Legislature(2009 - 2010)CAPITOL 106

03/12/2009 03:00 PM HEALTH & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 50 LIMIT OVERTIME FOR REGISTERED NURSES TELECONFERENCED
Heard & Held
+= HB 2 BIRTH CERTIFICATE FOR STILLBIRTH TELECONFERENCED
Moved CSHB 2(HSS) Out of Committee
HB 50-LIMIT OVERTIME FOR REGISTERED NURSES                                                                                    
                                                                                                                                
3:09:52 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER announced that the  final order of business would                                                               
be  HOUSE  BILL  NO.  50,  "An Act  relating  to  limitations  on                                                               
mandatory overtime  for registered nurses and  licensed practical                                                               
nurses in health care facilities;  and providing for an effective                                                               
date."                                                                                                                          
                                                                                                                                
3:10:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PEGGY WILSON,  Alaska State Legislature, explained                                                               
that  HB   50  would  prevent  Alaska   Registered  and  Licensed                                                               
Practical  Nurses  from  being  forced to  work  overtime.    She                                                               
defined  overtime  as "work  beyond  an  agreed to  predetermined                                                               
regularly scheduled  shift."  She  offered her opinion  that this                                                               
would  protect patients  from the  dangers  caused by  overworked                                                               
nurses.   She  warned that  a  standard staffing  tool for  "most                                                               
hospitals  in  the state"  was  the  use of  forced,  involuntary                                                               
overtime and required "on-time" call,  as this was less expensive                                                               
than hiring more  full time nurses.  She stated  that HB 50 would                                                               
not allow a nurse  to be coerced to work beyond  a 14 hour shift,                                                               
work beyond 80 hours in a  14 day period, or accept overtime that                                                               
would jeopardize patient or employee  safety.  She also explained                                                               
that a  nurse must be  allowed at  least 10 consecutive  hours of                                                               
off-duty  time  immediately following  a  scheduled  shift.   She                                                               
detailed  the  exceptions  to include  an  "unforeseen  emergency                                                               
situation,"  overtime on  a medical  transport  aircraft, and  an                                                               
occasional special event for a school.                                                                                          
                                                                                                                                
3:14:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   WILSON  suggested   the  three   most  important                                                               
questions  to   be:  are  nurses  working   overtime  immediately                                                               
following a 12 hour work period;  are nurses working more than 14                                                               
consecutive  hours;   and,  do   nurses  go  to   on-call  status                                                               
immediately following  a regular shift.   She opined  that nurses                                                               
were working more hours with less help.                                                                                         
                                                                                                                                
3:17:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WILSON reported  that  nurses  felt subjected  to                                                               
mandatory on-call  duties and forced  overtime, and  she declared                                                               
that  nurses had  an ever  present  fear of  retaliation if  they                                                               
reported  complaints.   She noted  an  Alaska Nurses  Association                                                               
survey which  mentioned that over  80 percent of  nurses reported                                                               
to be  forced to work  overtime, and  all of the  nurses surveyed                                                               
reported  that mandatory  on-call  was required.   She  predicted                                                               
that  this led  to burn-out  and contributed  to the  shortage of                                                               
nurses.                                                                                                                         
                                                                                                                                
3:19:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WILSON  noted  that other  professions  had  work                                                               
schedule limitations  imposed by  the legislature.   She affirmed                                                               
that 15  states had  enacted similar  legislation.   She reported                                                               
that nurses  were three times more  likely to make an  error when                                                               
shifts lasted more than 12.5 hours.                                                                                             
                                                                                                                                
3:22:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LYNN noted that he  had a conflict of interest, as                                                               
two of his daughters were registered nurses.                                                                                    
                                                                                                                                
3:22:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked  for an explanation of  page 3, lines                                                               
9 & 10, Section 2 (4).                                                                                                          
                                                                                                                                
REPRESENTATIVE WILSON  explained that  a nurse  would agree  to a                                                               
schedule before it was published.                                                                                               
                                                                                                                                
3:23:43 PM                                                                                                                    
                                                                                                                                
REBECCA  ROONEY, Staff  to  Representative  Peggy Wilson,  Alaska                                                               
State  Legislature,  said that  the  nurses  would testify  about                                                               
this.                                                                                                                           
                                                                                                                                
3:24:05 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON referred  to  a letter  from  the Alaska  Native                                                               
Health  Board,  dated  March  6, 2009.    [Included  in  members'                                                               
packets.]  He  noted that ANHB expressed  "deep reservations over                                                               
HB  50" and  he  asked  Representative Wilson  to  remark on  two                                                               
points regarding  the reasons that  similar legislation  had been                                                               
adopted in 15 states: (1) out  of concern that hospitals might be                                                               
under-hiring; and (2) that mandatory  overtime rules were used as                                                               
a collective  bargaining tactic.   He  asked if  the under-hiring                                                               
and collective bargaining tactics were issues in Alaska.                                                                        
                                                                                                                                
