Legislature(2003 - 2004)
04/10/2003 03:05 PM House HES
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
April 10, 2003
3:05 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Carl Gatto, Vice Chair
Representative John Coghill
Representative Paul Seaton
Representative Kelly Wolf
Representative Sharon Cissna
MEMBERS ABSENT
Representative Mary Kapsner
COMMITTEE CALENDAR
HOUSE BILL NO. 211
"An Act relating to a student loan repayment program for nurses,
and amending the duties of the Board of Nursing that relate to
this program; and providing for an effective date."
- MOVED CSHB 211(HES) OUT OF COMMITTEE
REPORT ON STATE HEALTH POLICY MEETING IN CHICAGO
- SCHEDULED BUT NOT HEARD
PREVIOUS ACTION
BILL: HB 211
SHORT TITLE:NURSE EDUC LOAN REPAYMENT PROGRAM
SPONSOR(S): REPRESENTATIVE(S)WILSON
Jrn-Date Jrn-Page Action
03/24/03 0618 (H) READ THE FIRST TIME -
REFERRALS
03/24/03 0618 (H) HES, FIN
03/31/03 0722 (H) COSPONSOR(S): GARA
04/08/03 (H) HES AT 3:00 PM CAPITOL 106
04/08/03 (H) -- Meeting Canceled --
04/10/03 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
DIANE BARRANS, Executive Director
Alaska Commission on Postsecondary Education
Department of Education and Early Development
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 211, and answer
questions from the members.
CAMILLE SOLEIL, Executive Director
Alaska Nurses Association (ANA)
Anchorage, Alaska
POSITION STATEMENT: Testified via teleconference in support of
HB 211.
RHONDA RICHTSMEIER, Deputy Chief
Nursing Section
Division of Public Health Nursing
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 211.
LARAINE DERR, President and Chief Executive Officer
Alaska State Hospital and Nursing Home Association
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 211 and answered
questions from the committee.
ACTION NARRATIVE
TAPE 03-33, SIDE A
Number 0001
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:05 p.m.
Representatives Wilson, Gatto, Seaton, and Cissna were present
at the call to order. Representatives Wolf and Coghill arrived
as the meeting was in progress. Representative Kapsner was
excused.
HB 211-NURSE EDUC LOAN REPAYMENT PROGRAM
CHAIR WILSON announced that the only order of business would be
HOUSE BILL NO. 211, "An Act relating to a student loan repayment
program for nurses, and amending the duties of the Board of
Nursing that relate to this program; and providing for an
effective date."
Number 0044
CHAIR WILSON moved to adopt CSHB 211, Version 23-LS0861\D, Ford,
dated 3/29/03, as the work draft. There being no objection
Version D was before the committees.
CHAIR WILSON turned the gavel over to Vice Chair Gatto.
Number 0105
VICE CHAIR GATTO asked if Chair Wilson would speak on Version D.
CHAIR PEGGY WILSON, sponsor of HB 211, explained the purpose of
the bill and answered questions from the members. She told the
committee she believes this is a very important bill for two
reason. First, she said because she is a nurse she feels very
close to the subject matter. Second, she told the committee the
state has a crisis in nursing because of the nursing shortage.
Right now there are 2,500 RNs [registered nurses] that live in
Alaska. However, because of the nursing shortage there are not
enough nurses residing in Alaska to provide for Alaska's
workforce needs. So there are many nurses who come up to Alaska
from the Lower 48 to work at great cost to the institutions.
Including the nonresident nurses working here, Alaska has an
11.5 percent employment vacancy rate. The number of RNs needed
to fill projected new jobs from industry growth in the next
seven years will exceed 4,100 nurses. Chair Wilson told the
committee that is very scary because that is almost double the
number in Alaska now. The rate for turnover of nurses is almost
24 percent. That indicates difficulties in retaining nurses.
Number 0198
CHAIR WILSON explained the reasons for nurse shortages in Alaska
and across the nation. She said the biggest reason is an aging
workforce, and all the baby boomers are getting ready to retire.
