Legislature(2005 - 2006)CAPITOL 106

05/03/2005 03:00 PM HEALTH, EDUCATION & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 288 MEDICAID PERSONAL NEEDS ALLOWANCE TELECONFERENCED
Heard & Held
+ SB 150 ALASKA CHILDREN'S TRUST FUND GRANTS TELECONFERENCED
Moved Out of Committee
+ HB 271 LIMIT OVERTIME FOR REGISTERED NURSES TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
HB 271-LIMIT OVERTIME FOR REGISTERED NURSES                                                                                   
                                                                                                                                
4:18:05 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON announced  that  the final  order  of business  was                                                               
HOUSE BILL  NO. 271 "An  Act relating to limitations  on overtime                                                               
for registered  nurses in health  care facilities;  and providing                                                               
for an effective date."                                                                                                         
                                                                                                                                
4:18:25 PM                                                                                                                    
                                                                                                                                
[CHAIR WILSON turned the gavel over to Vice-Chair Seaton.]                                                                      
                                                                                                                                
The committee took an at-ease from 4:18:37 PM to 4:19:26.                                                                     
                                                                                                                                
4:19:31 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON,  as  sponsor  of HB  271,  stated  that  mandatory                                                               
overtime causes significant  problems, including increased injury                                                               
rates,  for both  patients and  health care  workers, and  can be                                                               
life  threatening.   She  reported that  the  abuse of  mandatory                                                               
overtime  shifts  has been  associated  with:   unhealthy  weight                                                               
gain, increased  use of alcohol  and tobacco, and  lowered levels                                                               
of  functional ability  in  job performance.    A national  study                                                               
showed  that   between  44,000-98,000  hospital  deaths   can  be                                                               
attributed   to   medical   errors   each  year.      The   final                                                               
recommendation  of  the  Institute   of  Medicine  was  that  all                                                               
overtime done  by nurses  - voluntary and  mandatory -  should be                                                               
curtailed.                                                                                                                      
                                                                                                                                
CHAIR WILSON noted  that in a study entitled,  "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 is  three times higher  when nurses  work shifts                                                               
longer than  12 hours,  which she  indicated is  one of  the main                                                               
reasons  nurses are  leaving their  profession.   She recalled  a                                                               
study a  couple of years  ago that said  by the year  2010, 4,000                                                               
more  nurses will  be needed  in Alaska.   She  offered anecdotes                                                               
about her experience as a nurse.                                                                                                
                                                                                                                                
CHAIR WILSON  said the proposed  legislation will not  prohibit a                                                               
nurse from working  overtime, but it will  discourage an employer                                                               
from assigning  mandatory overtime.   It  would also  prohibit an                                                               
employer  from threatening  or retaliating  against  a nurse  who                                                               
refuses overtime.   Nationwide,  she said,  10 other  states have                                                               
mandated this type of legislation,  while similar legislation has                                                               
been proposed in 20 other states.                                                                                               
                                                                                                                                
REPRESENTATIVE  GARDNER   said  she  supports   this  legislation                                                               
because  it seems  like a  human rights  issue.   Notwithstanding                                                               
that, she  asked what  the result  would be  for patient  care in                                                               
Alaska if the bill passes.                                                                                                      
                                                                                                                                
4:28:16 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON  noted  that critical  access  hospitals  would  be                                                               
exempted.   She said hospitals  in Alaska work with  personnel as                                                               
much  as  they  can  to  ensure that  they  don't  use  mandatory                                                               
[overtime]  for nurses.   She  said the  only complaints  she has                                                               
received  were  from  state institutions:    API,  the  Pioneer's                                                               
Homes, and  [the Department  of Corrections].   In response  to a                                                               
follow-up  question from  Representative  Gardner, she  confirmed                                                               
that the bill would apply to state institutions.                                                                                
                                                                                                                                
REPRESENTATIVE CISSNA said that part  of this is really a quality                                                               
issue for patients.                                                                                                             
                                                                                                                                
