Legislature(2019 - 2020)BUTROVICH 205

03/06/2020 01:30 PM Senate HEALTH & SOCIAL SERVICES

Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.

Download Mp3. <- Right click and save file as

* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved CSSB 120(HSS) Out of Committee
Heard & Held
Moved SJR 13 Out of Committee
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
         SB 179-NURSING: LICENSURE; MULTISTATE COMPACT                                                                      
1:33:08 PM                                                                                                                    
CHAIR   WILSON  reconvened   the   meeting   and  announced   the                                                               
consideration of  SENATE BILL  NO. 179, "An  Act relating  to the                                                               
licensure  of nursing  professionals;  relating  to a  multistate                                                               
nurse licensure compact; and providing for an effective date."                                                                  
He  noted the  committee first  heard  the bill  on February  28,                                                               
2020. He  stated his  intention to hear  both invited  and public                                                               
1:33:43 PM                                                                                                                    
ROSE   LAWHORNE,  Chief   Nursing   Officer,  Bartlett   Regional                                                               
Hospital, Juneau,  Alaska, said she  has been in health  care for                                                               
nearly  30  years.  In  the  last  decade,  she  has  been  in  a                                                               
management role. Health care facilities,  especially in remote or                                                               
isolated  locations, would  benefit  from the  state joining  the                                                               
Nurse  Licensure   Compact.  She  described  and   instance  last                                                               
December when  Bartlett Regional  Hospital experienced a  loss of                                                               
staff and  an increase in  the number of influenza  patients. The                                                               
hospital struggled  with skeleton  crews and needed  nursing help                                                               
immediately. Patient  flow, safety,  and capacity  are negatively                                                               
affected when licensure processing  time is delayed, sometimes up                                                               
to four months. She acknowledged  that temporary licensing offers                                                               
one  strategy, but  it does  not eliminate  screening delays  and                                                               
adds duplicative costs and processes.                                                                                           
She  said the  increased cost  of an  interstate license  via the                                                               
compact  would offer  a permanent  multistate license.  Licensure                                                               
issues   can   reduce   the   hospital's   ability   to   provide                                                               
uninterrupted  care  to  patients  without  overloading  existing                                                               
staff.  Maintaining multiple  licenses is  cumbersome and  costly                                                               
and is a deterrent to nurses selecting work destinations.                                                                       
MS. LAWHORNE said the Nurse  Licensure Compact supports a healthy                                                               
workforce and  offers a  broad resource  pool for  recruitment of                                                               
nurses.  Specialty areas  such as  the  operating room,  recovery                                                               
room,  infusion  therapy,  and  oncology  experience  recruitment                                                               
challenges.  During  disasters  or typical  influenza  outbreaks,                                                               
such  as with  the coronavirus,  rapid mobilization  of qualified                                                               
nursing staff  is essential for continuity  of operations. Shared                                                               
resources must be facilitated in whatever manner possible.                                                                      
MS.  LAWHORNE said  the Nurse  Licensure Compact  will help  fill                                                               
existing gaps  in nursing  resources and  serve as  a recruitment                                                               
tool. It is  not uncommon for traveling nurses to  come to Juneau                                                               
and decide to stay, which will  keep dollars in Alaska that would                                                               
otherwise filter out to contract workers.                                                                                       
MS.  LAWHORNE said  that in  the growing  world of  telemedicine,                                                               
licensure  compacts facilitate  effective  and  efficient use  of                                                               
nursing resources,  provide interstate  educational opportunities                                                               
and collaboration for hospitals.                                                                                                
MS.  LAWHORNE said  demand for  nurses is  expected to  grow. She                                                               
expressed concern  that the nursing  workforce deficit  will grow                                                               
and  jeopardize patient  care unless  the state  acts. She  asked                                                               
members to support SB 179.                                                                                                      
1:38:10 PM                                                                                                                    
JIM  REINEKE, Chief  Nurse Executive,  Providence Alaska  Medical                                                               
Center,  Regional Chief  Nursing Officer,  Providence Health  and                                                               
Services  Alaska,  Anchorage, Alaska,  said  the  mission of  the                                                               
Alaska Board  of Nursing is  to actively promote and  protect the                                                               
health of the  citizens of Alaska through the  safe and effective                                                               
practice of nursing as defined  by law. Alaska's participation in                                                               
the Nurse  Licensure Compact  supports that  mission in  a manner                                                               
that provides greater opportunity  for nurses considering Alaska.                                                               
