Legislature(2021 - 2022)BUTROVICH 205

02/25/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES

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Audio Topic
01:33:29 PM Start
01:34:15 PM SB67
02:32:08 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                       February 25, 2021                                                                                        
                           1:33 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Senator David Wilson, Chair                                                                                                     
Senator Shelley Hughes, Vice Chair                                                                                              
Senator Mia Costello via teleconference                                                                                         
Senator Lora Reinbold                                                                                                           
Senator Tom Begich                                                                                                              
MEMBERS ABSENT                                                                                                                
All members present                                                                                                             
COMMITTEE CALENDAR                                                                                                            
SENATE BILL NO. 67                                                                                                              
"An Act relating to the licensure of nursing professionals;                                                                     
relating to a multistate nurse licensure compact; and providing                                                                 
for an effective date."                                                                                                         
     - HEARD AND HELD                                                                                                           
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: SB  67                                                                                                                  
SHORT TITLE: NURSING: LICENSURE; MULTISTATE COMPACT                                                                             
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
02/03/21       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/03/21       (S)       HSS, L&C                                                                                               
02/23/21       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
02/23/21       (S)       Heard & Held                                                                                           
02/23/21       (S)       MINUTE(HSS)                                                                                            
02/25/21       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
WITNESS REGISTER                                                                                                              
SARA CHAMBERS, Director                                                                                                         
Division of Corporations, Business, and Professional Licensing                                                                  
Department of Commerce, Community and Economic Development                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Answered questions about SB 67.                                                                           
VICKY BYRD, Montana Nurses Association                                                                                          
Clancy, Montana                                                                                                                 
POSITION STATEMENT: Testified with concerns about SB 67.                                                                      
SHANNON DAVENPORT, Member                                                                                                       
Alaska Nursing Association                                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in opposition to SB 67.                                                                         
BOB PAWLOWSKI, Chair                                                                                                            
Pioneer Homes Advisory Board                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified about the value of SB 67 to                                                                     
military spouses and to Pioneer Homes.                                                                                          
LYNN VAN VACTOR, Director of Quality                                                                                            
Alaska State Hospital and Nursing Home Association (ASHNA)                                                                      
Dillingham, Alaska                                                                                                              
POSITION STATEMENT: Testified in support of SB 67.                                                                            
MIKE COONS, President                                                                                                           
Mat-Su Chapter of Association of Mature Citizens (AMAC)                                                                         
Palmer, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 67.                                                                            
TINA REIN, Director of Nursing                                                                                                  
Denali Center                                                                                                                   
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 67.                                                                            
REBECCA FOTSCH, Director                                                                                                        
State Advocacy & Legislative Affairs                                                                                            
National Council of State Boards of Nursing                                                                                     
Chicago, Illinois                                                                                                               
POSITION STATEMENT: Addressed concerns about SB 67.                                                                           
PATRICIA FISHER, representing self                                                                                              
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT: Testified in support of SB 67.                                                                            
LORI ENLOW, representing self                                                                                                   
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT: Testified in support of SB 67.                                                                            
LAURA BONNER, representing self                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in opposition to SB 67.                                                                         
