ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
January 24, 2006
3:09 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Carl Gatto
Representative Sharon Cissna
Representative Vic Kohring
Representative Berta Gardner
MEMBERS ABSENT
Representative Tom Anderson
COMMITTEE CALENDAR
HOUSE BILL NO. 357
"An Act updating the terminology in statutes for persons with
disabilities; and providing for an effective date."
- HEARD AND HELD
HOUSE BILL NO. 271
"An Act relating to limitations on overtime for registered
nurses in health care facilities; and providing for an effective
date."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 357
SHORT TITLE: STATUTORY REFERENCES TO DISABILITIES
SPONSOR(s): REPRESENTATIVE(s) WILSON
01/11/06 (H) READ THE FIRST TIME - REFERRALS
01/11/06 (H) HES, FIN
01/24/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 271
SHORT TITLE: LIMIT OVERTIME FOR REGISTERED NURSES
SPONSOR(s): REPRESENTATIVE(s) WILSON
04/15/05 (H) READ THE FIRST TIME - REFERRALS
04/15/05 (H) L&C, HES, FIN
04/30/05 (H) L&C AT 1:00 PM CAPITOL 17
04/30/05 (H) Moved Out of Committee
04/30/05 (H) MINUTE(L&C)
05/02/05 (H) L&C RPT 4DP 3NR
05/02/05 (H) DP: CRAWFORD, LYNN, GUTTENBERG,
ANDERSON;
05/02/05 (H) NR: LEDOUX, ROKEBERG, KOTT
05/03/05 (H) HES AT 3:00 PM CAPITOL 106
05/03/05 (H) Heard & Held
05/03/05 (H) MINUTE(HES)
08/29/05 (H) HES AT 1:30 PM Anch LIO Conf Rm
08/29/05 (H) Heard & Held
08/29/05 (H) MINUTE(HES)
09/23/05 (H) HES AT 8:00 AM Anch LIO Conf Rm
09/23/05 (H) Heard & Held
09/23/05 (H) MINUTE(HES)
01/24/06 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
JOAN O'KEEFE, Executive Director
Southeast Alaska Independent Living
Juneau, Alaska
POSITION STATEMENT: Her testimony supporting HB 357 was read by
Representative Peggy Wilson.
GALE SINNOT, Director
Division of Vocational Rehabilitation
Department of Labor & Workforce Development (DLWD)
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 357.
KEVIN GADSEY, Independent Living Specialist and Counselor
Southeast Alaska Independent Living (SAIL)
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 357.
CARRIE PRADEGER, Health and Social Services Planner
Governor's Council on Disabilities and Special Education
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 357 and
suggested revisions.
ROD BETIT, President/CEO
Alaska State Hospital and Nursing Home Association (ASHNHA)
Juneau, Alaska
POSITION STATEMENT: Testified in opposition to HB 271.
RUSSELL GRANGE, Chief Human Resources Officer
Providence Health System Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 271.
SHARA SUTHERLIN, Chief Nurse Executive
Providence Alaska Medical Center
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 271.
MILA COSGROVE, Director
Division of Personnel
Department of Administration (DOA)
Juneau, Alaska
POSITION STATEMENT: Testified on HB 271.
JANET CLARKE, Assistant Commissioner
Finance and Management Services
Department of Health & Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Expressed concerns with HB 271.
MICHELLE MURPHY, Registered Nurse (RN)
Providence RN's Union Health and Safety Officer
Providence Alaska Medical Center
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 271.
KATHLEEN GETTYS, RN
Progressive Care Unit,
Providence Alaska Medical Center;
President of Providence RN's Bargaining Unit;
Representative, Alaska Nurses Association (ANA)
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 271.
STACY ALLEN, RN
Business Agent
Laborers Local 341
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 271.
DIANNE O'CONNELL, Executive Director and Labor Director
Alaska Nurses Association
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 271.
MIKE ALEXANDER, RN
Alaska Psychiatric Institute (API)
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 271.
CATHY FEASTER, Supervising Nurse Practitioner
Division of Community Health Services
Department of Health and Human Services
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 271.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:09:37 PM.
Representatives Wilson, Gatto, Seaton, Cissna, and Gardner were
present at the call to order. Representative Kohring arrived as
the meeting was in progress.
