Final
Fourth Health Care Task Force Meeting

HEALTH CARE TASK FORCE

Votes:
Action Taken:
Moved to forward the bill (Attachment BB) that imp
Moved to forward the bill (Attachment Y) related t
Moved to forward the bill (Attachment Z) that requ		FAIL
PASS
PASS


09:05 AM -- Overview of Health Care Workforce Issues in Colorado

Sue Carperelli, President and CEO of the Colorado Center for Nursing Excellence, and a member of the State Workforce Development Council, distributed a packet of materials (Attachments A - D). Attachment A provides an overview of the Center for Nursing Excellence and summarizes several projects that the Center is involved in related to workforce shortage issues. Attachment B summarizes a study that was undertaken to examine the nursing workforce shortage. Attachment C overviews strategies for nursing faculty development. Attachment D is a brochure that looks at labor market information in the health care fields.

Ms. Carperelli stated that her short presentation would: 1) provide insights regarding critical factors which impact both the need and the ability to produce a sufficient supply of health care workers in Colorado; 2) emphasize the link between health occupations workforce development and the economic vitality of communities across the state; 3) underscore the exacting nature of work performed by health care professionals; and 4) highlight solution building efforts that are being built and sustained through effective public private collaboration in Colorado. Ms. Carperelli stated that significant shortages exist in the health care arena in all parts of the state, and these shortages are projected to grow over the next 15 years, especially in nursing. She added that 1 in 10 Coloradans work within the health care industry, and that health care will create more jobs than any other sector in the next decade. Some factors leading to this shortage include the number of providers nearing the age of retirement with not enough younger workers to replace these retiring workers, and the increasing aging population that will increase the need for health care in the future.

Ms. Carperelli discussed health care preparation programs in higher education and the needs of these programs. She stated that there must be a viable and accessible higher education system in order to train health care workers. This is a challenge, especially in the rural areas. She added that there are a limited number of factors that influence increases and decreases in the workforce. These include: worker education; compensation; work conditions; and migration and retirement factors. She discussed the need for long term strategies that are sustainable over time, adding that solutions must be created to meet community-specific needs and conditions, and innovation and change must be involved. Collaborative approaches among industry stakeholders, between industry and the public sector, and between practice and education with involvement of the foundation community and others are required. She talked about pipeline efforts being made in education, and partnerships between the Colorado Department of Labor and industry, which are resulting in a significant increase in enrollment numbers in higher education.

She stated that the agenda for the day would address pipeline issues, work environment issues, and others. She offered the resources and expertise of the Colorado Workforce Council to the committee. Ms. Carperelli responded to a question about how efforts of recruiting in areas that are under-represented are going, stating that education in student's the early years, work with school counselors to guide students into the field, mentorship programs for students in higher education, and support of practicing nurses as mentors is critical. A lot must and can be done to increase participation of a diverse group of individuals in the health profession. Representative Frangas asked Ms. Carperelli to provide any written suggestions that she has to the committee.

Senator Keller asked whether there are programs for certified nurse assistant (CNA) training, for example that allow a student to learn the program while still in school. Ms. Carperelli stated that there are in the form of school to career programs. She talked about how funding for school to career programs has diminished. She addressed mentor programs, specifically the Lamplighter Program where practical nurses reach out to students waiting to be admitted to nursing programs. Then once the student is in school, the practical nurses encourage them and even provide some tutoring.


09:25 AM -- Role of the State Board of Nursing

Sharon Pappas, Chair of the State Board of Nursing, and Chief Operating Officer at Porter Adventist Hospital, stated that the role of the board is to protect the public through enforcement. She distributed four handouts (Attachments E - H). Attachment E provides a breakdown of faculty requirements by the type of nursing program offered. Attachment F shows the number of Colorado students taking the national licensing exam in Colorado for the first time between 2003 and 2005. Attachment G describes the differences between certified nurse aides (CNA), licensed practical nurses (LPN), and registered nurses (RN). Attachment H provides a 50-state survey of the number of clinical and theory hours required for the various levels of nursing. Ms. Pappas stated that the board has 11 members whose qualifications are set forth in statute, and described who the members represent. She discussed the responsibilities of the board including: 1) establishing standards for the practice of nursing; 2) licensure; 3) discipline; and 4) education. She referenced the handouts including the comparison of the minimum number of clinical and theory hours required by state.

Ms. Pappas provided some statistics. There are approximately 54,000 licensed RN's in Colorado. There has been about a 28 percent increase in RN's taking the state boards in the past few years due to the increase in the number of nursing programs in the state, and 87 percent of RN's taking the test pass on the first try. She added that the typical nurse is 47 years old and practices in a hospital, 95 percent are female, 92 percent are white, and 43 percent have a baccalaureate degree. She referenced a book written by the Institute of Medicine which pertains to the health of the public and the nurses. Ms. Pappas continued talking about nursing programs in Colorado stating that there are 19 associate programs, 10 baccalaureate programs, 6 master's programs, and 2 PhD programs in the state. The State Board of Nursing monitors the pass rates at each of these schools. Since 2003, there have been 12 new nursing programs in Colorado, which as Ms. Pappas discussed before, has resulted in a 28 percent increase in the first year of students taking the licensing exam, and an 8 percent increase in the second year. This expansion of nursing programs may explain the increase in the number of practicing nurses.