3:26:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WILSON replied  that  she did  not  know if  some                                                               
hospitals were under-hired.   She opined that an  increase to the                                                               
shortage of  nurses would  lead to an  under-hired dilemma.   She                                                               
offered  her belief  that nurses  would be  attracted to  a state                                                               
with safeguards  in place, and  would help alleviate  the nursing                                                               
shortage.                                                                                                                       
                                                                                                                                
3:26:49 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER  asked if there  was data to support  that nurses                                                               
migrated to states with safeguards.                                                                                             
                                                                                                                                
3:27:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WILSON replied that there was not yet any data.                                                                  
                                                                                                                                
3:27:25 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  KELLER  referred to  the  Alaska  Native Tribal  Health                                                               
Consortium  (ANTHC)   position  paper,   dated  March   9,  2009.                                                               
[Included in  members' packets.]  He  asked Representative Wilson                                                               
to comment on  the first paragraph on page 2,  "The bill provides                                                               
no new resources and no new options."                                                                                           
                                                                                                                                
3:28:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WILSON  replied  that   she  disagreed  with  the                                                               
statement.  She  explained that there were new options,  as HB 50                                                               
would  protect  nurses  from  retaliation  for  refusal  to  work                                                               
overtime.                                                                                                                       
                                                                                                                                
3:30:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  asked about the  suitability of HB  50 for                                                               
rural Alaska.                                                                                                                   
                                                                                                                                
3:31:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WILSON said  that,  even though  most states  had                                                               
limited the work day to 12 hours,  HB 50 would limit the work day                                                               
to 14 hours.                                                                                                                    
                                                                                                                                
3:32:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA referred  to the  list of  exceptions, and                                                               
asked if these were designed for rural Alaska.                                                                                  
                                                                                                                                
3:33:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WILSON,  in  response to  Representative  Cissna,                                                               
noted  that the  exceptions were  not for  a specific  group, but                                                               
were intended to maintain safety for everyone.                                                                                  
                                                                                                                                
3:34:47 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER opened public testimony.                                                                                        
                                                                                                                                
3:35:06 PM                                                                                                                    
                                                                                                                                
DR.  PATRICK NOLAN,  Providence Hospital,  commented that  nurses                                                               
worked  long hard  hours.   He accepted  the correlation  between                                                               
fatigue and errors,  and noted that this was a  safety issue.  He                                                               
offered his  belief that a  predictive schedule was  important to                                                               
attracting nurses.  He noted that  he had submitted a letter with                                                               
comments on HB 50, in which  he quoted the National Institute for                                                               
Occupational Safety  and Health  comments about high  error rates                                                               
with  overtime work.   [Included  in the  members' packets.]   He                                                               
opined that  HB 50 would be  conducive to nurses working  in high                                                               
stress situations.                                                                                                              
                                                                                                                                
3:39:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  BERTA GARDENER,  Alaska  State Legislature,  said                                                               
that prior testimony  had convinced her that  hospitals used this                                                               
as a  cost control tool.   She stressed the  need for a  limit on                                                               
mandatory overtime  and mandatory  call.   She agreed  that rural                                                               
Alaska had special needs.                                                                                                       
                                                                                                                                
3:41:18 PM                                                                                                                    
                                                                                                                                
EVANGELYN DOTOMAIN,  President & CEO, Alaska  Native Health Board                                                               
(ANHB),  said  that  Alaska Native  Health  Board  employed  7000                                                               
people and  served more than  130,000 patients.  She  praised the                                                               
Tribal  health  providers and  nurses,  and  their dedication  to                                                               
provide high-quality  care.   She expressed  concerns that  HB 50                                                               
would  hurt patient  care in  rural Alaska.   She  explained that                                                               
should a nurse  decide that they don't want to  work overtime, it                                                               
could often  mean that the  shift was  not covered.   She pointed                                                               
out that  rural health providers  did not have the  same resource                                                               
as  urban providers  to call  in other  off-duty nurses,  to call                                                               
temporary "agency"  nurses on short  notice, or to  send patients                                                               
to other  facilities.  She surmised  that this could be  a reason                                                               
that  no  rural  states  had   adopted  this  legislation.    She                                                               
expressed  concern  for  the  increased  cost  to  Tribal  health                                                               
providers if they were forced  to over hire regular shift nurses,                                                               
fly in temporary nurses at  the last minute, or transfer patients                                                               
to an urban provider.  She opined  that HB 50 had been adopted by                                                               
states  concerned that  urban  hospitals  under-hired and  abused                                                               
mandatory overtime  as a control  for payroll and  benefit costs,                                                               
or  as a  collective bargaining  tactic.   She acknowledged  that                                                               
there were  chronic challenges  for nurse  staffing in  a remote,                                                               
rural location,  but she denied  that this  was a tactic  used by                                                               
Tribal health providers.  She  observed that nursing was a "tough                                                               
profession,"  but that  the challenges  came with  the healthcare                                                               
territory,  and   she  added  that   physicians,  administrators,                                                               
technicians, and  clerks also adjusted  their scheduling  to meet                                                               
the  needs of  the patients.   She  suggested that  the mandatory                                                               
overtime  issues could  be  addressed  in employment  agreements.                                                               
[Letters to committee included in members' packets.]                                                                            
                                                                                                                                
