Legislature(2003 - 2004)

04/10/2003 03:05 PM House HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                    ALASKA STATE LEGISLATURE                                                                                  
          HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES                                                                         
                       STANDING COMMITTEE                                                                                     
                         April 10, 2003                                                                                         
                           3:05 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Representative Peggy Wilson, Chair                                                                                              
Representative Carl Gatto, Vice Chair                                                                                           
Representative John Coghill                                                                                                     
Representative Paul Seaton                                                                                                      
Representative Kelly Wolf                                                                                                       
Representative Sharon Cissna                                                                                                    
MEMBERS ABSENT                                                                                                                
Representative Mary Kapsner                                                                                                     
COMMITTEE CALENDAR                                                                                                            
HOUSE BILL NO. 211                                                                                                              
"An Act relating to a student loan repayment program for nurses,                                                                
and amending the duties of the Board of Nursing that relate to                                                                  
this program; and providing for an effective date."                                                                             
     - MOVED CSHB 211(HES) OUT OF COMMITTEE                                                                                     
REPORT ON STATE HEALTH POLICY MEETING IN CHICAGO                                                                                
     - SCHEDULED BUT NOT HEARD                                                                                                  
PREVIOUS ACTION                                                                                                               
BILL: HB 211                                                                                                                  
SHORT TITLE:NURSE EDUC LOAN REPAYMENT PROGRAM                                                                                   
SPONSOR(S): REPRESENTATIVE(S)WILSON                                                                                             
Jrn-Date   Jrn-Page                     Action                                                                                  
03/24/03     0618       (H)        READ THE FIRST TIME -                                                                        
03/24/03     0618       (H)        HES, FIN                                                                                     
03/31/03     0722       (H)        COSPONSOR(S): GARA                                                                           
04/08/03                (H)        HES AT 3:00 PM CAPITOL 106                                                                   
04/08/03                (H)        -- Meeting Canceled --                                                                       
04/10/03                (H)        HES AT 3:00 PM CAPITOL 106                                                                   
WITNESS REGISTER                                                                                                              
DIANE BARRANS, Executive Director                                                                                               
Alaska Commission on Postsecondary Education                                                                                    
Department of Education and Early Development                                                                                   
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Testified in support of HB  211, and answer                                                               
questions from the members.                                                                                                     
CAMILLE SOLEIL, Executive Director                                                                                              
Alaska Nurses Association (ANA)                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   Testified via teleconference  in support of                                                               
HB 211.                                                                                                                         
RHONDA RICHTSMEIER, Deputy Chief                                                                                                
Nursing Section                                                                                                                 
Division of Public Health Nursing                                                                                               
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 211.                                                                            
LARAINE DERR, President and Chief Executive Officer                                                                             
Alaska State Hospital and Nursing Home Association                                                                              
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in  support of HB 211 and answered                                                               
questions from the committee.                                                                                                   
ACTION NARRATIVE                                                                                                              
TAPE 03-33, SIDE A                                                                                                            
Number 0001                                                                                                                     
CHAIR PEGGY WILSON called the  House Health, Education and Social                                                             
Services  Standing  Committee  meeting  to  order  at  3:05  p.m.                                                               
Representatives Wilson,  Gatto, Seaton,  and Cissna  were present                                                               
at the call  to order.  Representatives Wolf  and Coghill arrived                                                               
as  the meeting  was  in progress.    Representative Kapsner  was                                                               
HB 211-NURSE EDUC LOAN REPAYMENT PROGRAM                                                                                      
CHAIR WILSON announced  that the only order of  business would be                                                               
HOUSE BILL NO. 211, "An Act  relating to a student loan repayment                                                               
program  for nurses,  and amending  the  duties of  the Board  of                                                               
Nursing  that  relate  to  this program;  and  providing  for  an                                                               
effective date."                                                                                                                
Number 0044                                                                                                                     
CHAIR WILSON moved to adopt  CSHB 211, Version 23-LS0861\D, Ford,                                                               
dated  3/29/03, as  the work  draft.   There  being no  objection                                                               
