Legislature(2021 - 2022)BUTROVICH 205
02/23/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB67 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 67 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 23, 2021
1:33 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Shelley Hughes, Vice Chair
Senator Mia Costello
Senator Lora Reinbold
Senator Tom Begich
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 67
"An Act relating to the licensure of nursing professionals;
relating to a multistate nurse licensure compact; and providing
for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 67
SHORT TITLE: NURSING: LICENSURE; MULTISTATE COMPACT
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
02/03/21 (S) READ THE FIRST TIME - REFERRALS
02/03/21 (S) HSS, L&C
02/23/21 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
JULIE ANDERSON, Commissioner
Department of Commerce, Community, and Economic Development
(DCCED)
Anchorage, Alaska
POSITION STATEMENT: Introduced SB 67 on behalf of the Senate
Rules Committee, sponsor by request.
SARA CHAMBERS, Director
Division of Corporations, Business, and Professional Licensing
Department of Commerce, Community and Economic Development
(DCCED)
POSITION STATEMENT: Introduced SB 67 on behalf of the Senate
Rules Committee, sponsor by request.
ROSE LAWHORNE, Chief Nursing Officer
Bartlett Regional Hospital
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 67.
DANETTE SCHLOEDER, Chair
Alaska Board of Nursing
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 67.
TAMMIE PERREAULT, Northwest Regional Liaison
U.S. Department of Defense
Washington, D.C.
POSITION STATEMENT: Testified in support of SB 67.
BRIAN NORTON, R.N., Manager
Cook Inlet Dialysis Fresenius Kidney Care
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 67.
REBECCA FOTSCH, Director
State Advocacy & Legislative Affairs
National Council of State Boards of Nursing
Chicago, Illinois
POSITION STATEMENT: Offered to answer questions about the Nurse
Licensure Compact.
ACTION NARRATIVE
1:33:14 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:33 p.m. Present at the
call to order were Senators Begich, Costello, Hughes, and Chair
Wilson. Senator Reinbold joined shortly thereafter.
SB 67-NURSING: LICENSURE; MULTISTATE COMPACT
1:33:38 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 67
"An Act relating to the licensure of nursing professionals;
relating to a multistate nurse licensure compact; and providing
for an effective date." He stated his intent to hear an overview
of the bill and take invited testimony. He called on
Commissioner Anderson and Director Chambers to introduce the
bill.
1:35:23 PM
JULIE ANDERSON, Commissioner, Department of Commerce, Community,
and Economic Development (DCCED), Anchorage, Alaska, said that
SB 67 will allow Alaska to become part of the Nurse Licensure
Compact (NLC). SB 67 is a pro healthcare, pro military,
bipartisan piece of legislation. By joining the NLC, registered
and practical nurses are able to practice in any of the
participating states in the NLC. The standards to obtain a
multistate license are high. Alaska has hundreds of nursing
vacancies and projections show that the vacancy rate will only
increase over the next decade. The Board of Nursing will retain
full regulatory authority over nurses practicing in the state.
Alaska nurses and healthcare facilities across the state support
this legislation, as does the U.S. Department of Defense. The
military has clearly stated that license reciprocity for
military spouses is a key factor in basing decisions. Nursing is
one of the most common professions for military spouses.
Enacting the NLC in Alaska will not only improve Alaskan access
to healthcare and allow mobility for Alaskan nurses but will
also increase economic opportunities for the state through
potential military expansion.
MS. ANDERSON said her team did a wonderful job handling the
hundreds of applications for new nurse licenses that were
necessary once COVID-19 hit Alaska, but had the NLC been in
place at that time, the response efforts could have been quicker
and more cost effective for all parties involved. This
legislation is win-win for Alaska.
1:38:29 PM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community and
Economic Development (DCCED), said the NLC is a voluntary,
multistate agreement that allows highly qualified practical and
registered nurses to practice nursing in any member
jurisdiction. Becoming a member of the NLC would be especially
timely for Alaska because it solves several problems.
MS. CHAMBERS said that the NLC eliminates additional costs,
delays and bureaucracy from the delivery of healthcare services.
The purpose of occupational licensure is to ensure that
individuals meet minimal, jurisdictional requirements to perform
a professional service. The licensing takes time, money, and a
lot of paperwork. In Alaska an initial nursing license can cost
up to $500 and take many weeks to complete. During this time,
the applicant cannot work as a nurse in the state. The applicant
loses income and a clinic or hospital cannot provide a certain
level of care to its patients while the position goes unfilled.
When emergencies like an earthquake or pandemic affect the
state, the demand for nurses goes up, creating additional delays
in processing licenses and delaying the delivery of healthcare.
When the state needs nurses the most, they are more difficult to
obtain.
MS. CHAMBERS said that failure to participate in the NLC affects
the state's military community. The U.S. Department of Defense
recognizes the difficulty military families face when relocating
and has declared that economic decisions such as base location
and expansion will rely heavily on state policies toward
military spouse employment. The NLC is considered the gold
standard in license reciprocity.