A recent  poll showed that  over 600 nursing positions  are open.                                                               
This  number  cannot be  realistically  filled  with the  current                                                               
registered  nurse workforce  or by  Alaska's projected  number of                                                               
nursing program graduates.                                                                                                      
MR. REINEKE  said Providence Medical Center,  the state's largest                                                               
health care facility, has experienced  180 vacancies in specialty                                                               
areas,   such   as   critical  care,   emergency   service,   and                                                               
cardiovascular  care.  He  expressed   concern  for  patients  in                                                               
Kodiak, Seward,  and Valdez for  acute care, long-term  care, and                                                               
home   health   care  services.   He   offered   his  view   that                                                               
participating  in   the  compact   would  remove  a   barrier  to                                                               
recruitment for nurses for short-term assignments and for long-                                                                 
term,  permanent employment,  which is  good for  nurses and  for                                                               
MR. REINEKE said having a larger  pool of nurses who can join the                                                               
workforce  in a  rapid manner  will provide  a more  flexible and                                                               
sustainable nursing workforce in  Alaska. This does not adversely                                                               
impact  Alaskan  nursing  graduates  from  becoming  licensed  or                                                               
finding work in  Alaska. It would also provide  a more attractive                                                               
option for nurses during the tourism season.                                                                                    
MR.  REINEKE  said  he  would  like to  eliminate  the  need  for                                                               
traveling  nurses. He  currently has  85 traveling  nurses across                                                               
his  system. Although  traveling nurses  do not  impact the  wage                                                               
scale for  Providence nurses,  the cost  of agency  staffing does                                                               
impact  the overall  labor  cost  of care.  He  said waiting  for                                                               
nurses coming to Alaska to  gain their licenses jeopardizes care.                                                               
He said  the NLC is  attractive to novice and  experienced nurses                                                               
who  to come  to  Alaska.  There is  a  need  for more  seasoned,                                                               
experienced nurses, particularly in specialty areas.                                                                            
MR.  REINEKE  said  inclusion  in the  compact  also  provides  a                                                               
recruiting opportunity  for those  experienced nurses  who decide                                                               
to  become  faculty  members or  consider  an  advanced  practice                                                               
opportunity  in  the  state's changing  health  care  atmosphere.                                                               
There   are  additional   opportunities  for   Advanced  Practice                                                               
Registered Nurses (APRNs) as Alaska moves outside of facility-                                                                  
based care.                                                                                                                     
MR.  REINEKE  said prior  to  joining  Providence Alaska  Medical                                                               
Center, he  was an active duty  military nurse for 30  years. His                                                               
final assignment  was as  chief nurse  at Joint  Base Elemendorf-                                                               
Richardson.  In  that role,  he  has  seen barriers  to  military                                                               
members  and  their  spouses.  A  separate,  Alaska-only  license                                                               
delays  individuals  who  are  stationed  in  Alaska  from  rapid                                                               
employment despite clear, unrestricted  licenses in other states.                                                               
Nurses  who come  to Alaska  for  a single  assignment are  often                                                               
reluctant  to  obtain  a  single-state   license  for  one  stay,                                                               
especially  if these  nurses are  seeking  part-time or  registry                                                               
positions. The  need for an  Alaska license for clinical  care in                                                               
those sites  not covered by federal  supremacy negatively impacts                                                               
collaboration for training for military nurses.                                                                                 
MR. REINEKE  said inclusion  in the compact  does not  negate the                                                               
appropriate  review  of  applications.   Rather,  it  provides  a                                                               
consistent, timely  process that is  accepted by the  majority of                                                               
Boards of Nursing nationwide. The  responsibility of nurses to be                                                               
aware  of and  accountable to  Alaska   Nurse  Practice Act  will                                                               
continue,  as  does  the  need  of  facilities  to  ensure,  safe                                                               
appropriate practice  by nurses under  their employ. As  a member                                                               
of  the compact,  Alaska's administrator  can vote  on rules  and                                                               
bylaws as a member state.  This national collaboration provides a                                                               
venue  for  action and  discussion  on  the current  practice  of                                                               
nursing in  a broader forum and  ensures Alaska is a  partner for                                                               
national impact.  It will allow  Alaskan nurses to  provide their                                                               
expertise on  rules and  policies on  rural and  frontier nursing                                                               
issues.  He asked  the committee  to support  SB 179,  which will                                                               
support nurse, nursing, and access to care for Alaskans.                                                                        
