Legislature(2009 - 2010)

04/09/2009 01:09 PM L&C


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          SB  12-LIMIT OVERTIME FOR REGISTERED NURSES                                                                       
                                                                                                                                
1:30:13 PM                                                                                                                    
CHAIR PASKVAN announced SB 12 to be up for consideration.                                                                       
                                                                                                                                
TOM  OBERMEYER,  staff  to  Senator  Davis,  sponsor  of  SB  12,                                                               
reviewed the intent of the  bill. It prevents licensed nurses and                                                               
licensed practical  nurses in health  care facilities  from being                                                               
forced to work mandatory overtime.  It also requires reporting of                                                               
any  overtime  with  the  overtime  designated  as  voluntary  or                                                               
mandatory by  the RN,  and provides penalties.  The intent  is to                                                               
eliminate mandatory overtime for RNs  unless overtime is due to a                                                               
grave and unforeseen  event. Use of mandatory  overtime in excess                                                               
of  the  bill's  limitations  will  result in  a  report  to  the                                                               
Department of Labor and Work Force Development.                                                                                 
                                                                                                                                
He  explained   that  the  overtime   is  beyond   an  agreed-to,                                                               
predetermined,   regularly  scheduled   shift  and   it  protects                                                               
patients  from  the  dangers  caused  by  overworked  nurses.  It                                                               
applies  to  all hospitals  and  health  care facilities  in  the                                                               
state. Under  this bill, a nurse  may not be required  or coerced                                                               
directly or  indirectly to  work more  than 14  consecutive hours                                                               
without  10 hours  of  rest, beyond  80 hours  in  a 14-day  work                                                               
period,  or  to  accept  an  assignment of  overtime  if  in  the                                                               
judgment of the  nurse it would jeopardize  the patient's safety.                                                               
Nurses can volunteer to work  additional shifts beyond this limit                                                               
so long as  they do not work more than  14 consecutive hours with                                                               
the 10 hours of rest.                                                                                                           
                                                                                                                                
MR.  OBERMEYER said  that a  number of  concessions were  made to                                                               
Alaska's hospitals.  The 14-hour maximum  work day with  10 hours                                                               
of rest exceeds  that allowed in many other states,  it permits a                                                               
2-hour transition  for nursing supervisors to  call in additional                                                               
help after  12-hour shifts. This  provision was intended  to help                                                               
remedy  the  problem  of  calling nurses  back  to  work  without                                                               
adequate  rest after  working a  12-hour  shift. Exceptions  have                                                               
been  provided for  flight nurses  on medical  transports, school                                                               
nurses  on  school-sponsored  field   trips  and  official  state                                                               
emergencies. This  bill limits hospital reporting  hours to twice                                                               
a  year  and  eliminates  triple  time  penalties  for  egregious                                                               
violations, limits  maximum fines  and requires  enforcement only                                                               
for knowing violations.                                                                                                         
                                                                                                                                
He explained that  there are few official  overtime complaints by                                                               
nurses due to  their busy schedules and, to some  extent, fear of                                                               
direct or  indirect retaliation by employees,  which is forbidden                                                               
under this bill. Many nurses  have testified to overwork fatigue,                                                               
disruption of  family life,  unexpected shift  changes, mandatory                                                               
overtime,  and  mandatory  on-call  over the  course  of  several                                                               
hearings on a similar bill last year.                                                                                           
                                                                                                                                
It has been estimated that  500,000 licensed registered nurses in                                                               
this country have  left or are not working in  the profession. He                                                               
explained  that Congress  is addressing  the nursing  shortage by                                                               
discussing  bills  for  financial  aid  for  education  and  more                                                               
rigorous regulation  of overtime  hours. The Journal  of American                                                               
Medical Association October 2002  reported that nurses who suffer                                                               
from  fatigue, increased  workloads and  shifts in  excess of  12                                                               
hours greatly  increase nursing errors and  mortality rates among                                                               
patients who have common surgeries.                                                                                             
                                                                                                                                
1:34:56 PM                                                                                                                    
They estimate  about 98,000  deaths each  year are  attributed to                                                               
errors  in hospitals.  Nursing  fatigue is  one  of the  factors.                                                               
Other safety  sensitive jobs like commercial  airline pilots, FAA                                                               
controllers,  railroad  engineers  and  long-haul  truckers  have                                                               
established workload guidelines.                                                                                                
                                                                                                                                
He said the  nursing profession has to attract  more young people                                                               
to replace  the aging  nurse workforce,  the national  average of                                                               
which is  46 years -  95 percent of them  are women. In  the year                                                               
2000, only 9 percent of RNs were  under the age of 25 compared to                                                               
25 percent  in 1980,  which indicates that  they are  leaving the                                                               
profession. SB 12 will encourage  employers to employ more nurses                                                               
rather than  using mandatory overtime and  mandatory on-call with                                                               
short staffs  to fill  routine and critical  care positions  on a                                                               
regular basis.  The greatest beneficiaries  will be  the patients                                                               
who receive the care and safety they deserve.                                                                                   
                                                                                                                                