1:41:15 PM
MS. CHAMBERS said that Alaska's ability to keep up with the
demand for healthcare has been at crisis levels even before the
pandemic. The Alaska State Hospital and Nursing Home Association
(ASHNHA) reported 670 nursing vacancies in 2019. Even before the
pandemic there were not enough skilled nurses to meet Alaska's
healthcare needs. Since July 2020, the Alaska Board of Nursing
issued 324 emergency courtesy licenses to keep up with the COVID
pandemic. These licenses were created by emergency regulations
by the board last year and represent the additional help needed
to keep up with the crisis. The Bureau of Health Workforce
estimates that Alaska will need 23 percent more nurses by 2030.
That is 5,400 more registered nurses (RN) when the state already
has vacancies for almost 700 nurses. An additional measure of
concern is that RN and APRN (Advanced Practice Registered Nurse)
licenses expire this Sunday in Alaska and 25 percent of nurses,
more than 4,500 nurses, have not renewed their licenses.
MS. CHAMBERS said that the NLC is a voluntary agreement among
state legislatures that sets high, mutual standards for nurses
who wish to receive a multistate license. The multistate license
is optional for resident nurses, but it allows nurses to work in
any member state without having to apply for licensure each
time. Each state board of nursing retains authority over the
practice of nursing in its state. The practice standards don't
change. Violations of practice standards prohibit offenders from
further practice in the state and any violation is reported to
the home state board of nursing for disciplinary action.
Healthcare vacancies can be filled quickly at little expense for
the facility, the nurse, or the state government. The multistate
license is attractive to Alaska nurses. The ability to work in
member states is attractive to Alaska nurse graduates who are
leaving the state because of lack of this automatic reciprocity.
So far, 35 states and territories have adopted the NLC and
another 11 have introduced legislation to join.
1:44:16 PM
SENATOR HUGHES asked of the 324 emergency courtesy licenses, how
many were coming from out of state.
MS. CHAMBERS replied that they were all from out of state.
CHAIR WILSON asked how many nurses were expedited to graduate
early through the University of Alaska.
MS. CHAMBERS answered that she would get that information.
MS. CHAMBERS said that the benefits joining the NLC are many. If
Alaska had joined the NLC when legislation was introduced in
January 2020, expenses to healthcare facilities, private
individuals, and state government could have been reduced.
Alaska nurses would not have had to bear the great burden during
the COVID surge last fall. An Anchorage Daily News article from
November 28 captured the desperation and burnout faced by
Alaskan nurses during the height of the surge. In the article,
the labor representative for the Alaska Nursing Association
urged administrators to do more to increase nurse numbers. The
NLC is one of the tools facilities need most in their employment
toolbox.
MS. CHAMBERS said that the NLC requirements to obtain a
multistate license are rigorous and exceed the current standards
under Alaska law. The Board of Nursing retains jurisdiction to
oversee and enforce nursing practice in Alaska. The board does
not lose any ability to defend the public's right to a safe
nursing workforce. Alaska would have a vote on the NLC
commission and multistate license fees will pay for their own
program expenses. A single state Alaska license will continue to
function as it currently does. Perhaps most importantly, the
standards enacted in the NLC cannot be changed without the
agreement of the Alaska State Legislature. It is a contract
among state leaders.
1:47:41 PM
SENATOR BEGICH said that Director Chambers stated that NCL
requirements are rigorous and exceed Alaska's. He asked about
the possibility that someone who might have had a multistate
license before the NLC changed could be grandfathered in and not
have to meet the current NLC standards.
MS. CHAMBERS replied that there is no grandfathering in this
agreement. All states have to meet the same standards. Several
years ago there was a first attempt at a compact that did not
have that same level of agreement, but it was abandoned and
states have to agree through their legislatures on the same
standards. There is no one who will hold a multistate license
who does not meet these high standards.
SENATOR BEGICH asked if that is why Pennsylvania endorsed the
NLC.
MS. CHAMBERS responded that at least one state had been working
from the past NLC language and is working to rejoin because its
legislature would finally agree to those higher standards. There
were states that would not join the original compact but who are
determining that now is the time because some of these old
problems have been addressed.
MS. CHAMBERS reviewed the many benefits for Alaska joining NLC
on slide 7:
• Reduces cost and burden on employers in Alaska.
• Expedites disaster relief.
• Increases access to care for Alaskans.
• Increases telehealth options for Alaskans.
• Adds options to keep Alaskan-trained nurses in state.
• Expands employment opportunities for Alaskan nurses.
• Facilitates online education.
• Offers seasonal employee flexibility.
• Eases costs and burden for military families.
• Increases economic opportunities for military base
selections or expansions.
• Reduces cost and burden on nurses moving or
transferring to Alaska.
MS. CHAMBERS presented a table on slide 8 illustrating how NCL
requirements exceed Alaska requirements. The Alaska Board of
Nursing has flexibility considering past civil or criminal
violations, the NLC has zero tolerance for risks to public
safety. Alaska nurses could keep the single state license, but
any nurse who holds a multistate license would be subject to
this rigorous level of scrutiny.