Senator Keller asked about a California effort that dealt with staff ratios in hospitals. Ms. Pappas stated that California was one of the early states that enacted this effort. She added that many times staff ratios create a "floor" rather than representing what may actually be needed. She stated that retaining flexibility at the hospital level to set staff ratios based on need is better than setting a specific staff ration. This allows staffing to occur based on patient need. Representative Todd asked about overtime in the time of nurse shortages and how hospitals address this. Ms. Pappas stated that this is usually looked at within each institution. Senator Keller asked whether the board has any enforcement authority when there are problems. Ms. Pappas stated that the State Board of Nursing does not have any enforcement over situations where staff may be complaining, but that the board can refer a problem to other state agencies that may have authority over the situation.


09:44 AM -- The 2004 Colorado Nursing Faculty Supply and Demand Study

Lynn Dierker, Colorado Health Institute, provided an overview of the study that her organization conducted at the request of the Center for Nursing Excellence and funded by the Colorado Workforce Development Council. She distributed a copy of her presentation (Attachment I). A copy of the full study is available on the web at:

http://www.coloradonursingcenter.org/PDF/NFSDMarch2005.pdf.

Ms. Dierker discussed the focus of the study which was to understand the current nursing faculty supply and demand, to identify: key factors influencing supply, current and potential practices, and policy implication. She walked through the study methodology which included review of literature and data, data collection, and analysis. She discussed how they classified rural as being anything outside of the front range metropolitan area. She talked about the severity of need for clinical instructors in the 4-year programs.

Ms. Dierker explained some of the factors influencing faculty recruitment and retention including a noncompetitive work environment (salary and workload demands), rapid program expansions taxing the faculty (in Colorado in the last 1 to 3 years there have been increases in both the number of programs and the number of spots in each program), the need for innovation and new technology, Colorado's difficult budget situation, the national nursing faculty shortage, and barriers to obtaining graduate nursing degrees for those who have other demands in their lives.

Ms. Dierker talked about the impact of faculty shortages, stating that it limits the ability to train more nurses or to expand nursing programs, it compromises the quality of those coming out of nursing programs, and relies on the private sector and industry for resources to supplement nursing education. She added that the key findings of the report are: qualified applicants are being turned away from nursing programs, students are not successful in completing a programs due to inadequate pre-nursing preparation, and uneven curriculum standards within and between programs as a result of the rapid expansion.

Ms. Dierker continued discussing promising practices that are going on including collaborative investment by education and practice. There are innovative strategies to strengthen clinical education, redesigning nursing curriculum, and exploring opportunities for systemic redesign of education programs. Ms. Dierker summarized the key themes and policy implications: 1) balance quality and quantity (Colorado pushed for the expansion of nursing programs, but needs to get a sense of balance to be sure that the quality of students coming out of these programs is being maintained); 2) make it financially feasible and professionally attractive to serve as faculty (institutions need a succession plan for faculty); 3) promote nursing education innovations to optimize resources and improve quality (12 new programs have begun in the last 3 years); 4) align efforts to achieve investment in resources in higher education and nursing education; and 5) invest in data, monitoring, and educational research (to keep looking at supply and demand).

Representative Butcher expressed some concern about one of the policy statements related to quantity and quality of programs. Ms. Dierker stated that what she heard in the study was that new graduates are coming in to the clinical setting somewhat unprepared to be fully active, therefore they need more mentoring and adjustment time. She added that they are entering the field in a shortage situation so there is not as much time to get these new graduates up to speed, rather they need to hit the ground running.


10:21 AM -- Higher Education and Workforce Issues Affecting Southern Colorado

Dr. Mike Davis, President, Pueblo Community College, distributed a packet of materials with much of the panel's comments and issues included (Attachment J). Sandy Summers, Chair of the Nursing Department at Lamar Community College, discussed the situation with the faculty at Lamar. Dr. Rhonda Johnson, Chair of the Nursing Department at CSU-Pueblo, stated that when she became Chair three years ago, she found that the curriculum was quite outdated, and she lost a lot of faculty right away. So she went to the community for help. They have now started a master's program in that region in order to have community-based faculty in the future. She discussed the success of her program in the last couple of years and the curriculum changes and enhancements that have been done.

