The Alaska Nurse - Vol. 58 No. 2 - May 2008

The Official Publication of the Alaska Nurses Association Circulation 10,000 to every Registered Nurse, Licensed Practical Nurse and Student Nurse in Alaska

Volume 58 • No. 2

May 2008

Certificates of Need in Alaska: Do We Really Need Them?

Page 8

Legislative Fly-In 2008

by Christine Sagan, ANP The third annual Nurse Legislative Fly-in to Juneau was the biggest yet. Fifteen nurses from around the state joined together for the Fly-In February 25-26. The luncheon reception sponsored by the Alaska Nurses Association hosted over 50 people including legislators, aides, nurses from Juneau and student nurses.

Meet the Professional Practice Committee

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Alaska Nurse Alert

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Inside This Issue Nurses and Nurse Practitioners from around the state attended the Fly-In. Seated from left, AaNA President Debbie Thompson; AaNA Executive Director, Tom Renkes; Donna Phillips; Janet Capito; Mary Stackhouse. Back row from left, Kay Lahdenpera, Corky Olson, Donna Patrick; ANPA President, Dianne Tarrant; Christine Sagan, Nancy Davis; Rhonda Richtsmeier; Pat Senner; Chris Van Cleve; Lynn Hartz.

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SB 28 Passes Senate, Falls Short in House Hospitals Lobby to Kill SB 28 Banning Mandatory Overtime for Nurses Publicly state they don’t require nurses to work forced overtime

By Pat Senner, ANP Senator Bette Davis sponsored SB 28, which banned hospitals from forcing nurses to work mandatory overtime, capped the number of consecutive hours a nurse could work to 14 and required a 10-hour rest period between worked shifts. The bill successfully made its way through the Senate (17-3) and the House HESS Committee.

The Alaska Nurses Association sent nurses to Juneau on several occasions to lobby for the protection of patients and nurses: with your help the bill made it further than any previous effort. Our lobbying effort in the last week of session generated more than 75 calls and a large volume of email. We were one committee away from a floor vote and had a strong majority in the House (picking up nine

cross-sponsors) for a vote if SB 28 had made it to the floor.

However, as a result of intensive lobbying by hospitals, the bill was killed when it was kept from having a hearing in House Finance.

At one point the hospitals had no less than nine lobbyists working against the bill including the Teamsters and the Tribal Health Consortium. During hearings held on SB 28 hospitals repeatedly claimed they do not use mandatory overtime and want to maintain their flexibility in meeting their staffing needs.

For the last four years, the Alaska Nurses Association has lobbied hard to pass legislation banning the practice of using mandatory overtime as staffing tool. When we first started this effort the use of overtime to staff was rare, but as the nursing shortage intensifies the practice has become more common each year. The hospitals have shifted from using mandatory overtime to mandatory

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Meet the AaNA Staff . . . . . . . . . . . . . . . . . . . . 2 Legislative Fly-In 2008 Photos . . . . . . . . . . . . 3 Nurses in the News . . . . . . . . . . . . . . . . . . . . . 5 Alaska NPs Go to Washington, DC . . . . . . . . . 5 Legislative Report . . . . . . . . . . . . . . . . . . . . . . 6 Thank You’s to Legislators. . . . . . . . . . . . . . . . 7 Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Seed Money for Your Dreams . . . . . . . . . . . . 11 Meet the Professional Practice Committee . 12 Membership Application . . . . . . . . . . . . . . . . 12 Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Alaska Nurse Alert . . . . . . . . . . . . . . . . . . . . 13 Upcoming Events . . . . . . . . . . . . . . . . . . . . . . 14

The AaNA Vision Empowering Alaska nurses to be dynamic leaders, powerful in both the health care and political communities.

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Page 2—Alaska Nurse—May 2008

Author Guidelines for the Alaska Nurse The editorial committee welcomes original articles for publication. Preference is given to nursing and health related topics in Alaska.

Authors are not required to be members of the Alaska Nurses Association.

Format and Submission Articles should be Word documents in 10 or 12 point font, single or double spaced.

There is currently no limit on the length of the article. Include the title of the article and headings if applicable. Author’s name should be placed after the title with credentials, organization/and or employer and contact information. Authors must identify potential conflicts of interest, whether of financial or other nature and identify any commercial affiliation if applicable.

All references should be listed at the end of the article. Pictures in black and white

or color are encouraged and may be sent as a jpg. file, as an email attachment or on disc. Photographs sent to the Alaska Nurse will become property of the AaNA. We hope that we will be sent copies, not originals and prefer emailed files. Be sure to spell check, grammar check and second check the article, any website addresses, references or phone numbers. It is recommended you have a colleague review your article before submission.

Prepare the article as a WORD document and attach it to an email to editor@aknurse. org. If you do not have WORD, try pasting the text of the article directly into the body of the email. You may also mail the article on disc to Editor, AK Nurse, Alaska Nurses Association, 3701 East Tudor Road Ste 208, Anchorage, AK 99507. If you have any questions email the Editor, Lynn Hartz at lhartz@alaska.com.

An official publication of the Alaska Nurses Association, 3701 East Tudor Rd., Ste. 208, Anchorage, AK 99507. Tel: 907/274-0827. Web site: www.aknurse.org. Published quarterly.

Materials may not be reproduced without written permission from the Editor. Views stated may not necessarily represent those of the Alaska Nurses Association.

Editor: Lynn E. Hartz, MSN, FNP lhartz@alaska.com AaNA Board of Directors President: Debbie Thompson BSN Vice President: Nancy C. Davis, MSN Secretary: Michelle Murphy, RN Treasurer: Donna Phillips, BSN

Meet the AaNA Staff

Credits on Alaska Photo Thank-you to all those who sent in photos for the masthead. Many beautiful pictures came in. In this issue is a photo taken by LCDR Gail L. Surrena, MSN, RN on a drive home to Wasilla. We hope you will continue to send in landscape photos to editor@aknurse.org as we continue to feature our local photographers on the masthead!

Corrections In our last issue we inadvertently left out information on two of the new graduates.

Leanne Blanks from Ketchikan AAS program received the Spirit of Nursing Award and Brenda Karras from the Fairbanks AAS program received the Director’s Award for Fall 2007. Congratulations Leanne and Brenda!

Directors: Labor Council Chair: Susan Walsh, RN Greater Alaska Director: Jane Conrad, RN Staff Nurse Director: Kathleen A. Gettys, BSN, BA Rural Director: Open Director at Large: Carolyn S. Adkins, MS Paul T. Mordini, RN Shirley LaForge, RN Martha Clinehens, RN Jennifer Straight, RN AaNA Labor Council Chair—Donna Phillips, BSN Vice-Chair—Kathleen Gettys Secretary—Karen Friedl Joshua Meals, ADN Jenni Hancock, RN Mary Stackhouse, RN UAN Rep.—Kathleen A. Gettys, RN, BSN, BA PAMC BU Rep.—Cindy Price, RN Soldotna BU Rep.—Velinda Albrechta-East, RN Ketchikan BU Rep.—Susan Walsh, RN

Lynne Sangster Administrative Assistant Lynne Sangster has worked at the Alaska Nurses Association since February of 2007 in the front office. She is originally from Georgia but has lived in Alaska for thirty-seven years. When not answering the phone and doing the multiple odd jobs demanded off a small office, Lynne enjoys genealogy, hiking and walking at H2 Oasis. Lynne feels her job with the nurses at AaNA is a fantastic addition to her life. One of her favorite parts of work is “talking to nurses from around this great state of Alaska.” She is also happy to be the grandmother of five-year-old Michael and three year old Trenton.

