Legislature(2005 - 2006)HOUSE FINANCE 519

04/07/2006 09:00 AM FINANCE


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 271 LIMIT OVERTIME FOR REGISTERED NURSES TELECONFERENCED
Heard & Held
*+ HB 362 INCREASE BASE STUDENT ALLOCATION TELECONFERENCED
<Bill Hearing Postponed to 1:30 PM Today>
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 51 EMPLOYER ASSN FOR WORKERS' COMP INS TELECONFERENCED
Heard & Held
<Bill Hearing Rescheduled from 04/05/06>
HOUSE BILL NO. 271                                                                                                            
                                                                                                                                
     "An Act relating to limitations on overtime for                                                                            
     registered nurses in health care facilities; and                                                                           
     providing for an effective date."                                                                                          
                                                                                                                                
REPRESENTATIVE  PEGGY  WILSON,  sponsor, introduced  HB  271.                                                                   
She  reported that  this is  not  an overtime  issue. It's  a                                                                   
safety issue  for both  patients and  nurses.  Truck  drivers                                                                   
have  a  limit   to  the  number  of  hours   they  can  work                                                                   
consecutively  for safety  reasons.   Pilots can  only fly  8                                                                   
hours within a 24-hour period.   Air traffic controllers work                                                                   
a limited number of hours per  shift.  Railroad engineers are                                                                   
also  limited in  the number  of hours  they can  work.   The                                                                   
common denominator  is that lives  are at stake if  a mistake                                                                   
is made.   Nurses  who monitor  our health  should be  in the                                                                   
same category.                                                                                                                  
                                                                                                                                
Representative Wilson related  that mandatory overtime causes                                                                   
significant  problems   for  both  patients   and  healthcare                                                                   
workers.   Forcing  nurses  to  work beyond  their  regularly                                                                   
scheduled shift has  been linked to increased  error rates in                                                                   
providing patient  care, and increased injury  rates for both                                                                   
patients and health  care workers.  For nurses,  these errors                                                                   
or mistakes  may cause  life-threatening situations  for both                                                                   
the patient and  the nurse, from back injuries  to medication                                                                   
errors to  client deaths.   With  these mistakes and  errors,                                                                   
there is  also the chance of  lawsuits with loss  of licenses                                                                   
and increases in malpractice insurance rates.                                                                                   
                                                                                                                                
Representative Wilson  reported that surveys have  shown that                                                                   
the exodus  of registered nurses, therapists,  technologists,                                                                   
technicians and  service and maintenance workers  is directly                                                                   
attributable  to  difficult  working   conditions,  including                                                                   
inadequate  staffing,  mandatory  overtime  and  insufficient                                                                   
compensation.  Mandatory overtime  is one of the main reasons                                                                   
nurses leave  nursing.  Recent  studies indicate that  one in                                                                   
five nurses are considering leaving  nursing.  When polled on                                                                   
their  reasons  for leaving,  mandatory  overtime  is  always                                                                   
listed  in the  top ten reasons.   In  the face  of a  severe                                                                   
nursing shortage, nurses need to be kept at the bedside.                                                                        
                                                                                                                                
Representative Wilson  observed that as baby  boomers retire,                                                                   
more nurses  will retire, which  will cause further  problems                                                                   
with shortages.   She stated that eleven states  have enacted                                                                   
legislation   to   prohibit   mandatory   overtime.   Similar                                                                   
legislation has been proposed in 19 other states.                                                                               
                                                                                                                                
Representative  Wilson  related that  HB  271  has two  major                                                                   
components.    The first  is  that  the growing  shortage  of                                                                   
nurses in the workforce is escalating,  which empowers nurses                                                                   
to evaluate  their own  limitations.   She cited two  studies                                                                   
that show  that mandatory overtime  is detrimental  to worker                                                                   
performance  and  contributes  to  medical errors.    HB  271                                                                   
requires a semi-annual report  that will provide insight into                                                                   
how both  private and public  institutions are  responding to                                                                   
the shortages.   This report  will document the  total number                                                                   
of  overtime  hours  worked  broken  down  by  voluntary  and                                                                   
mandatory, the number of on-call  hours worked broken down by                                                                   
voluntary and  mandatory, and also  the number of  hours used                                                                   
by contract nurses.                                                                                                             
                                                                                                                                