Version D was before the committees.                                                                                            
CHAIR WILSON turned the gavel over to Vice Chair Gatto.                                                                         
Number 0105                                                                                                                     
VICE CHAIR GATTO asked if Chair Wilson would speak on Version D.                                                                
CHAIR PEGGY WILSON,  sponsor of HB 211, explained  the purpose of                                                               
the bill and  answered questions from the members.   She told the                                                               
committee  she believes  this is  a very  important bill  for two                                                               
reason.   First, she said because  she is a nurse  she feels very                                                               
close to the subject matter.   Second, she told the committee the                                                               
state has  a crisis in  nursing because of the  nursing shortage.                                                               
Right now  there are 2,500  RNs [registered nurses] that  live in                                                               
Alaska.  However,  because of the nursing shortage  there are not                                                               
enough  nurses  residing  in  Alaska   to  provide  for  Alaska's                                                               
workforce needs.  So there are  many nurses who come up to Alaska                                                               
from the  Lower 48  to work  at great  cost to  the institutions.                                                               
Including  the nonresident  nurses  working here,  Alaska has  an                                                               
11.5 percent employment  vacancy rate.  The number  of RNs needed                                                               
to  fill projected  new jobs  from  industry growth  in the  next                                                               
seven  years will  exceed 4,100  nurses.   Chair Wilson  told the                                                               
committee that  is very scary  because that is almost  double the                                                               
number in Alaska now.  The  rate for turnover of nurses is almost                                                               
24 percent.  That indicates difficulties in retaining nurses.                                                                   
Number 0198                                                                                                                     
CHAIR WILSON explained the reasons  for nurse shortages in Alaska                                                               
and across the  nation.  She said the biggest  reason is an aging                                                               
workforce, and all the baby  boomers are getting ready to retire.                                                               
She  said it  is  important to  find ways  to  keep them  working                                                               
longer if  possible.   Another reason for  the nurse  shortage is                                                               
that  there   are  fewer  individuals  going   into  the  nursing                                                               
profession.   For  many years,  women  could only  go into  three                                                               
professions.  The  choices were being a housewife, a  nurse, or a                                                               
teacher.   That has  drastically changed in  the last  few years,                                                               
and there are  a lot more options available for  women.  In order                                                               
to reduced  health care costs  across the nation,  procedures are                                                               
being done  on an outpatient  basis, so hospital stays  have been                                                               
shortened;  however,   the  people  that  are   admitted  to  the                                                               
hospitals are much sicker  than they used to be.   So not only do                                                               
the hospitals  have sicker patients,  but there are  fewer nurses                                                               
to care for them.   As a way to save  money, hospitals are giving                                                               
nurses more  duties and more  patients.   As a result,  nurses do                                                               
not  feel good  about their  work, are  exhausted, and  feel they                                                               
cannot do  it any more.   Overall, this  practice has made  a big                                                               
difference in  job satisfaction  for nurses.   One of  the single                                                               
most important  criteria for  nurses to  be satisfied  with their                                                               
working conditions  is to  have time to  provide quality  care to                                                               
Number 0398                                                                                                                     
CHAIR WILSON shared her personal  experience when she first began                                                               
her career  as a nurse.   She said  she had  all the time  in the                                                               
world to come  into a patient's room, sit down,  hold a patient's                                                               
hand, talk to  him/her about the procedure, and  help the patient                                                               
deal  with the  anxiety  level, so  they would  be  able to  heal                                                               
better.   In contrast, the last  time she worked in  nursing that                                                               
practice was nonexistent because she  had many more patients, and                                                               
did  not have  an aide  to help  her.   She  said she  had to  do                                                               
everything, including scrubbing down the  bed and the rest of the                                                               
room to  be ready  for the  next patient.   It  is a  lot harder.                                                               
This is similar to what has  happened to teachers.  Teachers used                                                               
to just teach.                                                                                                                  
Number 0454                                                                                                                     
CHAIR WILSON  said if the  2008 projections holds true,  RNs will                                                               
be the largest  single health care occupation in  this state, and                                                               
the seventh largest occupation in Alaska.   This is going to be a                                                               
crisis  shortly.   It  is  nationwide  and  not just  in  Alaska.                                                               
Alaska [University  of Alaska  School of  Nursing] can  only turn                                                               
out 110  nurses per year.   There is no  way to keep up  with the                                                               
demand.  The  university wants to double the number,  but that is                                                               
only 220 nurses per year.                                                                                                       