1:36:26 PM                                                                                                                    
SENATOR BUNDE said  that legislative findings on page  2, line 6,                                                               
states  that  health  care  facilities  shall  provide  safe  and                                                               
adequate nursing  staff without  the need for  overtime. Research                                                               
has shown that  there is a shortage of nurses  and he didn't want                                                               
a health  care facility  to be  in violation of  the law  if they                                                               
simply couldn't find nurses.                                                                                                    
                                                                                                                                
MR. OBERMEYER replied that that section could be removed.                                                                       
                                                                                                                                
SENATOR MEYER said one hospital  has negotiated two 16-hour days.                                                               
Would this bill make that contract a violation?                                                                                 
                                                                                                                                
MR.  OBERMEYER replied  that he  was referring  to North  Star, a                                                               
part  of Universal  Health Services,  Inc.,  the most  profitable                                                               
hospital  association  in  the  country. Yes;  it  is  an  issue;                                                               
several  of their  nurses  testified that  they  like these  long                                                               
hours, but he  didn't know if the average nurse  in Alaska at age                                                               
48 wanted to work those  hours every week. However, he recognizes                                                               
that some nurses want to work those long hours.                                                                                 
                                                                                                                                
SENATOR MEYER asked why they  wouldn't just let the employees and                                                               
management negotiate  this personnel matter rather  than making a                                                               
law about it that could make matters worse.                                                                                     
                                                                                                                                
MR. OBERMEYER  replied this country  is facing a  nursing crisis;                                                               
nurses are not coming into the  profession, and there is an aging                                                               
population.  These  nurses  are  the  backbone  of  the  hospital                                                               
systems in the country; if they  are overworked and have too many                                                               
patients to  attend to, they will  make errors. At the  same time                                                               
it  creates  dissatisfaction with  work  among  these nurses.  He                                                               
agreed that most  facilities want to work with  their nurses, but                                                               
the bottom  line is they find  them somewhere. The irony  is that                                                               
overtime that was  designed many decades ago to  try to encourage                                                               
employers to hire more people is  no longer a limiting factor. It                                                               
has become a routine part of staffing and has no remedy.                                                                        
                                                                                                                                
1:41:21 PM                                                                                                                    
SENATOR DAVIS  stated that  she would  prefer that  the concerned                                                               
parties  could   negotiate  a   resolution  instead   of  passing                                                               
legislation. Other  states have had to  pass legislation, because                                                               
they have not been able to  agree among themselves. She has given                                                               
every  opportunity for  that to  take place  here, and  she hoped                                                               
something  would happened  in  the  current negotiations  between                                                               
hospitals  and nurses,  but she  wasn't sure  they could  come up                                                               
with a solution on their own.                                                                                                   
                                                                                                                                
1:42:31 PM                                                                                                                    
CHAIR  PASKVAN  added  that  he  met  with  a  representative  of                                                               
Providence Hospital  this morning, and  he was assured  they were                                                               
working on  this issue and  expected to conclude  negotiations in                                                               
May or June  2009. If they cannot reach a  resolution, they would                                                               
not oppose this legislation next year.                                                                                          
                                                                                                                                
1:43:13 PM                                                                                                                    
SENATOR DAVIS said she was glad  to hear they had that discussion                                                               
with him;  they had that discussion  with her, too. But  it would                                                               
be an injustice to not move the  bill forward; her goal was to at                                                               
least get it to Finance this year.                                                                                              
                                                                                                                                
SENATOR MEYER  said he didn't  see this as a  Providence Hospital                                                               
bill,  and they  shouldn't hold  it up  because one  hospital was                                                               
having negotiations.                                                                                                            
                                                                                                                                
1:46:10 PM                                                                                                                    
MICHAEL WALLERI, General Counsel,  Tanana Chiefs Conference, said                                                               
it  is a  regional  health corporation  serving  the Interior  of                                                               
Alaska  and operates  the Chief  Andrew Isaac  Health Clinic.  He                                                               
said he  opposed SB  12 in  its current  form, because  it covers                                                               
federal  facilities.  Some issues  are  unique  to Indian  health                                                               
service contracted facilities that  would make the situation much                                                               
worse for them.                                                                                                                 
                                                                                                                                
He  explained that  their  nursing staff  is  composed of  direct                                                               
hires which  may or may  not be  subject depending on  whether or                                                               
not the  bill applies to  federal facilities. But they  also have                                                               
commissioner  corps  Indian  health  service  employees  who  are                                                               
nurses operating under the  Intergovernmental Personnel Act (IPA)                                                               
that this  legislation would  not affect.  In this  situation the                                                               
bill would apply to their  non-IPA positions, but would not apply                                                               
to  their  IPA positions,  which  would  increase the  burden  of                                                               
mandatory  staffing over  to the  IPA  nurses, which  exacerbates                                                               
burnout and overwork among that group.                                                                                          
                                                                                                                                
