03/12/2009 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB2 | |
| HB50 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 50 | TELECONFERENCED | |
| += | HB 2 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 12, 2009
3:04 p.m.
MEMBERS PRESENT
Representative Bob Herron, Co-Chair
Representative Wes Keller, Co-Chair
Representative John Coghill
Representative Bob Lynn
Representative Paul Seaton
Representative Sharon Cissna
Representative Lindsey Holmes
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 2
"An Act relating to the issuance of a certificate of birth
resulting in a stillbirth."
- MOVED CSHB 2 (HSS) OUT OF COMMITTEE
HOUSE BILL NO. 50
"An Act relating to limitations on mandatory overtime for
registered nurses and licensed practical nurses in health care
facilities; and providing for an effective date."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 2
SHORT TITLE: BIRTH CERTIFICATE FOR STILLBIRTH
SPONSOR(s): REPRESENTATIVE(s) GATTO
01/20/09 (H) PREFILE RELEASED 1/9/09
01/20/09 (H) READ THE FIRST TIME - REFERRALS
01/20/09 (H) HSS, JUD
02/26/09 (H) HSS AT 3:00 PM CAPITOL 106
02/26/09 (H) Heard & Held
02/26/09 (H) MINUTE(HSS)
03/12/09 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 50
SHORT TITLE: LIMIT OVERTIME FOR REGISTERED NURSES
SPONSOR(s): REPRESENTATIVE(s) WILSON, GARA, TUCK, PETERSEN,
LYNN, SEATON, GATTO, CISSNA, MUNOZ, GARDNER
01/20/09 (H) PREFILE RELEASED 1/9/09
01/20/09 (H) READ THE FIRST TIME - REFERRALS
01/20/09 (H) HSS, FIN
03/12/09 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
SANDRA WILSON, Staff
to Representative Carl Gatto
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Spoke about the proposed CS to HB 2 on
behalf of the prime sponsor, Representative Carl Gatto, and
responded to questions.
REPRESENTATIVE CARL GATTO
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Spoke as the prime sponsor of HB 2.
REPRESENTATIVE PEGGY WILSON
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HB 50 as the joint prime
sponsor.
REBECCA ROONEY, Staff
to Representative Peggy Wilson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions about HB 50.
DR. PATRICK NOLAN
Providence Hospital
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 50.
REPRESENTATIVE BERTA GARDENER
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified as a joint prime sponsor of HB
50.
EVANGELYN DOTOMAIN, President & CEO
Alaska Native Health Board (ANHB)
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 50.
DEBBIE THOMPSON, Executive Director
Alaska Nurses Association
Anchorage, Alaska
POSITION STATEMENT: Testified about HB 50.
MARIE ORIA
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 50.
STACY ALLEN
Laborers' Local 341
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 50.
CHRISTIE ARTUSO, Director of Neurosciences
Providence Alaska Medical Center
Anchorage, Alaska
POSITION STATEMENT: Testified about HB 50.
MARY STACKHOUSE
Alaska Nurses Association
Anchorage, Alaska
POSITION STATEMENT: Testified about HB 50.
CAROL CLAUSSON
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 50.
CINDY ALKIRE, Assistant Chief Nurse Executive
Providence Alaska Medical Center
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 50.
MARILYN EDWARDS, Operating Room Clinical Manager
Providence Alaska Medical Center
Anchorage, Alaska
POSITION STATEMENT: Testified about HB 50.
ROGER LEWERENZ, RN
Providence Alaska Medical Center
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 50.
GENEVA EDMISTON, Associate Administrator
Denali Center, Fairbanks Memorial Hospital
Fairbanks, Alaska
POSITION STATEMENT: Testified in opposition to HB 50.
BRENDA FRANZ, Director of ICU and Emergency
Fairbanks Memorial Hospital
Fairbanks, Alaska
POSITION STATEMENT: Testified about HB 50.
DONNA PHILLIPS, RN
Girdwood, Alaska
POSITION STATEMENT: Testified in support of HB 50.