C. W. Smith, Chief Executive Officer, Parkview Hospital in Pueblo, discussed the support that the hospitals give to the higher education programs. He distributed a handout related to economics in the Pueblo area (Attachment K). He stated that the training needs and exposure of K-12 kids to the concepts of medicine (like math and science) are critical. Senator Keller stated that while she appreciated the proposed solutions, the state fiscal situation makes it almost impossible to solve the problem via the state budget.

Sandra Nebl, Director of Nursing , St. Mary Corwin Hospital in Pueblo, stated that the hospitals are taxed when additional clinical sites are sought by the school programs. They just do not have the capacity to take on all of the clinical training when they have workforce shortages themselves. She added that there is a need to train nurses to be business people. She stated that many nurse practitioners are going into the field rather than going into teaching since they can make $20,000 - $30,000 more a year in the field.

Dr. Davis summarized the panel's presentation and stated that maybe looking toward federal grants or foundation money to increase the supply of faculty in colleges will be needed. He discussed the recruitment of minority students, referencing as an example the Health Academy in Pueblo high schools that gets kids into the science and math classes that they need. He stated that higher education and the health professions need to work more with school counselors to make sure that kids know what they need to get into the health field.


10:52 AM -- Discussion of Magnet Hospitals in Colorado

Colleen Goode, Vice-President and Chief Nursing Officer, University of Colorado Hospital, provided some history about magnet hospitals. She distributed a handout that summarizes her presentation (Attachment L). She discussed the characteristics of a magnet hospital and talked about how magnet hospitals are credentialed. She stated that her hospital has a new nursing residency program and that they are talking to the Centers for Medicaid and Medicare to seek funding similar to what the medical residency programs receive. She discussed some work site programs that allow University Hospital employees to go back to school with some financial help from a Department of Labor grant that pays their salary for one day a week in class. The classes are taught on-site unless it is a lab class that must be taught at the college, and about 20-25 nurses each year participate in this program. Ms. Goode talked about the importance of nurses having bachelor of science degrees since a BSN is required to get a master's and since a master's is required to teach in both 2- and 4-year schools of nursing.

Kelly Johnson, Vice-President, Patient Care Services, Craig Hospital, discussed Craig Hospital's role and the fact that Craig just received its magnet status in August 2005. She provided a copy of her presentation (Attachment M) and discussed the what being a magnet facility entails including: quality of nursing leadership, organizational structure, management style, personnel policies and programs (for example competitive salaries and benefits and fixed schedules), professional models of care, quality of care, quality improvement, consultation and resources, autonomy, community and the health care organization, nurses as teachers, image of nursing, interdisciplinary relationships, and professional development.


11:22 AM -- State Efforts to Address Workforce Shortage Issues

Tom Looft, Director of Workforce Development Programs, and Elise Lowe-Vaughn, Director of Workforce Operations within Workforce Development Programs, both within the Department of Labor and Employment, came to the table. Mr. Looft discussed how workforce centers help in communities. He added that there are 19 workforce regions in Colorado and distributed a map of the regions (Attachment N). He talked about the State Workforce Development Council and discussed the funding of the workforce councils, stating that a big part of it is from federal funds that came about significantly after September 11, 2001. He stated that the workforce system decided to focus on the health care workforce shortages to develop local and statewide projects (a list of projects is attached as Attachment O). Mr. Looft stated that as Colorado's economy improves federal funding may decrease in the future. He discussed a new statewide program that Ms. Lowe-Vaughn was heading up. Ms. Lowe-Vaughn distributed an executive summary of this demonstration grant (Attachment P) and explained the breadth of the grant creators. She added that this center will be housed at the Fitzsimons redevelopment center at the Fitzsimons campus.

Mr. Looft and Ms. Lowe-Vaughn responded to questions from the committee, including a question about why the center would be located at the Fitzsimons site and how the investments into these programs have impacted the state and the sustainability of jobs in Colorado. Mr. Looft explained how the Workforce Development Council goes about providing training across the state, adding that workforce centers recruit only for those jobs that are in high demand.


11:47 AM -- Other Efforts to Address Workforce Shortage Issues

Laurel Petralia, Program Officer, The Colorado Trust, provided background about the Trust, and specifically the health professions initiative which is intended to increase the number of trained health care professionals across Colorado (Attachment Q). She walked through the initiatives that the Trust is working on and responded to questions from the committee.


12:00 PM -- Lunch


01:13 PM -- The Causes and Cost of High Vacancy Rates and High Turnover in Nursing

Becky Romero, Jule Monnens, and Bernie Patterson, all registered nurses in Colorado, discussed the myths of the nursing shortage. They distributed a handout of their testimony (Attachment R). Ms. Romero stated there is a 12 percent vacancy rate in nursing that accounts for 3,600 vacancies. She explained that there are currently 51,000 RNs licensed in Colorado but only 30,000 work in hospitals which leaves 21,000 already qualified nurses who choose not to work in acute care hospitals. Ms. Romero stated that the retention of nurses is the problem, not a lack of qualified nurses. Senator Keller asked if nursing homes were included in the nurse's definition of hospitals to which Ms. Romero responded no, they are only speaking to acute care.