Additionally,  he said  the bill  does not  cover nurses  who are                                                               
traveling outside of the borough.  Fundamentally, he said, Alaska                                                               
is  dealing with  a nursing  shortage. The  University of  Alaska                                                               
developed  a comprehensive  program to  develop and  train nurses                                                               
who would be  uniquely qualified to serve Alaska  and focusing on                                                               
the resident  Native population, which  will be less  mobile. The                                                               
same  thing was  done  for UAA's  Licensed  Clinical Social  Work                                                               
program  (LCSW). At  first they  tried to  regulate the  area and                                                               
that didn't work. They think they can do the same thing here.                                                                   
                                                                                                                                
1:49:46 PM                                                                                                                    
SUSAN  JOHNSTON, Regional  Director, Human  Resources, Providence                                                               
Health  Services, asked  them to  allow negotiations  to conclude                                                               
with the  Alaska Nurses Association  before taking any  action on                                                               
this bill. Their analysis has  indicated this bill would increase                                                               
Providence's budget by $9.3 million.                                                                                            
                                                                                                                                
Some of the  potential actions they believe would  be required by                                                               
Providence  to insure  compliance  with this  bill  would be  the                                                               
elimination of  on-call and call-back nurses,  the elimination of                                                               
some of their overtime that  may lead to unintentional violation,                                                               
and moving their  nurses from 12-hour to  8-hour shifts. Although                                                               
a move  of this  nature could  potentially provide  a significant                                                               
cost savings  for Providence, it  would also be  a "dissatisfier"                                                               
for their nurses.                                                                                                               
                                                                                                                                
1:51:35 PM                                                                                                                    
ROGER   LEWERENZ,   Clinical   Nurse  Educator,   Heart   Center,                                                               
Providence Health Center, said he had  been a nurse for 14 years,                                                               
12 of those at Providence. He  is responsible for staff that work                                                               
in  the  cardiac  catheterization  lab  as  well  as  the  cardio                                                               
vascular observation  unit and  the cardio  vascular intervention                                                               
unit, a  24-hour nursing unit.  The technical nature of  the work                                                               
requires  an extra  one year  of technical  training. While  many                                                               
other  areas can  supplement  staff with  nurses  from the  float                                                               
pool, he can't take just any nurse into the lab.                                                                                
                                                                                                                                
He explained that it is infrequent,  but not unusual, for a nurse                                                               
to work more than 14 hours  caring for patients there. Limiting a                                                               
nurse to 14 hours could  jeopardize the availability of this unit                                                               
to provide  care for a  patient in an emergency.  It's impossible                                                               
to schedule for emergencies. Anything  outside of those hours are                                                               
covered by  a "call  team" which completes  cases that  are added                                                               
during the  day. Because  of that  they occasionally  stay longer                                                               
than 14 hours.                                                                                                                  
                                                                                                                                
He agreed  with the intent of  this bill, and agreed  that nurses                                                               
should  not  be  scheduled  for   mandatory  overtime,  but  this                                                               
scenario  would be  nearly impossible  to implement.  Many nurses                                                               
would be  frustrated and quit  their jobs. He summarized  that he                                                               
wants the most competent nurses, not the most rested.                                                                           
                                                                                                                                
1:54:32 PM                                                                                                                    
MARILYN  EDWARDS,  Head  OR Nurse,  Providence  Health  Services,                                                               
opposed  SB  12.  Her  immediate  concerns  revolve  around  safe                                                               
quality patient outcomes  and a safe work environment  for her OR                                                               
staff.  Some  of  the  concerns  they  have  expressed  are  that                                                               
restrictions on  overtime would mean  her staff would  work their                                                               
scheduled shifts and  then go to other facilities in  the area to                                                               
get their  additional hours. They  expressed other  concerns that                                                               
the  bill encompasses  issues that  are highly  individualized by                                                               
circumstances and that SB 12 is  a one-size solution to a problem                                                               
that does  not exist at the  PNCOR. They provide quality  care to                                                               
all  patients  needing   surgical  intervention  while  providing                                                               
optimal work/life balance. She has 48  RNs who can choose to work                                                               
8, 10,  or 12-hour shifts; 22  of them work full  time; the other                                                               
26 work either  a .9, .8 or  .6. She has zero  vacancies, and she                                                               
has one "traveler" whose contract is up this week.                                                                              
                                                                                                                                
MS.  EDWARDS summarized  that  the OR  staff  like their  current                                                               
shifts. They  don't want  their call assigned  on days  when they                                                               
are not  scheduled to  work. Current practice  is to  group their                                                               
workdays with  their calls so  that their scheduled  off-days are                                                               
not  encumbered  with  call responsibilities.  This  practice  is                                                               
their preference and their professional choice.                                                                                 
                                                                                                                                