JOHN BRINGHURST, Administrator
Petersburg Medical Center
Petersburg, Alaska
POSITION STATEMENT: Testified about HB 50.
WENDY CONRADI, RN
POSITION STATEMENT: Testified in support of HB 50.
ROD BETIT, President & CEO
Alaska State Hospital and Nursing Home Association (ASHNHA)
Juneau, Alaska
POSITION STATEMENT: Testified in opposition to HB 50
LAUREE MORTON
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 50.
ACTION NARRATIVE
3:04:28 PM
CO-CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:04 p.m.
Representatives Keller, Herron, Lynn, Coghill, and Seaton were
present at the call to order. Representatives Cissna and Holmes
arrived as the meeting was in progress.
HB 2-BIRTH CERTIFICATE FOR STILLBIRTH
3:05:07 PM
CO-CHAIR KELLER announced that the first order of business would
be HOUSE BILL NO. 2, "An Act relating to the issuance of a
certificate of birth resulting in a stillbirth." [Before the
committee was CSHB 2, Version R, the working document.]
3:05:49 PM
CO-CHAIR HERRON moved to adopt the proposed committee substitute
(CS) for HB 2, version 26-LS0003\S, Mischel, 3/5/09, as the
working document.
3:06:04 PM
REPRESENTATIVE SEATON objected for the purpose of discussion.
3:06:19 PM
SANDRA WILSON, Staff to Representative Carl Gatto, Alaska State
Legislature, explained that the changes in Version S included:
all references to "stillborn" were removed, and the definition
of "stillbirth" in subsection (h), paragraph (1) was now the
same definition as AS 18.50.240.
3:07:04 PM
REPRESENTATIVE SEATON removed his objection. There being no
further objection, Version S was adopted as the working
document.
3:07:16 PM
REPRESENTATIVE CARL GATTO, Alaska State Legislature, said that
the bill had been approved by the Alaska House of
Representatives during the 25th Legislature, but he opined that
the reason it had not passed out of the Senate due to concern
that the bill was pro-life or pro-choice. He pointed out that
the bill had no connection to pro-life or pro-choice, and that
it was written for mothers.
3:08:17 PM
CO-CHAIR KELLER opened public testimony.
3:08:29 PM
CO-CHAIR KELLER closed public testimony.
3:08:42 PM
CO-CHAIR HERRON moved to report CSHB 2, Version 26-LS0003\S,
Mischel, 3/5/09, out of committee with individual
recommendations and the accompanying zero fiscal notes. There
being no objection, CSHB 2 (HSS) was reported from the House
Health and Social Services Standing Committee.
HB 50-LIMIT OVERTIME FOR REGISTERED NURSES
3:09:52 PM
CO-CHAIR KELLER announced that the final order of business would
be HOUSE BILL NO. 50, "An Act relating to limitations on
mandatory overtime for registered nurses and licensed practical
nurses in health care facilities; and providing for an effective
date."
3:10:20 PM
REPRESENTATIVE PEGGY WILSON, Alaska State Legislature, explained
that HB 50 would prevent Alaska Registered and Licensed
Practical Nurses from being forced to work overtime. She
defined overtime as "work beyond an agreed to predetermined
regularly scheduled shift." She offered her opinion that this
would protect patients from the dangers caused by overworked
nurses. She warned that a standard staffing tool for "most
hospitals in the state" was the use of forced, involuntary
overtime and required "on-time" call, as this was less expensive
than hiring more full time nurses. She stated that HB 50 would
not allow a nurse to be coerced to work beyond a 14 hour shift,
work beyond 80 hours in a 14 day period, or accept overtime that
would jeopardize patient or employee safety. She also explained
that a nurse must be allowed at least 10 consecutive hours of
off-duty time immediately following a scheduled shift. She
detailed the exceptions to include an "unforeseen emergency
situation," overtime on a medical transport aircraft, and an
occasional special event for a school.
3:14:26 PM
REPRESENTATIVE WILSON suggested the three most important
questions to be: are nurses working overtime immediately
following a 12 hour work period; are nurses working more than 14
consecutive hours; and, do nurses go to on-call status
immediately following a regular shift. She opined that nurses
were working more hours with less help.