Number 0544                                                                                                                     
CHAIR WILSON explained  some of the solutions.  One  option is to                                                               
try to bring more Native  Alaskans into the profession.  Another,                                                               
with this bill,  is to offer loan reimbursements for  nurses.  In                                                               
order to  get nurses to move  to Alaska to work,  there will have                                                               
to  be  an increase  in  salaries  and  that  means money.    She                                                               
commented  that  the  committee  knows  what  that  means:    the                                                               
industry  will  pull  back  and   consolidate,  but  it  will  be                                                               
necessary  to raise  nurses' pay.   Hopefully,  that will  entice                                                               
some nurses  to come to Alaska.   There will be  some recruitment                                                               
programs   aimed   at   grade  school   children,   high   school                                                               
development,  pre-nursing  preparation,  and the  development  of                                                               
postgraduate RN training for high-needs  areas like the operating                                                               
room and ICU  [intensive care unit].  Another  option in enticing                                                               
nurses  to come  to Alaska  would  be to  encourage employers  to                                                               
offer incentive  bonuses or sign-on fees.   In some areas  in the                                                               
Lower  48  this is  already  going  on.    Providers need  to  be                                                               
responsive to  the RN needs, for  instance, prohibiting mandatory                                                               
overtime and lowering the 12-hour  shifts to maybe 6-hour shifts.                                                               
Maybe the older nurses could share shifts.                                                                                      
Number 0648                                                                                                                     
CHAIR WILSON summarized  her comments by saying that  HB 211 will                                                               
hopefully  serve as  an incentive  to attract  new nurses  to the                                                               
state and encourage  Alaska nurses to pursue  their vocation here                                                               
in Alaska.   This bill provides  that a nurse working  and living                                                               
in  Alaska will  be  offered the  incentive  of being  reimbursed                                                               
$2,000 per  year for every year  worked up to five  years, not to                                                               
exceed $10,000.                                                                                                                 
Number 0747                                                                                                                     
CHAIR SEATON asked for clarification  on one point.  According to                                                               
the bill, a  nurse would have to have an  outstanding loan.  This                                                               
is not a payment for $2,000 per  year for up to five years; it is                                                               
simply a  reimbursement for an  existing student loan.   He asked                                                               
if that is correct.                                                                                                             
CHAIR WILSON  replied that is correct.   In other words,  a nurse                                                               
that has  been in  Alaska for  50 years cannot  apply and  get an                                                               
incentive  payment.    It  must  be  an  individual  who  has  an                                                               
outstanding student loan.   She said there  are several criteria.                                                               
For example,  the individual must be  hired as a nurse  in Alaska                                                               
on or  after July 1, 2003;  the individual must be  employed as a                                                               
nurse during the  loan repayment program; the  individual must be                                                               
licensed  to  practice  in  Alaska   and  agree  to  fulfill  any                                                               
requirements of the program and must have an outstanding loan.                                                                  
REPRESENTATIVE  SEATON  said  he  is trying  to  figure  out  the                                                               
criteria  in the  program.   For  example, if  a  nurse has  been                                                               
working here in  Alaska for two years and has  $18,000 in student                                                               
loans, she  would have to quit  or change jobs and  go to another                                                               
employer to  be eligible for this  program.  Is that  the correct                                                               
interpretation of the program?                                                                                                  
CHAIR WILSON responded that is correct.   The purpose of the bill                                                               
is to  encourage recruitment  of new  nurses to  the state.   She                                                               
said she hates  the fact that the state cannot  help those nurses                                                               
who are already here working as nurses.                                                                                         
Number 0808                                                                                                                     
REPRESENTATIVE SEATON  asked Chair Wilson about  interaction with                                                               
existing local programs.  He  said that the Homer Hospital offers                                                               
a local program  as an incentive to nurses.   Can this program be                                                               
used in conjunction with other programs?                                                                                        
CHAIR  WILSON responded  that there  is no  problem with  a nurse                                                               
availing himself/herself  of both  programs.   In fact,  she said                                                               
she hopes that  providers will be creative in  enticing nurses to                                                               
come to Alaska.                                                                                                                 
Number 0866                                                                                                                     
VICE CHAIR GATTO asked, if a  nurse comes to Alaska, collects the                                                               
reimbursement  for  three years,  and  then  leaves, whether  the                                                               
individual has to give the money back.                                                                                          
Number 0916                                                                                                                     