Affiliate Organizations: Alaska Chapter of the American College of Nurse Midwives Alaska Home Health and Hospice Association Alaska Nurse Anesthetists Association Alaska Nurse Practitioner Association Alaska School Nurses Association Forensic Nurses Association, Alaska Chapter Executive Director: Tom Renkes, RN, MS Advertising Rates Contact—Arthur L. Davis Publishing Agency, Inc., 517 Washington St., P.O. Box 216, Cedar Falls, IA 50613, 800-626-4081. AaNA and the Arthur L. Davis Publishing Agency, Inc. reserve the right to reject any advertisement. Responsibility for errors in advertising is limited to corrections in the next issue or refund of price of advertisement.

May 2008—Alaska Nurse—Page 3

Legislative Fly – In 2008 Nurses in the House

Pictured in the House Chambers standing in the rear are Speaker of the House John Harris and seated his chief of staff John Bitney. In the front row left to right are, AaNA lobbyist Mark Hickey; AaNA Labor Council Chair Donna Phillips; Carol Clausson; UAN Rep. Kathleen Gettys and AaNA Executive Director Tom Renkes.

Student Nurses from Juneau at the Silverbow Inn Reception

From left to right, Mae Clifton; Juanita Reese; Rigel Falvey and Rachael Sturrock.

And More Student Nurses…..

From left to right, Keith Goering; Sandy Hamblin; Melissa Rose; Donna Phillips; Hannah Mendelsohn; Patrick Grieser; Kirsten Kincaid.

Nurse Practitioner HistoryMaker Joins Reception

Connie Trollan, ANP and owner of Wellspring Integrative Medical Center in Juneau was a moving force in changing the state statute in the 70’s that eventually led to independent practice by nurse practitioners in Alaska.

Page 4—Alaska Nurse—May 2008

SB 28 Passes Senate

Legislative Fly-In 2008

call. To avoid loopholes caused by semantics, SB 28 capped the number of consecutive hours a nurse can work at 14.

Research has shown that nurses who work over 12 hours are three times more likely to make errors. These errors can have serious consequences for patients and nurses. Banning the practice of making nurses work excessively long hours is preventative on several fronts. Rested nurses provide better patient care, they are less likely to make errors, they are less likely to experience injuries and they are more likely to stay with their jobs. The use of mandatory overtime aggravates the nursing shortage because nurses who are required to regularly work long hours quit their jobs and look for better work settings.

We started out last year behind on this issue; we’ll start out ahead next time in terms of legislators who support us, information in the public record, and strong grassroots organizing efforts. We can win next session with more nurses coming forward to lend their voices to the effort— we need your willingness to get involved and share your stories. Washington State, Oregon, and California have all passed bills banning mandatory overtime. Hopefully next session Alaska will join their neighbors in passing this needed protection.

[Pat Senner works for Covenant House and is Chairperson of the AaNA Legislative Committee.]

Nurses flew down to Juneau to speak to legislators about issues important to nursing.

Members from AaNA, the Alaska Nurse Practitioner Association (ANPA), School Nurses Association and Public Health were present from Fairbanks, Chickaloon, Wasilla and Juneau. Our local nursing leaders, AaNA executive director Tom Renkes and ANPA president Dianne Tarrant were present as well. The time was well spent —a busy 48 hours strategizing, planning and discussion. Over 18 legislators were visited, with our top-notch lobbyists Mark Hickey and Caren Robinson keeping us informed and booked. Various groups of nurses visited senators and representatives every 15 minutes to voice our concerns. The morning began with UAA Chancellor Fran Ulmer addressing the group about funding concerns for UAA; later Lynn Hartz testified in front of the Senate Labor and Commerce Committee in support of Senator Hollis French’s health care bill SB 160. Several nurses collectively presented in front of the House HESS committee regarding the status of nursing in Alaska.

After a long day of interacting at the capitol, we decompressed and reflected on the journey to Juneau. Overwhelmingly, nurses agreed it was well worth it. Janet Capito, a school nurse from Juneau who has been in the profession since 1966, remarked, “All of these years that I have lived in Juneau, I have never spoken to legislators about issues. It was very interesting— fascinating to watch the process of how information is gathered.

They really are available to us. I did not think they had the time to listen or engage.” Others had the same sentiment regarding the attentiveness of the legislators. But distance is not the only barrier in having opportunities to engage with our politicians. The legislators are bogged down with 500 bills and just 90 days to wade through

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them. Not only did we shed light on bills that affect nurses, but our presence made a statement.

The face-to-face interaction and the opportunity to educate them on our role in community health care should prove important when the bills come up for vote.

Nurses preparing to lobby their legislators, left to right Donna Phillips; Kay Lahdenpera; Dianne Tarrant; Christine Sagan and AaNA President Debbie Thompson.

Chris Van Cleve, the Alaska representative of the National Association of School Nurses, shared what she learned from her first time with legislators, saying, “Nurses really do support one another no matter what the specialty. All nurses are bound by a common thing.”

Renkes has made four trips to Juneau in the past five months. He said trips to Juneau give visibility to the profession and do make a mark on the legislature. “They do take notice,” he said.

May 2008—Alaska Nurse—Page 5

Nurses in the News

Debbie Kiley MS, ANP, FAANP

Congratulations to Debbi Kiley, MS, ANP, FAANP, who was re-elected as the Region 10 Director of the American Academy of Nurse Practitioners. Region 10 encompasses the states of Alaska, Washington, Idaho and Oregon. The American Academy of Nurse Practitioners (AANP) is a professional society of nurse practitioners with over 24,000 members.

Alaska NPs Go To Washington, DC Dianne Tarrant, ANPA president, Debbi Kiley, AANP Region 10 Director, and Cathy Giessel, Alaska State Representative, attended the Leadership Fellowship in Washington DC on April 6-8 hosted by the American Academy of Nurse Practitioners (AANP).

The Fellowships are convened twice a year, by invitation extended to state leaders. The Alaska leaders visited the offices of our Congressional team, to discuss issues important to nurse practitioners. Jan Towers, Director of health Policy for the Academy helped identify the following as key points to discuss with congressional members: • Title VIII Reauthorization of funding for Nurse Practitioner Educational Programs and Traineeships; this is the only federal funding source for these programs since they have no access to graduate medical (GME) funds.

• Reimbursement Authorization for services under The Federal Employee’s Compensation Act (FECA). NPs have been recognized and reimbursed in the Federal Health Insurance Program for 20 years; they have not been identified as authorized providers in the Federal Employee Workers Compensation Program. Seek an amendment to add nurse practitioners to the list of providers authorized to provide services.

Barb Berner ANP, EdD is on the left; Mary Anne Wilson, ANP, MSN is on the right.

Two nurse practitioners had their retirement parties April 14 at UAA. Barbara Berner, the Co-ordinator of the Family Nurse Practitioner Program for 10 years and Mary Anne Wilson, the Director of UAA Student Health and Counseling Center for 13 years. Barb retires after 41 years in nursing and Mary Anne after 26 but if they are like other “retired” nurses, we’ll believe when we see it! Congratulations and thank you for your years of service.

Dr. Barbara Berner also received a national award recently. She has been recognized as the Outstanding Nurse Practitioner Faculty Person of the Year by the National Organization of Nurse Practitioner Faculties (NONPF) at their annual conference in Louisville, KY. Berner was given the award for “her innovative approach in teaching and developing the Family Nurse Practitioner curriculum at the University of Alaska Anchorage. She has successfully merged a focus on independent, critical thinking with clinical competence to produce superbly qualified graduates of the FNP program. And she has done this in both a classroom setting and through distance learning.”