1:45:35 PM                                                                                                                    
CHAIR WILSON opened public testimony on SB 179.                                                                                 
1:45:58 PM                                                                                                                    
BETH  FARNSTROM, Director  at Large,  Alaska Nurses  Association,                                                               
Anchorage, Alaska,  said she  has been  an RN  for 40  years. She                                                               
served  on the  state Board  of  Nursing for  eight years.  Since                                                               
2007, she  has been  familiar with the  nurse compact.  The Nurse                                                               
Licensure  Compact   was  started   so  nurses  in   states  with                                                               
connecting  borders could  drive  a short  distance  and work  in                                                               
another state.  A license to  practice in multiple  states sounds                                                               
great,  but it  is not  that  simple. She  did not  find the  NLC                                                               
comparable to the  driver license compact. Anyone  who makes this                                                               
comparison  is   not  aware  of   Alaska  nursing   statutes  and                                                               
regulations and the complex  profession of nursing. Historically,                                                               
employers have  said it  takes too  long for  some nurses  to get                                                               
licensed in  Alaska. As  of July  2019, nursing  applications are                                                               
submitted  electronically,   which  gives   applicants  immediate                                                               
knowledge  of  any deficiencies  in  the  application that  could                                                               
cause a delay. Alaska has a  diligent Board of Nursing and staff.                                                               
At the February  2020 Board of Nursing meeting,  the board stated                                                               
that licensing  can be done  in a few  weeks if an  applicant has                                                               
properly completed the online application.                                                                                      
MS.  FARNSTROM said  the  governor   letter  of  support for  the                                                               
nurse  compact  said  the multistate  requirement  are  rigorous,                                                               
exceeding  those   of  Alaska's.  After  comparing   the  uniform                                                               
licensure  requirements  that  compact  states  must  adopt,  the                                                               
Alaska  Nurses Association  disagrees with  this statement.  Many                                                               
compact  states  do  not  require  continuing  education.  Alaska                                                               
values current  nursing education  and requires 30  contact hours                                                               
every two  years for  license renewal.  SB 179  is not  needed in                                                               
Alaska, she said.                                                                                                               
1:48:41 PM                                                                                                                    
JANE ERICKSON,  President, Alaska Nurses  Association, Anchorage,                                                               
Alaska, said  she has  been a  nurse over 32  years and  works in                                                               
adult critical care at Providence  Alaska Medical Center. She did                                                               
not  believe that  any state  using the  NLC can  show data  that                                                               
joining  the  compact has  eliminated  or  reduced their  nursing                                                               
shortages.   Alaska  nursing   regulations  can   address  health                                                               
emergencies and the  board can expedite licensure  for nurses. In                                                               
February  and   March  2007,  there  was   a  severe  respiratory                                                               
infection  in the  northern villages  that required  more nurses.                                                               
The  Board of  Nursing successfully  met the  licensing needs  by                                                               
using the regulation of courtesy  licensing, under 12 AAC 44.318.                                                               
Alaska  is part  of the  Emergency Management  Assistance Compact                                                               
that allows  full transferability  of professional  licensing for                                                               
disaster response.                                                                                                              
MS. ERICKSON said  military spouses have time to  apply for their                                                               
Alaska license.  If a nurse  moves to Alaska and  declares Alaska                                                               
as the  primary address, the  compact requires that  the licensee                                                               
must apply for an Alaska  compact license. Often military spouses                                                               
are employed  on bases or  in the Veterans  Administration system                                                               
and can  begin working using their  out-of-state licenses. Alaska                                                               
licensing protects  its citizens and  the Board of  Nursing staff                                                               
does  an exceptional  job. Employers,  such as  dialysis clinics,                                                               
are interested in the compact  licensure because these clinics do                                                               
not  want to  pay  for  another state's  licensure,  which is  an                                                               
employer business  expense. The mission  of the Board  of Nursing                                                               
is to keep the public safe.  If Alaska joined the NLC, nurses may                                                               
leave the  state to  work in another  compact state,  which would                                                               
increase the  Alaska nursing shortage.  Joining the  compact will                                                               
increase the $200 [biennial] nurse  license fees. She offered her                                                               
view that Alaska  already has one of the  highest license renewal                                                               