BRITTANY MACKEY, Member                                                                                                         
Alaska Nursing Association                                                                                                      
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT: Testified in opposition to SB 67.                                                                         
SARA MASSMANN, Legislative Cochair                                                                                              
Alaska Nursing Association                                                                                                      
Ketchikan, Alaska                                                                                                               
POSITION STATEMENT: Testified in opposition to SB 67.                                                                         
PAT DOOLEY, representing self                                                                                                   
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 67.                                                                            
MARGE STONEKING, Director for Advocacy                                                                                          
AARP Alaska                                                                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 67.                                                                            
ACTION NARRATIVE                                                                                                              
1:33:29 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:33 p.m.  Present at the                                                               
call to order  were Senators Begich, Hughes,  Reinbold, and Chair                                                               
Wilson. Senator Costello joined via teleconference.                                                                             
         SB  67-NURSING: LICENSURE; MULTISTATE COMPACT                                                                      
1:34:15 PM                                                                                                                    
CHAIR WILSON announced the consideration of SENATE BILL NO. 67                                                                  
"An  Act  relating to  the  licensure  of nursing  professionals;                                                               
relating to  a multistate nurse licensure  compact; and providing                                                               
for  an effective  date." He  stated  his intent  to take  public                                                               
testimony.  The  committee  heard  an overview  of  bill,  had  a                                                               
sectional analysis,  and heard invited  testimony. He  noted that                                                               
Director Sara Cambers was available online for questions.                                                                       
1:34:42 PM                                                                                                                    
SENATOR REINBOLD announced  that she needed to  excuse herself to                                                               
attend another meeting.                                                                                                         
1:35:06 PM                                                                                                                    
SENATOR  BEGICH  said that  in  his  conversations with  Director                                                               
Chambers and in committee, she  had indicated that there had been                                                               
no opposition  to the bill  from organized labor. AFL-CIO  sent a                                                               
strong letter  of concern to  the committee and he  also received                                                               
unsupportive  comments from  some of  the representatives  of the                                                               
Nurses Association, which has 7,000  members. He asked if she had                                                               
not received any notice of those objections.                                                                                    
1:36:07 PM                                                                                                                    
SARA CHAMBERS, Director, Division  of Corporations, Business, and                                                               
Professional  Licensing, Department  of  Commerce, Community  and                                                               
Economic  Development (DCCED),  replied that  her agency  had not                                                               
received any letter  or notification of opposition  from the AFL-                                                               
CIO  or Nurses  Association about  this  bill this  year. As  she                                                               
mentioned  on  Tuesday,  nurses overwhelming  support  the  Nurse                                                               
Licensure  Compact.  She  review  that  information  and  provide                                                               
responses to any concerns raised.                                                                                               
SENATOR BEGICH said  that he thought the responses  were a result                                                               
of the  previous hearing on  the bill.  He looked forward  to the                                                               
public testimony today  and he will reach out to  make sure those                                                               
people put their objections on the record.                                                                                      
1:37:46 PM                                                                                                                    
At ease                                                                                                                         
1:38:35 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
1:38:38 PM                                                                                                                    
SENATOR  HUGHES said  the Nurses  Association has  7,000 members.                                                               
She asked how many nurses are licensed overall in the state.                                                                    
MS.  CHAMBERS  replied that  the  state  about 20,000  registered                                                               
nurses and  licensed practical  nurses who  would be  affected by                                                               
the bill. The  bill does not affect  certified nursing assistants                                                               
or advanced practice registered nurses.                                                                                         
