Legislature(2023 - 2024)ADAMS 519
05/03/2024 09:00 AM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB149 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 187 | TELECONFERENCED | |
| + | HB 149 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE BILL NO. 149
"An Act relating to the licensure of nursing
professionals; relating to a multistate nurse
licensure compact; and providing for an effective
date."
9:10:24 AM
REPRESENTATIVE MIKE PRAX, SPONSOR, relayed that he
introduced the bill at the request of the Alaska Board of
Nursing (ABN) who unanimously supported the muti-state
Nurse Licensure Compact (NLC). He explained that the NLC
allowed registered and licensed practical/vocational nurses
to practice under one multistate license, with the
privilege to practice in their home state and other NLC
states without obtaining additional licenses. The
requirements were more stringent than Alaska's and allowed
nurses moving to the state to start working sooner. He
believed that adoption of HB 149 would help alleviate the
state's nursing shortage. He reported that the only change
to the bill was in Section 6 that required the board to
submit a report to the legislature if the requirements of
the compact no longer met or exceeded Alaska's licensing
requirements. He recommended proposing some amendments to
clean up the conforming language, possibly including a
sunset date, and require reporting from hospitals as to the
efficacy of the program. He pointed out that the the
effective date would need to be updated to July 1, 2025.
Co-Chair Foster indicated that he would like to proceed to
public testimony.
9:15:25 AM
Co-Chair Johnson remarked that all legislators had gotten
requests from nurses asking them to help with speeding up
licensure. She asked if there would be a database of out-
of-state nurses participating in the compact in Alaska.
Representative Prax deferred the answer to the Department
of Commerce, Community and Economic Development (DCCED).
9:16:44 AM
Co-Chair Foster OPENED public testimony.
9:17:30 AM
KATI CAPOZZI, PRESIDENT AND CHIEF EXECUTIVE OFFICER, ALASKA
CHAMBER OF COMMERCE, testified in support of HB 149. She
relayed that the chamber supported the bill. She elaborated
that the mission of the chamber was to promote a healthy
business environment in the state. The chamber was the
largest business organization in the state with over 700
members. The chamber had a formal policy position that
supported joining the multi-state nurse compact. She
elaborated that a poll conducted by the chamber showed 86
percent of Alaskans also supported joining the NLC. The NLC
was an agreement between states that allowed nurses to work
in any states that join the compact under a single license.
Currently, 39 states had joined the compact. Joining the
NLC would reduce delays in the licensure process which were
known barriers to nurses wanting to work in Alaska. She
noted that there were many active duty military members in
the state with licensed nurse spouses. The compact would
help them transition into the state's healthcare workforce.
9:19:54 AM
Representative Josephson asked if she was aware that only
22 percent of Alaska's licensed nurses responded to the
survey and 40 percent of all respondents were out of state.
Ms. Capozzi responded that she had just gotten the results
of the survey and it had not been made public yet.
Representative Josephson deduced that he was referring to
another survey and asked if she was aware of the data he
cited. Ms. Capozzi answered in the negative.
Representative Ortiz asked how many people were surveyed in
the poll Ms. Capozzi cited. Ms. Capozzi answered that 697
responded and that it was a public opinion survey.
Representative Stapp asked whether Alaska would have more
nurses or less nurses if the bill was adopted. Ms. Capozzi
responded that she thought the state would have more
licensed nurses. Representative Stapp agreed. He asked if
having more nurses was a good thing. Ms. Capozzi responded
that it would be good.
9:22:42 AM
VICKY BYRD, CEO, MONTANA NURSES ASSOCIATION, CLANCY,
MONTANA (via teleconference), did not support the compact.
She explained that Montana had been in the compact since
2015 and there had been some significant unintended
consequences. She related that public opinion made the
license compact sound great. She shared some
misperceptions. She emphasized that nurses with a multi-
state license still had to obtain a new home state license.
She elucidated that there were nurses in Montana who did
not obtain a home state license. Some nurses practicing
under another state's multi-state license expired leaving a
couple of nurses that were working without a valid license.