She said it is important to find ways to keep them working
longer if possible. Another reason for the nurse shortage is
that there are fewer individuals going into the nursing
profession. For many years, women could only go into three
professions. The choices were being a housewife, a nurse, or a
teacher. That has drastically changed in the last few years,
and there are a lot more options available for women. In order
to reduced health care costs across the nation, procedures are
being done on an outpatient basis, so hospital stays have been
shortened; however, the people that are admitted to the
hospitals are much sicker than they used to be. So not only do
the hospitals have sicker patients, but there are fewer nurses
to care for them. As a way to save money, hospitals are giving
nurses more duties and more patients. As a result, nurses do
not feel good about their work, are exhausted, and feel they
cannot do it any more. Overall, this practice has made a big
difference in job satisfaction for nurses. One of the single
most important criteria for nurses to be satisfied with their
working conditions is to have time to provide quality care to
patients.
Number 0398
CHAIR WILSON shared her personal experience when she first began
her career as a nurse. She said she had all the time in the
world to come into a patient's room, sit down, hold a patient's
hand, talk to him/her about the procedure, and help the patient
deal with the anxiety level, so they would be able to heal
better. In contrast, the last time she worked in nursing that
practice was nonexistent because she had many more patients, and
did not have an aide to help her. She said she had to do
everything, including scrubbing down the bed and the rest of the
room to be ready for the next patient. It is a lot harder.
This is similar to what has happened to teachers. Teachers used
to just teach.
Number 0454
CHAIR WILSON said if the 2008 projections holds true, RNs will
be the largest single health care occupation in this state, and
the seventh largest occupation in Alaska. This is going to be a
crisis shortly. It is nationwide and not just in Alaska.
Alaska [University of Alaska School of Nursing] can only turn
out 110 nurses per year. There is no way to keep up with the
demand. The university wants to double the number, but that is
only 220 nurses per year.
Number 0544
CHAIR WILSON explained some of the solutions. One option is to
try to bring more Native Alaskans into the profession. Another,
with this bill, is to offer loan reimbursements for nurses. In
order to get nurses to move to Alaska to work, there will have
to be an increase in salaries and that means money. She
commented that the committee knows what that means: the
industry will pull back and consolidate, but it will be
necessary to raise nurses' pay. Hopefully, that will entice
some nurses to come to Alaska. There will be some recruitment
programs aimed at grade school children, high school
development, pre-nursing preparation, and the development of
postgraduate RN training for high-needs areas like the operating
room and ICU [intensive care unit]. Another option in enticing
nurses to come to Alaska would be to encourage employers to
offer incentive bonuses or sign-on fees. In some areas in the
Lower 48 this is already going on. Providers need to be
responsive to the RN needs, for instance, prohibiting mandatory
overtime and lowering the 12-hour shifts to maybe 6-hour shifts.
Maybe the older nurses could share shifts.
Number 0648
CHAIR WILSON summarized her comments by saying that HB 211 will
hopefully serve as an incentive to attract new nurses to the
state and encourage Alaska nurses to pursue their vocation here
in Alaska. This bill provides that a nurse working and living
in Alaska will be offered the incentive of being reimbursed
$2,000 per year for every year worked up to five years, not to
exceed $10,000.
Number 0747
CHAIR SEATON asked for clarification on one point. According to
the bill, a nurse would have to have an outstanding loan. This
is not a payment for $2,000 per year for up to five years; it is
simply a reimbursement for an existing student loan. He asked
if that is correct.
CHAIR WILSON replied that is correct. In other words, a nurse
that has been in Alaska for 50 years cannot apply and get an
incentive payment. It must be an individual who has an
outstanding student loan. She said there are several criteria.
For example, the individual must be hired as a nurse in Alaska
on or after July 1, 2003; the individual must be employed as a
nurse during the loan repayment program; the individual must be
licensed to practice in Alaska and agree to fulfill any
requirements of the program and must have an outstanding loan.
REPRESENTATIVE SEATON said he is trying to figure out the
criteria in the program. For example, if a nurse has been
working here in Alaska for two years and has $18,000 in student
loans, she would have to quit or change jobs and go to another
employer to be eligible for this program. Is that the correct
interpretation of the program?