MS. CHAMBERS said that holding a multistate license would be
optional if Alaska entered the compact, but nurses overwhelming
want that opportunity to make that decision. In a December 2019
survey, 92 percent of Alaska licensed respondents said they
support Alaska joining the NLC; 89 percent of these respondents
have primary residency in Alaska and 87 percent of supporters of
the NLC are members of a nursing union. The NLC is good for
residents and the workforce and Alaska nurses want this
employment option.
SENATOR BEGICH commented that it is good to see the survey
results. He asked if any of the unions responded directly to her
in support of the legislation.
MS. CHAMBERS replied that her department has not been in touch
with the union this year on this bill.
CHAIR WILSON asked which union as there are several nursing
unions.
SENATOR BEGICH clarified that he was asking about any union, but
he thinks that Director Chambers is stating that no union has
submitted a letter of support.
MS. CHAMBERS replied that the department has not been in contact
with any of the unions of any type about the NLC this year. Last
year a union representing a fraction of nurses, the Alaska
Nurses Association, had some concerns about the proposed
legislation, and the department addressed all those concerns
with them in hearings. The department is happy to do so again if
concerns are raised.
SENATOR BEGICH clarified that he meant to ask if they had
received any opposition from unions and the answer he is hearing
is no.
MS. CHAMBERS answered that they have not.
1:54:54 PM
SENATOR COSTELLO asked what percentage of the total nurse
population responded to the survey.
MS. CHAMBERS answered about 22 percent of nurses responded. A
standard survey response is 2 or 3 percent. The department
surveyed over 16,000 nurses and received over 3,500 responses.
MS. CHAMBERS presented a list on slide 10 of supporters of
Alaska joining the NLC. The list includes economic development
organizations, military stakeholders, and healthcare providers.
This is just a partial list of Alaska groups supporting the NLC.
The list of national supporters is much longer and a link is
available from the Alaska Board of Nursing's NLC web page.
MS. CHAMBERS thanked the committee for the opportunity to
present and asked for their support.
1:56:31 PM
At ease
1:57:11 PM
SENATOR BEGICH thanked DCCED legislative liaison Glen Hoskinson
and Sara Chambers for meeting with him to address concerns he
had last year about a similar bill. The department's interests
and his are fundamentally the same. They want to ensure that
Alaskan are safe and getting the highest level of care. It
appears that the compact has a high level of care for those in
it, but there is a potential economic impact for the state
because the $500 will not come to the state. He asked how to
address the impact of the bill on the Board of Nursing funding.
MS. CHAMBERS replied that all professional licensing programs
are self-funded. State law requires that. Now the state has
single state licenses. As the board receives funding to cover
the cost for single license, the state will see similar funding
for multistate applications. A fee is shifting to a different
type of license. Applicants will pay for either a single state
license or the multistate license. This is a fundamental
question that many states have had. None of the 35 states and
territories that have joined the compact have seen an economic
downturn because of the shift in cost. The administration is
committed to making sure entering the NLC will not have a
detrimental impact on any other nursing license type and will
continue to follow state law to make sure licenses pay for
themselves.
SENATOR BEGICH said that the initial nurse license fee can cost
up to $500. He asked what the cost is for the NLC license.
MS. CHAMBERS responded that the $500 is the ceiling for a new RN
license. That accounts for several costs such as fingerprinting.
The multistate license will be set by the board and department
using the same economic fee-setting structure that is used now
to determine the license cost. There is not a set national cost
for the NLC. That fee is set at the state level.
SENATOR BEGICH asked if it is reasonable to assume that the NLC
license will be around $500.
MS. CHAMBERS responded that it is highly likely. The department
has to take into account many factors, including how many nurses
will want multistate licenses. Once the legislature adopts the
NLC, that will be done through the public regulation process. It
should be about the same as a regular license because a lot of
the processes are similar. The savings comes when people who
hold a multistate license come to Alaska to work or when
Alaskans want to use a multistate license outside of the state.
They only pay a fee one time and do not have to accumulate
licenses from various states.
2:03:28 PM
SENATOR BEGICH said that it should say that an initial Alaska
nurse license can cost over $500 for those already holding a
multistate license, but the consequence would if they are
already holding a multistate license they will not pay the
Alaska fee.
MS. CHAMBERS answered that is correct.
SENATOR COSTELLO said that a federal law requires that if nurses
change facilities, in the same state or a different state, that
they are responsible for getting a new set of fingerprints
processed. She asked who would pay for the fingerprinting that
is required by federal law for those nurses who come from out of
state to take a position.
MS. CHAMBERS replied that her agency and the Board of Nursing
are responsible for state licensing and are not responsible for
employment-related requirements for fingerprinting. People in
healthcare facilities often have to get multiple sets of
fingerprints because federal law prohibits sharing that
fingerprinting. That is between employees and employers.
SENATOR COSTELLO said that in the governor disaster declaration,
he asked for a six-month delay for fingerprinting for those
coming into the state in the nursing profession. The argument is
that this brings nurses on more quickly, but the committee needs
to learn more about the fingerprinting process. If there will be
a delay anyway, then it may not be accurate to say this will get
nurses on the frontlines more quickly.