3:17:28 PM
REPRESENTATIVE WILSON reported that nurses felt subjected to
mandatory on-call duties and forced overtime, and she declared
that nurses had an ever present fear of retaliation if they
reported complaints. She noted an Alaska Nurses Association
survey which mentioned that over 80 percent of nurses reported
to be forced to work overtime, and all of the nurses surveyed
reported that mandatory on-call was required. She predicted
that this led to burn-out and contributed to the shortage of
nurses.
3:19:34 PM
REPRESENTATIVE WILSON noted that other professions had work
schedule limitations imposed by the legislature. She affirmed
that 15 states had enacted similar legislation. She reported
that nurses were three times more likely to make an error when
shifts lasted more than 12.5 hours.
3:22:12 PM
REPRESENTATIVE LYNN noted that he had a conflict of interest, as
two of his daughters were registered nurses.
3:22:33 PM
REPRESENTATIVE SEATON asked for an explanation of page 3, lines
9 & 10, Section 2 (4).
REPRESENTATIVE WILSON explained that a nurse would agree to a
schedule before it was published.
3:23:43 PM
REBECCA ROONEY, Staff to Representative Peggy Wilson, Alaska
State Legislature, said that the nurses would testify about
this.
3:24:05 PM
CO-CHAIR HERRON referred to a letter from the Alaska Native
Health Board, dated March 6, 2009. [Included in members'
packets.] He noted that ANHB expressed "deep reservations over
HB 50" and he asked Representative Wilson to remark on two
points regarding the reasons that similar legislation had been
adopted in 15 states: (1) out of concern that hospitals might be
under-hiring; and (2) that mandatory overtime rules were used as
a collective bargaining tactic. He asked if the under-hiring
and collective bargaining tactics were issues in Alaska.
3:26:01 PM
REPRESENTATIVE WILSON replied that she did not know if some
hospitals were under-hired. She opined that an increase to the
shortage of nurses would lead to an under-hired dilemma. She
offered her belief that nurses would be attracted to a state
with safeguards in place, and would help alleviate the nursing
shortage.
3:26:49 PM
CO-CHAIR KELLER asked if there was data to support that nurses
migrated to states with safeguards.
3:27:09 PM
REPRESENTATIVE WILSON replied that there was not yet any data.
3:27:25 PM
CO-CHAIR KELLER referred to the Alaska Native Tribal Health
Consortium (ANTHC) position paper, dated March 9, 2009.
[Included in members' packets.] He asked Representative Wilson
to comment on the first paragraph on page 2, "The bill provides
no new resources and no new options."
3:28:12 PM
REPRESENTATIVE WILSON replied that she disagreed with the
statement. She explained that there were new options, as HB 50
would protect nurses from retaliation for refusal to work
overtime.
3:30:02 PM
REPRESENTATIVE CISSNA asked about the suitability of HB 50 for
rural Alaska.
3:31:26 PM
REPRESENTATIVE WILSON said that, even though most states had
limited the work day to 12 hours, HB 50 would limit the work day
to 14 hours.
3:32:21 PM
REPRESENTATIVE CISSNA referred to the list of exceptions, and
asked if these were designed for rural Alaska.
3:33:17 PM
REPRESENTATIVE WILSON, in response to Representative Cissna,
noted that the exceptions were not for a specific group, but
were intended to maintain safety for everyone.
3:34:47 PM
CO-CHAIR KELLER opened public testimony.
3:35:06 PM
DR. PATRICK NOLAN, Providence Hospital, commented that nurses
worked long hard hours. He accepted the correlation between
fatigue and errors, and noted that this was a safety issue. He
offered his belief that a predictive schedule was important to
attracting nurses. He noted that he had submitted a letter with
comments on HB 50, in which he quoted the National Institute for
Occupational Safety and Health comments about high error rates
with overtime work. [Included in the members' packets.] He
opined that HB 50 would be conducive to nurses working in high
stress situations.