CHAIR WILSON responded that is correct. The purpose of the bill
is to encourage recruitment of new nurses to the state. She
said she hates the fact that the state cannot help those nurses
who are already here working as nurses.
Number 0808
REPRESENTATIVE SEATON asked Chair Wilson about interaction with
existing local programs. He said that the Homer Hospital offers
a local program as an incentive to nurses. Can this program be
used in conjunction with other programs?
CHAIR WILSON responded that there is no problem with a nurse
availing himself/herself of both programs. In fact, she said
she hopes that providers will be creative in enticing nurses to
come to Alaska.
Number 0866
VICE CHAIR GATTO asked, if a nurse comes to Alaska, collects the
reimbursement for three years, and then leaves, whether the
individual has to give the money back.
Number 0916
CHAIR WILSON replied that he/she does not have to give the money
back.
REPRESENTATIVE SEATON asked if this reimbursement could be used
for continuing education. For example, if a nurse comes to
Alaska and is hired now, and needs to get more classes to
upgrade credentials, can this program be used to offset a new
student loan or is it only a previous student loan?
Number 0953
DIANE BARRANS, Executive Director, Alaska Commission on
Postsecondary Education (ACPE), Department of Education and
Early Development, testified in support of CSHB 211, Version D
and answered questions from the members. She told the
committee, as she understands the bill, the education debt needs
to be pre-existing at the time the nurse is first hired in the
state. As the bill is currently constructed, if a
nurse/employee goes back to school to go from a LPN [licensed
practical nurse] to RN [registered nurse], that debt would not
be covered.
VICE CHAIR GATTO posed a situation in which a nurse comes to
Alaska with $6,000 in debt and after three years of employment
that debt is gone. The nurse decides to stay; the nurse does
not get $2,000 as a bonus. Is that correct?
MS. BARRANS replied that is correct. The construction of the
bill is such that the nurse would not even see the money. That
was the sponsor's intention in prorating the benefits. If a
year is served, a one-year benefit is paid; if two years are
served, the second year's benefit is paid. He/she does not
receive a full benefit unless the nurse works a full five years
in the state.
VICE CHAIR GATTO responded that this brings him back to the
original question. If a nurse only works three years, then the
person gets three years' worth of benefit. There is no penalty
for leaving employment or Alaska in less than five years.
Number 1052
MS. BARRANS agreed and added that there would not be any cash
coming to the nurse for working an additional two years, even
though the debt had been fully satisfied.
Number 1059
REPRESENTATIVE COGHILL asked if there will be a regulatory issue
involved in providing proof of employment.
MS. BARRANS said that is correct. There would have to be an
annual certification that whatever the service requirements are
have been met. Alaska Commission on Postsecondary Education
(ACPE) would look to the Board of Nursing to say what is a full-
time employee, and would set those criteria, and the employer
would have to certify that those criteria had been met.
REPRESENTATIVE COGHILL commented that these are always the areas
that legislators hear about because whenever there is a limit,
there is always someone who falls one hair's breadth under the
limit. That is something the committee needs to look at. He
said he would like to hear the sponsor's perspective on full-
time employment and what that definition is so that ACPE would
have something to build regulations from.
CHAIR WILSON replied that Section 7 allows the Board of Nursing
and ACPE to adopt necessary regulations immediately upon the
passage of the Act. So Ms. Barrans would work with the Board of
Nursing to come up with these regulations.
REPRESENTATIVE COGHILL explained that he is interested in having
a discussion on what the limits might be. For example, Chair
Wilson was talking about those who may have started a whole new
career, like he did at 48 years old. An individual may not want
to work 60 hours per week as in a previous career. What if
someone wants to only work a 20-hour workweek? It still
benefits the health care system and relieves tremendous tension
in the system, but the number of hours may not qualify for
reimbursement under this program.
Number 1192
MS. BARRANS responded that is correct. One of the concerns the
sponsor had in crafting the bill was to make sure the Board of
Nursing had the latitude, expertise, and knowledge to design the
criteria so that the state is getting the most efficient use of
these funds. There is concern that there probably never will be
a sufficient amount of money in the fund to fully satisfy all
the folks who would seek to participate in the program. Alaska
Commission on Postsecondary Education does not have the
expertise to say what a reasonable workday, workweek, or work
year would be for a nurse in Alaska. So ACPE would look to the
Board of Nursing to set those kinds of criteria.