MS. CHAMBERS responded that they are different topics and
different types of fingerprinting. As a licensing agency, her
department used the provision in SB 241 that then was carried
through the governor's health orders. It was hard to get
fingerprints done in person during COVID; it was difficult to
get hand-rolled fingerprints. The agency worked through the
National Fingerprinting Compact to get a grace period to do
name-only checks and followed up with fingerprints later. There
is no delay in fingerprinting at this time.
2:07:03 PM
SENATOR HUGHES asked if there is a nursing shortage here in
Alaska, is there is a national shortage.
MS. CHAMBERS replied that it depends on the state. Many states
have an increasing older population, which increases nursing
needs. Some states are projected to have a surplus of nurses and
some are projected to have a deficit. It is nuanced. It depends
on location, age, and availability.
SENATOR HUGHES asked if Alaska nurses want to be part of the
compact, will they need the Alaska and the multistate licenses
or just the multistate license.
MS. CHAMBERS answered that they would only need the multistate
license. That would be their pass to all states, including
Alaska.
SENATOR HUGHES asked if enforcement by the Board of Nursing
would only be for Alaska nurses, whether they have only an
Alaskan or multistate license, or would the board have
jurisdiction when an out-of-state nurse comes to Alaska with a
multistate license and action must be taken against the nurse.
MS. CHAMBERS said that is an important question. The Alaska
Board of Nursing would retain jurisdiction over nurses whose
home state is Alaska and the practice of nursing in Alaska that
occurs in Alaska. That would include multistate licensees who
are practicing in Alaska. It depends on the location of where
services are being delivered. If someone with a multistate
license is not an Alaskan came to Alaska and did something to
violate state statutes or regulations or state practice act,
then the Board of Nursing would have a responsibility under the
compact to take action to prohibit that person from continuing
to practice. The board would also have to report the violation
to the compact administration. Then the commission reports that
to the home state and the multistate license is suspended in all
states until it is unencumbered again. It maintains the same
level of governance over anyone practicing nursing in Alaska.
SENATOR HUGHES commented that that is helpful because she was
hearing misinformation which said that the Board of Nursing
would not have that jurisdiction.
2:12:07 PM
SENATOR REINBOLD asked if any nurses have been furloughed
because of COVID. The unemployment numbers are high. She wants
to get that information about what nurses are unemployed at this
time before the state gets people from Outside.
MS. CHAMBERS replied that the Board of Nursing does not employ
nurses and does not have those numbers. Employment numbers would
need to come from employers.
SENATOR REINBOLD said that she wants to see those numbers before
engaging in this discussion about this bill. She wants to know
if there is a surplus of nurses anywhere in the state. Local
hire is important.
MS. CHAMBERS said the ASHNHA survey showed 670 vacancies in 2019
prior to COVID and the board issued almost 400 emergency
licenses during COVID. The numbers show it is heading in the
other direction.
CHAIR WILSON said someone from ASHNHA is online and perhaps
could provide that information.
SENATOR REINBOLD said that she has heard that many nurses have
been laid off and that some offices and clinics have closed. She
wants to look at the landscape of who is already out there
before making any significant changes.
CHAIR WILSON called on Rose Lawhorne to address the unemployment
question.
2:14:45 PM
ROSE LAWHORNE, Chief Nursing Officer, Bartlett Regional
Hospital, Juneau, Alaska, said she was also speaking on behalf
of ASHNHA. Multiple nurses are working in various environments.
She is not aware of any furloughed nurses, especially in
Southeast, who were not repurposed in other jobs. Bartlett
Hospital worked hard to provide employment to nurses whose jobs
were temporarily suspended because of the pandemic. Training
needs to be in place prior to repurposing a nurse from one area
to another. The licensure requirements are the same, but there
are specialty certifications required before a nurse can work
safely in specialty areas. Her colleagues in Anchorage said the
facilities worked hard to provide jobs to nurses whose jobs were
affected by the pandemic.
SENATOR REINBOLD said she wants to make sure no one is
unemployed. She prefers Alaska preference.
SENATOR BEGICH said he had a question about page 26 of the bill
about indemnity but responded to the chair's suggestion to wait
until the sectional.
SENATOR COSTELLO asked about the nurse hotline. A nurse in
Alaska who wants to help administer the COVID vaccine can call
the hotline to find a position. She asked how many nurses are
waiting to administer the vaccine.
MS. CHAMBERS replied that the hotline would be administered by
the Department of Health and Social Services (DHSS). The Board
of Nursing is not engaged with the hotline but will get that
information.
CHAIR WILSON asked Director Chambers to present the sectional.
MS. CHAMBERS said that before going into the sectional, she
wanted to point out that Sections 1-22 and 24-36 are all
conforming amendments. She will go through the sectional for the
new parts of the law, AS 08.69. She will focus on Section 23,
which would establish the compact. These articles are uniform to
all states in the compact and are mandatory for participation.
Section 23 is not flexible language. All states must agree to
that language if they want to adopt the compact.