HB 357-STATUTORY REFERENCES TO DISABILITIES
3:09:53 PM
CHAIR WILSON announced that the first order of business would be
HOUSE BILL NO. 357, "An Act updating the terminology in statutes
for persons with disabilities; and providing for an effective
date."
[CHAIR WILSON passed the gavel to Vice Chair Seaton, for the
duration of the meeting.]
3:13:42 PM
CHAIR WILSON, speaking as the prime sponsor of HB 357,
paraphrased from the following written sponsor statement
[original punctuation provided]:
After the Americans with Disabilities Act of 1990,
most states modified their statutes to reflect a
positive reference- changing the word "handicapped" to
"person with a disability". This bill changes all
Alaska State Statues to rid them of this archaic
reference that has negative and demoralizing
connotations in reference to a person's ability and
potential. Using "a person with a disability"
reflects language that is in Federal legislation- the
Federal Workforce Investment Act, the American's with
Disabilities Act, the Civil Rights Act of 1991; The
Individuals with Disabilities Education Act (IDEA) and
the Rehabilitation Act of 1973 as amended in 1992 and
1998.
These changes are being proposed in consultation with
the Department of Labor, other state agencies, and
along with the Governor's Council on Disabilities and
Special Education. There is support for this bill
from numerous other organizations such as the South-
East Alaska Independent Living Center, which represent
people with disabilities. This bill is not designed
to modify any existing requirements or exemptions, nor
will it be changing any existing requirements or
exemptions with the new terminology. This bill is
designed to serve the constituents of everyone across
the state that are affected by this existing negative
and demeaning terminology.
I ask for your support of HB 357 to update and
modernize the language that is in our Alaska Statutes.
3:16:14 PM
CHAIR WILSON paraphrased a letter submitted by Joan O'Keefe,
Executive Director, Southeast Alaska Independent Living,
[original punctuation provided]:
We strongly urge the removal of the word "handicap"
from the legal vocabulary, noting it as a slur and
reference to begging for food (cap in hand) as our
people had to do less than 100 years ago. Other terms
such as "mental disabilities" and "emotionally
disturbed" can be described differently and positively
as "cognitive disabilities" and "emotional
disabilities."
American culture consistently redefines itself through
language and sub-cultures often use language to
redefine themselves. Negroes became blacks then
African-Americans. Homosexuals chose the term "gay"
for themselves. People with disabilities have done
the same during the years, attempting to fight
stereotypes and negative imagery.
Through all the changes, person-first language has
become the most effective and descriptive of all
choices. As the House Bill 357 passes from committee
to committee, please keep in mind that we are all
people first. Some people have red hair, some blue
eyes; some are persons with developmental disabilities
and some are persons who experience low vision. Yet
underneath it all, we are simply human beings. It is
in this vein we urge your support of House Bill 357.
3:17:55 PM
GALE SINNOT, Director, Division of Vocational Rehabilitation,
Department of Labor & Workforce Development (DLWD), stated
support for HB 357. She named the various state agencies that
would benefit from HB 357, and said that the word handicapped is
an archaic term which invokes a negative response versus
terminology which reflects abilities. In response to questions,
she explained why the term "handicapped" is considered archaic
and provided the root of its meaning. She related that "persons
with disabilities" would not like to be referred to as
"handicapped."
3:23:03 PM
KEVIN GADSEY, Independent Living Specialist and Counselor,
Southeast Alaska Independent Living (SAIL), expressed his
support of HB 357 stating that it represents the best option of
terminology available. He requested additional changes as
follows: page 2, line 6, replace "emotionally disturbed" with
"emotional disability"; page 2, line 20, replace "mental
retardation" with "developmental or cognitive disability"; page
17, line 28, replace "emotionally disturbed" with "emotional
disability". He emphasized that [Alaska's State Statute]
terminology needs to be contemporary across the board and
utilize the standard that is used throughout the nation and
preferred by the people characterized by its usage. In response
to a question, he stated that the rule of thumb is to be as
specific as possible in the description [of the disability] and
when possible to name the limitation. He highlighted the
importance of being recognized as a person prior to being
categorized by terminology. He said that misuse of language may
also cause stereotypes.
