Legislature(2021 - 2022)BUTROVICH 205
02/25/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB67 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 67 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 67-NURSING: LICENSURE; MULTISTATE COMPACT
1:34:15 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 67
"An Act relating to the licensure of nursing professionals;
relating to a multistate nurse licensure compact; and providing
for an effective date." He stated his intent to take public
testimony. The committee heard an overview of bill, had a
sectional analysis, and heard invited testimony. He noted that
Director Sara Cambers was available online for questions.
1:34:42 PM
SENATOR REINBOLD announced that she needed to excuse herself to
attend another meeting.
1:35:06 PM
SENATOR BEGICH said that in his conversations with Director
Chambers and in committee, she had indicated that there had been
no opposition to the bill from organized labor. AFL-CIO sent a
strong letter of concern to the committee and he also received
unsupportive comments from some of the representatives of the
Nurses Association, which has 7,000 members. He asked if she had
not received any notice of those objections.
1:36:07 PM
SARA CHAMBERS, Director, Division of Corporations, Business, and
Professional Licensing, Department of Commerce, Community and
Economic Development (DCCED), replied that her agency had not
received any letter or notification of opposition from the AFL-
CIO or Nurses Association about this bill this year. As she
mentioned on Tuesday, nurses overwhelming support the Nurse
Licensure Compact. She review that information and provide
responses to any concerns raised.
SENATOR BEGICH said that he thought the responses were a result
of the previous hearing on the bill. He looked forward to the
public testimony today and he will reach out to make sure those
people put their objections on the record.
1:37:46 PM
At ease
1:38:35 PM
CHAIR WILSON reconvened the meeting.
1:38:38 PM
SENATOR HUGHES said the Nurses Association has 7,000 members.
She asked how many nurses are licensed overall in the state.
MS. CHAMBERS replied that the state about 20,000 registered
nurses and licensed practical nurses who would be affected by
the bill. The bill does not affect certified nursing assistants
or advanced practice registered nurses.
SENATOR HUGHES said that is a good reference point.
1:39:44 PM
CHAIR WILSON opened public testimony.
1:40:10 PM
VICKY BYRD, Montana Nurses Association, Clancy, Montana, said
that SB 67 is similar to a bill that already passed in Montana.
She wants to share the unintended consequences the committee
should be aware of before considering the NLC. There is no way
to monitor compact nurses working in Montana. They do not check
in with the state Board of Nursing. The employer only needs to
see that they have a current multistate license. If they move to
Montana, they are supposed to get a new home state license, but
that is not happening. Nurses are renewing their out-of-state
licenses. A nurse from Tennessee was hired in 2018 and still
does not have a Montana license. There is no way to enforce them
to abide by Montana's continuing education rules and get a home
state license. That is a loss of revenue. Other Montana nurses
must pay for any investigations that may need to happen with
those nurses. That is a super challenging aspect. The NLC is a
nongovernmental, nonregulatory agency. The compact does not
apply to travel nurses. It applies to the agencies that employ
them. Agencies usually have to buy licenses in each state that
they dispense nurses to, but with the compact, the agencies are
saving money, not nurses. Montana passed the NLC, but it was
against the wishes of the professional nursing association.
SENATOR BEGICH clarified that Ms. Byrd said that out-of-state
nurses didn't have to register with Montana's Board of Nursing.
MS. BYRD replied yes, nurses from other compact states can work
immediately without registering with the board. The facility
just needs to see if they have a legal license. Those nurses are
supposed to get a new home state license once they establish
residency in Montana, but it doesn't always happen. Therefore,
the state is losing revenue.
1:45:08 PM
At ease
1:45:53 PM
CHAIR WILSON reconvened the meeting.