Kathleen Gettys, RN of Anchorage has been elected as a national Director at Large in the United American Nurses, AFL-CIO (UAN) union.

Gettys serves on the Alaska Nurses Association (AaNA) Board of Directors and the AaNA Labor Council.

Go to aknurse.org For online CE Nursing News Alaska nursing links And more!

• Medical Home developed around the patientcantered care model that includes physicians at the center of delivery and doesn’t include language to have nurse practitioners in the role of primary care providers. We seek language to include all primary care providers, and we want input in the development and design of the programs.

• Nurse practitioners want to be able under Medicare rules to write orders for home health and to admit and manage care in longterm facilities.

• The Medicaid bill needs co-sponsors so there is reimbursement across the board to NPs providing primary care to Medicaid recipients.

The entire Alaskan nurse practitioner delegation met with Health Legislative Aides Liz Connell (Stevens) and Amanda Makki (Murkowski); both of them were very familiar with the essential role that NPs play in Alaska healthcare delivery and indicated that they would be investigating legislation language to allow expanding NP participation and reimbursement for healthcare services.

We had the opportunity to talk to Senator Murkowski in person for about 20 minutes. She expressed a clear understanding of NP scope of

practice and quality of care, stating that NPs were critical providers of primary care in Alaska. She inquired about UAA nurse education programs and ideas to expand access to healthcare.

Dianne had a 30 minute visit with Congressman Young and had the opportunity to discuss with him the important role that NPs play in the delivery of primary care to Alaskans citizens across the entire state.

Dianne will keep her Legislative Fellowship Program (that reviews the legislation important to nurse practitioners) at the ANPA office.

Please contact Catherine Giessel FNP if you will be attending the American Academy of Nurse Practitioners National Convention during June 26–July 1, 2008 and would like to be part of an Alaskan delegation meeting with our congressional members on the hill on June 26th. You can e-mail her at: cgiessel@mac.com. Please go to the AANP web site or email 2008conference@aanp.org regarding registration questions or concerns.

Page 6—Alaska Nurse—May 2008

Legislative Report

by Pat Senner SHORTENED SESSION HURTS NURSES EFFORTS As chair of the Alaska Nurses Association’s Legislative Committee I was very worried at the beginning of the session about the impact of the shortened session on the ability of nurses to get legislation passed. Usually the nurses are able to prevail by wearing down their opponents, who often have more money and therefore better pull with certain legislators.

Our lack of success this session bore this concern out with two of our bills dying because they were held up in House Finance and Rules (SB 28 and SB 212). We just didn’t have time to break them loose even though we had the votes to get them passed on the floor.

Efforts to Increase the Number of Children and Pregnant Women Covered by Denali KidCare Fail in House SB 212, Medical Assistance Eligibility, increased the financial eligibility criteria for accessing Denali KidCare to 200 percent of the federal poverty guidelines. Unfortunately, Rep. Coghill kept the bill from the House Floor for a vote on the last day of session. Since the bill died, approximately 1200 children and 200 pregnant women will not have health care during the next year.

The Alaska Nurses Association testified in favor of SB 212. One of the arguments against this bill is that people in the 200 percent of poverty income bracket should be able to afford health insurance.

In doing research to counter this argument, we found that to purchase Blue Cross Blue Shield insurance for a mother and two children would cost over $9,000 dollars a year. This would be about a quarter of a person’s income at the 200 percent level. In contrast, Denali KidCare costs the state $642 a year per enrollee. The total cost to the state of the increased eligibility would have only been $770,000 per year.

Alaska ranks 42nd in the country in the percentage of children it covers with its state child health insurance program (SCHIP) Denali KidCare.

With the increased alarm about the amount of uncompensated care being provided by hospitals, and the State having billions of dollars in excess revenue, it is hard to imagine that a small amount couldn’t have been spared to cover Alaska’s children.

Nurses Weigh in on Discussion of Controlled Substance Prescription Database One of the bills to pass the legislature this session was SB 196, sponsored by Senator Lyda Green. The bill establishes a controlled substance

prescription database. The bill requires the Board of Pharmacy to develop a controlled substance prescription database that contains information about who has had prescriptions filled for controlled substances I through V on the Federal list. Every time a pharmacist fills a prescription for a controlled substance they must enter into the State database the name address and date of birth of the person for whom the prescription was written and the name, strength and quantity of prescription prescribed.

The Alaska Nurses Association testified that since ANPs are prescribers of controlled substances we welcome having data to confirm what the patients tell us about what medications they have been prescribed in the past. We testified that from our standpoint we are more interested in preventing patients from becoming addicted to controlled substances than we are in “catching the bad guy.”

However, as patient advocates, we are concerned about the safety of the data in the database and who might access it. For instance, a person might access the data to find out whether a co-worker or famous person has been prescribed a controlled substance. Worse yet, a person seeking drugs might access the database to find out which homes to break into to obtain controlled substances.

In order for outside agencies, such as a law enforcement agency or the Board of Nursing, to access the data in the database they need a search warrant or subpoena. Individuals have the right to access their personal information to make sure it is accurate and an identity theft has not occurred.

Because of the Nurses Association testimony many protective clauses were put into the bill during committee deliberations that were not in the original bill. We plan to follow the development of the database and regulations governing it to insure as much safety as possible.

May 2008—Alaska Nurse—Page 7

Thank-you’s to Legislators The Alaska Nurses Association wishes to express THANK YOU’s for their work during the last legislative session to the following legislators: Senator Bettye Davis for Sponsoring SB 28, banning mandatory overtime, and SB 212, increasing Denali KidCare eligibility, and working so hard to get the bills passed.

CPR Successful! SB 160 will be back next session.

Christine Sagan, ANP discussed health care with Senator Hollis French.

Pictured are Kathleen Gettys RN, Senator Bettye Davis and AaNA Executive Director Tom Renkes, RN. Representative Peggy Wilson for working so hard to try to get SB 28, banning mandatory overtime, through the House and for allowing SB 212, regarding Denali KidCare, through her committee.

Representative Berta Gardner for her constant support of nurses and asking such good probing questions of the hospitals during hearings on SB 28.

Representative Paul Seaton for co-sponsoring SB 28 and for voting to pass SB 212, Denali KidCare, out of committee.

Senator Johnny Ellis for co-sponsoring SB 196, SB 212 and SB 160.

Representative Sharon Cissna for voting to pass SB 28 and SB 212 out of House HESS Senator Joe Thomas for asking good questions of hospital representatives during hearings on SB 28 and for voting to pass SB 212.

Representative Carl Gatto for co-sponsoring SB 28 and for always being a supporter of nurses.

Senator Lesil McGuire for sponsoring a bill to require health insurance companies to cover well baby visits and for voting for SB 28 and SB 212.

Representative Bob Lynn for co-sponsoring SB 28 and his support of nurses.

Senator Bill Wielechowski for co-sponsoring SB 160 and SB 28 and voting for SB 212.

Senator Hollis French for Sponsoring SB 160, which would allow persons to get vouchers based on a sliding scale to purchase health insurance, and for co-sponsoring SB 28.

Representative Harry Crawford for cosponsoring SB 28 in the House and for his support of making sure workers work in a safe environment.

Senator Con Bunde for voting for SB 28 in the Senate.

Senator Bert Stedman for letting SB 28, SB 212 and SB 160 be heard in his Senate Finance Committee.

Representative John Harris for his support of SB 28 in the House.