3:29:51 PM
REPRESENTATIVE GATTO asked whether pregnant women/mothers with
toddlers should be legally allowed to use parking spaces
designated for the handicapped.
MR. GADSEY opined that pregnancy could be seen as a temporary
disability. To further questions, he clarified his recommended
terminology changes for HB 357, and added that the words
"serious" or "severe" should be changed to "significant". He
said that in using terminology it is important to find common
ground when addressing people of any disposition.
3:39:02 PM
CARRIE PRADEGER, Health and Social Services Planner, Governor's
Council on Disabilities and Special Education, Department of
Health and Social Services, stated support ("Council") for HB
357 and requested that the bill also include language that would
respectfully address seniors, mental health patients, and
substance abusers. She noted that the committee packet should
include a letter from Kathleen Fitzgerald, Chair, Governor's
Council on Disabilities and Special Education, DHSS, which
specifies the proposed changes.
VICE CHAIR SEATON stated that the changes are included in the
committee packet in the form of a conceptual amendment. He
reviewed the terms being discussed for change as follows:
"mentally disturbed" changed to "emotional disability"; "those
who are ill" changed to "with an infirmity"; and "mental
retardation" changed to either "cognitive disability" or
"developmental disability". He also reviewed the pages and
lines where the terms "aged," "infirm," or "alcoholics" and
"drug addicts" appear in HB 357. He then asked for the
Council's preferred replacement for "infirm".
MS. PRADEGER clarified that the Council suggests that "infirm"
be changed to "someone with an illness". However, she conceded
that additional "wordsmithing" may be necessary.
3:45:12 PM
REPRESENTATIVE GARDNER suggested that when referring to a person
who is frail, or with constricted movement, the term "infirmity"
might be appropriate rather than "ill."
MS. PRADEGER agreed, and pointed out that "aged" should be
"seniors," and putting "person" before the defining term is the
Council's primary concern such that the language would read:
"persons with developmental disabilities"; "persons who are
blind"; "persons with mental illness"; and "persons with
substance abuse disorders" or "persons with behavioral
health/substance abuse issues".
REPRESENTATIVE CISSNA suggested that it may be helpful to have a
written source for the acceptable language commonly in use in
this arena, which would be helpful to avoid conflicts when
implementing the appropriate terminology.
3:49:06 PM
CHAIR WILSON pointed out that [the bill packet] includes an
example of how Minnesota has dealt with updating its statutes to
reflect the currently preferred terms. She highlighted the
unanimity in having the word "person" preceding any defining
term, but stated that there does not seem to be a strict
standard, as every state deals with it slightly different. In
response to a question, she stated that it would be important to
comply with federal terminology, especially regarding the use of
the term "disorder," to avoid unnecessary conflict resulting in
program funding issues.
3:52:00 PM
CHAIR WILSON moved to adopt Amendment 1, which read [original
punctuation provided]:
Page 2, line 3: "(A) itinerant outreach services to
students who are deaf, deaf-blind, mentally… "
Page 2, line 6: "… disturbed (and) or students with
multiple disabilities;"
Page 9, line 3 & 4 "… and usable by persons with
disabilities (and by the aged,) seniors or (infirm)
those who are ill."
Page 9, line 12 & 13: " … a person with a disability
(or an) a (aged) senior citizen or (infirm( ill
passenger…"
Page 9, line 22:" (aged) seniors or( infirm) ill
passengers."
Page 9, line 25: "…disabilities and by (aged) seniors
or (infirm) ill passengers,…"
Page 10, line 4: "…aged or (infirm) ill."
Page 13, line 6, 7 & 8: "… services designed to meet
the (special) needs of children with disabilities,
(the aged) seniors, (the) persons with
(developmentally) developmental (disabled)
disabilities, (the blind) persons who are blind, (the
mentally ill) persons with mental illness, person
with physical disabilities, and (alcoholics and drug
addicts) persons with substance abuse disorders."
Page 17, line 27: " hearing, deaf, speech impaired,
visually (disabled) impaired, seriously…"
CHAIR WILSON indicated the need to take more time to review the
changes encompassed in Amendment 1. [The committee treated the
motion to adopt Amendment 1 as withdrawn.]