SENATOR HUGHES said that is a good reference point.                                                                             
1:39:44 PM                                                                                                                    
CHAIR WILSON opened public testimony.                                                                                           
1:40:10 PM                                                                                                                    
VICKY  BYRD, Montana  Nurses Association,  Clancy, Montana,  said                                                               
that SB 67  is similar to a bill that  already passed in Montana.                                                               
She  wants to  share  the unintended  consequences the  committee                                                               
should be  aware of before considering  the NLC. There is  no way                                                               
to monitor compact  nurses working in Montana. They  do not check                                                               
in with  the state Board of  Nursing. The employer only  needs to                                                               
see that they have a current  multistate license. If they move to                                                               
Montana, they are  supposed to get a new home  state license, but                                                               
that  is not  happening. Nurses  are renewing  their out-of-state                                                               
licenses.  A nurse  from Tennessee  was hired  in 2018  and still                                                               
does not have a Montana license.  There is no way to enforce them                                                               
to abide by  Montana's continuing education rules and  get a home                                                               
state license.  That is a  loss of revenue. Other  Montana nurses                                                               
must  pay for  any investigations  that may  need to  happen with                                                               
those nurses.  That is a super  challenging aspect. The NLC  is a                                                               
nongovernmental,  nonregulatory  agency.  The  compact  does  not                                                               
apply to  travel nurses. It  applies to the agencies  that employ                                                               
them. Agencies  usually have to  buy licenses in each  state that                                                               
they dispense nurses  to, but with the compact,  the agencies are                                                               
saving  money, not  nurses. Montana  passed the  NLC, but  it was                                                               
against the wishes of the professional nursing association.                                                                     
SENATOR  BEGICH clarified  that Ms.  Byrd said  that out-of-state                                                               
nurses didn't have to register with Montana's Board of Nursing.                                                                 
MS. BYRD replied  yes, nurses from other compact  states can work                                                               
immediately  without registering  with  the  board. The  facility                                                               
just needs to see if they  have a legal license. Those nurses are                                                               
supposed  to get  a new  home state  license once  they establish                                                               
residency in  Montana, but it  doesn't always  happen. Therefore,                                                               
the state is losing revenue.                                                                                                    
1:45:08 PM                                                                                                                    
At ease                                                                                                                         
1:45:53 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
1:45:58 PM                                                                                                                    
SHANNON   DAVENPORT,   Member,    Alaska   Nursing   Association,                                                               
Anchorage,  Alaska,  said   that  she  is  a   hospice  nurse  at                                                               
Providence Alaska  Medical Center.  SB 67 is  not a  valid option                                                               
for the  state and its  people. Every  nurse has story  about why                                                               
they become a  nurse. Hers began as a mistake.  In 2005, she went                                                               
into  premature labor  in  her first  pregnancy  while living  in                                                               
North  Carolina. Due  to a  traveling nurse's  inability to  read                                                               
pertinent  medical  information,  her family  paid  the  ultimate                                                               
price.  Her daughter  lived for  24 minutes.  She wonders  if the                                                               
outcome would have  been different if the nurse had  been held to                                                               
the  same standards  as  those  in North  Carolina.  Alaska is  a                                                               
melting pot  with a  unique and  diverse community.  Alaska holds                                                               
her to a  higher standard of competency and  knowledge. Alaska is                                                               
a  complex and  distinct entity  that requires  that nurses  have                                                               
more than medical knowledge. They need a grasp of culture.                                                                      
1:49:00 PM                                                                                                                    
BOB PAWLOWSKI,  Chair, Pioneer  Homes Advisory  Board, Anchorage,                                                               
Alaska, said  the Pioneer Homes  Advisory Board is  interested in                                                               
SB  67 to  increase the  licensed nurses  in the  six communities                                                               
with Pioneer Homes  but have yet to take an  advisory position to                                                               
the governor. That will be  discussed at their March meeting, but                                                               
he did want  to make the following points. The  six Pioneer Homes                                                               
have assisted living  for 446 residents with 243 over  the age of                                                               