CHAIR WILSON replied that he/she does  not have to give the money                                                               
REPRESENTATIVE SEATON  asked if this reimbursement  could be used                                                               
for  continuing education.   For  example,  if a  nurse comes  to                                                               
Alaska  and is  hired  now,  and needs  to  get  more classes  to                                                               
upgrade credentials,  can this  program be used  to offset  a new                                                               
student loan or is it only a previous student loan?                                                                             
Number 0953                                                                                                                     
DIANE   BARRANS,  Executive   Director,   Alaska  Commission   on                                                               
Postsecondary  Education  (ACPE),  Department  of  Education  and                                                               
Early Development,  testified in support  of CSHB 211,  Version D                                                               
and  answered  questions   from  the  members.     She  told  the                                                               
committee, as she understands the  bill, the education debt needs                                                               
to be  pre-existing at the time  the nurse is first  hired in the                                                               
state.     As   the   bill  is   currently   constructed,  if   a                                                               
nurse/employee goes  back to  school to go  from a  LPN [licensed                                                               
practical nurse]  to RN [registered  nurse], that debt  would not                                                               
be covered.                                                                                                                     
VICE CHAIR  GATTO posed  a situation  in which  a nurse  comes to                                                               
Alaska with  $6,000 in debt  and after three years  of employment                                                               
that debt  is gone.   The nurse decides  to stay; the  nurse does                                                               
not get $2,000 as a bonus.  Is that correct?                                                                                    
MS. BARRANS  replied that  is correct.   The construction  of the                                                               
bill is such that  the nurse would not even see  the money.  That                                                               
was  the sponsor's  intention in  prorating the  benefits.   If a                                                               
year is  served, a  one-year benefit  is paid;  if two  years are                                                               
served,  the second  year's benefit  is  paid.   He/she does  not                                                               
receive a full  benefit unless the nurse works a  full five years                                                               
in the state.                                                                                                                   
VICE  CHAIR GATTO  responded that  this  brings him  back to  the                                                               
original question.   If a nurse only works three  years, then the                                                               
person gets three  years' worth of benefit.  There  is no penalty                                                               
for leaving employment or Alaska in less than five years.                                                                       
Number 1052                                                                                                                     
MS. BARRANS  agreed and added  that there  would not be  any cash                                                               
coming to  the nurse  for working an  additional two  years, even                                                               
though the debt had been fully satisfied.                                                                                       
Number 1059                                                                                                                     
REPRESENTATIVE COGHILL asked if there  will be a regulatory issue                                                               
involved in providing proof of employment.                                                                                      
MS. BARRANS  said that  is correct.   There would  have to  be an                                                               
annual certification  that whatever the service  requirements are                                                               
have  been met.    Alaska Commission  on Postsecondary  Education                                                               
(ACPE) would look to the Board of  Nursing to say what is a full-                                                               
time employee,  and would  set those  criteria, and  the employer                                                               
would have to certify that those criteria had been met.                                                                         
REPRESENTATIVE COGHILL commented that  these are always the areas                                                               
that legislators  hear about because  whenever there is  a limit,                                                               
there is  always someone who  falls one hair's breadth  under the                                                               
limit.   That is something  the committee needs  to look at.   He                                                               
said he would like to hear the sponsor's perspective on full-                                                                   
time employment  and what that  definition is so that  ACPE would                                                               
have something to build regulations from.                                                                                       
CHAIR WILSON replied  that Section 7 allows the  Board of Nursing                                                               
and  ACPE to  adopt  necessary regulations  immediately upon  the                                                               
passage of the Act.  So Ms.  Barrans would work with the Board of                                                               
Nursing to come up with these regulations.                                                                                      
REPRESENTATIVE COGHILL explained that  he is interested in having                                                               
a discussion  on what the  limits might  be.  For  example, Chair                                                               
Wilson was talking  about those who may have started  a whole new                                                               
career, like he did at 48 years  old.  An individual may not want                                                               
to work  60 hours  per week  as in  a previous  career.   What if                                                               
someone  wants  to  only  work  a 20-hour  workweek?    It  still                                                               
benefits the  health care system and  relieves tremendous tension                                                               
in  the system,  but  the number  of hours  may  not qualify  for                                                               
reimbursement under this program.                                                                                               
Number 1192                                                                                                                     
MS. BARRANS responded  that is correct.  One of  the concerns the                                                               
