Legislature(2003 - 2004)
05/06/2003 01:35 PM Senate L&C
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* first hearing in first committee of referral
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= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 154-NURSE EDUC LOAN REPAYMENT PROGRAM
CHAIR BUNDE announced SB 154 to be up for consideration.
SENATOR FRENCH, sponsor, told members:
SB 154 addresses one big issue, which is the shortage
of nurses in the State of Alaska. According to the
Alaska Community Health and Emergency Management
Services, about 30 communities in Alaska are
designated as federal health professional shortage
areas. Another study by the Alaska Colleagues in
Caring showed a vacancy rate for RNs across the state
of 11.5% in 2002 and in other parts of the state as a
20.8% vacancy rate. The rate of turnovers in RNs in
Alaska is 24% and probably most interestingly, in the
year 2001, about 18% of RNs working in Alaska were
non-residents, i.e. traveling nurses and about 52% of
the RNs were over 45 years old.
The need for nurses is going to double by the year
2010. We've got about 4,500 nurses employed in the
state right now; the number is going to go to 8,500.
In the face of that growing problem, we looked at ways
to increase the number of nurses in the state so that
our citizens would have adequate health care should
they need it. We mulled over a bunch of different
possibilities and arrived at this one after
discussions with a variety of interested groups. The
idea is to pay money each year to nurses employed in
the state in qualifying positions and correct
qualifying education, to pay them up to 20% of their
student loan or $2,000, whichever is less. The idea is
to string those payments out over a period of five
years so as to keep folks who come here who may see
this as an incentive to move to the state, who come
here and take up jobs and get them to spend a long
enough time here so that they'll grow to love it like
most of the rest of us have and keep them here when
their five-year period is up.
The idea is, frankly, workforce development and to use
a little bit of government stimulus to increase the
number of nurses working here in the state. The
University of Alaska has recently gotten money to
double the size of its nursing program. Nevertheless,
that program is going to graduate, even once it's
fully up and running, about 220 nurses a year, which
is nowhere near the number the state needs to maintain
an adequate nursing population....
SENATOR STEVENS asked if the goal is to attract people from
other states.
SENATOR FRENCH answered that is correct and, according to the
Department of Labor and Workforce Development, the nursing
shortage is nationwide. Alaska must compete for RNs or educate
its own nurses to keep up with demand caused by an aging society
and the aging of RNs.
SENATOR STEVENS asked what percentage is traveling nurses.
SENATOR FRENCH replied 17.7% of the RNs working in Alaska are
non-residents.
MS. CATHY GIESSEL, Alaska Nurse Practitioners Association, said
that Senator French did a great job of portraying the problem
and that they support SB 154. She asked the committee to
remember that when there aren't enough nurses to fill the jobs,
less qualified personnel fill them and in many cases those
employees give medications. She said she gets recruiting calls
from the Lower 48 and noted, "I believe this bill would be a
wonderful recruitment device."
MS. GIESSEL said that Florida, South Dakota and Virginia have
loan repayment program offers for nurses.
CHAIR BUNDE noted that in two years this bill, if passed, would
cost the state about $3 million and, in five years, would cost
over $5 million.
MS. CAMILLE SOLEIL, Executive Director, Alaska Nurses
Association, agreed with previous testimonies and supported SB
154. She really likes the discretion given to the Board of
Nursing that allows it to target the funds toward the areas of
need and set up appropriate criteria. It doesn't guarantee the
right to the loan forgiveness. The average graduating nurse is
looking at $20,000 to $40,000 in student loans that need to be
repaid. Nurses like to retire between the ages of 55 and 60,
especially out of acute care where they are needed the most.
CHAIR BUNDE noted the discretionary part of any potential state
subsidy soon disappears in the public's mind. When the longevity
bonus first passed, it was said in the record that in 15 or 20
years, if the state can't afford it, it can just cut it out.
MS. LARAINE DERR, President, Alaska State Hospital and Nursing
Home Association, said she has talked to the legislature in
previous years about the impending nursing shortage crisis. She
is in the process of doing a survey and has results from seven
of 17 hospitals. Last year they spent $16 million on traveling
nurses. That money doesn't necessarily stay in the state. She
said the University is doubling the number of nurses it
graduates by 2006 and industry is donating more than $2.3
million over the next three years, however there is a problem in
finding the faculty, as there is a shortage there as well.
SENATOR STEVENS said the loans would repay not only Alaska
student loans, but out-of-state loans as well.
MS. DERR replied that is correct.
SENATOR FRENCH said he contemplated setting the forgiveness
provision up for Alaska residents who, for example, went outside
to school and came back, but that wouldn't supply enough nurses
to fill the vacancies.
CHAIR BUNDE asked how he defines a resident.