Jule Monnens discussed the inadequacy of nursing education programs. She stated she teaches at Denver Community College and that she took a $20,000 a year pay cut to do so. Ms. Monnens went through the factors that have been found to successfully attract and retain nurses. She stated nurses need: 1) adequate staffing levels in order to ensure a reasonable caseload; 2) competitive wages; 3) respect and empowerment; 4) residency programs and relationships with nursing schools to ensure an ongoing supply of nurse trainees and graduates; and 5) opportunities for continuing education and advancement. Senator Keller commented that she has heard from many in the health care profession that competitive wages are not the issue and that the biggest issue is lack of staff. Ms. Monnens clarified that bedside nurse's wages and nursing faculty wages are inadequate.

Bernie Patterson addressed the costs associated with the retention of nurses and turnovers. She stated that there needs to be more attention on retention rather than recruitment. Ms. Patterson explained that the staffing shortfalls are due to lack of retention not lack of staff. Senator Tochtrop asked if JCAHO, the Joint Commission on Accreditation of Healthcare Organizations, has any staffing ratio requirements. Ms. Patterson responded that they do not, and that no one from JCAHO has ever asked her how safe the staff are. She added that it is no surprise when JCAHO comes, therefore the hospital has time to prepare and increase the number of staff on duty while the inspection is occurring, but once JCAHO leaves, staffing returns to the normal levels. Senator Tochtrop agreed with Ms. Patterson's statements about JCAHO and spoke of her own experiences as a nurse in an acute care hospital inspected by JCAHO.

Senator Tochtrop asked the nurses how they expect to gain empowerment and respect without organizing. She stated that the nurses must unite in strength together. Ms. Monnens replied that they were there because of the Colorado Nurse Alliance, a branch of the Service Employees International Union (SEIU), stating they have organized nurses around these issues and membership is growing. Senator Tochtrop asked Ms. Patterson about her experiences at St. Anthony Central to organize over the past 25 years. Ms. Patterson explained that the nurses at St. Anthony Central had attempted to organize with SEIU three times over the 25 years she was a nurse at the hospital, and each time the nurses were fought by the hospital organization. She stated that in order for the nurses to organize themselves they need legal advice and help because they are fighting major entities like Centura and Exempla.

Representative Todd asked the nurses to elaborate on why staff nurses are sent home due to hired travel nurses. Ms. Patterson explained that the travel nurses receive guaranteed hours so when there is no work to do staff nurses are sent home whereas the travel nurses get to stay because their hours are contracted. Representative Todd asked about the difference in pay between staff nurses and travel nurses. Ms. Patterson stated that travel nurses are paid the same or a little bit more then they are. Senator Tochtrop asked if staff nurses are contracted with guaranteed hours. Ms. Romero stated she could never use her vacation time because she had to use it to make up for the lost wages from being sent home early.

Representative Butcher stated that she sees the issues as: no guaranteed hours and too many RNs while not enough LPNs, nurse aides, and orderlies. Representative Butcher explained that the RNs have to do the work of the LPNs on top of their work because there are so many RNs and not enough LPNs. Ms. Patterson agreed and stated that LPNs and nurse aides are needed and are not utilized enough. In response to a question from Representative Butcher, Ms. Patterson explained that if a nurse jumps from an Associates to a Bachelor's Degree they receive no more money unless they go into management.


01:43 PM -- Meeting Physician Workforce Demands

Dr. Krugman. Dean of the University of Colorado School of Medicine, gave a brief background of his employment history. He discussed the physician workforce demands and distributed three handouts: Attachment S is a PowerPoint presentation on the University of Colorado School of Medicine; Attachment T is an article he wrote entitled "Preparing for a Doctor Shortage" that appeared in the Denver Post on October 2, 2005; and Attachment U is the University of Colorado School of Medicine's curriculum. He gave a brief overview of the School of Medicine at the University of Colorado. He explained the School of Medicine's mission is to provide Colorado, the nation, and the world with programs of excellence in education, research, clinical care, and community service.

Dr. Krugman explained there is a need for more physicians due to: 1) managed care; 2) Medicare and Medicaid reimbursement levels; 3) the lifestyle of the new group of doctors who are more interested in the career hours rather than the salary; and 4) the debt to income ratio. He stated the average debt incurred by the a medical student is $100,000 a year at public universities and $125,000 - $150,000 a year for private universities, and it must be repaid in the 3rd year of residency. Dr. Krugman went on to explain that Colorado's population is growing rapidly and the University of Colorado School of Medicine is the only medical school within 500 miles of Denver.

