR ELLIS said SB 28 has generated a lot of interest and will
be back before the committee.
| Document Name | Date/Time | Subjects |
|---|