85.  Each community  that has  a Pioneer  Home has  a significant                                                               
military presence,  whether in Sitka, Ketchikan,  and Juneau with                                                               
the Coast Guard or Anchorage,  Palmer, and Fairbanks with the Air                                                               
Force  and Army.  The  Army  and Air  Force  have used  executive                                                               
orders to allow  military spouses to work  on federal properties.                                                               
He could  not find  anything similar with  the Coast  Guard. When                                                               
active  duty members  come  to Alaska  with  spouses licensed  to                                                               
practice as nurses,  the spouses should be able to  come into the                                                               
workplace easily. His  board hopes this bill  would address that.                                                               
The U.S. Public Health Service  works in the Coast Guard stations                                                               
and Indian  Health Services throughout  the state.  Those workers                                                               
also have  skilled spouses  who travel  with them.  Department of                                                               
Health  and   Social  Services  Commissioner  Crum   supported  a                                                               
comparable bill  in the last  legislature, recognizing  the needs                                                               
of the Pioneer  Homes, and [Alaska National  Guard] Major General                                                               
Saxe supported SB 67. Pioneer  Homes have 97 nurse positions, but                                                               
only 83 are filled.                                                                                                             
1:52:15 PM                                                                                                                    
LYNN VAN VACTOR,  Director of Quality, Alaska  State Hospital and                                                               
Nursing Home  Association (ASHNA),  Dillingham, Alaska,  said she                                                               
is also the liaison for  the ASHNHA nurser leader committee. This                                                               
is  an important  decision and  ASHNHA  requests the  committee's                                                               
full support to join the NLC.  The NLC improves access to care by                                                               
making  it easier  for  nurses to  start  providing patient  care                                                               
right  away  rather than  waiting  weeks  for official  approval.                                                               
Timely  filling  of nursing  vacancies  is  imperative to  assure                                                               
continuity of  care and  safe staffing  levels for  patients. The                                                               
compact has  high standards and uniform  requirements. Currently,                                                               
Alaska nurses are  required to have multiple  licenses to provide                                                               
training and  patient care across  state lines. With  the advance                                                               
of telehealth, such licensing burdens  are a regulatory nightmare                                                               
and expensive.  Alaska needs  to be  more competitive  to attract                                                               
professional nursing staff. Travel nurses  who would love to stay                                                               
and  work  in Alaska  have  refused  to accept  permanent  vacant                                                               
positions  because NLC  nurses who  change  their residencies  to                                                               
Alaska do not  maintain their NLC licenses. Alaska  would be more                                                               
attractive for nurses as an  NLC member. Concerns have been heard                                                               
that the  NLC will  allow out-of-state nurses  to take  jobs away                                                               
from Alaska nurses.  While ASHNHA does not keep  track of nursing                                                               
vacancies, members  do have nursing  shortages. As  of yesterday,                                                               
one  large hospital  in  Alaska had  101  nursing vacancies,  one                                                               
medium  hospital  had  20 nursing  vacancies,  and  one  critical                                                               
access hospital  had 14.  These three  facilities alone  have 135                                                               
nursing vacancies.  Alaska has 41  licensed, acute  care critical                                                               
access  and long-term  care facilities.  The need  is there,  the                                                               
need is great, and the the need to join the compact is now.                                                                     
1:55:44 PM                                                                                                                    
MIKE COONS,  President, Mat-Su Chapter  of Association  of Mature                                                               
Citizens  (AMAC),  Palmer, Alaska,  said  that  his AMAC  chapter                                                               
supports SB 67,  along with AARP. He has read  the pros and cons.                                                               
He is  impressed with the large  support in and out  of state. Up                                                               
to the writing of his testimony,  the only opposition is from the                                                               
nurses union. As an Air  Force retiree and contract paramedic, he                                                               
sees  the  need for  this  compact.  His chapter  supported  this                                                               
legislation in  the past session,  but it didn't pass  because of                                                               
the pandemic.  That was  sad because it  would have  been helpful                                                               
during the pandemic.  More patients could have  been treated with                                                               
far  less fatigue  by limited  nursing staff.  Mat-Su AMAC  is in                                                               
full support of SB 67.                                                                                                          
