Lawmakers hear comments on ways to recruit, retain nurses

NURSING: Nurses prepare for incoming vaccine patients at a vaccine clinic in Dededo on Jan 26. Guam senators on Wednesday discussed ways to recruit and retain nurses on Guam. Kevin Milan/The Guam Daily Post

Testimony was mixed during a legislative public hearing Wednesday on Bill 13-36, a measure that would adopt the Nurse Licensure Compact as well as establish additional duties for the Guam Board of Nurse Examiners to facilitate the compact.

The Nurse Licensure Compact allows nurses to possess one multistate license with the ability to practice in their home state and other compact states. Proponents argue adopting the compact will help alleviate nursing shortages on island. Thirty-four states are currently NLC members and eight jurisdictions have pending NLC legislation, including Guam. 

But Guam resident David Lubofsky, who has called for changes to Guam's health care laws following the death of his young son, stated it would result in the opposite.

"In my opinion, if this bill becomes law, it will put the poorest people on Guam in more jeopardy for increased poor medical care than they already now receive at (Guam Memorial Hospital) due to the departure of nurses for better salaries," said Lubofsky, who continued to say that nurse retention is already an issue on Guam. He asked if Bill 13 was needed if the government of Guam paid its nurses better. 

Lynette Fires, an intensive care unit registered nurse at Guam Regional Medical City and a military spouse who spoke in favor of Bill 13, said Guam is challenged with nursing shortages much more than its stateside counterparts due to the island's remoteness and a lack of a "float pool" of nurses for support. 

Fires said if someone did move from Guam, it wouldn't be just because they held a multistate nursing license.

"If someone is going to move, they're going to move, whether or not they have had a multistate license. ... When nurses are asked what factors keep them at their current nursing job, we can probably agree that there are so many factors but we will never know unless we are able to have a pool of nurses to choose from," Fires said. 

But retention concerns were also shared by the dean of the School of Health at the University of Guam, who urged against "glamorizing" or suggesting that local nurses take advantage of the NLC, as the reality is there is a severe shortage of nurses on Guam, according to testimony read by Speaker Therese Terlaje. 

"We must, as leaders, take care in promoting the compact as a means of bringing nurses to Guam, not as a way to enable our nurses to have increased mobility," Terlaje said, reading from the dean's testimony.

The bill may be a step in the right direction but will not increase retention without other measures, Terlaje read from the testimony.

Bill 13 was introduced by Sens. Mary Torres and Amanda Shelton, and by Vice Speaker Tina Muña Barnes, and is a reintroduction of legislation proposed in the 35th Guam Legislature which did not make it into session.

Torres, Shelton and Barnes each read written testimony from those in support, including the Office of the Assistant Secretary of Defense and Bernadette Santos, the chairwoman of the Guam Board of Nurse Examiners for the last five years.

Licensure issues for transitioning military members and their spouses have been a longstanding priority for the Department of Defense, according to Kelli May Douglas, the Southwest Regional Liaison for the Defense-State Liaison Office.

Santos, making note of the influx of physicians as a result of fully implementing the Medical Compact in 2019, stated that the NLC will benefit patients and the local health care system by being better able to attract talented nurses from other systems who could introduce better practices or efficiencies in nursing care to Guam. 

The Guam Board of Nurse Examiners surveyed licensed nurses on Guam over the past weekend. A total of 510 out of 1,456 Guam licensed nurses replied, and out of that amount, 98% – 498 respondents – indicated they support joining the NLC, according to Santos.

Terlaje said not every state is part of the NLC and cautioned that Guam has its own unique position and will have to make a unique decision.

"GMH says although the advantage of the NLC is the expediency and reduction of processing the nurse licensure application ... the downside is that there will also be a continual loss of our local nurses. Hence, it is imperative that we address and adjust the current salary structure for our nurses," Terlaje said. 

As Torres noted early in the hearing, a bill had been passed in the prior Legislature that would appropriate $50,000 from the unexpended funds of her office and another $50,000 from the General Fund to conduct a study of the Nurse Pay Plan. 

But Terlaje said GovGuam has set up programs over the years to address nurse shortages so that Guam can grow and pay its own local workforce higher salaries. The speaker also noted that despite lifting nurse licensure requirements during the pandemic, there was no rush of off-island nurses to Guam.

"We will continue to face these issues, I think, despite whether we make the licensing easier or we continue to impose our own standards on licensing, we need to fix the systems that all the experts have pointed to us need to be fixed, which are the recruitment and retention programs," Terlaje said. 

Torres said there is no data on outmigration for nurses because there is no known or obvious outmigration as a result of the NLC.

"To say that we aren't providing that, well that data doesn't exist, because that negative effect does not exist," Torres said, referring to information from Jim Puente, the NLC director. "What the director did point out was, one reaction to that kind of an adverse effect would be for them to choose to get out ... they would sever from the compact. And that statistic has also not happened."

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