3:46:46 PM                                                                                                                    
                                                                                                                                
DEBBIE THOMPSON,  Executive Director, Alaska  Nurses Association,                                                               
stated that  she was  a professional  registered nurse,  and that                                                               
she had worked  as an operating room nurse.   She emphasized that                                                               
nurses  would   not  leave  patients   without  coverage   in  an                                                               
emergency.    She reported  that  her  extensive interviews  with                                                               
nurses throughout  Alaska indicated that 100  percent agreed that                                                               
mandatory overtime was  a problem which affected  the decision to                                                               
work  in acute  care.   She relayed  that hospital  personnel had                                                               
suggested addressing  this in  employment agreements,  yet nurses                                                               
had been  told that this was  not a negotiable issue.   She asked                                                               
if patient  safety was any  less of a  concern in rural  or urban                                                               
environments.   She referred to  SB 139, which  offered financial                                                               
incentives for recruitment in hard  to fill health care jobs, and                                                               
she suggested  that these  could be used  for staffing  the rural                                                               
areas.   She  explained that  it was  necessary "to  have a  good                                                               
patient  -  nurse  ratio  in  order to  have  a  quality  patient                                                               
outcome."                                                                                                                       
                                                                                                                                
3:52:37 PM                                                                                                                    
                                                                                                                                
MARIE  ORIA  said that  she  worked  in a  residential  treatment                                                               
center without  acute medical concerns.   She said that  she does                                                               
not have  mandatory overtime,  and that she  has not  been called                                                               
during her off time to do  mandatory overtime.  She observed that                                                               
the current economic situation  was financially overwhelming, and                                                               
that HB 50 would limit her work time opportunities.                                                                             
                                                                                                                                
3:58:21 PM                                                                                                                    
                                                                                                                                
STACY ALLEN, Laborers' Local 341, said that she was required to                                                                 
accept mandatory on-call on the weekends.  She acknowledged that                                                                
although she could choose her on-call time, this meant that she                                                                 
would be responsible to work 16 hour shifts.  She shared that                                                                   
other nurses had mentioned that mandatory on call was a reason                                                                  
to "look around for something else to do because it was too                                                                     
exhausting."  She opined that most hospitals did not choose to                                                                  
use mandatory overtime as a management tool, but that it was "a                                                                 
relatively easy thing to do."  She confirmed the difficulty for                                                                 
refusal to work overtime knowing that a patient may be                                                                          
abandoned.  She expressed the support of Laborers' Local 341 for                                                                
HB 50.                                                                                                                          
                                                                                                                                
4:02:32 PM                                                                                                                    
                                                                                                                                
CHRISTIE  ARTUSO, Director  of  Neurosciences, Providence  Alaska                                                               
Medical Center, said  that she was also a national  member on the                                                               
Board  of  Directors for  the  Certification  Corporation of  the                                                               
American  Association   of  Critical   Care  Nurses,   which  she                                                               
described as the largest  national specialty nursing association,                                                               
representing over  500,000 registered nurses working  in critical                                                               
care and acute  care settings.  She stated  that the organization                                                               
had  been  actively  studying  the  components  of  healthy  work                                                               
environments.   She  shared that  one component  was the  nurse's                                                               
ability  to participate  in the  decision making  about the  work                                                               
environment,  which   included  the  types  of   shifts  and  the                                                               
flexibility of the  work hours.  She asked  that consideration be                                                               
given for a nurse's ability to  choose the work environment.  She                                                               
summarized that  HB 50 would  negatively impact patient  care and                                                               
nurses' satisfaction, as it would remove the choices.                                                                           
                                                                                                                                