1:57:01 PM                                                                                                                    
TINA  REIN,  Director  of   Nursing,  Denali  Center,  Fairbanks,                                                               
Alaska, said  that she  has been  in her role  for 15  years. Her                                                               
experience with nursing shortage in  the long-term care sector is                                                               
the  same  as  the  Pioneer   Homes  and  other  assisted  living                                                               
facilities  in  the  state.  Denali Center  this  last  year  and                                                               
historically  has  not  experienced  layoffs  or  furloughs.  The                                                               
center   currently   has   three  licensed   openings   with   no                                                               
applications. The  center has 30  licensed nurses. The  center is                                                               
forecasting losing over  40 percent of its licensed  staff in the                                                               
next four  years. Its  nursing staff is  aging and  moving toward                                                               
retirement. The  center uses licensed practical  nurses (LPN) and                                                               
with no LPN program in the  state, the center has to recruit from                                                               
out of state.  The Interior has over 16,000 people  over 65. That                                                               
number is growing and the  need for qualified geriatric nurses is                                                               
growing, but  licensed nurses  have options.  Many do  not choose                                                               
long-term  care  assisted living.  All  of  this is  creating  an                                                               
oncoming  crisis. Delays  in licensing  is and  will continue  to                                                               
lead  to  unsafe  conditions in  long-term  care  centers  across                                                               
Alaska. ASHNHA supports the NLC.                                                                                                
CHAIR WILSON  passed on  information that  Senator Hughes  had to                                                               
leave for  another meeting. She appreciates  those testifying and                                                               
her staff  is in  the room  taking notes. She  will follow  up by                                                               
listening to testimony as well.                                                                                                 
SENATOR BEGICH  noted that Senator Costello  was participating by                                                               
phone  and Chair  Wilson added  that she  also has  staff in  the                                                               
SENATOR  COSTELLO said  that  she is  listening  intently to  the                                                               
1:59:37 PM                                                                                                                    
REBECCA FOTSCH,  Director, State Advocacy &  Legislative Affairs,                                                               
National Council  of State Boards of  Nursing, Chicago, Illinois,                                                               
said that  her organization is  the drafter of the  NLC language.                                                               
The compact has been enacted in  34 states and now 10 states have                                                               
pending legislation like Alaska. She  has heard the concerns from                                                               
states  over the  years.  Many  of which  are  the  same. It  was                                                               
brought up that  compact nurses do not need to  register with the                                                               
Board of  Nursing when practicing  in a  state. That is  true and                                                               
intentional. The  purpose of  the compact  is to  eliminate those                                                               
regulatory  hurdles.  By  allowing nurses  to  immediately  begin                                                               
practicing  across  state  lines  with  the  multistate  license,                                                               
nurses can  immediately cover gaps  in care caused  by disasters,                                                               
flu seasons,  or just shortages.  It was  said that the  Board of                                                               
Nursing would  not know who is  practicing in a state.  Right now                                                               
Boards of Nursing do not know  who is practicing in their states.                                                               
Employers don't  report who is  employed. Boards of  Nursing know                                                               
who is licensed but not practicing  in their states. It would not                                                               
be much of a difference with  the compact. In the first committee                                                               
hearing  and today,  she heard  comments about  travel nurses.  A                                                               
compact nurse and a travel  nurse not synonymous. A compact nurse                                                               
has  a compact  license. There  are travel  nurses practicing  in                                                               
Alaska under their  single state license. Travel  nurses are used                                                               
to  cover gaps  in care  and used  whether a  state has  joined a                                                               
compact  or not.  The nursing  standards are  uniform across  the                                                               
country.  Nurses must  pass the  same test,  the NCLEX,  to be  a                                                               
licensed RN.  That is  the same  in all states.  That is  why the                                                               
compact  has been  able to  operate safely  and successfully  for                                                               
over 20 years.                                                                                                                  
SENATOR  BEGICH  asked  if  she   had  any  objection  to  nurses                                                               
registering with the state.                                                                                                     
MS.  FOTSCH answered  that without  getting into  too many  legal                                                               