VICE CHAIR SEATON asked for agreement to change the language
"emotionally disturbed" to "a person with emotional disability,"
and "or infirm" to "a person with an infirmity," as indicated
in the amendment.
3:54:24 PM
REPRESENTATIVE GATTO questioned whether inserting the word
"senior" in place of "aged" provides a useful characterization,
because the term "senior" affords various opportunities, and is
based on differing ages. He pointed out that the term "senior"
is not defined in the legislation.
REPRESENTATIVE GARDNER stated that if the change were being made
from "infirm" to "people with an infirmity," perhaps the word
"senior" could be omitted. Therefore, able-bodied seniors would
not fall under the statute.
3:57:23 PM
VICE CHAIR SEATON directed the committee's attention to each
line of HB 357 that was being amended [all pages and lines
previously annotated in this text]. He requested committee
consensus on the terms that were suggested for consideration
from the Governor's Council and SAIL for the amendment re-write,
and he asked for any other observations and suggestions from the
committee.
REPRESENTATIVE GATTO pointed out that on page 17, line 27, of
the amendment, the word "disabled" is removed and substituted
with "impaired", but in the bill "handicapped" is removed and
"disabled" is substituted.
CHAIR WILSON explained that in narrowing the area down to visual
problems the preferred term is "visually impaired" versus
"visually disabled", as submitted by the Governor's Council on
Disabilities and Special Education, but she said that she would
check on behalf of the committee for clarity.
VICE CHAIR SEATON stated his intent to have HB 357 before the
committee again, with the suggested re-writes, on Thursday
[January 26, 2006].
HB 271-LIMIT OVERTIME FOR REGISTERED NURSES
4:01:18 PM
VICE CHAIR SEATON announced that the next order of business
would be HOUSE BILL NO. 271 "An Act relating to limitations on
overtime for registered nurses in health care facilities; and
providing for an effective date."
CHAIR WILSON, speaking as the prime sponsor of HB 271,
paraphrased from the following sponsor statement [original
punctuation provided]:
This bill will prohibit an employer from assigning
mandatory overtime and from threatening or retaliating
against a nurse who refuses overtime. It will also
give the nurse the latitude to make the judgment call
about whether they are safe to practice (work
overtime) or not. The bill assigns the administration
of implementation and enforcement to the Commissioner
of Department of Labor.
Mandatory overtime hours are those hours above an
agreed upon, predetermined, regularly scheduled shift,
which the employer makes compulsory (as opposed to
voluntary). The threat of reprisals includes but is
not limited to discharge, discipline, demotion or
assignment to unattractive tasks or work shifts or in
some cases licensure removal, retaliatory reporting,
and charges of "patient abandonment."
Mandatory overtime contributes to poor quality patient
care because fatigue and loss of concentration, which
results from excessive overtime, increases the
likelihood of errors. According to a study by the
National Institute for Occupational Safety and Health
(NIOSH), when staff plans to work additional shifts on
a volunteer basis, they are more likely to be prepared
and get plenty of rest immediately prior to working
the extended shift. However, when an employer
mandates overtime, this occurs with little or no prior
notice. The result is high levels of fatigue and thus
increased errors.
For nurses, these errors or mistakes may cause life-
threatening situations for both the patient and the
nurse. These situations run the gamut from back
injuries for the nurse to patient medication errors to
even death. The evidence is very strong that
prolonged work hours and fatigue affect worker
performance.
Emergency situations and Critical Access Hospitals are
exempt from this bill.
4:05:33 PM
REPRESENTATIVE GATTO asked whether this bill would make it
illegal to allow a nurse to work overtime even if the nurse is
willing and able.
CHAIR WILSON explained that this bill protects nurses from being
required to work overtime when they know that they are too tired
to continue but fear possible employer retribution. In answer
to further questions, she stated that being able to hire an
adequate nurse work force will continue to become more difficult
with the expected nursing shortage, which is expected to impact
state and private facilities. To further questions, she
answered that this bill would not penalize or prohibit a nurse
from working planned, consensual overtime.
VICE CHAIR SEATON expressed concern for a facility's ability to
function because, if it is unable to retain an adequate nursing
staff, available personnel may be required to work overtime.