1:56:54 PM                                                                                                                    
VALERIE   DAVIDSON,  Alaska   Native  Tribal   Health  Consortium                                                               
(ANTHC),  said  they  were  formed pursuant  to  federal  law  to                                                               
provide a range of medical  and community health services to over                                                               
130,000  Alaska   Natives;  ANTCH  and   Southcentral  Foundation                                                               
jointly  manage  the  Alaska  Native  Medical  Center  (ANMC)  in                                                               
Anchorage and  employ 500 nurses. They  do not support SB  12. In                                                               
January of this  year ANMC was recognized for a  second time as a                                                               
"magnet hospital,"  a highly prized  award given by  the American                                                               
Nursing  Association.  Only  5  percent  of  all  U.S.  hospitals                                                               
achieve this status and even  fewer are designated a second time.                                                               
ANMC is  the first and  only Alaska  hospital to receive  it. She                                                               
explained that magnet hospitals  have demonstrated that they meet                                                               
a set  of criteria designed  to measure the strength  and quality                                                               
of  their  nursing  including  the   ability  of  its  nurses  to                                                               
contribute to  patient outcomes and with  nurse job satisfaction,                                                               
low turnover rates and appropriate  grievance resolution are part                                                               
of the standard.                                                                                                                
                                                                                                                                
MS.  DAVIDSON said  they don't  support SB  12 or  any bill  that                                                               
legislates work schedules and ties  the hands of managers who are                                                               
constantly  juggling the  demands  of patient  care against  work                                                               
force availability, rising costs  and chronic underfunding of the                                                               
Tribal Health System.                                                                                                           
                                                                                                                                
They have  three primary concerns  as the bill is  written. First                                                               
is that it  would have a detrimental  and disproportionate impact                                                               
on patients  in Alaska, especially  in rural Alaska,  but because                                                               
they are  transferred into Anchorage  for tertiary care  it would                                                               
impact the Alaska  Native Health Medical center  as well. Second,                                                               
it  conflicts with  Alaska's long-standing  policy of  supporting                                                               
access to health care through  allowing health care facilities an                                                               
appropriate  degree of  flexibility in  scheduling direct  health                                                               
care providers. Third, it creates  the inaccurate impression that                                                               
it applies to federal and tribal facilities.                                                                                    
                                                                                                                                
1:59:42 PM                                                                                                                    
She  explained   that  in  rural   Alaska,  when   nurses  aren't                                                               
available,  patients must  be diverted  to another  facility. The                                                               
challenge is that then those  patients get diverted to the Alaska                                                               
Native Medical Center, which disrupts  the continuity of care for                                                               
patients and poses  an additional financial burden  on an already                                                               
underfunded health care system.                                                                                                 
                                                                                                                                
MS.  DAVIDSON   said  under  federal  law,   a  federal  facility                                                               
performing a federal function is  not subject to state regulation                                                               
even if the  function is carried out by  another entity. Congress                                                               
has  not  authorized  state regulation  of  federal  health  care                                                               
facilities serving tribes.                                                                                                      
                                                                                                                                
She said the  Fair Labor Standards Act was  recently revised with                                                               
the benefit of comprehensive  comments from nursing associations,                                                               
patient  advocacy groups  and health  care facilities.  It allows                                                               
for that degree of flexibility.                                                                                                 
                                                                                                                                
2:01:04 PM                                                                                                                    
ANGEL  DOTOMAIN, CEO,  Alaska Native  Health  Board (ANHB),  said                                                               
they represent  24 Alaska tribal  health entities and  opposed SB
12. She said collectively they  employ 7,000 Alaskans and provide                                                               
health  services to  approximately 130,000  Native customers.  In                                                               
many  areas  they  are  the only  providers  of  health  services                                                               
servicing Natives and non-Natives, alike.                                                                                       
                                                                                                                                
2:02:14 PM                                                                                                                    
JAMIE  EASTERLY, staff  nurse, said  she represents  quite a  few                                                               
nurses in Ketchikan  and that patient safety  is their number-one                                                               
concern. They all  support SB 12. She said that  money is not the                                                               
issue, but rest periods  are. She said it may be  time to look at                                                               
nursing in a different form and  reminded them that it was a very                                                               
big deal when  pilots' time in an airplane was  limited, but many                                                               
lives were  saved because of it.   They also need  to think about                                                               
the new  young nurses coming  into this profession; some  of them                                                               
don't  come into  nursing because  they are  not willing  to give                                                               
their lives away to the hospital.                                                                                               
                                                                                                                                
2:04:44 PM                                                                                                                    
NICOLE  WELCH, Interim  Chief Human  Resource Officer,  Fairbanks                                                               
Memorial Hospital  (FMH), opposed  SB 12, because  their facility                                                               
has been  able to work  directly with staff  regarding scheduling                                                               
to come up  with the best plan to meet  their patient needs. They                                                               
do so  through a variety of  shifts including 8, 10,  and 12-hour                                                               
shifts  as well  as  varying full-time,  part-time  and per  diem                                                               
statuses and  using on-call and  call-back. They have not  had to                                                               
mandate overtime and have been  able to staff through the ability                                                               
to be  flexible.  The hospital  needs to be able  to maintain its                                                               
ability  to work  directly with  its nursing  staff and  specific                                                               
patient needs.  This flexibility also  leads to their  ability to                                                               
retain the nursing staff who  are looking for creative scheduling                                                               
to accommodate their work/life balance.                                                                                         
                                                                                                                                