2:20:24 PM
MS. CHAMBERS began the sectional analysis:
Section 23: Creates AS 08.69, Multistate Nurse
Licensure Compact. These articles are uniform to all
34 other states within the compact and mandatory for
participation.
Article 1: Establishes the legislature's findings of
the need for the compact and its declaration of the
compact's purpose in Alaska.
Article 2: Establishes definitions and terminology for
use in this section.
Article 3: Establishes the general provisions for
multistate licensure common across all participating
states:
• It clarifies that partner states have
jurisdiction to take adverse action against
multistate licensure privilege and requires
states to notify the administrator of the
coordinated licensure system when adverse
action against a multistate license occurs.
• It enforces that a nurse practicing in a
partner state must comply with the practice
laws of the state in which the client is
located at the time the service is provided.
• It clarifies that nothing in the compact
shall affect the requirements established by
a partner state for the issuance of a
single-state license.
•
Article 4: Creates uniform standards for applications
for multistate licensure.
Article 5: Provides licensing boards with the power
to:
• Take action against a nurse's privilege to
practice in that partner state;
• Complete pending investigations of a nurse
who changes primary residency and to report
those actions to the administrator of the
coordinated licensure system;
• Obtain and submit fingerprints to the FBI
for criminal background checks and to use
those results for the purpose of licensure;
• If permitted by state law, to recover from
the affected nurse the costs of
investigations and disposition of cases
resulting from adverse action taken against
that nurse; and
• Deactivate the multistate privilege if
adverse action is taken in the home state
until such time that all encumbrances are
removed from the license.
Article 6: Establishes the rules for a coordinated
licensure information system and provides for exchange
of information among partner states, including
provisions for ensuring the privacy of information
contained in such system.
Article 7: Creates the Interstate Commission of Nurse
Licensure Compact Administrators, which is the body
overseeing the function of the multistate license.
• Each state shall have only one
administrator, who is a voting member of the
Commission.
• With few exceptions as allowed by law,
meetings will be open to the public and
publicly noticed. Meetings held in executive
session will be noticed, the cause for a
closed meeting will be stated, and all
resulting actions will be taken in public.
• This article confers certain administrative
powers to the Commission, which do not
impinge upon the sovereignty of partner
states.
2:24:00 PM
SENATOR BEGICH said that he wanted clarification about Sections
2 and 3 on page 26, Qualified Immunity, Defense and
Indemnification, "the administrators, officers, executive
director, employees and representatives of the Commission shall
be immune from suit and liability." He described that as
standard language, but he asked if Alaska would then be
potentially liable if the commission were to pass down fines or
settlements to individual states.
MS. CHAMBERS replied that she will explore that question with
the Department of Law. This indemnification language is similar
for board members in Alaska. If acting within the reasonable
scope of state law they are protected by Alaska state law and
not held personally responsible. To her this language seems
similar to that. She will ask the Department of Law for a
response.
SENATOR BEGICH said a simple response from the Department of Law
would be satisfactory.
MS. CHAMBERS continued the sectional:
Article 8: Establishes a transparent and public
rulemaking process to carry out the powers in the
previous article.
Article 9: Establishes the agreement for oversight,
dispute resolution, and enforcement of the compact.
Article 10: Sets an effective date for the compact,
the process for a state legislature's withdrawal from
the compact, and the process of amendment of the
compact through statutory changes in each member
state.
Article 11: Reinforces the primacy of the
constitutions of each party state and codifies
additional interpretation of the construction and
severability of the compact.
Sections 24-36: Amend statutes to add AS 08.69
(created by Section 23 of this Act) to the definitions
of nursing as found throughout state law:
Section 37: Allows the department to adopt regulations
necessary to implement the changes made by this Act,
to take effect under AS 44.62 on the effective date as
noted in Section 38.
Section 38: Makes Section 37 (Transition Regulations)
effective immediately once the bill is signed.
Section 39: Makes Sections 1-36 of this Act effective
as of July 1, 2022.
CHAIR WILSON asked if the compact would create any obstacles for
state auditors to complete their functions.
2:27:42 PM
MS. CHAMBERS replied that she did not think so because this
compact and its agreements will be in Alaska state law and
auditors could perform the same fiduciary responsibilities and
have access to the same information as they do now.
SENATOR BEGICH commented this has been a very thorough overview
and gave him a greater idea than last year about what the
compact does. He appreciated that. She mentioned something in
passing about the expiration of licenses all on the same day,
this coming Sunday. He asked if nursing licenses expire on a
particular date.
MS. CHAMBERS replied that all of Alaska licenses in all
professions are two-year licenses. Each profession expires on
the same date. This allows the agency efficiency in helping
licensees to know that date and to streamline processes.
SENATOR BEGICH commented that he recognizes that is good for
notification but he guesses that creates a huge crunch for
approval of licenses on her staff. He clarified that on any
weekend in a two-year period the state can lose up to 23 percent
of its nurses.