fees. She  estimated that the  additional license fees  under the                                                               
compact were estimated  at $60. In closing, she  said the compact                                                               
will not bring more nurses to Alaska.                                                                                           
1:51:29 PM                                                                                                                    
SARA MASSMANN,  Legislative Co-Chair, Alaska  Nurses Association,                                                               
Ketchikan, Alaska, said  she works fulltime as  a permanent nurse                                                               
in the Intensive  Care Unit at the PeaceHealth  Medical Center in                                                               
Ketchikan.  The committee  heard testimony  in opposition  to the                                                               
compact from  some Alaska  Nurses Association  members. Ketchikan                                                               
has never had an issue  employing enough traveling nurses who are                                                               
already licensed in Alaska nor  have nurses needed to delay their                                                               
start date awaiting licensure  in Alaska. PeaceHealth permanently                                                               
employs  U.S. Coast  Guard spouses  as  registered nurses.  These                                                               
nurses  have given  her sufficient  notice upon  receiving orders                                                               
for  new destinations  and had  plenty  of time  to obtain  their                                                               
nursing  license in  the  new state.  She has  not  heard of  any                                                               
problems nurses had transitioning to Alaska.                                                                                    
1:53:35 PM                                                                                                                    
LYNDA  MCCARTY, Health  Care Representative,  Anchorage Laborer's                                                               
Local 341,  Anchorage, Alaska, said  the Laborer    Union opposes                                                               
SB 179.  She offered  her opposition  to SB  179 as  a registered                                                               
nurse. She  expressed a number  of concerns, including a  loss of                                                               
state  sovereignty  by ceding  to  the  compact's regulations,  a                                                               
decrease  in   revenue  from  license   applications,  difficulty                                                               
monitoring nurses  who come  to Alaska  to practice  nursing, and                                                               
safety  concerns.  Under current  guidelines  from  the Board  of                                                               
Nursing, she must complete 30  hours of continuing education each                                                               
renewal period  to keep up to  date with changes in  health care.                                                               
She  graduated  from  nursing  school  four  years  ago  and  the                                                               
practices she  learned are no  longer considered  best practices.                                                               
Some compact states  do not require any  continuing education for                                                               
nurses  for  license  renewal. Eight  states,  plus  one  pending                                                               
legislation, require  zero continuing education for  renewal, and                                                               
five, plus one  pending legislation, require 15 hours  or less in                                                               
a two-year  period. This falls  far short of  Alaska's continuing                                                               
education  requirements.  Becoming  a  compact  state  would  not                                                               
inspire  a  culture  of  safety   in  hospitals,  long-term  care                                                               
facilities,  or clinics.  Alaska needs  competent nurses  to fill                                                               
critical positions. She  offered her belief that  the board needs                                                               
an  overhaul. Joining  the compact  would dilute  Alaska's strong                                                               
workforce and lower safety standards.                                                                                           
1:56:15 PM                                                                                                                    
NICOLE LIVANOS, Senior Associate,  State Advocacy and Legislative                                                               
Affairs, National  Council of State  Boards of  Nursing, Chicago,                                                               
Illinois, said  she wanted to  focus on  the basics of  the Nurse                                                               
Licensure Compact  (NLC). The NLC  was created in the  late 1990s                                                               
and  has  been operational  for  almost  20  years. It  is  safe,                                                               
proven, and  successful in  addressing licensure  mobility issues                                                               
in its 34-member states. About  five years ago, other health care                                                               
professionals  viewed  the NLC  as  a  model for  building  their                                                               
compacts. Today, there are six  health care licensing compacts at                                                               
different stages  of enactment.  State lawmakers  are considering                                                               
compacts  for  various  health care  professions  to  update  the                                                               
nearly  100-year  old  licensure  system that  does  not  provide                                                               
flexibility  for practitioners  or patients  demanded by  today's                                                               
health care landscape.                                                                                                          
1:57:44 PM                                                                                                                    
Ms. LIVANOS said the specifics of  the NLC are best considered in                                                               
relation  to  the 29  other  compacts  in Alaska.  The  governing                                                               
structure  for the  NLC  is  an interstate  commission.  It is  a                                                               
nongovernmental  agency   charged  with  administration   of  the                                                               
compact. The  commission is comprised  of one  administrator from                                                               