1:45:58 PM
SHANNON DAVENPORT, Member, Alaska Nursing Association,
Anchorage, Alaska, said that she is a hospice nurse at
Providence Alaska Medical Center. SB 67 is not a valid option
for the state and its people. Every nurse has story about why
they become a nurse. Hers began as a mistake. In 2005, she went
into premature labor in her first pregnancy while living in
North Carolina. Due to a traveling nurse's inability to read
pertinent medical information, her family paid the ultimate
price. Her daughter lived for 24 minutes. She wonders if the
outcome would have been different if the nurse had been held to
the same standards as those in North Carolina. Alaska is a
melting pot with a unique and diverse community. Alaska holds
her to a higher standard of competency and knowledge. Alaska is
a complex and distinct entity that requires that nurses have
more than medical knowledge. They need a grasp of culture.
1:49:00 PM
BOB PAWLOWSKI, Chair, Pioneer Homes Advisory Board, Anchorage,
Alaska, said the Pioneer Homes Advisory Board is interested in
SB 67 to increase the licensed nurses in the six communities
with Pioneer Homes but have yet to take an advisory position to
the governor. That will be discussed at their March meeting, but
he did want to make the following points. The six Pioneer Homes
have assisted living for 446 residents with 243 over the age of
85. Each community that has a Pioneer Home has a significant
military presence, whether in Sitka, Ketchikan, and Juneau with
the Coast Guard or Anchorage, Palmer, and Fairbanks with the Air
Force and Army. The Army and Air Force have used executive
orders to allow military spouses to work on federal properties.
He could not find anything similar with the Coast Guard. When
active duty members come to Alaska with spouses licensed to
practice as nurses, the spouses should be able to come into the
workplace easily. His board hopes this bill would address that.
The U.S. Public Health Service works in the Coast Guard stations
and Indian Health Services throughout the state. Those workers
also have skilled spouses who travel with them. Department of
Health and Social Services Commissioner Crum supported a
comparable bill in the last legislature, recognizing the needs
of the Pioneer Homes, and [Alaska National Guard] Major General
Saxe supported SB 67. Pioneer Homes have 97 nurse positions, but
only 83 are filled.
1:52:15 PM
LYNN VAN VACTOR, Director of Quality, Alaska State Hospital and
Nursing Home Association (ASHNA), Dillingham, Alaska, said she
is also the liaison for the ASHNHA nurser leader committee. This
is an important decision and ASHNHA requests the committee's
full support to join the NLC. The NLC improves access to care by
making it easier for nurses to start providing patient care
right away rather than waiting weeks for official approval.
Timely filling of nursing vacancies is imperative to assure
continuity of care and safe staffing levels for patients. The
compact has high standards and uniform requirements. Currently,
Alaska nurses are required to have multiple licenses to provide
training and patient care across state lines. With the advance
of telehealth, such licensing burdens are a regulatory nightmare
and expensive. Alaska needs to be more competitive to attract
professional nursing staff. Travel nurses who would love to stay
and work in Alaska have refused to accept permanent vacant
positions because NLC nurses who change their residencies to
Alaska do not maintain their NLC licenses. Alaska would be more
attractive for nurses as an NLC member. Concerns have been heard
that the NLC will allow out-of-state nurses to take jobs away
from Alaska nurses. While ASHNHA does not keep track of nursing
vacancies, members do have nursing shortages. As of yesterday,
one large hospital in Alaska had 101 nursing vacancies, one
medium hospital had 20 nursing vacancies, and one critical
access hospital had 14. These three facilities alone have 135
nursing vacancies. Alaska has 41 licensed, acute care critical
access and long-term care facilities. The need is there, the
need is great, and the the need to join the compact is now.
1:55:44 PM
MIKE COONS, President, Mat-Su Chapter of Association of Mature
Citizens (AMAC), Palmer, Alaska, said that his AMAC chapter
supports SB 67, along with AARP. He has read the pros and cons.
He is impressed with the large support in and out of state. Up
to the writing of his testimony, the only opposition is from the
nurses union. As an Air Force retiree and contract paramedic, he
sees the need for this compact. His chapter supported this
legislation in the past session, but it didn't pass because of
the pandemic. That was sad because it would have been helpful
during the pandemic. More patients could have been treated with
far less fatigue by limited nursing staff. Mat-Su AMAC is in
full support of SB 67.