sponsor had  in crafting the bill  was to make sure  the Board of                                                               
Nursing had the latitude, expertise,  and knowledge to design the                                                               
criteria so that  the state is getting the most  efficient use of                                                               
these funds.  There is concern  that there probably never will be                                                               
a sufficient  amount of money  in the  fund to fully  satisfy all                                                               
the folks who  would seek to participate in the  program.  Alaska                                                               
Commission  on   Postsecondary  Education   does  not   have  the                                                               
expertise to  say what  a reasonable  workday, workweek,  or work                                                               
year would be for  a nurse in Alaska.  So ACPE  would look to the                                                               
Board of Nursing to set those kinds of criteria.                                                                                
Number 1225                                                                                                                     
REPRESENTATIVE COGHILL  commented that the reason  he is bringing                                                               
this issue  up at  all is  that the Board  of Nursing  would have                                                               
something  to  fall back  upon  in  terms  of discussion  by  the                                                               
committee.     He  said  his   concern  is  that  if   there  are                                                               
applications en masse,  then there will be a  difficult choice in                                                               
deciding who  to eliminate, but if  the state does not  have that                                                               
many applications, those  who want to work split  shifts could be                                                               
allowed  into  the  program.    Recently,  he  was  talking  with                                                               
Representative Joule,  who posed the question  of someone working                                                               
at  the Kotzebue  Hospital for  a while,  who then  goes home  to                                                               
Selawik, and  has a friend  work in  the hospital for  two weeks.                                                               
This would  not be full-time  employment, but it might  worthy of                                                               
Number 1305                                                                                                                     
CAMILLE  SOLEIL, Executive  Director,  Alaska Nurses  Association                                                               
(ANA), testified  via teleconference in  support of HB 211.   She                                                               
told the  committee about  the impending  crisis with  respect to                                                               
the  nurse shortages.   Currently,  traveling  and agency  nurses                                                               
increase the  cost of health  care.   When safety is  called into                                                               
question,  which is  what  the  state is  facing  with a  nursing                                                               
shortage, it is important to look  for health care solutions.  In                                                               
some cases, facilities  look at people who are not  RNs, which is                                                               
always  dangerous  because they  do  not  have the  training  and                                                               
expertise to treat people.  There  are so many reasons to address                                                               
this  issue.    Ms.  Soleil  told the  committee  this  piece  of                                                               
legislation complements  other pieces that are  already in place.                                                               
One  area the  ANA is  supporting is  the University  of Alaska's                                                               
efforts to  double the number  of nursing graduates by  2006, and                                                               
it has a  $2.25-million commitment from the  private sector, such                                                               
as Providence  Health Systems,  Alaska Regional  Hospital, Yukon-                                                               
Kuskokwim Health  Care Corporation, Fairbanks  Memorial Hospital,                                                               
and the Alaska Native Tribal  Health Consortium.  She pointed out                                                               
that  the school  of  nursing  still needs  $2  million in  state                                                               
funds, which have yet to be appropriated.                                                                                       
Number 1399                                                                                                                     
MS. SOLEIL told  the committee that HB 211 is  very attractive to                                                               
the ANA  because it  does two  things.  First,  it looks  at loan                                                               
repayment,  which is  a  definite enticement  to  nurses who  are                                                               
looking at where  to work.  Nurses can go  anywhere because there                                                               
is such good  money offered and there is  an incredible shortage.                                                               
Second, this  loan repayment plan  entices nurses to stay  in the                                                               
state.  Alaska  Nurses Association goal is to  have them practice                                                               
in Alaska  for at least five  years, and maybe in  that time they                                                               
will have made a  life here and will choose to  stay.  Ms. Soliel                                                               
commented that as the state  faces a severe financial crisis, the                                                               
shortage of  nurses will cause  the cost  of health care  to rise                                                               
and the quality of services to  decline.  The ANA will be talking                                                               
with the Board  of Nursing and will be  providing any information                                                               
to assist them.                                                                                                                 
Number 1477                                                                                                                     
MS. SOLEIL said that both the  House and Senate have been looking                                                               
at a method  of prioritizing where the nursing  shortages are the                                                               
greatest.   Many remote villages  should have nurses, but  do not                                                               
because  of their  location  and the  payment  that is  available                                                               
there.  This bill would help  attract people to those areas.  The                                                               
ANA has asked the Board of  Nursing to look at this issue closely                                                               
as it develops the regulations  related to this legislation.  Ms.                                                               