2:06:07 PM                                                                                                                    
STACY ALLEN,  RN, Palmer Laborers  Local 341, said  it represents                                                               
about 250 nurses  at Alaska Regional Hospital.  She remarked what                                                               
other industry  lets the boss  and employees work out  matters of                                                               
public safety?  She said  so far the  health care  facilities and                                                               
the  health care  associations had  not showed  a willingness  to                                                               
work together to  come up with a solution; and  this indicates to                                                               
her that it will take a legislative solution.                                                                                   
                                                                                                                                
Most of  her members  work construction and  are highly  aware of                                                               
safety, but nurses don't have the  choice of walking away from an                                                               
unsafe  situation.  They  may  be   putting  their  licenses  and                                                               
patients on the  line; nurses are torn by this  issue. People are                                                               
being driven  out of  the profession particularly  in the  OR and                                                               
the  dialysis unit.  The  Local very  much supports  SB  12 as  a                                                               
public safety issue.                                                                                                            
                                                                                                                                
2:07:37 PM                                                                                                                    
NANCY DAVIS, President, Alaska  Nurses Association (ANA), Juneau,                                                               
said  she has  over  1,000  RN members.  They  have been  working                                                               
together for over  five years to address this  issue of mandatory                                                               
overtime  and  excessive work  hours  for  registered nurses  and                                                               
licensed  practical  nurses.  They   support  SB  12  because  it                                                               
addresses  both  the  patients'  and  the  workers'  safety.  She                                                               
thought that they should be able  to come together on the side of                                                               
safety and  SB 12 facilitates  that in  a standard way  whether a                                                               
nurse has a collective bargaining agreement or not.                                                                             
                                                                                                                                
2:10:11 PM                                                                                                                    
KENDALL SAWA,  Vice President,  Patient Care  Services, Ketchikan                                                               
General  Hospital,  opposed SB  12.  Overtime  there is  strictly                                                               
voluntary and he has heard of  no complaints in the calendar year                                                               
of 2008 around inappropriate use  of overtime, nor do they expect                                                               
any in the future as  they continue their unrestricted practices.                                                               
To prevent  burnout many hospitals emphasize  creative scheduling                                                               
practices.  One such  practice  is  to allow  nurses  to work  at                                                               
partial FTEs -  .8 or .9 for 36 hours/wk  for full benefits. This                                                               
is in the midst of a nursing  shortage and to respond to an aging                                                               
nursing population.                                                                                                             
                                                                                                                                
2:11:43 PM                                                                                                                    
ROD  BETIT,   President,  Alaska  State  Hospital   Nursing  Home                                                               
Association  (ASHNHA), opposed  SB 12.  He said  his members  are                                                               
meeting the intent of the  legislation already. Patient safety is                                                               
paramount to  his members  and their facilities  are equal  to or                                                               
better  than those  happening nationally.  Mandatory overtime  is                                                               
not used in their facilities to  make up for short staffing. This                                                               
is what  happens in  other states,  and that  is what  has caused                                                               
legislation  to come  forward there.  Their chart  indicates that                                                               
very little mandatory overtime has  been reported; it was at API,                                                               
but that was  addressed two years ago. Overtime  is voluntary and                                                               
generally comes at  the request of nursing staff  rather than any                                                               
kind  of  mandating  imposed  by   management.  There  are  local                                                               
flexibility  issues; Petersburg  has  reported  being on  12-hour                                                               
shifts because  the nursing staff  asked for  it. It is  not cost                                                               
effective  for many  facilities  to have  12-hour shifts  because                                                               
they end up having  3/12s for 36 hours and lose  4 hours per week                                                               
per individual employee.                                                                                                        
                                                                                                                                
He pointed  out that  hospitals had  taken a  number of  steps to                                                               
solve  this   problem;  not  the   least  of  which   was  making                                                               
contributions to  the University  of Alaska  to grow  its nursing                                                               
program from 100 to 200 graduates each year.                                                                                    
                                                                                                                                
2:14:33 PM                                                                                                                    
SENATOR THOMAS said they are already complying.                                                                                 
                                                                                                                                
MR. BETIT  responded that  they are  complying with  the findings                                                               
and intent  of the bill, which  is to treat nurses  fairly and to                                                               
provide  top patient  care.  They  are doing  that  by not  using                                                               
mandatory overtime, for one thing,  and by using other techniques                                                               
to  get   there.  Temporary  nursing   hours  is  one   of  those                                                               
provisions.                                                                                                                     
                                                                                                                                
SENATOR THOMAS said even though  their longest shift is 12 hours,                                                               
he was  still concerned with  exemption language on page  3, line                                                               
14, that  precludes anything longer  than 14-hour shifts  as long                                                               
as they were not back-to-back and there was a 10-hour break.                                                                    
                                                                                                                                