1:57:01 PM
TINA REIN, Director of Nursing, Denali Center, Fairbanks,
Alaska, said that she has been in her role for 15 years. Her
experience with nursing shortage in the long-term care sector is
the same as the Pioneer Homes and other assisted living
facilities in the state. Denali Center this last year and
historically has not experienced layoffs or furloughs. The
center currently has three licensed openings with no
applications. The center has 30 licensed nurses. The center is
forecasting losing over 40 percent of its licensed staff in the
next four years. Its nursing staff is aging and moving toward
retirement. The center uses licensed practical nurses (LPN) and
with no LPN program in the state, the center has to recruit from
out of state. The Interior has over 16,000 people over 65. That
number is growing and the need for qualified geriatric nurses is
growing, but licensed nurses have options. Many do not choose
long-term care assisted living. All of this is creating an
oncoming crisis. Delays in licensing is and will continue to
lead to unsafe conditions in long-term care centers across
Alaska. ASHNHA supports the NLC.
CHAIR WILSON passed on information that Senator Hughes had to
leave for another meeting. She appreciates those testifying and
her staff is in the room taking notes. She will follow up by
listening to testimony as well.
SENATOR BEGICH noted that Senator Costello was participating by
phone and Chair Wilson added that she also has staff in the
room.
SENATOR COSTELLO said that she is listening intently to the
testimony.
1:59:37 PM
REBECCA FOTSCH, Director, State Advocacy & Legislative Affairs,
National Council of State Boards of Nursing, Chicago, Illinois,
said that her organization is the drafter of the NLC language.
The compact has been enacted in 34 states and now 10 states have
pending legislation like Alaska. She has heard the concerns from
states over the years. Many of which are the same. It was
brought up that compact nurses do not need to register with the
Board of Nursing when practicing in a state. That is true and
intentional. The purpose of the compact is to eliminate those
regulatory hurdles. By allowing nurses to immediately begin
practicing across state lines with the multistate license,
nurses can immediately cover gaps in care caused by disasters,
flu seasons, or just shortages. It was said that the Board of
Nursing would not know who is practicing in a state. Right now
Boards of Nursing do not know who is practicing in their states.
Employers don't report who is employed. Boards of Nursing know
who is licensed but not practicing in their states. It would not
be much of a difference with the compact. In the first committee
hearing and today, she heard comments about travel nurses. A
compact nurse and a travel nurse not synonymous. A compact nurse
has a compact license. There are travel nurses practicing in
Alaska under their single state license. Travel nurses are used
to cover gaps in care and used whether a state has joined a
compact or not. The nursing standards are uniform across the
country. Nurses must pass the same test, the NCLEX, to be a
licensed RN. That is the same in all states. That is why the
compact has been able to operate safely and successfully for
over 20 years.
SENATOR BEGICH asked if she had any objection to nurses
registering with the state.
MS. FOTSCH answered that without getting into too many legal
specifics, there have been some states with the same concerns.
As a way to address those concerns, they have required their
hospitals and institutions to provide that information. The only
problem is if nurses are required to do that before practicing
because that it is not required in any other state. Compacts act
like a contract between states, so Alaska cannot add additional
stipulations to that contract, but if the employer is required
to do that, that is outside the purview of the compact.
SENATOR BEGICH asked if any state has stepped away from the
compact.
MS. FOTSCH answered that no state has repealed the contract
language.