4:12:29 PM
ROD BETIT, President/CEO, Alaska State Hospital and Nursing Home
Association (ASHNHA), presented a written statement opposing HB
271. He directed attention to page 1, which lists the hospitals
and nursing homes that would be effected by the adoption of HB
271, and expressed his membership's regret in not being able to
support this bill. Despite his work with the sponsor during the
interim, the bill is still considered inadequate by his
constituency, he related. He said that mandatory overtime is
not an issue at non-state facilities, but is an issue at state-
run facilities.
MR. BETIT stated that the nursing situation in Alaska has
improved with the various statewide programs that are available
to train and support nursing staff. Due to these programs
position vacancies are minimized, which has reduced the need to
locate/hire temporary nursing staff; a heretofore common and
expensive practice. He related that his research has indicated
the most frequent complaints of mandatory overtime abuse stem
from the Alaska Psychiatric Institute (API). Such complaints
may be occurring at API because of the following: 1.
Inadequate number of filled nursing positions to provide patient
care due to hiring difficulties caused by non-competitive
salaries and the stress of the job leading to higher turnover
than in general acute care facilities. 2. An overall
expectation for API to take all patients who need
hospitalization regardless of available staff, given that API is
the sole provider of certain specialty nursing needs. 3.
Inadequate provisions, in state employee contracts, to allow API
to request a market survey to validate salary disparities with
the private health care market, and permission to increase
salaries to be competitive throughout the year without
legislative review. 4. Inadequate funding in API's operating
budget to actually pay higher salaries and hire staff as soon as
it deems there to be a problem developing without budget
authority from the legislature, which generally cannot come in
time to head off a serious problem.
MR. BETIT stated that HB 271 would provide punishment for
excessive use of mandatory overtime without putting measures in
place to break the cycle of overtime use in state facilities.
In addition, he opined, the bill creates a burden in regard to
reporting and monitoring overtime, which ASHNHA does not
support, given the lack of evidence of any problem with use of
mandatory nurse overtime in non-state facilities.
MR. BETIT suggested 5 alternative solutions to curb mandatory
overtime issues at state facilities, paraphrasing from his
prepared statement [original punctuation provided]:
1. Immediately authorize managers to offer higher
salary levels, as validated by market surveys, so that
they can hire additional nurses sooner contemporary
with market conditions.
2. Consider providing API funding for an ongoing
nurse preceptor program that will help newly hired
nurses gain advanced skills to provide care in an
inpatient psychiatric setting. With competitive pay,
mentorship, preceptor training and periodic respite
from intense nursing demands in an inpatient
psychiatric setting, API will have more success
attracting and keeping the nursing staff they need.
3. Help API create a pool of temporary nurses that
can be hired during staffing crises to fill gaps, in
the specialized area of psychiatric care.
4. Consider establishing a separate bargaining unit
for essential health care related staff separate from
other employees to allow special procedures to be
developed that will address these problems in the
future. Ongoing market surveys of nursing salaries
should be a routine part of this program.
5. Create a work group to find other solutions to
this problem.
MR. BETIT concluded his prepared statement reading:
We think the solutions outlined above have merit, but
more importantly recommend a work group be convened to
support the sponsor's efforts to figure out how to
place state facilities on a more solid footing so they
do not have to resort to excessive mandatory overtime
for lack of other options.
4:21:53 PM
VICE CHAIR SEATON asked how a pool of specialty nurses is
generated.
MR. BETIT suggested various means to accomplish this goal:
retired nurses in a given community could be retained for these
specialty purposes; alert nursing organizations, that provide
temporary staffing, to specific needs in a given area; and
provide a financial incentive to encourage prospects. In answer
to another question, he clarified that, when speaking of the
need for a separate union bargaining unit, it is the state
operated facilities that are critical. He suggested that
problems arise in unions supporting nurses when they are made
part of a larger bargaining group outside of the profession.
However, he opined, that there are enough allied health care
professionals impacted to warrant creating a separate bargaining
entity for their benefit. In answering whether the legislature
would have to create such a unit or if it would be handled by
the union structure, he responded that he did not know. He
reiterated that mandatory overtime is not an issue in non-state
facilities.