specifics, there  have been some  states with the  same concerns.                                                               
As  a way  to address  those concerns,  they have  required their                                                               
hospitals and institutions to provide  that information. The only                                                               
problem is  if nurses are  required to do that  before practicing                                                               
because that it is not required  in any other state. Compacts act                                                               
like a contract  between states, so Alaska  cannot add additional                                                               
stipulations to  that contract, but  if the employer  is required                                                               
to do that, that is outside the purview of the compact.                                                                         
SENATOR  BEGICH asked  if any  state  has stepped  away from  the                                                               
MS.  FOTSCH answered  that  no state  has  repealed the  contract                                                               
2:04:33 PM                                                                                                                    
PATRICIA FISHER,  representing self,  Wasilla, Alaska,  said that                                                               
COVID  made it  clear that  nursing should  not be  restricted by                                                               
state  lines. The  news this  past  year showed  that cities  and                                                               
states were  pleading for nurses to  come help them. That  is not                                                               
going to go  away. There could be a COVID  relapse next winter or                                                               
another medical  crisis. Alaska needs  to recognize being  in the                                                               
21st century.  The world grows smaller  every day. It is  time to                                                               
join the  NLC to allow  nurses to  easily cross state  lines. All                                                               
Alaskans are hurt  by a shortage of nurses, which  Alaska has had                                                               
for some time.  This shortage has a significant  impact on senior                                                               
Alaskans,  like herself.  Many  older Alaskans  do  not have  the                                                               
resources or  ability to get  to their appointments or  they live                                                               
in rural  areas. They need  the ability to receive  healthcare in                                                               
person or  through telehealth technologies. The  NLC makes nurses                                                               
more available  to Alaskans. She  urged the committee to  pass SB
67 with amendments to address the issues raised by Ms. Byrd.                                                                    
2:06:33 PM                                                                                                                    
LORI ENLOW,  representing self, Wasilla,  Alaska, said she  is an                                                               
RN  who works  in Anchorage  at  Providence Medical  Center in  a                                                               
specialty nursing  field. One  thing that  has made  it difficult                                                               
this year  is that  a nurse  from another  unit cannot  just walk                                                               
into  her unit  do the  job they  do in  her specialty  unit. She                                                               
supports the NLC  because Providence would have been  able to get                                                               
nurses more  quickly. She  worked in two  other states  that were                                                               
part  of the  NLC. She  saw the  ability for  nurses to  be hired                                                               
quickly, especially  for military spouses. Joining  the NLC would                                                               
be a good thing for the state.                                                                                                  
2:08:44 PM                                                                                                                    
LAURA BONNER, representing self,  Anchorage, Alaska, said that is                                                               
always  skeptical  of  Alaska automatically  accepting  licensing                                                               
from  other states  that may  have  lower standards.  There is  a                                                               
national shortage of  nurses, so this won't help  Alaska with its                                                               
shortage. The  state should  be recruiting  in state  and growing                                                               
its own. She  knows young women who wants to  be nurses but there                                                               
are  few opportunities  to be  accepted.  It would  be better  to                                                               
provide the education and training  to Alaskans. Alaskans who are                                                               
educated  here are  more likely  to  stay here.  They would  also                                                               
understand Native cultures better.                                                                                              
2:10:20 PM                                                                                                                    
BRITTANY  MACKEY, Member,  Alaska  Nursing Association,  Wasilla,                                                               
Alaska, said  she is  a nurse at  Providence Medical  Center. The                                                               
NLC  would  cause  a  loss of  state  sovereignty.  Alaska  would                                                               
forfeit its self-determination of  nursing standards and practice                                                               
to the unelected, interstate commission  of the NLC. Alaska would                                                               
lose  its  ability  to  establish rules  that  cover  all  nurses                                                               
working in  the state. It  is a threat  to public safety  with an                                                               
inability  to  monitor  and discipline  unsafe  conduct.  Nursing                                                               
education requirements varies widely  state to state. Some states                                                               
don't require any continuing education  and the NLC only requires                                                               