She stressed that there were many challenges with the
compact that she was experiencing in Montana. The compact
had not staffed the state's hospitals and a compact did not
necessarily bring more nurses into a state. The nurse can
choose what state she wanted to work in. Due to some nurses
not obtaining their new home state license, Montana had
unlicensed nurses practicing in the state. The employer can
confirm that a nurse has a multi-state license, but the
nurse was not abiding by the rules of the compact by not
obtaining a home state license as well. She cautioned that
home state licensing was a significant misunderstanding and
NCL education regarding the compact was inadequate.
9:25:53 AM
Representative Stapp asked if the issue was unique to the
compact or if it was a state regulatory issue. He relayed
personal information regarding his multi-state real estate
license. Ms. Byrd responded that it was a compact issue.
She explained that the compact mandated that a nurse must
obtain a new home state license along with the multi-state
compact license.
Representative Hannan asked if she was familiar with travel
nurses. Ms. Byrd answered in the affirmative and thought
that travel nurse companies were "laughing all the way to
the bank" regarding the NCL. She indicated that before the
compact, most travel nurse companies would purchase
licenses in neighboring states and send nurses there. With
the compact they only need to purchase a multi-state
compact license therefore the business owners would make
more money, but the savings was not passed along in nurses'
salaries. Representative Hannan asked if she had seen a
reduction in travel nurses in Montana due to the compact.
Ms. Byrd responded that she would need to ask the health
facilities for data. She emphasized that the compacts did
not staff the hospital pre or post pandemic. Her facility
was hiring the same number of traveling nurses.
Representative Hannan asked if multi-state compact nurses
were getting paid the same wages as resident nurses. Ms.
Byrd replied that travel nurses employed through a travel
agency were paid two to three times higher whether or not
they have a multi-state compact license; they were still
employed through the agency regardless of license type.
Representative Hannan was asking about a multi-state
compact nurse who was coming to work for a period of time.
Ms. Byrd responded that the nurse would get paid the same
as the resident nurses.
9:32:04 AM
Representative Ortiz asked if Alaska joined the compact
agreement would it have any impact on reducing the number
of travel nurses being utilized throughout the state. He
wondered whether they were related to each other in any
way. Ms. Byrd responded that in her opinion and experience
the travel nurse utilization would remain the same or
increase. The compact did not encourage more or less nurses
to a state because the nurse still got to choose what state
she moved to. She reiterated that the compact would not
staff Alaska's hospitals. Representative Ortiz asked if
Alaska joined the compact agreement, would it give Alaska
nurses more ability to leave and practice in other states.
Ms. Byrd replied that nurses would still have the choice to
leave regardless of the compact; they could leave the state
just as easily as others could come into the state. She
related that when a nurse left a state with a multi-state
license and obtained another home state license, she would
have to reapply and obtain her original home state license
if she returned.
9:35:12 AM
Representative Galvin asked whether Ms. Byrd's conclusion
that the compact would not fill vacancies in Alaska was
based on data. Ms. Byrd answered that her conclusion was
anecdotal. It had been her personal experience as a nurse
in Montana for 35 years and in her association role for a
decade that the compact was not staffing Montana's
hospitals. She stressed that the number one issue remained
staffing. Representative Galvin she asked if nurses left
the state more during the winter months. Ms. Byrd responded
that she did not have any data on the topic, but the
compact would not affect whether people chose to go south
for the winter.
9:38:11 AM
Co-Chair Johnson shared that Alaska had a high military
population, which brought spouses seeking employment. She
asked if she felt like the compact helped people who came
to the state for a short period of time if a nurse did not
want to change their home state license. Ms. Byrd responded
that the military spouse nurse aspect was a small
population. She shared that she had been an army nurse and
relocation was known in ample time. Any licensing barriers
could be dealt with by a state's board of nursing. She had
not seen a significant issue or barrier that prevented
military spouse nurses from getting licenses or work.