Representative Beth Kerttula for supporting SB 28 in the House.

Representative Scott Kawaskaki for his support of SB 28 in the House and for co-sponsoring a student loan repayment bill.

Representative Mike Doogan for supporting SB 28 in the House and for writing such interesting newsletters that helped keep us informed during session.

Representative Anna Fairclough for doing such good research in preparation for hearings on SB 28.

Senator Kim Elton for asking good questions of the hospitals during hearings on SB 28 and support of SB 212.

Representative Lindsey Holmes for making important changes to SB 196, the prescription drug database bill, and for being a supporter of all Alaskans having access to health care.

Representative Mike Doogan autographs his book for Christine Sagan, ANP.

Lynn Hartz, ANP, Representative Lindsey Homes and Pat Senner, ANP. Representative Gabrielle LeDoux for cosponsoring SB 28 in the House.

Representative Les Gara for introducing a bill in the House to increase Denali KidCare eligibility.

Representative Craig Johnson for sponsoring a loan repayment program that would included nurses.

Representative Bill Stoltze for co-sponsoring SB 28 in the House.

Representative Jay Ramras for co-sponsoring SB 28 in the House.

Representative Max Gruenberg for cosponsoring SB 28 in the House.

Representative Bob Buch for co-sponsoring a student loan repayment bill in the house.

Senator John Cowdery for voting for SB 28 and SB 212 in the Senate.

Senator Lymans Hoffman for voting for SB 28 and SB 212 in the Senate.

Senator Albert Kookesh for voting for SB 28 and SB 212 in the Senate.

Senator Donald Olson for voting for SB 28 and SB 212 in the Senate.

Representative Mike Hawker for supporting SB 28 in the House.

Senator Gary Stevens for voting for SB 28 in the Senate.

Senator Gene Therriault for voting for SB 28 in the Senate.

Representative Mike Chenault for supporting SB 28 in the House Senator Fred Dyson for voting for SB 28 in the Senate Senator Thomas Wagoner for voting for SB 28 in the Senate.

Senator Gary Wilken for voting for SB 28 in the Senate.

Page 8—Alaska Nurse—May 2008

Commentary Certificates of Need in Alaska: Do We Really Need Them?

by Thomas J. Hendrix, PhD, RN The state of Alaska is currently defending itself against multiple lawsuits because our government denied the plaintiffs an opportunity to use their own resources to build health care infrastructure within the state.

It is through the “Certificate of Need” (CON) regulatory process that these potential investors have been denied the ability to build. Stating that Thomas Hendrix PhD, RN Alaska is in an indefensible legal position, Governor Palin has requested that the state of Alaska eliminate CON regulations because they inhibit the purchase and/or construction of new, large-scale health care infrastructure. The Alaska legislature took up the issue and it is currently embroiled in a debate and, at this point, it appears that consensus is almost impossible. This article will provide a little background into CON. Why did they get started? What do they do? What are recent trends? Who are the winners and losers? Are there nursing implications? Why do some people want to eliminate (or modify) CON programs and why do others refuse to budge from the current level of regulation that CON rules require?

History: The seeds of CON started in 1966 when the U.S. Congress required that all states receiving funds for public health or Social Security programs had to establish a state planning agency.

In 1972 Congress made this law more intrusive by requiring that all states review all health care infrastructure expenditures exceeding $100,000 and if states failed to comply, they risked losing Medicaid payments from the federal government.

In 1974, Congress went a little further. Not only did individual states need to review health facility expenditures, they would now be required to determine if those expenditures were “necessary” and, once again, the threat of losing federal dollars resulted in an offer that the states simply could not refuse1. Back then, almost the entire health care system was “cost-based.” That is, the level of

review prior to providing services was minimal (if at all) and the providers of health care services were not that concerned about whether they would receive payment for their services. They simply sent the bill to a private insurance company or the government and they were paid. In fact, the incentive for providers was essentially the following: the more I do; the more money I make.

In a world with that kind of incentive, providers tended to do a lot and costs were rising rapidly.

Congress was trying to react to these cost-based incentives by attempting to reduce the supply of health care facilities because they feared that “if you build it they will come” and, in a costbased system with rapidly rising Medicare and Medicaid budgets, Congress was beginning to fear the impact on their own budget. Beginning in 1975, individual states began to pass CON laws and by 1982, all 50 states had some form of CON regulation on the books. However, healthcare costs were not being contained by the presence of CON regulations and, in 1982, Congress, appearing to admit the failure of CON legislation, repealed the mandatory health planning law and, subsequently, 14 states have repealed their own CON laws2.

Thus far, Alaska has not. In fact, according to the Washington Policy Center, Alaska currently has the second largest scope of CON regulations of all the fifty states (Connecticut is first). The Policy Center calculates scope by multiplying the number of services covered under CON and the dollar level at which CON regulation begins1. In other words, if many services are covered and the dollar threshold for coverage is low, the scope of government oversight and intervention through CON is large. Alaska’s scope remains relatively large.

Economic Theory: A government intervention, by economic definition, raises the cost of whatever area of the economy it is involved in. This is unarguable. All else equal, efficient and free markets have been proven over time to provide the highest quality product or service at the lowest price. That said, not all products and services exist within free markets and therefore, markets do not always function correctly or efficiently. When markets are “broken,” society turns to government.

For example, individual citizens do not purchase battleships and jet fighters: the government takes care of that. We don’t each purchase a road or utility pole: we pool our resources through a government entity. So, as in many other aspects of health policy, we are left to try and determine whether government intrusion into a (potential)

market is justified because of an “unfixable” market failure or whether the government damages a (potential) functioning market through regulation thus lowering quality and raising prices for everyone. That said, let’s examine CON. In a nutshell, the state currently has the power, through CON laws, to prohibit the construction or purchase of expensive health care infrastructure by simply determining that the new equipment or business is not “needed” and therefore, the proposed construction or purchase is not “certified.” This has the effect of reducing overall competition by protecting existing businesses from potential new competitors who are prohibited by law from putting infrastructure in place. Markets function best when there are many sellers putting downward pressure on price and/or upward pressure on quality. New entrants attempt to stake a claim into a market niche through one (or both) of these mechanisms. They offer the same product or service at a lower price or, for a similar price; they offer a higher quality product. As a result of increased competition, existing businesses must either become more efficient to compete on price or they must produce a higher quality product.

Both of these choices necessarily reduce the profit margins of the existing business. From a pure profit perspective, it is certainly in the best interest of the existing business to limit their competition in order to maintain higher profits. The government, through CON rules, accomplishes this for them.

How? To comply with CON regulations, potential new entrants into the healthcare arena must first spend additional time and money conforming to the regulatory process and then, after making that upfront expenditure, they may still be denied permission to put their infrastructure in place and compete. However, it is not a market (customers) that makes that verdict through purchasing decisions. Rather, the decision to deny permission comes from a government entity, in this case from an arm of Health and Social Services, which can simply state that, we do not “need” that particular infrastructure and therefore it cannot be built or bought. This process clearly contributes, at some level, to monopoly profits for existing businesses because the government, in effect, protects the existing business from competition. However, the story does not end there. As stated previously, sometimes there are societal reasons to justify this sort of government intrusion into markets.

Therefore, we (the citizens) need to answer the following question: is the market broken to such a degree that we willingly (and knowingly) restrict competition which necessarily leads to monopoly profits (at some level) flowing to existing healthcare organizations because, by doing so, we serve the greater good? Although various stakeholders may attempt to cloud the

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Certificates of Need in Alaska . . .

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issue with many shades of grey, this really is the only question.