each  participating state  who vote  on commission  business. The                                                               
commission's ability to make rules  is limited to rules needed to                                                               
facilitate  and coordinate  implementation and  administration of                                                               
the compact. Just  as under Alaska's other  compacts, these rules                                                               
are binding and have the  force of law. The commission's meetings                                                               
are  public, with  notice, comment,  and  opportunity for  public                                                               
hearings. The NLC has almost 20  years of proven safe mobility of                                                               
licensure  and the  NLC helps  facilitate access  to care  across                                                               
1:58:57 PM                                                                                                                    
DANETTE  SCHLOEDER, Chair,  Alaska Board  of Nursing,  Anchorage,                                                               
Alaska,  said people  are  privileged  to live  in  a country  of                                                               
borderless health  care. Any  Alaskan can get  care in  Alaska or                                                               
can  seek care  outside of  Alaska. Alaska  does not  offer every                                                               
innovation in health  care. The Board of Nursing  is committed to                                                               
find ways to advance the practice  of nursing and allow nurses to                                                               
work safely across  borders and protect the health  and safety of                                                               
residents by ensuring  that Alaska has the nurses  to meet health                                                               
care needs.                                                                                                                     
2:00:23 PM                                                                                                                    
JARED  KOSIN,  President  and  CEO,  Alaska  State  Hospital  and                                                               
Nursing  Home Association,  Anchorage, Alaska,  said SB  179 will                                                               
help avoid delays  during the licensing process  and allow nurses                                                               
to get  to work quickly and  more efficiently. Based on  a survey                                                               
conducted in November,  the state has over  670 nursing vacancies                                                               
in hospitals and  nursing homes across the state.  This bill will                                                               
provide  a  tool  to  help  address  shortages,  which  could  be                                                               
especially  useful   for  emergency  preparedness   and  disaster                                                               
relief.  It  is good  for  military  families because  it  allows                                                               
military spouses  who are  nurses to  continue working  each time                                                               
the family relocates.                                                                                                           
2:01:34 PM                                                                                                                    
WENDY SCHRAG, Director of Advocacy  and State Government Affairs,                                                               
Fresenius  Medical Care,  Wichita,  Kansas,  said several  weeks                                                                
time to get  a temporary license is not fast  enough for dialysis                                                               
because patients need treatment three  times a week. Fresenius is                                                               
supportive  of the  compact because  there may  be times  when it                                                               
needs to bring  nurses in quickly. If the  coronavirus gets worse                                                               
and staff  is impacted, it will  be important to bring  people in                                                               
quickly. When  the enhanced  version of the  NLC was  issued, all                                                               
member states rejoined. Since then,  about eight more states have                                                               
joined the NLC,  which shows that states that  participate in the                                                               
compact find that it is working.                                                                                                
2:03:03 PM                                                                                                                    
BRIAN  NORTON, Registered  Nurse  and  Clinic Manager,  Fresenius                                                               
Medical  Care,  Anchorage,  Alaska,  said  his  company  provides                                                               
dialysis  and   kidney  care  to   334  patients   in  Anchorage,                                                               
Fairbanks, Juneau, Soldotna, and Wasilla.  He came to Alaska as a                                                               
traveling  nurse but  had  ample time  to  gain licensure  before                                                               
coming  to Alaska  because there  was no  crisis. Currently,  his                                                               
company employs 36  nurses and has 12 openings  that it struggles                                                               
to  fill.  Medicaid  regulations  require that  nurses  have  six                                                               
months  of  experience  with  dialysis   before  the  nurses  can                                                               
independently care  for patients and newly  graduated nurses must                                                               
have 12 months of dialysis experience.                                                                                          
He recalled at the last  hearing questions arose about wages. The                                                               
compact  would  not  change his  company's  hiring  methods,  but                                                               
nurses holding a compact license  would have an advantage because                                                               
of the ease  in locating them and their ability  to start working                                                               
quickly, minimizing negative impacts  to patient care. Currently,                                                               
his  company  acquires  staff through  three  different  methods:                                                               
external travel nurses, Alaska-based  permanent employees, and an                                                               
internal traveler program. All  nurses receive competitive wages.                                                               
External  traveling   nurses  are  paid  through   their  agency.                                                               