Number 1225
REPRESENTATIVE COGHILL commented that the reason he is bringing
this issue up at all is that the Board of Nursing would have
something to fall back upon in terms of discussion by the
committee. He said his concern is that if there are
applications en masse, then there will be a difficult choice in
deciding who to eliminate, but if the state does not have that
many applications, those who want to work split shifts could be
allowed into the program. Recently, he was talking with
Representative Joule, who posed the question of someone working
at the Kotzebue Hospital for a while, who then goes home to
Selawik, and has a friend work in the hospital for two weeks.
This would not be full-time employment, but it might worthy of
consideration.
Number 1305
CAMILLE SOLEIL, Executive Director, Alaska Nurses Association
(ANA), testified via teleconference in support of HB 211. She
told the committee about the impending crisis with respect to
the nurse shortages. Currently, traveling and agency nurses
increase the cost of health care. When safety is called into
question, which is what the state is facing with a nursing
shortage, it is important to look for health care solutions. In
some cases, facilities look at people who are not RNs, which is
always dangerous because they do not have the training and
expertise to treat people. There are so many reasons to address
this issue. Ms. Soleil told the committee this piece of
legislation complements other pieces that are already in place.
One area the ANA is supporting is the University of Alaska's
efforts to double the number of nursing graduates by 2006, and
it has a $2.25-million commitment from the private sector, such
as Providence Health Systems, Alaska Regional Hospital, Yukon-
Kuskokwim Health Care Corporation, Fairbanks Memorial Hospital,
and the Alaska Native Tribal Health Consortium. She pointed out
that the school of nursing still needs $2 million in state
funds, which have yet to be appropriated.
Number 1399
MS. SOLEIL told the committee that HB 211 is very attractive to
the ANA because it does two things. First, it looks at loan
repayment, which is a definite enticement to nurses who are
looking at where to work. Nurses can go anywhere because there
is such good money offered and there is an incredible shortage.
Second, this loan repayment plan entices nurses to stay in the
state. Alaska Nurses Association goal is to have them practice
in Alaska for at least five years, and maybe in that time they
will have made a life here and will choose to stay. Ms. Soliel
commented that as the state faces a severe financial crisis, the
shortage of nurses will cause the cost of health care to rise
and the quality of services to decline. The ANA will be talking
with the Board of Nursing and will be providing any information
to assist them.
Number 1477
MS. SOLEIL said that both the House and Senate have been looking
at a method of prioritizing where the nursing shortages are the
greatest. Many remote villages should have nurses, but do not
because of their location and the payment that is available
there. This bill would help attract people to those areas. The
ANA has asked the Board of Nursing to look at this issue closely
as it develops the regulations related to this legislation. Ms.
Soleil summarized her comments by saying that the ANA is very
supportive of HB 211.
Number 1494
MS. BARRANS spoke on one area of concern that Representative
Coghill had on the bill. She said that as the bill is currently
constructed, she does not see a barrier to the Board of
Nursing's prioritizing tiers or alternative benefit structures
as long as the regulations do not violate the terms that are in
the bill. For instance, if a nurse that was working what the
board would categorize as part-time, the board could certainly
authorize the participation of that nurse in the program with a
pro rata benefit. The bill says that benefits can be paid out
over no less than five years, but could be longer in the case of
a part-time nurse, or no more than $10,000. That language
captures how much money and the minimum length of time the
repayment plan would cover for that amount of money, so if the
Board of Nursing wanted to have another alternative benefit
structure, Ms. Barrans said she does not see a barrier to
implementing that in the current bill.
Number 1550
VICE CHAIR GATTO asked if there is anything in the bill that
says this program can be canceled five years from now and that
if individuals have not collected, it will be too late.
CHAIR WILSON replied that there is a section in the bill that
says "providing that the funds are available," which should
cover Vice Chair Gatto's concern.