3:39:02 PM
REPRESENTATIVE BERTA GARDENER, Alaska State Legislature, said
that prior testimony had convinced her that hospitals used this
as a cost control tool. She stressed the need for a limit on
mandatory overtime and mandatory call. She agreed that rural
Alaska had special needs.
3:41:18 PM
EVANGELYN DOTOMAIN, President & CEO, Alaska Native Health Board
(ANHB), said that Alaska Native Health Board employed 7000
people and served more than 130,000 patients. She praised the
Tribal health providers and nurses, and their dedication to
provide high-quality care. She expressed concerns that HB 50
would hurt patient care in rural Alaska. She explained that
should a nurse decide that they don't want to work overtime, it
could often mean that the shift was not covered. She pointed
out that rural health providers did not have the same resource
as urban providers to call in other off-duty nurses, to call
temporary "agency" nurses on short notice, or to send patients
to other facilities. She surmised that this could be a reason
that no rural states had adopted this legislation. She
expressed concern for the increased cost to Tribal health
providers if they were forced to over hire regular shift nurses,
fly in temporary nurses at the last minute, or transfer patients
to an urban provider. She opined that HB 50 had been adopted by
states concerned that urban hospitals under-hired and abused
mandatory overtime as a control for payroll and benefit costs,
or as a collective bargaining tactic. She acknowledged that
there were chronic challenges for nurse staffing in a remote,
rural location, but she denied that this was a tactic used by
Tribal health providers. She observed that nursing was a "tough
profession," but that the challenges came with the healthcare
territory, and she added that physicians, administrators,
technicians, and clerks also adjusted their scheduling to meet
the needs of the patients. She suggested that the mandatory
overtime issues could be addressed in employment agreements.
[Letters to committee included in members' packets.]
3:46:46 PM
DEBBIE THOMPSON, Executive Director, Alaska Nurses Association,
stated that she was a professional registered nurse, and that
she had worked as an operating room nurse. She emphasized that
nurses would not leave patients without coverage in an
emergency. She reported that her extensive interviews with
nurses throughout Alaska indicated that 100 percent agreed that
mandatory overtime was a problem which affected the decision to
work in acute care. She relayed that hospital personnel had
suggested addressing this in employment agreements, yet nurses
had been told that this was not a negotiable issue. She asked
if patient safety was any less of a concern in rural or urban
environments. She referred to SB 139, which offered financial
incentives for recruitment in hard to fill health care jobs, and
she suggested that these could be used for staffing the rural
areas. She explained that it was necessary "to have a good
patient - nurse ratio in order to have a quality patient
outcome."
3:52:37 PM
MARIE ORIA said that she worked in a residential treatment
center without acute medical concerns. She said that she does
not have mandatory overtime, and that she has not been called
during her off time to do mandatory overtime. She observed that
the current economic situation was financially overwhelming, and
that HB 50 would limit her work time opportunities.
3:58:21 PM
STACY ALLEN, Laborers' Local 341, said that she was required to
accept mandatory on-call on the weekends. She acknowledged that
although she could choose her on-call time, this meant that she
would be responsible to work 16 hour shifts. She shared that
other nurses had mentioned that mandatory on call was a reason
to "look around for something else to do because it was too
exhausting." She opined that most hospitals did not choose to
use mandatory overtime as a management tool, but that it was "a
relatively easy thing to do." She confirmed the difficulty for
refusal to work overtime knowing that a patient may be
abandoned. She expressed the support of Laborers' Local 341 for
HB 50.
4:02:32 PM
CHRISTIE ARTUSO, Director of Neurosciences, Providence Alaska
Medical Center, said that she was also a national member on the
Board of Directors for the Certification Corporation of the
American Association of Critical Care Nurses, which she
described as the largest national specialty nursing association,
representing over 500,000 registered nurses working in critical
care and acute care settings. She stated that the organization
had been actively studying the components of healthy work
environments. She shared that one component was the nurse's
ability to participate in the decision making about the work
environment, which included the types of shifts and the
flexibility of the work hours. She asked that consideration be
given for a nurse's ability to choose the work environment. She
summarized that HB 50 would negatively impact patient care and
nurses' satisfaction, as it would remove the choices.