Co-Chair Foster noted that there were 17 more testifiers
and he wanted to make sure people had the opportunity to
testify.
Representative Josephson relayed that the state's nursing
board reported that it was taking about 4 weeks to process
a license. He asked if the timeframe sounded positive. Ms.
Byrd responded that she was not aware of the process in
Alaska, but the board could either speed up or delay the
process. She deduced that four weeks did not sound bad and
someone moving to the state could prepare before the move.
9:42:13 AM
CHRIS LOGAN, NURSE, ADVANCED PRACTICE REGISTERED NURSES
ALLIANCE, ANCHORAGE (via teleconference), favored the
legislation. She related that she was a nurse in Alaska for
24 years and worked in Anchorage and Homer. She currently
worked as an advanced practice nurse in anesthesia. She
represented 1,800 advanced practice nurses in the state and
supported the passage of HB 149. She believed that the
nursing shortage was a crisis. There were many avenues to
increase the number of nurses and the legislation was just
one of the avenues. It was imperative that the legislature
take any action that could help increase the number of
nurses in the state. She indicated that if a multi-state
compact nurse became a permanent resident of another state,
the nurse did need to obtain a home license. The multi-
state license decreased the licensing burden. She
referenced the survey cited by Representative Josephson and
reported that it was conducted by the Board of Nursing and
was available on its website. She relayed that 89 percent
of the state's registered nurses were in favor of the
compact and 85 percent of nurses in a union were in favor
of the compact. She furthered that 48 states had adopted or
had pending legislation. She elaborated that the compact
license requirements included state and federal
fingerprints and background checks and a 60 day primary
state of residency license requirement. It required the
nurse to accept a permanent position and obtain an Alaska
compact license. She indicated that a military spoused did
not have to obtain an Alaska license if she was working in
the state for short time. She asked the committee to pass
the bill.
9:45:34 AM
Representative Stapp thought her testimony clarified some
facts and felt that it was important to have people who
lived in Alaska testify. He shared that he had about 2
dozen registered nurses in Fort Wainwright who were not
practicing nursing because they could not get certified in
Alaska. He asked if she could articulate how important it
would be for military nurses for the state to adopt the
compact. Ms. Logan replied that it was difficult for her to
answer the question. She could only offer anecdotal
evidence. She deferred to the board.
Representative Cronk asked why anyone might oppose the
bill.
Ms. Logan responded that she thought the unions believed
that having more active nurses would drive down wages.
However, she thought the argument was moot because the
shortages were driving wage increases. Representative Cronk
understood the unions would oppose the compact, but 85
percent of union nurses supported it. Ms. Logan responded
in the affirmative.
9:48:08 AM
BRUCE SEETON, SELF, ANCHORAGE (via teleconference), spoke
in opposition to the bill. He argued that the bill would be
bad for nurses and bad for Alaskans. There were large
corporate staffing pools and travelers would be paid more
for nursing. He mentioned Artificial Intelligence (AI) and
telehealth and the believed that nurses would be employed
in other states. He maintained that the compact would not
bring residents to the state. He voiced that he had been a
nurse for over 20 years and worked with many travelling
nurses. There were shortages in all the compact states.
Many travelers did not get the same benefits as residents.
He offered that the nursing programs in the state graduated
100 nurses each year. Nursed from Alaska that remain in
state build community versus itinerary workers. He believed
that the bill was disservice to the state. He pointed out
that there were no compacts for other professions. He
believed in local hires for local work. He concluded that
if the state wanted to help nurses it should create a safe
work environment.
9:51:28 AM
PAIGE SPENCE, DIRECTOR, GOVERNMENT RELATIONS, OREGON NURSES
ASSOCIATION (via teleconference), testified in opposition
to the bill. She offered that Oregon also did not have a
nurse compact. She mentioned an FBI investigation in 2023
called "Operation Nightengale." The operation unearthed a
scheme where schools in Florida were selling fraudulent
nursing degrees. It resulted in people without nursing
qualifications working throughout the country. She
indicated that many states were currently still dealing
with nurses practicing with fake diplomas. She related that
due to rejecting the compact, all Oregon nurses had current
and valid licenses through its board and swiftly identified
and took appropriate disciplinary action including removing
licenses from the nurses practicing illegally. She believed
that joining the compact would cause the state to lose the
workforce data that helped the state plan for the future.