2:04:33 PM
PATRICIA FISHER, representing self, Wasilla, Alaska, said that
COVID made it clear that nursing should not be restricted by
state lines. The news this past year showed that cities and
states were pleading for nurses to come help them. That is not
going to go away. There could be a COVID relapse next winter or
another medical crisis. Alaska needs to recognize being in the
21st century. The world grows smaller every day. It is time to
join the NLC to allow nurses to easily cross state lines. All
Alaskans are hurt by a shortage of nurses, which Alaska has had
for some time. This shortage has a significant impact on senior
Alaskans, like herself. Many older Alaskans do not have the
resources or ability to get to their appointments or they live
in rural areas. They need the ability to receive healthcare in
person or through telehealth technologies. The NLC makes nurses
more available to Alaskans. She urged the committee to pass SB
67 with amendments to address the issues raised by Ms. Byrd.
2:06:33 PM
LORI ENLOW, representing self, Wasilla, Alaska, said she is an
RN who works in Anchorage at Providence Medical Center in a
specialty nursing field. One thing that has made it difficult
this year is that a nurse from another unit cannot just walk
into her unit do the job they do in her specialty unit. She
supports the NLC because Providence would have been able to get
nurses more quickly. She worked in two other states that were
part of the NLC. She saw the ability for nurses to be hired
quickly, especially for military spouses. Joining the NLC would
be a good thing for the state.
2:08:44 PM
LAURA BONNER, representing self, Anchorage, Alaska, said that is
always skeptical of Alaska automatically accepting licensing
from other states that may have lower standards. There is a
national shortage of nurses, so this won't help Alaska with its
shortage. The state should be recruiting in state and growing
its own. She knows young women who wants to be nurses but there
are few opportunities to be accepted. It would be better to
provide the education and training to Alaskans. Alaskans who are
educated here are more likely to stay here. They would also
understand Native cultures better.
2:10:20 PM
BRITTANY MACKEY, Member, Alaska Nursing Association, Wasilla,
Alaska, said she is a nurse at Providence Medical Center. The
NLC would cause a loss of state sovereignty. Alaska would
forfeit its self-determination of nursing standards and practice
to the unelected, interstate commission of the NLC. Alaska would
lose its ability to establish rules that cover all nurses
working in the state. It is a threat to public safety with an
inability to monitor and discipline unsafe conduct. Nursing
education requirements varies widely state to state. Some states
don't require any continuing education and the NLC only requires
that member states meet minimum standards. No evidence exists to
suggest that joining will bring more nurses to Alaska. The
nursing shortage is a national issue. There is no current
analysis that licensing is a barrier to hiring. The Board of
Nursing can expedite license applications and grant temporary or
courtesy licenses in case of emergency.
2:12:54 PM
SARA MASSMANN, Legislative Cochair, Alaska Nursing Association,
Ketchikan, Alaska, said she an ICU nurse at Ketchikan Medical
Center. The Alaska Nursing Association is the voice of nurses in
Alaska and opposes SB 67. Regarding military spouse access to a
license, the association has reached out to JBER and Eielson to
find out what problems may impede getting licenses. Last year
they heard that military spouses couldn't apply for a position
until they reached their destination in Alaska. They found that
transfer orders come months before moving to Alaska. These
spouses are encouraged to find employment off-base if they are
interested in that when they get the notice of transfer. They
can be fully licensed prior to arrival. For JBER and Eielson the
cost of a new license is reimbursed by the military. Joining the
NLC will not solve the issue of a nursing shortage. There are
not many nursing spots in the universities and nursing graduates
are having trouble finding jobs. Multiple graduates have left
the state because of an inability to find jobs.
SENATOR BEGICH said that yesterday, University of Alaska
[Interim] President Pitney in the state of the university speech
spoke with pride about the 236 students that came out of the
university. He asked if Ms. Massmann is saying there are not
positions for them. The committee has heard about vacancies
today. He asked her to elaborate on that.
MS. MASSMANN replied that it may be more specific to Ketchikan.
Ketchikan does not have enough student positions and after
graduation there are not enough positions for them in Ketchikan.
