Legislature(2005 - 2006)CAPITOL 106


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Heard & Held
Heard & Held
HB 271-LIMIT OVERTIME FOR REGISTERED NURSES                                                                                   
4:01:18 PM                                                                                                                      
VICE  CHAIR SEATON  announced  that the  next  order of  business                                                               
would be  HOUSE BILL NO. 271  "An Act relating to  limitations on                                                               
overtime  for registered  nurses in  health care  facilities; and                                                               
providing for an effective date."                                                                                               
CHAIR  WILSON,  speaking   as  the  prime  sponsor   of  HB  271,                                                               
paraphrased  from  the   following  sponsor  statement  [original                                                               
punctuation provided]:                                                                                                          
     This  bill will  prohibit  an  employer from  assigning                                                                    
     mandatory overtime and  from threatening or retaliating                                                                    
     against a  nurse who  refuses overtime.   It  will also                                                                    
     give the nurse  the latitude to make  the judgment call                                                                    
     about  whether   they  are   safe  to   practice  (work                                                                    
     overtime) or not.  The  bill assigns the administration                                                                    
     of implementation  and enforcement to  the Commissioner                                                                    
     of Department of Labor.                                                                                                    
     Mandatory  overtime  hours  are those  hours  above  an                                                                    
     agreed upon, predetermined,  regularly scheduled shift,                                                                    
     which  the employer  makes  compulsory  (as opposed  to                                                                    
     voluntary).   The threat of  reprisals includes  but is                                                                    
     not  limited  to  discharge,  discipline,  demotion  or                                                                    
     assignment to  unattractive tasks or work  shifts or in                                                                    
     some  cases licensure  removal, retaliatory  reporting,                                                                    
     and charges of "patient abandonment."                                                                                      
     Mandatory overtime contributes  to poor quality patient                                                                    
     care because  fatigue and loss of  concentration, which                                                                    
     results   from   excessive  overtime,   increases   the                                                                    
     likelihood  of errors.   According  to a  study by  the                                                                    
     National Institute  for Occupational Safety  and Health                                                                    
     (NIOSH), when staff plans to  work additional shifts on                                                                    
     a volunteer basis, they are  more likely to be prepared                                                                    
     and  get plenty  of rest  immediately prior  to working                                                                    
     the  extended   shift.    However,  when   an  employer                                                                    
     mandates overtime, this occurs  with little or no prior                                                                    
     notice.  The result is  high levels of fatigue and thus                                                                    
     increased errors.                                                                                                          
     For nurses,  these errors or  mistakes may  cause life-                                                                    
     threatening  situations for  both the  patient and  the                                                                    
     nurse.    These  situations  run the  gamut  from  back                                                                    
     injuries for the nurse to  patient medication errors to                                                                    
     even  death.     The  evidence  is   very  strong  that                                                                    
     prolonged   work  hours   and  fatigue   affect  worker                                                                    
     Emergency situations and  Critical Access Hospitals are                                                                    
     exempt from this bill.                                                                                                     
4:05:33 PM                                                                                                                    
REPRESENTATIVE  GATTO  asked  whether  this bill  would  make  it                                                               
illegal to  allow a nurse to  work overtime even if  the nurse is                                                               
willing and able.                                                                                                               
CHAIR WILSON explained that this  bill protects nurses from being                                                               
required to work overtime when they  know that they are too tired                                                               
to continue  but fear possible  employer retribution.   In answer                                                               
to  further questions,  she stated  that  being able  to hire  an                                                               
adequate nurse work force will  continue to become more difficult                                                               
with the expected  nursing shortage, which is  expected to impact                                                               
state  and  private  facilities.     To  further  questions,  she                                                               
answered that  this bill would  not penalize or prohibit  a nurse                                                               
from working planned, consensual overtime.                                                                                      