4:07:11 PM
REPRESENTATIVE LYNN asked if all registered nurses had the
health, stamina, and personality to work the long hours.
4:08:09 PM
MS. ARTUSO replied that nurses had the right to choose. She
noted the ineffectiveness of this legislation as nurses could
still work at two different institutions, in order to meet their
personal needs.
4:09:05 PM
REPRESENTATIVE LYNN asked if the hospital administration brought
undue pressure on nurses to work.
4:09:37 PM
MS. ARTUSO said that she had always been permitted to leave,
even in hospital settings with mandatory overtime. She allowed
that she had heard stories, but had never seen it happen. She
opined that it was not happening in the overwhelming majority of
cases.
4:10:34 PM
MARY STACKHOUSE, Alaska Nurses Association, commented that the
work environment was "running people away from the bedside."
She expressed that nurses' had autonomy and responsibility for
their work performance. She offered her opinion that mandatory
overtime undermines these obligations. She asked that the
legislature protect the nurses' professional judgment. She
emphasized that mandatory overtime eliminated professional
judgment and autonomy, yet it still required professional
accountability. She read from a resolution by the National
Council of State Boards of Nursing: "recognizes the professional
responsibility of nurses to accept or decline overtime
assignments based on their self assessment of ability to provide
safe care." She shared that mandatory overtime was used when
patient assignments were heavy and staffing was a problem.
4:14:51 PM
CAROL CLAUSSON said that she was a registered nurse. She
pointed out that it was very hard work, and that she was tired
at the end of her 12 hour shift. She noted that she was not as
mentally sharp when she was tired. She opined that mandatory
overtime would worsen the nursing shortage. She said that she
supported HB 50.
4:16:19 PM
CINDY ALKIRE, Assistant Chief Nurse Executive, Providence Alaska
Medical Center, said that Providence Alaska Medical Center did
not use mandatory overtime, and instead, allowed nurses to bid
on overtime if they desired. She considered that the on-call
part of the legislation was vague and would create
misinterpretations. She explained that the medical center only
had three specialized areas which utilized "on-call," the
availability to come to work and care for patients within 30
minutes. She spoke specifically about the Operating Room (OR).
She explained that there was always an OR team at the hospital,
but in the event of a second emergency, there would be a need
for a second team. She disclosed that the need for quick
response was the reason for an "on-call" team. She shared that
the agreement to be "on-call" for the three specialized areas
was clearly stated at hiring. She reported that nurses were
allowed to schedule their "on-call" time, but that this could be
affected by the interpretation of "on-call" in HB 50. She
explained that, should "on-call" be interpreted to mean the same
as "work," this would limit staff scheduling of "on-call" to
follow time actually worked. She offered that union
negotiations were a better way to deal with this issue. [Letter
included in members' packets.]
4:22:12 PM
REPRESENTATIVE LYNN asked if she was a nurse prior to becoming a
supervisor.
MS. ALKIRE said that she was.
REPRESENTATIVE LYNN asked if her attitude had changed when she
became a supervisor.
MS. ALKIRE said that her attitude had not changed. She said
that she became a nurse because she cared about patients. She
said that she did not want HB 50 to stop nurses when they wanted
to work. She agreed that nurses had the right to leave when
they were tired. She offered her concern that HB 50 would take
away a nurse's choice and professional judgment.
REPRESENTATIVE LYNN asked if she would have given the same
testimony as a new nurse.
MS. ALKIRE indicated that she worked long shifts as a new nurse.
She said that she gave good care.
4:25:08 PM
MARILYN EDWARDS, Operating Room Clinical Manager, Providence
Alaska Medical Center, shared that she had been a nurse for 31
years. She said that her immediate concerns were for a safe
work environment and safe quality patient outcomes. She offered
her opinion that a "one size solution" prescribed in state law
to resolve mandatory nurse overtime would be devastating for
patients at Providence Medical Center. She detailed the
staffing schedule for the operating room at Providence. [Letter
included in members' packets.]
