[Contains discussion of SB 28.] 3:07:45 PM CHAIR WILSON announced that the first order of business would be a presentation from the Alaska Nurses Association. She introduced Patricia Senner. 3:10:29 PM PATRICIA SENNER, Family Nurse Practitioner; Chair, Legislative Committee, Alaska Nurses Association (AaNA), introduced members of the various nursing groups representing nursing in Alaska. 3:11:29 PM DIANNE TARRANT, Family Nurse Practitioner; President, Alaska Nurse Practitioner Association, informed the committee that she has been an Alaska resident since 1973. Her experience began as a registered nurse in 1976 and she now teaches family nurse practitioners (NP)s in the graduate program at the University of Alaska (UA). She stated that nurse practitioners perform as primary caregivers, which means that they can prescribe and diagnose common acute and chronic problems. Most nurse practitioners have master's degrees and the UA offers the only statewide program to graduate as a primary care provider in the state. The UA graduates approximately 10 nurse practitioners per year and 90 percent of those graduates stay in the state to practice. Mandated in 2015, there will be an entry level Doctorate in Nursing Practice available through the UA. 3:15:57 PM CHAIR WILSON asked about the mandated program. MS. TARRANT re-stated that the mandated program is a NP entry level program that has been directed by the American College of Nursing and Accrediting. 3:16:05 PM REPRESENTATIVE CISSNA related her personal experience and noted that advanced NP's provide a mid-range of care. She opined that advanced degrees will raise the cost of care and asked whether there will be a lower, thus lower cost, level of NP care available. 3:17:34 PM MS. TARRANT stated that the issue is yet to be resolved at the national level. The UA charges $300 per unit and credit, which educates the graduate for $25,000. 3:18:41 PM CHAIR WILSON observed that, in Alaska, advanced NPs are used as providers in many areas. In the process of further education for nurse practitioners, the cost of health care in Alaska will increase. 3:19:44 PM MS. TARRANT opined that the ultimate result is unknown. She listed the specialties for NPs and compared the quality of care with that of physicians. Ms. Tarrant listed studies that indicate that NPs provide a quality of care equal to that of family physicians at a lower cost. In a 2007 survey, it was found that there are 465 advanced NPs practicing in Alaska. She opined that NPs can be invisible, even though they provide 835,192 primary care visits per year. Furthermore, the average NP earns $45 per hour, 7.6 percent of NPs are the sole health care provider in their community, and one in four practice in a medically underserved community. She then explained that 76 percent of NPs accept Medicare reimbursement, often without limits, and 86 percent will accept Medicaid reimbursement. Nurse Practitioners serve a disproportionate number of elderly, low income, and minority groups. Ms. Tarrant concluded that Alaskan NPs want to participate in the discussion of health care in the state and need the support of the legislature for the nurse practitioner program at the UA. She warned that the UA may lose the psychiatric nurse practitioner program due to the lack of faculty. 3:27:56 PM REPRESENTATIVE ROSES asked for a comparison of populations served in urban, rather than rural, communities. 3:28:10 PM CHAIR WILSON expressed her understanding of the nursing profession's desire for advanced education; however, further education will increase cost, but not the level of service. MS. TARRANT stated that the goal of the master's program is to be close to a three-year degree. 3:30:12 PM DEBBIE THOMPSON, Operating Room Nurse; President, Alaska Nurses Association, stated that SB 28 addresses the matter of mandatory overtime. She noted that the bill has been improved by changes and bans mandatory overtime, also known as mandatory call, and limits working hours for nurses to fourteen hours per day with a rest period of ten hours. Ms. Thompson turned to the subject of nursing demographics and related the following: most are aged 51 to 60 years and are close to retirement; 84.4 percent leave their profession due to retirement; and nursing specialties include midwives, anesthetists, clinical specialists, educators, administrators, public health nurses (PHN)s, NPs, office nurses, nurse managers and staff nurses. Ms. Thompson then informed the committee that the Alaska Nurse Alert System (ANAS) is a volunteer program to mobilize nurses during public health emergencies. Presently, there are over 300 nurses who have volunteered, and 40 percent are prepared to serve in remote areas. 3:35:31 PM CHRIS VAN CLEVE, School Nurse; Alaska Representative, National School Nurses Association and Alaska School Nurses Association, stated that school nurses, principals, and parents are convinced that healthy kids learn better; in fact, care by school nurses reduces school absenteeism. The majority of school nurses serve children in Anchorage, the Mat-Su Borough, Kenai Peninsula, Fairbanks, and Juneau; there are very few school nurses in Bush communities. Ms. Van Cleve noted that the federal government recommends one registered nurse per every 750 regular education students, and a higher ratio for special education students. 3:38:27 PM REPRESENTATIVE ROSES observed that school nurses are also counselors and serve in many other capacities. A lack of a nurse can mean that school secretaries administer medications. 3:39:11 PM NANCY DAVIS, Registered Nurse; Public Health Nurse, Department of Health and Social Services, informed the committee that public health nursing is a combination of nursing art and science, and public health science. One hundred and fifty-two public health nurses (PHN)s connect with every community across the state and provide nursing service to every village with a school, and to any location where there is a communicable disease outbreak. Public health nurses focus on disease prevention and protection; health promotion and health education; community health assessment; community health development and problem solving of health issues; and timely intervention when emergencies occur. Ms. Davis stated that PHNs work for the state, local governments and tribal health organizations; in fact, one of their important functions is to link the public to needed government health services. She provided statewide statistics for public nursing services. 3:44:10 PM REPRESENTATIVE CISSNA recalled that there were more PHNs in the past. 3:44:36 PM MS. DAVIS said that the number of nurses stays about the same, although the general population has increased. 3:45:22 PM REPRESENTATIVE ROSES shared his experience as a teacher on TB test day. 3:45:53 PM MS. SENNER provided information about the University of Alaska Anchorage (UAA) School of Nursing. She pointed out that 9,000 Registered Nurse (RN) licenses have been issued in Alaska, but only 6,000 of those nurses live in Alaska. In fact, about one- third of the nursing workforce is traveling nurses. To address this shortage, a task force was convened in 2002, that made the following recommendations: double enrollments in, and graduations from, the nursing programs; extend those programs to rural and frontier communities; identify and implement strategies to retain nurses; and financially support the expansion. Although the UA wants to expand, and is supporting expansion financially, there are limits to the number of instructors and clinical sites available. At this time, the school of nursing has a two-year waiting list for acceptance into the program, and 600 waiting students who have completed their core courses. 3:50:30 PM REPRESENTATIVE GARDNER advised that many newly graduated nurses are not getting jobs due to lack of experience or specialty training. 3:51:04 PM MS. SENNER recalled that, about 20 years ago, hospitals eliminated many training programs for new graduates. Therefore, there is a shortage of nurses in that age group. 3:51:57 PM REPRESENTATIVE GARDNER asked whether training programs have been reinstated. MS. THOMPSON opined that most facilities now have internships and fellowships, depending on the specialty of the student. Providence Health finds that new graduates take four months to two years to feel comfortable in their work. Furthermore, technology is not taught in nursing school and must be learned with experience. 3:53:13 PM REPRESENTATIVE GARDNER asked whether feeling comfortable equated to competence. MS. THOMPSON indicated yes. 3:55:38 PM