Soleil summarized  her comments  by saying that  the ANA  is very                                                               
supportive of HB 211.                                                                                                           
Number 1494                                                                                                                     
MS.  BARRANS spoke  on one  area of  concern that  Representative                                                               
Coghill had on the bill.  She  said that as the bill is currently                                                               
constructed,  she  does  not  see  a  barrier  to  the  Board  of                                                               
Nursing's  prioritizing tiers  or alternative  benefit structures                                                               
as long as  the regulations do not violate the  terms that are in                                                               
the bill.   For instance,  if a nurse  that was working  what the                                                               
board would  categorize as part-time,  the board  could certainly                                                               
authorize the participation  of that nurse in the  program with a                                                               
pro rata  benefit.  The bill  says that benefits can  be paid out                                                               
over no less than five years, but  could be longer in the case of                                                               
a  part-time nurse,  or  no  more than  $10,000.   That  language                                                               
captures  how much  money  and  the minimum  length  of time  the                                                               
repayment plan  would cover for that  amount of money, so  if the                                                               
Board  of  Nursing wanted  to  have  another alternative  benefit                                                               
structure,  Ms.  Barrans said  she  does  not  see a  barrier  to                                                               
implementing that in the current bill.                                                                                          
Number 1550                                                                                                                     
VICE CHAIR  GATTO asked  if there  is anything  in the  bill that                                                               
says this  program can be canceled  five years from now  and that                                                               
if individuals have not collected, it will be too late.                                                                         
CHAIR WILSON  replied that there  is a  section in the  bill that                                                               
says  "providing  that the  funds  are  available," which  should                                                               
cover Vice Chair Gatto's concern.                                                                                               
REPRESENTATIVE SEATON  referred to the sponsor's  statement where                                                               
it  says that  the funding  for the  program may  be appropriated                                                               
from the Alaska Student Loan  Corporation dividend.  He asked for                                                               
clarification on that point.                                                                                                    
MS. BARRANS  said page 2,  Section 5, inserts some  language into                                                               
the  portion of  statute  that directs  the  Alaska Student  Loan                                                               
Corporation to  return a dividend  to the state.   Currently, the                                                               
Alaska Student  Loan Corporation, in any  year that it has  a net                                                               
income in  an excess of a  certain amount, calculates and  pays a                                                               
return to the state from its  income.  In the current fiscal year                                                               
that amount was $5.25 million.   The amount approved for FY 04 is                                                               
$5  million.   So  this  [language]  suggests  that would  be  an                                                               
appropriate use of [those funds] without a mandate.                                                                             
REPRESENTATIVE  SEATON replied  that essentially  the legislature                                                               
does not  have to fund  this program.   The amount in  the fiscal                                                               
note is  about $1  million.   He asked if  Ms. Barrans  is saying                                                               
that these funds can be  transferred from the Alaska Student Loan                                                               
Corporation directly to  this fund, and it does not  have to come                                                               
back to the legislature for appropriation.                                                                                      
MS. BARRANS responded that it means  just the opposite.  Once the                                                               
Alaska Student  Loan Corporation  has returned  the money  to the                                                               
state, the  legislature will appropriate  it to  various projects                                                               
that they  wish to fund.   This program would  be a line  item in                                                               
every operating budget.                                                                                                         
Number 1698                                                                                                                     
RHONDA RICHTSMEIER,  Deputy Chief,  Nursing Section,  Division of                                                               
Public Health Nursing, Department  of Health and Social Services,                                                               
testified  in support  of HB  211.   She told  the committee  the                                                               
entire nation is  suffering from the same  nursing shortages that                                                               
Alaska  is  facing, which  means  it  really  puts the  state  in                                                               
competition  with  rest  of  the nation  in  enticing  nurses  to                                                               
Alaska.   To some  degree, the  problem is also  a result  of the                                                               
demographic shift.  The Alaskan  senior population is expected to                                                               
triple by 2025.  An  increased aging population means an increase                                                               
in  chronic  disease and  increased  need  for nursing  services.                                                               
Alaska's  nurses are  also aging.   She  said that  right now  71                                                               
percent of Alaskan nurses are between the  ages of 41 and 71.  In                                                               
the  next five  to ten  years, one  quarter of  those nurses  are                                                               
expected to  retire.  So  the state is  facing a problem  of both                                                               
supply and demand.                                                                                                              
MS.  RICHTSMEIRER  said this  bill  is  intended to  address  the                                                               