4:07:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LYNN  asked  if  all registered  nurses  had  the                                                               
health, stamina, and personality to work the long hours.                                                                        
                                                                                                                                
4:08:09 PM                                                                                                                    
                                                                                                                                
MS. ARTUSO  replied that  nurses had  the right  to choose.   She                                                               
noted  the ineffectiveness  of this  legislation as  nurses could                                                               
still work at two different  institutions, in order to meet their                                                               
personal needs.                                                                                                                 
                                                                                                                                
4:09:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LYNN asked if  the hospital administration brought                                                               
undue pressure on nurses to work.                                                                                               
                                                                                                                                
4:09:37 PM                                                                                                                    
                                                                                                                                
MS.  ARTUSO said  that she  had always  been permitted  to leave,                                                               
even in hospital  settings with mandatory overtime.   She allowed                                                               
that she  had heard stories, but  had never seen it  happen.  She                                                               
opined that it was not  happening in the overwhelming majority of                                                               
cases.                                                                                                                          
                                                                                                                                
4:10:34 PM                                                                                                                    
                                                                                                                                
MARY STACKHOUSE,  Alaska Nurses  Association, commented  that the                                                               
work  environment was  "running  people away  from the  bedside."                                                               
She expressed  that nurses' had  autonomy and  responsibility for                                                               
their work performance.   She offered her  opinion that mandatory                                                               
overtime  undermines  these  obligations.   She  asked  that  the                                                               
legislature  protect  the  nurses' professional  judgment.    She                                                               
emphasized  that   mandatory  overtime   eliminated  professional                                                               
judgment  and  autonomy,  yet   it  still  required  professional                                                               
accountability.   She  read  from a  resolution  by the  National                                                               
Council of State Boards of  Nursing: "recognizes the professional                                                               
responsibility   of  nurses   to  accept   or  decline   overtime                                                               
assignments based on their self  assessment of ability to provide                                                               
safe care."   She  shared that mandatory  overtime was  used when                                                               
patient assignments were heavy and staffing was a problem.                                                                      
                                                                                                                                
4:14:51 PM                                                                                                                    
                                                                                                                                
CAROL  CLAUSSON  said that  she  was  a  registered nurse.    She                                                               
pointed out  that it was very  hard work, and that  she was tired                                                               
at the end of  her 12 hour shift.  She noted that  she was not as                                                               
mentally sharp  when she  was tired.   She opined  that mandatory                                                               
overtime would  worsen the nursing  shortage.  She said  that she                                                               
supported HB 50.                                                                                                                
                                                                                                                                
4:16:19 PM                                                                                                                    
                                                                                                                                
CINDY ALKIRE, Assistant Chief  Nurse Executive, Providence Alaska                                                               
Medical Center,  said that Providence  Alaska Medical  Center did                                                               
not use  mandatory overtime, and  instead, allowed nurses  to bid                                                               
on overtime  if they  desired.  She  considered that  the on-call                                                               
part   of   the   legislation   was  vague   and   would   create                                                               
misinterpretations.   She explained that the  medical center only                                                               
had  three  specialized  areas   which  utilized  "on-call,"  the                                                               
availability  to come  to work  and care  for patients  within 30                                                               
minutes.  She  spoke specifically about the  Operating Room (OR).                                                               
She explained that  there was always an OR team  at the hospital,                                                               
but in  the event of  a second emergency,  there would be  a need                                                               
for  a second  team.    She disclosed  that  the  need for  quick                                                               
response was the  reason for an "on-call" team.   She shared that                                                               
the agreement  to be  "on-call" for  the three  specialized areas                                                               
was  clearly stated  at hiring.   She  reported that  nurses were                                                               
allowed to schedule their "on-call"  time, but that this could be                                                               
affected  by the  interpretation  of  "on-call" in  HB  50.   She                                                               
explained that, should "on-call" be  interpreted to mean the same                                                               
as  "work," this  would limit  staff scheduling  of "on-call"  to                                                               
follow   time  actually   worked.     She   offered  that   union                                                               
negotiations were a better way to  deal with this issue.  [Letter                                                               
included in members' packets.]                                                                                                  
                                                                                                                                
4:22:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LYNN asked if she was  a nurse prior to becoming a                                                               
supervisor.                                                                                                                     
                                                                                                                                
MS. ALKIRE said that she was.                                                                                                   
                                                                                                                                
REPRESENTATIVE LYNN  asked if her  attitude had changed  when she                                                               
became a supervisor.                                                                                                            
                                                                                                                                