MR. BETIT  responded that a number  of exceptions are set  out on                                                               
page  3 and  he  didn't know  how they  played  out against  each                                                               
other, but  the 14-hour  limit seems to  be the  most controlling                                                               
one.  If someone  has  worked a  12-hour shift  and  has to  stay                                                               
either  voluntarily  or mandatorily,  that  14  hours comes  into                                                               
play. There  are times when  that will happen either  because the                                                               
nurse wants to do it or  because there is a need, particularly in                                                               
rural facilities,  where they don't have  other staff immediately                                                               
available.                                                                                                                      
                                                                                                                                
2:17:48 PM                                                                                                                    
SENATOR  THOMAS asked  what kind  of impact  the increase  in the                                                               
University's nursing program had.                                                                                               
                                                                                                                                
MR. BETIT replied  it is having a positive effect.  Every year he                                                               
tries to  get a subjective  opinion from  his CEOs as  to whether                                                               
they  see the  nursing situation  as better,  worse or  about the                                                               
same. About  12 of them responded  that it's the same,  8 said it                                                               
was worse and  4 said it was better; overall  they are not seeing                                                               
a major deterioration,  but the challenge is still  there and the                                                               
vacancy percentage  is still  pretty significant  in many  of the                                                               
facilities.                                                                                                                     
                                                                                                                                
2:19:06 PM                                                                                                                    
SENATOR THOMAS asked how it could be getting worse.                                                                             
                                                                                                                                
MR. BETIT  replied that nurses  don't come out of  the University                                                               
nursing program  ready to go to  work on the floor  of a hospital                                                               
or a nursing home. So, there is  a real need to continue to build                                                               
those  work ready  programs or  to have  capacity for  the larger                                                               
hospitals to actually train nurses that  could then go out to the                                                               
rural areas.                                                                                                                    
                                                                                                                                
2:19:50 PM                                                                                                                    
LIANN COX, Human Resources Manager,  Wildflower Court, opposed SB
12.  She  explained that  they  are  a small  non-profit  skilled                                                               
nursing facility with 57 beds and  have 14 full-time nurses and 3                                                               
casual  nurses.  In  the  past  three  years  they  have  had  no                                                               
mandatory  overtime at  all. They  have had  no complaints  about                                                               
overtime or the  shifts. They have 8, 10, and  12-hour shifts and                                                               
try to be flexible based on  what the employees want. SB 12 would                                                               
needlessly  set  a  precedent for  government  intervention,  she                                                               
said. Statistics reinforce their  position that statewide the use                                                               
of  mandatory   overtime  is  rare   in  hospitals   and  nursing                                                               
facilities.                                                                                                                     
                                                                                                                                
Further,  she said,  SB 12  would require  them to  document work                                                               
hour  details  for employees  affected  by  this legislation  and                                                               
since  it is  a  facility that  doesn't  implement the  mandatory                                                               
overtime, she didn't  see why they would want  to be additionally                                                               
burdened with the extra reporting.                                                                                              
                                                                                                                                
SENATOR DAVIS asked  if she had provided that  information to the                                                               
committee.                                                                                                                      
                                                                                                                                
MS. COX  replied that she  had commented through ASHNHA,  but she                                                               
would submit the information she has today.                                                                                     
                                                                                                                                
2:22:08 PM                                                                                                                    
KRISTI  ARTUSOU, RN,  Director, Neurosciences,  Providence Alaska                                                               
Medical  Center, said  she also  sits  on the  National Board  of                                                               
Directors  of  the  Certification  Corporation  of  the  American                                                               
Association  of  Critical  Care  Nurses.  They  are  the  largest                                                               
specialty organization in the country  and represent over 500,000                                                               
nurses.  They do  not advocate  mandatory overtime  for staffing;                                                               
however, they  also do not  believe that  government interference                                                               
is required for a nurse's ability  to schedule her work hours and                                                               
to balance their  work and personal life. So, she  opposed SB 12.                                                               
She related how  she worked overtime to get extra  money to buy a                                                               
home, to raise  kids, and to take trips with  her children. At no                                                               
time were  her patients  in jeopardy, because  she is  capable of                                                               
deciding  how  many hours  she  can  work.  She is  a  nationally                                                               
recognized  expert  in  critical   care,  progressive  care,  and                                                               
neuroscience nursing.                                                                                                           
                                                                                                                                
She said that  nurses are resourceful individuals,  but this bill                                                               
would directly  impact a their  ability to actually  control work                                                               
hours and  therefore, negatively impact their  ability to provide                                                               
access to quality health care services for Alaskan patients.                                                                    
                                                                                                                                
2:25:31 PM                                                                                                                    
SENATOR THOMAS  asked what  part of the  bill would  preclude her                                                               
from working voluntary overtime.                                                                                                
                                                                                                                                