Dialysis nurses  receive overtime after an  eight-hour shift. The                                                               
company  completes  background  checks   on  all  new  employees.                                                               
According to  a recent study  by 2030,  Alaska will be  the state                                                               
with the highest percentage of nursing vacancies at 23 percent.                                                                 
2:05:46 PM                                                                                                                    
TAMMIE  PERRAULT,  Northwest   Regional  Liaison,  Department  of                                                               
Defense  (DOD),   Joint  Base  Lewis-McChord,   Washington,  said                                                               
military  families  are  an  important  community  that  provides                                                               
additional  health care  resources for  Alaska. One  goal of  the                                                               
Department of  Defense (DOD) is  to remove barriers  for military                                                               
spouses.  The DOD  wants to  ensure additional  capacity for  the                                                               
professional careers and mobile  lifestyles that military spouses                                                               
must  endure for  military service  to country.  Accordingly, the                                                               
DOD  has encouraged  state policymakers  to engage  in interstate                                                               
compacts to  improve licensure portability  options. In  the case                                                               
of the  nursing profession,  34 states  have joined  the enhanced                                                               
NLC.  Thirty-four percent  of military  spouses  are required  to                                                               
maintain occupational licensure. It is  a readiness issue for the                                                               
DOD because  military spouses help  to determine  whether someone                                                               
will  decide  to stay  in  the  military.  A high  percentage  of                                                               
military spouses  need occupational licensure in  health care. In                                                               
a letter  from DOD Secretary Mark  Esper to the Council  of State                                                               
Governors, he  called on  the governors  to assist  with ensuring                                                               
that  that military  spouses have  access  to special  provisions                                                               
from states for licensure. He  asked states to implement policies                                                               
that  limit  state-specific  requirements  for a  wide  range  of                                                               
professions. He  asked states to approve  occupational interstate                                                               
compacts that allow licensure reciprocity for military spouses.                                                                 
2:09:04 PM                                                                                                                    
KRISTY  O'LAUGHLIN, representing  self,  Fairbanks, Alaska,  said                                                               
she has worked for  two of her 17 years as  a registered nurse in                                                               
Alaska. She  had had a  compact license her entire  career before                                                               
moving to  Alaska. She said  having a compact license  means that                                                               
she can be in place to work in less than a week.                                                                                
She said that  when she came to Alaska, she  paid nearly $500 and                                                               
waited several  weeks to get  her RN license by  endorsement. She                                                               
fell in  love with  Alaska and is  currently an  Alaskan resident                                                               
and homeowner.  Once she  was hired,  she was  partly responsible                                                               
for  hiring  nurses. She  reached  out  to  a  friend who  is  an                                                               
excellent  nurse with  a compact  license. Due  to the  licensing                                                               
requirements,  he found  it was  not worth  his time  to come  to                                                               
Alaska. In November  2018, she had two traveling  nurses lined up                                                               
to start.  One nurse could start  on time, but the  other nurse's                                                               
license was  delayed several months  because of a  backlog caused                                                               
by the  earthquake, so  her center was  short staffed  during the                                                               
holiday season.  Concerns were  raised at  the hearing  last week                                                               
about safety  issues and criminal history  issues. Every hospital                                                               
she  has worked  in has  performed their  own background  checks.                                                               
Many nurses in Alaska are  not licensed in Alaska because federal                                                               
facilities  do not  require a  specific-state license.  She urged                                                               
members to pass SB 179 because  is important that Alaska join the                                                               
compact.  If the  state has  a disaster  and needs  nurses, these                                                               
nurses could be on the next flight to Alaska.                                                                                   
2:11:49 PM                                                                                                                    
MINDY HURT, representing self,  Wasilla, Alaska, stated agreement                                                               
with the Mr.  Norton's testimony. She is the nurse  manager of an                                                               
outpatient dialysis  unit in Wasilla and  dialysis patients would                                                               
greatly benefit from the Nurse Licensure Compact (NLC).                                                                         
2:12:17 PM                                                                                                                    
AMANDA ROEDL, representing self,  Solano County, California, said                                                               
she is  a registered nurse  with an active license  in California                                                               
and inactive  licenses in  Alaska and Hawaii.  She is  a military                                                               
