Legislature(2005 - 2006)HOUSE FINANCE 519
04/07/2006 09:00 AM FINANCE
Download Mp3. <- Right click and save file as
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
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.