4:28:53 PM
ROGER LEWERENZ, RN, Providence Alaska Medical Center, said that
he was against the "on-call" section of HB 50. He explained
that he worked as a clinical educator in the heart center, that
this area was highly specialized, and that it required
approximately one year to fully train an experienced critical
care nurse. He reported that it was necessary to utilize an
"on-call" team as not all nurses had the necessary specialized
training. He allowed that this produced a chronic shortage of
staff. He offered his opinion that the "on-call" schedule was
"not that bad." He noted in his submitted written testimony
that the "restrictions that would be imposed if this bill passes
would negatively impact our ability to care for this patient
population due to the unavailability of trained staff." [Letter
included in members' packets.]
4:32:46 PM
GENEVA EDMISTON, Associate Administrator, Denali Center,
Fairbanks Memorial Hospital, said that she opposed HB 50, but
that she appreciated the intent of the bill to focus on patient
safety and nursing satisfaction. She expressed her disagreement
with legislation as the means of solution. She affirmed
awareness for the need to attract and retain registered nurses.
She said that Fairbanks Memorial Hospital hired the new nurse
graduates from University of Alaska Fairbanks (UAF) in support
for nursing services. She explained that the hospital would
spend the extra money for travelling nurses and temporary staff
to avoid the overtime issue. She noted that only four hospitals
and nursing homes in Alaska reported using mandatory overtime.
She agreed that the legislation was a "one size fits all" which
was not practical for Tribal and small community health
providers. She opined that it would have "unintended
consequences." She concluded that this was "unneeded
legislation at this time."
4:37:47 PM
BRENDA FRANZ, Director of ICU and Emergency, Fairbanks Memorial
Hospital, said that Fairbanks Memorial Hospital worked hard to
promote nursing and that there was a culture of patient and
nurse safety. She stated that the hospital did not support
mandatory overtime, and that each area scheduled collaboratively
with its nursing staff.
4:38:39 PM
REPRESENTATIVE SEATON asked if there was a safety issue when
nurses were required to work longer than a continuous 14 hour
shift.
MS. FRANZ replied that Fairbanks Memorial Hospital did not
support mandatory overtime, but that they allowed the choice and
encouraged nurses to communicate their needs.
4:39:14 PM
REPRESENTATIVE SEATON asked to clarify that voluntary overtime
did not impinge safety.
MS. FRANZ replied that nurses made the decision for overtime
work.
4:39:52 PM
REPRESENTATIVE LYNN asked if the refusal for overtime would
negatively impact a nursing career.
MS. FRANZ said that there was not any retaliation. She
expressed the priority for a safe, healthy working environment.
4:41:52 PM
DONNA PHILLIPS, RN, said that she had been a registered nurse
for 30 years. She expressed her concern for the patients, and
she read from a prepared statement [Included in members'
packets.]:
The Institute of Medicine (IOM) report has identified
how long hours and fatigue contributes to errors in
healthcare. These errors can cost lives, or increase
length of stay in the hospital which in turn adds to
the already ballooning cost of healthcare.
She urged support for HB 50.
4:43:58 PM
JOHN BRINGHURST, Administrator, Petersburg Medical Center, said
that he had been the administrator at Petersburg Medical Center
for eleven years. He called attention to the small hospital
perspective and noted that the nurses had requested the switch
to 12 hour work shifts. He said that Petersburg Medical Center
did not have mandatory overtime and that there was no pressure
to work an additional shift. He shared that there was mandatory
"on-call." He explained that the emergency room was staffed by
the acute care nurse. If an incoming case appeared difficult,
then the "on-call" nurse was summoned to cover the nurses'
station. He offered his belief that there was not any other
practical, economic way to staff the emergency room. He opined
that Alaska was being responsible in its [medical] facility
staffing without legislation, and that regulations were stifling
the [hospital] industry.
REPRESENTATIVE SEATON asked if the nurses went "on-call"
immediately following a 12 hour shift.