REPRESENTATIVE SEATON referred to the sponsor's statement where
it says that the funding for the program may be appropriated
from the Alaska Student Loan Corporation dividend. He asked for
clarification on that point.
MS. BARRANS said page 2, Section 5, inserts some language into
the portion of statute that directs the Alaska Student Loan
Corporation to return a dividend to the state. Currently, the
Alaska Student Loan Corporation, in any year that it has a net
income in an excess of a certain amount, calculates and pays a
return to the state from its income. In the current fiscal year
that amount was $5.25 million. The amount approved for FY 04 is
$5 million. So this [language] suggests that would be an
appropriate use of [those funds] without a mandate.
REPRESENTATIVE SEATON replied that essentially the legislature
does not have to fund this program. The amount in the fiscal
note is about $1 million. He asked if Ms. Barrans is saying
that these funds can be transferred from the Alaska Student Loan
Corporation directly to this fund, and it does not have to come
back to the legislature for appropriation.
MS. BARRANS responded that it means just the opposite. Once the
Alaska Student Loan Corporation has returned the money to the
state, the legislature will appropriate it to various projects
that they wish to fund. This program would be a line item in
every operating budget.
Number 1698
RHONDA RICHTSMEIER, Deputy Chief, Nursing Section, Division of
Public Health Nursing, Department of Health and Social Services,
testified in support of HB 211. She told the committee the
entire nation is suffering from the same nursing shortages that
Alaska is facing, which means it really puts the state in
competition with rest of the nation in enticing nurses to
Alaska. To some degree, the problem is also a result of the
demographic shift. The Alaskan senior population is expected to
triple by 2025. An increased aging population means an increase
in chronic disease and increased need for nursing services.
Alaska's nurses are also aging. She said that right now 71
percent of Alaskan nurses are between the ages of 41 and 71. In
the next five to ten years, one quarter of those nurses are
expected to retire. So the state is facing a problem of both
supply and demand.
MS. RICHTSMEIRER said this bill is intended to address the
critical problem of nurse recruitment and retention by providing
at least a small financial incentive to attract new people into
the profession, as well as keeping people in the profession
working. She told the committee that the nursing shortage
Alaska is facing is not just an abstraction of numbers or a
problem for those who need to find and employ nurses. More
important, it is a problem of access to health care, quality of
health care for those institutions that are providing it, and
cost of health care for all Alaskans. She summarized by saying
that the Department of Health and Social Services strongly
supports HB 211 and asks for the committee's approval.
Number 1817
LARAINE DERR, President and Chief Executive Officer, Alaska
State Hospital and Nursing Home Association (ASHNHA), testified
in support of HB 211 and answered questions from the committee.
She told the committee all the hospitals and nursing homes in
the state belong to the association. The hospitals really
employ the greatest number of nurses in the state. She said of
the top 15 categories identified by the Alaska Department of
Labor and Workforce Development as the fastest increasing
occupations, health care occupies 13 of those 15 positions. So
the need for health care workers is really expanding. She said
ASHNHA got interested in this issue about four years ago when
they saw the increasing crisis coming with regard to health care
shortage. Four years ago, ASHNHA had a summit where they talked
about it. On 9/11 [2001], the day the tragedy hit, there was a
nursing summit in Anchorage, and it was pertinent at that time.
There are many pieces of the puzzle and this is one. As the
committee has heard, the university is graduating 110 nurses per
year and will be increasing its program so it can graduate 220
nurses a year. Alaska needs to graduate 400 per year, so there
is a need for other programs to help.
MS. DERR talked about the fact that Alaskan health care
providers are paying "travelers" or visiting nurses. Alaska
State Hospital and Nursing Home Association just completed a
survey this week to show how much money is spent in this
practice. That study showed that $11 million is spent in the
state each year to pay travelers. That money goes outside. The
figure would be $14 million if radiologists were included.