MS. ALKIRE  said that  her attitude  had not  changed.   She said                                                               
that she  became a nurse because  she cared about patients.   She                                                               
said that she did not want HB  50 to stop nurses when they wanted                                                               
to work.   She  agreed that  nurses had the  right to  leave when                                                               
they were tired.   She offered her concern that  HB 50 would take                                                               
away a nurse's choice and professional judgment.                                                                                
                                                                                                                                
REPRESENTATIVE  LYNN  asked if  she  would  have given  the  same                                                               
testimony as a new nurse.                                                                                                       
                                                                                                                                
MS. ALKIRE indicated that she worked  long shifts as a new nurse.                                                               
She said that she gave good care.                                                                                               
                                                                                                                                
4:25:08 PM                                                                                                                    
                                                                                                                                
MARILYN  EDWARDS,  Operating  Room Clinical  Manager,  Providence                                                               
Alaska Medical  Center, shared that she  had been a nurse  for 31                                                               
years.   She said  that her  immediate concerns  were for  a safe                                                               
work environment and safe quality  patient outcomes.  She offered                                                               
her opinion  that a "one  size solution" prescribed in  state law                                                               
to  resolve mandatory  nurse overtime  would  be devastating  for                                                               
patients  at  Providence  Medical   Center.    She  detailed  the                                                               
staffing schedule for the operating  room at Providence.  [Letter                                                               
included in members' packets.]                                                                                                  
                                                                                                                                
4:28:53 PM                                                                                                                    
                                                                                                                                
ROGER LEWERENZ,  RN, Providence Alaska Medical  Center, said that                                                               
he was  against the  "on-call" section  of HB  50.   He explained                                                               
that he worked  as a clinical educator in the  heart center, that                                                               
this  area   was  highly  specialized,   and  that   it  required                                                               
approximately  one year  to fully  train an  experienced critical                                                               
care nurse.   He  reported that  it was  necessary to  utilize an                                                               
"on-call" team  as not all  nurses had the  necessary specialized                                                               
training.   He allowed that  this produced a chronic  shortage of                                                               
staff.   He offered his  opinion that the "on-call"  schedule was                                                               
"not  that bad."   He  noted in  his submitted  written testimony                                                               
that the "restrictions that would  be imposed if this bill passes                                                               
would  negatively impact  our ability  to care  for this  patient                                                               
population due to the unavailability  of trained staff."  [Letter                                                               
included in members' packets.]                                                                                                  
                                                                                                                                
4:32:46 PM                                                                                                                    
                                                                                                                                
GENEVA   EDMISTON,   Associate  Administrator,   Denali   Center,                                                               
Fairbanks Memorial  Hospital, said  that she  opposed HB  50, but                                                               
that she appreciated  the intent of the bill to  focus on patient                                                               
safety and nursing satisfaction.   She expressed her disagreement                                                               
with  legislation  as  the  means  of  solution.    She  affirmed                                                               
awareness for the  need to attract and  retain registered nurses.                                                               
She said  that Fairbanks  Memorial Hospital  hired the  new nurse                                                               
graduates from  University of Alaska  Fairbanks (UAF)  in support                                                               
for  nursing services.   She  explained that  the hospital  would                                                               
spend the extra  money for travelling nurses  and temporary staff                                                               
to avoid the overtime issue.   She noted that only four hospitals                                                               
and nursing  homes in Alaska  reported using  mandatory overtime.                                                               
She agreed that  the legislation was a "one size  fits all" which                                                               
was  not   practical  for  Tribal  and   small  community  health                                                               
providers.     She   opined  that   it  would   have  "unintended                                                               
consequences."     She   concluded   that   this  was   "unneeded                                                               
legislation at this time."                                                                                                      
                                                                                                                                
4:37:47 PM                                                                                                                    
                                                                                                                                
BRENDA FRANZ,  Director of ICU and  Emergency, Fairbanks Memorial                                                               
Hospital, said  that Fairbanks Memorial  Hospital worked  hard to                                                               
promote  nursing and  that there  was  a culture  of patient  and                                                               
nurse  safety.   She stated  that  the hospital  did not  support                                                               
mandatory overtime, and that  each area scheduled collaboratively                                                               
with its nursing staff.                                                                                                         
                                                                                                                                
4:38:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON asked  if there  was a  safety issue  when                                                               
nurses were  required to  work longer than  a continuous  14 hour                                                               
shift.                                                                                                                          
                                                                                                                                
MS.  FRANZ  replied  that Fairbanks  Memorial  Hospital  did  not                                                               
support mandatory overtime, but that  they allowed the choice and                                                               
encouraged nurses to communicate their needs.                                                                                   
                                                                                                                                