She indicated that the compact was run by a private entity
versus a government entity. The state of Oregon invested
significantly in workforce development and retention. She
deduced that the compact could hinder the important
workforce analysis the state relied on.
9:54:21 AM
JESSICA SEXTON, SELF, ANCHORAGE (via teleconference), spoke
in opposition to HB 149. She shared that she was a critical
care nurse for 16 years. She elucidated that she had done
all types of nursing including travelling nursing. She
declared that the compact did not fix the nursing shortage.
The problem with the shortage was that there was no work
life balance, nurses did not feel safe causing them to
exit the job due to the working conditions. The compact
might bring in more travelers, which did not allow for
investing in resident nurses. In addition, travelers
undermined wages and union nurses and the home board lost
the ability and resources to investigate the issues
regarding nurses with multi-state licenses for infractions
like drug diversion and nurses practicing with illegal
licenses. She stated that a board needed to maintain the
ability to investigate nurses upon licensure and pay for
licensing fees. She believed that waiting a month to obtain
a license that was properly investigated and vetted was a
reasonable amount of time. She suggested that the board
receive more resources to employ other means to expedite
licensure and keep the community safe.
Co-Chair Foster reminded testifiers how to submit written
testimony.
9:58:26 AM
NICOLE LIVANOS, NATIONAL COUNCIL OF STATE BOARDS OF
NURSING, CHICAGO, ILLINOIS (via teleconference), relayed
that she was online for questions only.
9:58:49 AM
CARRIE PELUSO, CHIEF NURSING OFFICER, PROVIDENCE ALASKA
MEDICAL CENTER, ANCHORAGE (via teleconference), strongly
advocated for HB 149. She relayed that she had
responsibility for all the Providence Health facilities in
the state and worked as a nurse for 26 years in many areas
of nursing. She believed that experienced nurses were
needed to help and supervise newer caregivers. The state
needed to attract nurses from all experienced levels and
Alaska was at a disadvantage. She relayed that two nurses
who were trying to relocate to Kodiak to work for
Providence had both revoked their decision because
licensing was taking months. She shared that nursing
shortages were predicted to worsen in the state. The
Providence human resources team shared that it took twice
as long to get a license in Alaska than in other states.
She declared that Alaska was being left behind by not
joining the compact and that there were not enough nurses
in the state to meet existing needs. The question was no
longer if the state needed to attract new workers, but how
the state attracted them. She believed that an answer was
via the multi-state compact.
Co-Chair Foster wanted to finish public testimony and move
to invited testimony during the afternoon meeting.
10:01:55 AM
SHANNON DAVENPORT, SELF, ALASKA NURSING ASSOCIATION,
ANCHORAGE (via teleconference), testified in opposition to
the legislation. She relayed that she was an operating room
nurse and thought that there were many other ways to solve
the problem. She believed that retention was a significant
problem and instead of paying travelers three times the
amount, the wages for current nurses should be increased.
She advocated for educating youth about nursing careers.
She shared that she was on the board of the Health
Occupations Students of America (HOSA) that catered to 20
different high schools in the state; 350 students were
interested in nursing and medicine. She felt that improving
the nursing environment to prevent burnout would help with
retention. She related that currently military spouse
nurses could work under a temporary license in the state
for 6 months. She concluded that the problem could be
solved by working within the state and that resources could
be utilized in the state without the involvement of an
outside third party who does not have the state's best
interest at heart."
10:04:37 AM
JOLEEN CORLIS, SELF, ANCHORAGE (via teleconference), spoke
in opposition to the bill. She related that she was a
registered nurse in Alaska for 11 years and originally came
to the state via a traveler's contract. She quickly
received her Alaska license and did not find the process
challenging. She voiced that currently, the nursing board
completed thorough background checks prior to issuing
Alaska licenses. She thought that nurses in the compact
would not need to pay for an Alaska license. The health
care system in Alaska was unique and an outside entity
could not relate or understand the state's special needs.