Arguments and Analysis: The proponents of maintaining the present CON structure make quite a few arguments supporting their position.

Some seem to have more merit than others. Let’s examine them.

1. One argument states that health care consumers do not shop around for medical services the way they do for other goods and services. Therefore, competition will not have the same effect on price as it would in other areas of consumption and, it therefore follows, that regulation is a better way to help “set” prices. On its face, this argument has some merit though less than it used to.

First of all, individual consumers are not the only ones shopping for health care. Insurance companies and government payors are also interested in low prices. If a new entrant into a market were to offer the same product at a lower price, insurance companies would use that as a “bargaining chip” and begin to expect other suppliers to also lower their prices. This would eventually put downward pressure on premiums which benefits any purchaser of health insurance.

Secondly, in recent years there has been an attempt to inject market incentives into the system. Flexible Spending Accounts, Health Reimbursement Accounts and Health Savings Accounts have all been steps that put health care dollars into the hands of consumers in an attempt to incentivize them to pay more attention to price. As an appointed member of the Governor’s Health Care Strategic Planning Council, I know that a major recommendation of the Council was to try and move Alaska’s healthcare system in the direction of free markets and, in fact, we recommended a transparent website where the producers of healthcare goods and services would post their prices.

If consumers have price information and an incentive to save money, they should, in theory, comparison shop. Therefore, although at present there are not many individual “comparison shoppers” in healthcare, there are an increasing number of them and that number should continue to increase over time. In a world of more transparent pricing, competition, in fact, does set more efficient prices than a central planner.

2. Another argument in favor of maintaining CON regulations is based on the total cost to the system at large. According to the American Health Planning Association, CON laws limit health care spending. They state that, through regulation, an “appropriate” amount of competition can be maintained and, by controlling construction, the government can manage infrastructure in an effective way2. Some find this argument completely unpersuasive. First of all, government entities are wholly incapable of deciding what an “appropriate” amount of competition is. If some believe in an “appropriate” level of competition then, by necessity, they must also believe that there is a gap between market-based competition and an “appropriate” level of competition.

If, as we know, markets with many sellers produce efficient prices, then something less than market-based competition, for example “appropriate” competition, will produce higher prices and, once again, those currently providing those services would receive monopoly profits. In short, by restricting supply, you increase price.

So why would anyone want to do that? The government must believe that there is an unmet demand for care and as the payor for some of those services they will save money by restricting supply. Of course, if this is their belief then they must simultaneously believe that it is acceptable for an unmet demand for care to continue to exist; that it is all right for fellow citizens in need of services to remain in need them at some higher level than they otherwise would have been. One thought must necessarily follow the other. However, those that

believe that money is saved by restricting the supply of health care facilities are clearly mistaken. In 2004, the Department of Justice and the Federal Trade Commission both reported that CON laws actually increase prices, reduce quality and decrease access primarily because CON regulations inhibit competition. A 1999 study in the state of Washington arrived at a similar conclusion4. In fact, no credible statistical evidence that supported the notion that restricting supply through CON laws reduces cost was found. Conversely, instead of reducing expenditures, CON laws appear to simply redirect increased expenditures to those existing suppliers who then pocket monopoly profits.

3. The final argument for maintaining CON laws goes something like this. Hospitals are required by law to treat everyone that comes through the door irrespective of their ability to pay. Furthermore, a hospital is not, in reality, a single entity. It is, in fact, many smaller entities that all operate under the umbrella of the hospital. Many (most) of those smaller entities lose money. Very few hospital units are profitable and the hospital relies on the profits of those few units to make up for the losses throughout the rest of the facility. For the hospital to stay in business, the state must allow them to earn monopoly profits in those few areas that are profitable. Therefore, the state must restrict competition. Shawn Morrow, the head of Bartlett Memorial Hospital in Juneau, presented this argument quite nicely in an Anchorage Daily News article in February of this year5. Normally, this is not a persuasive argument and, in fact, in any of the lower 48 states, it would remain unpersuasive.

However, in some cases, this argument may have some merit in Alaska. As I learned firsthand during the Health Care Strategic Planning Council hearings, the logistics of this state are unique and make it extremely difficult to provide care in many geographic areas. Given that the law requires hospitals to provide care to everyone regardless of their ability to pay and that there are some areas of the state where there is only a single hospital serving the public, there may be a “public good” argument that the state has a responsibility to ensure that those isolated hospitals remains viable. CON laws may help accomplish this. However, it should also be stated that hospitals are not the only ones giving uncompensated care. Providers that accept Medicare and Medicaid patients receive something less than full compensation for their services.

Some providers take care of patients that never pay at all. This is also uncompensated care. Pharmaceutical companies provide tens of millions of dollars worth of prescription drugs at a zero or a reduced price based on ability to pay. Once again, this is uncompensated care. These are just a few examples of generosity within the healthcare industry: there are others. So, although hospitals are required by law to provide uncompensated services at a cost to them, many other providers do the same exact thing (also at a cost) though they are not required to do so. But, it is indeed true that hospitals are required by law to do so and that certainly must be a consideration when decision makers examine the role of CON regulations.

Current Legislation: To quickly summarize, Governor Palin called for an end to CON regulations and the legislature has taken up the issue. After much debate, there are two companion pieces of legislation which would amend current CON law. They both currently sit in House and Senate committees. Senate bill (SB) 656 and House bill (HB) 47 state the following: “An Act amending the certificate of need requirements to apply only to health care facilities that are nursing homes or residential psychiatric treatment centers or that are located in a borough with a population of not more than 25,000, in the unorganized

May 2008—Alaska Nurse—Page 9

borough, or in a community with a critical access hospital."

Additionally, there is another bill in the House (HB 3458) that states the following: "An Act amending the certificate of need requirements to exclude expenditures for diagnostic imaging equipment in certain circumstances."

This most recent bill (HB345) seeks to carve out an exception to CON for diagnostic imaging equipment if the equipment will be located in a population area of greater than 60,000 without a “critical access” hospital and has at least half ownership by at least one physician qualified to interpret the images produced by the facility.

Let’s start by stating that none of these bills is close to final passage. Therefore, we can expect continued debate and negotiation. The first two bills, HB4 and SB65, remove CON regulations except if the proposed infrastructure is in a geographic area with a population less than 25,000 or if the community has a “critical access” hospital.1 This seems to be in response to the concern that in small communities there is a “public good” to sustaining critical facilities.

There are good arguments on both sides of this compromise and, in my opinion; good people can disagree on whether there is a need to maintain this kind of government intervention. The other part of this amendment specifically targets nursing homes and inpatient psychiatric facilities. In other words, any entity (person or firm) that wishes to construct either of these kinds of facilities anywhere in the state of Alaska at a cost of more than one million dollars is still subject to existing CON regulations. Therefore, any new entrant must expend time and resources to go through the CON process and then may be turned down by the government. In all of healthcare, what is special about these two areas?

Currently we “ship” hundreds of our youth outside of Alaska for inpatient psychiatric care. However, the Alaska Mental Health Trust Authority, a relatively unique institution, has been implementing a long-range plan to expand mental health capacity within the state and, as such; they have steadily been reducing the number of Alaskans transported “outside”10. This is commendable. However, I have also heard that it is because of this long-range plan that the proponents wish to continue CON regulations in the area of inpatient mental health. They want to continue to implement their plan. They are concerned that an outside entrepreneur might initiate a project where patients are “warehoused” and would not receive appropriate care. While this may (or may not) be true, there is certainly a risk that no matter who opens a facility, patients may not receive appropriate care. This will be true whether the facility is “planned” or not. It is also true that irrespective of the good intentions of the planned expansion, this year we will still have hundreds of our youth residing thousands of miles away from where they live receiving treatment in another state. If you believe that the biggest predictor of today’s behavior is yesterday’s behavior, then it is curious that we would continue to allow a central planning process to dictate what can and cannot be built. There certainly appears to be a need for new capacity and if an investor chooses to invest, why would we be opposed to that? In a marketplace, if a new facility does not meet the needs of its customers, that facility will either go out of business or will be shut down.