critical problem of nurse recruitment  and retention by providing                                                               
at least a  small financial incentive to attract  new people into                                                               
the  profession, as  well  as keeping  people  in the  profession                                                               
working.    She told  the  committee  that the  nursing  shortage                                                               
Alaska  is facing  is not  just an  abstraction of  numbers or  a                                                               
problem  for those  who need  to find  and employ  nurses.   More                                                               
important, it is  a problem of access to health  care, quality of                                                               
health care  for those  institutions that  are providing  it, and                                                               
cost of health  care for all Alaskans.  She  summarized by saying                                                               
that  the  Department  of Health  and  Social  Services  strongly                                                               
supports HB 211 and asks for the committee's approval.                                                                          
Number 1817                                                                                                                     
LARAINE  DERR,  President  and Chief  Executive  Officer,  Alaska                                                               
State Hospital  and Nursing Home Association  (ASHNHA), testified                                                               
in support of  HB 211 and answered questions  from the committee.                                                               
She told  the committee  all the hospitals  and nursing  homes in                                                               
the  state  belong to  the  association.   The  hospitals  really                                                               
employ the greatest  number of nurses in the state.   She said of                                                               
the  top 15  categories identified  by the  Alaska Department  of                                                               
Labor  and  Workforce  Development   as  the  fastest  increasing                                                               
occupations, health care  occupies 13 of those 15  positions.  So                                                               
the need for  health care workers is really expanding.   She said                                                               
ASHNHA got  interested in  this issue about  four years  ago when                                                               
they saw the increasing crisis  coming with regard to health care                                                               
shortage.  Four years ago, ASHNHA  had a summit where they talked                                                               
about it.  On  9/11 [2001], the day the tragedy  hit, there was a                                                               
nursing summit in  Anchorage, and it was pertinent  at that time.                                                               
There are  many pieces  of the puzzle  and this is  one.   As the                                                               
committee has heard, the university  is graduating 110 nurses per                                                               
year and  will be increasing its  program so it can  graduate 220                                                               
nurses a year.   Alaska needs to graduate 400  per year, so there                                                               
is a need for other programs to help.                                                                                           
MS.  DERR  talked  about  the   fact  that  Alaskan  health  care                                                               
providers  are paying  "travelers"  or visiting  nurses.   Alaska                                                               
State  Hospital and  Nursing Home  Association  just completed  a                                                               
survey  this  week to  show  how  much  money  is spent  in  this                                                               
practice.   That study showed  that $11  million is spent  in the                                                               
state each year to pay travelers.   That money goes outside.  The                                                               
figure  would  be  $14 million  if  radiologists  were  included.                                                               
Providence Hospital  uses 17 radiologist technicians.   Last year                                                               
at  one  point  in  time,  Providence had  17  travelers  in  its                                                               
facility.   She told the  committee that  is a horrible  drain on                                                               
state  resources.    Alaska  State   Hospital  and  Nursing  Home                                                               
Association had an  inventory meeting last week,  this week there                                                               
is  an allied  health care  meeting, there  is a  health fair  in                                                               
Anchorage  today where  most  of the  hospitals  are involved  in                                                               
trying to find health care  workers, there are K-12 [kindergarten                                                               
through  12th grade]  programs,  and  there are  skills-standards                                                               
meetings  in  Bethel  and  Anchorage.    There  are  many  events                                                               
happening.   Ms. Derr  encouraged the  committee to  support this                                                               
bill and help recruit and retain nurses in Alaska.                                                                              
Number 1945                                                                                                                     
REPRESENTATIVE  SEATON referred  to page  4 [lines  9-10] of  the                                                               
bill,  where it  says, "the  applicant has  outstanding education                                                               
loans from a  lending institution".  He asked if  that covers the                                                               
state [loan program].                                                                                                           
VICE  CHAIR GATTO  responded that  the state  loan program  is an                                                               
authorized lending institution.                                                                                                 
Number 1966                                                                                                                     
REPRESENTATIVE  CISSNA  commented  that  ASHNHA  is  leading  the                                                               
health  providers in  taking this  issue on.   She  said she  was                                                               
attending the  nurses conference  on 9/11 when  the news  came in                                                               
that there might be an incoming  flight to Anchorage on that day.                                                               
The nurses  had to leave  the building;  it was the  most orderly                                                               
exit  imaginable,  and it  was  obvious  that these  people  were                                                               
trained  for  emergencies.   She  congratulated  the sponsor  and                                                               
ASHNHA for the incredible work being done.                                                                                      