Providence Hospital uses 17 radiologist technicians. Last year
at one point in time, Providence had 17 travelers in its
facility. She told the committee that is a horrible drain on
state resources. Alaska State Hospital and Nursing Home
Association had an inventory meeting last week, this week there
is an allied health care meeting, there is a health fair in
Anchorage today where most of the hospitals are involved in
trying to find health care workers, there are K-12 [kindergarten
through 12th grade] programs, and there are skills-standards
meetings in Bethel and Anchorage. There are many events
happening. Ms. Derr encouraged the committee to support this
bill and help recruit and retain nurses in Alaska.
Number 1945
REPRESENTATIVE SEATON referred to page 4 [lines 9-10] of the
bill, where it says, "the applicant has outstanding education
loans from a lending institution". He asked if that covers the
state [loan program].
VICE CHAIR GATTO responded that the state loan program is an
authorized lending institution.
Number 1966
REPRESENTATIVE CISSNA commented that ASHNHA is leading the
health providers in taking this issue on. She said she was
attending the nurses conference on 9/11 when the news came in
that there might be an incoming flight to Anchorage on that day.
The nurses had to leave the building; it was the most orderly
exit imaginable, and it was obvious that these people were
trained for emergencies. She congratulated the sponsor and
ASHNHA for the incredible work being done.
REPRESENTATIVE SEATON asked if traveling nurses are hired on a
time-on, time-off basis.
MS. DERR responded that traveling nurses are hired in a lot of
different ways. Some of them come to Alaska for two weeks or a
month. There is one person who has been in a position for three
years as a traveler because she gets more money that way. There
are psychiatrists who work six months on six months off.
REPRESENTATIVE SEATON commented that it would depend on the way
the board structures the regulations as to whether travelers
would be eligible for this program. He pointed out that there
is nothing in the bill that says a nurse must be a resident in
order to qualify for the program.
MS. DERR said that issue would be addressed by the Board of
Nursing as the standards and criteria are laid out.
Number 2099
REPRESENTATIVE COGHILL noted that there are some financial
impacts, but since the bill is referred to the House Finance
Committee, that issue will be addressed there.
Number 2125
CHAIR WILSON referred to Section 5, where it says, "The money
made available under this subsection may be appropriated for the
Alaska nurse recruitment loan repayment program".
REPRESENTATIVE COGHILL responded that he has no problem with the
bill.
CHAIR WILSON told the committee that an issue with respect to
traveling nurses has just come to her attention that is
important. She said it is hard on the morale of nurses who work
and live in Alaska when traveling nurses may be making as much
as $45 per hour, plus a free place to stay, the ability to eat
at the hospital for free, and other kinds of perks. Chair
Wilson said she thinks it would not be a good idea to have
travelers qualifying for this program because this program is
really intended for someone who wants to come up to Alaska to
work and live. She said that language could be developed by the
time the bill comes before the next committee of referral.
REPRESENTATIVE CISSNA agreed with Chair Wilson's comments and
shared the views from her former house sitter who was a
traveling nurse. He took a $10,000 bonus to come to Alaska to
work for one year because his mother lived here. In fact, he
was incensed that there were a lot of people who came to Alaska
for a week that actually got a lot more money than he had. He
felt it was unfair that there were nurses who made more and
cared less about the patients in the hospital, and thought they
did a poor job.
REPRESENTATIVE COGHILL moved to report CSHB 211, Version 23-
LS0861\D, Ford, 3/29/03, out of committee with individual
recommendations and the accompanying fiscal notes.
REPRESENTATIVE SEATON asked about a new fiscal note for the
committee substitute.
Number 2255
CHAIR WILSON replied that a new fiscal note was passed out to
members. She explained that originally the fiscal note was
based on the belief that there would be a need for 1,600 more
nurses in the next few years, but it was revised to indicate
there will actually be a need for 4,100 nurses. So the new
fiscal note was changed to reflect the difference.
Number 2275
VICE CHAIR GATTO asked if there were any objections to the
motion. There being no objection, CSHB 211(HES) was reported
from the House Health, Education and Social Services Standing
Committee.
VICE CHAIR GATTO returned the gavel to Chair Wilson.
Number 2294
CHAIR WILSON announced that the Report on State Health Policy
Meeting in Chicago by Representative Cissna will be postponed
until next week.
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 3:50 p.m.
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