Dr. Krugman explained what the School of Medicine has done to address the shortage. He stated the school's move to Fitzsimons will allow more students to enroll. He also mentioned they have implemented a new curriculum and have explored the expansion for clinical rotations to the Western Slope in Grand Junction. Senator Mitchell asked Dr. Krugman what the biggest changes to the curriculum were, and Dr. Krugman explained that they moved to a department-based curriculum with classes now being taught by a clinician and a PhD professor. He stated that ethics is now incorporated into each class instead of teaching it as its own class and that now they focus on the students learning in small groups rather than large lectures.


02:05 PM

Dr. Krugman answered questions from the committee.


02:08 PM -- Labor Management Partnerships

Donna Lynne introduced herself as the President of Kaiser Permanente Colorado. She distributed a handout entitled "Labor Management Partnership" (Attachment V) and gave a brief background of Kaiser Permanente's history since 1969 when it began in Colorado. Ms. Lynne explained that Kaiser Permanente is both a health plan and a delivery system. In addition, there is a partnership between Kaiser Foundation Health Plan and Colorado Permanente Medical Group. She stated that Kaiser Permanente is a not-for-profit health plan and a substantial portion of its staff is unionized. She added that there are about 2,000 employees that are covered by SEIU Local 105 and about 1,300 covered by UFCW Local 7.

Ms. Lynne stated that Kaiser Permanente has taken a novel approach to both the delivery of health care and labor management partnership. She stated that there are 29 unions throughout Kaiser in 8 states, and, in order to make that relationship work, Kaiser created a labor management partnership.

Ms. Lynne stated that retention is a concern, and Kaiser spends a lot of time on training of staff, such as nurses. She added that in order to equip the staff with the skills they need, Kaiser offers internal training, career ladders, and educational opportunities to its employees.

Ms. Lynne stated that as a result of the labor management partnership, satisfaction of employees has gone up, and Kaiser has a turnover rate of 3.5 percent. Ms. Lynne explained that in the most recent bargaining round, they looked at workforce development and creating a fund over the next five years for training programs to continue or enhance employees' careers.


02:15 PM

Mr. Ackerman, President of SEIU Local 105, explained that his union represents 2,000 Kaiser employees in Colorado and 47,000 Kaiser employees throughout the United States. Mr. Ackerman discussed the national agreement between Kaiser Permanente and 83,000 employees represented by the Coalition of Kaiser Permanente Unions. He stated that the agreement contains a commitment to workforce development that is completely unprecedented in the health care industry. Mr. Ackerman discussed the unique labor management partnership agreement and employment security agreement negotiated between Kaiser Permanente and its Unions in 1997, with the philosophy to have an engaged workforce that will be the champions and agents of innovation in a rapidly changing industry. He stated that in order to achieve this, the employment security agreement stated that if employees do good work, they will have long term employment at Kaiser Permanente barring a catastrophic event. He added the labor management partnership agreement allowed employees, through their unions, to have a meaningful voice to shape the health care they deliver everyday.

Mr. Ackerman stated that the union members recently concluded a second national collective bargaining agreement with Kaiser that includes a commitment to workforce development. He noted that Kaiser Permanente is unique in its commitment to job security, market leading wages, superior benefits, and a meaningful collective voice in decisions that impact the employees work.

Mr. Ackerman stated that the agreement includes mechanisms for turnover analysis through exit interviews in order to optimize working conditions and retain skilled employees while creating a culture of life-long learning and career advancement opportunities for Kaiser's unionized employees. Mr. Ackerman explained the program is funded by an initial investment of $105 million dollars in the first 3 years of the agreement. He stated the fund provides for: career counselors in every region, trust funds to ensure joint union management decision making, employee access programs during work time, employee access to career mapping, and job pipelines.

Mr. Ackerman concluded his testimony stating that the agreements Kaiser has made with its unions will address Kaiser's workforce needs along with the needs of the community, save millions a year in turnover costs, and improve quality by creating a stable workforce.


02:23 PM

Mr. Duran, President of the United Food and Commercial Workers Union Local 7, spoke briefly about the types of health care employees that makeup the union. He stated that the number one job related issue is work load or staffing. Mr. Duran explained that in the contract, Kaiser employees are guaranteed time off and there are mechanisms to ensure that vacancies will be filled when they do.

Senator Keller asked how Kaiser and the unions handle someone whose performance is less than satisfactory. Ms. Lynne explained that the workforce development piece does not relate to that, but the normal disciplinary process does. She stated the contracts do provide for several tiers of review done by a supervisor, human resources, and in the most extreme cases, an actual grievance procedure. Senator Mitchell noted that when there are employee performance issues, it seems there are employee security systems designed to protect employees from being fired for less than adequate reasons, and then there are other systems that make it impossible for employers to fire employees. Senator Mitchell asked where Kaiser fell on that spectrum. Mr. Duran replied that they use an impartial third party arbitrator to make the decision as to whether the employee is terminated or not. Ms. Lynne added that the employee is also given a written plan in order to help the employee improve. She explained that Kaiser does not immediately terminate employees because of all the time and money invested in each employee, rather the first step they take is to try to improve the employee's performance.