VICE CHAIR SEATON  expressed concern for a  facility's ability to                                                               
function because, if  it is unable to retain  an adequate nursing                                                               
staff, available personnel may be required to work overtime.                                                                    
4:12:29 PM                                                                                                                    
ROD BETIT, President/CEO, Alaska  State Hospital and Nursing Home                                                               
Association (ASHNHA),  presented a written statement  opposing HB
271.  He directed attention to  page 1, which lists the hospitals                                                               
and nursing  homes that would be  effected by the adoption  of HB
271, and expressed  his membership's regret in not  being able to                                                               
support this bill.  Despite his  work with the sponsor during the                                                               
interim,  the   bill  is  still  considered   inadequate  by  his                                                               
constituency, he  related.   He said  that mandatory  overtime is                                                               
not an issue  at non-state facilities, but is an  issue at state-                                                               
run facilities.                                                                                                                 
MR.  BETIT  stated  that  the nursing  situation  in  Alaska  has                                                               
improved with  the various statewide programs  that are available                                                               
to  train and  support  nursing  staff.   Due  to these  programs                                                               
position vacancies are  minimized, which has reduced  the need to                                                               
locate/hire  temporary nursing  staff;  a  heretofore common  and                                                               
expensive practice.   He related that his  research has indicated                                                               
the  most frequent  complaints of  mandatory overtime  abuse stem                                                               
from  the Alaska  Psychiatric Institute  (API).   Such complaints                                                               
may  be  occurring   at  API  because  of  the   following:    1.                                                               
Inadequate number of filled nursing  positions to provide patient                                                               
care  due  to  hiring   difficulties  caused  by  non-competitive                                                               
salaries and  the stress  of the job  leading to  higher turnover                                                               
than  in  general  acute  care   facilities.    2.    An  overall                                                               
expectation   for   API   to   take   all   patients   who   need                                                               
hospitalization regardless of available  staff, given that API is                                                               
the  sole  provider  of  certain specialty  nursing  needs.    3.                                                               
Inadequate provisions, in state  employee contracts, to allow API                                                               
to request  a market survey  to validate salary  disparities with                                                               
the  private  health  care market,  and  permission  to  increase                                                               
salaries   to  be   competitive  throughout   the  year   without                                                               
legislative review.   4.   Inadequate funding in  API's operating                                                               
budget to actually pay higher salaries  and hire staff as soon as                                                               
it  deems  there  to  be  a  problem  developing  without  budget                                                               
authority from  the legislature,  which generally cannot  come in                                                               
time to head off a serious problem.                                                                                             
MR.  BETIT  stated  that  HB 271  would  provide  punishment  for                                                               
excessive use  of mandatory overtime without  putting measures in                                                               
place to  break the  cycle of overtime  use in  state facilities.                                                               
In addition,  he opined, the bill  creates a burden in  regard to                                                               
reporting and monitoring overtime, which ASHNHA does not                                                                        
support, given the lack of evidence of any problem with use of                                                                  
mandatory nurse overtime in non-state facilities.                                                                               
MR. BETIT suggested 5 alternative solutions to curb mandatory                                                                   
overtime issues at state facilities, paraphrasing from his                                                                      
prepared statement [original punctuation provided]:                                                                             
     1.   Immediately  authorize  managers  to offer  higher                                                                    
     salary levels, as validated by  market surveys, so that                                                                    
     they  can hire  additional  nurses sooner  contemporary                                                                    
     with market conditions.                                                                                                    
     2.    Consider providing  API  funding  for an  ongoing                                                                    
     nurse  preceptor program  that  will  help newly  hired                                                                    
     nurses  gain  advanced skills  to  provide  care in  an                                                                    
     inpatient psychiatric  setting.  With  competitive pay,                                                                    
     mentorship,  preceptor  training and  periodic  respite                                                                    
     from   intense   nursing   demands  in   an   inpatient                                                                    
     psychiatric  setting,   API  will  have   more  success                                                                    
     attracting and keeping the nursing staff they need.                                                                        