4:31:24 PM                                                                                                                    
                                                                                                                                
VICE CHAIR SEATON  asked why the bill only  applies to registered                                                               
nurses  and further  asked  if  the effect  will  be that  lesser                                                               
qualified employees are substituted for those nurses.                                                                           
                                                                                                                                
CHAIR WILSON said that is  a possibility; however, she said there                                                               
are guidelines  regarding what level  of practitioner must  be on                                                               
duty to supervise others.                                                                                                       
                                                                                                                                
4:33:57 PM                                                                                                                    
                                                                                                                                
VICE CHAIR SEATON  clarified that he wants to know  if it's being                                                               
said that  overtime is dangerous  for registered nurses,  but not                                                               
for licensed practitioner nurses.                                                                                               
                                                                                                                                
CHAIR WILSON  said, "I'm sure  that that  would be also  the same                                                               
for them."   She said she  wouldn't have any objection  to adding                                                               
LPNs.                                                                                                                           
                                                                                                                                
4:34:26 PM                                                                                                                    
                                                                                                                                
JANE  BARNES,  Nursing  Director,  Alaska  Psychiatric  Institute                                                               
(API),  told  the  committee that  API  employees  40  registered                                                               
nurses  and has  no  LPNs.   Currently there  are  5 staff  nurse                                                               
vacancies, which  is about the  norm.  Some improvement  was made                                                               
when the  a raise was approved  in 2002; at that  time there were                                                               
12 vacancies, or 25 percent of  the staff nursing positions.  Ms.                                                               
Barnes  said API  does use  mandatory overtime  in order  to meet                                                               
patient  care demands.    It uses  mandatory  overtime only  when                                                               
needed  to  minimally  staff  the  patient  care  unit,  and  the                                                               
mandatory overtime  used is minimal.   She offered  some details.                                                               
She  stated that  the use  of  voluntary overtime  is higher,  at                                                               
about 337 hours  monthly.  It is estimated that  over half of the                                                               
nurses who volunteer  for overtime do so to  avoid being assigned                                                               
mandatory overtime.                                                                                                             
                                                                                                                                
MS. BARNES  said should HB  271 pass,  she expects about  half of                                                               
the nurses currently doing voluntary  overtime to decline working                                                               
overtime altogether.   She said  she anticipates that  the result                                                               
would be  maybe 200  hours of  overtime that  wouldn't be  met by                                                               
voluntary  means.   She predicted  that [API]  would have  to use                                                               
"agency nurses" at  $60/hour for 13-week periods.   It could also                                                               
ask for the establishment of  additional positions, but given the                                                               
fact that  there is already  a difficulty filling  the positions,                                                               
that may be of little help.                                                                                                     
                                                                                                                                
MS.  BARNES,   regarding  agency  nurses,  indicated   that  it's                                                               
problematic  that those  nurses are  there for  short periods  of                                                               
time and  sometimes don't  know how to  use certain  equipment or                                                               
have to  learn a program  unique to API's therapeutic  milieu and                                                               
work with  a team.   A new nurse at  API, she noted,  partakes in                                                               
intensive training  for four  weeks, which she  pointed out  is a                                                               
third of an agency nurse's contract time.                                                                                       
                                                                                                                                
MS. BARNES concluded:                                                                                                           
                                                                                                                                
     The  total elimination  of  mandated overtime,  without                                                                    
     any options  for a lesser  bill, such as  limiting that                                                                    
     overtime  to so  many hours  at a  time, places  a real                                                                    
     burden on us as an employer,  and I believe will have a                                                                    
     negative impact on patient care.                                                                                           
                                                                                                                                
REPRESENTATIVE GARDNER asked  if it is fair to say  that the real                                                               
problem is that  [API] cannot find the staff it  needs to hire or                                                               
can't retain staff.                                                                                                             
                                                                                                                                