Senator Mitchell commented on how happy he and his family have been with Kaiser's services and asked if there was something about Kaiser that made it more or less conducive to the collaboration system they described and how transferable the system would be to other health care arenas. Mr. Ackerman stated that there are other health care companies looking to Kaiser as an example.


02:35 PM -- Creation of a Workforce Database

Pam Dinkfelt, Colorado Health Institute, distributed a handout of her PowerPoint presentation (Attachment W). She stated that as steps are taken to optimize the health care workforce, it is critical to track related data. She shared with the committee the creation of a comprehensive database specific to the health care profession. Ms. Dinkfelt explained that the mission of the database is to advance the overall health of the people of Colorado by serving as an independent, impartial source for reliable and relevant health-related information for sound decision making. The type of information the database would include for each licensed health care professional is their: zip code, address of their home or business, age, education, licensing and or certificates, current employment, tuition reimbursement, and what reimbursement levels their health setting is receiving.

Senator Keller asked when the system will be compiled and ready to go. Ms. Dinkfelt responded that they are currently 4 months into a 4-year project. Responding to a question from the committee, Ms. Dinkfelt stated that the database only includes health care professionals licensed in Colorado.


02:46 PM -- Public Testimony

Paula Stearns, Executive Director, Colorado Nurses Association, distributed a handout of her testimony (Attachment X) and stated that bills relating to the nursing shortage may not be needed at this time. She discussed the 2002 additions to the Nurse Practice Act that were added to address the nursing shortage and what had been done with that act. She stated that one idea she feels can really be built on is the idea of a clearinghouse for a single point of contact for nurses to access shared resources. Ms. Stearns stressed to the committee that the answer to the nursing shortage is not to reduce the qualifications to become a nurse. She added that nursing licensure minimums in Colorado are one of the lowest already, thus they do not need to be made any lower. She also stated that Colorado has a really good career ladder concept that does not need to be changed either.

Senator Keller asked if the Colorado Nurses Association ever has discussions with hospitals on how they can change their format and how they can use staff on the floor to be more of a collaborative team approach. Ms. Stearns stated that the Colorado Nursing Association has not spoken with individual hospitals, but they have brought it up in general nursing discussions and meetings. She added that what works for one institution might not work for another. Senator Keller asked whether the Nurses Association is pushing nurses to talk with their own facilities rather than hiring consultants. Ms. Stearns agreed and stated that she feels the Nurses Association should take it further. Senator Keller urged her to do so and asked the committee for any further questions. Ms. Stearns concluded her testimony.


02:56 PM

Eve Hoygaard, a public health nurse, a nurse practitioner, and President of the Colorado Nurses Association, stated that the new generation of nurses are looking less at the money aspect, and more at the working schedule and lifestyle aspects of the job. As a result, Ms. Hoygaard stated that more and more nurses do not want to work Christmas, nights, or weekends. She explained that 12-hour shifts are a compromise to solve those problems and have worked well.

Ms. Hoygaard discussed the mature workforce and how to keep nurses in the profession. She stated that as nurses get older, 12-hour shifts become difficult. She suggested that part-time work options may help keep those nurses in the profession and reduce the workforce shortages.


02:59 PM

Gene Stile stated that one of the concerns he had not heard addressed was illegal immigration, and the cost hospitals incur by providing emergency services to this population. He stated that the money hospitals lose because of unpaid health care could be used instead to pay nurses salaries and benefits. Mr. Stile asked the committee to address the problem of illegal immigrants utilizing emergency rooms as their primary physician care. Senator Keller asked Mr. Stile if he had any data on how much emergency room care is given to illegals without insurance versus to U.S. citizens who do not have insurance. Mr. Stile responded that he did not know. He gave a personal account of the types of non-emergency problems people go to emergency rooms for instead of a doctor's office. Senator Keller agreed that it is a problem, and stated that the Joint Budget Committee visited a few hospitals in Grand Junction that have problems with the uninsured utilizing hospitals for primary care. She explained that the hospital in Grand Junction opened a nonprofit clinic for the uninsured to go to for non-emergencies. She stated that the committee could look at similar efforts. Senator Keller also noted that each patient at the clinic in Grand Junction pays a co-pay.


03:05 PM

Kristy Reuss, Department Head, Department of Nursing and Radiologic Sciences, Mesa State College, updated the committee on some of the innovations Mesa State has been doing as a regional education provider utilizing some of the resources the committee had heard about throughout the day. Ms. Reuss discussed the number of students who have and will be expected to graduate from Mesa's nursing program. She stated that within 5 years, Mesa State will have tripled the number of nursing students. Ms. Reuss stated that Mesa State College is able to do that by collaborating with the Workforce Development Center, the Colorado Trust and many local area hospitals. She stated that a Workforce Center grant allowed Mesa to bring back the associates degree program eliminated in the mid-1990s and to create an efficient and effective career ladder model allowing students to advance to the next level of education while working. She mentioned that Mesa will be extending the LPN program to the Montrose and Delta area.