2:29:47 PM
MS. CHAMBERS responded that the agency starts the process more
than three months ahead of time. The renewal is all online. The
renewal is less onerous than the initial license. Nurses have
had at least five months to renew their licenses. The data point
is interesting because it speaks to nurses who apparently do not
intend to renew their licenses because they have had plenty of
opportunities to do so. The agency looks to the system to be
efficient to keep staffing numbers low. All facilities and
nurses know when those licenses expire. It allows fees to be
consistent and keep costs lower. The agency is always open to
new ideas and improvement, but this process seems to have worked
best for everyone. No nurse is unaware of the licenses expiring
on Sunday.
SENATOR BEGICH said these have been extraordinary times with
tremendous burdens on the health system. Extraordinary actions
have been demanded of nurses and other medical practitioners. He
hoped there would be some effort at assessing that 23 percent
and whether the process should be more lenient at this time.
SENATOR HUGHES asked what has happened in other states with a
shortage of nurses that have entered into the compact in terms
of in-state nurses. For example, Alaska had 670 openings. Alaska
is graduating nurses from the university system. If the state
were to do this and bring in nurses with multistate licenses
from out of state, she asked if there will still be plenty of
jobs for Alaska nurses. She wondered how that might impact
salaries. She assumed a hospital would not pay less to a nurse
from out of state. Even though the survey indicated an
overwhelming number of nurses support the compact, she has heard
some concern about that.
MS. CHAMBERS replied that she did not want to leave the
impression that there are no out-of-state nurses in Alaska now.
That 22 percent of nonrenewing nurses could very well be all of
the out-of-state nurses who have been working in Alaska who
don't intend to renew in Alaska. Out-of-state nurses provide a
bulk of employment in the state now and they always have. Her
agency licenses anyone who meets the criteria set in law and
regulation. Residency is not a factor in their employment. This
bill reduces government barriers to hospitals and clinics
bringing in the nurses they are already bringing in. They could
do that with less paperwork and expense. The nurses wouldn't
need to go through her office. They could just get to work That
is good for healthcare in Alaska. These are nurses who are going
come to Alaska one way or another. It is not a recruitment to
suddenly pull a lot of nurses from other states. It reduces
government barriers if someone wants to come to work in Alaska.
SENATOR REINBOLD said that she and Senator Hughes have been
saying the same thing about the impact to Alaska nurses. She
would like to know the unemployment numbers for those in the
medical profession, especially nurses, and changes in licensure
from 2019 to 2020 because COVID has changed the landscape. She
would prefer the 2020 numbers. She wants to know the impact for
Alaska nurses because unemployment is high in the state.
CHAIR WILSON asked if Director Chambers could help the committee
get the 2020 data on licensure.
MS. CHAMBERS said her agency maintains the licensure data and
will work with the Department of Labor, DHSS, ASHNHA, and
private agencies to locate the unemployment numbers for the
nursing sector.
SENATOR HUGHES asked that Director Chambers listen to the
meeting recording to fully understand her question and provide
an answer in writing. Senator Hughes would like to know what has
happened with states that have had shortages and whether that
will make it tough for Alaska nurse graduates as well as nurses
in the state. She wants to understand the impact of the NLC on
in-state nurses and would like the answer in writing. Director
Chambers mentioned the bulk of nurses are from out of state. She
asked if that meant the nurses picked up to fill these vacancies
or, at any one point in time, are more nurses working in the
state from out of state than in state.
MS. CHAMBERS replied that she will follow up in writing.
2:38:35 PM
CHAIR WILSON moved to invited testimony.
2:38:55 PM
DANETTE SCHLOEDER, Chair, Alaska Board of Nursing, Anchorage,
Alaska, said one of the duties of the board is licensing. A
common belief is that only the best nurses get Alaska licenses.
In reality, a license of any type is awarded to someone who
meets the minimum qualifications as established by law. All
nurses graduate from accredited programs and sit for the exact
same national licensing examination. Licensing and competency
are not synonymous. The licensing requirements under the NLC are
stricter than Alaska's current requirements. In August of 2019
the board voted to support the NLC after listening to nurses and
employers. The board examined the current evidence-based
literature and nursing practice trends in Alaska and across the
nation. The board also considered the experiences of boards of
nursing that enacted the NLC.
MS. SCHLOEDER said that the previous version of the NLC may not
have been a good fit for Alaska, but the current NLC with its
uniform licensing requirements is a good fit. The federal
government projects over 200,000 new nurse positions will be
created in the years 2016-2026. The committee has heard
information about the current vacancies in Alaska. Nationally
about 33 percent of nurses engage in telehealth activities
across state lines. The Alaska Board of Nursing met a nurse who
holds 17 single state licenses to do her job. Holding multiple
licenses does not make her a better nurse but adds an
unnecessary barrier to nursing practice. The NLC was first heard
by this committee in February 2020. At that time no one could
have predicted the events that unfolded. The Board of Nursing
issued emergency regulation for the courtesy licensing. That
emergency regulation allowed courtesy licenses to be issued to
any nurse with an unencumbered nursing license in any state.
Although the board issued almost 400, it was not enough to meet
the ongoing need.