She felt that a compact might help Alaska healthcare
corporations, but it would hurt the state's collective
bargaining power. In addition, being a part of the compact
had not shown to decrease nursing shortages or foster safe
nursing environments. She advocated for safe staffing
levels for nurses mandated through legislation.
10:06:35 AM
BRANDON CALCATERRA, PRESIDENT, LABOR'S LOCAL 341, ANCHORAGE
(via teleconference), was in opposition to the bill. He
shared that the union represented over 400 nurses at Alaska
Regional Hospital. He emphasized state sovereignty and
voiced that the state had the ability to make important
healthcare decisions, but the compact would bar the state's
ability to make substantial changes and would preclude the
legislature from modifying the compact. The threats to
public health and safety would be incurred and it
jeopardized patient care. The compact depended on the
diligence of other member states to report serious
disparate actions by nurses and states had different
violation classifications. There were concerns with
staffing and statistics from Healthdata.gov showed that
between 2020 and 2023, compact states had higher
percentages of hospital stays and staffing shortages. In
addition, the compact could encourage nurses to travel to
other warmer climates during the Alaska winter. There were
some real conversations to be had with fixing the issues
and improve recruitment and retention, funding to increase
the number of available seats in nursing programs,
improving the administrative efficiency of the state's
licensing process, and enacting legislation to assist with
staffing, ratios, etc. He questioned the board's survey
statistic that 85 percent of union nurses supported the
contract and asked for the list of participants. He
wondered whether the nurses were aware of the details of
the compact.
Representative Josephson cited the survey Mr. Calcaterra
mentioned and asked if he was talking about the state
official who used state resources to try to rally support
for the bill. Mr. Calcaterra replied in the affirmative.
Representative Ortiz referenced a statement that the states
that were part of the compact had higher rates of vacancies
than those that did not. He asked if there was data to back
the statement up. Mr. Calcaterra responded in the
affirmative and added that the source was from the National
Nurses United published in Healthdata.gov. He offered to
send the information.
10:11:34 AM
Representative Coulombe cited testimony requesting
workplace changes via legislation for things like staffing
levels. She was confused because she thought the issues
were things that the union addressed in contracts. Mr.
Calcaterra answered that the union had bargaining sessions
every three years or so, however staffing was considered a
management right regarding running their operations. He
relayed situations wherein nurses were being sent home
during shifts due to low patient volume. However, the other
nurses remaining on staff were often not able to take
breaks because the acuity of patients or their condition
changed. He believed that a legislative solution would be
helpful. Representative Coulombe relayed that her daughter-
in-law was a nurse, and she understood the issue. She
thought it seemed like the union wanted the legislature to
dictate the conditions, but she felt that it was an issue
between the private contractor and the union to fix. Mr.
Calcaterra responded that the unions were always trying to
negotiate staffing ratios. He noted that other states were
enacting staffing ratios.
Representative Galvin cited previous testifiers regarding
concerns that passing the bill would lessen the ability of
unions to negotiate issues. She asked if the bargaining
power would be diminished by allowing the compact. Mr.
Calcaterra replied that the unions had many concerns. He
stressed that the nurses were the voice behind the
provisions the unions negotiated. The nurses had the power
to leverage the issues and the union tried to avoid labor
actions during negotiation, but if there was a time in
which nurses were dealing with unsafe conditions and
exercised their rights via a labor action bringing in
dozens or hundreds of nurses from outside the state could
negatively impact negotiations.
10:16:14 AM
Representative Hannan wondered how many states had nursing
ratios in statute. Mr. Calcaterra responded that he did not
have current information.