4:26:43 PM
RUSSELL GRANGE, Chief Human Resources Officer, Providence Health
System Alaska ("Providence"), said he is unable to support HB
271. He emphasized that minimizing mandatory overtime relates
directly to employee satisfaction. He expressed concern with
the bill, in that it may cause an adverse impact if the 900
nurses, of Providence, decide their own overtime; unit managers
are paid to make overtime judgment calls and it is important
that they retain that authority/capacity. He also expressed
concern that ambiguity in the language of HB 271 may create
administrative problems in interpreting certain overtime-
allowable situations, resulting in penalties being impugned on
the facility.
4:34:07 PM
SHARA SUTHERLIN, Chief Nurse Executive, Providence Alaska
Medical Center, announced her opposition to HB 271 and stated
support for a task force or special entity to be initiated, as
proposed by Mr. Betit's statement [suggestion 4]. She opined
that a separate bargaining unit could bring focus where needed.
Moreover, she opined, a statewide resource-nursing group could
be helpful. Referencing the suggestions proposed in Mr. Betit's
statement, she underlined the need to: utilize market analysis;
expand preceptor programs statewide; and assist facilities in
establishing intern/extern and fellowship programs, as currently
implemented at Providence. She added that, in terms of
recruitment and retention the focus should be on the issues at
large: keeping patients safe; understanding the impact of the
Institute of Medicine (IOM) reports and Institute of Health Care
Improvement (IHI) initiatives; and support for night shifts and
critical response workers by instituting IHI's "Best Practice"
model for a rapid response team. She opined that by
implementing these suggestions, and through statewide
coordination, overtime issues might be minimized. She pointed
out that, under her management, volunteers for overtime are
primarily utilized and "on-call specialty teams" are carefully
rotated/managed for optimal reduction of overtime hours.
Responding to how much overtime is used at Providence, Ms.
Sutherlin stated that, given the nebulous definition of
mandatory overtime, providing for the rotation of on-call teams,
and considering the staff that request overtime, she would
estimate less than 1 to 2 percent [of hours worked represent
overtime].
4:39:42 PM
VICE CHAIR SEATON inquired as to the impact on the recruitment
process, at Providence, if overtime is required.
MR. GRANGE opined that an excess of amount of mandatory overtime
would have a significant impact on hiring practices. He pointed
out that many of Providence's employees are hired via employee
referral, which reflects Providence's reputation as a good place
to work, with a high level of employee satisfaction. Upon
committee request, he agreed to provide mandatory overtime hours
to the committee, and reiterated the difficulty in defining
mandatory versus volunteer overtime for purposes of HB 271.
4:42:48 PM
MILA COSGROVE, Director, Division of Personnel, Department of
Administration (DOA), stated her intention to report on what
actions the state has been taking to proactively address the
recruitment and retention issues in the area of professional
nursing. She pointed out that difficulties in meeting nursing
needs are a nationwide concern and projections indicate that
this trend will continue. In response to a question, she
clarified that her statements today will be focused on state-run
facilities.
MS. COSGROVE explained that DOA has reviewed state statutes and
regulations that apply to the state's ability to compensate
employees. She projected that in the next fiscal year the new
policy and administrative guidelines, with regard to
compensation, will be in place. In addition, various strategies
have been undertaken in conjunction with the Department of
Health and Social Services (DHSS), and the Department of
Corrections. She stated that DOA now has a position dedicated
to professional recruitment, which includes entrance and exit
surveys and workplace environment modifications to boost
retention. The department is also reviewing how hiring managers
present the state benefits package, as it differs from private
sector benefits. She reported that, in partnership with the
other departments, an on-call pool of nurses is being developed
to address shortages and specialty nursing needs as well as a
retention strategy that assists employees with transfers between
state facilities.
4:48:35 PM
REPRESENTATIVE GARDNER asked Ms. Cosgrove to describe how she
expects the new retirement system to effect the
recruitment/retention issue.
MS. COSGROVE responded that the proof will ultimately be in the
numbers. However, she opined, that it would be prudent to
consider a portable retirement plan, noting, "All workplace
trends indicate that employees are not so much loyal to
employers as they are to their careers." She stated that being
able to provide a portable retirement package may provide a
broader range of recruits, although the impacts to retention
remain to be seen.