Ms. Reuss stated that St. Mary's Hospital created a nursing lab for the school to use, and that scholarships for students to continue their education have been funded by the Colorado Trust. She stated that the Colorado Trust grant has also allowed them to have an LPN program at Mesa. Ms. Reuss explained that part of the Colorado Trust grant has been used to grow clinical faculty for the future. She stated that the western slope does not have very many Master's level nurses, so many of their clinical nurse faculty have BS degrees and work under the direction of a Master's prepared faculty member. Mesa has placed their Registered Nurse Bachelor of Science program on-line for education advancement. This also links nurses together throughout the region and allows them to share best practices.

Ms. Reuss stated that Mesa has been exploring with a private foundation the idea of a summer camp to recruit minority, middle, and high school students to explore health care careers. Senator Keller mentioned a recent trip the JBC had taken to the western slope where they visited Mesa State College and stated that is was a good program. Senator Mitchell stated that it seems health care impacts regional economics and asked if there were any unique western slope economics she would like to share. Ms. Reuss stated that Grand Junction is different than other parts of Colorado because it has a cluster of health care facilities within the community. She stated they are the regional hub for health care, they offer competitive salaries, and there is a good collaboration between staff. Ms. Reuss concluded her testimony.


03:17 PM

Virginia Gillispie stated that she is part of the Colorado Nurses Association and sits on the Nursing Practice and Professional Issues Committee. She explained that the American Nurses Association has looked at safe staffing, patient safety, and workplace safety for nursing and that her committee translates that to the local level.

Ms. Gillispie stated that if funding is available, she would like to see it spent on hands-on clinical training as well as technology. Senator Tochtrop commented on technology programs and asked why the Nursing Board allows nurses to train with a model, but will not use similar on-line programs for health care professionals who want to advance their careers. Ms. Gillispie described the types of simulation and on-line programs. Representative Butcher stressed the importance of the simulation models for rural areas and stated that it is good to have a percentage of clinicals done on models and the rest in a hospital. She stated that it would increase the capacity for clinical for nursing students.

Senator Mitchell asked if Ms. Gillispie could explain what she was referring to about priorities or spending decisions that are contributing to a shortage of training and education capacity for new nurses. Ms. Gillispie explained that since nursing faculty get paid significantly less than nurses in a health care delivery setting there is not much incentive to teach. Senator Mitchell commented that supply and demand should create rational pressure and rational incentives. Therefore, if there is a shortage of nurses, then it should affect the providers and cause them to remedy the problem. Ms. Gillispie mentioned some positive programs that have attempted to remedy the problem. Senator Keller added that the morning's presentations covered most of the innovative programs between hospitals, universities, nursing associations, and labor unions.


03:30 PM

Mike Kingsbury, a nurse at Denver Health Medical Center, commented on his personal philosophy as a nurse to treat every patient the same regardless of their racial background, county of origin, and citizenship status. He stated that, as a nurse, he is morally obligated and professionally bound to provide care to all persons no matter their status or ability to pay. Senator Keller closed public testimony.


03:32 PM -- Consideration of Proposed Legislation

Senator Keller stated that the committee has three proposed bills to discuss. She reminded the committee that at its September 27 they approved a bill to forward to Legislative Council related to hospital acquired infection rates, and that she and Representative McCluskey would be sponsoring that bill.

Michele Hanigsberg, Office of Legislative Legal Services, came to the table to discuss the draft bill related to telemedicine in the Department of Corrections (LLS No 06-0218.01) - (Attachment Y). She stated that the bill requires the department to study and report on the state's options for providing medical services to state inmates in correctional facilities through the use of telemedicine. Senator Keller asked if there were any amendments. None were offered.
BILL:Telemedicine in the Department of Corrections
TIME: 03:36:06 PM
MOVED:Keller
MOTION:Moved to forward the bill (Attachment Y) related to telemedicine in the Department of Corrections to the Legislative Council Committee. The committee determined that rather than a safety clause, a referendum clause was appropriate. The motion to forward the draft bill to the Legislative Council passed on a 7-0-3 roll call vote.