MR. BRINGHURST replied that this was a decision made by each
nurse, but that the practice was to first ask the nurses who had
not worked that shift.
REPRESENTATIVE SEATON asked how often a nurse worked more than a
continuous 14 hour shift.
4:49:17 PM
MR. BRINGHURST replied that the nurses had the option to sign up
for an "on-call" shift which immediately followed a regular
shift.
4:49:41 PM
WENDY CONRADI, RN, said that she had been a registered nurse for
16 years. She said that similar Washington State legislation
had had a positive effect on patient care and nurse's lives.
[Letter included in members' packets.]
4:50:39 PM
The committee took an at-ease from 4:50 p.m. to 4:51 p.m.
4:51:35 PM
ROD BETIT, President & CEO, Alaska State Hospital and Nursing
Home Association (ASHNHA), said that he represented 27 private,
tribal, state, and federal health facilities and they did not
support HB 50. He said that ASHNHA members had a strong
commitment to nursing, and that they did not use mandatory
overtime as a strategy to fulfill the staffing needs. He
reported that collective bargaining and informal agreements were
used to reach solutions to staffing issues. He mentioned that
the latest survey indicated that there was not a lot of
mandatory overtime. He reported that ASHNHA members did not use
mandatory overtime as it was not good for patients or staff. He
cited that ASHNHA members were showing a strong responsible
commitment to patient care that was good for the patient and the
nurse.
4:55:23 PM
REPRESENTATIVE COGHILL asked if ASHNHA kept track of nurse
turnover rates within specific hospitals.
MR. BETIT, in response to Representative Coghill, said that the
vacancy rate was an annual average, but that it did not reflect
the total staff turnover in relation to the total staff.
REPRESENTATIVE COGHILL opined that the turnover rate and the
formal grievances filed might give an indication of the misuse
of work timelines.
MR. BETIT said that the Department of Labor had not received any
of these grievances.
4:57:10 PM
REPRESENTATIVE COGHILL asked how many lawsuits had been
proffered based on nurse malpractice, and on what basis.
MR. BETIT said that he would ask.
4:57:50 PM
REPRESENTATIVE LYNN asked if mandatory overtime was minimal.
MR. BETIT said yes.
4:58:14 PM
MR. BETIT, in response to Representative Lynn, said that the
bill was attempting to place, in statute, one solution for work
scheduling that would not work for every facility. He said that
there was not a problem with mandatory overtime that would
suggest the need for legislation.
REPRESENTATIVE LYNN concluded by stating that it was a problem
for some people, hence the legislation.
4:58:51 PM
REPRESENTATIVE SEATON asked about the mandatory "on-call."
MR. BETIT said that it was used, and that it was used
differently in different situations. He elaborated that "on-
call" was more often being used in specially trained staffing
units that could not be staffed all of the time.
5:00:24 PM
REPRESENTATIVE SEATON said that the legislation was to not
schedule for longer than 14 consecutive hours. He asked if
ASHNHA members agreed that it was safe to work longer than a 14
hour shift.
MR. BETIT said that ASHNHA did not perceive this as a safety
issue.
5:01:33 PM
REPRESENTATIVE SEATON referred to the list of mandatory "on-
calls" each month, and asked if that was reasonable, even if it
occurred immediately after a regular shift.
MR. BETIT, in response to Representative Seaton, noted that an
"on-call" listing did not specify whether the nurse had actually
worked. He added that these "on-calls" were scheduled in
agreement with the nursing staff.
5:02:48 PM
REPRESENTATIVE LYNN compared nursing to other occupations with
hourly work limitations for safety, and asked why nurses would
not have these same limitations.