2:18:22 PM
PAT DOOLEY, representing self, Anchorage, Alaska, said she is a
recently retired RN. She wants to talk about the economic toll
of the current system and quality of care. She spent almost 10
years managing a hospice program in Anchorage and the past two
years provided nursing orientation for new nurses at a skilled
nursing facility. There is a significant delay in providing a
job offer and a nurse actually getting to the bedside to care
for someone. This could mean a delay in getting admission for
hospice. Travel nurses are expensive and short-term and not the
best for continuity of care. Many might stay if there were an
easier path to licensure for them. In long-term care, the amount
of time it takes to fill positions with out-of-state nurses who
are waiting for their licenses takes a toll on staff, resulting
in burnout and poor retention of staff. Patients and residents
suffer. Alaska has a limited pool of RNs. Currently 34 states
are in the compact. Joining the compact would make Alaska
attractive to nurses. Some nurses can't wait 90 days to get a
job, so the state may lose them. The state makes it so hard for
nurses to come up to Alaska and start working. She has no
concerns about the quality of care and safety. There will be
background checks and nurses will be practicing under state
regulations.
2:21:41 PM
MARGE STONEKING, Director for Advocacy, AARP Alaska, Anchorage,
Alaska, said that Alaska has a the fastest growing senior
population in the country. The need for healthcare workforce
grows as people age. There is already a nursing shortage in
Alaska. According to state and federal data, almost half of
Alaska RNs are over the age of 45. Given current projections,
Alaska will need 5,400 additional nurses by 2030. That is in
addition to the hundreds of chronic current vacancies. It is
unrealistic for Alaska to grow its own at that scale. Nurses are
the largest segment of the U.S. healthcare workforce. The
shortage is only growing worse. The compact makes it easier and
more affordable for nurses to practice across state lines, which
helps expand access to care, which is particularly important for
Alaska seniors and those in rural areas. The nursing compact may
not be a silver bullet for the nursing shortage, but it is a
proven tool for removing a barrier to quickly and easily
supplement the resident workforce. It makes more sense in Alaska
than anywhere else as Alaska has a long history of a workforce
boosted by traveling nurses. Joining the compact maximizes the
use of nurses to address Alaska's most pressing healthcare
challenges, access, quality, and cost. AARP urges the committee
to pass SB 67.
2:24:56 PM
CHAIR WILSON noted that written testimony could be sent to
shss@akleg.gov. He closed public testimony.
SENATOR COSTELLO said that she would like to follow up with the
nurse from Ketchikan.
CHAIR WILSON asked Sara Massmann to reach out to his office.
SENATOR BEGICH shared some observations. The issue of a
nationwide shortage needs more detail. If it is a nationwide
shortage, then states are competing across state lines. He wants
to know the state of that. He did hear the state of the
university speech yesterday and noted President Pitney's
comments about the nursing program. He is curious about the
placement numbers for that program. The committee could request
that from the university. The idea of forgiveness as a
recruitment tool for nurses has been briefly discussed. The data
from the university would help with knowing whether that would
keep graduates in state. If there is a nationwide shortage, he
asked what does protecting Alaska workforce require. He wants
more information about the registration issue. He was concerned
the comments that adding additional criteria like registration
might violate the compact. There are ways around that, but there
should be a discussion. If this becomes law, given the testimony
from Montana and other comments perhaps a sunset provision
should be explored to have the ability to make sure there are no
unintended consequences, such as depressing wages and putting
the public at risk.
2:29:46 PM
CHAIR WILSON said that the bill needs further discussion and his
office will work with the bill sponsor to get more information
to work through the policy side of this legislation. He held SB
67 in committee.
SENATOR BEGICH thanked Director Chambers and the division
legislative liaison for walking him through the bill. Most of
his questions arose from discussion of the bill.
CHAIR WILSON said that he will get answers to the committee
members.
[SB 67 was held in committee.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 67, Letters of Support, 2.24.21_Redacted.pdf |
SHSS 2/25/2021 1:30:00 PM |
SB 67 |
| SB 67, Board of Pharmacy SB 67 Letter of Support (2.24.2021).pdf |
SHSS 2/25/2021 1:30:00 PM |
SB 67 |