4:39:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked to  clarify that  voluntary overtime                                                               
did not impinge safety.                                                                                                         
                                                                                                                                
MS.  FRANZ replied  that nurses  made the  decision for  overtime                                                               
work.                                                                                                                           
                                                                                                                                
4:39:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LYNN  asked if  the  refusal  for overtime  would                                                               
negatively impact a nursing career.                                                                                             
                                                                                                                                
MS.  FRANZ  said  that  there  was  not  any  retaliation.    She                                                               
expressed the priority for a safe, healthy working environment.                                                                 
                                                                                                                                
4:41:52 PM                                                                                                                    
                                                                                                                                
DONNA PHILLIPS,  RN, said  that she had  been a  registered nurse                                                               
for 30  years.  She expressed  her concern for the  patients, and                                                               
she  read  from  a  prepared   statement  [Included  in  members'                                                               
packets.]:                                                                                                                      
                                                                                                                                
     The Institute  of Medicine (IOM) report  has identified                                                                    
     how  long hours  and fatigue  contributes to  errors in                                                                    
     healthcare.   These errors can cost  lives, or increase                                                                    
     length of  stay in the  hospital which in turn  adds to                                                                    
     the already ballooning cost of healthcare.                                                                                 
                                                                                                                                
She urged support for HB 50.                                                                                                    
                                                                                                                                
4:43:58 PM                                                                                                                    
                                                                                                                                
JOHN BRINGHURST,  Administrator, Petersburg Medical  Center, said                                                               
that he had  been the administrator at  Petersburg Medical Center                                                               
for  eleven years.   He  called attention  to the  small hospital                                                               
perspective and  noted that the  nurses had requested  the switch                                                               
to 12 hour  work shifts.  He said that  Petersburg Medical Center                                                               
did not  have mandatory overtime  and that there was  no pressure                                                               
to work an additional shift.   He shared that there was mandatory                                                               
"on-call."  He  explained that the emergency room  was staffed by                                                               
the acute  care nurse.   If an incoming case  appeared difficult,                                                               
then  the  "on-call" nurse  was  summoned  to cover  the  nurses'                                                               
station.   He offered  his belief  that there  was not  any other                                                               
practical, economic way  to staff the emergency room.   He opined                                                               
that  Alaska  was being  responsible  in  its [medical]  facility                                                               
staffing without legislation, and  that regulations were stifling                                                               
the [hospital] industry.                                                                                                        
                                                                                                                                
REPRESENTATIVE  SEATON   asked  if  the  nurses   went  "on-call"                                                               
immediately following a 12 hour shift.                                                                                          
                                                                                                                                
MR.  BRINGHURST replied  that this  was a  decision made  by each                                                               
nurse, but that the practice was  to first ask the nurses who had                                                               
not worked that shift.                                                                                                          
                                                                                                                                
REPRESENTATIVE SEATON asked how often  a nurse worked more than a                                                               
continuous 14 hour shift.                                                                                                       
                                                                                                                                
4:49:17 PM                                                                                                                    
                                                                                                                                
MR. BRINGHURST replied that the nurses  had the option to sign up                                                               
for  an  "on-call" shift  which  immediately  followed a  regular                                                               
shift.                                                                                                                          
                                                                                                                                
4:49:41 PM                                                                                                                    
                                                                                                                                
WENDY CONRADI, RN, said that she  had been a registered nurse for                                                               
16 years.   She  said that  similar Washington  State legislation                                                               
had  had a  positive effect  on patient  care and  nurse's lives.                                                               
[Letter included in members' packets.]                                                                                          
                                                                                                                                
4:50:39 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 4:50 p.m. to 4:51 p.m.                                                                       
                                                                                                                                
4:51:35 PM                                                                                                                    
                                                                                                                                
ROD BETIT,  President &  CEO, Alaska  State Hospital  and Nursing                                                               
Home Association  (ASHNHA), said that he  represented 27 private,                                                               
tribal, state,  and federal  health facilities  and they  did not                                                               
support  HB  50.   He  said  that  ASHNHA  members had  a  strong                                                               
commitment  to  nursing, and  that  they  did not  use  mandatory                                                               
overtime  as  a strategy  to  fulfill  the  staffing needs.    He                                                               
reported that collective bargaining  and informal agreements were                                                               
used to  reach solutions to  staffing issues.  He  mentioned that                                                               
the  latest  survey  indicated  that  there  was  not  a  lot  of                                                               
mandatory overtime.  He reported  that ASHNHA members did not use                                                               
mandatory overtime as it was not  good for patients or staff.  He                                                               
cited  that  ASHNHA members  were  showing  a strong  responsible                                                               
commitment to patient care that was  good for the patient and the                                                               
nurse.                                                                                                                          
                                                                                                                                