MS.  ARTUSOU went  to the  language  that limits  overtime to  14                                                               
hours.  She  explained  that although  8-hours  shifts  are  much                                                               
easier for a hospital and  an administration to manage, 12-shifts                                                               
were created  across the country  to meet the nurses'  need. Most                                                               
nurses in  her units are on  12-hour shifts, but if  they want to                                                               
stay  the extra  4 hours;  that would  be a  16-hour shift.  That                                                               
would not be permitted under this  bill. What about the nurse who                                                               
works a 16-hour shift on Monday  and Friday because those are the                                                               
days her  husband is home  to take care  of the children,  or the                                                               
one who choose to work back to back Wednesday Thursday?                                                                         
                                                                                                                                
2:27:17 PM                                                                                                                    
SENATOR THOMAS  asked if she  would like  the bill if  allowed 16                                                               
hours of voluntary work and still disallowed mandatory overtime.                                                                
                                                                                                                                
MS. ARTUSOU  replied that professionally she  didn't think nurses                                                               
should have  legislation that interferes with  their professional                                                               
decisions. It would impact a  nurse's interest in wanting to stay                                                               
in the profession.                                                                                                              
                                                                                                                                
SENATOR MEYER  said he was  glad to hear that  flexible schedules                                                               
make nurses happy, but the ultimate  concern is the safety of the                                                               
patient.                                                                                                                        
                                                                                                                                
MS. ARTUSOU explained  how after 18 months  of consistent 16-hour                                                               
shifts 3-days  a week her  performance was stellar; she  was even                                                               
asked to become  the manager of the Emergency Room  in a New York                                                               
hospital. She said as a  professional, you have to recognize your                                                               
own limitations.                                                                                                                
                                                                                                                                
2:31:25 PM                                                                                                                    
LORRIE HERMAN, Regional  Director, Government Affairs, Providence                                                               
Health and  Services, said  they are  in negotiations  with their                                                               
nursing  union  and  hope  to  conclude those  by  June.  If  the                                                               
overtime issue hasn't been settled  by then, she was committed to                                                               
working  with nurses,  other hospitals  in the  state and  tribal                                                               
organizations  to  come  up  with  a  compromise  so  legislation                                                               
wouldn't be needed.                                                                                                             
                                                                                                                                
2:32:53 PM                                                                                                                    
SENATOR MEYER asked if negotiations had started.                                                                                
                                                                                                                                
MS. HERMAN replied yes.                                                                                                         
                                                                                                                                
SENATOR MEYER asked how long have they had been going on.                                                                       
                                                                                                                                
MS. HERMAN  replied that she is  not a member of  the negotiating                                                               
team, but knew of two  meetings. At the first meeting, Providence                                                               
submitted its  list of  issues, and she  was sure  that mandatory                                                               
overtime  was on  it.  The  nurses union  presented  its list  of                                                               
issues at the second meeting.  The third meeting is scheduled for                                                               
Monday, April 13 is when negotiations would begin.                                                                              
                                                                                                                                
2:34:14 PM                                                                                                                    
DEBBIE   THOMPSON,   RN,   Executive  Director,   Alaska   Nurses                                                               
Association, supported SB 12. She  impressed on them that this is                                                               
a  patient and  nursing  safety  bill. She  pointed  out that  50                                                               
percent of nurses are not represented  by unions nor do they have                                                               
the option  to negotiate overtime with  their employer. Mandatory                                                               
overtime was brought  up in one facility in her  hospital and the                                                               
negotiating team  was told  it would  be settled  in Juneau  as a                                                               
legislative  matter; so  it has  not come  up in  negotiations at                                                               
Providence,  yet. She  reminded  them that  the  Baylor Plan  was                                                               
never intended  to be two 16-hour  shifts. It was intended  to be                                                               
two  12-hour shifts  and  pay the  nurses for  40  hours to  have                                                               
coverage on the weekends.                                                                                                       
                                                                                                                                
2:35:53 PM                                                                                                                    
KATHLEEN GEDES,  RN, Providence Alaska  Medical Center,  said she                                                               
is the  Union President.  She feels compelled  to set  the record                                                               
straight.  She submitted  a Providence  job  description for  the                                                               
record and said in the  description they are held accountable for                                                               
medical mistakes. She referenced a  book called "Wall of Silence"                                                               
written by Rosemary Gibson. It's  the untold story of the medical                                                               
mistakes that kill and injure millions of Americans daily.                                                                      
                                                                                                                                
MS.  GEDES related  that her  mother when  she was  41 years  old                                                               
because of a misdiagnosis. She then  had to drop out of school to                                                               
take  care of  her three  siblings; but  she ended  up graduating                                                               
with a  social work  degree. So,  instead of  going over  all the                                                               
error rates, she wanted them to see her, an error rate.                                                                         
                                                                                                                                