JANET CLARKE, Assistant Commissioner, Finance and Management
Services, Department of Health & Social Services (DHSS), said
that DHSS has been working on dealing with the symptoms in the
system that are causing mandatory overtime. She admitted that
hiring and retention is a problem, with vacancy figures ranging
from 15-20 percent in state-run facilities. She expressed
concern that, despite various strategies, mandatory overtime is
still utilized and negative repercussions will occur if HB 271
is adopted as drafted. Because the state facilities are not
allowed to refuse patients, she questioned whether a wing at the
Alaska Psychiatric Institute (API) would need to be closed to
avoid incurring penalties. She stated that the governor has
included a one-range salary increase for direct care nurses in
the Fiscal Year (FY) 2007 budget. This is in anticipation of
providing a market base pay scale, which may help to ease the
recruitment/retention situation. Due to the fact that there is
only one API, the consequences of passing HB 271 may have
significant negative impacts, she said, reiterating her
reservations. She opined that costs may need to be increased at
state facilities. She then highlighted fiscal notes provided in
the committee packet to illustrate her concerns.
VICE CHAIR SEATON said that since the state system could be in
violation as the primary user of mandatory overtime, it would be
important to know how the commissioners of the Department of
Labor & Workforce Development (DLWD), and DHSS would be expected
to handle possible penalties if incurred. He questioned whether
the departments would be subject to mutual lawsuit; his
attention was called to the legal opinion in the bill packet.
4:54:33 PM
MICHELLE MURPHY, Registered Nurse (RN), Providence RN's Union
Health and Safety Officer, Providence Alaska Medical Center,
stated her support for HB 271. She related her understanding
that the nursing shortage will continue to increase, along with
the need for more nurses, given the population and health care
demands. She said the International Council of Nurses (ICN)
defines mandatory overtime as "obligatory, compulsory, or
imposed by the employer leaving no choice to the employee."
With the shortage of nurses growing, mandatory overtime is
reportedly being used for staff management on a routine basis
versus emergency situations, as it once was. This, she opined,
is of major concern given the care that nurses are required to
provide. Overtime becomes a dangerous situation, she
maintained, when a nurse is required to calculate drug dosages
or make other critical decisions with diminished abilities due
to overtiredness. To illustrate her point, she related personal
accounts of working long shifts which highlighted the physical
and mental toll involved in working overtime. She stated that
the use of mandatory overtime is detrimental to nurses,
dangerous to patients, and does not promote employee
recruitment/retention. In response to a question, she stated
that Providence does not utilize mandatory overtime, because the
union contract provides for regular rest times.
VICE CHAIR SEATON stated that he would like to further
understand the ramifications of voluntary overtime versus
mandatory overtime and asked why the state should put into law
an item that is a negotiating point between a nurses union and a
facility.
MS. MURPHY pointed out that not all nursing facilities have the
benefit of a union and the nursing staff need protection against
mandatory overtime.
5:03:36 PM
KATHLEEN GETTYS, RN, Progressive Care Unit, Providence Alaska
Medical Center; President, Providence RN's Bargaining Unit;
Representative, Alaska Nurses Association (ANA), opined that
there is great concern regarding mandatory overtime in the
nursing profession, which has resulted in strikes across the
nation. She reported that by strictly regulating the hours of
overtime, the quality of health care is increased and the number
of medical errors is reduced. When nurses work 12 or more hours
statistics show that errors increase. She pointed out that,
unlike other industries for which public safety is a concern,
health care is exempt from [federal] regulation limiting the use
of mandatory overtime as a staffing tool. Standards have been
established to limit the number of hours that pilots, flight
attendants, truck drivers, and railroad engineers can safely
work before consumer safety is considered endangered. However,
she said, no similar limitations exist for our nation's nurses
who are caring for patients. Nurses' professional obligations
are undermined when they are forced to work mandatory overtime,
and outside of collective bargaining, nurses have few avenues to
challenge required overtime, she maintained. She called for the
legislature to be responsive to its constituents, the nurses and
patients, concerning the unethical use of mandatory overtime,
and to set new state limits on the ability of health care
facilities to impose overtime. She added that there is an
available pool of 500,000 trained nurses, across the nation, who
have left the profession in direct correlation with their
working environment.