4:55:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  COGHILL  asked  if  ASHNHA kept  track  of  nurse                                                               
turnover rates within specific hospitals.                                                                                       
                                                                                                                                
MR. BETIT, in  response to Representative Coghill,  said that the                                                               
vacancy rate was  an annual average, but that it  did not reflect                                                               
the total staff turnover in relation to the total staff.                                                                        
                                                                                                                                
REPRESENTATIVE  COGHILL opined  that  the turnover  rate and  the                                                               
formal grievances  filed might give  an indication of  the misuse                                                               
of work timelines.                                                                                                              
                                                                                                                                
MR. BETIT said that the Department  of Labor had not received any                                                               
of these grievances.                                                                                                            
                                                                                                                                
4:57:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  COGHILL   asked  how   many  lawsuits   had  been                                                               
proffered based on nurse malpractice, and on what basis.                                                                        
                                                                                                                                
MR. BETIT said that he would ask.                                                                                               
                                                                                                                                
4:57:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LYNN asked if mandatory overtime was minimal.                                                                    
                                                                                                                                
MR. BETIT said yes.                                                                                                             
                                                                                                                                
4:58:14 PM                                                                                                                    
                                                                                                                                
MR.  BETIT, in  response to  Representative Lynn,  said that  the                                                               
bill was attempting  to place, in statute, one  solution for work                                                               
scheduling that would not work for  every facility.  He said that                                                               
there  was  not a  problem  with  mandatory overtime  that  would                                                               
suggest the need for legislation.                                                                                               
                                                                                                                                
REPRESENTATIVE LYNN  concluded by stating  that it was  a problem                                                               
for some people, hence the legislation.                                                                                         
                                                                                                                                
4:58:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked about the mandatory "on-call."                                                                      
                                                                                                                                
MR.  BETIT  said  that  it  was   used,  and  that  it  was  used                                                               
differently  in different  situations.   He elaborated  that "on-                                                               
call" was  more often  being used  in specially  trained staffing                                                               
units that could not be staffed all of the time.                                                                                
                                                                                                                                
5:00:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  said  that  the legislation  was  to  not                                                               
schedule  for longer  than 14  consecutive  hours.   He asked  if                                                               
ASHNHA members agreed  that it was safe to work  longer than a 14                                                               
hour shift.                                                                                                                     
                                                                                                                                
MR. BETIT  said that  ASHNHA did  not perceive  this as  a safety                                                               
issue.                                                                                                                          
                                                                                                                                
5:01:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON referred to the list of mandatory "on-                                                                    
calls" each month,  and asked if that was reasonable,  even if it                                                               
occurred immediately after a regular shift.                                                                                     
                                                                                                                                
MR. BETIT,  in response to  Representative Seaton, noted  that an                                                               
"on-call" listing did not specify  whether the nurse had actually                                                               
worked.    He  added  that these  "on-calls"  were  scheduled  in                                                               
agreement with the nursing staff.                                                                                               
                                                                                                                                
5:02:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LYNN  compared nursing  to other  occupations with                                                               
hourly work  limitations for safety,  and asked why  nurses would                                                               
not have these same limitations.                                                                                                
                                                                                                                                
MR.  BETIT replied  that each  individual  occupation had  unique                                                               
reasons  for  this structure.    He  said  that nursing  was  one                                                               
important piece  of the health  care delivery system.   He agreed                                                               
that there  were limits to  what should  be asked of  nurses, and                                                               
that  ASHNHA  members respected  those  limits,  and allowed  the                                                               
nurses the choice.  He opined that HB 50 was attempting to:                                                                     
                                                                                                                                
     legislate  what an  individual  thinks their  abilities                                                                    
     are, and  where they want  to practice in  health care,                                                                    
     and whether  they want to  work in a  specialized unit,                                                                    
     knowing  full  well  it  takes  some  on-call  with  it                                                                    
     because of  the nature  of that  unit, or  whether they                                                                    
     want to stay in a  more generalized unit where they can                                                                    
     work an 8 or 10 or 12  hour shift.  So, the current law                                                                    
     gives us that flexibility,  the current law gives local                                                                    
     hospitals,  nursing   homes,  and  nursing   staff  the                                                                    
     flexibility to  work through that.   We just  don't see                                                                    
     any evidence that  we need to do  anything to legislate                                                                    
     something  to limit  that because  the  record is  very                                                                    
     good, I think, in terms of  what we have put before you                                                                    
     as  far  as  our  hospitals'  and  our  nursing  homes'                                                                    
     performance.                                                                                                               
                                                                                                                                