10:41:22 AM                                                                                                                   
                                                                                                                                
Representative  Wilson   informed  the  committee   that  the                                                                   
evidence  is  very  strong  that  prolonged  work  hours  and                                                                   
fatigue affect worker performance.   A study by the Institute                                                                   
of Medicine provides compelling  evidence that nurses working                                                                   
long hours  has an  adverse effect  on patient's safety.  The                                                                   
Institute  of Medicine  estimates between  44,000 and  98,000                                                                   
hospital  deaths can  be attributed  to  medical errors  each                                                                   
year.   Mandatory overtime is  a serious contributing  factor                                                                   
to  medical  errors.     The  final  recommendation   of  the                                                                   
Institute Of  Medicine is that  all overtime -  voluntary and                                                                   
mandatory - should be curtailed.                                                                                                
                                                                                                                                
Another  study titled  "The Working Hours  of Hospital  Staff                                                                   
Nurses  and  Patient  Safety" published  in  the  July/August                                                                   
issue  of Health Affairs  found  that the risk  of making  an                                                                 
error was three  times higher when nurses had  to work shifts                                                                   
that were longer than 12 hours,  when they worked significant                                                                   
overtime, or when they worked more than 40 hours in a week.                                                                     
                                                                                                                                
10:44:33 AM                                                                                                                   
                                                                                                                                
Representative  Stoltze  expressed support  for  nurses.   He                                                                   
questioned   the   affects   of    employment   displacement.                                                                   
Representative  Wilson observed  that some institutions  that                                                                   
are  having trouble  attracting  nurses,  have forced  nurses                                                                   
into overtime.                                                                                                                  
                                                                                                                                
Representative  Stoltze  suggested that  displacements  would                                                                   
put  pressure   on  overtime   requirements  for   nurses  in                                                                   
Anchorage.   Representative  Wilson  responded  that she  was                                                                   
assured that would not happen.                                                                                                  
                                                                                                                                
Representative  Weyhrauch  questioned   if  suggestion  boxes                                                                   
would be  mandated so that  patients could voice  complaints.                                                                   
Representative Wilson was unsure.                                                                                               
                                                                                                                                
10:48:15 AM                                                                                                                   
                                                                                                                                
Representative Weyhrauch  questioned if lunchtime  is counted                                                                   
in the 12 hours.  Representative  Wilson noted that the clock                                                                   
stops when a nurse leaves the  floor and it begins again when                                                                   
they return.                                                                                                                    
                                                                                                                                
Representative  Weyhrauch questioned if  coercion is  a state                                                                   
of  mind and  how  it could  be quantified.    Representative                                                                   
Wilson responded  that it  would be  coercion if they  feared                                                                   
job loss and added that they should be able to say no.                                                                          
                                                                                                                                
10:49:51 AM                                                                                                                   
                                                                                                                                
Representative  Weyhrauch  questioned  how a  facility  could                                                                   
respond to  allegations of  coercion.  Representative  Wilson                                                                   
responded that  the intent is  to allow the nurse  to decline                                                                   
extra hours.   In response to  a question by  Co-Chair Meyer,                                                                   
she  observed that  hours vary.   Some  have 12-hour  shifts,                                                                   
with rotating schedules.                                                                                                        
                                                                                                                                
10:52:17 AM                                                                                                                   
                                                                                                                                
Representative  Kerttula noted  that  problems with  overtime                                                                   
are at state facilities, not at private hospitals.                                                                              
                                                                                                                                
10:52:54 AM                                                                                                                   
                                                                                                                                
ROD BETIT, PRESIDENT, ALASKA STATE  HOSPITAL AND NURSING HOME                                                                   
ASSOCIATION   (ASHNHA),  testified   in  opposition   to  the                                                                   
legislation.   He maintained that  the need for the  bill has                                                                   
not been documented and that mandatory  overtime reporting is                                                                   
not required.   He  provided members  with a chart  detailing                                                                   
the results  of a  survey by  ASHNHA.   The survey  looked at                                                                   
critical  access, nurses  union, shortage,  length of  shift,                                                                   
nurse vacancy,  mandatory overtime,  on-call policy,  the use                                                                   
of temporary nursing services  used to fill the gaps, and the                                                                   
number of grievances filed by  nurses.  ASHNHA also looked at                                                                   
the  starting  nursing  salary.   He  concluded  that  higher                                                                   
salaries  at  private  intuitions  were  a  factor  in  API's                                                                   
inability  to hire  staff.  He  added that  API receives  the                                                                   
hardest cases and that they have  no choice in the cases they                                                                   
take.  He did  not think that overtime is being  used to fill                                                                   
the nursing  gap.  Their members  want to be able to  come up                                                                   
with local solutions to their problems.                                                                                         
                                                                                                                                