I find the inclusion of nursing homes even more curious especially since this is an arena that many professional nurses nationwide have chosen as a platform to start their own businesses. Is there a surplus of nursing home beds that I am unaware of? Our population gets older every year and this trend will continue for quite awhile. Many of our older citizens leave the state for all or part of the year for many reasons but some leave, in part, because of a lack of support facilities. I am open to be educated about this, but it appears that this is simply an example of the government protecting the monopoly profits of existing skilled nursing

Continued on page 10 1 A critical access hospital is certified to receive cost based reimbursement from Medicare. They must be located in a rural area. In Alaska, these are Valdez Community, Providence Seward, Cordova Community, Kanaknak, Norton Sound, Petersburg, Sitka Community, Manilaq, and Ketchikan General9.

Page 10—Alaska Nurse—May 2008

Certificates of Need in Alaska . . .

Continued from page 9

home enterprises. If those in favor of continuing CON regulation in the nursing home industry are concerned about quality, once again, the market should take care of that. New facilities would need to be certified to receive federal funds. Additionally, why can’t the citizens or their families or other interested parties play the watchdog? If there are citizens that require skilled nursing care, they should have an opportunity to receive it. More facilities would certainly help. If there is not an unmet demand for skilled nursing care and a firm chooses to enter the nursing home market, economic theory suggests they would have to increase quality for a similar price or offer similar quality at a reduced price. Either outcome would be good.

Finally, HB345 proposes more protection to existing businesses then HB4 and SB65. First, it increases the population threshold from 25,000 to 60,000. This, in effect, increases the number of existing businesses that would receive government protection from new competition. It also targets diagnostic imaging centers which happen to be one of the areas within hospitals that are very profitable. I can understand why it is in the best interest of existing diagnostic imaging centers to restrict competition but I cannot understand why it is in the best interests of the citizens as expressed through their representatives. A new imaging center would have to compete in the existing marketplace on either quality or price or both. Lower prices and/or higher quality benefits everyone except those already in the imaging business. The amendment also restricts ownership so that more than 50% of the enterprise must be owned by at least one physician “qualified” to read the images produced by the facility. Why is this?

Do we require farmers and ranchers who grow crops and produce beef to be majority owners in a grocery store? Do we require people who fish to be majority owners in a cannery? Why would we

require physician ownership? Couldn’t an expert in running an efficient business hire a qualified physician to interpret the images? Couldn’t a nurse be that person? Maybe the new business would enter into a contract agreement with a qualified physician where the efficient imaging center would pay a price to the physician for their expert interpretation. On its face, this amendment seems to accomplish nothing except to continue to protect existing, high-priced diagnostic imaging centers and “qualified” physician owners. However, I am open to be convinced otherwise.

Nursing Implications: If CON regulations remain unchanged, the nursing environment will remain as it currently exists. Nurses can judge for themselves whether that is good or bad.

If CON regulations are amended to allow more competition, the landscape will certainly change over time. First, nurses, like every consumer of health care, would prefer to see health care costs go down or at least to not rise quite so rapidly.

Amending CON laws should help that happen.

As workers within the health care system, it is hard to predict what would happen. It appears that hospitals and physicians would have less influence in the healthcare marketplace. How much less remains to be seen but if they have less, some other entity would certainly have more. Nurses are a distinct possibility. The areas in hospitals that would be impacted the most are diagnostic imaging centers and day surgery.

These are the most profitable and therefore, the most attractive to a potential competitor. Unless a major hospital goes out of business, which is highly unlikely, bedside nurses should see little effect. I suspect that if hospitals feel an urgency to compete based on price because of reduced profits, hospital administrators will look for ways to become more efficient. Some of the areas they might pay increased attention to are mid-level

management, wasted supplies and medical errors, though all three of these areas are almost always being scrutinized already. I could also picture many more opportunities for nurse entrepreneurs.

If the playing field were to become more open to new entrants, I have great faith in nurses to capitalize on business opportunities and compete for health care dollars across the spectrum.

Initially, these opportunities might be limited to nurse practitioners and advanced degree nurses with certifications but, over time, young nurses could stand on their shoulders and enter the profession with a dream of leaving their mark on the business end of health care.

Conclusion: High quality healthcare is important to nurses and to society at large. High quality healthcare at an efficient price would also be nice. The cost of healthcare, in insurance premiums, out-of-pocket costs and government expenditures, has been outpacing inflation for decades and is unsustainable at its current pace.

As a believer in free markets, I do not begrudge either hospitals or physicians making profits within the health care marketplace. In fact, I applaud them. However, unless there is a clear and logical “public good,” the government should not artificially increase the cost of care to all of us by, in effect, mandating monopoly profits to some health care providers. In the end, each person must decide for them self where to draw the imaginary line that defines “public good;” a line where government intervention is deemed a necessity and not just an obstacle. Finally, this issue is not over. The three aforementioned amendments to CON law are currently sitting in committee. Powerful statewide stakeholders with a vested interest in the outcome are prepared to advance and protect their own self-interests.

Governor Palin has stated she wants to eliminate CON regulations because the state is currently the recipient of multiple lawsuits filed by those that simply want to compete in our healthcare market but are being blocked by current law. Stay tuned.

This could get very interesting.

Certificates of Need in Alaska . . .

Continued from page 10

References 1. Barnes, J. (2007). The Failure of Government Central Planning. Retrieved 4/2/08 from the Washington Policy website: http://www.washingtonpolicy.org/Centers/ healthcare/policybrief/06_barnes_constudy.html#1 2. National Conference of State Legislatures (2008).

Retrieved 4/2/08 from http://www.ncsl.org/programs/ health/cert-need.htm 3. The Federal Trade Commission, Department of Justice (2004. Improving Health Care: a dose of competition.

Retrieved 4/3/08 from http://www.justice.gov/atr/public/ health_care/204694.pdf 4. Washington State Joint Legislative Audit and Review Committee (JLARC), “Effects of Certificate of Need and Its Possible Repeal,” January 8, 1999, p. i.

5. Associated Press (Feb 14 2008). Hospital head fears end of Certificate of Need requirement. Retrieved 4/6/08 from http://www.adn.com/legislature/story/314759.html 6. Alaska State Legislature (2008). Bill History/Action for the 25th Legislature. Retrieved 4/9/08 from http://www. legis.state.ak.us/basis/get_bill.asp?session=25& bill=SB%20 %2065 7. Alaska State Legislature (2008). Bill History/Action for the 25th Legislature. Retrieved 4/9/08 from http://www. legis.state.ak.us/basis/get_bill.asp?session= 25&bill=HB%20 %20%204 8. Alaska State Legislature (2008). Bill History/Action for the 25th Legislature. Retrieved 4/9/08 from http:// www.legis.state.ak.us/basis/get_fulltext.asp?session=25 &bill=HB345 9. Rural Assistance Center (2008). Retrieved 4/10/08 from http://www.raconline.org/info_guides/hospitals/ cahfaq.php#whatis 10. The Trust: The Alaska Mental Health Trust Authority (2008). 2007 Annual Report. Retrieved 4/9/08 from http://www.mhtrust.org/documents/AMHT_AR_07. pdf

[Dr. Thomas Hendrix is an Assistant Professor at the UAA School of Nursing. He has a Master’s degree in Health Services Administration, a Master’s degree in Adult Health Nursing and a PhD in Health Policy & Administration with an emphasis in Health Economics.]