5:04:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  LYNN responded  by  concluding  that those  other                                                               
occupations with  hourly limitations also deemed  that they could                                                               
safely work more hours.                                                                                                         
                                                                                                                                
5:05:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HOLMES allowed that  she was attempting to balance                                                               
both  sides.   She asked  why  the mandatory  overtime issue  was                                                               
being advocated so strongly, if it was not a problem.                                                                           
                                                                                                                                
MR. BETIT agreed that ASHNHA  members were also confused by this,                                                               
and that they did not  understand the reasons behind the concern.                                                               
He  reported   that  ASHNHA  records  showed   no  problems  with                                                               
mandatory overtime.   He shared a desire to know  the reasons for                                                               
the concern,  as collective bargaining should  bring these issues                                                               
to the  table.  He  reiterated that  ASHNHA members had  stated a                                                               
commitment to not implement mandatory  overtime, and he asked how                                                               
that was being heard differently by nursing staff.                                                                              
                                                                                                                                
5:07:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SEATON  asked   if  ASHNHA   represented  Alaska                                                               
Psychiatric Institute (API).                                                                                                    
                                                                                                                                
MR. BETIT  said that  API was  a state  operated facility  and an                                                               
ASHNHA member,  so that  API did  report its data  on the  use of                                                               
mandatory overtime.  He did not  know if API had taken a position                                                               
on  HB  50.    He  offered  his  belief  that  API  had  received                                                               
additional  funding  for nursing  salaries,  and  that they  were                                                               
coordinating with private facilities for "on-call" staff.                                                                       
                                                                                                                                
5:08:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  referred to  prior testimony  which stated                                                               
that  API  was  unsafe.    He asked  if  those  testimonies  were                                                               
fabricated or truthful about the existing situation.                                                                            
                                                                                                                                
MR. BETIT offered  his personal belief, not that  of ASHNHA, that                                                               
the testimony was the truth.   He shared that API officials would                                                               
have stated that wages were very  low, which made it difficult to                                                               
hire enough qualified  staff.  He explained that API  had not had                                                               
the same  financial tools as  the private facilities to  fill the                                                               
staffing vacancies.   He offered  his belief that this  issue had                                                               
recently been addressed and resolved.                                                                                           
                                                                                                                                
5:10:41 PM                                                                                                                    
                                                                                                                                
LAUREE  MORTON said  that she  was representing  herself and  her                                                               
parents.   She allowed that she  did not have any  major hospital                                                               
horror  stories, but  that many  small  indignities had  occurred                                                               
during the  more than two  years that  she cared for  her mother:                                                               
pain  medication that  was administered  incorrectly  or not  on-                                                               
time; or  [lack of]  assistance with  use of  the bathroom.   She                                                               
acknowledged  that nurses  wanted  to  do what  was  right.   She                                                               
offered her  belief that patients,  as consumers of  the service,                                                               
were  more confident  with shorter  work shifts.   She  requested                                                               
that nursing staff  be fresh, "on their toes," and  ready to give                                                               
the  best  care possible.    She  agreed  that these  were  tough                                                               
decisions  without easy  answers, but  should be  weighed against                                                               
the call to do no harm.   She stipulated that the right of nurses                                                               
to decide their own schedule should  not be at the expense of the                                                               
patient.   She  suggested that  hospitals make  the schedule  for                                                               
mandatory  on-call to  ensure that  staff had  the required  rest                                                               
periods.    She stressed  that  patient  safety was  the  guiding                                                               
principle,  and not  a catch  phrase.   She  emphasized that  the                                                               
legislature should  determine the  length of  work shift  by what                                                               
was  best  for  the  patient.     [Letter  included  in  members'                                                               
packets.]                                                                                                                       
                                                                                                                                
5:17:11 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER closed public testimony.  [HB 50 was held over.]                                                                
                                                                                                                                

Document Name Date/Time Subjects
Background from ANA.PDF HHSS 3/12/2009 3:00:00 PM
HB 50
Background ANA.PDF HHSS 3/12/2009 3:00:00 PM
HB 50
sponsor statement.PDF HHSS 3/12/2009 3:00:00 PM
HB 50
sectional analysis.PDF HHSS 3/12/2009 3:00:00 PM
HB 50
HB 50.PDF HHSS 3/12/2009 3:00:00 PM
HB 50
Fiscal note.PDF HHSS 3/12/2009 3:00:00 PM
HB 50
Letters of support.PDF HHSS 3/12/2009 3:00:00 PM
HB 50
Opposition from ANTHC.PDF HHSS 3/12/2009 3:00:00 PM
HB 50