10:16:40 AM
SERGIO ACUNA, SELF, ANCHORAGE (via teleconference),
testified in opposition to HB 149. He related that instead
of letting a private organization extract money from the
state, he suggested keeping money in the state by enforcing
high standards. He recommended that the state invest in
local funding for more nursing programs and make the
licensing process more efficient. He disapproved of
bringing in out-of-state nurses to compete with Alaska
nurses. He urged the committee not to enact the
legislation, which he felt would make it more difficult for
resident nurses.
10:18:58 AM
DONNA PHILIPS, CHAIR, LABOR COUNCIL, ALASKA NURSES
ASSOCIATION, GIRDWOOD (via teleconference), strongly
opposed the legislation. She relayed that the Biden
administration had passed legislation that enabled military
spouse more portability with their nursing licenses. She
pointed out that California instituted nurse patient ratios
and Connecticut and Washington enacted staffing laws that
strengthened the nurses ability to speak out when the
levels were unbalanced. Massachusetts adopted nurse
staffing ratios for its intensive care units. In addition,
Oregon passed legislation that spoke to nurse and patient
ratios as well as nursing assistant ratios. She delineated
that when a facility had to abide by nurse patient ratios,
any prior ancillary help disappeared. She considered the
Oregon law "groundbreaking legislation." She indicated that
there were 22,000 nursing licenses in the state but only
10,000 had an Alaska address on file.
10:22:04 AM
MARGE STONEKING, ADVOCACY DIRECTOR, AARP ALASKA, ANCHORAGE
(via teleconference), spoke in favor or the nurse licensure
compact. She stated that Alaska had the highest growing
senior population in Alaska but the need for healthcare
workers was predicted to grow due to an aging workforce.
She elucidated that nursing topped the list of the state's
healthcare shortages. She believed that the shortage
resulted in less access to care for Alaskans and longer
wait times in hospitals and emergency rooms (ER) putting
increased burdens on seniors and their care givers. She
voiced that extreme nursing shortage increased overall
healthcare costs. She did not think that the compact was a
"silver bullet" to the problem but merely one solution to
immediately bring more nurses to the state.
10:23:53 AM
JAMES DAHL, SELF, ANCHORAGE (via teleconference), was in
opposition to the legislation. He shared that he knew a lot
of people who worked in the medical field and had heard a
lot of the same comments expressed during the hearing about
the negative impacts of the NCL.
10:25:04 AM
JANE ERICKSON, SELF, PALMER (via teleconference), was in
opposition to the bill. She indicated that she was the
immediate past president of the nurses' association. She
felt that the compact would not help with reducing the
nursing shortage, which was nationwide. She deduced that
the licensing fees would increase to compensate for loss in
revenue by the out-of-state nurses that were exempt from
the state's licensing fees. She disapproved of out-of-state
nurses taking care of Alaska residents. She wondered what
the ramifications would be if nurses left the state due to
the compact making the shortage worse.
Representative Josephson acknowledged her past presidency
of the nurses association. He asked if the association
knew of her position on the compact at the time of her
election. Ms. Erickson answered in the affirmative.
Representative Josephson commented that the association
still voted her in as president.
10:27:32 AM
Co-Chair Foster CLOSED public testimony.
Representative Galvin commented that there were many prior
amendments for the bill that were never heard in a prior
committee. She asked if there could be a recap of the
amendments.
Co-Chair Foster suggested that the sponsor work up a
summary of the amendments.
Representative Coulombe pointed out that the amendments
were not adopted. She believed that it would not be the
best use of the committees limited time.
Co-Chair Foster offered that he would open up committee
discussions with the sponsor and the issues would be
"hashed out" via the House Finance Committee's amendment
process.
Representative Hannan thought there were some amendments
that were never offered due to a time cut off. She noted
that the sponsor suggested adding three amendments and she
wanted to discuss the amendments.
Co-Chair Foster asked the committee members to work out the
amendment issues with the sponsor.
HB 149 was HEARD and HELD for further consideration.
Co-Chair Foster reviewed the afternoon meeting.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 149 Amendments 1-9 050824.pdf |
HFIN 5/3/2024 9:00:00 AM |
HB 149 |