May 2008—Alaska Nurse—Page 11

Seed Money for Your Dreams

by Tina Delapp RN, EdD. Have you been mulling over a special project that involves your nursing expertise and that will benefit your patients or your community? Is there a continuing education course or learning activity that will enhance your skills and the skills of those who work with you? Is the only thing stopping you from doing that project or signing up for that course MONEY? If so, the Alaska Nurses Foundation may be your solution!

Applications for 2008 grants will be posted on the Alaska Nurses Association website, under the Alaska Nurses Foundation tab, in July 2008. Applications will be due on October 1, 2008 and awards will be made in December. Three broad categories of grants exist, including: Community Project Grants, Individual Continuing Education Grants, and Workshop Delivery Grants.

The Alaska Nurses Foundation was established in 1995 with funds from a settlement between Premera Blue Cross and state public health nurses, the Foundation has funded small grants to public health nurses since 1998; in 2004, the Foundation Board of Directors created General Nursing Support grants. Funding for grants comes from revenues generated by the investment of the original settlement monies as well as from contributions and memberships. Funding from the Foundation has facilitated the delivery of the Alaska Public Health Nursing Conference and the Annual Conference of Alaska Nurse Midwives.

Individual continuing education grants provided a jump-start for LeMay Hupp as she worked to find a focus to develop the Alaska Nurse Alert System and enhanced the knowledge and skills of Kate Haeussler, staff nurse in the Providence Alaska Medical Center ICU.

Communities have also benefitted from Alaska Nurses Foundation Grants, Most recently new parents in Delta Junction had the opportunity to enhance their parenting skills through a series of parenting classes taught by PHN Janice TemplinWeller; and while those parents attended those classes, they could relax, knowing that their children were cared for by teen volunteers recently certified in CPR—thanks to AaNF funding!

So if you need help to jumpstart an evidence-based practice project or to institute some health enhancing project in your community or to enhance your own nursing skills and knowledge, think about the Alaska Nurses Foundation. Foundation funding may be just what you need! Check it out at http://www.aknurse.org under the Alaska Nurses Foundation tab!

[Ms. Delapp is the ANF treasurer and can be reached at tdelapp@ak.net.]

Page 12—Alaska Nurse—May 2008

Meet the Professional Practice Committee

Membership Application

Shirley LaForge, RN, MSN I was born and raised in the 50th state and began nursing as a diploma student then received my BSN from the University of Washington, then my Masters in Nursing from the University of Hawaii at Manoa, Honolulu, Hawaii. I have been a nurse for 30 years, and began in Intensive Care nursing and practiced nursing both in Washington and Hawaii. Teaching in nursing academia started for Shirley LaForge RN MSN me in 1989 when I returned to campus for my Masters Degree in Nursing. I taught in Hawaii at the Associate Degree program until 1996, then began a Nurse manager position on a medical-surgical unit. In 1999, I moved to Fairbanks, AK and continued as a staff nurse at Fairbanks Memorial Hospital.

Currently I hold the lead faculty position for the University of Alaska Anchorage School of Nursing, on this outreach campus at University of Fairbanks that began in the Fall of 2002. Besides carrying a full workload for the School of Nursing, I also engage in academic advising and recruiting to the local campuses in Fairbanks.

Much of my spare time is spent with church activities, as I am also a religious education instructor for my parish. I also volunteer in the Alaska Health Fairs activities. Currently I am the Secretary for AaNA District IV, member of the Professional Practice Committee and a newly appointed member to the AaNA Board of Directors.

Advancing and Supporting the Profession of Nursing Integrity Professionalism ~ Advocacy Empowerment~ Representation

Membership Categories

Full Membership—Employed Full-time or Part-time Reduced Membership—Not Employed * EDPP is the monthly Electronic Dues Full time student Payment Plan Amount New graduate from basic Nursing Education program, within first six = Yearly dues/12 months after graduation (first year only), or months + $.50 per 62 years of age or over and not earning more than Social Security allows. month service charge Special Membership—Not employed and 62+ years or totally disabled

Dues

Anchorage Monthly (*EDPP) & Fairbanks Yearly

Full $28.00 $330.00

Reduced $14.25 $165.00

Special $7.38 $82.50

All Other Locations

$322.50 $27.38

$161.25 $13.94

$80.62 $7.21

Yearly Monthly (*EDPP)

______________________________________ Last Name/First Name/ Middle Initial

_________________________________________________ Social Security Number

______________________________________ Street or PO Box City/State /Zip

_________________________________________________ Home Phone

______________________________________ Employer Name Unit City/State/Zip

_________________________________________________ Work Phone

____________________________ RN License Number/State

__________________________ FAX Number

__________________________ E-mail Address

Payment Method—see above for categories and amounts Apply Online at www.nursingworld.org—Join Today! Alaska!

Check—Please make checks payable to the American Nurses Association MasterCard or Visa—(available for annual payment only) ________________________ Card Number

Return application and payment to: AaNA 3701 E. Tudor, Suite 208, Anchorage, AK 99507

_____/_____ $_______ _______________________________ Expiration Amount Signature

Monthly Electronic Dues Payment Please (1) read and sign the below authorization form and (2) enclose a check for the first month.

1/12 of your yearly dues will be withdrawn from your checking account monthly along with a monthly service fee.

AUTHORIZATION to provide monthly electronic payments to the American Nurses Association (ANA): This is to authorize ANA to withdraw 1/12 of my annual dues and any additional service fees from my checking account designated by the enclosed check for the first month’s payment. ANA is authorized to change the amount by giving the undersigned thirty (30) days written notice. The undersigned may cancel this authorization upon receipt by ANA of written notification of termination twenty (20) days prior to the deduction date as designated above. ANA will charge a $5 fee for any return drafts. ________________________________________ Signature for EDPP Authorization

Return to: AaNA, 3701 E. Tudor, Suite 208, Anchorage, AK 99507 or fax (907) 272-0292 or e-mail aknurse@aknurse.org and tell us your selection.

Integrity ~ Advocacy Professionalism Empowerment Representation

Share your Expertise!

Get Informed! >>check off and return form to AaNA

A Benefit of Membership: AaNA Member Name: __________________ E-mail: ________________________________ Informational E-mail ❏ Various Nursing Information—If you would like National, State and Local nursing information e-mails from AaNA on a weekly basis. ❏ Action Alerts—If you would like political action alerts for National and State legislative issues involving nursing and health care issues.

Taskforce E-mail Pools Taskforce E-mail Pool members will receive requests to work on a variety of projects on nursing issues, and may choose to participate in only the projects that interest them. ❏ Professional Nursing Practice Issues— Taskforces will consider issues relating to AaNA’s policy on RN practice and other professional issues. ❏ Health and Safety Issues—Taskforces will consider safety and health issues of nurses and patients. ❏ AaNA Event Planning—Taskforces will plan events such as the AaNA Fall Retreat, open house events, AaNA General Assembly, or other events for AaNA members. ❏ Other interest? Let us know what you would like to work on:______________ AaNA Committees ❏ Legislative Committee—Actively involved in reviewing and coordinating strategy and testimony for legislative issues related to health and nursing. Works closely with the AaNA Lobbyist. Usually meets on the second Monday of the month. Current Chair is Pat Senner. ❏ Conference Planning Team—Participates help plan the Alaska Statewide Nurses Conference. Roles include working with program planning, marketing, vendor and sponsor recruitment and onsite assistance. ❏ Continuing Education Committee—Members individually review applications for continuing education approval based on the established guidelines of the American Nurses Credentialing Center and in coordination with the CE Director. Makes recommendations for improvements in the application process. The current CE Director is Norma Monsen. ❏ Alaska Nurse Newsletter Editorial Board— Members work with the editor to recruit articles and pictures for the quarterly newsletter. The current editor is Lynn Hartz.