that member states meet minimum  standards. No evidence exists to                                                               
suggest  that  joining will  bring  more  nurses to  Alaska.  The                                                               
nursing  shortage  is  a  national issue.  There  is  no  current                                                               
analysis  that licensing  is a  barrier to  hiring. The  Board of                                                               
Nursing can expedite license applications  and grant temporary or                                                               
courtesy licenses in case of emergency.                                                                                         
2:12:54 PM                                                                                                                    
SARA MASSMANN,  Legislative Cochair, Alaska  Nursing Association,                                                               
Ketchikan, Alaska,  said she  an ICU  nurse at  Ketchikan Medical                                                               
Center. The Alaska Nursing Association  is the voice of nurses in                                                               
Alaska and opposes  SB 67. Regarding military spouse  access to a                                                               
license, the association  has reached out to JBER  and Eielson to                                                               
find out  what problems  may impede  getting licenses.  Last year                                                               
they heard  that military spouses  couldn't apply for  a position                                                               
until they reached  their destination in Alaska.  They found that                                                               
transfer  orders  come  months  before moving  to  Alaska.  These                                                               
spouses are  encouraged to find  employment off-base if  they are                                                               
interested in  that when  they get the  notice of  transfer. They                                                               
can be fully licensed prior to  arrival. For JBER and Eielson the                                                               
cost of a new license is  reimbursed by the military. Joining the                                                               
NLC will  not solve the  issue of  a nursing shortage.  There are                                                               
not many nursing spots in  the universities and nursing graduates                                                               
are  having trouble  finding jobs.  Multiple graduates  have left                                                               
the state because of an inability to find jobs.                                                                                 
SENATOR  BEGICH   said  that  yesterday,  University   of  Alaska                                                               
[Interim] President Pitney in the  state of the university speech                                                               
spoke with  pride about  the 236  students that  came out  of the                                                               
university.  He asked  if Ms.  Massmann is  saying there  are not                                                               
positions  for  them. The  committee  has  heard about  vacancies                                                               
today. He asked her to elaborate on that.                                                                                       
MS. MASSMANN replied  that it may be more  specific to Ketchikan.                                                               
Ketchikan  does  not  have enough  student  positions  and  after                                                               
graduation there are not enough positions for them in Ketchikan.                                                                
2:18:22 PM                                                                                                                    
PAT DOOLEY, representing  self, Anchorage, Alaska, said  she is a                                                               
recently retired  RN. She wants  to talk about the  economic toll                                                               
of the  current system and quality  of care. She spent  almost 10                                                               
years managing  a hospice program  in Anchorage and the  past two                                                               
years provided  nursing orientation for  new nurses at  a skilled                                                               
nursing facility.  There is  a significant  delay in  providing a                                                               
job offer  and a nurse  actually getting  to the bedside  to care                                                               
for someone.  This could  mean a delay  in getting  admission for                                                               
hospice. Travel nurses  are expensive and short-term  and not the                                                               
best for  continuity of care.  Many might  stay if there  were an                                                               
easier path to licensure for  them. In long-term care, the amount                                                               
of time it  takes to fill positions with  out-of-state nurses who                                                               
are waiting for  their licenses takes a toll  on staff, resulting                                                               
in burnout  and poor retention  of staff. Patients  and residents                                                               
suffer. Alaska  has a  limited pool of  RNs. Currently  34 states                                                               
are  in  the  compact.  Joining the  compact  would  make  Alaska                                                               
attractive to  nurses. Some nurses  can't wait  90 days to  get a                                                               
job, so the state  may lose them. The state makes  it so hard for                                                               
nurses  to come  up  to  Alaska and  start  working.  She has  no                                                               
concerns  about the  quality of  care and  safety. There  will be                                                               
background  checks  and nurses  will  be  practicing under  state                                                               
2:21:41 PM                                                                                                                    
MARGE STONEKING,  Director for Advocacy, AARP  Alaska, Anchorage,                                                               
Alaska,  said  that  Alaska  has a  the  fastest  growing  senior                                                               
population  in the  country. The  need  for healthcare  workforce                                                               