4:40:44 PM                                                                                                                    
                                                                                                                                
MS. BARNES answered that API can  usually find people to hire but                                                               
cannot retain them.  She said API  is one of the few hospitals in                                                               
town that will hire a  "full-time, permanent placement, brand new                                                               
nurse, new [graduate]."   Most other hospitals  require nurses to                                                               
have  6-12  months  experience  as   an  associate  nurse.    She                                                               
explained that  the nurses API hires  often work for one  year to                                                               
get that experience  and then leave to work  someplace else where                                                               
they can earn 25-35 percent more per hour.                                                                                      
                                                                                                                                
REPRESENTATIVE  GARDNER concluded  that bottom  line is  that the                                                               
pay rate is too low to retain qualified people.                                                                                 
                                                                                                                                
MS. BARNES answered yes.                                                                                                        
                                                                                                                                
REPRESENTATIVE CISSNA surmised that not  only is the pay too low,                                                               
but also  API must pay more  in constant training.   She asked if                                                               
that has ever been calculated.                                                                                                  
                                                                                                                                
MS. BARNES offered her understanding  that the committee received                                                               
a fiscal  impact statement.   She  said she  doesn't have  a good                                                               
calculation regarding what it takes to train any new employee.                                                                  
                                                                                                                                
VICE  CHAIR SEATON  asked if  API is  paying less  for registered                                                               
nurses than compared to hospitals in town.                                                                                      
                                                                                                                                
MS. BARNES answered that's correct.   She added that API has also                                                               
lost  nurses to  doctor's offices.   In  response to  a follow-up                                                               
question  from Vice  Chair  Seaton, she  guessed  that API's  pay                                                               
scale is set by the legislature.                                                                                                
                                                                                                                                
4:44:03 PM                                                                                                                    
                                                                                                                                
DIANNE   O'CONNELL,  Labor   Program   Director,  Alaska   Nurses                                                               
Association, said she  has been working with "a  number of nurses                                                               
throughout  the state,  and  quite  a few  at  API, actually,  in                                                               
developing,  ... supporting,  and encouraging  the passage  of HB
271."   She  said there  is more  than one  way of  attacking the                                                               
problem  at  hand.   She  noted,  "It's  been primarily  a  state                                                               
institution  problem."    She indicated  that  nurses  from  many                                                               
facilities  throughout   the  state  are  concerned   that  their                                                               
colleagues are  in "what they  consider an  untenable situation,"                                                               
but also that the problem will spread if nothing is done now.                                                                   
                                                                                                                                
MS.  O'CONNELL,   referring  to  Vice  Chair   Seaton's  previous                                                               
question, stated  her belief that the  pay scale [at API]  is set                                                               
by the Department  of Administration and perhaps  approved by the                                                               
legislature.   She said  currently there  is a  request in  for a                                                               
reclassification study,  which would take registered  nurses, for                                                               
example, "down a notch or two" in  order to make up for the 25-35                                                               
percent  pay differential.   She  said hopefully  that will  take                                                               
place; however, she  noted that that's a  "separate project" than                                                               
mandatory  overtime, although  they  are related.   She  revealed                                                               
that she had worked as a chaplain  at API, and she said it was an                                                               
emotional   place  to   work  [compared   to  some   health  care                                                               
institutions].  She  said, "And if you're there  and you're faced                                                               
with this mandatory  overtime in addition to  the lower salaries,                                                               
in  addition to  the stress,  in addition  to being  a brand  new                                                               
nurse, you're going to leave."                                                                                                  
                                                                                                                                
MS. O'CONNELL stated that the  reason the bill addresses RNs only                                                               
at  present is  that that's  where  the biggest  shortage is  and                                                               
that's where  most of the  responsibility lies for  patient care.                                                               
She echoed Ms.  Barnes' notation that although there  may be only                                                               
40 hours  of mandatory overtime, there  are 337 hours a  month of                                                               
what is euphemistically called "voluntary overtime."                                                                            
                                                                                                                                