MS. SCHLOEDER said that nurses have choices of where to work,
whether it is a permanent move or a temporary assignment. Nurses
are drawn to NLC states because they can immediately practice
nursing without delay or cost. Nurses have been at the
frontlines of this pandemic. They are asked to work extra shifts
every day. They have all seen images of these nurses in the
media. The pandemic has shown the skill, compassion, and
resiliency of these amazing nurses. In February 2021, the Board
of Nursing unanimously reaffirmed its complete support for the
NLC. The bill will help the mobility of the profession, simplify
the licensing process, and help healthcare move forward.
2:43:48 PM
TAMMIE PERREAULT, Northwest Regional Liaison, U.S. Department of
Defense, Washington, D.C., said that on behalf of military
families and the Department of Defense (DOD), she is supporting
SB 67. One of the DOD key quality of life issues is working to
help enact interstate compacts to improve licensure options for
military spouses, veterans, and service members. Easy licensure
transition is very important for military spouses as 68 percent
of service members reported that the ability of their spouses to
maintain a career impacts their decision to remain in the
military. Compacts such as the NLC are beneficial for the 53
percent of military spouses who work in healthcare professions.
The DOD has partnered with the National Council of State Boards
of Nursing to support the NCL, which allows military spouses to
use their state of legal resident as their home state for the
privilege to practice. Joining the NLC is a benefit to those
military spouses who are Alaska residents. By joining the
compact, Alaska spouses have the benefit to practice in 34
states when stationed away from their homes. These allows
military spouses from Alaska a seamless way of maintaining
careers when changing duty stations and then returning to
Alaska. Many service members retain multistate license allowing
them to work in a federal facility. However, they cannot conduct
training, seamlessly support emergencies, or provide additional
hours of service to maintain their skills in a nonfederal
facility. By joining the NLC, Alaska would benefit from military
members being available to train and provide care in their
communities. The percentage of military spouses in Alaska is the
second highest in the nation with nearly 8,000 active duty
spouses. Thirty-four percent of those spouses in the workforce
are in licensed occupations. Seventy percent of surveyed
military spouses who hold an occupational licenses have
encountered challenges maintaining them. SB 67 is a tremendous
step forward for the state to ease the burden of licensure for
military spouses, military members, and veterans.
2:47:26 PM
MS. LAWHORNE said that healthcare facilities in Alaska,
particularly those in isolated areas, would benefit from the
NLC. Bartlett Hospital is a small community hospital with
limited resources that experiences staffing challenges. The
prepandemic healthcare burnout was real. Currently nursing staff
is experiencing postpandemic burnout. Bartlett has 10 open
nursing positions. The cost of filling these with travelers is
double that of permanent nurses. Their contracts typically
extend for 13 weeks. That is much time and effort for 13 weeks
of nursing care. Bartlett hired 12 travelers last year when
volumes were down due to restrictions on elective procedures and
the hesitancy of patients to seek medical care. In the two years
prior, Bartlett hired 20 travelers per year. Cumbersome
licensing processes reduce Bartlett's ability to provide
uninterrupted care to patients without overloading existing
staff. Exhausted staff trying to fill staffing gaps leads to
reductions in quality of care, increased errors, susceptibility
to illness, and creates additional vacancies. Patient flow and
safety and hospital capacity are negatively impacted with
typical licensure processing time. Temporary licensing still
causes delays. Maintaining multiple licenses is costly and a
deterrent for nurses selecting work destinations. Specialty
areas experience additional recruitment challenges related to
certification requirements. During disasters and disease
outbreaks, like COVID-19, rapid mobilization of qualified
nursing staff is essential for continuity of operations. The NLC
will help fill gaps in nursing resources and serve as a
recruitment tool. It is not uncommon for nurses to come to
Juneau temporarily and decide to stay. In the growing world of
telemedicine, licensure compacts facilitate effective and
efficient use of nursing resources. The NLC promotes interstate
educational opportunities in hospitals that wish to collaborate
but don't due to licensure restrictions. The demand for nurses
is expected to increase in coming years. The nursing workforce
deficit will grow and jeopardize patient care unless the state
acts now to draw nurses to Alaska. The NLC supports healthy
workforce and offers a broad resource pool for recruitment and
selection of nurses.
2:51:44 PM
BRIAN NORTON, R.N., Manager, Cook Inlet Dialysis Fresenius
Kidney Care, Anchorage, Alaska, said that Fresnius Kidney Care
serves 330 patients in Anchorage, Fairbanks, Juneau, Soldotna,
and Wasilla. Dialysis nursing is a very specialized field.
Because Fresenius is a large company, it relies on the ability
to bring dialysis-trained nurses from other states in times of
need. The Centers for Medicare and Medicaid Services have strict
requirements for registered nurses in the dialysis setting that
make it difficult to use nurses who do not have experience to
fill in during shortages. If nurses give two-week notice when
they are leaving, the clinic can go from stable staffing to
instability quickly. Fresenius currently has 10 openings for
permanent RN positions. It takes an average of 75 days to fill
them. According to a study, by 2030 Alaska will have the highest
percentage of nursing vacancies at 23 precent. Twelve Fresenius
dialysis nurses used emergency temporary licensing allowed by
the Board of Nursing. For dialysis patients, interruptions and
delays in treatment schedules are more than just an
inconvenience, it is critical. It is vital to have a permanent
way to bring dialysis nurses from other states immediately
during any disaster. The compact has a history of working well.