SENATOR FRENCH replied that tying eligibility to the Permanent
Fund is a possibility. He added that the size of the loan could
be lowered to reduce the impact to the state.
SENATOR SEEKINS asked how the University plans to double the
output of nurses with a zero budget increase.
SENATOR FRENCH replied that the University got more money this
year [for that program].
SENATOR SEEKINS said that issue is before the Finance Committee
and cannot be counted on.
TAPE 03-29, SIDE B
SENATOR SEEKINS asked if the money to be provided to the
University program is matching money or what.
MS. DERR replied that the University is going to match the $2.3
million. She explained that the University of Utah has been
providing distance delivered nursing education here and through
the process of getting more nurses, she realized that Alaska was
paying money to Utah to educate our students. That is why they
came up with the money and the University matched it. Utah has
agreed that it will no longer be providing nursing education in
the state when the University of Alaska takes it over.
CHAIR BUNDE said he wished the university would use some of the
$5 million they use on intercollegiate athletics for nursing.
SENATOR STEVENS said he likes this bill because it is similar to
one that he has been working on about forgiveness of teachers'
loans. He said all the money in the fund is subject to
appropriation by the legislature each year.
MS. DIANE BARRANS, Executive Director, Alaska Postsecondary
Education Commission (ACPE), supported SB 154. The Commission
would administer the benefits as they are paid out to
individuals who qualify under the criteria set by the Board of
Nursing. Also, she suggested the legislature might look toward
the Alaska Student Loan Corporation dividend for the funding,
although the fiscal note calls for an appropriation from the
general fund each year.
CHAIR BUNDE asked what the fiscal note would be for the bill
that Senator Stevens is working on.
MS. BARRANS replied that those costs are somewhat comparable to
this bill.
CHAIR BUNDE asked if she worked with the Legislature a few years
ago when the Washington, Alaska, Montana, Idaho Medical
Education Program (WAMI), that subsidizes doctors, was
restructured so those students had to repay some of their
subsidy if they didn't come back to Alaska and work.
MS. BARRANS replied that she did.
CHAIR BUNDE asked her how effective that has been in bringing
students back to Alaska to practice.
MS. BARRANS replied at this point none of those students have
reached the point in their careers yet where they would be
returning to the state. She the suggested, to prevent putting
the legislature in a position of being morally obligated to
forgive loans, that ACPE solicit for participants, identify the
amount of debt that would be repaid as a benefit, and reserve at
the time they begin their service in Alaska the amount that
would be paid to them. That way, they would not be saying to
those participants the state can pay for their first year but
not their second year, etc. In the years when no funding is
available, they would shut off enrollment so no one would be
enrolled for benefits that were, at best, speculative. Numbers
would be revisited on an annual basis.
CHAIR BUNDE said some places have provided substantial bonuses
to attract people to come to work in an area of shortage, but
after acquiring the bonuses they moved elsewhere. He asked if a
nurse had to work here for five years, whether he or she would
be free to move after that.
MS. BARRANS said that is correct.
CHAIR BUNDE asked if this bill would reimburse any originator.
MS. BARRANS replied any commercial lender.
CHAIR BUNDE asked how limiting this bill to only borrowers of
Alaska loans would impact the fiscal note.
MS. BARRANS guessed that it would potentially cut the fiscal
note in half.
MS. RHONDA RICHTSMEIER, Deputy Chief, Public Health Nursing,
agreed with the nursing shortage estimates: in 2000, 30 states
had significant nursing shortages and in 2020, 46 states are
anticipated to have shortages. She said the reasons are multi-
pronged. There is an aging population with more chronic disease
and 71 percent of nurses in Alaska are 41 to 71 years of age; 25
percent of those are going to retire in the next 5 to 10 years.
MS. RICHTSMEIER said fewer students are graduating from nursing
schools. It is difficult to get people interested in nursing
because a lot of alternative careers offer higher salaries. In
addition, there aren't enough nursing instructors. Since 1995,
there has been a 31% reduction in the number of students
graduating from colleges of nursing. She believes there needs to
be a multi-pronged approach to this multi-pronged problem. They
need to address salary to bring new people into the profession
and keep them in the profession.
SENATOR DAVIS asked her to comment on the cost of training
nurses instate and out-of-state.
MS. RICHTSMEIER responded that she could only speak recently for
instate and that UAA's four-year program costs around $20,000
just for tuition and books.
SENATOR SEEKINS asked if the administration supports the bill as
well.
MS. RICHTSMEIER said she understood that to be the case.
SENATOR DAVIS moved to pass SB 154 from committee with
individual recommendations and the attached fiscal note.
SENATORS FRENCH, STEVENS and DAVIS vote yea; SENATORS SEEKINS
and BUNDE voted nay; and SB 154 passed from committee.
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