It was decided that the bill will start in the Senate, with Senator Tochtrop carrying it as the prime Senate sponsor, and Representative Butcher serving as the prime House sponsor. Representatives Frangas, McCluskey and Todd, and Senators Keller and Mitchell indicated that they wish to co-sponsor the bill. [Note: after the hearing, Senator Tochtrop and Senator Mitchell decided to switch the bills that they are prime sponsoring in the Senate, so Senator Mitchell will now be the prime Senate sponsor on this bill.]
SECONDED:
VOTE
Butcher
Yes
Clapp
Excused
Gordon
Excused
Johnson
Excused
McCluskey
Yes
Mitchell
Yes
Tochtrop
Yes
Todd
Yes
Frangas
Yes
Keller
Yes
Final YES: 7 NO: 0 EXC: 3 ABS: 0 FINAL ACTION: PASS


03:38 PM

Ms. Hanigsberg discussed a proposed bill related to telemedicine in home health care (LLS No 06-0219.01) - (Attachment Z). She distributed an amendment (Attachment AA) that clarifies that health care services should include but not be limited to medical equipment, devices and software. There was discussion about whether this would affect dual eligibles under Medicare Part D. Ms. Hanigsberg commented. The committee discussed whether the bill should be limited to telemedicine in home health care or if it should be broadened to cover all health care services. Senator Tochtrop stated that the bill is intended to address just home health care. Senator Mitchell suggested, in order to leave some flexibility, taking the word "home" out of the bill title. Representative Butcher stated that since this is a new program, focusing on home health care this session is important. Senator Tochtrop asked that the bill be kept with a focus on home health care in order to allow a more understandable fiscal note for the bill.
BILL:Telemedicine in Home Health Care
TIME: 03:49:22 PM
MOVED:Keller
MOTION:Moved to forward the bill (Attachment Z) that requires the Department of Health Care Policy and Financing to seek the necessary federal authorization for the reimbursement and provision of home health care services by certified home health care agencies through the use of telemedicine. The amendment to the bill related to what services are included was offered, and there was no opposition to the amendment (Attachment AA).

The motion to forward the bill, as amended, to the Legislative Council Committee was adopted on a 7-0-3 roll call vote.

It was decided that the bill will start in the Senate, with Senator Mitchell carrying it as the prime Senate sponsor, and Representative Todd serving as the prime House sponsor. Representatives Butcher and McCluskey and Senators Keller and Tochtrop indicated that they wish to co-sponsor the bill. [Note: after the hearing, Senator Tochtrop and Senator Mitchell decided to switch the bills that the are prime sponsoring in the Senate, so Senator Tochtrop will now be the prime Senate sponsor on this bill.]
SECONDED:
VOTE
Butcher
Yes
Clapp
Excused
Gordon
Excused
Johnson
Excused
McCluskey
Yes
Mitchell
Yes
Tochtrop
Yes
Todd
Yes
Frangas
Yes
Keller
Yes
Final YES: 7 NO: 0 EXC: 3 ABS: 0 FINAL ACTION: PASS


03:51 PM

Jeremiah Barry, Office of Legislative Legal Services, discussed the proposed bill related to a DUI surcharge to fund EMTS providers (LLS No. 06-0220.01) - (Attachment BB). Senator Keller asked whether this will be counted as revenue to the state under TABOR. Mr. Barry replied that it would be counted as revenue to the state. Senator Tochtrop stated that the auto insurance interim committee is already addressing the funding of trauma centers in that committee, and that she is concerned that this adds revenue to the state. Senator Keller agreed that raising more revenue is a concern since the state may need to turn around and refund it to the taxpayers.
BILL:Funding Trauma Services
TIME: 03:56:11 PM
MOVED:Frangas
MOTION:Moved to forward the bill (Attachment BB) that imposes an additional surcharge on persons convicted of certain alcohol driving offenses to fund emergency medical and trauma services to the Legislative Council Committee. The committee looked at two questions in the draft bill from the drafter. The first question is whether the committee wants to include a conviction for vehicular assault or vehicular homicide if the offense involved alcohol or drugs, and whether the committee wants to include an alcohol driving offense from another state as a previous conviction. Representative Frangas asked that the committee not include these additional offenses. The second issue was whether the committee wants a safety clause or a referendum clause in the bill. The committee determined that a safety clause was not needed.

The motion to forward the bill to the Legislative Council Committee failed on a 2-5-3 roll call vote.
SECONDED:
VOTE
Butcher
No
Clapp
Excused
Gordon
Excused
Johnson
Excused
McCluskey
No
Mitchell
Yes
Tochtrop
No
Todd
No
Frangas
Yes
Keller
No
Final YES: 2 NO: 5 EXC: 3 ABS: 0 FINAL ACTION: FAIL




03:58 PM

Senator Keller asked whether there were any additional bill requests. Representative Butcher commented on revolving loan funds, but wondered whether she should see what happens with Referendum C and D on November 1. Senator Keller encouraged the committee to wait until after the election on these types of issues since they involve funding.

Senator Mitchell and Senator Tochtrop decided that they would prefer to switch which bills they are prime sponsoring, therefore, Senator Tochtrop will be the prime sponsor on the home health care and telemedicine bill, and Senator Mitchell will prime sponsor the telemedicine in corrections bill.


03:59 PM -- Adjourn

The committee adjourned.