MR. BETIT replied that each individual occupation had unique
reasons for this structure. He said that nursing was one
important piece of the health care delivery system. He agreed
that there were limits to what should be asked of nurses, and
that ASHNHA members respected those limits, and allowed the
nurses the choice. He opined that HB 50 was attempting to:
legislate what an individual thinks their abilities
are, and where they want to practice in health care,
and whether they want to work in a specialized unit,
knowing full well it takes some on-call with it
because of the nature of that unit, or whether they
want to stay in a more generalized unit where they can
work an 8 or 10 or 12 hour shift. So, the current law
gives us that flexibility, the current law gives local
hospitals, nursing homes, and nursing staff the
flexibility to work through that. We just don't see
any evidence that we need to do anything to legislate
something to limit that because the record is very
good, I think, in terms of what we have put before you
as far as our hospitals' and our nursing homes'
performance.
5:04:15 PM
REPRESENTATIVE LYNN responded by concluding that those other
occupations with hourly limitations also deemed that they could
safely work more hours.
5:05:10 PM
REPRESENTATIVE HOLMES allowed that she was attempting to balance
both sides. She asked why the mandatory overtime issue was
being advocated so strongly, if it was not a problem.
MR. BETIT agreed that ASHNHA members were also confused by this,
and that they did not understand the reasons behind the concern.
He reported that ASHNHA records showed no problems with
mandatory overtime. He shared a desire to know the reasons for
the concern, as collective bargaining should bring these issues
to the table. He reiterated that ASHNHA members had stated a
commitment to not implement mandatory overtime, and he asked how
that was being heard differently by nursing staff.
5:07:30 PM
REPRESENTATIVE SEATON asked if ASHNHA represented Alaska
Psychiatric Institute (API).
MR. BETIT said that API was a state operated facility and an
ASHNHA member, so that API did report its data on the use of
mandatory overtime. He did not know if API had taken a position
on HB 50. He offered his belief that API had received
additional funding for nursing salaries, and that they were
coordinating with private facilities for "on-call" staff.
5:08:55 PM
REPRESENTATIVE SEATON referred to prior testimony which stated
that API was unsafe. He asked if those testimonies were
fabricated or truthful about the existing situation.
MR. BETIT offered his personal belief, not that of ASHNHA, that
the testimony was the truth. He shared that API officials would
have stated that wages were very low, which made it difficult to
hire enough qualified staff. He explained that API had not had
the same financial tools as the private facilities to fill the
staffing vacancies. He offered his belief that this issue had
recently been addressed and resolved.
5:10:41 PM
LAUREE MORTON said that she was representing herself and her
parents. She allowed that she did not have any major hospital
horror stories, but that many small indignities had occurred
during the more than two years that she cared for her mother:
pain medication that was administered incorrectly or not on-
time; or [lack of] assistance with use of the bathroom. She
acknowledged that nurses wanted to do what was right. She
offered her belief that patients, as consumers of the service,
were more confident with shorter work shifts. She requested
that nursing staff be fresh, "on their toes," and ready to give
the best care possible. She agreed that these were tough
decisions without easy answers, but should be weighed against
the call to do no harm. She stipulated that the right of nurses
to decide their own schedule should not be at the expense of the
patient. She suggested that hospitals make the schedule for
mandatory on-call to ensure that staff had the required rest
periods. She stressed that patient safety was the guiding
principle, and not a catch phrase. She emphasized that the
legislature should determine the length of work shift by what
was best for the patient. [Letter included in members'
packets.]
5:17:11 PM
CO-CHAIR KELLER closed public testimony. [HB 50 was held over.]
5:17:45 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:17 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Background from ANA.PDF |
HHSS 3/12/2009 3:00:00 PM |
HB 50 |
| Background ANA.PDF |
HHSS 3/12/2009 3:00:00 PM |
HB 50 |
| sponsor statement.PDF |
HHSS 3/12/2009 3:00:00 PM |
HB 50 |
| sectional analysis.PDF |
HHSS 3/12/2009 3:00:00 PM |
HB 50 |
| HB 50.PDF |
HHSS 3/12/2009 3:00:00 PM |
HB 50 |
| Fiscal note.PDF |
HHSS 3/12/2009 3:00:00 PM |
HB 50 |
| Letters of support.PDF |
HHSS 3/12/2009 3:00:00 PM |
HB 50 |
| Opposition from ANTHC.PDF |
HHSS 3/12/2009 3:00:00 PM |
HB 50 |