     3.   Help API  create a pool  of temporary  nurses that                                                                    
     can be  hired during staffing  crises to fill  gaps, in                                                                    
     the specialized area of psychiatric care.                                                                                  
     4.   Consider establishing  a separate  bargaining unit                                                                    
     for essential  health care related staff  separate from                                                                    
     other  employees  to  allow special  procedures  to  be                                                                    
     developed  that  will  address these  problems  in  the                                                                    
     future.   Ongoing  market surveys  of nursing  salaries                                                                    
     should be a routine part of this program.                                                                                  
     5.   Create  a work  group to  find other  solutions to                                                                    
     this problem.                                                                                                              
MR. BETIT concluded his prepared statement reading:                                                                             
     We think  the solutions outlined above  have merit, but                                                                    
     more importantly recommend a  work group be convened to                                                                    
     support  the sponsor's  efforts  to figure  out how  to                                                                    
     place state facilities on a  more solid footing so they                                                                    
     do not  have to resort to  excessive mandatory overtime                                                                    
     for lack of other options.                                                                                                 
4:21:53 PM                                                                                                                    
VICE  CHAIR  SEATON asked  how  a  pool  of specialty  nurses  is                                                               
MR.  BETIT  suggested  various means  to  accomplish  this  goal:                                                               
retired nurses in  a given community could be  retained for these                                                               
specialty  purposes; alert  nursing  organizations, that  provide                                                               
temporary  staffing,  to specific  needs  in  a given  area;  and                                                               
provide a financial incentive to  encourage prospects.  In answer                                                               
to  another question,  he clarified  that, when  speaking of  the                                                               
need  for a  separate  union  bargaining unit,  it  is the  state                                                               
operated  facilities  that  are  critical.    He  suggested  that                                                               
problems arise  in unions  supporting nurses  when they  are made                                                               
part  of a  larger bargaining  group outside  of the  profession.                                                               
However,  he opined,  that there  are enough  allied health  care                                                               
professionals impacted to warrant  creating a separate bargaining                                                               
entity for their  benefit.  In answering  whether the legislature                                                               
would have  to create such  a unit or if  it would be  handled by                                                               
the  union structure,  he responded  that he  did not  know.   He                                                               
reiterated that mandatory  overtime is not an  issue in non-state                                                               
4:26:43 PM                                                                                                                    
RUSSELL GRANGE, Chief Human  Resources Officer, Providence Health                                                               
System Alaska  ("Providence"), said  he is  unable to  support HB
271.   He emphasized that  minimizing mandatory  overtime relates                                                               
directly  to employee  satisfaction.   He expressed  concern with                                                               
the  bill, in  that it  may cause  an adverse  impact if  the 900                                                               
nurses, of  Providence, decide their own  overtime; unit managers                                                               
are  paid to  make overtime  judgment calls  and it  is important                                                               
that  they retain  that authority/capacity.    He also  expressed                                                               
concern  that ambiguity  in the  language  of HB  271 may  create                                                               
administrative   problems  in   interpreting  certain   overtime-                                                               
allowable situations,  resulting in  penalties being  impugned on                                                               
the facility.                                                                                                                   
4:34:07 PM                                                                                                                    
SHARA  SUTHERLIN,   Chief  Nurse  Executive,   Providence  Alaska                                                               
Medical Center,  announced her  opposition to  HB 271  and stated                                                               
support for  a task force or  special entity to be  initiated, as                                                               
proposed by  Mr. Betit's  statement [suggestion  4].   She opined                                                               
that a separate  bargaining unit could bring  focus where needed.                                                               
Moreover, she  opined, a  statewide resource-nursing  group could                                                               
be helpful.  Referencing the  suggestions proposed in Mr. Betit's                                                               
statement, she underlined the need  to:  utilize market analysis;                                                               
expand  preceptor programs  statewide; and  assist facilities  in                                                               