May 2008—Alaska Nurse—Page 13

Resources Alaska health, social services help hot line available A new hot line for those seeking health and social service help is now in service.

Brenda Hewitt with the United Way says Alaskans can dial 211 to get immediate help with anything dealing with health and social services.

Hewitt says the programs are mostly provided by non-profit organizations and represent a huge variety of resources that are available.

Alaska 211 phone service is currently available 8:30 a.m. to 5 p.m. weekdays.

Most Alaskans can access the call center in Anchorage by dialing 211. Cell phones will work in many areas. An alternate number is 1-800-478-2221.

Help is also is available anytime on the Web at www.alaska211.org. - Anchorage Daily News.

3/9/08 ANA Board Adopts Revised Health System Reform Agenda & Strategic Plan 03/26/08 As part of its long standing and aggressive education and advocacy work for guaranteed affordable and accessible health care for all, the American Nurses Association (ANA) today released ANA’s Health System Reform Agenda, an update of the organization’s 2005 call for comprehensive health care reform. ANA’s Health System Reform Agenda calls for dramatic changes in the US health care system in order to achieve guaranteed, high-quality, affordable health care for all.

4/21/08 The American Nurses Association issued a white paper, “Adapting Standards of Care Under Extreme Conditions: Guidance for Professionals During Disaster, Pandemics, and Other Extreme Emergencies.” It is available as a document by searching "extreme conditions" at www. nursingworld.org and following the "adapting standards of care" link. The paper is the result of a series of multidisciplinary policy conferences in 2007.

On April 14, 2008, ANA unveiled the final contribution to nursing’s body of knowledge

by Margretta “Gretta” Madden Styles, RN, EdD, FAAN, at the 2008 Advanced Practice Registered Nurses (APRN) Stakeholder’s Meeting at ANA headquarters. Titled “Specialization and Credentialing in Nursing Revisited: Understanding Issues, Advancing the Profession” the book focuses on advanced practice nursing issues such as credentialing and regulations. For more information and purchasing, go to www. nursesbooks.org or call 1-800-637-0323.

04/03/08 New Mentoring Program for Healthcare Providers: Methadone for Chronic Pain, Opioid Addiction Substance Abuse and Mental Health Services Administration (SAMHSA) is launching a new national mentoring program to assist health care providers in the appropriate use of methadone for the treatment of chronic pain and opioid addiction.

Alaska Nurse Alert Have you heard of ANAS?

You mean the Alaska Nurse Alert System? The network of nurse volunteers who are willing to help in a crisis event? Like in a major earthquake, urban wildfire, volcanic eruption or a disease outbreak. I hear over 375 nurses have signed up!

Who are these nurses that have volunteered?

82% of our volunteers are RNs, 11% Advanced NPs, and 7% are LPNs and senior nursing students.

Our volunteers have very diverse areas of nursing expertise from public health to NICU and CCU, school health to nursing administration and management, forensic nursing to home health.

67% of us work full time while the remaining volunteers work either part time or are unemployed/ retired.

10% speak a second language other than English.

Our nurse alert volunteers represent 48 communities across the state from Barrow to Ketchikan and Nome to Delta Junction.

69% of us live in communities on the road system.

I’d like to sign up and be a part of that group. How can I become an Alaska Nurse Alert volunteer?

It’s easy! Go to www.nursealert.org or call 274-0827.

SAMHSA is responsible for certifying over 1,000 Opioid Treatment Programs (OTPs) which use methadone and buprenorphine in the treatment of opioid addiction. In 2004, there were 3,849 deaths from methadone poisoning, an increase of 390 percent in only five years. The death rate has continued to increase in many states.

The American Society of Addiction Medicine (ASAM) will administer the national mentoring network. It will offer clinical updates, evidencebased outcomes and training—free of charge—to “physicians and other medical professionals.”

ASAM currently operates a similar support network (a “Physician Clinical Support System” project) for the office-based treatment of opioid dependence with buprenorphine.

For more information, see 73 Fed. Reg. 16,026 (Mar. 26, 2008), or contact Shelly Hara of SAMHSA, at (240) 276-2321 or shelly.hara@samhsa.hhs.gov.

Page 14—Alaska Nurse—May 2008

Upcoming Events Summer Institute for Public Health Practice University of Washington, Seattle, WA August 11-15, 2008 www.nwcphp.org/si Courses include: --The Art of Dialogue --Community Behavioral Health --Epidemiology: Basic --Epidemiology: Intermediate --Geographic Information Systems (GIS) --Health Communications --Implementing Program Planning and Evaluation --Management: Effective Supervision Interwoven throughout the Summer Institute curriculum are expert presentations and case studies focused on Climate Change, Built Environment, and Communicable Disease.

Early Tuition Incentive Registration Deadline: June 11, 2008 Final Registration Deadline: July 21, 2008 Registration and detailed information about courses, faculty, and policies are available at www.nwcphp.org/si.

*******************************************

******************************************* Alaska Statewide Nurses Conference October 9-12 2008 Anchorage Downtown Marriott Sponsored by the Alaska Nurses Association

Alaska Nurse Practitioner Association’s 25th Annual Conference September 25, 26, and 27th, 2008 Anchorage Downtown Marriott Barb Bancroft, PNP, clinician, author, and popular nurse-humorist, is keynote speaker, and will also present a second talk, "The Teenage Brain: An Oxymoron." Back by popular demand are specialty tracks in psychiatry, pediatrics and women’s health. A much requested speaker from the DEA will update us on controlled substance issues of particular concern to health care providers in Alaska. Join your colleagues from across Alaska and outside for continuing education, networking, and a good time. For a complete conference brochure and registration information, go to: alaskanp.org

Please call the Alaska Nurses Association, at 907/274-0827, for information ******************************************* The American College of Nurse Practitioners 2008 ACNP National Clinical Conference is scheduled for October 29-November 2, 2008 at the Nashville Convention Center in Nashville, Tennessee. This year's conference will feature more than 120 clinical CE sessions as well as exciting and challenging keynote speakers.

ACNP's Clinical Conference has continued to grow strong and in Nashville we are anticipating that more than 1,200 Nurse Practitioners will be in attendance for the premier educational and clinical event for Nurse Practitioners.

For more details about ACNP and the 2008 National Clinical Conference, please visit www. acnpconference.com. ******************************************* SAVE THE DATE March of Dimes, AK Chapter Nurse of the Year Awards “Nurses Making an Imprint on Alaska” Friday, November 14, 2008 Anchorage Sheraton Hotel Dinner, Silent Auction and Awards Ceremony The March of Dimes Nurse of the Year Awards program recognizes nurses in 19 categories. The recipient in each category will be a RN or LPN whose leadership and contributions have made a significant impact in their community to the profession of nursing. Colleagues, friends, patients, businesses and organizations may nominate nurses.

Applications will be available starting in August at www.marchofdimes.com/alaska or call 1-800-478-5345.