5:08:34 PM
STACY ALLEN, RN, Business Agent, Laborers Local 341, stated her
support for HB 271, and disputed Mr. Betit's assertion that
private institutions do not use mandatory overtime. She
explained how she has watched this situation evolve over her
tenure as a registered nurse. She said that this bill generates
an incentive for creativity in the industry to solve this issue,
and provides needed protection for patients and nurses. In
answer to a question she stated that, for Laborers Local 341,
mandatory overtime has not been a negotiating point, although
they are ready to address it should it become necessary.
5:14:24 PM
DIANNE O'CONNELL, Executive Director and Labor Director, Alaska
Nurses Association, stated that the exceptions, listed in
section (b), beginning on line 13, page 2, of the CSHB 271,
Version Y, do not address staffing shortages due to sick leave
and vacation coverage. She testified that, for API, these are
the pitfall areas. Although API is working to develop a plan to
address these situations, including creating a float pool, there
is not one currently in place. She reiterated the suggestions
that Mr. Betit made in his statement. Additionally, she pointed
out that prescheduled on-call time, in which a nurse volunteers
to work overtime, is not covered. This brings up the question
as to whether to allow a nurse to work beyond his/her scheduled
shift; certainly a pilot could not volunteer for additional
flights, and should "we stand in their way" if a nurse is
volunteering for an additional shift, she asked. She responded
that the 36-hour on-call rotation is not addressed in the bill
either, but said that she did not have the appropriate
experience to comment or make a suggestion. In emergencies, she
maintained, the bill does not say that overtime cannot be used,
although it specifies that a penalty will be incurred if used.
She opined that HB 271 will provide managers a disincentive to
use overtime, and compel them to seek better solutions to meet
the needs. She pointed out that allowances in the bill ensure
that patients will not be left without care. She echoed earlier
testimony that not all nurses are represented by a collective
bargaining agreement and HB 271 is needed to provide a
foundation for a public policy requiring safety for patients and
nurses and to create better working conditions. In response to
questions, she stated that Providence Medical Center does have
what is termed "mandatory call" and it is used in certain units,
but will not be expanded to other areas of the hospital.
5:22:29 PM
MIKE ALEXANDER, RN, Alaska Psychiatric Institute, stated his
support for HB 271. He related his current situation of working
mandatory overtime during the holiday season. He also stated
that the pay rate is "behind," employees are exhausted, nine
staff positions are unfilled, and any time off is nebulous. He
added that API lowered the acuity ratings of patients in order
to require fewer attending staff per patient, although the
patient needs haven't changed. Therefore, unsafe conditions
have resulted, he suggested. He opined that job loss is being
experienced as well as patient abandonment. In response to a
question, he said that the clerks union covers the nurses at
API. However, the [union agents] "don't really operate in our
realm," he stated, and for them to understand any situation
outside of a standard eight-hour day is difficult. Neither does
there seem to be a possibility for the API nursing group to move
to a different bargaining unit, in which nurses would be
representing nurses. Despite efforts to create an understanding
of the nurses needs, he said that the union representation has
become unresponsive and somewhat hostile.
5:30:14 PM
CATHY FEASTER, Supervising Nurse Practitioner, Division of
Community Health Services, Department of Health and Human
Services, stated support for HB 271, but expressed reservations
regarding its possible consequences to the Sexual Assault
Response Team (SART). She described how this team is assembled
and scheduled to provide around the clock availability, and she
offered to work with the bill sponsor to ensure there aren't
repercussions on SART. In response to questions, she explained
that many of the SART members have full-time jobs, but make a
commitment to be on-call for a specified time. The concern is
that the language of HB 271 may adversely effect availability,
she explained, of SART nurses who are called out after just
having completed a full shift at their regular facility.
5:34:41 PM
CHAIR WILSON assigned a subcommittee to work on HB 271,
comprised of the following members: Representatives Wilson,
Gardner, Seaton, and invited other committee members to join
them. She established February 16, 2006, as a deadline for the
subcommittee to have the bill back before the committee.
5:39:25 PM
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 5:39:39 PM.