In 2018 the original 26 states passed the enhanced Nurse
Licensing Compact. Additional states have joined. In 2020, the
Pennsylvania state nurses association surveyed 15 compact states
and found that concerns such as lost revenue to state boards of
nursing and public safety concerns had not materialized. The
association changed from opposing the compact to supporting it.
He asked the committee to support the NLC.
SENATOR BEGICH shared that he had met some of his staff last
year who talked about Fresenius efforts to develop local
workforce. He asked Mr. Norton to share the work his company has
done with local workers.
MR. NORTON replied that work frequently in community to promote
ways of helping patients who receive dialysis. The company
engages nurses in other facilities to coordinate care.
2:55:46 PM
REBECCA FOTSCH, Director, State Advocacy & Legislative Affairs,
National Council of State Boards of Nursing, Chicago, Illinois,
said she had called in to answer any technical questions about
the compact or any other questions.
CHAIR WILSON responded that there were no questions at this
time. He clarified with Director Chambers that any changes to
the compact must be approved by the legislature. He asked if any
there were any anticipated changes with the compact that would
need action from the legislature that would possibly hinder
participation in the compact.
MS. CHAMBERS asked for clarification.
CHAIR WILSON said perhaps Ms. Fotsch could answer whether there
have been any changes to the compact that all the states had to
agree to.
MS. CHAMBERS responded that her understanding is that if there
is a change that must happen to Section 23, all of the states
would have to ratify the same kind of change. That would only be
for the multistate license and not affect any changes to the
state license.
MS. FOTSCH said that has happened once. All of the states came
together because they knew they needed to make a change in the
language. That old compact was in existence for 15 years and had
25 members. The old NLC language stalled at 25 members, so the
NLC states changed it so that all states could be members. All
the compact states had to agree to it. She hopes there will be
no change any time soon. The intent of the compact states is not
to have to do that.
SENATOR COSTELLO said that is important to her that Alaska grow
its own in Alaska, such as engineers, teachers, and nurses. She
has observed nurse graduation ceremonies in Anchorage. If the
NLC requirements are more stringent than the state license
requirements, the multistate license gives individuals more
flexibility, she asked if that license will be valued more than
an Alaska license. She asked if there any concerns about
displacing Alaskans who are committed to living here with nurses
from outside of the state.
MS. CHAMBERS responded that the intent is to provide more
flexibility and mobility for nurses to meet healthcare needs.
Her agency has talked one constituency group, those graduating
nurses, who are leaving the state because Alaska does not have
the compact. They want to pay for one license and have
flexibility to travel. The agency is responding to the desire of
graduating nurses to have that flexibility. The question of
whether a multistate is more valuable than an Alaska license is
an interesting question. That is a question for each employer.
There is no change in what a registered nurse or licensed
practical nurse could do with either an Alaska license or the
multistate license. The Alaska Practice Act governs the practice
of nursing. The agency is trying to retain Alaskan homegrown
nurses and make sure they don't want to leave Alaska by adding
this attractive tool in their toolbox.
3:04:00 PM
CHAIR WILSON held SB 67 in committee. He encouraged written
testimony be sent to shss@akleg.gov.
3:04:29 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 3:04 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 67 version A.PDF |
SHSS 2/23/2021 1:30:00 PM |
SB 67 |
| SB 67 Transmittal Letter to the Senate (1.29.21).pdf |
SHSS 2/23/2021 1:30:00 PM |
SB 67 |
| SB 67 Sectional Analysis for (S)HSS.pdf |
SHSS 2/23/2021 1:30:00 PM |
SB 67 |
| SB 67 FN 1 DCCED.pdf |
SHSS 2/23/2021 1:30:00 PM |
SB 67 |
| SB 67 FN 2 DHSS.pdf |
SHSS 2/23/2021 1:30:00 PM |
SB 67 |
| SB 67 FN 3 DPS.pdf |
SHSS 2/23/2021 1:30:00 PM |
SB 67 |
| SB 67 NLC Fast Facts (NCSBN).pdf |
SHSS 2/23/2021 1:30:00 PM |
SB 67 |
| SB 67 NLC States Map (NCSBN).pdf |
SHSS 2/23/2021 1:30:00 PM |
SB 67 |
| SB 67 USAF Support of Military Families - Professional Licensure Portability in Basing Decisions (Feb 2020).pdf |
SHSS 2/23/2021 1:30:00 PM |
SB 67 |
| SB 67 Supporting Doc - Nurse Licensure Compact One-Page Summary (2.5.21).pdf |
SHSS 2/23/2021 1:30:00 PM |
SB 67 |
| SB 67 - DCCED Nurse Licensure Compact Presentation (2.19.21).pdf |
SHSS 2/23/2021 1:30:00 PM |
SB 67 |
| SB 67 Letters of Support 2.22.21_Redacted.pdf |
SHSS 2/23/2021 1:30:00 PM |
SB 67 |