grows  as people  age. There  is  already a  nursing shortage  in                                                               
Alaska.  According to  state  and federal  data,  almost half  of                                                               
Alaska RNs  are over  the age of  45. Given  current projections,                                                               
Alaska  will need  5,400 additional  nurses by  2030. That  is in                                                               
addition  to the  hundreds of  chronic current  vacancies. It  is                                                               
unrealistic for Alaska to grow its  own at that scale. Nurses are                                                               
the  largest  segment  of  the  U.S.  healthcare  workforce.  The                                                               
shortage is only  growing worse. The compact makes  it easier and                                                               
more affordable for nurses to  practice across state lines, which                                                               
helps expand access to care,  which is particularly important for                                                               
Alaska seniors and those in  rural areas. The nursing compact may                                                               
not be  a silver  bullet for  the nursing shortage,  but it  is a                                                               
proven  tool  for  removing  a  barrier  to  quickly  and  easily                                                               
supplement the resident workforce. It  makes more sense in Alaska                                                               
than anywhere  else as Alaska has  a long history of  a workforce                                                               
boosted by  traveling nurses. Joining  the compact  maximizes the                                                               
use  of  nurses  to  address Alaska's  most  pressing  healthcare                                                               
challenges, access,  quality, and cost. AARP  urges the committee                                                               
to pass SB 67.                                                                                                                  
2:24:56 PM                                                                                                                    
CHAIR  WILSON  noted that  written  testimony  could be  sent  to                                                               
shss@akleg.gov. He closed public testimony.                                                                                     
SENATOR COSTELLO said  that she would like to follow  up with the                                                               
nurse from Ketchikan.                                                                                                           
CHAIR WILSON asked Sara Massmann to reach out to his office.                                                                    
SENATOR  BEGICH   shared  some  observations.  The   issue  of  a                                                               
nationwide  shortage needs  more detail.  If it  is a  nationwide                                                               
shortage, then states are competing  across state lines. He wants                                                               
to  know  the  state of  that.  He  did  hear  the state  of  the                                                               
university   speech  yesterday   and  noted   President  Pitney's                                                               
comments  about the  nursing  program. He  is  curious about  the                                                               
placement numbers  for that program. The  committee could request                                                               
that  from  the   university.  The  idea  of   forgiveness  as  a                                                               
recruitment tool for nurses has  been briefly discussed. The data                                                               
from the  university would help  with knowing whether  that would                                                               
keep graduates  in state. If  there is a nationwide  shortage, he                                                               
asked  what does  protecting Alaska  workforce require.  He wants                                                               
more information  about the registration issue.  He was concerned                                                               
the comments  that adding  additional criteria  like registration                                                               
might violate the compact. There  are ways around that, but there                                                               
should be a discussion. If  this becomes law, given the testimony                                                               
from  Montana  and  other comments  perhaps  a  sunset  provision                                                               
should be explored to have the  ability to make sure there are no                                                               
unintended  consequences, such  as depressing  wages and  putting                                                               
the public at risk.                                                                                                             
2:29:46 PM                                                                                                                    
CHAIR WILSON said that the  bill needs further discussion and his                                                               
office will  work with the  bill sponsor to get  more information                                                               
to work through  the policy side of this legislation.  He held SB
67 in committee.                                                                                                                
SENATOR  BEGICH  thanked  Director   Chambers  and  the  division                                                               
legislative liaison  for walking  him through  the bill.  Most of                                                               
his questions arose from discussion of the bill.                                                                                
CHAIR  WILSON said  that he  will  get answers  to the  committee                                                               
[SB 67 was held in committee.]                                                                                                  
2:32:08 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson adjourned  the Senate  Health  and Social  Services                                                               
Standing Committee meeting at 2:32 p.m.                                                                                         

Document Name Date/Time Subjects
SB 67, Letters of Support, 2.24.21_Redacted.pdf SHSS 2/25/2021 1:30:00 PM
SB 67
SB 67, Board of Pharmacy SB 67 Letter of Support (2.24.2021).pdf SHSS 2/25/2021 1:30:00 PM
SB 67