She did  not want this  to be a  Providence issue, but  rather an                                                               
Alaskan  consumer  safety  issue.   Mandatory  overtime  was  not                                                               
brought forward by  Providence on the first  day of negotiations,                                                               
nor  on the  second day,  contrary to  what the  previous speaker                                                               
said.  She is  the one  who brought  it up.  Further, Ms.  Gedes,                                                               
corrected that  there are actually  15 states, not 13,  that have                                                               
developed  laws  and 14  other  states  are lining  up.  National                                                               
legislation  is  also  pending  to   ban  the  use  of  mandatory                                                               
overtime,  and Representative  Young actually  signed on  to that                                                               
bill.                                                                                                                           
                                                                                                                                
MS. GEDES said that 73  percent of Providence nurses fill vacancy                                                               
holes by working voluntary overtime.  The problem is that all the                                                               
studies look at mandatory overtime;  they don't look at the error                                                               
rates  for voluntary  overtime.  With the  nursing shortage  they                                                               
have employee travelers;  the adult critical care  unit alone has                                                               
21 travelers.  They have  no investment in  the community  nor is                                                               
there continuity of care when their 6 or 11 weeks is finished.                                                                  
                                                                                                                                
She also  remarked that  she graduated from  high school  in 1983                                                               
when Ms. Artusou bought her first  house. She was a spry 18 years                                                               
old and  didn't have a grey  hair, but she couldn't  be confident                                                               
that  at 16  hours of  work she  provided safe  care. How  do you                                                               
know? There are errors of  omission and errors of commission, the                                                               
ones you don't even know happened because you were too fatigued.                                                                
                                                                                                                                
MS. GEDES  closed saying that the  Alaskan public has a  right to                                                               
expect  when they  walk  into  a health  care  facility that  the                                                               
nurses taking care  of them are alert and  properly rested. Every                                                               
family member should  ask their bedside nurse how  many days they                                                               
have worked in  a row and how  many hours they had  worked in the                                                               
last few days, how many hours  they had worked today, and if they                                                               
had received any  meals or breaks today. Get the  facts. She said                                                               
eliminating mandatory  overtime is common sense;  it will protect                                                               
the  patient and  the nurses;  it  will help  retain and  recruit                                                               
nurses.                                                                                                                         
                                                                                                                                
2:41:06 PM                                                                                                                    
BARBARA  HUFF-TUCKNESS,  Director, Governmental  and  Legislative                                                               
Affairs, Teamsters Local  959, said she supported  the concept of                                                               
SB 12. She represents nurses  and actually the entire health care                                                               
work  force at  South Peninsula  Hospital and  at Kodiak  Island.                                                               
They  they have  a somewhat  semi-private facility  as well  as a                                                               
Providence   Kodiak   Island  facility.   Collective   bargaining                                                               
agreements have been  in place at South  Peninsula Hospital since                                                               
1989.  Their  agreement  has language  that  addresses  mandatory                                                               
versus  voluntary   hours,  and   nurses  are  allowed   to  work                                                               
voluntarily up  to 16  hours. She said  they are  concerned about                                                               
some of the flexibility, but agreed  with some of the points made                                                               
today.                                                                                                                          
                                                                                                                                
On-call is a  much bigger issue at their facility.  They are also                                                               
looking at the number of patients  per nurse. She is currently in                                                               
negotiations with  South Peninsula  facility and next  month will                                                               
be going into negotiations for Providence Kodiak.                                                                               
                                                                                                                                
She remarked  that a large  number of nurses are  unorganized. So                                                               
if they don't  pass this legislation, it would  be an opportunity                                                               
to continue  organizing or  there would  be protection  for those                                                               
unorganized  workers. She  the concept  embodied in  SB 12  is an                                                               
issue that needs to be addressed.                                                                                               
                                                                                                                                
2:43:37 PM                                                                                                                    
SENATOR MEYER asked if overtime can be negotiated.                                                                              
                                                                                                                                
MS. HUFF-TUCKNESS  replied yes;  it has  been in  their contracts                                                               
for eight  years. She said  organization as an option  for nurses                                                               
outside  of the  union would  not be  guaranteed if  this doesn't                                                               
pass.                                                                                                                           
                                                                                                                                
SENATOR MEYER  reasoned that if unorganized  nurses see organized                                                               
nurses getting  something they are  not, they will either  ask it                                                               
and management will grant it or they may become organized.                                                                      
                                                                                                                                
MS.  HUFF-TUCKNESS said  she has  dealt with  employers, herself,                                                               
and she wouldn't guarantee that would be the case.                                                                              
                                                                                                                                
2:45:27 PM                                                                                                                    
CHAIR PASKVAN closed public testimony.                                                                                          
                                                                                                                                
SENATOR BUNDE asked  if people in federal  facilities wouldn't be                                                               
affected by SB  12, why would they be concerned  about it one way                                                               
or the other.                                                                                                                   
                                                                                                                                
SENATOR DAVIS  responded that  she was  confused also.  This bill                                                               
was  before  the  committee  last   year  and  an  amendment  was                                                               
negotiated that they said was okay.  Now they are saying that was                                                               
not their only issue.                                                                                                           
                                                                                                                                
2:47:50 PM                                                                                                                    
CHAIR PASKVAN held SB 12 until Tuesday.                                                                                         
                                                                                                                                

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