establishing intern/extern and  fellowship programs, as currently                                                               
implemented  at  Providence.    She   added  that,  in  terms  of                                                               
recruitment and  retention the focus  should be on the  issues at                                                               
large:   keeping patients safe;  understanding the impact  of the                                                               
Institute of Medicine (IOM) reports  and Institute of Health Care                                                               
Improvement (IHI)  initiatives; and support for  night shifts and                                                               
critical response  workers by  instituting IHI's  "Best Practice"                                                               
model  for   a  rapid  response   team.    She  opined   that  by                                                               
implementing   these    suggestions,   and    through   statewide                                                               
coordination, overtime  issues might  be minimized.   She pointed                                                               
out  that,  under her  management,  volunteers  for overtime  are                                                               
primarily utilized  and "on-call  specialty teams"  are carefully                                                               
rotated/managed   for  optimal   reduction  of   overtime  hours.                                                               
Responding  to  how much  overtime  is  used at  Providence,  Ms.                                                               
Sutherlin  stated   that,  given   the  nebulous   definition  of                                                               
mandatory overtime, providing for  the rotation of on-call teams,                                                               
and  considering  the  staff that  request  overtime,  she  would                                                               
estimate  less than  1 to  2 percent  [of hours  worked represent                                                               
4:39:42 PM                                                                                                                    
VICE CHAIR  SEATON inquired as  to the impact on  the recruitment                                                               
process, at Providence, if overtime is required.                                                                                
MR. GRANGE opined that an  excess of amount of mandatory overtime                                                               
would have a significant impact  on hiring practices.  He pointed                                                               
out that  many of Providence's  employees are hired  via employee                                                               
referral, which reflects Providence's  reputation as a good place                                                               
to  work, with  a  high  level of  employee  satisfaction.   Upon                                                               
committee request, he agreed to  provide mandatory overtime hours                                                               
to  the  committee, and  reiterated  the  difficulty in  defining                                                               
mandatory versus volunteer overtime for purposes of HB 271.                                                                     
4:42:48 PM                                                                                                                    
MILA  COSGROVE, Director,  Division of  Personnel, Department  of                                                               
Administration  (DOA), stated  her  intention to  report on  what                                                               
actions  the state  has been  taking to  proactively address  the                                                               
recruitment  and retention  issues  in the  area of  professional                                                               
nursing.   She pointed out  that difficulties in  meeting nursing                                                               
needs  are a  nationwide  concern and  projections indicate  that                                                               
this  trend  will continue.    In  response  to a  question,  she                                                               
clarified that her statements today  will be focused on state-run                                                               
MS. COSGROVE explained  that DOA has reviewed  state statutes and                                                               
regulations  that  apply to  the  state's  ability to  compensate                                                               
employees.   She projected that in  the next fiscal year  the new                                                               
policy   and   administrative    guidelines,   with   regard   to                                                               
compensation, will be in place.   In addition, various strategies                                                               
have  been  undertaken  in conjunction  with  the  Department  of                                                               
Health  and  Social  Services  (DHSS),   and  the  Department  of                                                               
Corrections.   She stated that  DOA now has a  position dedicated                                                               
to  professional recruitment,  which includes  entrance and  exit                                                               
surveys   and  workplace   environment  modifications   to  boost                                                               
retention.  The department is  also reviewing how hiring managers                                                               
present the  state benefits package,  as it differs  from private                                                               
sector  benefits.   She reported  that, in  partnership with  the                                                               
other departments, an  on-call pool of nurses  is being developed                                                               
to address  shortages and  specialty nursing needs  as well  as a                                                               
retention strategy that assists  employees with transfers between                                                               
state facilities.                                                                                                               
4:48:35 PM                                                                                                                    
REPRESENTATIVE  GARDNER asked  Ms. Cosgrove  to describe  how she                                                               
expects    the   new    retirement   system    to   effect    the                                                               
recruitment/retention issue.                                                                                                    
MS. COSGROVE responded  that the proof will ultimately  be in the                                                               