REPRESENTATIVE SEATON  asked if traveling  nurses are hired  on a                                                               
time-on, time-off basis.                                                                                                        
MS. DERR  responded that traveling nurses  are hired in a  lot of                                                               
different ways.  Some  of them come to Alaska for  two weeks or a                                                               
month.  There is one person who  has been in a position for three                                                               
years as a traveler because she  gets more money that way.  There                                                               
are psychiatrists who work six months on six months off.                                                                        
REPRESENTATIVE SEATON commented  that it would depend  on the way                                                               
the  board structures  the regulations  as  to whether  travelers                                                               
would be  eligible for this program.   He pointed out  that there                                                               
is nothing in  the bill that says  a nurse must be  a resident in                                                               
order to qualify for the program.                                                                                               
MS.  DERR said  that issue  would be  addressed by  the Board  of                                                               
Nursing as the standards and criteria are laid out.                                                                             
Number 2099                                                                                                                     
REPRESENTATIVE  COGHILL  noted  that  there  are  some  financial                                                               
impacts,  but since  the bill  is referred  to the  House Finance                                                               
Committee, that issue will be addressed there.                                                                                  
Number 2125                                                                                                                     
CHAIR WILSON  referred to  Section 5, where  it says,  "The money                                                           
made available under this subsection  may be appropriated for the                                                           
Alaska nurse recruitment loan repayment program".                                                                           
REPRESENTATIVE COGHILL responded that he  has no problem with the                                                               
CHAIR WILSON  told the  committee that an  issue with  respect to                                                               
traveling  nurses  has  just  come   to  her  attention  that  is                                                               
important.  She said it is hard  on the morale of nurses who work                                                               
and live  in Alaska when traveling  nurses may be making  as much                                                               
as $45 per  hour, plus a free  place to stay, the  ability to eat                                                               
at  the hospital  for  free, and  other kinds  of  perks.   Chair                                                               
Wilson  said she  thinks it  would  not be  a good  idea to  have                                                               
travelers  qualifying for  this program  because this  program is                                                               
really intended  for someone who  wants to  come up to  Alaska to                                                               
work and live.  She said  that language could be developed by the                                                               
time the bill comes before the next committee of referral.                                                                      
REPRESENTATIVE  CISSNA agreed  with Chair  Wilson's comments  and                                                               
shared  the  views  from  her  former  house  sitter  who  was  a                                                               
traveling nurse.   He took a  $10,000 bonus to come  to Alaska to                                                               
work for  one year because  his mother lived  here.  In  fact, he                                                               
was incensed that  there were a lot of people  who came to Alaska                                                               
for a week  that actually got a  lot more money than he  had.  He                                                               
felt  it was  unfair that  there were  nurses who  made more  and                                                               
cared less about  the patients in the hospital,  and thought they                                                               
did a poor job.                                                                                                                 
REPRESENTATIVE  COGHILL moved  to  report CSHB  211, Version  23-                                                               
LS0861\D,  Ford,  3/29/03,  out   of  committee  with  individual                                                               
recommendations and the accompanying fiscal notes.                                                                              
REPRESENTATIVE  SEATON asked  about  a new  fiscal  note for  the                                                               
committee substitute.                                                                                                           
Number 2255                                                                                                                     
CHAIR WILSON  replied that a  new fiscal  note was passed  out to                                                               
members.   She  explained  that originally  the  fiscal note  was                                                               
based on  the belief that  there would be  a need for  1,600 more                                                               
nurses in  the next  few years,  but it  was revised  to indicate                                                               
there  will actually  be a  need for  4,100 nurses.   So  the new                                                               
fiscal note was changed to reflect the difference.                                                                              
Number 2275                                                                                                                     
VICE  CHAIR GATTO  asked  if  there were  any  objections to  the                                                               
motion.   There being  no objection,  CSHB 211(HES)  was reported                                                               
from  the House  Health, Education  and Social  Services Standing                                                               
VICE CHAIR GATTO returned the gavel to Chair Wilson.                                                                            
Number 2294                                                                                                                     
CHAIR WILSON announced that the Report on State Health Policy                                                                   
Meeting in Chicago by Representative Cissna will be postponed                                                                   
until next week.                                                                                                                
There being no further business before the committee, the House                                                                 
Health, Education and Social Services Standing Committee meeting                                                                
was adjourned at 3:50 p.m.                                                                                                      

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