4:50:04 PM                                                                                                                    
                                                                                                                                
CAROL  WIDMAN, Registered  Nurse,  Alaska Psychiatric  Institute,                                                               
testified in support of HB 271.   She said every time she goes to                                                               
work she  is subject  to mandatory  overtime.   She said  she has                                                               
difficulty coming  in on her days  off because she has  two small                                                               
children; therefore, she  is generally at the top of  the list of                                                               
those who  have to stay [for  mandatory overtime].  She  said she                                                               
gives medications to  20-30 patients.  She  stated that mandatory                                                               
overtime is  very dangerous  and has  caused many  medication and                                                               
judgment errors.                                                                                                                
                                                                                                                                
4:51:14 PM                                                                                                                    
                                                                                                                                
DAVE WILLIAMS,  Project Coordinator,  Pioneers' Homes,  said that                                                               
RNs are crucial  to pioneers' homes, but there are  also LPNs and                                                               
Certified Nurse  Assistants (CNAs).   He said  there is a  lot of                                                               
overtime.  Most of it is  voluntary, but some of it is mandatory.                                                               
He  said  the   pioneers'  homes  staff  of   RNs  work  overtime                                                               
voluntarily  because they  care  greatly for  the residents  they                                                               
serve.  He  said the bill would require  careful documentation as                                                               
to whether overtime was voluntary  or mandatory, because "some of                                                               
the provisions  in the  bill would  penalize if  it wasn't."   In                                                               
response  to a  question from  Vice Chair  Seaton, he  stated his                                                               
belief that every  one of the RNs, LPNs, and  CNAs work overtime.                                                               
He noted  that the  RNs are "Nurse  I, II, and  III in  the state                                                               
system" and are  the people who the pioneers'  homes are required                                                               
by licensure to  have on board in order to  provide services.  He                                                               
said  he does  not  know what  the pioneers'  homes  would do  if                                                               
nobody showed up to work and  it was necessary to call someone up                                                               
without the ability to use mandatory overtime.                                                                                  
                                                                                                                                
MR.  WILLIAMS  said one  alternative  may  be to  use  contracted                                                               
services; however,  he said  he doesn't  know how  practical that                                                               
would be, especially in a more  remote place.  He stated that the                                                               
issue is supply;  there are not enough RNs available.   He opined                                                               
that nurses who  work at the pioneers' homes  carefully weigh the                                                               
benefits they  receive, because  "it's the  package of  wages and                                                               
benefits that need  to be balanced against what's  in the private                                                               
sector."  He proffered that if  working at the pioneers' homes is                                                               
made  more  valuable,  then  there  may  come  a  time  when  the                                                               
hospitals  would have  a "hole"  in their  system.   He indicated                                                               
that he also  works with hospitals and he confirmed  that they do                                                               
"look at contract nurses."  He  reemphasized the need to have RNs                                                               
available in  order to operate.   He said  he would get  a fiscal                                                               
note  to  the committee  to  reflect  how  much overtime  at  the                                                               
pioneers' homes is voluntary and how much is mandatory.                                                                         
                                                                                                                                
4:55:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA asked  if "lifting"  is used  to alleviate                                                               
the nursing  load.  In  response to a request  for clarification,                                                               
she  said   by  "lifting"   she  means   shifting  some   of  the                                                               
responsibilities that  don't require  the education  of an  RN to                                                               
other employees.                                                                                                                
                                                                                                                                
MR. WILLIAMS  said the pioneers' homes  do that, which is  why it                                                               
employs a lot of CNAs.                                                                                                          
                                                                                                                                
4:57:11 PM                                                                                                                    
                                                                                                                                
VICE CHAIR SEATON closed public testimony.                                                                                      
                                                                                                                                
CHAIR WILSON moved to adopt the fiscal note from the Department                                                                 
of Labor and Workforce Development, dated 4/19/05.  There being                                                                 
no objection, it was so ordered.                                                                                                
                                                                                                                                
VICE CHAIR SEATON returned the gavel to Chair Wilson.                                                                           
                                                                                                                                
[HB 271 was held over.]                                                                                                         

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