numbers.   However,  she  opined,  that it  would  be prudent  to                                                               
consider  a  portable  retirement plan,  noting,  "All  workplace                                                               
trends  indicate  that  employees  are   not  so  much  loyal  to                                                               
employers as they  are to their careers."  She  stated that being                                                               
able  to provide  a  portable retirement  package  may provide  a                                                               
broader  range of  recruits, although  the  impacts to  retention                                                               
remain to be seen.                                                                                                              
JANET  CLARKE,  Assistant  Commissioner, Finance  and  Management                                                               
Services,  Department of  Health &  Social Services  (DHSS), said                                                               
that DHSS  has been working on  dealing with the symptoms  in the                                                               
system that  are causing mandatory  overtime.  She  admitted that                                                               
hiring and retention  is a problem, with  vacancy figures ranging                                                               
from  15-20  percent  in state-run  facilities.    She  expressed                                                               
concern that,  despite various strategies, mandatory  overtime is                                                               
still utilized  and negative repercussions  will occur if  HB 271                                                               
is  adopted as  drafted.   Because the  state facilities  are not                                                               
allowed to refuse patients, she  questioned whether a wing at the                                                               
Alaska Psychiatric  Institute (API)  would need  to be  closed to                                                               
avoid  incurring penalties.   She  stated that  the governor  has                                                               
included a  one-range salary increase  for direct care  nurses in                                                               
the Fiscal  Year (FY) 2007  budget.   This is in  anticipation of                                                               
providing a  market base pay  scale, which  may help to  ease the                                                               
recruitment/retention situation.   Due to the fact  that there is                                                               
only  one  API, the  consequences  of  passing  HB 271  may  have                                                               
significant   negative  impacts,   she   said,  reiterating   her                                                               
reservations.  She opined that costs  may need to be increased at                                                               
state facilities.  She then  highlighted fiscal notes provided in                                                               
the committee packet to illustrate her concerns.                                                                                
VICE CHAIR  SEATON said that since  the state system could  be in                                                               
violation as the primary user  of mandatory overtime, it would be                                                               
important  to know  how the  commissioners of  the Department  of                                                               
Labor & Workforce Development (DLWD),  and DHSS would be expected                                                               
to handle possible penalties if  incurred.  He questioned whether                                                               
the  departments   would  be  subject  to   mutual  lawsuit;  his                                                               
attention was called to the legal opinion in the bill packet.                                                                   
4:54:33 PM                                                                                                                    
MICHELLE  MURPHY, Registered  Nurse (RN),  Providence RN's  Union                                                               
Health  and Safety  Officer,  Providence  Alaska Medical  Center,                                                               
stated her  support for  HB 271.   She related  her understanding                                                               
that the nursing  shortage will continue to  increase, along with                                                               
the need  for more nurses,  given the population and  health care                                                               
demands.   She  said the  International Council  of Nurses  (ICN)                                                               
defines  mandatory   overtime  as  "obligatory,   compulsory,  or                                                               
imposed  by the  employer  leaving no  choice  to the  employee."                                                               
With  the  shortage  of nurses  growing,  mandatory  overtime  is                                                               
reportedly being  used for  staff management  on a  routine basis                                                               
versus emergency situations,  as it once was.   This, she opined,                                                               
is of  major concern given the  care that nurses are  required to                                                               
provide.     Overtime   becomes   a   dangerous  situation,   she                                                               
maintained, when  a nurse is  required to calculate  drug dosages                                                               
or make  other critical decisions  with diminished  abilities due                                                               
to overtiredness.  To illustrate  her point, she related personal                                                               
accounts of  working long shifts  which highlighted  the physical                                                               
and mental  toll involved in  working overtime.  She  stated that                                                               
the  use   of  mandatory  overtime  is   detrimental  to  nurses,                                                               
dangerous   to   patients,   and  does   not   promote   employee                                                               
recruitment/retention.   In  response to  a question,  she stated                                                               
that Providence does not utilize  mandatory overtime, because the                                                               
union contract provides for regular rest times.                                                                                 