spouse whose  husband is in  the U.S.  Coast Guard so  her family                                                               
moves every  two to three years.  She works while her  husband is                                                               
deployed,  although  it is  difficult  when  licensure is  state-                                                               
specific.  SB  179  will allow  military  spouses  to  seamlessly                                                               
continue  working without  having to  obtain a  new license  when                                                               
relocating.  Each  of  her  nursing   licenses  has  a  different                                                               
expiration  date.  Military families  who  are  moving face  many                                                               
obstacles. She is  currently working in Solano  County, which had                                                               
the first  case of community-acquired Covid-19.  She acknowledged                                                               
the  demands  that increase  with  each  shift. She  offered  her                                                               
belief that  Alaska can do something  now to prepare for  what is                                                               
coming. She offered her support for the NLC.                                                                                    
2:14:19 PM                                                                                                                    
KAREN LYON,  representing self, Baton Rouge,  Louisiana, said she                                                               
is the NLC commissioner for  Louisiana and the executive director                                                               
and  CEO  of  the  Louisiana  Board of  Nursing.  In  July  2019,                                                               
Louisiana joined  the NLC, which  has been a  positive experience                                                               
for  nurses and  employers. Louisiana  has 65,000  active nurses.                                                               
The Louisiana  Board of Nursing only  regulates registered nurses                                                               
(RNs)  and  Advanced  Practice  Registered  Nurses  (APRNs).  She                                                               
acknowledged  Louisiana  experienced  some  initial  expenses  to                                                               
implement  the NLC,  but  the costs  have  not been  problematic.                                                               
Louisiana is  on target for 95  percent of its revenue  with four                                                               
months left in  the fiscal year. In Louisiana, she  was the first                                                               
of 3,500 nurses  who converted to the multistate  license and she                                                               
found the transition  seamless. Louisiana has not  had any safety                                                               
issues and 350  nurses from Mississippi and 250  from Alabama who                                                               
had their multistate licenses are  currently working in Louisiana                                                               
under the compact.                                                                                                              
2:16:40 PM                                                                                                                    
CHAIR WILSON found no further testimony on SB 179.                                                                              
2:16:53 PM                                                                                                                    
SARA  CHAMBERS,  Division  Director,  Division  of  Corporations,                                                               
Business  and  Professional  Licensing, Department  of  Commerce,                                                               
Community  and Economic  Development,  Juneau,  Alaska, said  the                                                               
compact is a critical piece of  the large and complex health care                                                               
system  in  Alaska.  The pressure  of  recent  events,  including                                                               
Covid-19, has highlighted this issue.  Military spouses have been                                                               
requesting  this change  for  the  last several  years.  It is  a                                                               
priority  in basing  decisions  with the  DOD.  The Alaska  State                                                               
Hospital and  Nursing Home  Association have  urged the  Board of                                                               
Nursing and  the DCCED  to move licensure  forward as  quickly as                                                               
possible.  Although Ketchikan  reported that  it has  no problems                                                               
hiring  nurses, her  division has  received letters  in the  last                                                               
five years  from Ketchikan PeaceHealth Medical  Center stating it                                                               
was  so desperate  for  nurses it  might need  to  shut down  its                                                               
emergency  room.  She characterized  the  NLC  in  SB 179  as  an                                                               
important   tool   to   lower   costs,  to   give   nurses   more                                                               
opportunities,  and above  everything  else,  to improve  patient                                                               
health in Alaska.                                                                                                               
2:19:25 PM                                                                                                                    
SENATOR SHOWER said his wife is  a nurse. He spent decades in the                                                               
military, so  his family  has experienced  this firsthand.  As an                                                               
operations officer and commander,  he received feedback that this                                                               
is  an issue  for the  military throughout  the nation.  It helps                                                               
spouses to  get jobs  when spouses  are deployed.  He understands                                                               
the bill  quite well from  the military perspective. He  asked if                                                               
the bill would adversely impact Alaskans seeking jobs.                                                                          
MS. CHAMBERS said this bill  would increase job opportunities for                                                               
nurses in Alaska, not decrease them.                                                                                            
SENATOR SHOWER  related his understanding  that the  consensus is                                                               
that nurses prefer to join the compact.                                                                                         