11:02:03 AM                                                                                                                   
                                                                                                                                
KATHLEEN   GETTYS,   PRESIDENT,  RESIDENT   HOSPITAL   NURSES                                                                   
BARGAINING  UNIT,  ANCHORAGE,  testified  in support  of  the                                                                   
legislation.   She provided  members with written  testimony.                                                                   
She  observed   that  healthcare  is  exempt   from  overtime                                                                   
limitation.   She questioned  why you would  want a  nurse to                                                                   
work  for you  when  it has  been clearly  demonstrated  that                                                                   
overtime contributes  to medical errors and  compared nursing                                                                   
to  piloting.   Mandatory  overtime  contributes  to  greater                                                                   
costs in hiring and training.   She observed that the cost of                                                                   
serious  care  adds  approximately  $22,000  to  $28,000  per                                                                   
patient from mandatory overtime.                                                                                                
                                                                                                                                
She noted that  they anticipated a loss to  the Mat-Su Valley                                                                   
with the option of transportation.                                                                                              
                                                                                                                                
11:07:02 AM                                                                                                                   
                                                                                                                                
Ms.  Gettys  addressed  coercion   and  grievances  filed  at                                                                   
Providence  Hospital.   There is no  clear delineation  about                                                                   
whether  overtime  is  voluntary  or forced.    Full-time  at                                                                   
Providence  equals 36  hours per  week,  in any  combination.                                                                   
There have been no grievances  filed at Providence, but there                                                                   
is  a  report  that  is  filed   called  "Assignment  Despite                                                                   
Objections".                                                                                                                    
                                                                                                                                
11:08:20 AM                                                                                                                   
                                                                                                                                
Representative  Kerttula asked what  the report shows  and if                                                                   
it could be made public.  Ms.  Gettys responded that it could                                                                   
be made  public without  using  names.  Most  of the  reports                                                                   
involved assignment  to a unit without  adequate preparation,                                                                   
or wrong patient placement.  The  purpose of the report is to                                                                   
increase  the  quality  of  care.    Working  conditions  are                                                                   
excellent.    Representative  Kerttula  asked if  the  report                                                                   
shows incidences  of overtime.   Ms.  Gettys replied  that it                                                                   
does.    Representative  Kerttula  requested a  copy  of  the                                                                   
report.                                                                                                                         
                                                                                                                                
11:10:56 AM                                                                                                                   
                                                                                                                                
MIKE ALEXANDER,  NURSE, ANCHORAGE, testified  about mandatory                                                                   
overtime at  API, which is  clearly stated  up front.   It is                                                                   
difficult to work a 16-hour shift  and it puts the patient at                                                                   
risk.  Having a choice to work overtime is important.                                                                           
                                                                                                                                
11:13:34 AM                                                                                                                   
                                                                                                                                
DIANNE  O'CONNELL, ALASKA  NURSES  ASSOCIATION, testified  in                                                                   
favor of  the bill, as revised,  for the sake of  patient and                                                                   
community safety,  for protection  of the nursing  staff, and                                                                   
for the purpose of gathering data  about the use of mandatory                                                                   
and voluntary overtime.                                                                                                         
                                                                                                                                
11:15:51 AM                                                                                                                   
                                                                                                                                
RON ATTLER, API, ANCHORAGE, testified  about compensation and                                                                   
incentives.   He  maintained  that the  state's  compensation                                                                   
plan needs a serious overhaul  in order to retain and recruit                                                                   
nurses.  He applauded Representative  Wilson's hard work.  He                                                                   
testified in opposition to HB 271.                                                                                              
                                                                                                                                
Co-Chair   Chenault   stated   that   amendments   would   be                                                                   
forthcoming.                                                                                                                    
                                                                                                                                
HB  271  was   heard  and  HELD  in  Committee   for  further                                                                   
consideration.                                                                                                                  
                                                                                                                                

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