VICE  CHAIR  SEATON   stated  that  he  would   like  to  further                                                               
understand  the   ramifications  of  voluntary   overtime  versus                                                               
mandatory overtime  and asked why  the state should put  into law                                                               
an item that is a negotiating  point between a nurses union and a                                                               
MS. MURPHY pointed  out that not all nursing  facilities have the                                                               
benefit of a union and  the nursing staff need protection against                                                               
mandatory overtime.                                                                                                             
5:03:36 PM                                                                                                                    
KATHLEEN  GETTYS, RN,  Progressive Care  Unit, Providence  Alaska                                                               
Medical  Center;  President,  Providence  RN's  Bargaining  Unit;                                                               
Representative,  Alaska  Nurses  Association (ANA),  opined  that                                                               
there  is  great  concern regarding  mandatory  overtime  in  the                                                               
nursing  profession, which  has  resulted in  strikes across  the                                                               
nation.   She reported that  by strictly regulating the  hours of                                                               
overtime, the quality of health  care is increased and the number                                                               
of medical errors is reduced.   When nurses work 12 or more hours                                                               
statistics  show that  errors increase.   She  pointed out  that,                                                               
unlike other  industries for  which public  safety is  a concern,                                                               
health care is exempt from  [federal] regulation limiting the use                                                               
of mandatory  overtime as a  staffing tool.  Standards  have been                                                               
established  to limit  the number  of hours  that pilots,  flight                                                               
attendants,  truck drivers,  and  railroad  engineers can  safely                                                               
work before  consumer safety is considered  endangered.  However,                                                               
she said,  no similar limitations  exist for our  nation's nurses                                                               
who are  caring for patients.   Nurses'  professional obligations                                                               
are undermined when  they are forced to  work mandatory overtime,                                                               
and outside of collective bargaining,  nurses have few avenues to                                                               
challenge required overtime, she maintained.   She called for the                                                               
legislature to be responsive to  its constituents, the nurses and                                                               
patients,  concerning the  unethical use  of mandatory  overtime,                                                               
and  to set  new  state  limits on  the  ability  of health  care                                                               
facilities  to impose  overtime.    She added  that  there is  an                                                               
available pool of 500,000 trained  nurses, across the nation, who                                                               
have  left  the  profession  in  direct  correlation  with  their                                                               
working environment.                                                                                                            
5:08:34 PM                                                                                                                    
STACY ALLEN, RN,  Business Agent, Laborers Local  341, stated her                                                               
support  for HB  271,  and disputed  Mr.  Betit's assertion  that                                                               
private  institutions  do  not   use  mandatory  overtime.    She                                                               
explained  how she  has watched  this situation  evolve over  her                                                               
tenure as a registered nurse.   She said that this bill generates                                                               
an incentive for creativity in  the industry to solve this issue,                                                               
and  provides needed  protection  for patients  and  nurses.   In                                                               
answer to  a question  she stated that,  for Laborers  Local 341,                                                               
mandatory  overtime has  not been  a negotiating  point, although                                                               
they are ready to address it should it become necessary.                                                                        
5:14:24 PM                                                                                                                    
DIANNE O'CONNELL,  Executive Director and Labor  Director, Alaska                                                               
Nurses  Association,  stated  that   the  exceptions,  listed  in                                                               
section  (b), beginning  on line  13, page  2, of  the CSHB  271,                                                               
Version Y,  do not address  staffing shortages due to  sick leave                                                               
and vacation  coverage.  She  testified that, for API,  these are                                                               
the pitfall areas.  Although API  is working to develop a plan to                                                               
address these situations, including  creating a float pool, there                                                               
is not  one currently in  place.  She reiterated  the suggestions                                                               
that Mr. Betit made in  his statement.  Additionally, she pointed                                                               
out that prescheduled  on-call time, in which  a nurse volunteers                                                               
to work  overtime, is not covered.   This brings up  the question                                                               
as to whether  to allow a nurse to work  beyond his/her scheduled                                                               