MS. CHAMBERS  answered that an  overwhelming majority  of Alaska-                                                               
based nurses and union nurses support the compact.                                                                              
2:21:25 PM                                                                                                                    
SENATOR GIESSEL asked how many  nurses participated in the [Board                                                               
of Nursing] survey.                                                                                                             
MS. CHAMBERS replied that more than 3,000 nurses participated.                                                                  
SENATOR  GIESSEL asked  which licenses  the participating  nurses                                                               
MS.  CHAMBERS  responded that  the  RNs  and  LPNs who  would  be                                                               
eligible to join the compact responded.                                                                                         
SENATOR  GIESSEL observed  that according  to the  last Board  of                                                               
Nursing audit, at least 14,000  nurses were in that category. She                                                               
offered her belief that the survey was a small sample.                                                                          
MS. CHAMBERS replied that it  was well above statistical sampling                                                               
SENATOR  GIESSEL  noted  that  Ms.  Chambers  stated  this  would                                                               
increase nursing  jobs, not decrease  them, but the  question was                                                               
whether this bill would decrease jobs for Alaskans.                                                                             
MS. CHAMBERS responded  that it will increase  jobs for Alaskans.                                                               
Many nurses in Alaska would  like to participate in telehealth or                                                               
telemedicine to  augment their professional work.  This bill will                                                               
increase nurses'  ability to teach  as nurse educators.  It would                                                               
also  give them  an  opportunity to  work  seasonally outside  of                                                               
Alaska and  still maintain their  Alaskan nursing  license. There                                                               
are  many ways  that this  bill  will assist  Alaska nurses.  New                                                               
nurses would  like to join a  compact state to lessen  their cost                                                               
burden and  some are leaving Alaska  because it is not  a compact                                                               
state.  She offered  her view  that nurses  would stay  if Alaska                                                               
were a compact state.                                                                                                           
SENATOR GIESSEL  responded that the  reason may be so  that these                                                               
nurse can get jobs in other states.                                                                                             
MS. CHAMBERS said nurses want options.                                                                                          
SENATOR GIESSEL said Washington  rejected the compact legislation                                                               
last week, which  is of interest since Washington  is the closest                                                               
state to Alaska.  It has been pointed out that  the compact would                                                               
be  logical if  Alaska were  Iowa or  Colorado and  someone could                                                               
drive 30  minutes to  be in  another state.  She said  that after                                                               
reviewing the  National Licensure Commission and  the language in                                                               
the  bill, she  found that  many  legal questions  have not  been                                                               
addressed. She  would like to  explore the legal  implications of                                                               
joining  a compact.  Although Alaska's  executive director  would                                                               
have a vote  on the National Licensure Commission,  it would only                                                               
be one vote so as the  compact expands to other states, that vote                                                               
would be  diluted. The National Licensure  Commission is actually                                                               
a private  entity in Illinois.  She asked  what it would  cost to                                                               
join the commission.                                                                                                            
MS.  CHAMBERS answered  that it  would  cost the  state $6,000  a                                                               
SENATOR GIESSEL  pointed out  that state money  would be  used to                                                               
fund  a private,  nongovernmental entity  outside of  Alaska that                                                               
would  have  jurisdiction  and make  decisions  related  to  this                                                               
compact.  She expressed  concern that  the legislature  would not                                                               
have any jurisdiction over the NLC.                                                                                             
CHAIR  WILSON  said  the  committee   should  try  to  get  their                                                               
questions answered by Legislative Legal Services.                                                                               
SENATOR SHOWER  asked if the  Alaska Board of Nursing  would lose                                                               
its ability to check on nurses.                                                                                                 
MS. CHAMBERS replied  the board would retain all  of its existing                                                               
[CHAIR WILSON held SB 179 in committee.]                                                                                        

Document Name Date/Time Subjects
SB 120 Public Input 3.5.20.pdf SHSS 3/6/2020 1:30:00 PM
SB 120
SJR 13 Public Input No. 1 3.5.20.pdf SHSS 3/6/2020 1:30:00 PM
SJR 13
SJR 13 Public Input No. 2 3.5.20.pdf SHSS 3/6/2020 1:30:00 PM
SJR 13
SB 179 SHSS DCEED Follow-Up Information 3.4.20.pdf SHSS 3/6/2020 1:30:00 PM
SB 179
SB 179 Public Input 3.5.20.pdf SHSS 3/6/2020 1:30:00 PM
SB 179
SB 179 Public Input 3.6.20.pdf SHSS 3/6/2020 1:30:00 PM
SB 179
SJR 13 Public Input 3.6.20.pdf SHSS 3/6/2020 1:30:00 PM
SJR 13
Lee_SB120_SHSS_03062020.pdf SHSS 3/6/2020 1:30:00 PM
SB 120
Bird_SJR13_SHSS_03062020.pdf SHSS 3/6/2020 1:30:00 PM
SJR 13
Lee_SJR13_SHSS_03062020.pdf SHSS 3/6/2020 1:30:00 PM
SJR 13
Brower_SJR13_SHSS_03062020.pdf SHSS 3/6/2020 1:30:00 PM
SJR 13
Rolph_SJR13_SHSS_03062020.pdf SHSS 3/6/2020 1:30:00 PM
SJR 13
Timlin_SJR13_SHSS_03062020.pdf SHSS 3/6/2020 1:30:00 PM
SJR 13