shift;  certainly  a pilot  could  not  volunteer for  additional                                                               
flights,  and should  "we  stand  in their  way"  if  a nurse  is                                                               
volunteering for an  additional shift, she asked.   She responded                                                               
that the  36-hour on-call rotation  is not addressed in  the bill                                                               
either,  but  said   that  she  did  not   have  the  appropriate                                                               
experience to comment or make  a suggestion.  In emergencies, she                                                               
maintained, the bill  does not say that overtime  cannot be used,                                                               
although it  specifies that a  penalty will be incurred  if used.                                                               
She opined  that HB 271  will provide managers a  disincentive to                                                               
use overtime,  and compel them  to seek better solutions  to meet                                                               
the needs.   She pointed out  that allowances in the  bill ensure                                                               
that patients will not be left  without care.  She echoed earlier                                                               
testimony that  not all  nurses are  represented by  a collective                                                               
bargaining  agreement  and   HB  271  is  needed   to  provide  a                                                               
foundation for a public policy  requiring safety for patients and                                                               
nurses and to  create better working conditions.   In response to                                                               
questions, she  stated that Providence  Medical Center  does have                                                               
what is termed "mandatory call" and  it is used in certain units,                                                               
but will not be expanded to other areas of the hospital.                                                                        
5:22:29 PM                                                                                                                    
MIKE  ALEXANDER, RN,  Alaska  Psychiatric  Institute, stated  his                                                               
support for HB 271.  He  related his current situation of working                                                               
mandatory overtime  during the  holiday season.   He  also stated                                                               
that  the pay  rate is  "behind," employees  are exhausted,  nine                                                               
staff positions are  unfilled, and any time off is  nebulous.  He                                                               
added that  API lowered the  acuity ratings of patients  in order                                                               
to  require  fewer  attending staff  per  patient,  although  the                                                               
patient  needs haven't  changed.    Therefore, unsafe  conditions                                                               
have resulted,  he suggested.  He  opined that job loss  is being                                                               
experienced as  well as  patient abandonment.   In response  to a                                                               
question,  he said  that the  clerks union  covers the  nurses at                                                               
API.   However, the [union  agents] "don't really operate  in our                                                               
realm,"  he stated,  and  for them  to  understand any  situation                                                               
outside of a standard eight-hour  day is difficult.  Neither does                                                               
there seem to be a possibility  for the API nursing group to move                                                               
to  a  different  bargaining  unit,  in  which  nurses  would  be                                                               
representing nurses.  Despite efforts  to create an understanding                                                               
of the  nurses needs, he  said that the union  representation has                                                               
become unresponsive and somewhat hostile.                                                                                       
5:30:14 PM                                                                                                                    
CATHY  FEASTER,  Supervising   Nurse  Practitioner,  Division  of                                                               
Community  Health  Services,  Department   of  Health  and  Human                                                               
Services, stated  support for HB 271,  but expressed reservations                                                               
regarding  its  possible  consequences   to  the  Sexual  Assault                                                               
Response Team (SART).   She described how this  team is assembled                                                               
and scheduled to  provide around the clock  availability, and she                                                               
offered  to work  with the  bill sponsor  to ensure  there aren't                                                               
repercussions on SART.   In response to  questions, she explained                                                               
that many  of the SART  members have  full-time jobs, but  make a                                                               
commitment to  be on-call for a  specified time.  The  concern is                                                               
that the  language of HB  271 may adversely  effect availability,                                                               
she  explained, of  SART nurses  who  are called  out after  just                                                               
having completed a full shift at their regular facility.                                                                        
5:34:41 PM                                                                                                                    
CHAIR  WILSON  assigned  a  subcommittee   to  work  on  HB  271,                                                               
comprised  of the  following  members:   Representatives  Wilson,                                                               
Gardner,  Seaton, and  invited other  committee  members to  join                                                               
them.  She  established February 16, 2006, as a  deadline for the                                                               
subcommittee to have the bill back before the committee.                                                                        

Document Name Date/Time Subjects